the entire civilized world to join the united states and european allies and everyone join us in condemning this outrageous act. events like this tragedy have no place in the modern world, and this unassailable fact needs to be acknowledged globally, and more than once. repeatedly until it becomes so loud that putin and russians can hear it in moscow and in the kremlin and see that what is taking place here is the direct result of their engagement in eastern ukraine. secondly, i think we need to demand complete cooperation with the ongoing investigation. positive steps are beginning to take place far too late but at least they're starting to take place. our commitment to the rule of law, rules of evidence and the demands of justice require that

we go through this investigative process and we must insist on the access to do so. we must demand full, immediate, unhindered access to the site of the tragedy, including all parts of the aircraft, missile battery and site evidence and, most of all, proper treatment of the remains of the many victims. president putin by himself can ensure that success and that access and he absolutely must be required to do so. third, we need to demand an immediate russian standdown in the ukraine. crimes like malaysia air flight 17 can only happen in such a lawless wasteland of renegades and desperado with their fingers on the triggers of the most advanced weapons. lawless reigns in ukraine because the government of that nation does not yet have control

over its sovereign territory. the situation is greatly exacerbated as a result of president putin's outrageous territorial aggression that has already severed an arm of ukraine and threatens the entire country's disintegration. make no mistake, the russian separatists in eastern ukraine have been organized, motivated, trained, equipped, unleashed, guided and controlled by the forces of the russian federation who are controlled themselves with totalitarian execution by none other than vez slood mere t vladimir putin. now we see a new tragic result of this aggression and sponsorship of ruthless renegades, a blatant act of terrorism inflicted on innocent people. this problem will only get worse unless we demand -- demand -- that russian behavior change and putin's aggression stop. it needs to be a voice that

resounds from every nation -- civilized nation in the world. the only solution to the ukraine problem is the consistent -- is doing what is consistent with international law. the demands of order and civility and the requirements of justice is what russia must acknowledge and that the government of ukraine must have sovereign control over its own territory. number four, the u.s. and europe must at last act vigorously and in unison if we are to succeed in this effort. until now, president obama has sent largely weak signals to putin about the seriousness of russia's actions and our european partners have been reluctant to act, some hypnotized by anxiety about their economic dependency on

russian oil and gas. let us hope that after this horrific act of terror against 298 innocent passengers on malaysia air flight 17 that this view is changing and changing quickly. history will see this event as a watershed moment. some argue that the soviet downing of korean flight 007 in 1983 was an event that exposed the true nature of the soviet regime and hastened its decay. similarly, malaysia air flight 17 reveals to any remaining doubters the nature of putin and his brutal ambitions and ruthlessness. with illusions stripped away and the inadequacy of half measures revealed, we must now act and act together. we can respond to this tragedy by forming and forging a new unity. but only the most robust and

concerted actions to impose economic sanctions on russia has a chance to change putin's behavior and end russian support for the separatist militants. and to be effective here, we and the europeans must do this together, imposing these costs. we need to target the fragile, dependent russian economy through sanctions on russia's energy sector and state-backed arms exporter. and while it may take time for russia to feel the effects of sanctions on the energy sector, we can take action today that would have an immediate effect. i have previously introduced legislation that prohibits all government contracts with putin's arms dealers. taking steps to meaningfully obstruct this agency's work and the revenue it provides the russian state is among the most effective ways we can condemn putin's aggression. through these specific sanctions, we can demand that putin end his support for the separatists and accept and work

toward a stable ukraine. if not, i suggest we do whatever is necessary to bring russia's economy to its knees. we need to see that stock market plummet. we need to see confidence and support for anything russia makes or exports denied by the civilized nations of the world. we need to put measures there to prevent their shipment of arms, manufacture and shipment of arms to people like assad in syria, to the iranians, to those that are to the -- groups that are creating havoc around the world. russia's arms exports are a major source of their revenue and we need to stop them. the decision's in their hands. following this horrific, brutal, tragic event. they have the responsibility to the world's nations to step up

and address this issue. this crisis has reached a point of high tension, great tragedy and escalating consequences. these potential consequences are dangerous for all of us but most of all they're dangerous for putin's russia. russia's president holds in his hands the ability to de-escalate this crisis or to pay a very steep price. we need to define and implement that steep price if he doesn't take this action. it is putin's choice to bring this situation back from the brink. it is our obligation, along with our european partners, to make putin's choice crystal clear. madam president, with that, i yield the floor. mr. inhofe: madam president? the presiding officer: the senator from oklahoma. mr. inhofe: what is the general order right now?

the presiding officer: the time between now and 12:30 is equally divided and the republicans control five minutes. mr. inhofe: i ask unanimous consent i be recognized for five minutes. the presiding officer: without objection. mr. inhofe: let's say for eight minutes. the presiding officer: without objection. mr. inhofe: than inhofe all: al. thank you very much. madam president, later this week we're going to have the e.p.a. administrator come to our environment and public works committee to testify about the greenhouse gas rule being developed for existing fleets of power plants. now, we know what the rule is for the new power plants. this is for the existing. in light of that, it's important to point out that the senate has been debating global warming for well over a decade, actually around 14 years now. the first cap and trade bill the senate debated was when republicans were in the majority. i was chairman at that time, madam president, of the environment and public works committee.

it was the -- the first bill was the mccain-lieberman bill which would have set co2 limits on all facilities that emit at least 10,000 tons of greenhouse gases per year. now, that was defeated october the 30th, 2003, by a vote of 43-55. that was when i was all alone. actually at that time, everyone thought eventually something was going to pass and they're all afraid of the issue. now times have dramatically changed. now, since that time, we've had other bills that have come up. in 2005, we had the same bill by the same authors. it was defeated even at that time by a wider range. then in 2008, the lieberman-warner bill came up and it failed also. that was actually when the republicans had lost the majority. so even with the democrats as a majority, they were not able to get it through. most recently we debated the waxman-markey bill of 2009 which

seti missions to -- set emissions to facilities over 25,000 tons a year. now, that bill passed the house but was never brought up to the senate for a vote because they knew it would fail. each of these bills had one thing in common -- their cost wase norm outs. we found out -- cost was enormous. we found out some time ago that if we were to pass cap and trade, the cost would be in the area of $300 billion to $400 billion a year. now, i do calculations every time i hear a large number and i go back. in my state of oklahoma, we have -- i calculate the number of people, families that actually file a federal tax return and do the math. that would cost each family in oklahoma about $3,000 a year. now, we know that it doesn't make any difference because by the testimony of the administrator of the e.p.a., lisa jackson, who was appointed by this president, obama, she said, in response to my question on public record, that the -- even if we were to pass something here, it would not have the effect of reducing

co2 emissions worldwide because this isn't where the problem s. the problem's in china and other places. now, since that time -- and it's not me who's saying this -- it's "nature" magazine, the "economist," and even the ipcc. madam president, the ipcc is the united nations. they're the one who started all this stuff. and they even admit for the last 15 years there's been no increase in global temperatures. and meanwhile, the co2 emissions have increased a lot. so obviously it's not warming and that has gone back into a normal cycle. unfortunately this hasn't deterred the president from making global warming a key part of domestic policy. what he couldn't accomplish through legislation he's now doing through regulations at the e.p.a. but the american people don't want anything to do with this. the polls -- i can remember, madam president, when the polls were something like it was the number one or number two issue. the last gallup poll just this

past week had it number 14 out of 15 issues. peissues. pew research something, 15% of the people who believe in global warming don't believe humans cause human throw po human anth. remember i showed his picture and read the comments he's made. he's raising a hundred million dollars to put into campaigns. he's already put up $50 million and has been unable to raise anything close to the next $50 million. so people are not rallying to pour money into this lost cause. and the international community has started to give up too. last week australia -- i was with the secretary of defense of australia last night and he was one of them who is very strongly in opposition to the cap and trade that they adopted in australia and they have now as of a month ago, they have

repealed it. so if you look at other countries, not just australia but others who were believing this at one time, they are dropping off. so the australian people should thank their prime minister. it's my hope that we'll be able to protect the american people from this sceneless global warming -- senseless global warming policies in the united states. tomorrow we're actually going to have a committee hearing on this and the momentum has really -- has actually gone from the other side. with that, madam president, i yield the floor and suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

you quorum call:

mr. thune: madam president, i ask unanimous consent that the quorum call be dispensed with. the presiding officer: without objection. mr. thune: madam president, we're here on another day in the senate facing another political gimmick. that's the way things -- things seem to work in the democrat senate, and that's what's happening yet again this week. yesterday democrats introduced their latest designed-to-fail,

the bring jobs home act. it is a bill that they know is not going to pass. the reason i say the bill is only designed to fail is because it has already failed. it's been voted on here before in the previous congress. but that's not stopping the democrats. the bring jobs home act would supposedly encourage american companies to bring jobs back home to the united states and to discourage companies from sending jobs sending overseas. but the bill completely ignores the real problem and the reason american companies are sending jobs overseas: america's broken tax code and our sky-high tax rate on business. america is one of the highest corporate tax rates in the developed world. many companies simply can't afford to pay it and stay profitable. so if democrats were truly serious about solving the problem of american jobs going overseas, they'd be sitting down with republicans to hammer out reform of our tax code. we should be substantially

lowering overall tax rates to allow american businesses to keep jobs here at home while remaining competitive in the global marketplace. instead fed serious reform, however -- instead of serious reform, however, democrats have chosen to do nothing to address the real problem we're dealing with. democrats aren't bringing this up bill in the hopes of actually fixing problems. they're bringing it up in hopes of winning a few votes in the november election. this isn't a secret, madam president. when democrats first brought this bill up two years ago ahead of the 2012 election, reuters described it as an example of members of congress -- and i quote -- "offering up measures they know will not pass but can be used to fire up their respective supporters in the run-up to november's elections." end quote. that's from two years ago when this was brought up the last time. that, mr. president, has been democrats' preferred method of operating in the senate this yier.

-- this year. back in marks the democrats planned to spend the spring and summer on messaging votes timed -- and i quote -- "to quo inside with the -- to key inside with the campaign-style trips made by president obama. that's from "the new york times" earlier this year. democrats concede "the times" tinged, that making new laws is not really the point. rather, they're trying to force republicans to vote against them. that's again -- that's a vote from "the new york times" story from a few months back, that making new laws is not really the point. what we're talking about here, madam president, isn't fixing problems. it's just creating political opportunities. madam president, five and a half years of democrat policies have left american families hurting. unemployment, which the president's advisors predicted would fall in 2012, is still above 6% two years later. almost 10 million americans are unemployed. 3.1 million of them for six

months or longer. those numbers would be even worse if so many americans hadn't given up on finding work and dropped out of the labor force altogether. our current labor force participation rate is at lows we haven't seen literally since the 1970's during the presidency of jimmy carter. and in fact, madam president, if the labor participation rate were today what it was when the president took of course, the unemployment rate right now wouldn't be a little over 6%; it would be 10.2%. that's how many people have quit looking for work entirely. household income has plummeted bid more than $3,300 on the president's watch. at the same time, prices have risen. food prices have increased. the price of gas has nearly doubled. college costs continue to soar. and family health insurance premiums have skyrocketed by almost $3,000 despite the president's promise that they would fall.

and what do you get when you combine high prices, fewer opportunities for employment and advancement, and reduced income? you get a lot of struggling middle-class families. and i stead of spending this year taking up serious legislation to help those families, democrats, by their own admission, by their own admission have spent this year on political show votes that they hope will win them a few votes in the november election. madam president, last week the congressional budget office issued its yearly long-term budget outlook. the news on that front was grim. the congressional budget office reported that articlesly as 2039, under its business line scenario, the nation could see public debt reach 106% of g.d.p. which would be a level of debt seen only once before in our nation's history. by 2039, under an alternative fiscal scenario, the debt-to-g.d.p. ratio could rise to more than 180% of g.d.p. by comparison, greece's current

debt-to-g.d.p. ratio is 135%. our economy could go the way of greece's in just a few short years if nothing is done. we have to take up significant budget reform and reduce the size of government. look for ways that we can make government wo work more efficiently, more effectively, reform programs that need to be reformed, chipping away around the edges isn't going to get the job done. it's not going to cut it, madam president. even before the president came into office, our national debt presented a serious and pressing problem. but over the past five and a half years of the current administration, the problems get exponentially worse. if you look at our total debt, total debt which includes the public debt and intergovernmental debt, when president obama kaim came into office, our national debt was $10.6 transform that's the total debt. today just five and a half years later, our national total debt stands at $17.6 trillion.

that's a 66% increase on the president's watch. madam president, that's horrifying. and yet president obama and his party continue to act as if our country isn't hurtling toward a fiscal crisis. among the president's many fiscally irresponsible policies, obamacare stands out as one of the worst. douglas holtz-eakin has estimated that the president's health care law will increase the deficits by hundreds of billions of dollars in its first ten years alone and by more than $1 .5 trillion over the next ten. political reports that the congressional budget office attributes the coming growth of the debt to, among other things, "rising health care costs" and the expansion of subsidies offered through obamacare." end quote. so much for the president's claim that the health care law would be, and i quote, "the largest deficit-reduction plan in over a decade."

but that's par for the course for the affordable care act. the president also promised that the law would reduce americans' health insurance premiums by $2,500. instead, as i mentioned, they've already risen by almost $3,000 and they're still going up. i'd like to just read a few headlines from this past week. this is from kaiser health news yesterday. and i quote, "florida's biggest health insurance signals rate hikes ahead." from the nebraska radio network yesterday, "nebraskans' premiums may bounce 30% under obamacare." from the nashville business journal last wednesday, "here come higher premiums. tennessee's insurance providers request rate increases." from the associated press last tuesday, "delawareans could face higher rates under the affordable care act."

from the new orleans "times-picayune," "some insurance carriers looking for double-digit increases for affordable care act policies." madam president, that's just a sample of some of the headlines from newspapers around this country just this last week. i could go on about the health care law's broken promises. i could also talk about the fact that the president promised americans would be able to keep their doctors and hospitals but americans are now finding that the new health plans exclude doctors and hospitals that they have been using literally for years. or the fact that the health care bill was supposed to give more americans access to health care, but that many americans are struggling to find doctors who will take their obamacare insurance. one doctor reporting on her patients' experience with the obamacare plan said -- and i quote -- "we're running into problems with coverage in the same way we were when they were

uninsured." end quote. let me repeat that, madam president. this is from a doctor talking about one of her patient's experience with an obamacare plan. "we're running into problems with coverage in the same way we were when they were uninsured." if that doesn't sum up the law's failure, i don't know what does. then there was the president's promise that shopping for health care on the exchanges would be like buying a tv on amazon or a plane ticket on kayak as americans quickly found out and are still finding outing almost ten months later shopping on the exchange is more like a nightmarish experience with the d.m.v. obamacare is failing americans and so is the obama economy. and instead of focusing on making things better, democrats are focused on trying to get reelected in november. republicans have solutions to challenges facing the american people, solutions like approving the keystone pipeline and the

tens of thousands of jobs that it would support. repealing the obamacare 30-hour workweek provision which is slashing employees' hours and wages. stopping the job-killing national energy tax which will eliminate hundreds of thousands of jobs and drive up americans' energy bills. enacting trade promotion authority to open new markets to american farmers, workers, and businesses. repealing the medical device tax which is costing american jobs. and passing real health care reform, the kind that will lower costs, increase choice, and put americans back in charge of their health care. if democrats were serious about helping american families, they would be working with us on these priorities instead of tying up the senate with partisan legislation. and they would be taking up the 40 house-passed jobs bills

currently gathering dust on the majority leader's desk. madam president, every day the senate spends on designed to fail bills, designed to fail legislation, things that we know aren't going anywhere, is a day the senate is not spending on bills to provide real relief to the american people. it is high time, madam president, for democrats to stop wasting time on partisan legislation and start working with republicans on real reform. middle-class, middle-income families around this country have been squeezed for long enough. the american people have been waiting long enough. there are 40 house-passed jobs bills waiting for action here in the united states senate, and instead we're spending week after week after week of the senate's time voting on bills that are designed to fail, that are designed to do nothing more than score political points

heading into an election. that is wrong on so many levels, madam president, but most of all it's wrong for the american people. it has to change. madam president, i yield the floor. a senator: madam president? the presiding officer: the senator from new mexico. a senator: i have nine unanimous consent requests for committees to meet during today's session of the senate. i ask unanimous consent that these requests be agreed to and these requests be printed in the record. the presiding officer: without objection. under the previous order, the senate stands in recess until senate stands in recess until

>> the director of the centers for disease control, tom frieden, dr. tom frieden is speaking at the press club today on the reported mishandling of anthrax by cd -- cdc staff. live coverage from the press club at 1 p.m. here on c-span2. later today on c-span3 we will be bringing you the hearing on the president's veterans nomination, former procter & gamble ceo were robert donald nominee by the president to head up the veterans affairs department. he will be before the senate committee with a confirmation hearing coming up at 3 p.m. eastern. we will have that live on c-span3. also today in washington a federal appeals court has delivered a serious setback to president obama's health care law. the ap writes potentially derailing subsidy from the low and middle income people who have bought policies, and a

right also a three-judge panel in washington ruled that the law as written only allows insurance subsidies and states that set up their own exchanges. that invalidated an irs regulation that allowed subsidies in all 50 states. >> coming up next on c-span2, david cameron, british prime minister on the situation of the downing of the malaysian jetliner in ukraine, and also the conflict in israel, the israelis and the palestinians. he has also responded to by the labour leader in the uk. >> order. statement, prime minister. >> thank you, mr. speaker.

mr. speaker, this is the first time the house is met since the tragic loss of malaysian airlines flight in its 17 last thursday, and i think it's right to make a statement about this and the ongoing crisis initial and gaza. mr. speaker, flight in late 17 was traveling from amsterdam to follow the poor when it was shot down by a surface-to-air missile over eastern ukraine. all 298 people on board were killed. that includes 10 of our own citizens, as many as 80 children, and victims from nine other countries, including 193 dutch citizens. it also includes members of an australian family who lost relatives on malaysia airlines flight mh370 earlier this year. from adelaide to amsterdam, from kuala lumpur to newcastle, we are seeing heart-wrenching scenes of grief as communities come together to remember their loved ones. i am sure that the whole house will join me in sending our deepest condolences to the friends and families of everyone

affected. >> here, here. >> mr. speaker, alongside sympathy for the victims, there is also anger. there is anger that this could happen at all. there is anger that the murder of innocent men, women and children has been compounded by sickening reports of looting of victims' possessions and interference with the evidence, and there is rightly anger that a conflict that could have been curtailed by moscow has instead been fomented by moscow. that has to change now. in the past few days, i have spoken to presidents obama and hollande, chancellor merkel, and the prime ministers of the netherlands, malaysia, poland and australia. we are all agreed on what must happen. first, those with influence on the separatists must ensure that they allow the bodies of the victims to be repatriated and provide uninhibited access to the crash site to enable a proper international investigation of what happened to flight mh17.

secondly, president putin must use his influence to end the conflict in ukraine by halting supplies and training for the separatists. thirdly, we must establish proper long-term relationships between ukraine and russia, between ukraine and the european union. and, above all, between russia and the european union, nato and the wider west. let me take each of those points in turn. the first priority remains ensuring that there is proper access to the crash site to repatriate the bodies and investigate what happened. the uk has sent air accident investigators and a police-led victim identification team to help the international effort. the ukrainian ministry of emergency situations has searched an area of 32 square kilometers around the crash site and recovered 272 bodies. the work has been made more difficult by the presence of armed separatists. the bodies sitting on a refrigerated train have still not been allowed to leave. the pictures of victims' personal belongings being gone through are a further sickening

violation of the tragic scene. it is welcome that international experts have been able to visit the site, but this should not have taken four days, and even now they are still not getting the unimpeded access that they need. i spoke to president putin last night and made it clear that there can be no more bluster or obfuscation. we expect him to help right now by using his influence with the pro-russian separatists to secure full access for international investigators, and to support the repatriation of the bodies by handing them over to the appropriate authorities and ensuring that they are treated with dignity. families want information and answers, and we must make sure that they get them. the uk and australia have tabled a joint resolution at the united nations security council demanding proper access in support of a credible international investigation, and we expect that resolution to be voted on this evening. secondly, i also made it clear to president putin that we expect russia to end its support for the separatists and their attempts to further destabilize ukraine.

no one is saying that president putin intended flight mh17 to be shot down, it is unlikely that even the separatists wanted this to happen, but we should be absolutely clear about what caused this terrible tragedy to happen. the context for this tragedy is russia's attempt to destabilize a sovereign state, violate its territorial integrity, and arm and train thuggish militias. over the past month there has been an increasing amount of heavy weaponry crossing the border from russia to separatist fighters in ukraine, and there is evidence that russia has been providing training to separatist fighters at a facility in south-west russia, including training on air defense systems. seconds before flight mh17 dropped out of contact, a surface-to-air missile launch was detected from a separatist-controlled area in south-eastern ukraine. according to expert analysis, an sa-11 is the most likely missile type.

in an intercepted conversation, a known separatist leader was overheard claiming that a separatist faction had downed an aircraft. another separatist leader claimed on twitter at about the same time to have shot down an aircraft, while a video on social media over the weekend showed an sa-11 missile system, missing at least one missile, travelling back towards russia. those who argue that the ukrainians could be responsible need to explain all of this. in addition, there is no evidence that ukrainian forces have fired a single surface-to-air missile during the conflict, and no ukrainian air defense systems appear to have been within range of the crash. by contrast, pro-russian separatist fighters have downed more than a dozen ukrainian aircraft over the past few months, including two transport aircraft, so the picture is becoming clearer and the weight of evidence is pointing in one direction. mh17 was shot down by an sa-11 missile fired by separatists. thirdly, this is a defining moment for russia.

the world is watching, and president putin faces a clear choice in how he decides to respond to this appalling tragedy. i hope that he will use this moment to find a path out of this festering and dangerous crisis by ending russia's support for the separatists, but if he does not change his approach to ukraine in that way, europe and the west must fundamentally change our approach to russia. >> here, here. >> those of us in europe should not need to be reminded of the consequences of turning a blind eye when they countries only smaller countries. we should not shrink from standing up for the principles that govern conduct between independent nations in europe, and that ultimately keep the peace on our continent. for too long there has been a reluctance on the part of too many european countries to face up to the implications of what is happening in eastern ukraine. it is time to make our power, influence and resources felt. over the weekend i agreed with chancellor merkel and president hollande that we should push our partners in the european union to consider a new range of

hard-hitting economic sanctions against russia. we should take the first step at the foreign ministers meeting in brussels tomorrow, and if russia does not change course, then we must be clear that europe must keep increasing the pressure. russia cannot expect to continue enjoying access to european markets, european capital and european knowledge and technical expertise while she fuels conflict in one of europe's neighbors. we must do what is necessary to stand up to russia and put an end to the conflict in ukraine before any more innocent lives are lost. let me now turn to the ongoing crisis in israel and gaza. the crisis was triggered by hamas raining hundreds of rockets on israeli cities, indiscriminately targeting civilians in contravention of all humanitarian law and norms. in the last fortnight, hamas has fired 1,850 rockets at israeli cities. this unprecedented barrage continues to this moment, with hamas rejecting all proposals for a ceasefire, including those put forward by the egyptian

government. i have been clear throughout this crisis that israel has the right to defend itself. those criticizing israel's response must ask themselves how they would expect their own government to react if hundreds of rockets were raining down on british cities today. but i share the grave concern of many in the international community about the heavy toll of civilian casualties. the figures are very disturbing. more than 500 people have now reportedly been killed in gaza, and over 3,000 injured. the u.n. estimates that over 83,000 people have been displaced so far. israel has also faced loss of life, with 18 soldiers and two a civilians killed, including 13 soldiers yesterday alone. i spoke to prime minister netanyahu again about this crisis last night. i repeated our recognition of israel's right to take proportionate action to defend itself, and our condemnation of hamas's refusal to end its rocket attacks, despite all international efforts to broker a ceasefire. but i urged him do everything to avoid civilian casualties, to

exercise restraint, and to help find ways to bring this situation to an end. prime minister netanyahu made it clear that israel had been ready to accept each of these ceasefire proposals and had unilaterally implemented a temporary ceasefire in the hope that hamas would follow suit. my right honorable friend the foreign secretary has spoken to president abbas to welcome his support for a ceasefire and underline our wish to see the palestinian authority back in gaza. the united nations security council met in a special session last night and issued a call for an immediate ceasefire. the council expressed serious concern about rising casualties, and called for respect for international humanitarian law and the protection of civilians. we strongly endorse that call. it is vital that hamas recognizes the need to enter into serious negotiations to end this crisis. in particular, we urge hamas to engage with the ceasefire proposals put forward by the egyptian government. it is only by securing a ceasefire that the space can be created to address the underlying issues and return to

the long and painstaking task of building the lasting and secure peace that we all want to see, and i commend this statement to the house. >> harriet harman. >> here, here. >> i thank the prime minister for his statement and advance sight of it. the shooting death of inmate 17 over the skies of ukraine was a tragedy which shocked the world. on the half of the leader of the opposition who is visiting washington, can i join the prime minister in expressing our heartfelt and deepest sympathy to the relatives of those who lost their lives. all of us have been outraged by the images of the site, the site left open for anyone to trample over. the way the bodies of the deceased have been handled with what looks like casual indifference. we have all been horrified, what must he be like for the families of the deceased to see this? the families not only face grief

and loss, but multiple practical issues. will be identified a senior minister to coordinate support for them? this role was performed by the right honorable member after 9/11, 77, and after the tsunami. will he ensure that his government does everything it can to enable the international community to help secure the site, repatriate the bodies, gather the evidence which shows who is responsible? does he agree that as soon as the investigation into this disaster is complete, there should be an emergency meeting of european heads of government to consider what further steps should be taken? it appears that international civil aviation regulators imposed no restriction on crossing that part of eastern ukraine. in light of the attack on flight inmate 17, can he say whether their specific travel advice now

to british citizens planning to go abroad? as he set out in his statement, the evidence is growing that this was not simply a tragedy but a terrible crime. surely this is a moment of reckoning for europe. this is the moment for strong and determined eu to step up to its responsibilities and confront the russian action. europe must show its sorrow but it must also show its strength. i welcome the prime minister's commitment to seek a company of the eu sanctions against russia at tomorrow's eu council meeting. can he tell us what measures he wants to see considered? will be support decisive steps to extend sanctions not just against specific individuals but also sanctions against russia commercial organizations him to dissuade president putin from the supply of arms and the sport of separatists that he is now providing across the russian border?

mr. speaker, turning to the whore which is unfolding in gaza, it is intolerable to see the harrowing images of hospitals overwhelmed more jabari's overflowing, and parents devastated as they cradled their dying children. yesterday, the world stood witness to the most bloodstained day. since the start of this conflict, 20 israelis have been killed, 18 of them soldiers. over 500 palestinians have been killed, including countless children. mr. speaker, innocent young children, their short lives ended in the most brutal and horrific of circumstances. you can't reduce this conflict to a lecture of casualties, but we must acknowledge the scale of suffering in gaza, because the life of a palestinian child is worth every bit as much as the life of an israeli child. >> here, here. >> and every death of a

palestinian child will fuel the hatred, emboldened israel's enemies and recruit more supporters to terrorist groups like hamas. we stand up for israel's right to defend itself, but this escalation will not bring israel lasting security. does he agree with the secretary-general of the u.n. ban ki-moon that we must continue to press for an immediate cease-fire, for an immediate end to the israeli military operation has to come to an end of the rocket fire by hamas, that all sides must respect international humanitarian law, and that israel must exercise maximum restraint? what is his review of the report suggesting that israel is using flash shells? does he agree that the only way to avoid the cycle of violence and perpetual insecurity in the region is to address the root causes of the conflict and that

there must be an immediate return to the negotiating table and talk for a two-state solution? in the worst of ban ki-moon, israelis but also palestinians need to feel a sense of security. palestinians but also israelis need to say a horizon of hope. >> here, here. >> prime minister. >> can i thank the right honorable lady for her response and also for her condolences for those of lost loved ones. i think she is right to say that this is a deeply human tragedy, what has happened over the skies of ukraine. and that is how we should see it first and foremost. our thoughts should be with the victims, their families and the need to get those bodies out of that site and found that site properly dealt with. that is the first priority that we should be focused on. she asked a number of specific questions and make some specific points. in terms of the consular work that is being done that is being led by the honorable member for

boston and its goodness, in the foreign office, and he's dealing with that. i would also want to discuss very directly with the victims of families in time how best we can take care of all their needs and concerns. she raises a question of whether there should be and eu heads of state, heads of government european council emergency meeting. i certainly don't rule that out but in the first instance i think what we should do is task of foreign ministers were meeting on tuesday night to set up a tough measures that are necessary to show that europe is heading on a different path. then she asked about the advice to uk citizens about travel. of course, euro control is the organization that sets the parameters for where airplanes can and cannot fly and where as we give advice to the individual countries that people should and should not travel to and that information is readily updated on the foreign office website.

she's right to say this is a moment of reckoning for europe, and i very much hope that the european council will not be found wanting boucher specifically what other steps that should be taken. she knows we have a tear to sanctions, some of which a party been put in place but there's more that can be done. naming individuals, increasing the number of asset freezes and travel bans. i was suggesting that the european council last week when we met that they should be broadened to include the cronies and oligarchs around president putin and other leaders, even if there isn't a direct link between them and the crimea and ukraine. i made some progress on that in wednesday night. i hope to make more progress but i think it is time to start go into the tier three sanctions, which we discuss. so for instance, future military sales i don't think should be going head from any country in europe. we've already started those from britain. there are a number of other suggestions that were made about airlines and banks, particularly connected with the crimea that haven't yet been acted on.

so there's a whole set of things that need to be put in train with a very clear message. on gaza, i think she is right that we cannot look at this in terms of a ledger of casualties. but again this is a deeply human tragedy. and anyone seen those pictures in gaza, picture of the children running across the beach before their young lives are snuffed out, as a father of three you can't help but be incredibly moved by that. it is heartbreaking what is happening in gaza. i think we have to be absolutely clear the about how this could most quickly be brought to an end. and visit is for hamas to stop the rocket attacks on israel which if they stop those, but all the other things that we need, the end of the israeli operation, and the cease-fire would all be in place. again, i agree with her about the root causes. we need to make progress with a two-state solution. that is not going to happen while we don't have a cease-fire and while hamas is objecting israel to rocket attacks. that is the root cause of this and that needs to be change and change quickly in order to bring

-- in order to bring piece to the middle east. >> the u.s. senate is in the usual tuesday break. their weekly party caucus meetings and they will be back at 2:15 to hold a confirmation vote on judicial nominations that they advanced earlier. nominations to circuit courts in california, florida and louisiana. live coverage of the send on c-span2 when they return. in about five minutes we're going to take you to the national press club and director of the centers for disease control, dr. tom frieden, is the featured speaker. you will talk about the recently reported mishandling of anthrax by cdc staff. he will take questions from press club reporters. our coverage starts at 1 p.m. eastern on c-span2. later today live on c-span3, former procter & gamble ceo robert mcdowell, president obama's nominee to head up the veterans affairs department would be before the senate veterans' affairs committee for his confirmation hearing. you can join the conversation,

participate on facebook, facebook.com/cspan combat post comments on twitter as well, #cspanchat. tv coverage at three on c-span3. >> this weekend on booktv's afterwords. i thought it would be compelling to tell the story of a white family and a black family with the same name who come from the same place and followed them from slavery through the civil war, reconstruction, jim crow, the civil rights movement up until today. and compare and contrast. >> chris tomlinson on his families slaveowning history and how the legacy of slavery still affects america american societe talked with of our tunnels and, the brother of former nfl running back ladanian tomlinson about their families lineage as former slaves from the hill. saturday night at 10 eastern on c-span2's "after words."

>> c-span2 providing live coverage of the u.s. senate floor proceedings and key public policy fans. and every weekend booktv, now for 15 years the only television network devoted to nonfiction books and authors. c-span2 created by the cable tv industry and brought to you as a public service by your local cable or satellite provider. watch us in hd, like us on facebook and follow us on twitter. >> the health care law has been very much in the news today with a couple of rulings. the political writing about the appeals court upholding the obamacare tax subsidies in both state and federal tax exchanges. just hours after a separate court dealt a major blow to the health law by striking down the subsidies for millions of americans in a federal healthcare.gov exchange. political rights the fourth circuit court of appeals in richmond said today the irs enacted -- acted correctly to go

to a federal and state run exchanges. it was a unanimous ruling by the three-judge panel. earlier a three-judge panel of the d.c. circuit court of appeals ruled 2-1 the exact opposite in a similar case, and from the white house earlier today, they said the spokesman for the president of the ministry she says health care subsidies will keep flowing despite the court decision to some reaction from john bennett, the house speaker issuing a statement a bit earlier today saying today's ruling is further proof that president obama's health care law is completely unworkable. another piece of news out of washington from the federal aviation administration. ..

>> former international bureau chif with the associated press and the 107th president of the national press club. the national press club is the world's leading professional organization for journalists committed to our profession's future through our programming with events such as this while fostering a free press worldwide. for more information about the national press club, please visit our web site at press.org. on behalf of our members

worldwide, i'd like to welcome our speaker and those of you attending today's event. our head table includes guests of our speaker as well as working journalists who are club members, and so if you hear applause in our audience, i note that members of the general public are attending, so it's not necessarily evidence of a lack of journalistic objectivity. [laughter] i'd also like to welcome our c-span and public radio audiences. you can follow the action on twitter using the hashtag nbclunch. after our guest's -- npclunch. now it's time to introduce our head table guests and ask each of you to stand briefly as your name is announced. from the audience's right, charles snyderman, md, ph.d., the washington bureau chief of audio video news; news editor of

fierce medical devices.com and fierce drug delivery.com. camille -- [inaudible] board member, world prevention alliance. ruth katz, director of the health, medicine and society program of the aspen institute and a member of the cdc foundation board. anna miller, associate editor, monitor on psychology magazine. christian john lillis, director of the peggy lillis memorial foundation and guest of dr. frieden's. donna lejeur, reporter for "usa today," vice chair of the national press club speakers' committee and former president of the national press club. skipping over our speaker, doris mar go lis, president of editorial associations, speakers' committee member who organized today's luncheon.

thank you, doris. susan heavey, correspondent for reuters. carolyn block, publisher and editor, federal telemedicine news. washington bureau chief of kyoto news. this time last week dr. tom frieden was busy cramming for his july 16th appearance before the house committee on energy and commerce. the director of the centers for disease control, dr. frieden had been summoned to washington to answer questions about the startling and potentially dangerous lab errors at the cdc. and while that topic is likely to come up again here today, dr. frieden joins us to explore a much bigger and broader issue looming worldwide health threats, including the alt

generals that -- pathogens that put modern medicine at risk. he will discuss what can be done about mers, a disease that has no known cure and has recently emigrated to our country. mers haunts the arabian peninsula and now is showing up through travelers to other destinations far away. the virus' recent arrival in the united states sent hundreds of cdc staff into emergency mode, and some now refer to this illness as public enemy number one. other key issues that dr. frieden will tackle this afternoon include the dramatic increase in the number of measles cases in america and the growing threat that dangerous new pathogens pose to world health. these diseases can hitchhike rides and criss-cross the globe in a day. he also will update us about the new program the cdc launched three weeks ago to combat

drug-resistant pathogens. some of these killer microbes jump from animals to humans, and a growing number of them are resistant to all currently-known drug treatments. dr. frieden has been director of the cdc since june 2009. a physician with training in internal medicine, infectious diseases, public health and epidemiology, he's especially well known for his expertise in tuberculosis control. from 1990 til 2002, dr. frieden worked for the cdc, starting as an epidemic intelligence service officer at the new york city health d.. fluent in -- health department. fluent in sir, he's a graduate of overlin college and received received -- both his master's degree from columbia university. dr. frieden has won many awards and honors and has published

more than 200 scientific articles. his talk today is titled "mers: public enemy number one?" that's with a question mark. dr. frieden last appeared at our podium last september. ladies and gentlemen, please join me in welcoming back to the national press club dr. tom frieden, director of the centers for disease control and prevention. [applause] >> thank you very much, it's great to be here, and thank you so much to the national press club, to president myron belkind and doris mar go lis for the invitation and arranging it, and thanks to all of you for your interest in health. what i'd like to do is talk to you about some of the biggest threats facing us today. some of you may have heard about problems at the cdc laboratory where we've had two safety lapses in recent months.

these lapses should never have happened. the cdc laboratories are some of the best scientifically in the world, and now we're taking rapid and decisive action to headache sure that they're -- to make sure that they're also some of the safest laboratories anywhere in the world. i'll be happy to talk about that later, but right now i want to talk a little bit more about some of the challenges that we face. sometimes at cdc problems like the one that has come to light recently occur because people are so used to working with danger. we're currently mounting a substantial response in west africa where three countries in that region are battling e bo la. -- e bow la. there have been more than a thousand cases and more than 600 depths from e bow la virus. i had been at the place called

python cave in uganda which is, as you might imagine, a cave with a very large python in it, about 15 feet large -- [laughter] and about 10,000 bats, and those bats, it turns out our researchers identified, have about a 5% infection rate with the marburg virus. marburg is just like ebola, but it hasn't had a movie made after it. [laughter] there were two infections a few years back, and our staff went in there to try to understand how the bats were moving around the region and what might be able to be done to control marburg there. and i asked them, weren't you scared to go into this cave that had 10,000 bat, lots of them with marburg, an often fatal virus, and this enormous python? they said the python didn't worry us and the bats didn't worry because we were wearing

those moon suits and the marburg didn't worry us. the cobras worried us. [laughter] and underneath their moon suits, they had to wear leather chants so that -- chaps so if they had a cobra strike, they wouldn't be killed by it. sometimes that kind of experience does make people too used to risk. and we have to always remember that above all, do no harm needs to be more than a motto. it needs to be an organizing principle for all of our work. now, like other health care workers, i have my personal experiences with risk. sometime back i was working in rural latin america on public health programs in communities, and i'm sorry to say this other lunch, but i won't go into details, communities that didn't have great sanitation. and i became extremely ill. it was in the brief period between medical school and starting internship and residency. and i had learned in medical

school what a ryger was, but if you have ever had it, it's a violent chill, so violent that the bed shakes. bacteria in your blood. and i became quite ill. i returned to the u.s. feeling a little bit better to start my internship, and i was tested and found to have an organism which is from poor sanitation. it had been in my bloodstream, and i was very ill with it. it's highly infectious. in fact, 10 or 20 organisms can infect another person, and just to give you a sense of scale, you can fit about a million organisms on the head of a pin. so when i went in for testing, the doctor said, well, you've got che get la, they did test for it, and it's resistant to every antibiotic known. i said, well, i have to to start my internship -- [laughter]

and the infectious disease attending said you need to go home. but we always want to be art of the solution. and in health, that can sometimes be part of the problem. so what -- now, a little footnote to that story, that episode of illness, it's self-limiting, so i did eventually get percent. not as quickly as i would woulde liked, but i did get better and recovered completely. about a year later the first -- [inaudible] came onto the market, and two years later i wrote an article published in the journal of the american medical association, jama, on the widespread use, and it took exactly two years to have a new, wonderful medicine that has an important role widely overused. so i have a quiz for you. what do these six organize to nhls all in -- organismings all have in common besides the fact they're all infectious diseases? mers, ebola, measles,

multidrug-resistant -- [inaudible] cre. any guesses for what these three -- what these six diseases all have in common, these six infectious diseases? yes. >> [inaudible] >> they are preventable, yes. they are all preventable. that's one thing they have in common. how about how they spread? is there something common? you've got ebola from maybe bats, mers maybe camels -- >> [inaudible] >> some are airborne be, some are not. yes. >> [inaudible] >> sow nottic? three-quarters of the new infections we face are sow nottic, so it's a good guess, but not all, no. any other guesses? all right. well, they're all very importantly spread in hospitals. we can be part of the problem if we're not careful.

all of them. and i'll talk a little bit more about that. now, when i went to medical school, they taught me to use some really fancy words. i know reporters never use fancy words, but, you know, we don't say we gave it to them in a hospital. we say it's nose comb y'all. that's much more polite, right? [laughter] and we also don't say the doctor made them sick. we say it's yacht progenerallic. so this is a nice, fancy 50-cent word that will avoid an uncomfortable truth. and then there's my most favorite of all, we know exactly the cause of his illness. it's idiopatrick. id owe patrick. that means we don't know what causes us. another definition is the patient is sick, and the doctor is an idiot. [laughter] now, mers is very concerning because, like sars which occurred a decade ago, it has a case fatality rate n. the case of mers, it may be as high as 30

percent. mers also could cause significant not only illness, but economic dislocation. sars cost the world more than $30 billion in just three or four months. we're learning more about mers, ask that quiz i gave -- and that quiz i gave earlier was actually the key lesson we've learned. as we've worked closely with the saudis, and we're now working very closely with them on a variety of investigations and control measures, we've found that the overwhelming majority of mers cases in recent months -- or in the past 6-12 months -- have been associated with hospitals. they've been spread in hospitals, patients, staff, visitors, others associated with hospitals. that's bad news and good news. bad news because it shouldn't have happened, and we should be arable to prevent it -- able to prevent it, but good news because we know how to protect health care workers and others through infection control measures. and we received, i received an

e-mail last week from the saudi minister of health to our staff who reported that in the past ten weeks they had not had a single case of mers in a health care worker now that they've implemented stringent infection control measures. when you know how something happens, you can stop it. there's still something we don't know. we don't have a cure, we don't have a vaccine. we don't know how it's jumped from animals to people. it does seem that camels have, perhaps, been infected by bats and perhaps have something like mers. whether it's direct contact with camels or camel products, we don't know, but we're undertaking studies to find that out. the more we understand something, the better we can prevent it. but the next pandemic is not likely to be mers unless it mutates to develop the capacity to spread easily from person to person. it may or may not be an avian influenza like that emerged in china a couple of years ago, and

that's a curl wonderful story of how we have global collaboration. we've already completed trials on a vaccine against this new avian influenza virus. but maybe the thing we are most at risk for is not the thing that we don't know, but something that's hide anything many plain sight. hiding in plain sight. something that could kill any of us. something that could undermine our ability to practice modern medicine. something that could devastate our economy and something that could sicken or kill millions. now, someone here in this room, christian lillis, knows about this problem. christian's mother, peggy, was a beloved kindergarten teacher. she went in for a routine root canal procedure. within a week she had sepsis, that's infection of the bloodstream from an infection that complicated antibiotic

treatment. and tragically, at the age of 56, she died. christian and others have carried the standard to make clear what is the human face behind the tragedies that we read about. because in public health we're at our best, as bill takegy has said, when we see and help others see the faces and the lives behind the numbers. i think of nile moss, a 15-year-old who loved music. had a congenital abnormality, malformation, not major, and went in for a routine checkup. two days later, had a resistant bacterial pneumonia and died easter weekend. i think of josh nim, a young man from colorado, 27 years old. loved sky skydiving. had an injury from skydiving, got infected, began to recover, then developed a

highly-resistant organism and also died at the age of 27. josh's mother, victoria -- as christian has -- has been an activist, an advocate for improving the way we address infections in this country. antibiotic resistance could affect any of us. in fact, two million americans get resistant infections each year. 23,000 americans die from infections each year resistant infections each year, and another 14,000 americans have deaths like christian's here from c-dif or contributed to by. i'm an infectious disease physician. i've treated patients for many infections, and i've also treated patients for whom there were no antibiotics left. i felt like a time traveler going back to an era before antibiotics. we talk about the pre-antibiotic era and the antibiotic era. if we're not careful, we will soon be in a post-antibiotic

era. and, in fact, for some patients and some pathogens, we're already there. antimicrobial resistance is a big problem, and it's getting worse. it costs us at least $20 billion a year in health care costs alone, and is it creates two -- and it creates two problems that are worthying of separately. one of the them are the usual thing we think of as infections, pneumonias, urinary tract infections, and we're seeing more and more resistance from those organize to nhls. but there's -- organisms. but there's a second problem that we may not think of naturally, and that is how important control of infections is to the practice of modern medicine. 600,000 americans a year get cancer chemotherapy. when we give cancer chemotherapy, we drive down all of the body's defenses so we can wipe out the harmful cancer

cells, and patients get fevers and serious infections, and we're able to keep them in check until the body's resistance comes back because we have antibiotics that work. so cancer chemotherapy may be at risk. we have more than 400,000 americans who are on dialysis. infections commonly complicate dialysis. if we lose the ability to treat those infections, it will make dialysis much more difficult to do. and modern treatments for everything from arthritis to asthma suppress the immune system because these are partly autoimmune diseases, and our ability to give these cutting edge treatments is at risk because of the spread of drug resistance. every day we delay means that it will be harder and more expensive to fix this problem tomorrow. bacteria are evolving very quickly. we need to move quickly to get ahead, catch up and to to

control it. it's possible to keep resistant bacteria from spreading. it's possible for some pathogens to actually reverse the level of drug resistance, but only if we act now and act decisively. what we've seen in some organisms like c-dif and cre, a highly resistant organism that can be highly lethal, is that they can start in the hospital and, in fact, our most resistant organisms start in the hospital. it used to be that almost all of our c-dif and all of our mrsa, another resistant organism, was in hospital. and now we've seen it go out into the community so that now the most common pathogen recovered from patients with cuts and wounds in the emergency room department is mrsa. but it's not too late. we know that in cre we're largely dealing with a hospital

infection. we can keep it in the hospital, and we can shrink the numbers and control it. if we don't, then common intexts like urinary tract infections may be very difficult to treat, and we may be, many of us -- where i've unfortunately been in that time machine -- looking at what a world was like before antibiotics. to stop drug resistance, we need fundamentally to do four things. first, we need better detection. second, better control. third, better prevention. and, fourth, more innovation. on detection we need realtime systems to find out what's happening around the country. in fact, this week cdc will be launching for the first time a system that will allow any hospital in the country to track electronically, automatically with no extra work after the initial uploading work all of the antibiotics dispensed this their hospital and all the antibiotic resistance patterns

of patients who have infections. that will allow doctors to be 'em oured with the right -- empowered with the right information at the right time to make the right decision so that they can give a patient antibiotics that are needed neither too broad, nor too narrow. so better detection is the first step in controlling drug-resistant organisms to allow us to improve prescribing practices, to identify outbreaks sooner, to figure out if our outbreak control measures are working. the second key step has to do with control. as with the quiz earlier, hutch of this -- much of in the is a -- [inaudible] problem, and we have to take seriously above all do no harm. too many infections are being spread in our hospitals. too many patients are coming in with one condition and leaving with an infection that they didn't come in with. but prevention requires work across many facilities. even the best of hospitals can't do it alone. they need to intersect with the nursing homes, with the

outpatient providers, with other facilities in their communities. and that can best be done with public health department cans serving a convening, collaborating and facilitating role. state health departments will be key to reversing drug resistance and the hospital spread of infections. and many of them are doing it, and they're doing a wonderful job, but we have much more that we need to do. third is prevention. the fact is that the quality of treatment for many conditions is nowhere near what we would like it to be. my father was a cardiologist. he used to say that when you see how other doctors practice medicine, you realize how resilient the human body is. [laughter] improving prescribing practices in all sectors is crucially important.

we recommend at cdc that every single hospital in the country has an antibiotic stewardship program. this means that antibiotics are looked at carefully, the data from their hospital both resistance and tribing patterns, is -- prescribing patterns are tracks regularly. and if there are aberrations or things that aren't right, they're improved. about a third of all antibiotics used in this country are unnecessary or inappropriate. there are enormous differences between one region of the country and the other. we know that team-based care, checklists, reporting, feedback, accountability, these are all simple management tools that need to be applied systematically to prevent drug resistance. and we know that many antibiotics that are being used are not necessary. with every medication whether it's for infectious disease or other, we need to think about the risk/benefit ratio and always think about that ratio.

there is no medicine without risks, and we have to balance that risk/benefit ratio. that risk may include drug resis dance, it may include c-dif. that's a current hypothesis for which there's some data, though, frankly there's thom some data for hot of hypotheses for what is contributing to the obesity epidemic. another benefit we've seen is with prescription opiates which turn out to be both extremely addictive and potentially deadly. take a little bit too much, and you stop breathing and die. so for all of the medicines we use, we have to keep track of that risk/benefit ratio. ironically, we underutilize a lot of medications that have a very favorable risk/benefit ratio for people at high risk of a heart attack or who have had a heart attack or stroke, aspirin

is only used about half the time. blood pressure is only controlled about half the time. even among those at highest risk, statens -- which are very effective -- are only used about half the time. we have to get that risk/benefit ratio that we're, above all, doing no harm and on balance doing as much good as possible. the fourth is innovation. we need new tools. and while we need new drugs and antibiotics, they're at least 5-10 years away, they may or may not be available, they may or may not work for some of our resistant organisms, and today we can stop, slow or even reverse this trend. and there's also innovation needed in tracking resistance, understanding better, figuring out what works to reverse it. in the president's budget for 2015, there's an initiative that would be the first of a five-year initiative, $30 million a year, that would allow us to build five regional centers of excellence all around the country so that we could

help doctors understand whether patients have resistance faster and in realtime whether there are outbreaks and how we can stop them that would help us develop a bank of resistant organisms that pharmaceutical and companies and others could use to come up with more rapid diagnostics. they would allow us to scale up programs like hospital stewardship programs and improve antibiotic prescribing. we project that, if funded, we would be able to not only save money, but more importantly, save lives. we project based on real data that with this initiative over five years, we would be able to cut our two deadliest threats in half, both cre -- the nightmare back bacteria that's spreading in many of our intensive care units -- and c-dif. we know that because places that have done that right have had that result. we can make this succeed across the country but only with investment. in fact, over five years we project we could reduce by

600,000 the number of resistant infections, by 27,000 the number of deaths from resistant infections and by $7.7 billion the health care costs from it. public health is a best buy. but we have to act now. antimicrobial resistance has the possible to devastate our economy and to make our health care system less stable. confronting this has the ability to protect americans from the moment they're born and throughout their lives. but every day we delay it gets harder and more expensive to reverse it. it's too late for peggy, for nile, for josh and for 23,000 people who died this year from infectionings that might have been -- infections that might have been able to be prevented if we had taken these actions

before. and although the problem is big and although it's getting worse, it's not too late to reverse it by taking decisive of action now. we can reverse it, and we can protect these abilities. the con -- these antibiotics. the concept of stewardship is an important concept. we're protecting them not only for ourselves, we're protecting them for our families, for our children and for our children's children. thank you very much. [applause] >> thank you, dr. frieden. according to a recent report by the fda, 80th of all antibiotic -- 80% of all antibiotics used in the united states are fed to farm animals. this means that only 20% of antibiotics which were originally developed to protect human health are actually used to treat infections in people. what is being done to address this issue?

>> we want to see rational antibiotic use wherever antibiotics are used. and i think that means, for example, in farm animals or feed animals that if animals are ill, they should be treated. using antibiotics that are of importance to humans for growth promotion is clearly something that we, the fda, the usda is and the food industry is concerned about. i think that's something that we'll see progress on in the coming months and years. it's more of a fda/us, the a issue than it is a cdc issue. but we do recognize as cdc that some of the most resistant organisms we're seeing like cre which is a nightmare bacteria, it's resistant to virtually all antibiotics, and and it covers multiple different organisms that have a fatality rate as high as 50% in the hospital. some of our most resistant

organisms are in the health care system, marley in the hospitals -- particularly in hospitals. but we want to see rational prescribing everywhere antibiotics are prescribed. >> antibiotic development is not as profitable for drug companies as drugs such as stat tins and viagra. how do we encourage pharmaceutical companies to develop new antibiotics to treat these emerging antibiotic-resistant infections? >> we do really have a rob with the incentives -- a problem with the incentives. one of the, from a strictly business standpoint, a terrible thing about antibiotics is that they cure people, and then you have -- you can stop taking them. that's not a model for a highly lucrative pharmaceutical product. you want a product that's going to be taken for a long, long time. and that's not what we want with antibiotics. so we have to figure out a way for government and industry to

work together so that the incentives for antibiotic production and antibiotic development match the need. and there have been important steps taken by congress in the past few years, bicamera, bipartisan, new laws in place that improve those incentives. but it's going to require creativity, it's going to require innovation, it's going to require a dialogue between government and industry thinking about ways to reduce the risk for developers to improve the benefit and to insure that there's reasonable profit without excessive profit that might result in a backlash. so these are tough issues, but they're important to address. we do want new antibiotics, they're important. but we also have to recognize that we may or may not succeed. we don't know why the antibiotic pipeline has thinned out in recent years, but it has. is that because of less investment? maybe. is it because the low-hanging fruit has all been plucked and

it's going to be harder to make antibiotics in the future? maybe, we don't know. we can't assume that we're going to develop new drugs to get ourselves out of this mess. we have to assume that we have to make rapid progress with the tools we have and preserve the antibiotics we have while thames we promote -- while at the same time we promote new development of antibiotics as well. >> is cdc looking into natural cures in addition to prescriptions? >> there's some really interesting developments in a variety of ways to reduce infection. we know that lots of things will reduce your susceptibility to infection or improve your susceptibility to infection. if you're healthier, if you're physically fit, the you get enough sleep -- if you get enough veep, this improves your overall immune system. and there's some intriguing new data on the microbiome. we sometimes can think of ourselves as at war with

microbes. they're the enemy, and we try to keep them out. actually, we've got trillions of microbes in us, and they're important for our health. some of the new tools, some of which congress funded cdc to expand the use of called advanced molecular detection which allow us to sequence the genomes of microbes in realtime, some of these are teaching us new things about the my microbes that are helpful. for c-dif there are new treatments that involve providing microbes that fight against c-dif as a way of battling microbes with my microbes. if you go back to the first drug developed against "good morning america", shell month wiseman figured out there had to be things in nature that fought tuberculosis. so they went into the soil of staten island and figured out

there were bacteria there that produced chemicals that killed the tuberculosis back tier ya. so there are ways we can use fire fight fire, if you will. >> the cdc or hhs take regulatory steps to enforce responsible use of abilities in hospitals? antibiotics in hospitals? >> we have to work in collaboration with the health care system. and one of the biggest challenges for public health in the coming years is that inte duration of public health and clinical medicine. at cdc we've been delighted to have a very positive, constructive partnership. we've run something called the national health care safety network, and we had many hospitals involved, and then cms said, oh, and by the way, if you want to get 100% of your reimbursement, you must participate, and suddenly we had 14,000 facilities participating, and they benefit from that. they are given information that

they can act on to improve their care. just yesterday the person who's leading much of our work here met with eight different health care systems to figure out how can we sustainably achieve the kind of hospital stewardship programs. so it's not so much of question of mandating and forcing as figuring out together what's needed and then making sure we have a level playing field so that that get dons. -- gets done and provide tools to hospitals to improve the quality of their care. >> it's september 2013, cdc put out a report, an antimicrobial resistance in which the agency identified new drug development as a pillar of a strategy to combat amr. congress is currently considering legislation to facilitate drug development by creating a new approval pathway for drugs to treat serious and life-threatening infections for

which there are few or no treatments. from cdc's perspective, which are are the infections for which we most need new drugs? >> well, we have one success story, but act by lin is a new truck that's useful for tuberculosis -- drug, and the fda was able to approve that rapidly. there was some controversy about that, but the data was strong, and cdc recommended it, and cdc is in support of that decision. we need to look at the organisms for which we have the greatest risk. that includes the whole spectrum. it includes the graham negative rods which are deadly, things like e. coli in our intense i care units finish intensive care units but also like staph where we have mrsa. so there are a range of organisms for which we need better treatment, and we also need to understand them better. and the tools that we're now using of advanced detection are

fascinating. we're learning that many of our assumptions were real simplifications, that if you have an innext, it may include not just one organism, but a broad range within that species, what is sometimes called quasispecies, and how we measure that in laboratory may be different from what's actually happening and causing illness in people. so there's a lot we need to learn about the patterns of disease not only within the population, but within individual people so we can innovate and target our innovations most effectively. >> perhaps the battle against high croak y'all resistance will have to be fought genetically, at the 40 lek lahr level. can you dress some of -- address some of the steps that are being taken into the molecular or nano level? >> i've mentioned cre a couple of times. let me give you a little bit more detail.

cre is -- [inaudible] you'll be quizzed on that if you want to have a second cupcake, which i recommend. [laughter] but the cre is something we really have not seen before. it is a jumping gene, a has mid, a part of the genome, a part of dna sequence that can move not only between one organism and another, but between one see cease and another. and not -- species and another. and not only can it move between species, but it can encode for resistance to an entire class of antibiotics. all of the pencillen and penicillin-like antibiotics. first generation, second generation, third generation, these are our big guns. these are what we've got to protect people. and this organism can spread its resistance to multiple species and multiple abilities. and -- antibiotics. and we've seen a couple of

different ways it can be spread. there's a dominant one and a secondary one in this country, and that's an area where we need to do more research to understand, all right, if that's what the jumping gene is doing, if that's what's causing -- that's what's driving the resistance to our biggest gun antibiotics, what can we do to counteract that across multiple species for multiple antibiotics. >> have you seen the latest mers study saying it may be airborne and your thoughts, please? >> we're working very closely with the saudis and with other countries in the region to better understand and control mers. we have teams on the ground. we've done studies, we did one in jordan a couple of years ago that was fascinating. i showed that if there were lapses in infection control, you had a lot of spread in the health care facility. but if you had good infection control, just standard infection control, even if you had several

infectious patients and lots of exposure, you had, essentially, no spread as confirmed by checking soology of -- zoology of health care workers. so we're still understanding how mers jumped the species barrier, how it is continuing to seed cases. but from everything we've seep, it's largely been spread in recent years, in the past two years, in hospital, and that's largely controllable by rigorous infection control. and that's good news. that doesn't mean it won't change in the future, but at least that's where we are now with it. >> you have called the bird flu safety breaches the most distressing to you of all the breaches. why is that breach most troubling to you? >> we had two laboratory breaches at cdc. one was anthrax where there was potential -- probably not, but potential exposure of workers at

cdc to infectious anthrax. what happened, basically, was that a laboratory thought they had killed the anthrax, but subsequently, it was not clear that they had. we've done subsequent studies which suggest that though it's not impossible that some of the anthrax heavy exposed other people -- may have exposed other people at cdc, it's extremely unlikely. but still, that was a reflection of a set of policy and procedural lapses that should never have occurred. and we're now taking active measures to make sure that we do everything that we can to make sure that the risk of that is minimized. the h5n1 situation was rather different. through a means that we're still not sure of in our laboratory, a nonpathogenic or nonharmful bird flu was mixed up with a harmful bird flu and then sent to a u.s. department of agriculture laboratory. all of this work was done in what's called enhanced bsl3 laboratories. very, very highly contained,

people wearing very fancy respirators, people who shower out when they come out. so there was no risk at any point of a release of this into the community. but the fact that we were dealing with such a deadly virus that could have big impact on agriculture and that there was a six week delay between people at cdc being notified about this and being be notified up the chain at cdc made me very concerned that we need to do a better job of encouraging a culture of safety, of encouraging people to report problems or potential problems if they have the slightest concern that there may be a problem. and whatever the reason, we're still investigating that is second incident. whatever the reason, the fact that, first off, it happened in our flu lab. and without exaggerating, i can say that our flu lab is as good as any in the world. it's a phenomenal laboratory. so that made me really stunned that if this could happen at the cdc flu lab, what else could something like this happen?

and second, i was deeply disappointed that it took so long to notify, and we're still underring the reasons for that -- understanding the reasons for that. we've stopped all shipments of all biological materials from are all of our high containment laboratories until i personally review and approve the inactivation procedures laboratory by laboratory. we've appointed a single senior scientist at cdc to review those protocols with the help of a working group and strengthen them before they come to my review. we have also insured that we're going to take a look at every aspect of our safety to improve the culture there and improve that, again, as i said in the beginning, we have not only some of the scientifically most advanced laboratories in the world, but also some of the safest laboratories in the world. >> this touches on your previous comments, but let me ask.

in a recent hearing, you told congress that you recognized a pattern of weaknesses within the culture of safety. how were those weaknesses allowed to develop? >> when we look back at the last few years, we see that there have been isolated incidents, and i believe in each of those isolated incidents the staff at cdc and i took responsible behavior to address the concern that was raised. and what i missed and what i think our staff missed was that these isolated incidents did reflect at earn. and it was pattern -- a pattern. it was a pattern of insufficient attention to safety in our laboratories, and that's what we're addressing now. and i think you can hypothesize about the reason the story i told at the outset about python cave and ebola is likely to be part of it. if you work with dangerous organisms day after day, month after month, year after year, sometimes there is a tendency to get lax. what we have to insure is that though human error may be

inevitable, human harm shouldn't be. we should do everything in our power to insure that -- and we will do everything this our power to insure there are redundant systems in place so that if there is human error, there will not be human harm. i think the broad arer lesson -- broader lesson is that it's possible to minimize the risk of many things, but it may be not possible to achievement and zero risk -- achieve zero risk. and that has a lot of us thinking hard about what makes sense to do this that risk/benefit ratio. if we're balancing a minimal but non-zero risk against a potential benefit, we'd better be very sure both that we make that risk as low as possible and that we have a reasonable expectation that there will be a benefit. >> you describe the sweeping changes in quotes that you have initiated at the cdc?

i realize you touched on some of them, you might want to expand. >> so we have done a series of things. we have -- i've issued a moratorium on transfer of all biological materials out of high containment laboratories. we've closed the two laboratories where these incidents occurred, and we will not reopen them until we're assured they can open safely. i've appoint toed a single point of accountability to oversee laboratory safety throughout cdc, and he and his group, dr. michael bell, are reviewing first and foremost those applications to lift the moratorium lab by lab. they will work not just as an individual group, but throughout every part of cdc to promote that culture of safety which has to be every lab worker, every supervisor, every lab branch chief and team lead. we will also take disciplinary action as appropriate. we have convened and i've invited an external advisory group of all people who have never worked for cdc before to

come in and give us a fresh look. tell us what we could do different or better to improve safety. we're investigating the incident with flu, that's not completed yet, and we're looking at our function as a regulatory agency. we regulate over 300 other entities that work with dangerous organisms, and what are the lessons from our experience to make sure that we do that regulation effectively. >> do i hear that are you advocating for harsh punishment against those who breach safety in labs, and what can congress do to improve lab safety? >> it's really important to balance two competing visions of how you deal with an incident like this. in one vision you find the culprits, and you punish them. in another vision you fix culture, and you fix the policies and procedures. i don't think either of those on it own is the right way to move

forward. on the one hand, you have to insure that you have policies and procedures and a culture that promotes safety continuously, that recognizes that risks are serious and nonminimal and does everything to the -- to analyze what are the risks. if there is negligence, if if there is a failure to report, then you have to take appropriate action. i think those aren't either/or. that's a combined approach. in terms of congressional action, there are observers who have said perhaps there should be a different entity to look at these dangerous pathogens. and i think that's certainly an idea worth exploring. it's complicated to investigate these laboratories, to inspect them, to insure that they do a good job. we do as good a job as we can on that with the division of select agents and toxins, but we're going to look at that and see if there are ways we can do it better. several years ago because of my concern that it would look like

a conflict of interest, i asked the agriculture department -- which also inspects such laboratories -- to minute cdc's lab so we wouldn't be one part of cdc inspecting another part of cdc. but we're open to ideas, and more broadly, i think we have to look at do we have the right number of laboratories? do we have the right risk/benefit ratio calculations for some of the research that's going on? >> you faceed tough questions during last week's house hearing. >> i noticed. [laughter] >> what was your takeaway from what you heard from the committee members? >> i think the committee very appropriately had concerns that if something like this can happen at cdc, first off, how did it happen, are you going to fix it, and what's happening elsewhere? so i think the questions were tough but fair. and the approach that i'm taking with my staff and that i encouraged congress to take is

very much a trust but very tie approach -- verify approach. we're going to do things to improve safety, but don't take us at our word. we will review and share the results of that and insure that what we do, we do transparently, openly, clearly. we always find that it's much better to be clear and open about a problem than otherwise. and i think we have been about these problems from the moment we learned about them x. that will be our way going forward as well, to say here's what we've done, here's what's achieved and not achieved. i would be disappointed but not surprised if we identified other incidents in the past or other things happened in the future. and that may well be an indication that we're improving safety rather than failing to correct what is an important issue to address. so i think the questions were tough but fair, and we will continue to provide information because we have such important work to do. this work is not done out of

idle curiosity. this work is done because anthrax continues to kill people around the world, because anthrax has been used a biological weapon, because these select or dangerous agents, organisms, are still both spreading in nature and potentially could be used in a bioterrorrist event. >> we have some media-related questions. what is your reaction to the media coverage of recent are incidents involving laboratory safety at cdc? >> i generally think the media has been responsible in their cover act. i sometimes -- coverage. i sometimes wish it would be a little different, but i don't think that's something that anyone wouldn't say at some point or another. i think the smallpox discovery on the nih campus somehow has gotten conflated in some of the reports. what happened there was a researcher, probably in the 1960s -- before there was smallpox eradication -- put

aside hermetically sealed vials of smallpox and ore pathogens -- other pathogens. it was a different era, it was not done out of malice. and it was kept in a cold room for decades, apparently, and the moment it was touched, the fda appropriately informed nih, they appropriately immediately informed us, and we mobilized over the july 4th weekend, actually, to make shower -- make sure that we were able to secure the materials, make sure they were secure at all times, travel -- transport them securely back to cdc. then in a controlled environment in the only laboratory outside -- there are two laboratories in the world that are allowed to have smallpox, ours and one in russia, in that lahr story with the worker who's the most experienced in the world at working with historical collections of smallpox safely open it, analyze it, test and determine that it was, in fact, still viable smallpox. what we will do from that as we've said from the very first

moment it became apparent is we will fully analyze the genome, and once that genome is sequenced and analyzed, we will then invite the world health organization observers in, and we will destroy the strains and all of the biologically viable material associated with the strains. this is part of the story that i think sometimes has been confused. it really shows cdc staff working 24/7 to protect people and make sure that we can understand and control what turned out to be not a risk, but that required a very active response and is got that response. >> another media-related question, why does cdc prohibit staff members from speaking with appropriators despite -- reporters despite the fact that in previous times there were no such restraints? >> as far as i'm aware, cdc does not prohibit staff from talking

to reporters. we do -- without media staff present. we do like to have media staff present so we can follow up on any questions and headache sure that you're talking to the right people. sometimes a reporter might ask a question of one part of cdc that might actually be best answered by another part of cdc, so we try to facilitate that. we really do like to be quite open, and the more information there is out there about what cdc does in this country and around the world 24/7 to protect people from threats, the challenges that we have as well as the programs that we're imelementing, the better with. implementing, the better. >> we are almost out of time, but before asking the last question, we have a couple of housekeeping matters to take care of. first of all, i'd like to remind you about our upcoming events and speakers. on august 1st, the president of the republic of congo will discuss peace, security and stability of the central african region and oil investments in his country. and on august 4th we have just

announced that his excellency, jacob zuma, president of south africa, will speak at the national press club on the eve of the u.s./africa leaders' summit. next i'd like to present our guest with the traditional national press club mug, you can add this to your collection. laugh -- [laughter] [applause] and the traditional last question: how does your experience appearing before the national press club compare to your experiences last week before congress? [laughter] >> the food was much better here. [laughter] it's a pleasure to be with you. it's a pleasure to share with you what cdc does, because despite the recent incidents, the fact is that cdc has more than 15,000 staff, we work in over 50 countries and every state in the u.s. we provide two-thirds of our resources to state and local entities, and we're there 24/7 to protect people from threats

whether they're infectious disease, environmental threats chronic diseases, cancer and heart disease can, whether they're intentionally created, manmade or naturally to occurring, whether they're in this country or anywhere in the world, and we do see the press as a vital partner in providing information and shedding light on the important health challenges that we face. so thank you all so much. [applause] >> thank you all for coming today. i'd also like to thank national press club staff including its journalism institute and the broadcast center for helping to organize today's event. finally, here's a reminder that you can find more information about the national press club on our web site. also if you'd like to get a copy of today's program, please check out our web site at press.org. thank you, and we are adjourned. [applause] [inaudible conversations]

>> you can see all of today's press club luncheon online at c-span.org. well, two federal appeal court panels issued conflicting decisions today on whether the government can offer subsidies to people who purchase health insurance on the federal insurance exchange. a panel of the d.c. court of appeals ruled this morning that the subsidies were meant to apply only to state-run health insurance exchanges. hours later the federal appeals court in richmond, virginia, ruling in a different case held that the government is allowed to offer subsidies on the federal exchange healthcare.gov. meanwhile, the white house spokesman, josh earnest, said today the administration will continue subsidy cans as the issue makes its way through the court system. we'll hear more about that at 2:15 when the senate comes up. they're going to vote on several judicial nominations for district courts in california, florida and louisiana. we expect debate later also this

afternoon on a measure giving tax breaks to employers who return jobs to the united states. earlier today at the white house just a short while ago, the president signed a bill assed by the house and senate -- passed by the house and senate that overhauls work force training programs. we're going to show you that from earlier today and wait until the senate comes in at 2:15. [applause] >> thank you. thank you so much. everybody, please be seated. thank you. welcome to the white house, everybody. and i want to thank joe for the generous introduction, but more importantly, for everything he does day in, day out on behalf of american workers. and i want to thank the members of congress who are here from both parties who led the effort to reauthorize the work force investment act. you know, when president clinton signed the original work force investment act back in 1998, he said it was a big step forward