and capacity to control the impulses was virtually nonexistent. the genetic evidence was used to challenge it saying the person didn't have the necessary mental state. to provide a novel serious -- that the person's own self provoked him rather than some external person, totally novel theory; right? and try to mitigate. didn't work in this case, and hasn't worked in a lot of cases because the objective circumstances are different than the neurological evidence. evidence of planning as we ordinarily understand it by a guy, taking it to a place, pulling a trigger saying die all right. those objective things lint face a lot of neurological ens. this just tells you -- the red bar is bad for the criminal defenses. the blue bar is good for the

criminal defenses. whenever you are in the room you should see a lough red. you should see a little bit of blue and the little bit of blue you should see is around mitigation. in effective assistance of counsel mitigation, and soming aggravation. in general, it's not working we again, remember it's a subset of cases. it may be more effective in plea bargaining. in cases where there's good evidence of neurological or biological it may never get to trial. it may be a skewed sample. at least in the casing i'm looking at it's not having a huge impact as of yet. it's causing people to ask a lot of questions. the amount of ink the people are spilling and trying to address these issues is increasing in volume. so it's an issue that we're going to have to address. so in conclusion, the use of this evidence is rapidly

expanding, and we're going have to figure out what it means for concept of responsibility and punishment. it's showing up in a lot of criminal cases. primarily in sentencing but also in pretrial, trial, and sentencing. it requires us to evaluate our norms about what it means to hold a person responsible and punish them. and it's going to appear increasingly as an explanation of behavior across law. we have time for question and an. one area that is really interested in a longer talk i would address and we can talk about in questions and answers is its role in the civil system. it can be used to substantiate injuries. all right. if you look at the person's brain and see they actually have a headache, they actually have pain, there's been some fascinating studies that actually have shown that you can see neurological signatures for pain or increase predispositionses to suffer from

pain. is that the plaintiff we're talking about? and showing up in tremendous numbers of cases and other cases. this evidence is evidence we're going have to address. we're going have to think about its role in the criminal justice system and a role in the civil system. i'm sure it's already appeared before many of you. thank you. and i look forward to your questions. [applause] we have time for one or two questions for you, professor. saving them for the whole group. we have a question coming. marching down the aisle. >> have no choice.

one of the problems in a lot of cases is involuntary use as defined but clearly a difference between having no choice and having -- i think that's richard who first put forth that distinction. i think it's really, really useful. at least i found so in my own work. i wondered if you would comment on that. >> i think that's right. we have -- we treat it as a black and white. it was voluntary or involuntary. not there are really shades of gray of well, it was voluntary but a harder choice. and that's because in criminal law, we treat people according to a norm. we say you, you know, if you're able to reach that norm. great. if you fall below it you reach your own peril. it goes back to oliver wendell homes and the theory of reasonsness. we have to evaluate that. now we have better evidence that some people can't live by the reasonable person standards.

should it matter to us? it goes to the question of what is the they theory of punishment. just because for utility, safe guarding society? about -- we'll have to figure it out. and the shades of gray that science is making apparent now is things stwre to think about and address. >> okay. thank you, anita. [applause] [applause] give me fifteen minutes. well, i don't know if the last speaker needs an introduction. he's not againing one. it's me. so far you've heard talk about science largely but not entirely in a courtroom context. i want to open the frame some. and talk about how genetics and genomic technologies in particular are going change our world in ways that will have some effects in courtrooms and in law offices. so those here as judges or

lawyers, or spouses of partners and judges and lawyers we'll see some of that professionally. firsthand or secondhand. but it's also going have enormous effects on each much us. as patients, citizens, as parents, and grandparents, and great grandparents. it's going to transform our world and physically transform who our grabbed children and great grandchildren are. that's what i want to talk about in my brief time. i want to focus on two specific areas. first, the rise of whole genome sequencing. and second, implication of prenatal genetic testing. let me start with the first one, genome sequencing. how many of you have had a agree -- agree nettic test? raise your hands.

i see about eight hands. anybody in here who is born after the early '70s should have raised his or her hand. all of you who have children in the united states or other developed world countries after the early mid '70s have had your children genetically tested, whether you knew or not. i don't remember the informed consent. you weren't given it you weren't asked to consent. it's mandatory that children be tested shortly after birth through a variety of agree nettic diseases. it has been around for 40 years. 110 there were about ,000 cars in california. sometimes differences in kind are really important but to other times differences in degree are more important. the thousand cars 110 years ago

were a curiosity. the 20 million cars today have changed everything about how californians live, where they live, where they work, how they work, when they have sex, how they have sex. and the very air that we breathe. we have had genetic testing for over 40 years. but it's been minor. only eight of you raised your hand when i asked you about genetic tests. i suspect within the next ten years, almost everyone in this room, not only will have been genetically tested, but will have his or her genome sequence on file in your electronic medical records. by the way, it's really important that we now have electronic medical records because if we were to write out your genetic code, a, c, g, t that lynn gave you a piece long. they would be as long as f second. not one volume of f second but from one f second to 999f

second. this is something i can't tell my law students anymore because they think f second a label applied to things that come up on westlaw and lexus. but those old enough to remember the books, a thousand, 12,000 page volume. that's the genome. we're going have all of that in every one of your electronic health records, probably within a decade. why? lynn pointed to one of the answers for why, because we can. because it's getting cheaper and easier and faster. we've moved from $3 billion to $100 million, to $50,000, to $3,000. in the beginning of 2012, several companies announced by the end of 2012, they would have $1,000 genome. they didn't. they're not going to have $1,000 genome by the end of 2013, yet. but by 2014? i think it will be there. and by 2020, the $100 genome

will probably be around. now, what will that be useful for? first, any time a child is born, instead of doing the tests we currently do for 50 diseases, they cost several hundred dollars. we will probably test for everything. when the whole genome sequence becomes cheap enough, people will say 30, 40, 50 tests. let get them all. all at once. and second, that's going to happen to us in our own medical care. some of that will be you go fhfa for a genetic test for one particular thing. so you a family list of colon cancer. and your physician thinks, you know, you might have lynch syndrome. a colon cancer syndrome that give you a 20eu9 95% chance of having colon cancer during your lifetime. we should find out about that, if we know you have it, we can

keep you dying from colon cancer confidently. we can inspect and monitor you, we can do surgery. not the best thing in the world to have done to you, but it's better than colon cancer. if you have the family history, let's test and see if you have a bad copy of the gene. but if whole genome sequencing is really that cheap, both the doctor and the insurance company will say, why test for one thing. let's get the whole genome sequence. spend the $2,000, get the whole sequence and never have to test you again for the sequence. we'll know everything and we'll be able to tell you about all sorts of different things that may be to your advantage. this, i think, is an exert belie where the scientific medical complex is going to lead us for reasons both good in medical and maybe not so good in commercial. but like every good thing, it's

got some issues with it. first, how accurate will the whole genome sequencing be? if it only makes a mistake one in a million times, that's pretty good. but if you've got 3 billion base pairs, that's 3,000 mistakes. so how do we know that that problem in your brac one gem gene is a problem in the gene and not an accurate simplified problem with the test? we might think the fda will make the tests accurate. they're not regulating them. at least not yet. second issue, lynn referred to this. interpretation. they gave them the raw data. what dna was there, what snips, what single nuke tide --

they were perfect. they were all the same. on what that meant medically for each sample, the companies differed a lot. the gao distinguished high-risk, medium risk, and low risk. a third of the time one said high and another said low. who does the interpretation? and how accurate will that be? i think that's going a huge problem particularly if the interpretation is done by private companies using privating a georgia rhythm that are transparent, that aren't open to analysis, that aren't fda approved. and company says you're at high-risk for diabetes. company b. said low risk. what do you know? and diabetes that's one where the progressive efforts are good for you like lose weight. what it's high-risk that lead to surgery? one company said we should take

out your prostate gland. and another company says, no, no problem with your prostate gland. how are we going to do decide that? i think the biggest, hardest issue will be how in the world will we explain this to people like you and me. and people like you and me who may be even less sophisticated about medicine than most of you and i are. -- something like that. it's hard. right now the saving grace if you go for a genetic test to test for one thing usually. t a test for breast or ovarian cancer. you know something about the condition. your doctor knows what you know. the doctor knows about a test. the doctor can say, here is what it means. but if you back not just the result for one thing but the result for everything, your doctor doesn't know what the 4,000 diseases how and how to interpret it. neither do you. and that can be a big problem.

information can be wonderful if it's used well. but can be awful if used poorly. take breast and ovarian cancer testing you've heard i'm sure the brac1 and 2 genes subject of the patent decision. it a woman does not have a new dated version if she has a normal version of the genes she's not at 80 to 90% risk of getting breast or ovarian cancer from the gene paps woman gets the test, learns that she's not at high-risk, what if she say, great, i don't have to get mammograms anymore. serious problem. because not being a 90 percent risk doesn't mean you are a low-risk. the average american woman's risk of being diagnosed with breast cancer is about 12%. the average american woman with a normal brac1 or 2 gene risk of getting breast cancer is about

11.95%. acting improperly on that information could be deadly. about 20% of us in this room -- so quite a lot of this people, are at double or triple the number risk of getting alzheimer's disease. because of our genes. if you learn that, and you decided, oh my god, i better take senior status early, i'm going to check out and take the retire early, take my 401(k) go around the world while i can remember it. might be a wise idea. it might not be. because that two or three times the normal risk is still less than 50%. and if you don't have somebody explaining that to you, you can miss interpret the information in ways that will be damaging. how are we going explain 4,000 genetic results to people who can't even spem -- spell dna and how are the doctors, many of whom who are trained without any genetic in

the training able to explain it? it's going to be a huge challenge. a couple of other little challenges, the maryland v. king case, expanding the data bases for criminal purposes to include people who have been arrested but not convicted. interesting and important decision. will we need it? if everybody's whole genome sequence is in their electronic health record, and the police have suspect's dna, crime scene dna, do they even go to code or send a s&p to -- subpoena to the local system. or the veteran's administration or inner mountain west or whoever has your electronic health records? health information, the good news is, is pretected. genetic information is protected just like all other health information. that's the good news but also the bad news. it's not deeply protected. what are the confidentially

issues? what are the issues about research? researchers would love to get their hands on whole genome sequence of 100 million people with the electronic health records combined. maybe those patients don't want to be research subject. are we going ask for our consent to be researched on or aren't we? what about kids? so right now the consensus in the field is, don't test children for diseases where it doesn't make any difference while they're children. if somebody might be at risk for huntington disease, a terrible neurological disease that strikes in the 30s, 40s, or 50s. don't test while a kid. it won't help them. but if you do whole genome sequencing after birth, you have all the information. you've got then. what do you do with it? do you give it to the infant? probably not. do you give to the parents? do you give it to the pediatrician and hope that 18 years later that pediatrician will be in contact? if you put if in an envelope and

do not open until 18? these are questions we're going to have to deal with. when all of our genomes are in all of our electronic health records, medicine will change in i trust ultimately will be before -- for the better but we will face challenges in try to figure out what to do with it. even more than important that, is the change we're going see in having babies. people will still have babies and i think people will still have sex. but i don't think people will have sex to have babies. nearly as much as they have in the past. prenatal genetic testing, has existed also for 40 years. some of of you may remember it. the long needle at 16 to 18 weeks. or corp.ontic sampling a shorter needle at 12 weeks.

we don't have a third child. we can do it, but it's invasive, unpleasant, and somewhat risky for if the last almost 2 years, four companies in the united states have been offering prenatal testing from a blood draw. a quarter of an ounce of blood from a woman who may be as early as eight weeks pregnant to tell whether or not that fetus will have down syndrome. or 13 or 18 or in the near future a new dated gene or high-risk of alzheimer's or colon cancer or blue eyes. one blood draw, no muss, no fuss. those who have been pregnant and gotten prenatal care, no doubt remember you had a lot of blood draws. it's just one more eight milliliter tube in an early blood draw. and that's going to change which

babies are born because it will make it currently about 2% of american women get prenatal genetic testing. i suspect within 10 years it's going to be 70 or 80% who learn more about the genes of their fetus in a time when they can do something about it. that's going to be transformative. but i think the real revolution is 20 or 30 years away. i call it -- i'm writing a book on it. a now long overdue book called "the end of sex." the good news is, not the end of there being boys or girls or the end of things boys and girls do with each other we call sex. or boys and boys or girls and girls, but it's going to be the end for a large chunk of the population in using sex to conceive babies. babies will no long we are conceived in bed or the backseat of one of those california cars, or in a water bed or under the

grass or any place else. they will be conceived in an ivf clinic. why? a procedure used for many years. if you've got the embryo and day three it's eight cells, in kind of a water balloon filled with clear jell-o. you can think of eight grapes inside a water balloon filled with jell-o. and what we can do is take one of those cells out. do a genetic test on that, and say, this embryo is going to have down syndrome. this embryo won't have down syndrome but get huntington disease late in life. this would be a great tissue donor for the older brother who has leukemia. people have done that for twenty years. there's a problem with it though, it's no that the kids end up missing an arm or leg. the other cells make up for the cell taken. it's that in order to do that, you have to do ivf.

because if you conceive the old fashioned way, when an embryo is three days old, it's half way down one of the woman's two fallopian tubes. good luck trying to find it. you can see by ivf where it is at day three. it's where you put it. the p inspect the -- ivf is pain. i'm sure some of you have gone through it. i'm sure you know people who have gone through it. i should qualify that. like many unfair things. men are the genetic disadvantage. they are at the genetic advantage. no man has ever been hospitalized as a result of sperm donation. egg harvest is expensive, unpleasant, dangerous, 1% of the 200,000 american women every year go through it end up in the hospital. it hasn't happened from sperm

harvest. as far as we know. life is unfair. goating eggs is the problem that has limited ivf. it's going it change. we will be able to stake stem cell and turn them in to liver cells, brain cells, and eggs and sperm. not the human embryonic stem cells you have heard about. a lot we can do it with them. six years ago in japan invented what they're called induced stem cells. you take normal cells. you take skin cells, you hit them with a cocktail of things and start acting like embryonic stem cells nape can become heart cells and brain cells and lung cells and kidney cells and eggs and sperm. in fact, a different japanese scientist made it work. he has done mice in-vitro

vertlyization using mouse egg derived from mouse stem cell and mouse sperm derived from mouse stem cell and made healthy mice. don't try this at home yet. mice are not people. medicine will finally cure us all when they figure out how to turn us in to mice. we're not there yet. ten years from now, twenty years from now, a couple wants to have babies, they'll do the following: they'll go a clinic, the woman will give up a skin cell, which will be turned to a stem cell, the man will give up sperm probably the old fashioned way. cheap and easy. magazine costs, video cost, those are low. they will make embryo. how many will they make? well, right now with ivf that's limited by how many ripe eggs you get in a procedure. eight, 10, 15, maybe 20 in a

healthy young woman. making them from stem cells, the sky limit. 100, 1,000. 10,000 embryos. and then each of those embryos at day three gets a genetic test. that will be the limiting factor. the cost of doing the test will let's say couples stop with 1,000. stop with 100. they have 100 embryons. for each of those they learn five categories of eggs. does it have any nasty early onset disease like down syndrome or tay-sach or cystic buy fro -- cystic fie bro sis? what about risk of alzheimer's, breast cancer, prostate cancer? category three blue eyes or brown. what hair color, what skin color? tall or short. lucky enough to have early gray hair like the gorilla in the

band. or male pattern baldness or somewhere in between? category four will be behavioral traits. not just issues of violence, but the not asking for directions trait. wait, no we know where it is. the y scroam zone. i don't think it will be huge. i think behavior is complicated. i don't think we'll be able to say 2350 on the s.a.t. 174 on the l s.a.t. i think we will see this embryo has a 60% chance of being in the top half. whether it's for test scores, musical ability, or sports ability, or personality traits all things we know are complicated. but that we know from various studies have genetic correlations. and the fifth category the

easiest boy or girl. so the couple will get 100 readout on 100 and be asked, which one do you want to try to make your baby? one side effect will be divorces, i think. when the guy says i want number 12. that's andrew luck. he's going to be a great quarterback. and the woman says no, i want 33. that's hillary clinton or don't -- condolezza rice. andrew luck is an easy one. i'm not sure the equivalent on the other side of the spectrum. but they'll have those choices. they won't be able to pick the designer baby. they'll only be able to give on a path on what they have to give. two blue-eyed parents will not be to be produce a brown-eyed child this way. and further more with a number of different traits 100 embryos or even 1,000 won't give you a good chance of getting your favorite on each of 20 different traits or 30 traits. but on ten that are important to

you? odds are pretty good. so what will that mean? i don't know. i think it will mean our children, and grandchildren, will face different kinds of parenting issues than we do. the issues will start well before birth in deciding what kind of baby they want. how will that baby feel knowing he was picked to be andrew luck? and rather than having andrew as a dream of being an architect, he instead, wants to be a poet. or how will the parent feel when their football quarterback turns out to be a poet? what is going happen in term of fairness? will some people able to afford it and some not? my own guess, frankly, everyone will be offered this for free. because if you're an insurance company or national health care system, preventing the birth of one really sick baby out of 100 will pay for 1,000 of these

procedures. one child's two weeks in the neonatal intensive care unit is several million dollars. that pays for a lot of the easy pgd. what about issues of coerce? can the state say you can't use it? you have to use it. countries that say we want our children to be born em embryos are above average? i don't know the answers to the questions. we are to confront them. not because anyone sets out to turn to create brave new world, but because research intended and focus on the relief of human suffering. on medical purposes teaches us thing with secondary uses. teaches us more about

interventions than necessarily we wanted to know. and give us the opportunity move in to these areas. slowly. the first use will not be for teeing. will be because adults who can't have children, quote, of their own because have their own genetic children. the fd aapprove that. the other uses it follow it. the world will change. it changing all the time. our great grandparent wouldn't recognize the world we live in. we won't recognize the world our great grandchildren will live in. part will be ginoic.

part will necessarily affect the law. more basically it will affect each of us as members of the species going forward. thank you. [applause] ic i will waive my specific question and an time and ask the fellow panelists to come up to open the general q & a. again, please forward to the microphone. if you don't ask questions, we'll have to go among each other. that's probably a bad idea. everybody can see where we are supposed to sit except us. questions? yes. i assume most of you are familiar with the national academy of science -- several reports.

one that judge edwards chair as i understand it said dna is about the only area of science that have a lot of confidence in. the others vary depending on which one. what is your thoughts about that report and the fact that generally the judicial system is ignored? who wants to take that on? >> i will -- start on that on that question. i think it's probably fair to say and i would be interested in my fellow panelist's opinion on this. ic it would be fair to say dna evidence in part because relatively recent and lends itself well to quantitative analysis is probably best scientifically supported forensic evidence that does not

machine it's perfect. and that does not mean other forms of forensic science -- evidence are so imperfect they shouldn't be used. but i think the consensus that dna evidence is scientifically in general quite well supported. it's one reason why it's been generally well accepted. >> some cases will be very valuable and some cases won't. genetic seven-day forecast interesting. maybe useful and important. i bet she could say as low as possible to 100% certainty that is certain wound are made by certain sort of -- she may not be able to say that for all sort of evidence she sees. but i think all of science the

problem is there is such a thing as science or genetics or as forensic anthropologist. it gets downtown specific question. and in some specific questions, science can be really, really helpful and another others it can't. which is why you need hope you have good expert witnesses who can tell the difference between the two. >> can i? >> sure. >> can i make a remarking. of course. the precise statement in the report this is 95% of the words used. said that dna evidence is the only form of evidence shown reliably and to permit an association between the crime scene sample and a single individual. it department say t the mo reliable form of evidence for any purpose. it depend -- so i chaired -- i didn't chair but edited a report for the national institute of science and technology on fingerprinting.

finger fingerprint analysts suffer grave dna envy. on the other hand, it is clear that when done properly, and when -- the evidence can be extremely valuable. so it is generallyization have to be applied on a case by case basis. >> yes. >>. >> i'm shocked to learn that my son was genetically tested when he was born. and i think he's going to be shocked as well. where is this information? how can i get it? how can his father get it? how can he get it? who has access. and have there been any court case on the issue? constitutional or otherwise. >> all right. there our topic for the rest of the twenty minutes of q & a. [laughter]

every state require knee -- it started with a handful of disease. the poster child is a -- or pku. in to another amino acid. you need it to live. but if it doesn't get turned too much of it build up. and for reason that we still don't understand, 50 years after we have understood the basis of the disease, it kills brain cells. so kids with pku that are not treated end up severe mentally retarded. usually. we're not talking special olympics or working at mcdoddles. kids who never learn to talk. clothe themselves, et.

if you put them on a special diet their brains are normal or close to normal. they may lose a few iq point but not very many. so they said every kid needs to be tested for pku at birth. over the last 35, 40 years. the number of diseases tested for has expanded. states require this two states only allow a regular choice by parents not to do it. a few states have philosophical or religious opt out. there have been a couple of interest and examples. typically you may learn it's been done. but typically parents won't even learn it or won't know because if it comes back as a negative result. negative this this case being

good. your kid doesn't have it. no reason to tell you. they haven't been told if itst a positive result they have to figure out a true or false. and that's maybe one in 1,000 kids goes through that. those are the parents who find out. a couple of years ago, people in texas and minnesota discovered that these blood spots from heel pricks for little kids were being used for research. and the texans, i think made a political misqueue by allowing the fbi to use some for criminal research. our babies are being put in the data base? they weren't but used for research on the frequency of different genetic variations. they sued both the texas and minnesota. the texas case settled with now texas parent being presented a chance to opt out of any research use. and 5 million stored blood sample being incinerated.

the minnesota case is pending. find out your state's public heath law. they're probably not going give you the result. they will be on a handful of diseases. depending how old your children. and almost certainly negative on all of them. somebody did the tests. >> i would like to clarify one thing, though, the tests that were done say in the '70s or '80s not strictly speaking genetic tests. nobody was looking at dna. they were looking at things like -- >> right. >> so they were call the metabolic screen. >> with all due respect to my friend and colleague here. i think it's equivalent in the sense they weren't trueing dna. we aren't testing dna now with the mass speck. we're testing the protein from most of the neonatal testing. [inaudible] it's still tests of proteins, really. but it's the test that tells you something about the underlying

dna. >> so a word. two things. and have to contradict miest steamed colleague. the fbi didn't get ahold of any sample from texas. the department of defense did for what said. namely, to look at the frequency of my tow con degreial dna. they thought it was going to a data base. i i mailed here and could not persuade her otherwise. disspite the fact it was cleared. >> i will accept the friendly amendment. >> i want to raise an even broader issue with the king case. i come back to the same things. and namely what is the difference between being arrested and not being arrested for -- a lot of people get arrested. it's estimated that what is it 20% or 30% of population more than that will be arrested. is there a real difference? so i have written in my more provocative moments with some

colleagues that maybe we ought to consider having at the stage of the neonatal testing done. the genetic testing for the -- not done by the police

start thinking about why do we care? all right, where are we worried about people access to the genetic information. what are we afraid of. if we're afraid of people discriminating against us or afraid of employer discrimination or health care discrimination or long-term

disability care distribution. if we think it's an offense to our digty because tied of up who we are as people. and other people knowing information about it is us problematic. we need to think about use restriction and regulations around misuse of ghee nettic information. but access restrictions not just in this area but probably lots of areas of information will be difficult to enforce. before we get to the other question. there's another kind of information you get from dna and some people including me have paid to get gene logical or

ancestral information. one thing you can learn pretty clearly from dna usually is relationships. whether the person is your -- changed your diapers occasionally you can find that out from genetic information. there was a case famous case several years ago now of a kid who had known that his father was a sperm donor who brilliant kid at age 15 did some snooping genetic genology and ended up telephoning a guy and saying hi, i thing your my dad. the guy was a sperm donor under a condition of anonymity. he didn't want to be known or contacted without reaching any kind of confidentty one smart kid was able to trace it down. if we get the sequencing on everybody in the family. we may learn secrets we may not

want to know. if -- but quarter genetically similar, that says something about whether they actually question winly same the parents or not. >> when yo made your presentation, you talked about the stakes with the number of different. one which was one in 50 and another one in 70 and then based on the presumption that you could multiply them together talked about there would be one in 3,500 and another individual would have the same two. that has within it the assumption there's no overlap. in that context, and in particular in light of the king case there's a concern that with regard to the system, which is completely controlled by the fbi and the government in that

context, is there a need to make the system completely transparent now that every time somebody gets arrested, there mouth can be swabbed and data base created. >> there are actually two questions there. the first one regarding the case i presented part of the evaluation that i had to present was of the reference population in which we have made the estimates of 1 in 70 and one in 50. of it not -- in fact. i don't think it existed back then. staffs state of utah reference population where we had about 200 persons of european

ancestry. and in making that determination of independence, i have to testify about all of the procedures that were done to demonstrate independence in those data. there was nothing. all of the procedure was completely open and disclosed. now the second question about was about -- and my feeling with scientists is that a data base like that be identified should be available to any researcher to be evaluated in any way for the validity. there have been several working groups who have done the evaluations. i think it should be -- i think it should be broadly opened to the scientific community for evaluation.

and perhaps -- is not a very good data base for genetic research. it contains many relative. we don't know how many. when you try to test independence and stuff that way. you get mistakes. second, they raised an ethical issue along the lines we heard about even if you deidentify the data base will it be a problem? but if all the -- it strikes me as a nonargument. i won't go in to why. >> oob, you know, i think it may take something like a judge's decision to give defense counsel access to it and change that view. there have been lawsuits to the

affect. arizona was provided as a result of that. it's not like there no study of the sort have been done with convicted offender data base. the largest in the world has not been studied in that way. >> and the fact that it isn't allowed to be studied,ic, raises questions they could resolve by allowing it for study. thank you. >> there are many laws that prohibit discrimination open the basis of race. there are case -- i do native american law that is recently around 1920 that native americans are an infour your race. that follows other decisions

that talk about other people that support the concept of race? other than man being an infour your race. >> i will speak to it with the it's more likely a social construct. there are certainly ancestral component we can see in genomics. and question see differents bases on different patterns. and so it may be that with genomic get to a place of greater precision and dwiegd people up by different heritage and ancestries. rather than by the crurkt of simply the type of a person's skin. looking at the person tell you

about their ancestry than being able to look at genomic heritage . and able to see that way through that kind of grouping. so there have been some interesting arms that different legal scholars have written to talk about a new kind of racial profiling or ethnic profiling based on gino type. and but it's a question people are asking, which is is it possible that certain inheritance patterning, certain patterns have an increase prevalence, for example, -- [inaudible] expression agree no type inspect which case we might end upstarting to say well subtype a or ue31 or whatever it is. more likely to have criminal behavior or this subtype is more

likely to have higher iq predispositions. it could happen. we're a far away off from it happening. the e presentation of behavioral trade. it's certainly a possibility. it will become more precise by looking at the person's skin. >> so i think genetic z has really helped us with this concept of race. because most scientists in my experience don't really like the term or the concept of race because it's just too broad a classification. it it's a blunt tool for a very, very complicated issue. when we look at the imee gnome what we often see with the individuals is some comes from africa. some comes from asia. some comes from europe. a lot of us are very interesting and complicated memberture --

mixtured. it has important public health informing. you may have a particular section of chromosome found in european diseases. but on another you may have ancestry fromlet say africa. so because we are often complicated mixtures, genetics enlights us and tells us race is too blunt a tool too crude a tool to to an most of the important questions we face. >> we actually all are african within the last 80 to 100,000 years. all of our ancestors in africa. maybe a little longer. and we are all lorelly cousins. some are second cousins. some are 200th cousins.

recently one of my colleagues published a u paper with new information about the y chromosome. looks like all men and all the women's fathers shared drn -- that a common ancestor about 80,000 years ago. which is about the same time we got from a common mother the dna that comes only through the maternal line somewhere around 80 to 120,000 years ago. it doesn't mean there was just two people. each one of us dissented from the same person. in part a tiny part from the dna from 100,000 years ago. we're all cousin and not very distant cousins. a band of chimps is ten time more genetically diverse than the entire human pee cease. we are new species and a close i had-related one. i think that's the most important lesson they can tell

us about race. >> this question for professor -- it may spread a little bit through the panel. could you i know your time is short. and one of the points that you're making about the work in yugoslavia, is the potential for collaboration what you do and genetic identification can do. can you make a minute and elaborate on that? >> yes, thank you. as we all spoke about our sub discipline what we do. what i think is important to unthis work is collaborative. the work in the and so many

times we're working in the lab with agree nettists. if we get the remains, possible to test every little bit of bone. it's not aren't inspect the initial source we do and then working with them do a positive id. it's clashtive work. no one is the real super hero in the lab. even though they make it sound that way. we come in and identify these individuals. along with that it's been amazing work with data bases stripping identities and working with the families. i think former yugoslavia challenging in that have all the

men in the family and extended family had died somewhere in the same grave, and so trying to get the matches from families that had moved to the united states, moved to other parts of the world was really a heroic effort by icmp and various human rights groups. so i think the former yugoslavia how we can work carefully with law enforcement collective and college the data needed for prosecution also how to work closely with human rights group. their primary interest is in getting those individuals back to the families. and so those families have claimed death and have some income where they have none at all. >> so i've been trying to run this railroad on time. and we're near the end of that time. i suspect there are more

questions than people at the microphones. and more certainly than we have time to an. my own e-mail is available easily online. i'm sure all of my colleague academic are available online. i would be happy to take follow-up questions at lunch or e-mail subsequently. i suspect i speak for all of us. i'm sure i speak for all of us in thanking you for listening to us for the last three and a half hours. [applause] sphwhrncht in a few moments a senate aging committee hearing on transportation options for senior citizens. then environmental protection agency administrator gina mccarthy testifying before the house science committee. the

at the heavy water nuclear reactor. at today's state department briefing, spokesman said that under last week's nuclear deal they cannot work on the reactor. >> he keeps saying that construction is continuing as the heavy water reactor facility. why is not a breaking of the deal? >> well, we've seen his comments where he said and just so -- in case folks have not seen them. what he said the capacity of the site is not going to increase. it means no nuclear fuel produced. and no installations will be installed. but construction will continue there. we're not sure exactly what he means by construction in the comment that he makes. but there will be no work on the reactor in the comment he made. ..

>> i'm happy to check. >> you says yesterday too, i think. i mean, surely they are in touch with people already; right? >> well, i think what i said was, well, we don't, you know, if he's referring to a road or outbuilding there, that's something different. obviously, there's specific

requirements. he repeated them in the public comments as well as in that no nuclear fuel be produced, no installations installed. the reason we put specific requirements in place is because, you know, we wanted to ensure that iraq would not be operational in this time frame. >> [inaudible] >> sure. >> would it be fair to say that you are not convinced that anything he said necessarily implies that they are or are planning to violate the agreement; correct? >> correct. >> and that fundamentally, you draw a distinction between construction, which could include, you know, just building buildings, and this specific things that they committed not to do including commissioning, the reactor, installing components. >> right. and just to add more to that, it's those, but it's also commissioning the reactor,

transferring fuel or heavy water. >> yes. >> to the reactor for the transaction of the agreement, not producing more fuel for the reactor, not installing the instrumentation and control systems among other components, and not undertaking processing or construction of facilities capable of processing. the specific requirements in there are what our expectation is that they will meet. >> right. >> on the next "washington journal," a conversation on the economy, unemployment, and the minimum wage.

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on many campuses, young women are talkedded they live in a society where girls are shortchanged in school, robbed of their self-esteem, and channeled into low paying fields. once in the workplace, they are cheated out of 25% of their salary, face invisible barriers, and all sorts of forces that hold them down and keep them back, keep them out of high echelons of power. now, this picture does not fit reality. it's distorted. the false claims that supported -- that supported have been repeated so many times. they have taken on than ora of truth. >> critiques of late 20th century feminism and contemporary american culture led critics to label here as anti-feminist. sunday, on "in-depth," your questions live for three hours beginning at noon eastern, and

looking ahead to the new year, join radio talk show host mark levin. it's the first sunday of every month on c-span2. >> the senate special committee on aging held a hearing this month on transportation options for senior citizens. the committee lookedded at the retiring baby boom generation and need for alternatives to cars as they are less able to drive. this is an hour 20 minutes. >> my dear friend, senator collins, but suggesting this hearing today on the need for safe and reliable transportation options for seniors. it's obviously a crucial topic to seniors in order to be able to get around and enhance their quality of life.

the lack of dependable transportation clearly affects a senior's quality of their lives. if they don't have it, they can't go to the grocery store smghts they can't get to the doctor's apaintment. they cannot connect with their friends. get to the doctor's appointment. they cannot connect with their friends. having access to transportation helps many older americans remain independent and self-sufficient. two very important things. and it's also a cost issue. with transportation representing 20% of consumer spending, second only to housing, obviously

that's a big chunk out of a senior's income. florida has a few examples that we can learn from. miami-dade county helps defray the cost of transportation for seniors through the golden passport program. and it allows residents of that south florida county who are 65 years or older to ride on all the transit system buses and rail for free. urban, suburban, rural communities face different transportation challenges. and, thus, a variety of options are needed to provide seniors with safe and reliable transportation. greater mobility also has a very real impact on health care cost

when you consider that elders with available transportation are more likely to use office-based care rather than emergency care with obviously the greater impact on cost to the overall health care system. and access to transportation has been linked to even reduced hospital readmissions. but we have to do a better job with coordinating federal dollars and working with private partners to ensure that we get the most out of the dollars that we have available. if we stay on our current path, estimates are that the national cost of alternative transportation for seniors will range anywhere between $572

billion and $2.2 trillion by the end of this decade. correction. by the end of the next decade. by the end of 2030. the gao found that while 80 federal programs fund transportation services for the disadvantaged, the total spending is unknown. well, we have to find out. the gao recommended that improved coordination has the potential to improve both the quality and cost effectiveness of these services. my state of florida, the safe mobility for life coalition, has brought together over 20 organizations, agencies and the universities to improve transportation safety, mobility

and access for our seniors. in addition to promoting safety for all road users, includie ii drivers, pedestrians and transit users, the coalition serves as a resource on the options for seniors in each community. connecting those seniors with a range of public and private services. now, we need coordination like this. and so it's fairly simple. we need to ensure that those who can drive are able to continue. but if a senior should not be driving, then they ought to have an alternative. and we don't want a senior getting behind the wheel who

should not be driving. even though the pressure is there on them to get to where they need to get for whatever the reason is. and so our seniors deserve nothing less. now, we're going to do something different here today. since senator collins was so gracious and insightful to suggest this hearing today, what i want to do is i want to turn the gavel over to her. senator collins. >> thank you very much, mr. chairman. this is typically gracious of you. and i might say it feels so good to have the gavel back in my hand. but i will pledge right now that should there ever be a change, that i will be as wonderful to

you as you have been to me. and i want to start by thanking you for holding this important hearing. throughout our committee's recent hearings, we've focused on a number of the great challenges facing our nation as our population ages. and much of that discussion has revolved around health care, social security, financial security, scams directed at our seniors, but there's another daunting challenge that has rarely been discussed at a public hearing. and i refer to the challenge of senior transportation. we americans love our automobiles. from the time that most of us were old enough to drive, we've been behind the wheel. cars mean freedom. not in some grand philosophical sense, but in a very real

practical sense that matters to us in our everyday lives. having a car and being able to drive it means the freedom to go where we want, when we want. but as we age, we find it harder and harder to use that freedom given to us by automobiles. as our abilities decline, driving becomes more and more complicated. finally the day comes when we wonder whether we should keep driving at all. and yet if we don't, how will we go about our daily lives? and many of us struggle with how to tell our parents or our grandparents that it's time to give up the keys to the car. that's one of the hardest conversations. that day has already come for millions of our senior citizens.

according to the census bureau, roughly 19% of our population, or 13.9 million people, will need alternative transportation options to continue living independently. the last white house conference on ageing identified transportation as the third most important issue for seniors out of literally hundreds of options for priorities. and this issue is particularly a critical concern in rural states like my state of maine. not being able to drive takes a particular toll on seniors living in a rural, low density population area. in 2004, the gao found that 60% of nondrivers in rural areas reported that they had stayed home on a given day because they lacked transportation. in addition, nondrivers over the

age of 75 and living in the suburbs reported significant dissatisfaction with how their transportation needs are being met compared to those living in cities. since three out of four older individuals live in low density areas, these concerns raise very real policy questions. public transportation, which is often hailed as the primary solution, simply doesn't meet the needs of many seniors. i think of my state. it's only the very largest communities that have any public transportation at all. more than a third of those over age 69 have no public transportation in their communities. and even those who do have to plan around route restrictions,

uneven trip frequencies, hours of operations, or advanced notice reservations. in rural areas, the options may not exist at all, but in -- even in cities, if, for example, you have problems with your sight or mobility, transportation on mass transit can be truly daunting. according to the maine office of ageing and disability services, of people using state-funded home care services, just 65% of those over age 65 reported that they could always get to the doctor when they needed. and only 36% could always get to the grocery store. most of them relied, 90%, on family and friends to drive them. it's not surprising since one in five americans aged 65 and older

does not drive. so without driving, seniors must find some other way to get to the places they need to go. and, you know, we talk a lot about doctors appointments and grocery stores. but there's also an issue with social isolation. not being able to drive to go see your friends. to keep up with family members. and that matters, too. and gets even less attention. the challenge of providing transportation alternatives to our seniors is literally growing by the day as the silver tsunami starts to hit our country. to meet the challenge, we must find reasonable, practical transportation models that allow seniors to stay active and mobile even after they stop driving. and one such model is itn

america. which has been operating in my home state of maine since the mid-1990s. and it's since branched out to other communities across the nation. itn america, which we'll hear more about today, uses private automobiles to provide rides to seniors whenever they want almost like a taxi service. and katherine freund, the founder of itm america, is here with us today. i'm delighted that she's able to join us as well as the rest of our outstanding panel of witnesses. this is an issue that is only going to grow as people are living longer and as the baby boomers, 10,000 of us every day, turn 65. this is a challenge that hasn't received the attention in my view that it's deserved.

and that's why i'm so delighted that our chairman has agreed to shine a spotlight on this issue today. now, mr. chairman, i understand you're even going to allow me to introduce the witnesses, which is -- given what a great panel we have is truly an honor. first, we're going to her from teresa mcmillan, federal administrator federal transit administration. who will talk about the administers's efforts to address the transportation and mobility needs of our nations. we'll then here from dr. grant baldwin, director of the division of unintentional injury prevention at the centers for disease control and prevention. we will then hear from virginia dize, the co-director of the national center on senior transportation administered by

the easter seals in partnership with the national association of area agencies on ageing. finally, as i mentioned, we will hear from katherine freund, the founder and president of itn america who will talk about the innovative transportation model that she developed. and, katherine, i hope you'll also tell the story of how you became interested in this issue. and you've done so much over so many years. we will start with ms. mcmillan. thank you. thank you all for being here. >> chairman nelson, ranking member collins, i'm excited to be here today. i'm ter reese mcmillan, deputy administrator for the federal transit administration. i want to thank you for highlighting the administration's efforts to

address transportation and mobility needs of america's seniors. our nation is undergoing a significant demographic shift that will profoundly affect our policies and priorities for years to come. by 2050, the number of americans aged 65 and older is projected to more than double. and the number of men and women 85 years and older could increase five-fold during that period. this population, as you observe, can face significant challenges including increased poverty, isolation and the struggle to access medical services. the department of transportation is committed to helping older americans to age in place and live with dignity in urban and rural communities alike. a key point of collaboration is the federal interagency coordinating council on access and mobility, or ccam chaired by the transportation secretary. in recent years, working with

several federal ccam partners, the fta awarded competitive grants in more than three dozen states and territories to help install one call, one click access to transportation. with a special focus on military veterans and their families. through this program, patients at the v.a. clinic in leigh county, florida, just to cite one example, will be able to arrange rides on the spot using a computer kiosk installed on site. importantly, many of these veterans are seniors. my agency, the fta, has entered into many other innovative, cooperative agreements to improve locally coordinated access to public transportation for older individuals. for example, working with easter seals and other industry partners, we've launched a new national center for mobility management. the center will, among other things, develop a data base to

identify best practices for delivering transportation to seniors as efficiently as possible. mobility management is a responsible and innovative use of taxpayer dollars that will extend fta's assistance into communities. this approach improves customer service to individuals by encouraging partnerships among transportation providers, both public and private, at the local level. there's no one size fits all. those who know their communities best will serve them the best. in fiscal year 2012, fta provided over $40 million for mobility management projects. a 4% increase over fiscal year 2011. thanks to ongoing investments in this area, today there are over 400 mobility managers nationwide and over half the states are planning one call centers. the funding picture is decidedly

mixed, however. on the one hand, mat 21, our current authorization, enhances funding and services for seniors and others. for example, our program to enhance mobility for seniors and people with disabilities is authorized to receive $28 million more in fiscal year 2012 than under the prior authorization. this includes, for example, providing rides on accessible taxicabs, which is working well in houston, texas, madison, wisconsin, and elsewhere. map 21 also increases spending by 25% for rural transportation. rural states are home to many of the nation's lowest income and most transit dependent seniors. and, importantly, map 21 enables the federal transit administration to leverage its own investments in coordinated transportation activities with matching funds drawn from a variety of other federal

programs, ranging from medicaid to head start. but the fy 2013 appropriations, the sequester and continuing resolutions have left the federal transit administration unable to fund even modest technical assistance to help grantees strengthen service, delivery and innovation. this reduces fta's ability to investigation in transportation coordination at a time when it's needed most. despite these and other challenges, however, we must continue helping communities to identify and fill the gaps in transportation for seniors and others. oftentimes, seniors simply may not know what services and transportation options are available to them or how to connect with them. therefore, we need to support mobility managers and similar initiatives across the country to foster even greater connectivity. mr. chairman, ranking member collins, this concludes my testimony, and i would be happy

to answer any questions. >> thank you. dr. baldwin? >> good afternoon, chairman nelson and ranking member collins. thank you for the opportunity to testify today. i am pleased to join my fellow panelists and speak about the intersection of transportation and public health and how it affects the health of older adults. i will also discuss what can be done to help older adults remain safe, active, mobile, independent and healthy as they age. as the committee is aware, the u.s. population continues to age. in 2012, 14% of the u.s. population was 65 years or older. and by 2030, it is projected to reach 20%. this is approximately 72 million older americans. the fastest growing segment of older adults is is those aged 85 and older. this group is at the greatest risk for experiencing frailty and requiring assistance with mobility. taken together, the upcoming growth in the size and life

expect tansy of the older adult population will create new challenges for older americans to get around. many older adults are dependent on cars. this is particularly true in suburben and rural areas where public transportation is often limited. in fact, nine out of ten trips by older adults are made in personal vehicles. as the baby boomers continue turning 65, between now and 2020, the suburbs will see a 50% increase in people aged 65 to 74. but it's more than the roads that we drive on that can make a difference. more broadly, the built environment, the human made physical characteristics of a community, can present challenges, too. if a community has an abundance of streets with fast and high volume traffic or lacks infrastructure like sidewalks and safe street crossings, it will be harder and more dangerous to walk, bike or use other forms of active transportation. but it's more than safety, though. the built environment can enable, facilitate and encourage older adults to be physically active, reducing their risk of

obesity, diabetes, heart disease and other chronic conditions. mobility, whether by car, public transit or another form of transportation, are critical for an older adult to remain independent. ride sharing, shuttles or volunteer driver services like those provided by itn america offer innovative transportation options for american seniors. beyond keeping an older adult connected with family and friends, mobility also enables older adults to receive vital health and preventive services. ease of mobility may also enable older adults to pursue volunteer or paid work opportunities, bringing additional meaning and asense of fulfillment to their lives and benefiting their communities as well. the benefits of mobility underscore the need to improve our understanding of the factors that enable older adults to successfully and cyclically manage the transition from driving to nondriving. in an upcoming cdc study, we find many older adults anticipate driving for years to come and do not plan for when they'll be unable to drive.

some older adults will face limitations in their ability to drive at night, when the weather is bad, or due to age related declines in vision, cognitive functioning or physical capacity. therefore, we are researching older adults' views about having to limit or stop driving. in addition, cdc is developing a tool to help older adults quickly assess their own mobility. changes to the built environment can also improve transportation options for older adults. affordable, accessible and suitable housing oche ining opt allow older adults and others living with disabilities to age in place and remain in their communities. the availability of public transit and the proximity of grocery stores, parks, places of worship and medical offices just to name a few places have an impact, too. these features are even more important when driving is no longer an opg. cdc works to save lives, protect people and save money through prevention. as america's leading health protection agency, we work with

many different partners to identify, develop and test programs that can make a difference in communities across the country. one of the strongest and longest standing collaborations is with the u.s. department of transportation. we are partners with shared interests. this includes a memorandum of understanding with the national highway traffic safety administration, anchored to a mutually agreed upon annual action plan, we work together to reduce the number of motor vehicle injuries by improving data, strengthening policy, sinner jazzing research and translating evidence based interventions into real world settings. we are currently dus cussing ways to include older mobility in our plans. for those older adults who are able to drive, we must continue to find ways to improve motor vehicle safety and reduce the disp disproportionate number of fatalities and injuries suffered by older adults whether drivers, passengers or pedestrians. we understand progress can be made through coordinated, sustained and complementary actions including by parking lot

nerships with organizations like aarp and others. in summery, at the intersection of transportation and public health are solutions that can help people get where they want to go and keep them safe across the life span. by helping older adults remain safe, active, mobile and independent as they age, we also have an opportunity to help them to -- to help them remain healthier longer. transportation's impact on health and safety is why these collaborations are a priority for cdc. good transportation is good for public health. thank you. >> thank you very much. ms. dize? >> thank you, chairman nelson, ranking member collins. it is, indeed, an honor to be here today to address the importance of transportation to older adults and the pivotal role of coordination in increasing the availability of public and private transportation options in local communities. my name is virginia dize. i'm co-director of the national center on senior transportation.

in our work with communities, we've seen firsthand the importance of coordinating transportation resources across modes and payment resources. and the value with making connections between transportation and health and human services. as our country ages, it's increasingly important that we get this right. the national center on senior transportation was created by congress in 2005. it's funded by fta. and it's cooperatively funded by easter seals and the national association on various agencies on ageing. our mission? to increase transportation options for older adults and enhance their ability to live more independently within their communities is achieved by gathering and sharing best practices, providing information, technical assistance and training, facilitating tart partnerships and community engagement and administering grants.

since 2006, ncst has reached hundreds of communities and provided $1.3 million in grant funding. let me provide just a few examples of ncst grantees' work. in dane county, wisconsin, they created a timing system to help provide transportation to dialysis patients. in knoxville, tennessee, an ncst grantee combined several funding streams to create a new volunteer force and purchase specially equipped vehicles to provide older adults the personal travel assistance they needed. in florida, a small grant to the united we guide project developed a one call system for information about transportation options, safety and mobility. finally, in wichita, kansas, outreach to encourage hispanic -- the hispanic community to use transit resulted in creation by the transit agency of a bilingual

mobility manager. simply put, being able to get around your community is vital to being able to age successfully in place. missed medical appointments can exacerbate medical conditions. social isolation due to lack of transportation can have an equally dire effect on health and mental health and may result in placement in long term care facilities. improvements in transit and railways that address the needs of older adults may benefit the community as a whole by making it easier, safer and more comfortable for everyone to get where they need to go. as older adults make up an increasing proportion of the overall population in most u.s. communities, their economic and social contributions can't be ignored. an increasing number of older adults continue working in their 60s and 70s. and we must'nt forget that often

the older volunteers are drivers and escorts who give rides to older people. but there are challenges. our communities need to do a better job coordinating programs and funding streams and use public and private mobility resources more efficiently to help older people travel. this is both financially and programatically sound. communities need support to find unique local solutions that work. even in urban areas where transit is robust, we know that many more older adults than currently use the system could benefit from the service. with interventions such as travel training and safe and secure walking routes to transit. however, we know that most older adults live in suburban or rural environments with fewer accessible transit options. so creative solutions such as volunteer driver programming and assisted transportation, funding with a combination of federal, state, local and private funds can help fill the need.

there are several things that congress can do within existing frameworks to help support communities looking to enhance mobility for older adults. first, there needs to be continued attention to breaking down the federal and state barriers to local public/private coordination of mobility assets. the united we ride initiative at fta provides an excellent framework for interagency coordination. second, this hearing can serve as a starting point to explore the following. perhaps forming a small working group of advocates and key decision makers to help develop recommendations in support of consistent coordination guidance to recipients of federal transportation funding. adoption of consistent legislative language on transportation coordination. and the older americas act, map 21, and other upcoming

authorizations. as coordination across federal funding streams is multijurisdictional, this committee might seize the opportunity to act on behalf of older adults. finally, and perhaps most importantly, we all need to work together to drive assure that cy transportation responds to the needs and preferences of older adults. one option is to infuse the concept of person-centered mobility management, which includes both individual education and counseling on transportation options plus community wide transportation coordination. that could be infused in all federal transportation programs. on behalf of ncst, i truly appreciate the opportunity provided by this hearing to spread understanding of the importance of mobility for all older americans. and the concept of person-centered mobility management has an effective model to better serve those

needs that federal, state, local officials and communities can embrace. i look forward to your questions and the opportunity to work with you. >> thank you very much for your testimony. >> chairman nelson, senator collins, on behalf of the older people we serve, their families, and their communities, i thank you for the opportunity to be here today. my name is katherine, and i'm the founder of the independent transportation network and founder and president of itn america, the first and only national nonprofit transportation service for america's ageing population. i want to begin by thanks senator collins for her long standing support for sustainable senior transportation, and i'd like to emphasize how much the independent transportation network and itn america are a product of public/private collaboration. i came to senior transportation

through a personal experience in 1988. my 3-year-old son was run over by an 84-year-old driver. ryan survived and is today a healthy young man, but others are less fortunate. in 2011 alone, more than 5,000 older people were killed and 185,000 were injured in vehicle crashes. with support from aarp, the transit idea program, the federal transit administration, national highway traffic safety, the southern main agency on ageing, private philanthropy and the people of portland, maine, we created a social enterprise that uses efficient business practices to build transportation that will scale with the ageing population. we call our enterprise the independent transportation network or itn, and we built it as a reply kabl model with a goal to connect itns into one

national system. today itn america has 25 affiliates in 20 states. we've delivered 600,000 rides. we're serving more than 5,000 people. and we're growing at the rate of 100,000 rides a year. these numbers are small when you look at the ageing population with 10,000 boomers turning 65 every day. what's important about itn is that it does not depend on taxpayer dollars for sustainability. a new itn affiliate may use up to 50% public money to launch but after five to eight years it must be sustainable through reasonable fares and a diversified base of private, local support. from a policy perspective, it is easy to justify public resources for senior mobility. the classic justifications for policy intervention, public safety, and market failure are clearly present. but the problem of insufficient public resources is a fiscal

reality unlikely to change. itn affiliates are nonprofit membership organizations that use automobiles and a combination of paid and volunteer drivers to provide service 24 hours a day, seven days a week. the core business innovations are the personal transportation account and a flexible approach to resources managed through itn rides, enterprise software that connected itn affiliates across the country. the personal transportation account is a mobility portfolio that holds assets in many forms. older people may trade their cars they no longer drive to pay for rides. volunteer drivers may save transportation credits to plan for their own transportation future. volunteers in one itn community may send their credits to another itn to pay for rides for a loved one. merchants and health care providers may help to pay for rides through ride and shop and healthy miles programs.

the result is an average fare of about $11 with the most common fare $6, which might seem expensive, but with 30% to 40% of our members at an income of less than $25,000 a year, our last five years of customer satisfaction surveys tell us that itn members buy about ten to one feel the fare is inexpensive for the service they receive. there is dignity and independence in paying for o oneself. about 20% are for personal needs and shopping, about 8% to work or volunteer. almost 40% of volunteers save their credits for their own future needs. a similar amount donate their credits to the road scholarship fund for low-income seniors. to assure these innovative practices comply with public policy, itn america has worked with state and local policy

makers in many statings, including florida, maine, illinois, new york, kentucky, missouri, ohio, and tennessee. itn america has completed a 50-state inventory of policies that create incentives or remove barriers to the use of private resources. and with with the national conference of state legislatures, we're disseminating the results to 10,000 policymakers. our research database is designed to study mobility for seniors. with the centers for disease control, we're studying driving transition for seniors in 17 communities across the country, and we've just completed six years of research to expand itn to rural communities through itn everywhere, a suite of software programs that brings together ride share, car share, volunteer transport and community transport. itn everywhere is to community mobility what ebay is to flea

markets. senator nelson, senator collins, public resources may be scarce, but through the use of information technology and policies that remove barriers to the voluntary use of private resources, the future for community mobility is bright and exciting. >> ms. freund, do we get any credit, susan and i, for having this hearing that we could then transfer on? >> or bank for when we need them. >> senator nelson, you may have all of my credits. >> thank you very much for your testimony. senator nelson, would you like to go first on questions? thank you. first of all, katherine, i'm very glad you talked about the personal experience that stimulated your getting involved because so many people would have reacted to that terrible

accident with anger. instead, you looked at the problem of the 84-year-old driver who clearly should not have been driving and came up with a solution. i think that's just so commendable, and i wanted you to share that and i appreciate that you did. i'm going to start with you, ms. mcmillan. in 2006, so seven years ago, i sponsored legislation that became part of the older americans act that created a five-year demonstration project to be overseen by the administration on ageing to establish a national nonprofit senior transportation network to help provide some transportation alternatives to our ageing population. i am sad to report that the administration on ageing really

has done nothing with the program that i created. so my question to you is, will we have better success if we transfer this program to do this pilot project from the administration on ageing to the department of transportation? there seems to be more interest at d.o.t. in the program, oddly enough, than at the administration on ageing. >> thank you, senator, for that question. i guess the first thing i would say is that one of the important concepts that i think all of us on the panel have stressed is that dealing with the challenge of transportation for seniors really involves work on a number of levels, and there's -- we need to be careful about siloing any of us to hold, you know, that we have full jurisdiction

over this issue. it's going to be extremely important that the federal agencies continue to work together. i mentioned the coordinating council on access and mobility and the whole point of setting that up was to make sure that all of the federal agencies could bring our resources and talents to deliver the program. so while there may be a lead administrating agency, and certainly we could look at that, i think the important point is we all need to continue working together to make sure that we're addressing these very complex issues on various levels. i think that's been one of the major factors that's made programs, for example, the national center for senior transportation, successful is this recognition that we need coordination on a number of different levels. so we'd be happy to, you know, work with your staff and talk about next steps further, definitely. >> although, the gao has been quite critical on the lack of

coordination. i guess i'm going to ask you, and i don't mean to put you on the spot, but since the administration on ageing has yet to provide funding for this program, which has existed for a long time now, i'm going to ask, were you aware of this program? >> i personally was not, but i don't want to claim that folks in my department weren't. >> fair enough. ms. freund, you talked about how you've been able to transform this program into one that relies on donations, on people who participate paying their way. i think it's important, and i'm not trying to take credit for this, but for us to note that there was some federal funding in the beginning that served as

a catalyst. would it have been -- and then you were able to transform it into a self-sustaining program, which is ideally what we always want to see when we're successful in securing some federal funding. do you think you could have gotten off the ground without having that initial federal funding as a catalyst for your program? would it have been harder to get it off the ground? >> yes, it would have been much, much, much harder to get it off the ground. the federal funding came from a number of different places. the fta funds a transit idea program, which sponsored some of the initial research. and it was, in fact, the transit idea program that directed us to look at technology to create efficiency. then in addition to that, the fta funded it, i think, three or four different times.

first to test some of the ideas. then to deploy some of the ideas. there was a grant to develop itn as a sustainable model. then there was a grant to plan the national rollout. so the government -- i mean, it really has been a public/private partnership. i think one of the difficulties, though, is there's a tendency to think if federal money goes in that it stays in. >> exactly. >> this is almost venture philanthropy or venture funding on the part of the fta to create an incentive for private resources and then to be willing to step away and let the private sector do it. >> and to me, that's what's so impressive in your program as you did have some federal funding initially, but you used it to establish the program and you're not dependent on the federal funding today and other communities have been able to replicate that. let me ask you, dr. baldwin, and

you ms. dice, the same question. that is, if the federal government could do one thing to help address the transportation needs of our seniors, what would it be? ms. dice, we'll start with you. >> i think i may have already answered that in my testimony because i believe that encouraging coordination and recognizing that creating a new program in the community is a very important thing 37 it can make a difference in some people's lives. but pulling together all the transportation resources and all of the players, including older adults and caregivers and advocates to look at the whole system, identify where there are gaps and identify the best way to fill those gaps so that the whole community benefits. i think that benefits older adults. i think that benefits everyone. >> thank you. dr. baldwin? >> sure. thank you for the question.

i'm not sure i can identify one specific thing, but one thing i did want to highlight is in my view, there are sort of three, sort of goals or touch points that we have to be sensitive to that i think many of us have talked about. the first is making older drivers safer and understanding and managing the transition between driving and nondriving. the second is making sure that older adults who are in a nondriving mode -- and it's my understanding that most of us will live six to ten years after we finish driving, that there are transportation options available to those older adults. i think some of the innovative solutions have been identified today. and lastly, i spoke in my testimony a little bit about the built environment, the community level solutions that help all of us from a design perspective. i think there are touch points in each of those sort of major issues that need attention over time. >> thank you. mr. chairman? >> you may be surprised to know

that in my state there are 325,000 drivers over the age of 85. now, of course, i know plenty of 85-year-olds that are quite capable of driving, but it underscores as the population ages more and more why this is an important topic. and you all have testified as to a number of ways to go about this coordination. for example, in florida there's a coalition, as i mentioned, of 20 organizations, agencies, and universities that try to improve the transportation for seniors.

for example, one of them is called find a ride, developed by the university of florida. and the senior goes and identifies the type of visit they need to make, such as it's a medical visit. they need help because they're disabled, where they need the ride. and then it is presented with various -- the senior is presented with various public and private options. so why don't you all share with susan and me something of other kind of innovative efforts other than what you've testified that might stimulate our thinking. >> i'd like to suggest a couple

of things. one is that a couple of years ago the ncst provided some support to researchers in missouri. he developed along with his colleague a tool called the assessment of readiness for mobility transition. it's a tool that can be used to have a conversation with older adults to help them identify how ready they are to transition, how it important driving is to their sense of self and independence. that way, interventions can be designed to help people become more ready and be prepared for driving transition. because i believe that unfortunately, so many people are faced with transition as a threat. they have had a fender bender or

a much more serious situation. or family members hide the keys from them. i think we really need to start having these conversations earlier. the a.r.m. tool is one instrument to help that happen. >> senator, one of the basic requirements for making a number of the initiatives we've outlined here is you need to really start with good planning and planning that is focused at the community that needs to coordinate the services. i think the example just outlined in florida is exactly the type of model we need to make work on a much more consistent basis throughout the country. under current rules to access the major funding source for enhanced services for seniors and disabled -- persons with

disabilities, we require that coordinated -- it's got a long name -- coordinated public transit and human services plan. but the point there is that we require that senior members and persons with disabilities must participate in the development of that plan so the users are helping to design the system. and it might seem a simple thing but it's incredibly important that when you're designing services that the people who are going to use them are involved very early. what we would like to see is not only that the standard for the transportation planning but as dr. baldwin pointed out, we need to have planning on such things as housing and medical care and the other elements. so having that type of coordinated planning effort in those sectors as well to link with what is happening at transportation could just make it much clearer in terms of what are the services and activities people need to access and then

connect that with how you get there, which is the transportation into things. >> yes, ma'am? >> i think that coordination is very, very important, but there are some important numbers to remember. public transportation for people over 65 accounts for between 2% and 3% of the trips they take. since most of the resources for transportation by a ratio of five to one are private. i think that a major part of the solution is when you engage the community, don't just engage the demand side of the problem, which is the consumers. it's a supply side business problem. there's not enough resources to address this. so bring the business community to the table, bring corporate america to the table.

i think a huge thing that could happen perhaps as a result of these hearings or other federal action, would be to awaken the american people to the social need that we' are looking for ad encourage everybody to look around them and give an older person a ride. i think the solution is sitting in driveways from coast to coast. if people will just open their eyes and see -- and i think people are really willing to help each other. but we just don't have a culture of looking around and realizing that older people have this need. so i mean -- and that's right there. that doesn't cost any public money at all. >> is it in your experience that a senior will limit their mobility because they don't want to be a burden on their family members? >> absolutely. absolutely. i mean, i must have heard an