this farm in middleburg is a snapshot. debris covers the land, most crops washed away, whatever is left, contaminated. the owners told me the worst sound they had ever heard was their cows suffering as the water rose. this year has been unprecedented disasters striking agricultural regions all across the united states, not just in new york. in order to help these rural agricultural communities rebuild in my state and across the country, i'm offering an amendment, number 838, to fund the backlog of state applications for the emergency conservation program and the emergency watershed program. i would like to call up this amendment now. this funding will help more than half the states in this nation with the disasters they've experienced so far this year, from the flooding in the midwest

to the droughts in texas, to the devastation that happened all across new york state. this is emergency funding that will help our farmers and our businesses survive, and i urge that my colleagues support this amendment to reduce the backlog of eligible projects that need -- are needed desperately right now by these families and these farms to rebuild. mr. president -- we'd like to bring up amendment number 869. the presiding officer: the clerk will report. the clerk: the senator from new york, mrs. gillibrand for herself and mr. schumer proposes amendment 869. on page 3, between lines nine and 10, insert the following. section a, notwithstanding any other profession of this -- provision of this act, one, the amount provided under

section 732 for the emergency conservation program for expenses resulting from a major disaster designation -- mrs. gillibrand: i ask unanimous consent that you dispense with the reading. the presiding officer: without objection. mrs. gillibrand: i'd like to add senators casey and schumer along with senator lee hey and i. the presiding officer: without objection. mrs. gillibrand: i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: quorum call:

the presiding officer: the senator from alabama. mr. sessions: i would ask that the quorum call be dispensed with. the presiding officer: without objection. mr. sessions: mr. president, there's no unanimous -- no consent to bring up amendment number 812 that i have offered. it's a very important amendment. it's something i will insist on through every appropriate power an individual senator has to get an amendment to be voted on, and hopefully it will be, come on up tomorrow or the next day. let me summarize it briefly, and then i will offer my full statement for the record. amendment 812 would prohibit the patent and trademark office from using funds to implement section 37 of the americans invent act,

more commonly known as the med cofix. when the patent bill moved through the senate and the house, efforts for -- efforts were made to reverse a decision by the patent and trademark office that had declared a major boston law firm had failed to file a document in time to preserve a patent for their client medco, and as a result of that medco was to lose its patent sooner than otherwise would be the case. they would be able to -- generic manufacturers would be able to manufacture the drug, and it was asserted that it would cost $214

million as a result of this error. well, if a doctor makes an error, they get sued for malpractice. if lawyers make errors, they get sued for malpractice. they have malpractice insurance. and apparently they had some insurance. but at any rate, it appears millions of dollars or hundreds of thousands -- millions of dollars were set aside for lobbying and other efforts to politically reverse the patent office during a time while the matter was litigated in court. when the patent bill came up a few months ago it was contended this is the only vehicle to fix this problem and we needed to fix it. the house voted not to put it in their bill. then somehow a new vote was obtained. by the narrowest of margin, the house put it in. and it came to the senate. and i had been objecting for a decade, and i objected and

others objected, and we had a vote. and by the margin of 51-47 it was decided not to amend the patent bill that the house had passed taopbd pass it just -- and to pass it just like the house did, although many people told me that they agreed with me that this medco fix intervening in an ongoing litigation should not occur, but changing the patent bill would he send it back to the house -- changing the patent bill would send it back to the house and endanger the passage of the bill. so i was disappointed there. but what we've discovered is that the litigation continues. it is now before the u.s. court of appeals. the court of appeals is taking arguments on a number of issues that relate to this. and it's a very real problem. it's a matter that ought to be decided by the courts, not

politicians. and if some special relief act is to be utilized, and sometimes those can be, they can't be utilized while a party still has litigation ongoing. only after the litigation is exhausted can someone appeal for a special relief act. in essence, that's what medco is asking for. so i don't think it's right. i practiced law for a long time. i know how the system works. i know this fine law firm in boston, every day, the first thing they look at when somebody sues one of their clients is did the person file the lawsuit too late? if they did, they'll dismiss it. every judge that sees a motion to dismiss for lack of timely filing objectively looks at it. if it's one day, one hour, one

minute late, you're out. that's the rule of law in america. it doesn't make any difference if you're a little widow lady or if you are the head of some company or if you are a big drug company or a big law firm. that's justice in america. so i don't think this is a good thing for to us do. and so now that we have this legislation before us, it's germane and appropriate because it has patent language in it for us to fix this decision we sort of got forced into making and to have a vote on it as part of this bill. what we know is that the language of the patent act we passed, the american invents act, would not take effect for one year from the date of enactment. so during that time, litigation

continues, congress ought not to intervene. congress ought to let the courts decide. and then if the only remedy in congress would be to file for a special relief act. and congress could consider it or not. based on the circumstances of the case. so, mr. president, i thank the chair for allowing me to share these remarks. i do believe it's a very important issue. i truly believe that congress is unwise, very, very, very unwise to begin to step in to ongoing litigation involving highly, highly competent parties with large amounts of money and start taking sides in that litigation.

i believe it would be wrong. so, mr. president, i thank the chair for the opportunity to share these remarks, would offer my full statement for the record. the presiding officer: without objection. mr. sessions: and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

is

quorum call:

mr. sessions: mr. president? the presiding officer: the senator from alabama. mr. sessions: mr. president, i ask that the quorum call be dispensed with. the presiding officer: without objection. mr. sessions: mr. president, time has been set aside for the heather higginbottom nomination. i had not intended to speak on that tonight but it's been suggested we might get started on that. i'll share my remarks tonight for the record, and hopefully we

can have a good discussion of it further tomorrow. the constitution makes it very clear that it is the president who nominates, that confirmation does not occur, however, without the consent of the senate. in federalist 76 alexander hamilton wrote quo tkwoe what purpose then to require the cooperation of the senate? i answer that the necessity of their concurrence would have a powerful though in general silent operation, it would be an excellent check up on a spirit of favoritism in the president and would tend greatly to prevent the appointment of unfit characters from prejudice, from family connection, from personal attachment or from a view to popularity." close quotes. in other words, the senate does have a duty to evaluate the president's nominees. unfortunately, the situation we pace today with the nomination

the heather higginbottom to be the deputy director for the office of management and budget is one of those cases. i do not know pherpblly, but -- her personally but let me state from the outset i have no questions about her character. she has many admirers. senator kerry for whom she worked is an admirer and i respect that. the president has certainly -- seeks her appointment and has asked me to try to see that that appointment moves along. i respect his desire to have an up-or-down vote and have agreed that we would have this vote and have so agreed for some time. but my concern is with the nominee's budgetary experience. it is the lack of experience that causes me to voice my

opposition. let me first mention the o.m.b., the office of management and budget, has the primary responsibility to assist the president in overseeing the preparation of the federal budget. this is a huge responsibility. in helping the president formulate his spending plan, o.m.b. must evaluate the effectiveness of agency programs, policies and procedures, assess competing funding demands among all these agencies and set the priorities and help the president. o.m.b. is not in charge. the president is. but in reality, o.m.b. is the one that raises the concerns with overspending with the various federal agencies. they submit their request, and then the o.m.b. says yea or nay. and it's a very serious matter because very important people are asking for money. and sometimes you just have to say "no" to very prominent

cabinet people. and the cabinet people can appeal to the president, but they don't do it often. they recognize that o.m.b. is a place where most of these matters have to be decided. o.m.b. speaks on behalf of the president. ms. higginbottom's experience points to someone who has been on the wrong side, however, of fiscal restraint. instead of crafting policies to decrease spending, she has been focused on new programs to increase spending. in a budget committee questionnaire, she was asked about her qualifications for the job. she cited her legislative and political experience. i believe she worked in a presidential campaign at one point. but cited no direct budgetary knowledge and provided no examples of developing a budget. in one prehearing question, i asked ms. higginbottom -- quote -- "your background is in

education and public policy. outside of your legislative and political experience, have you acquired any budget training including classes or continuing education?" close quote. she responded with one sentence: "i have not taken any formal continuing education classes on the budget." i asked her whether she was the primary budget staffer during her tenure in the senate. she essentially gave a nonanswer to that. it doesn't appear that she was deeply involved as a general office senate staffer in budgetary matters. not the primary staffer and not a staffer whose senator served on the budget committee. in another prehearing question, she was asked whether as a nation we needed to focus on deficit reduction rather than new spending. she responded by deferring to the president's fy 2012 budget

stating that it -- quote -- "begins the challenging but essential process of adjusting spending to achieve fiscal sustain ability immediately with a five-year freeze of nonsecurity discretionary spending." close quote. now this is the same budget that adds to the debt every single year, and has substantial deficits every single year. during her confirmation hearing before the budget committee, on which i was the ranking republican, she continued to use president obama's incorrect formulations. i use that phrase kindly. she testified that president obama's fiscal, fy 2012 budget, the one he submitted in january, would pay down the debt and -- quote -- "puts us on a path to stabilize our debt." close quote. but this is the same budget

proposal that by o.m.b.'s own estimate has a deficit of approximately $800 billion in year ten of the ten-year budget. and not a single deficit in the ten years this have budget that was submitted to us falls below $600 billion. i will just note that, for example, $600 billion is larger than any deficit president bush ever had. so in the ten years, the lowest budget deficit projected by president obama's office of management and budget is $600 billion. the lowest. surely a more experienced, skilled and serious nominee, one that's acquainted with the great

debt threat we have in america would recognize that these deficits are irresponsible and you can't say that we're living within our means or we are on a path to stabilize our debt. you can't say that. even secretary geithner, when he testified before the budget committee, said the president's budget would be unsustainable, if congress passed it, as written. but the senate budget committee was not the only forum in which ms. higginbottom was given an opportunity to highlight her experience. she had a hearing before the homeland security committee, and they asked about her qualifications also, which they indicated were lacking. senator collins asked her in opening statement -- quote -- "the nominee's background are" -- or stated that the nominee's background, while impressive in many respects, does not include a great deal of experience in

budget process or financial analysis." senator scott brown used his first question to deal with her experience. he said, "i notice from your resume you have some great political experience and some really good policy experience. i was wondering if you would share with the committee, you know, what type of accounting and budgetary experience you have." close quote. well, she first attempted to avoid the question, talking about her general legislative and policy experience. senator brown interrupted her and got to the heart of the matter. sew "so i guess my original question is, what type of budgetary and accounting experience do you have?" ms. higginbottom respond that she was not an accountant and that her goal was to implement the president's policy agenda through the budgetary process. i would note that the

president's policy agenda seems to be primarily to continue extraordinary new and expanded investments -- spending -- in many, many areas of our government. after opportunity to prove that she was qualified through prehearing questions and through testimony at two confirmation hearings, she was voted out of the homeland security and budget committees on a party-line vote. our democratic colleagues in both committees voted her out with the majorities that they had. because of her lack of experience, not one republican voted for her. so now a number of my colleagues have argued that the criticism is based on lack of -- not lack of experience but on her age, that somehow she's being unfairly treated because of that. and she is young -- young for this job. but the age allegation is not

correct. after her confirmation hearing, i sent her a follow-up question. quote -- "some of my democratic colleagues during your hearing before the budget committee indicated that when some of us questioned your experience that we were using experience as a code word for age. the experience i'm concerned about is actual budget experience." in a prehearing question, i asked you the following -- this is what i said to hemplet "i ask you this in your prehearing. your back brands is in education and public policy. have you acquired any budget training, including classes or continuing education? your response was, qush quote -- i have not taken any formal education classes. she said, quote, for over a drksd i've worked at the highest levels of policy-making in the united states senate and the

white house. this work has included but was floimented to budgetary implications of those policies. not budget but policy issues and budgetary implications of those policies. so the answer to the question that i asked is, no, clearly. she simply does not have the kind of serious budgetary experience to be the deputy director at an office that manages a government that is spending $3,700,000,000,000 this year and taking in about $2.3 trillion. borrowing 40 cents of every dollar we spend. this is a most august position, and it requires a person who can have the confidence and judgment to say "no" to people who always

want to spend more. arguably, she would be the least qualified deputy director in decades. the last two nominees in this position had a combined 21 years of budget and finance experience. for example, rob neighbors, the most recent nominee before her, served eight years on the house's appropriations committee and six years at the office of management and budget. steve mcmilan, the nominee before him, served three years on senate banking committee and four years at the office of management and budget. you learn something operating out of the office of mafnts and budget. -- of management and budget. that prepares you to have a leadership role. ms. higginbottom does not have one year of budget or finance experience. over the last 20 years nominees for this position have had an average of 6.5 years of experience. well, in certain circumstances

in certain times maybe less experience is okay. but at a time when this nation has never faced a more serious debt threat, we need real august, serious leadership. you know, mr. erskine bowles, who cochaired president obama's fiscal commission that issued a most serious report us to, warned that if the united states failed to take significant action on debt reduction, the country would face -- quote -- "the most predictable economic crisis in its history." we're eborrowing 40 cents of every dollar we spend. our nation's gross debt is larger than the entire economy. the last thing we need now is someone who doesn't have the gravitas to say "no" to those who always tend to want to spend more. that's just one of the jobs

o.m.b. has, to say "no." when the secretary of the interior or the secretary of the energy comes before the department asking for approval of their budget, which calls for more spending, a responsible o.m.b. director or his deputy must be able to say "no." looking at presiden president os fiscal year 2012 budget, i'm sorry to say this duty has not been met by mr. lieu, the director, and i can't see that he's going to get much strength and support for doing the right thing from this nominee. i supported director lu, but i have been disappointed in his leadership. when the president submitted his budget to congress, director lew came before the budget committee and made some of the most

indefensible claims that i've heard in public life. he did. director lew said that the president's budget would allow us to live within our means and to begin to pay down our debts and spend only money we're taking in each year. not one of those claims were true. multiple fact-check organizations checked them and found them to be false. even by o.m.b.'s own reckoning, the deficit would never be smaller than $600 billion at any point in the ten-year budget window. would not be -- we'd not be paying down our debt. we're not going to be spending only money we're taking in each year. -- under the president's budget. what would happen to a c.e.o. of a corporation if they told

potential investors, well, we're living within our means, we're -- we'll begin to pay down our debt, we're going to only spend money we're taking in each year, invest in our k and people invested in the company and they found out that there was no budget plan in place that showed anything less than huge deficits for the entire next decade and that the company was borrowing 40 cents of every dollar it spend -- were spending. what would happen then? i'm telling you, he would be sued, if not prosecuted, for fraud. so this is the kind of leadership we have at the budget. i'm not happy with it. the american people should not be happy with it. they came in to spend, not look the american people in the eye and tell them of the grave financial crisis we're facing in america. erskine bowles, heading the

commission appointed by president obama, he told us. he told us we're on an unsustainable path. it threatens our economic future, that we are facing the most predictable financial crisis in our history. and when asked when that crisis might occur, when might we have an economic damage arising from our debted, he said, two years, maybe a little less, maybe a little more. alan simpson, his cochairman, said i think it could be less. less than one year. this is not a game we're playing here. we don't need government officials spinning that we're living within our means and paying down our debt. we are running up debt in a fashion never, ever, ever before done in this nation. it's unsustainable and its so

dangerous because it's systemic and it's so hard to get off this trend. it's demographics, it's a lot of different reasons. but it's very serious, and we need -- a leaders in o.m.b. -- and we need leaders in o.m.b. that are watching every single dime that exspent, looking for every effort and place that savings can be affected. that's what we need. and i just don't feel like this nominee fits that bill. she is a good person, a good apparently staffer, has a lot of friends, but the position of deputy director of o.m.b. is a grave position. it has august responsibilities. it requires a most serious person willing to take strong stands and say "no" to people who want to spend more and more.

when asked about our financial situation, on one of her iranians she made reference to the first stimulus bill, the recovery act -- so-called -- and this is what the nominee said. "fortunately, the recovery act spending has been extraordinarily transparent, enabling the public to access the job impacts of the various programs funded. overall, the data demonstrate that the recovery act has delivered as promised. by creating and saving mlings of jobs millions of jobs across the country and has been an essential factor in rescuing the american economy." close quote.

well, i know the nominee is a friend and ally of the president, and i'm willing to give her a vote, and i suppose that she will be confirmed. but i just want to say, i think that's a bit of a pollyannish description of the bill. it just didn't meet those standards and i do feel that she's been less than rigorous in her understanding of the issues our nation faces so i encourage my colleagues to join me in opposing the nomination. i thank the chair, would yield the floor, and note the absence of a quorum. the presiding officer: the clerk will call the roll rovme. quorum call:

quorum call:

quorum call:

mr. reid: i ask that the call of the quorum be templetted. officer without objection. mr. reid: at a time to be determined by the majority leader, after consultation with the republican leader, the senate proceed at that series of votes in relation to the following aiming vitter 769, levin 759, merkley, 879 with the changes that are at the desk, brown of ohio 874 as modified with the changes at the desk, moran number 815, and grassley number 860, that there be no amendments or points of order against any of the amendments prior to the votes other than the budget points of order, that there be two minutes equally divided in the usual form prior to the vote, that the vitter, merkley, brown, grassley amendments be subject to a 60-vote affirmative threshold. all after the first vote be 10 minutes. following amendments be considered and agreed this evening: sanders 816, coburn 793, coburn 798, as modified with the

changes at the desk, final lirgs following first-degree amendments filed by coburn be in order calmed and made pending during tomorrow's session, 794, 797, 799, 801, 833. the presiding officer: without objection. mr. reid: i have a cloture motion at the desk. the presiding officer: the clerk will report. the clerk: cloture motion: we, the undersigned senators, in accordance with the provisions of rule 22 of the standing rules of the senate, do hereby move to bring to a close debate on amendment number 738 to h.r. 2112, an act making preciouses for agriculture, rural development, food and drug administration, and related agencies programs for the fiscal year sending september 30, 2012, and for other purntion signed by 18 senators as follows -- mr. reid:, i ask that the reading of the names be waived. officer without objection. mr. reid: i have another cloture motion at the desk. the presiding officer: the clerk will report.

the clerk: cloture motion: we, the undersigned senators, in accordance with the provisions of rule 22 of the standing rules of the senate, do hereby move to bring to a close debate on h.r. 2112, an act making appropriations for agriculture, rural development, food and drug administration, and related agencies programs for the fiscal year ending september 30, 2012, and for other purposes, signed by 18 senators as follows: mr. reid:, i ask unanimous consent that the reading of the nainls waived. officer without objection. mr. reid: i ask that the manned fry quorum under rule 22 be waived for both cloture petitions. the presiding officer: without objection. mr. reid: i ask unanimous consent that at a time to be determined by the majority leader in consultation with the republican leader, the senate proceed to executive session to consider calendar number 410, that there be four hours of debate equally divided in the usual form, upon the use or yeed yielding back of time, the senate proceed to vote to vote on calendar number 410, that the

vote shall subject to a 60-vote threshold, the motion to reconsider be laid on the table, no further motions be in order to the mom nation, any statements related to the nomination be printed in the record, the president being immediately notified of the senate's action and the senate then resume legislative session. the presiding officer: without objection. mr. reid: i ask unanimous consent that the senate proceed to calendar number 125. the presiding officer: the clerk will report. the clerk: calendar number 125, s.894, a bill to amend the united states code and sphoarms. the presiding officer: without objection, the senate shall proceed to the mairchlt reid i ask unanimous consent that the bill be read a third time, the motion passed any statements be placed in the record at the appropriate place as if read. the presiding officer: without objection. mr. reid: i ask we go to s. res. 289. the clerk: designating october 2011 as national work and family month. the presiding officer: without objection, the senate shall proceed to the mairchlt. mr. reid: i ask consent that

the resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid on the table, there be in intervening action or debate, a niment statements relating be placed in the record at the appropriate place as if read. the presiding officer: without objection. mr. reid: i ask that the senate proceed to s. res. 350. the presiding officer: the clerk will report. the clerk: senate resolution 300, supporting the goals and ideals of red ribbon week 2011. the presiding officer: without objection, senate shall proceed to the mairchlt. mr. reid: #eu ask that the resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid on the table. the presiding officer: without objection. mr. reid: i ask unanimous consent that the senate -- when the senate completes its business today, the senate adjourn until 10:00 a.m. tomming morning, thursday, october 20. i would note, mr. president, the unique reason we're coming in tomorrow -- i would like to come in very early -- but the -- senator harkin and senator endescree working very hard -- and senator enzi are working very hard in the committee to come up with a rewrite of the no child left behind."

they've -- of the leave no child behind. they've worked very, very hard. there's 140 amendments pending. more than 70 of them have been offered by one senator and that senator has objected to the committee meeting. it's hard how they're going to be considered when you to be a committee meeting. under the rules of the senate autograph right to object, if -- if the meeting takes more than two hours. after the senate comes into session. so, anyway, that's where we are. i think it's absolutely hard to comprehend how anyone could rationally do that. but that's what we have. so, anyway, we're coming in at 10:00 tomorrow morning. toll following the prayer and pledge, the journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day. because of that, the committee is meeting vection verlly so they can continue two hours after we come in. following any leader remarks the senate resume consideration of

h.r. 2k 112, that at 12:00 perjure the senate proceed to consider calendar 88, two minutes of debate divided and controlled in the usual form. further that when the senate resumes legislative serks the senate will go to h.r. 2112, and proceed to vote in relation to the vitter amendment and the webb amendment. and that at 2:00 p.m., the senate proceed to vote on the merkley amendment and the brown of ohio amendment and the moran amendment and the grassley amendment with all other provisions of the previous order remaining in effect. the presiding officer: without objection. mr. reid: i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: mr. reid: mr. president? i ask that the consent of the

call for the quorum be terminated. the presiding officer: without objection. mr. reid: in relation to the previous business conducted regarding calendar number 4010, i ask that that that be modified that the previous agreement to remove references to the motion to reconsider be that we take that oust my consent agreement. the presiding officer: without objection. mr. reid: roll call votes at about 2:00 p.m. expect additional roll call votes tomorrow in relation to the appropriations bill. if there is -- we're going to do our utmost to complete that bill moc tomorrow. if there's no further business to come before the senate, i ask that it adjourn under the previous order. the presiding officer: the the presiding officer: the

>> now, a hearing on detecting and treating concussions in student athletes. the transportation committee heard from a panel that including former soccer and football players testifying on the effect of brain injuries. this is a little more than two hours. [inaudible conversations] >> does anybody want to make opening statements besides me? you have to. you have to. okay. this hearing will come to order. it's going to be an absolutely wonderful hearing. there's actually 14 senators in front of you, you just can't see all of them. it's something we're working on

with nasa. we've become invisible at proper moments. i'm very proud that you're here, and i'm very proud of our two senators that are here. this one, although you'd never know looking at him, is a football player, or was i guess i should say, yeah. >> two -- [inaudible] >> there you go. i'll make an opening statement, and we want to keep it brief so you have time to talk and for us to question. i'm so grateful for all of you being here, all of you. this is a massive suggest. the story which i may tell about my son is parents can want be as effective as they'd like to be. i don't know whether i'll do that or not. i don't know if it's an invasion of his privacy, but you can advise me when you give your testimony. millions of the children head to the playing fields or rinkings

to participate in team sports, soccer fields to. it just doesn't make them stronger and healthier, but teaches them important values. they learn about hard work, leadership, living with pain, and going through it, about working together for a common goal. the comrade that comes from sports units is wonderful to see, it's real, and it lasts forever. most of our young athletes will not end up playing sports at the professional level, but we hope they carry the positive levels with them throughout life, and they will. the hearing today is about the head injuries tens of thois of these athletes obtain every year playing the sports they love. we are unwilling to talk about it because we know what a positive role the sports plays in our community. on the other hand, the last thing that we can do here is not

talk about this problem of concussions and greer and all the rest of it. i mean, america has to have this conversation, and there will be many, many hearings on it, i know. in fact, more of our children should be playing sports, not fewer. too many kids are in front of computer or television screens instead of on the sport field, and that's said by everybody involved in health care. i'll given you a couple figures. according to the latest data compiled by the disease control, only 17% of american high school students get an hour of daily physical activity, which is our current health guidelines, they say, that you need to have that to stay healthy. only 17%, one-third of our children, are now overweight or obese, making it more likely they'll suffer from heart disease, diabetes, things that plague them for the rest of their lives, as indeed, what

we'll be talking about today could do to some, but the risks involved in playing sports are also very, very real. we heard about the national football league players struggling with serious mental and physical health problems because they sustained repeated mild brain injuries, which is concussions are called, during their playing years, and it's very, very sad. i've seen a number of the players, people i worshiped, you know, growing up, in wheelchairs. who was the guy who played -- he was a quarterback for the raiders. the greatest intercepter of all time. woody -- come on -- >> [inaudible] >> no, no. >> [inaudible] >> doesn't matter. [laughter] i mean, it was awful. i was at an event with him, and

he was seated in a wheelchair, and he couldn't even pull his ahead up, and -- head up, and i leaned down and whispered in his ear. i think i kissed him too, i'm not sure, but having seen from this to that, and who knows, especially this was eight years ago, nobody was talking about it. we now understand, however, that this is not an injury only nfl players can suffer. according to research conducted at the nationwide children's hospital in columbus, ohio, more than 70,000 high school football players sustained concussions every single year. it's not just the football problem. one of our witnesses today, alexis bell will talk about concussions she suffered while playing soccer in high school and college. according to nationwide children's hospital, more than 10,000 high school girl soccer players sustain concussions each year, so what we're going to do

is hear from ms. bell and our other witnesses today who i should name. dr. jeffrey kutcher. you're not in my opening script, so i have to do that, and you'll forgive me. university of michigan districter of neurosport. and dr. ann mckee, director of neuropathology core bu alzheimer's disease center, i guess that's boston university, and dr. mike oliver, director of the national operating committee on standards for athletic equipment. we welcome all of you, and i'll just close right there and ask if the chairman of the subcommittee would wish to say something because he's been just

terrific on the subject and also the ranking member. go ahead. >> well, thank you, mr. chairman, again for us holding this very important hearing this afternoon. as a former player, it's something i'm interested in, but also, you know, there's so many moms and dads and coaches and players all across the country, you know, that are also very interested and probably should be more interested than what they realize, and i think that's the great thing about having this hearing is to try and get that information out and really discuss a potential, very serious problem, not a potential very serious problem, but a very serious problem, period. sports play a role in the development of young men and women, build youth, social relationships, and learn to work as a team while keeping them physically active, healthy, and having fun. according to the national high school sports related injury surveillance study, participation in high school

sports almost doubled in the last 30 years. this is fantastic news, and i think it's important for us to highlight the benefits of playing sports. however, participation in athletics does carry with it significant risk of injury. last week, there was news of a 2r57b8gic death of a 16 -- tragic death of a 16-year-old football player dying after sustaining a head injury during a game. it's important that everyone, coaches, parents, physician, and the athletes themselves understand those risks and be able to identify injuries when that occur. concussions especially have the potential for severe injury, and multiple concussions can cause significant repercussions later in life as we'll hear today. especially with many recent media reports with high profile sents, we associate football with concussions. as i'm well arare, concussions are a risk with playing football, but players in many sports run the risk of

sustaining concussion as we'll hear from ms. bell and her story in playing soccer. it's imperative for coaches and parents involved in all sports to be aware of the dangers associated with concussions, now how to recognize signs and symptom, and what to do if a player suffers a concussion. i look forward to hearing from you about the research to further the knowledge that we have about concussions, but many questions remain as to the causes and effects of concussions. i'm very interested in hearing from the experts on what is known and where we can go from here. as we'll also discuss, there's a wide variety of equipment that claim to use concussion preventing technology. parents want to keep their children protected, but navigating the many products and claims in the market place, especially online can be overwhelming. it's easy to read something offers the best maximum security

protection, and assume that their child will be safe from injury. that is simply not true. some products may offer better protection than others, but we need to explore what resources exist to help parents and coaches know what level of safety a product will actually provide. i also do not know how the average parent or coach is confident that the quick they purchase genuinely offers a better safety benefit or its advertisement is misleading or deceptive. our hope our witnesses today will be able to help me answer this question. along with knowing the safety benefits and limitations of sports equipment, parents and coaches need to educate themselves on what to look for in the event that an athlete has a potential concussion. there are a number of different materials available for this purpose, perhaps the most well-known education effort is the heads up initiative led by

the cdc in partnership with dozens of professional organizations and individuals, individual associations like usa football also have their own education campaigns for coaches, how to teach proper executions of plays and tackles so athletes are in little danger as possible, however, education campaigns must be effective in order to affect change. i'm interested in learn if there's data that shows whether these efforts are reaching o wide enough audience in promoting awareness sufficiently. mr. chairman, i know today's hearing will draw attention to the important safety issue. parents, coaches, and athletes must have resources available to them to understand concussions and how to react when one occurs. the benefits of participating in sports are many, and i hope the potential for injury does not prevent anyone from playing. mr. chairman, again, i thank you for calling this very important hearing and look forward to hearing from our

witnesses. i ask your unanimous consent that the statement from the sporting goods manufacturers association and usa football be in the record. >> it is so done. >> and with that, i yield back. >> i thank the senator and call upon senator udall who's been huge in putting together all of this. >> thank you, chairman rockefeller, and thank you for that nice comment, and i very much appreciate you holding this hearing today. i would like to say a few words and ask my full statement be put in the record, and mr. , mr. chairman, i greatly appreciate your efforts to promote brain research, and as chairman of the subcommittee, your close attention to consumer protection issues. concussions used to be dismissed as simply dings or bell-ringers. we know now that a concussion is a form of traumatic brain injury that should be taken seriously

according to a report, emergency room visits for sports and recreation traumatic brain injuries increased by 60% by children and adolescents over the last decade. the cdc attributes the rise to greater awareness, which is a good thing. now that athletes, parents, and coaches have a better understanding of concussions, some equipment makers appear to be taking advantage. there's "anti-concussion" and "concussion reducing" devices on the market. while we should encourage innovation to protect young athletes, advertisers need to play by the rules. research can shed light on "anti-concussion claims" used by some sports equipment manufacturers. we now know more about the dangers of concussion, we shouldn't forget how important sports and physical activity is for children.

the cdc estimates that only 18% of american high school students participate in at least one hour of physical activity a day. that's the amount recommended by the department of health and human services. among high school students in new mexico, only 23% are getting it..

she discusses a former nfl player who tragically took his own life earlier this year in 2007 he testified before this committee, according to news reports, dave duerson informed his family he wanted his brain to be studied. he hoped people could learn more about the effect of brain trauma so kids could play football more safely in the future. in keeping with this sentiment i hope this hearing will today will advance the goal of making sports safer for our children. with that, chairman rockefeller, thank you very much, and thanks for being here and the ranking member for being here. appreciate it. >> a powerful statement. >> thank-you. >> i would like to call on you first. alexis bell. >> chairman, members of the committee. did you for inviting me here today. i am a senior at the university of new mexico.

i appreciate the opportunity to take an advocacy role. i played soccer since i was four and have always been a high achieving student athletes. in high-school i was player of the year and valedictorian. in my junior year in college i was an academic all-american, captain of my team and received first-team all conference honors. i have accrued about as many concussions. i am medically disqualified from inclusion in athletics in september 2009 after a season of struggle following two concussions of sustained in the beginning of the season. >> what you're saying is so important in moving and powerful that i want you to slow down just a tiny bit so we don't miss a syllable. >> i'm sorry. >> okay during preseason i was offered the opportunity to show a doctor in the e.r. i was given an operation which i was not prepared to see. it was clear i had a concussion.

my coaches were not pleased and i call them the following morning and informed them of the concussion. according to the doctors requirements are set out for one week after which i met with them again. the normal concussion questions, headache, dizzy. steve you remember these words. i was experiencing headaches. it was the week of our first game and i wanted to play. i played for about two weeks. in our third game i take a header on the top of my head. i was not able to stand up and needed assistance to leave the field. i sustained another concussion, set out for a week and returned to play. the weeks following discussion were horrible. i was not myself. i was no longer it will to sleep at night. phyllis it around 3:00 a.m. after line restlessly sensed in p.m. i could not pay attention in any class is to be the most disturbing change was the

twisted my personality. i no longer enjoyed partaking in anything. i would begin crying randomly in the middle of practice and sit in my room and stare into space not comfortable in my own body. the high achieving half the was permanently gone. my mother was concerned about my well-being and forced me to see a doctor. i told him about my struggles and he was concerned. i took a narrow site test which revealed by of virtual memory was impacted and the 20th percentile of all people for visual recall. my doctor explained that i was experiencing prolonged symptoms from the combination of the two concussions i it sustained months prior. my doctor and i talked about the status of my future in soccer. we talked about indications for my future is or to sustain another concussion. i have accumulated ten concussions in eight years, most of which well wearing protective

headgear. the doctors concluded for the safety of my future i should hang up my cleats. this was something that needed to be done. alternately add to separate my head for my heart. concussions are a very serious injury to your brain. too often coaches, athletes, and parents of business severity because it is not a physical injury. if an athlete tears and a cl or sprains that ankle it is apparent that they are injured which is not the case with a concussion. doctors cannot see the physical manifestations. moreover, many of the symptoms are not usually associated with the initial blow. i had no idea that the insomnia or depression was correlated which is something i want to emphasize. athletes must be aware that symptoms can last longer than days or weeks, it can last a lifetime. another issue athletes need to

be aware of is the efficacy of headgear and comments. it was supposed to be a preventive measure against concussions, and clearly this did not hold true. i sustained a concussion while wearing them. the essential for athletes and coaches to know that athletes are not free from concussions because of protective headgear. furthermore, i believe it is important to know the mentality to return to play as quickly as possible is very prevalent in the world of politics. a lot of pressure to deal with the injury or be in jeopardy of losing their starting position. the environment, it is easy to lie about your symptoms, especially with concussions. i knew the answers needed to return to play and no one could prove whether i had a headache are not. in retrospect this was a poor decision, what i did not understand the severity of the time. i continue to play much longer than i should have due to the

high number of concussions i had and returned to play too quickly. people have only one brain. i will never have the visual memory i once had. i help from my story and more stores like mine, concussion awareness needs to be more prevalent among coaches and athletes. most do not truly understand the long-term ramifications of concussions. people need to understand that wearing protective gear does not stop concussions from occurring. i want to thank you for inviting me here and further public education about this. >> thank you. you did extremely well. mr. .. was a quarterback and is still there, starting quarterback. still associated working with

the team. >> coaching with the team. yes sir. thank you, chairman rockefeller and the other committee members for inviting me. it is a great honor to be speaking here on a topic that is changed my life, and i am happy to help raise awareness about such a critical issue. dealing with concussions can be a difficult process for the injured player and their family. exciting for me to see such a prestigious incapable group of individuals are willing to learn more an effort to help better educate and protect our athletes throughout my playing career i faced a multitude of injuries, however none cost more confusion literally and figuratively at the time of occurrence and concussions. each of the four documented concussions i experienced three unique in the way they occurred. as a stand concussions from hits to my head by another player, my head hitting the ground, and the result of consecutive impact on separate place. while my symptoms are often

similar, they ranged from slight dizziness and blurred vision to extreme light sensitivity and headache. the severity of my symptoms have no recognizable pattern, and in two cases i returned to play one week after the injury i sustained. in one instance it only took me two weeks to recover. however, my final concussion i suffered on november 262010, and the resulting symptoms were the reason i decided to end my career during my playing days brain injury was never a major concern. after my first concussion on the last play of a high school game senior season i was able to start the next game. it was not until my symptoms became serious that my attitude about the injury changed. at the time i decided to retire i saw my decision as the right one to make. however, in the aftermath it has become apparent that my decision can also be seen as an example of how dangerous brain injury is

i want to make it clear that my goal in speaking is not to deter athletes from competing. i always they acknowledge the seriousness of brain injury and respect the process that comes with recovery. in all sports a certain aggressive mentality is required to be successful. the passion and intensity if the plan relies on is an example of this and what makes the game beautiful. as a former quarterback i know the importance of and take pride in being physically and mentally tough, of working my opponent and leaving it all on the field and playing through injury. however, athletes must understand that all mild brain injury is not a mild shoulder separation or an injury to be played through. they must understand that playing through a brain injury is not a sign of toughness, but one that says athletes are often formed on the topic. statistics have recently revealed 40 percent of athletes who have sustained a concussion return to play too early and

that up to 50 percent go unnoticed. this makes me believe the only focus should be to create an open dialogue between athletes, coaches, doctors, and families that address the seriousness of brain injuries in athletics and the need for a full recovery before return to play. and know it is possible to decrease the statistics, and i also no progress on this issue is already being made in many states that have passed legislation. unfortunately there is no brain brace, no concussion-proof helmet or magic pill for immediate recovery. i believe there is a misunderstanding about prevention and treatment within the athlete cohort as well as the general public. for example, football helmet is often thought of as a brain protector when in reality it is designed to protect the bone structure of the individual and not the brain. if the helmet could guarantee concussion prevention of it still be playing football.

once again, i would like to thank you for the opportunity and more and partly for taking the time to learn and share your support for this issue and look for to the future progress the baena can and will be made on this topic. >> thank you very the, very much . you are very right. exactly right. dr. jeffrey kutcher. >> i will do my best. members of the committee, chairman, distinguished guests, it is my distinguished honor to join you. i am grateful to be given the opportunity to provide testimony. my name is jeffrey kutcher. since 2005i have been the director of michigan neurosport, comprehensive academics or serology program which provides clinical care for athletes of all ages and abilities and conducts clinical and basic science research on sports concussion, education to athletes, parents, coaches,

administrators, and health care providers. i care for athletes of the time of injury, threw their return to play process, the course of their season, careers, and after they retire. since 2009 have been the chair of these boards neurology. dedicated to the neurological care of athletes. kemp currently co-leading the effort to produce an evidence-based clinical practice guideline, an effort that includes the clinical review and reading of every academic papers published on sports concussion. also important to this topic, the director of the national basketball concussion program and console for the national hockey league players association. clearly there is an issue that has been gaining significant public and government interest of the past several years. the majority has been focused on athletes already in the spotlight, the wants to play

professional contact sports. while these are experienced the greatest doses over their lifetimes, they represent a small fraction of the population at risk of being injured, which is why i am encouraged today's hearing is focusing on protective equipment being used by all athletes regardless of level of play, age, or gender. a common misconception that concussion is a problem seen only in males. concussions occur and females as well with some data suggesting the incidence is actually higher in females compared to males playing similar sports. an injury that occurs at every age and level of play. over the three and a half million concussions occur each year, and the majority occur in our youth. there is great uncertainty and great concern regarding the notion a possible long-term effects, especially on the pediatric population, which may be an even greater risk giving

the ongoing development of the pediatric bring. what is a concussion? i will spend a moment describing that. an injury to the brain that occurs when the brain as fast enough or suddenly enough to disrupt the normal electrical function of its components cells given that the brain is floating in fluid inside of the skull and the head can act as a pendulum and the body is struck, movement of the brain significant enough to cause concussion can occur with or without a direct blow to the head, as long as this : does the brain inside is hit with enough force the normal processes of the brain may be compromised and the resulting in cash and can take on many different forms but typically includes disorientation, thinking, memory difficulties, or other signs of brain dysfunction. symptoms are also quite common. it cannot be diagnosed by anyone test. it is a diagnosis that can only be made after a clinical --

careful clinical evaluation performed by health care professional, and preferably one with training and experience dealing with brain injuries. not the only brain injury that can occur from head trauma. bleeding in or on the brain or skull fracture can occur any time. on the other side of the spectrum, there is emerging evidence brought forth by dr. ann mckee that forces from multiple impacts that may not even produce concussion meet have a potential negative long-term health affect on our brain. helmets have an extremely important role to play. without them the potential for serious injury would make many sports and recreational activities unacceptably risky. in this way, it's are extremely effective pieces of equipment. the introduction of hard shell helmets stole fractures in football have essentially been

eliminated. what they do not do well as slow down the contents of the scope. concussions occur not as a result of the force experienced by this bill, but the brain to read extremely unlikely that any helmet that can be designed that will prevent concussions to the same degree that it prevents call fractures. currently there is no convincing data that shows any particular moment being better than any other such state is hard to collect. given the many variables that exist in the athletic population and the varied exposure to impact, it's extremely difficult to perform a controlled clinical trial on the populations of athletes. given that a concussion is a clinical diagnosis with a diagnostic test, any study is significantly limited by the ambiguity of the very clinical outcome that is being studied. for these reasons there are no published data supporting the

idea for other types of protective equipment preventing concussions. moreover sports such as soccer, it results in athletes altering their playing style in the wrong direction. as the new-found sense of protection encourages more physically aggressive play. every week and asked in my clinic by parents, patience, and coaches by what they should buy. the simple truth is that no current piece of equipment can significantly prevent concussions from occurring. they occur as a result of the nature of our sports. prevention is more about teaching proper technique, playing by the rules, and letting did those of impact. the potential harm icy caused by products that claim to prevent concussion when they do not is far more than simply the financial harm. it is the harm that comes from having the false sense of security, not understanding how the injury occurs in what can be

done to prevent it. the public deserves to know that the equipment has a significant but inherently limited ability to prevent concussion. a tremendous amount yet to be learned about the nature of concussions. in the interim i am deeply encouraged by today's hearing and honored to be included in the efforts of the committee as you work together for the safety of our athletes. >> thank-you very much, doctor. can we go on? >> chairman and members of the committee, thank you for the invitation to testify on sports concussions and their consequences. i am a professor of neurology at boston university school of medicine and director of pathology laboratory at boston viejo. i am also co-director for the center for the study. my testimony reflects my professional opinion and am not speaking officially on the

behalf of the department of veterans affairs. a temporary state of neurologic this function resulting from forces on the brain, acceleration, deceleration, lateral, and rotational forces. sub concussion is caused by these same forces, but they are milder and no symptoms are produced. in all of these conditions concussion or sub concussion the brain looks normal after the injury, and there is no detectable demijohn retain merrill managing such as a ct scan or mri which is why these images are sometimes considered invisible. the forces caused the brain to move rapidly and the brain which is firm, but gelatinous is stretched and formed. there is stretch and strain. the brain abnormalities associated with a concussion and

sub concussion occur at the microscopic, cellular, molecular, and metabolic level. if an athlete returns to play before symptoms resolve their risk developing post concussion syndrome and second impact system, a rare but fatal condition. repetitive miles can cause of injury can trigger a progressive deterioration of the brain called chronic traumatic and set up the. chronic traumatic encephalopathy is a progressive nerve degeneration that evolves slowly over decades and usually does not become apparent until many years after the player has retired from the sport. cte is triggered by repetitive concuss of injury superimposed on a brand that has not healed from a previous injury. this is why concussion awareness is so critical and proper diagnosis and management of concussion allowing the brain to completely rest and recover after an injury is so important.

>> relatively young children his brains are still growing. >> absolutely. >> right. the immature brain is more susceptible to concuss of injury. children and young adults recover more slowly from a concussion. athletes are more at risk for concussion due to their disproportionately large head size compared to body size and the weakness of their neck musculature. furthermore, uniquely susceptible to second impact centrum which has only been reported in athletes under the age of 24, and most often under the age of 18. second impact syndrome occurs when a young athlete sustains an initial head injury and suffers a second head injury the for the symptoms associated with the first impact of cleared. typically the athlete returns to play to orally and receives a second blow to the head, which may be remarkably minor. the affected athlete may appear

stunned, but in the next few seconds to manage the athlete collapses to the ground semi comatose, and the outcome is often fatal or associated with severe and permanent disability. since 2008 as director of the center for the study of dramatic in support of the feed grain bank i have diagnosed 58 athletes and other individuals, which is more than double the history of the world's experience with this condition. i diagnosed cte and 40 football players including professional football players, college and high-school, hockey players and military veterans. chronic traumatic encephalopathy causes changes in behavior and personality. durable, angry, or aggressive. mood changes such as depression and sometimes suicidal and develop a drug and out of use. as the disease progresses that

develop short-term memory loss, which leads to increase the carnage of the impairment and ultimately dementia and in some cases parkinsonism. pathologically cte is caused by a buildup of a protein that forms within the brain. under normal circumstances this abnormal protein is found in only limited quantities, but in a cte there is a striking buildup of this protein, even at young ages. for example, advanced chronic traumatic encephalopathy was found in the brain of dave duerson, a former defensive back for the chicago bears began playing football at age eight and experienced more than ten concussions in his 11 year career. after retiring he was a very successful and have a loving family and three children -- for children. at the age of 46 he experienced financial difficulties and the dissolution of his marriage. hot tempered, physically and verbally abusive, memory lapses,

its wings, and piercing headache. on february 17th 2011 he kills himself inside his florida apartment. he left instructions to donate his brain to my laboratory and my examinations showed he was suffering from a moderately severe cte. another example is owen thomas. played football since age nine. one day in the spring of 2010 he called his parents and told them that he was dressed and having trouble with courses. two days later he hanged himself in his off-campus apartment. when i looked at his brain i saw unmistakable changes overly cte. if you compare the brain of owen thomas to the brain of dave duerson there are remarkably similar or pathology suggesting that if owen thomas had lived another 30 years his cte would have progressed to the advanced stage to mistreated by dave

duerson. i really had the opportunity to study the brain of a 17 year-old high-school football player who suffered a concussion three weeks before dying and had recently been cleared to return to play. during the game he intercepted a pass, was tackled and hit the ground. as he walked to the bench he complained of a severe headache, collapsed to the ground unconscious and died the following day. narrow path illogic examination showed a subdural hemorrhage -- hemorrhaged and very early changes of cte. the youngest player ever diagnosed with it cte. i have now examined the brains of 58 individuals with cte and have found early cte in college and high-school players including is ten and 17 and 18. we know that cte is a narrow degeneration associated with repeated because of injury that usually occurs in teens and 20's. once it is triggered that did generation progresses slowly

over decades to of all of widespread to generation of many brain structures. we know the symptoms of cte are subtle and begin in mid life with personality and behavioral changes including irritability, short fuse, depression, suicidal ideations, impulsivity, and memory loss. a slow deterioration. there are many things we do not understand about cte. we do not understand or know the exact incidents and prevalence of this disorder, even though we now clearly understand that this disease exists and is surprisingly common. what factors determine who will develop cte, how many concussions, sub concuss of injuries, how close together, house of year, and at what age are aspects that are unknown at this time. importantly we did not know how to diagnose the disease and living individuals, how to stop its progression or reverse its course, but we can make important changes to the

province the disease from developing in young athletes, and they include understanding what a concussion is, recognition of concussion when it occurs, and proper medical management of concussion after it happens. we can also teach our young athletes to play smart and keep their head out of the game as much as possible. changes to protect athletes from dangerous styles of play, will enforcement and player and coach education will go a long way toward reducing the frequency of concussion and so concussion. with these changes, continued education, increased scientific interest and research into the mechanisms of pathogenesis and the development of diagnostic tools and therapeutic strategies to interrupt this disease progression we can make enormous improvement to protect the mental health of millions of young athletes and military service members for many years to come. thank you.

>> that was excellent. and so we then finish with mr. mike oliver. >> having read my preparation to this hearing i am a little bit confused about what you do and don't do. >> thank you. members of the committee. i appreciate the invitation to come here today and provide testimony is important to me personally as well as the organization. my name is mike oliver. i have served as executive director and general counsel for the national operating committee on standards for athletic equipment. we are nonprofit corporation was develops and publishes standards for athletic equipment including helmets, face guards, safety balls, and even soccer shin

guards. we operate as a board of 18 directors representing a wide variety of national sports, sports medicine, and other interested organizations. each organization by definition through our bylaws selects one or two members to sit as a director of the board. in addition to the 18 voting directors there are two non-voting positions representing the national sports governing bodies of the ncaa and the national his school federation. there is no single controlling interest or interest group on the board. its balance of interest and non dominance is inherent in the operational structure and function provided through our bylaws. not a trade organization. there is no category. funding is received through licensing fees that recharge to manufacturers who want to certify equipment to our standards and use our trademarks and registered logos, parties, and phrases.

although we're not a certifying body, we do not certify equipment independently, we do engage in market surveillance of certified equipment and obamacare product performance through mandatory third-party laboratories validation testing as well as direct product testing through an accredited testing laboratory with a we contract to provide technical support and service. decisions regarding changes to standards or the creation and adoption of new standards are driven exclusively by science and motivated by the desire of all members to protect athletes, not by issues of manufacturer liability, profit, market share, or any other interest. the mission since its inception is to commission research and establish standards for athletic equipment where feasible and encourage the dissemination of research findings on athletic equipment and sports injuries. into filling that mission we

have funded more than $6 million in research grants since the first grant in 1994 including more than $5 million dedicated to concussion-related research. to be certified as meeting our standards helmets with a football or batters elements must score less than 1200 severity index units on each of 16 impacts conducted at 12 miles-per-hour including to high-temperature impacts and impacts on to randomly selected locations. in addition there are four impacts at lower speeds with lower requirements. although the standard for helmets are not concussion-specific, the standard does directly address linear forces that are involved in most concuss of events. a helmet that passes the standard does provide some level of protection against those concussions.

what the standards is not yet addressed and can not yet addressed and is the subject that is not addressed by any other high standard in the world is how to establish an incorporated threshold for rotational a acceleration of the head a result from impact force is not directed to the center of gravity of the head. these are directly involved in causing a significant number of concussions, and these types of accelerations can occur without a blow to the head. there is no protective equipment standard available today from any source that specifically addresses concussion prevention and the development of a concussion-specific standard for any protective equipment requires substantial scientific report that compliance with further eliminate or reduce the severity of concussions without increasing the risk of injury in other areas.

while helmets certified play an important role in protecting athletes, certainly they are not the only solution to providing better protection against concussion. prevention undiagnosed system of treatment, and management decisions about athlete returned to play are equally important. in some circumstances may be more immediately effective. education programs that have been referenced earlier address these issues and are under way for coaches and we have entered into a partnership to create a specific heads up program as an educational resource to promote this education among those who are certainly motivated to provide the best level of protection. we recognize that concussions are complex events via mechanically and physiologically, and scientists are working hard to understand these issues, so that improvements might be made in protection, prevention, and

treatment. one of the primary funding sources for this research, and we are hopeful answers will be found that will permit an amendment to our standards that will effectively and specifically address concussions. any device including hellman's premiere this they will to prevent, diagnose, or cure concussion must be supported by scientific data and peer-reviewed research. the same is true with regard to standards for athletic equipment. we fund research with the intent to advance science of the changes can be made to standards that will reduce concussions without increasing risk in other areas and have taken specific steps to be ready to do that with the answers are found. without solid scientific support for concussion specific change to an existing, standard any change made to address concussions becomes nothing more than a hopeful experiment turning players into involuntary test subjects which is something we will not do. i look forward to the community questions and discussions on the

topic we consider to be strictly important. >> thank you for that excellent testimony. [laughter] >> we do have a team, however. >> you do. >> thank you. >> i'm from west virginia. i deserve that. what is interesting to -- that is good. [laughter] i have spent -- my mother spent about 12 years thank from alzheimer's that she did. my wife's father died from alzheimer's. there are so many, 5 million people with alzheimer's, and one of the stabbing things about alzheimer's which incidently if you are working in a traumatic

brain injury area you can do that while you are working on alzheimer's because there are common threads. the stunning thing is the new york times came out with an article six or eight months ago basically saying that the last 30 years of research and the great institutes of research in this country have produced absolutely no progress whatsoever on finding the cure for alzheimer's, not prevention, slowing it down for testing to find out if you have it, although that may be on the way. the stunning figure now comes along. injuries sustained by concussions. made one poignant by the fact that they come so early in life and can have such terrible consequences you decided not to

do what you have spent your whole life preparing to do. not necessarily typical. a wise decision. i want to throw this at all of you. you could develop the 50-pound helmet, and all it would do is more securely, i think, unless i'm wrong, is more security make sure your head is not to split open. it would not do one thing for the movement of the brain or stop the movement of the brain, which is you say that emphatically enough, it raises the question of what you can do medically. analyze. we do that with alzheimer's. people leave their brains to be studied and you learn from that. you can tell.

that doesn't do them any good, and so i want to raise two questions. one is the medical side of this. td think i am wrong? do you think this is a relatively early discovery? to be quite honest, i did not know at all that somebody who played soccer could get this until i watched that movie about the wedding when we beat china back in 19 whenever it was, 1980. that incredible, powerful back, she just find them. she had chronic fatigue syndrome . she did not have a brain concussion of any sort. you see that a lot.

we wanted more, and you see people using their heads. it's just the amazing news of the ignorance of the american people about this problem even though we now know much more than we did know about it, i want to know right off the bat how hopeful you all are realistically about being able to find a problem so that the brain is not thrown off of its access, elector of stimulus and all the rest of it. can this happen? >> well, i personally am very hopeful. we didn't know about this disease five years ago in any real way, and we have learned has been extraordinary. we have made enormous gains in understanding how it affects the disease, what it looks like, how it progresses. now we understand it that this

disease exists and can try to model it in experimental systems and come up with those therapies that might help us to treat living patients. i actually think that this disease may ultimately be a window or provide insight into the diseases like alzheimer's. characterized by a buildup of the protein and maybe by understanding how this disease starts and how it progresses we may actually have insight into alzheimer's and how it starts. one of the most difficult things is we don't have any idea. its starts silently, maybe in of persons fifties. we can never identify how it precisely starts, but we know it has the time course and what to expect. it develops over time, and i think it will give us enormous opportunity for intervention. the other thing is most of those therapies. >> the disease because of

helmets or other -- >> no. understanding the actual path logic process and intervening there, intervening at the start of the disease where it is triggered or preventing it from progressing through the nervous system. there appears to be a trans disability. it develops in one cell and then it causes the disease to be propagated in another. if we could interrupt the progression we could make an enormous difference in this disease, and that may be applicable to alzheimer's as well. one of the issues, we were focused on a protein which has come up pretty -- we have not come up with much, but we have not focused on the cellular element that we need to start paying attention to. >> can i ask one of you to athletes, is it to the prevention of something that you now know you already have from

becoming worse that interests you the most? or is it the vast amount of change in the way everybody in this country thinks about the playing of sports, carrying out of sports and the responsibility. there are a lot of coaches in rural states that are also math teachers. that probably is not good for either coaching or math, but that is the way that works. people did not know. if you are talking about not letting it happen in the first place, you're going to tell the person to keep their head up. try telling that to an nfl player who has just been shot blocked by somebody and has a chance to get back at him. human behavior is very hard to control. and so i don't know what the chances are or if we have enough

time or maybe the shark of learning, if we do more of this that coaches and parents. parents are often a lot less helpful than they think they can be and a lot less influential because kids want to go ahead and do it. abcaseventeen. don't tell me at can't. so it is the -- you do it after you know you have it and try to prevent it from happening. >> i would say yes. i believe awareness would be the biggest issue. if you could increase the knowledge base for the general public and the athletes, i feel like recovery, athletes would do better with recovery, take time to allow their brains to recover i don't think brain injury is viewed as a serious issue to route athletes. it was not for me until i had a

concussion that, you know, changed what i was able to do in school on a daily basis. >> i'm way over time. i apologize. is there any discussion of all of this? >> concussions are talked about lately still, at least when i went through plane. a lot of people, even if you got a concussion one day and are resting players are like, well, i don't see them heard. why are they setting out. that mentality needs to change. you see your fellow athlete got a concussion. you need to give them the respect and let them rest. that comes from the culture we have right now about the ignorance about compassion. >> to our doctors kid could training of this in medical? >> not as good as i would like it. >> like geriatrics. they can make more money

elsewhere and the port. >> pretty much. that wraps it up. i would make a comment on the original question if i could. the answer is yes, i am optimistic. your story about alzheimer's and the lack of permanent and understanding for treatment is very applicable to the situation, but also not unique to brent apology in general. stroke, multiple sclerosis the bottom line is the brain is complicated. i want to make a quick comment that we're talking about more than one thing. at least two or three. cte on the one hand, a process coming from repetitive blows to the head and concussion i2 different things, and i don't think for a moment that these folks here are at a high risk of developing cte there are

degenerative disease itself. reran the stage where we are just trying to understand the scope of the problem. we don't know the prevalence of this. we are finding more and more often in brains of the athletes who have had impact and military personnel, but how does it relate to the disease? we don't know that. there are people that have no neurological problem not all. i don't want to over a long folks because they have had concussions that they're going to have a cte. if. >> i am way over my time. >> i am glad you mentioned that because i was going to ask. you mentioned the 17-year-old that passed away. one reported concussion and then passed away as opposed to other

reported concussions prior to that? >> no. i don't have any other reporter concussions. >> so we really don't know if he played through a concussion or as you mentioned the repeated blows of being in whatever position he was in. it is a real problem, and i think you testified so well. the problem is to play athletics at the level you play that, you are playing every day you go out there. sometimes you're not sit -- they're not significant. broken fingers, just nagging things that can be very painful. athletes are taught that you have to play through that or you don't get to the level that you all played through. it is very difficult. to follow up, you did not feel like then that the head

injuries, the concussion aspect really was talked about very much in your career? >> for me it was not a serious topic until my last concussion. playing quarterback i had to be out of the field. schiller's separation, ankle sprain, whenever. up and ready to go. that is not the case with brain injuries. deal with that letter and let it recover. >> sometimes not really being in horrible pain compared to other injuries. >> right. exactly. >> do you agree with that? >> i agree completely. something that is being taught in sports, but when i was growing up playing in high school and college, it's just concussion. that's all it was.

>> i have been on the committee in the house and now the senate. we really are spending a lot of money trying to figure out the ied component of this, which is, you know, similar, were the same to we have a test now that we can identify if somebody has gotten a pretty good blow? is there an easy test? >> we need lots of research to determine that. that is something we don't have. we don't have a way of identifying a definitive concussion other than a series of psychometrics tests, balance, all sorts of things. we don't have an easy way of detecting or monitoring. that is definitely a very important issue that the viejo is addressing as well as the department of defense. that is a crucial issue.

>> you too are board certified and well-trained, and i suppose that with your licensure you have to achieve so many hours of continuing education to continue your, you know, your certification. i guess what i am wondering in the course of this, we have not talked to much about the education aspect of people that are -- wanting to get in to coaching a little bit now and perhaps will pursue that. is there in the course of -- you have a major. >> no, sir. i am coaching as my playing career. >> i guess what i am concerned about and maybe we could visit with somebody at some point. when you're taking the course coaching football or basketball, whenever the institution, if they are talking about this and the importance -- go ahead.

>> i can speak to that. they have made a policy that all athletes and coaches need to receive concussion education annually conferences like the big ten are having the policy as well. when they start their careers, we did not do that. at the university of michigan all of our athletes get a lecture from the all one of my delegates on concussion. so things are improving. a long way to go, especially as we go down the levels to high-school and junior high school. a lot more work to do, but there is a push in that direction to make people need a ticket education before they participate as a player or coach >> i think that is excellent and do think that those of the little things that will make a difference. and again, encouraging our teaching institutions to include that. also in the state sanctions as

they do their continuing education to make this something that is talked about every year would be helpful. the other thing i would like to touch on very briefly, and you can comment. i know you will talk much more about this, but the idea of being able to certify a helmet as something that, you know, will prevent concussions or whenever, the chairman mentioned a 50-pound helmet. theoretically as you reinforce the helmet and make it heavier, if you can do that, it is more of a weapon. can you comment on the fact that is not possible. the advertisements we see. >> i appreciate that comment

because i think it is very apropos of the difficulties that we face in trying to come up with the standard to address a specific issue like concussions. to a certain extent the mass of the helmet is protected. the more mass the more energy it takes to move the helmet and head. in theory the ideal helmet has infinite mass at the point it is struck and that is back to zero mass after words which is still impossible to do, but there are limits to what you can do. you get a certain point that extra weight becomes a risk in other areas and increase the risk of neck injuries and the risk of other injuries by doing that. there is a trade-off in that regard. i do think there is progress that can be made once scientists to the point where they can identify the specific forces or combinations of forces that are likely responsible for some of these concuss of issues.

the thing that is most restrictive is the fact that you cannot study a living human brain at that level at the molecular level while it is being subjected to blows to the outside to see how the respond. there are ways to collect data in the field to show how much the forces are and how much the head is seeing, and we just started a very large research project with dartmouth university, dartmouth school of engineering and wayne state university to look at the use of the diffusion tensor imaging mri which can look at actually the nerve fibers following an injury to follow its football player from a concuss of event. we know the force and can do that dti imaging and take that information and put it into what is called a finite element analysis program that would then hopefully lead as model what

happens to the brain when struck in certain circumstances. be able to come up with concepts of how to address those forces and attenuate certain kinds of forces better than they're being done right now. the goal, and i am hopeful that we will get there, to be able to come up with the standard that we can confidently say if the helmet meets this standard, which would include these issues, then you can have a comfort level that it will provide against, provide protection against concussions. not all prevent a particular amount, but it would be designed to meet those specific issues that we no cause concussions. having the science behind that is absolutely preliminary, and you cannot move forward without it. >> thank you, mr. chairman. >> thank you. >> thank you, mr. chairman. your testimony states, and i think he said this also.

there is no data in the published medical literature that says any particular, being better than any other at preventing sports concussions. last year, however, the ceo testified before a different congressional committee that there is independent peer-reviewed public research in the medical journal of neurosurgery, of yuri 2006 showing that revolution, the name of their helmet, reduces the risk of concussions by 31 percent when compared to traditional moments. one of the authors of the 2006 study told the new york times earlier this year that he disagreed with the marketing, the 31 percent figure without a acknowledging its limitations, yet riddell has extensively used this concussion safety plan in its marketing.

here is one example with this poster that is behind me, an example taken today from the website of the parent company of riddell. i think that you can read it. do you think a single 2006 study provides a reasonable basis for riddell to claim their research shows that revolution helmets reduce the risk of concussion by 31 percent compared to the traditional home of? >> no, i do not. i am aware of the study, and what i said was that there is no significant data to make that claim in the literature. i no there is data. it may lead to problems with the study. first is the quality of the study itself, how it was set up and trying to look at two different populations, one wearing a certain helmet and one another. you want them to be as equal as

possible, other than which, they're wearing, and that was not very well done to the point where i would not really consider the study design to be acceptable scientific protocol. the second main critique is that the figure is a relative percentage change. the two populations, the old helmet, just over seven and a half% concussion rate over the study. the old helmet had just over 5%. the change was just over two and a half percent. the absolute percent change which is relative. when you put that figure in front of people like that they will think they are up 301% less concussions. well, that amount given the steady levitations more that account for that data.

>> you can see why the parent who would be concerned about concussions with all the increasing awareness out there would see something like this. think i'm going to get a really protective helmet for my child. what we're talking about is something that is very misleading. >> i see that every week in my clinic. parents want to buy the new helmet. what do you think about it. >> they're asking you that over and over again? >> correct. >> what do you tell them, and you know what to do afterwards? >> my advice is most importantly have a new helmet if you can get

one it is important. after that as a look at the manufacturer's. by the highest on the line. what is lost in this conversation, you can't have a, a session without force. force is not the only thing going on here. if i took 100 athletes and concussed then you will get 100 different responses some forced to the head and you will get 100 responses. to say that the concussion is the issue is ignoring the fact that it is forces acting on a brain that is individualized and dynamic. at the end of the day a helmet that has the least amount of force through, i'm going to pick the one that is the least amount of force through. >> to say it will prevent concussions is not understanding

the complexity of the issue. >> thank you very much. >> thank-you. >> thank you very much. the alzheimer's dinner, an athlete came and spoke. i walked away blown away. the facts and things that are out there and the need for more education. i then held an alzheimer's forum this summer. one of the things that i learned was that this is early diagnosis of alzheimer's. the same thing i learned was a lot of the players are donating their brains, i understand, that it dementia to research. the early diagnosis of alzheimer's and also the advancement of problems due to a concussion could help us not just help the patient but potentially develop a cure

because mayo clinic. the mayo clinic was able to do that because they have advanced ways to recognize what early diagnosis. i finally realized that is part of finding a cure because you cannot practice different kinds of solutions and medications without knowing. if you wait too long and someone is to advance to cannot actually tell whether things are working or not. >> you have to have some sort of test that can monitor the course of the disease in order to be a will to tell in a living patient if it is being effective. the first thing we have to do is develop diagnostic markers, markers of those concussions. these other phenomenon.

concussion, post concuss of some , and ct. all quite different, but windy the diagnostic marker so that we can monitor the patients. in that way, once we develop therapies in the lab and experimental models and get to the point where we are testing them in living people we can see if they are working. without that we cannot tell if they're working or not. >> the academy of neurology. we are part of the work of that association in our state. could you talk about the work being done to develop meaningful evidence based clinical practice guidelines? i know that is happening so that we are able to get guidelines for athletes and if there is any scientific data available. >> right now you will see maybe a dozen or more consensus statements, groups get together and come up with what the experts think should be the best way to approach concussion

diagnosis and management. today there has not been an effort that is looked at the totality of the literature in a critical way looking at the quality of data, sorting through papers, and coming up with what we have that is evidence based in this issue. that is what the effort was. the started this two and a half years ago. a committee of 12 people. other medical specialties, sports medicine, there's -- narrows ecology. the goal was to create a sense of where we are and where we need to go. there are some of our management practices that have evidence, but i will tell you most don't. and so the goal, and we are hoping to be published in the spring of 2012 is to set forth the steps we need to take to get the data to have a good sense that we're doing something evidence based. >> very good. thank you so much for being here today.

i know that organizations like the brain injury association, athletic trainers association, center for disease control are working to increase awareness and educate the public as students who have this happen. what do you think the best ways are to get the information out there to your fellow students employers? >> i believe there is a lot of progress being made already through information educational seminars that we have with the schools. in arizona i was part of bill 1521 that implemented protocol for high-school athletes. they have to attend a class. the parents have to attend, coaches have to attend. a requirement to understand what the brain is doing when it is injured and how serious that is. >> we did that in our state. >> and it is spreading and will

only increase to gain significance. >> i agree with preventive measures. start in high school, but if we can start your under, club soccer which is prevalent among youth. different clubs are taking initiatives to teach the coaches about concussions, and i think that needs to be spread to teams and parents as well because once people are aware of what a concussion is and how serious it can be there will take that next step forward. >> one last question, did you feel any pressure to keep playing from your peers or other parents? >> i personally did not. all of my doctors, coaches, family, fellow players are very supportive of my decision. >> i think people respect your decision to stop. obviously they want you to keep plane because the embassy playing with them, but overall

people have been very supportive >> thank you very much for being here. >> thank you. >> thank you. and thank you for having this hearing. it is a very important issue that touches this country all over the map and also in many different sports. let me start with you, if i may. i would like a little context on the legal framework in terms of state laws on helmets in sports, athletic conferences like high-school athletic conferences and associations, do they have rules about this and standards and also the end ca and nfl, they have standards? what is the legal framework?

>> the legal framework is simple. this tended to republish, that is the best example because it probably applies across the board. republish the standards that our performance standards that indicate what helmets are supposed to do to meet the standard. the organization will incorporate into their rules of play a requirement that helmets worn by those athletes meet our standards. >> in terms of the helmet of self? >> the helmet itself. you cannot wear a helmet for play in the ncaa blessed as been certified. >> and they may also change their rules in terms of white hitting the quarterback. >> absolutely. the rules of play and then control, if you will, of the helmets are used. certainly things like spearing or using your helmet as a weapon are prohibited by the rules of

play. the same process applies to high schools through the national high-school federation. it does not control directly each of the state associations, but they participate voluntarily there are some states, for example california has a law that requires at the high-school level that athletic equipment, including helmets, between your sanitized on an annual basis. that has been interpreted to mean that the helmet included in football player must be reconditioned. if they are reconditioned then they will be recertified. subject to recertification testing and evaluation. >> kneepads, no cracks. >> exactly. they have to be subject to a fairly rigorous program tested their tested again. but that is the only state, to my knowledge, that imposes the requirement by law. >> on the high-school level generally is it voluntary?

>> the conditioning? it is voluntary. no requirement that they be reconditioned or recertified. >> and how long in your organizations view, let's say with a football helmet, one season before it is to be reconditioned? >> that depends upon how hard it is used and what kind of use and abuse it has been subjected to. we strongly recommend any time i have contacted that helmets be subject to reconditioning and recertification simply because there is no way to tell in advance whether a particular helmet needs it or does not and we know from the data because we get it back every year that about 90 percent of the helmets that it recondition and recertified have been in the previous year. a large percentage are done on an annual basis. what is not happening and which is something we're trying to address through the cpsc as well as individual work, the

organizations at the youth level that are not subject to state control or in see a control, very little is known about the names with a population of those elements. if they don't voluntarily submit them to a certification program there is no umbrella organization that is in charge. that is an area that must be addressed. >> one last thing. what is the general life expectancy of a football helmet? >> it depends on the manufacturer. riddell has for years put a 10-year life on their helmets. they said after ten years of bill warnings apply and they don't allow them to be reconditioned or recertified, and that has been their policy for a long time. one of the other major manufacturers has said as long as it is properly cared for and reconditioned, which means parts replaced, putting replaced, inspected, at the end of ten years the only part of the

element that is ten years old will be the shell, and you cannot replace the shell. if it is cracked or damaged the helmet is done. so it depends on the helmet and how long is going to last. >> a fine may ask one more question. you might have covered this earlier. what is the age scale we are looking at for concussions in sports? ..