and that has to be us. so get ready. the next 20 months are going to be some of the hardest we've ever faced that nobody makes

history without a fight. [applause] and nobody knows that better than the woman that we are honoring tonight. we admire tori clinton because she has sex fully thought to expand opportunity here and all around the world. because without her, we would still be talking about universal healthcare as if it were some sort of pipe dream. and yes because she did put 18 million cracks in that glass ceiling. but she didn't get to do any of that stuff the easy way. nobody in american political history has faced more unfair attacks, more desperate opposition, or older you --

overwhelming diversity yet through her courage and resiliency and integrity, she has shown us all how to shake off the setbacks, ignore the haters and focus on moving our country forward. that's why she's more than an idle. she's an inspiration and whose talent we desperately need now more than ever. i am so proud to have her with us tonight. [inaudible] [laughter]

for every human being in every society we can't continue to campaign for -- the country that we all love and cherish will not be what it should be. human rights are women's rights and women's rights are human rights once and for all. activist, mother, secretary of state, grandmother. let us heed the call so we can create a world in which every woman is treated with respect and dignity. one of the things about the consistency with which she has worked on issues regarding people on the margin, women children, families after she finished law school she studied children development and that was a start of something that had always been with her helping

women and children. from the white house in the early '90s not only was healthcare reform front and center with children and women especially we will never stop fighting for quality affordable health care for every single american. >> hillary has a forward thinking importance to understand how important health insurance was to all of our families and schip was passed because of her leadership. >> funding to get women and girls a fighting chance isn't a nice thing to do. it isn't a luxury that we get to when we have time on our hands. a spec we are in st. lawrence county. we are not a rich county.

hillary saw what most of us hoped. we have people that make wonderful products but they don't have much for marketing. hillary clinton was able to help us create a pilot project that allowed us to learn how to sell the project through e-commerce and be able to sell the product worldwide. in the aftermath of 9/11 having been catastrophically injured one day i'm running a business and the next day i find myself in a hospital bed after months in a coma and with an incredibly warm smile. hillary was there to get something done. her chastity was evident even in those early days. she said i will help you. she just doesn't end no matter what frustrations, she's dressed in their day in and day out until the job is done.

>> and there was no more energetic and vibrant secretary of state. >> it's not just in the economic realm it is also in the enormous work that she did in helping to press the government to improve human rights civil liberties and respect for women. >> we are impressed in the engagement to advance hate. i think of the determination and faith in people and faith in the world. >> it is time to break the silence. the lead up to the speech was froth. there was a lot of pressure on her and i will never forget that this as long as i live when we were in the last leg of working on the speech she looked at me

and said i just want to push the envelope as far as i can on women's rights and human rights. >> if there is a message that echoes forth from this conference let it be that human rights are women's rights and women's rights are human rights once and for all. [applause] i graduated from business law when i heard those words and it inspired me to help find my voice and she has been inspiring me ever since. >> that has crystallized for me what hillary clinton is all about. >> every moment wasted looking back keeps us from moving forward. always aim high work hard and care deeply about what you believe in. when you stumble, keep faith. when you're knocked down, get right back up and never listen to anyone who says you can't or shouldn't go on because when

women succeed, families succeed in our country succeeds. it is for the 21st century. >> ladies and gentlemen, please welcome tonight recipient of the pr mle award -- we are emily award hillary clinton. [applause]

[applause] thank you all so much. my goodness, that's that was a walk down memory lane so many hairstyles. it is wonderful being with you tonight. i have to say i'm still in the grandmother go six months in is better than any spot treatment and i highly recommend it but if there's anything that can compete with it it is a room full of women and men who recognize the importance of making sure that all of our people have a chance to live up to their god-given potential and that includes running for office running campaigns,

standing up and being an advocate, then emily's list has been on the track for 30 years and hope 100 more until we are no longer needed. [applause] i want to answer one question at the start before it stirs up twitter. people have read a lot of different things into my pant suits. despite what you might think this outfit actually is not white and gold. i must say that gave us all a little bit of amusement in the middle of our days and i can't tell you how many people i've been with who have held up the pictures and asked me blue and black, white and gold.

i believe in freedom of thought and expression. the internet is a great enabler but it's nice to be with people that see what is before us as a country and that are committed to make this a fair or just better place for our girls and boys. i want to start by thinking stephanie. first up was an amazing speech. i am so impressed and proud. [applause] and the fact that she could get my friends of decades elected to the united states senate tells you everything you need to know about what an extraordinary person a patient stephanie is but she has led this indispensable organization into

the 21st century with such savvy and class. she took the baton and she has ran faster and farther than we could have hoped growing from 400,000 members to more than 3 million today under the leadership, emily's list is bigger, stronger, younger and more diverse than ever. [applause] so this anniversary is a chance to celebrate how far we have come together and where we need to go and why it matters not just for women but for the entire country i have to confess sometimes ideal feel like a broken record saying that. i know that there are still some people that roll their eyes when i or others say that women's issues are america's issues but

they just have to get used to it it's important for us to remember what it was like for women in politics before emily's list. it's not just that the playing field wasn't level. when men were barely in the game. they couldn't even get into the arena where it was being played. and that is the genius that inspired ellen who decided to shake things up. on that day in 1985 when she gathered those friends in her basement, none of them could have known exactly what kind of

impact they would have. but they did know something very important. they knew that when women participate in politics the effects ripple out far and wide and they know the country is full of brilliant talented women ready to step up and lead and who better to prove that dan a 4-foot 11-inch sparkplug named barbara mikulski. [applause] barbara has great integrity, but 4 feet 11 inches might be stretching it just a little. but the boys never saw her coming and with the help of emily's list the voters of maryland is not only saw her but they elected her again and again

and again. her victory in 1986 was a turning point for this organization, for women in politics and certainly for the united states senate. she blazed a path forward and among her many accomplishments one that i am particularly grateful for his then she forced the senate to allow women to wear pants suits on the floor. [applause] like so many of my fellow women senators i will always remember her kindness and wisdom when i was elected in the election it went something like this.

i followed and that was a hard fought race. now you need to figure out how to be a senator since you've been elected to serve as one. she came over and sat down with me and started giving me a tutorial that stood in such good stead but she also knew how to cut through all the hot air. we have to work out macro issues and also macaroni and cheese issues and for hard-working families, they are one and the same. it's hard to imagine the senate without senator mikulski. but i'm glad she's going to stay out there raising hell like she always has and inspiring even more people to consider public service because of the rewards

that despite all of the challenges come to you. they've come to the senate floor than 100 as you heard to congress and 11 governors. emily's list with your help has recruited and trained more than 9,000 women from every background to run for every office at every level. [applause] aren't you proud to see governors like a wonderful maggie from new hampshire and leading the way don't you love seeing nancy pelosi stand up against efforts of politics with the security nobody fights harder for middle-class families

day in and day out and didn't it make you want to cheer when it was a coalition of the women senators that finally broke the jam during the last government shutdown. [applause] were when patty murray showed that it is still possible to build relationships in washington when she worked out a budget deal with paul ryan. it's because of because of you that kirsten gillibrand can lead the fight against sexual assault in the military it's because of you that we can hold wall street accountable. it's because of you that barbara boxer can defend the rights of women to make our own reproductive health care choices [applause] and of course it's hard to believe we are losing both of

barbara is and about well i hope inspire more women to run to follow in their footsteps. i will always be grateful that i got to serve alongside so many terrific pro-choice democratic women senators. the least emily's list was there. as exciting as the past 30 years have been, think about the future. wasn't it amazing to hear from stacy abrams. [applause] they are both true rising stars to kind of leaders we needed to know how to find common ground when they can do to stand their ground when they last.

[applause] and even in 2014, a difficult year for democrats. you saw as nancy pelosi introduced them the nine new democratic women now serving in congress. so all of these women certainly fill me with hope about what we can accomplish together and also reminded me that we are not just standing up for women but for all people and for our families and communities and our country and indeed the kind of world we want for our children. we are fighting for an economy that works for everyone and includes everyone. that is the only way to achieve broad-based growth and prosperity in a world that is growing more competitive and interdependent every day.

we can't leave talent on the sidelines given the pressure and challenges we face. not when men and not the millions of young people who were out of schools and out of work. not the long-term unemployed or every day americans who work hard for years but find it tougher and tougher to get ahead. as the secretary of state i've spoken around the world about a new participation age and that's what we need here at home as well. next week as part of our no ceiling project at the clinton foundation i will be joining chelsea and melinda gates to unveil a sweeping report full of evidence about how women and girls have opportunities to dissipate. they lift up not just themselves but their families, their

economies and their entire society. we know that women moving into the workforce in large numbers help america's economic growth over the past 40 years. they would be earning less and our gross domestic product would be about $2 trillion smaller if those women hadn't gotten jobs and paychecks. but unfortunately today there are too many policies and pressures. but it makes it harder for the parents and men and women alike to work while also raising a family. it's hard to find the quality affordable child care.

they are often too far from predictable or flexible and sometimes simply unfair taking advantage of the low wage workers and so many women are paid less than men for the same work. its problems for families and the entire economy. let's be honest our families look different than they did decades ago, and so do our jobs. many families today depend on the incomes to make ends meet and 40% of mothers are now the primary breadwinners. that is a fact of life that we have not yet fully embraced. so when any parent has shortchanged the family has shortchanged if you go all the way up the ladder our economy is

shortchanged. when i talk with men at outfits i asked them to think about if their wife or sister or daughter or mother is getting taken advantage at work then they are suffering because of that. this is everyone's fight. we have to fight it together and win it together and that means making sure women have the legal tools they need to demand fairness at work and real transparency that makes accountability enforcement and negotiation possible. [applause] as a nation we know that the american middle class was built in part by the right for people to organize and bargain on the

health of themselves and their colleagues. [applause] this is one of those important issues that isn't just for the lieber issues. this is important for everybody who works because if there is not a balance of power in the workplace, everybody will suffer. so we have to get our economy to reflect the reality of the 21st century america and we are not doing that. we are not giving back when the hard work of women and men across the country is not rewarded with rising wages but the ceo pay goes up and up.

if they can exploit tax havens overseas but small businesses are held back by outdated redtape it's not happening when the workers have to jump from job to job in a dynamic market that often have to leave benefits they have earned behind. it's not happening when so many young people worry about no matter how much education they get, no matter how hard they work they won't be able to afford to pay for college or the middle-class lifestyle that their parents and grandparents enjoyed. across our country and americans feel the ground shifting under their feet. so many of the old jobs and careers are gone or

unrecognizable and certainly the old rules don't seem to apply any more come into the new rules are not at all clear. we have fought our way back from the crisis and recession but there is still so much anxiety and uncertainty and the games that we've made our real but fragile and we have to regain a sense of security and confidence if we want to find our balance and. we have to work together to build a 21st century economy. creating more and better jobs with higher wages that will make it possible to afford a middle-class life. helping more people start growth in small businesses and investing in the innovators and entrepreneurs that will create the new jobs of tomorrow. providing our kids and our adults with the education and skills they need for lifelong

earning to compete. changing the way we do business so that americans have the flexibility and support to be the great workers and great parents. and making washington work again not just for those at the top for those that have access and influence but for those whose great and hard work drove our comeback and have come back and have always been the backbone of the prosperity. we have to get back to investing in the long-term end of the things that matter most. if we remember how to work and grow together we can help more families find their footing in the middle class and make sure every one of our kids has a fair shot to climb that ladder of opportunity. we have always supported a

pro-choice democrat but if you look at the agenda from city hall to the congress we can see that they also stand for the kind of prosperity that has made it possible for so many of us to leapfrog our grandparents and parents. recently we have heard republicans try to sing out of the same hymnal talking about income inequality like watching the end of casablanca. [laughter] my goodness people are talking about it. round up the usual suspects. while, in fact we do not want to discourage their newfound interest. but we are not buying that old

trickle-down economics that didn't work before and can never work again because it defies arithmetic standard reality. [applause] so we welcome them to come with their ideas and that is what it should be about. they should be the contest of ideas. and i think emily's list has proven that in that contest of ideas the women that are willing to enter the arena well equipped with a great measure by the support they get from emily's list can make their case and can be elected. when i think in my own life history i like so many of you across the room and in the country grandfather was a

factory worker that started at the age of 11 and worked until he was 65 and got to retire. his son, my father went to college. he was a small businessman who worked really hard and made a good way for us. my mother had a terrible abusive childhood. have to leave at the age of 14 to go to work and having been abandoned by both her parents and paternal grandparents never got to go to college but had a spark of resilience that kept her going and gave her the capacity to create a family filled with love and support. when i hear stories like hers

and others i nodded my head and i saw a lot of others because just as she had another whose voice echoes in her head so did i.. and how fortunate i was and how we want it to be the experience of all of our children along like this way you get a chance to make millions of decisions. some of them are big like to you run for office? [cheering] others are even bigger like the ones that are wonderful husband

mark confronted like what do you do when a murderer a taxi that you survive how do you put that gift to work? she's one of the bravest women and men that i know and they are making such a difference. [applause] we have a lot to do in the next 20 months and we need to listen to the voices of those who set us on our own life journey into those that we still need with and encounter. when bill and i were at the hospital waiting for our granddaughter to make her grand entrance, one of the nurses said

to me thank you for piety to be co- fighting for paid leave. and i looked at her and i thought here she is taking care of other people's babies and having to worry about what happens when her child gets sick and how she makes all of that work. her words stayed with me. i remember being a young mother and having all of the balancing acts that we all have to do and i remember one morning getting ready to go to court and my pb center was sick and my daughter was sick and i was calling desperately to find somebody come and finally i found somebody that stayed but it made me so sick inside because i had to leave my daughter and i

rushed home after i finished in court and chelsea was fine sitting there with my friend and for the first time all day my heart stopped aching. it was one day for me but for so many moms and dads it is with them every day. that's what the nurse was talking about. that's what it's fundamentally about. whatever you have done all those years ago or if you have just discovered emily's list and you are a first-time member that you will redouble your efforts in the next months don't you want

to see more women running for school boards who will fight for better schools for our kids that don't you want to see more women running for mayor and governor who will put our families first don't you want to see more women running for congress who will follow in the footsteps of barbara mikulski for equal pay and equal opportunity you don't you want to see a woman president of the united states of america? ' [applause] all of these questions can only be answered by you.

so please, be recommitted. do everything you can do help us organize. take up the challenge, spread the word, talk to each other three at what make this a movement and put the sure that we do all we can to fulfill the vision and ability men that have gotten out there in the arena of those who have one and those who have lost. you actually learn more from losing. but stand with them and for them and be sure that it's not just an evening like tonight but a commitment from today because there is so much at stake.

i'm so grateful that it's been there for 40 years and i'm so appreciative to all of you who have made that possible. now we just have to resolve that it probably will be even harder for american women and families in future. we are truly at a turning point that i'm absolutely convinced we can wage these struggles and emerged victorious not just for the women who run that for all of those who will benefit from their commitment their victories and make sure that we go from strength to strength. let's keep up our pressure and understand what we are facing. let's go forth and when somebody

elections. [applause] [applause]

you would see a combination. washington was a large man. very robust, terrific national athlete. >> the gift i write most about is his ability to form remarkable partnerships with the great people of his era but it also dilutes his gift and talents of what he was able to do to help create the first self-sustaining constitutional republican. president obama's budget would

spend $21.6 billion on the national institute of health. 1 billion more than the current year. it is the government's main agency for funding biomedical research and and it funds 200 million for general mac research projects that would map the dna of 1 million volunteers. the head of the nih and related agencies testified about the budget request of the house appropriations subcommittee meeting. this is two hours. good morning. it's my pleasure to welcome you to the subcommittee on labor health and human services and education to discuss the fiscal

year 2016 national institute of health budget request. we are looking forward to hearing the testimony of doctor collins. i would like to publicly thank his staff at the nih for hosting me and other subcommittee members for touring the campus a few weeks ago. i think it is safe to say that we all left with a deep appreciation of the exciting work that your staff does every day to find ways to save lives. the scope of the biomedical research supported through is wide and we are confident that thanks to the scientists that work there will find cures for diseases like alzheimer's and ensuring that sufficient basic biomedical research base and supporting the next generation of researchers is critical to pave the way for these long-term advancement. your budget assumes many areas of advanced spending on genomic

activities including a focus on ebola antibiotic resistance and alzheimer's research to list only a few. of course we also support biomedical research but unfortunately right now sequester is the law of the land and given the reality of the funding allocations we might not be able to do everything that the administration is proposing as -- absent the agreement. i look forward to having a discussion with you this morning on your top three birdies give in our funding constraints. i would also be finished if i didn't point out how important it is to ensure that we continue to focus on the next generation of investigators. we know how long it takes for a treatment to make it from the lab to the patient so without a pipeline committed to following the scientific process of investigation and experimentation we won't be able to find the cures we see. today we welcome doctor francis

collins the director to the subcommittee. doctor collins is accompanied by five of his distinguished directors who can assist in answering specific questions. they are doctor anthony the director of the national institute of allergy and infectious diseases doctor thomas the protector of the institute of mental health doctor john lorch, the director of the national institute of general medical sciences, the director of the national institute on drug abuse and doctor gary gibbons. as a reminder to the subcommittee and witnesses we will abide by the five-minute rule and before we begin i would like to yield the floor to my chairman and the gentleman from kentucky and move to the ranking member and the gentle lady from connecticut and then from new york the ranking member on the subcommittee. or excuse me on the full committee. with that, you are recognized.

>> congratulations. the responsibilities that you have led and have taken on. welcome to all of you and thank you for being here. doctor collins, your leadership role in the groundbreaking human genome project is just one example of your many talents. i'm told that another one of your talents is playing guitar apparently. apparently very well. so you've got something to fall back on in case this doesn't work out. unquestionably, you all are at the helm of research at nih during the time that demands are in investment in medical research. the recent ebola epidemic in

west africa highlights the importance of the nih mission to gain and apply knowledge to enhance health and reduce illness and disability. medical research is one of the most important groups of preventing future epidemics and developing cures for diseases that are not preventable. the nih fiscal 16 budget request highlights prerelease and antimicrobial resistance. it is underestimated. nih research dollars not only impact research and facilities and researchers that they also help get new drugs and devices to the market place.

i would like to invite you this morning. as the director of the national institute of drug abuse can he has been a true pioneer in the science of drug abuse and addiction. she was one of the first people in history to use brain imaging to investigate the ethics and addictive properties of the drugs and her research has undoubtedly made the world we live in a much better place. she has been with us since day number one as the battles of drug abuse and by area in southern and eastern kentucky, hard hit especially by oxycontin and others. i'm looking forward to seeing both of you in fact at the summit on prescription drug abuse this summer thank you for

helping us battle this prescription drug abuse that's killing more americans than car racks and we appreciate your dedication to the especially. we are here to talk about two critical drug-related issues. first i am pleased that you are perceiving an adolescent brain and cognitive development study to collect the longitudinal data on the effects of marijuana alcohol, nicotine and other drugs to the young person's brain. it is unfathomable to me that states continue to pursue policies to decriminalize or legalize marijuana. in contravention of the federal law i might add. even here in the nation's capital it's ironic that in

washington, d.c. the nation's capital you can't smoke cigarettes but you can smoke pot. explain that to me. we don't have that data to tell us about the long-term impact of the use on the brain but hopefully this will open a lot of clients. this study will close the gap and bring so much needed sense to the issue about the use in this country. i'm interested to hear about recent efforts in the abuse and as you well know it's been characterized by your colleagues at the cdc has a national epidemic. i understand that you are partnering with nine major pharmaceutical companies.

if there are alternatives to the treatment we need to know about them and doctors need to be educated about them and i hope you can provide us an update on the science abuse medications. the drug that caused so much difficulty and still is but mostly back in the five or six years ago. it still maintains the good qualities of pain over an extended. co.. that's what can be done to stem

the use. in addition to the long-standing struggles with drug addiction and abuse, the research provided by the nih is critical to understanding preventing and developing the cure for the elements like diabetes to cancer and heart disease that continue to plague my region especially. we are proud of the partnerships we've established for example to cancer center, the national cancer institute at the university of kentucky and the center for clinical and translational science which previously receives your prestigious clinical translation science award for its work to confront chronic health issues in kentucky and kentucky in the world populations especially in the appalachia. currently 22 of the world's 50

top ranking universities for is -- science and we must continue to foster the next generation of scientists. we look forward to continuing these important efforts as we work together to bring an end to these devastating diseases. we thank you for being here and we expect to hear some good stuff. >> thank you mr. chairman. next we will go to the ranking member of the distinguished gentleman be from kentucky and a tireless camp david coke champion of this agency for many years. >> thank you esther chairman. it is a little earlier then we start the hearings but it's such an important topic that it's important to all of us to have the opportunity for the full two hours with the distinguished panel. i'm so thrilled to welcome you and the director of the nih the

doctor gibbons to discuss the 2016 budget request for the nih. first and foremost let me say thank you for your work. every scientific discovery come every medical breakthrough the research of human knowledge and it improves the quality of our lives and most of all estates lives. i'm alive today because of the grace of god and of biomedical research. when i was elected to the congress i made supporting the research one of my top priorities. as well as improving health research also drives our economy is the chairman said every dollar invested pays more than double that in local economic growth. it's the cornerstone of our life and science industry which envoys more than 7 million americans as almost $70 billion

to our gdp so there is no reason not to fund nih as fully as possible. in january along with the chairman and i had the pleasure of touring the nih along with other members of the subcommittee and it was as always a fascinating visit. while there we met with a investigator largely responsible for one of vaccine candidates is currently being tested in the clinical trial. that clinical trial is only possible because thanks to the nih support private doctor and her colleagues have been able to pursue a vaccine over many years since 1997. research can take a long time.

after adjusting for inflation nih is seeing the budget is even though divided about $3.6 billion to read about and area that's an evil & cut. sequestration is a terrible policy for any budget and it's especially cool when there are literally lines at stake. in 2013 it took more than $1.5 billion from the nih. even after modest increases over the past two years we still have not returned the budget to its pre- sequestration level. a decade ago they were able to fund almost one out of every three applications for research grants. amid the sequestration, that rate has fallen to one in six. in 2015 they will fund almost 1,000 fewer research projects than it did in 2010. we will never know how many scientific discoveries and medical breakthroughs the world may have missed out on because of the budgetary strains.

that is a disturbing context in which we consider the budget request for fiscal year 2016. overall this request starts to set us back on the right track. there are some exciting initiatives in this budget. the precision methods medicine will help to guide treatment and finally tailored to the individual characteristic of each patient. the combating antibiotic bacteria and initiative focuses on defending against deadly superbugs. the brain initiative holds the potential to revolutionize nero science and big advances to treat autism and many other brain disorders. the budget includes funding for research to develop a universal flu vaccine and potentially a cure for hiv aids. it also supports basic science research that has long-term benefits across multiple fields. as i said, i believe this is the right track. but given the neglect over the past few years i am disappointed

that we are not restoring the funding more quickly. this resource must and one third since fiscal year 2010. i introduced a bill in the last congress and again in this congress that would enable a committee to increase the funding by 10% this year and 50% over five years by providing a adjustment. that would ensure proper funding for the research without robbing other vital programs to do so. we have invested strongly in nih before. in the 1990s, i was among a bipartisan group of members of both chambers on this committee who fought to double the budget over five years. to this day stands among my most proud achievements. instead of starving the funds we should be seeking to repeat that achievement in the double the budget again. but this investment cannot happen unless and until we undo

the failed policy of sequestration and some of the courage to ask those who can't the wealthiest to have done so well in recent years to contribute more to support our national priorities. the biomedical research gives us the gift of life. it has done so for me and for countless others. that is what the nih represents. we can and we must find the resources to support it. and i think you. thank you mr. chairman. >> next to my good friend that lady from new york. >> thank you mr. chairman. it is a pleasure for me to be here today. and i would really like to thank the chairman and the ranking member for holding this hearing today. it is such an honor for me to have such a distinguished group of public servants.

i really appreciate you being with us today and i thank you for the life-saving work that you do everyday. every day. throughout my time in congress federal funding to the national institute of health has been on my very top priorities. the nih is the world's premier research institute and its researchers have mapped the human genome and i do remember that empty shape that you had filled up. it's really amazing. you have created a vaccine that are being tested to prevent the spread of ebola developed advances and cardiovascular diseases that have reduced death rates by more than 60% over the last half-century and invested in hiv therapies that turned what used to be death sentences into longer more productive lives.

..

it just sucks that had happened. >> increase funding as my colleague said, to research the workings of the brain develop treatments to combat alzheimer's disease, disease, autism, and other neurological and psychiatric conditions. these are the very definitions of where the federal investments. the pres. has also called for the end of a mindless austerity of sequestration. in fact i have heard some of my colleagues on the other side of the aisle refer to the mindless austerity of sequestration urging congress to replace it with more targeted spending cuts program integrity measures, closure of some outdated tax loopholes. i could not agree more. the effects of sequestration

are immense and they are still being felt. felt. in 2013 alone sequestration reduced the nih investment by more than $1.5 billion. fy 2015 funding is still below the pre- sequester levels. many critically important research initiatives were abruptly halted. it really was a worst-case scenario for many agencies command we have to make sure that it does not happen again. the united the united states must keep pace with the rest of the world while nih funding is $3.6 billion or 11 percent below the fy 2010 level when adjusted for inflation. others are making substantial increases. between 2007 and 2012 china and 2012 china increased their biomedical research spending by $9

billion increased while others are advancing our investments in biomedical research. as we begin the annual process for crafting a buzz it -- crafting a budget resolution i no there will be many key points that many of my colleagues may undoubtedly press for additional cuts and to leave the outdated sequester someplace but i think we all know how dangerous that is. discretionary funding which includes biomedical research, education, job training transportation infrastructure, and clean energy development is falling to its lowest level as a percentage a percentage of gdp since the eisenhower administration. we must act to ensure reasonable allocations to the important programs and investments funded through the appropriations process

especially the national institutes of health and those under the jurisdiction of the subcommittee. i look forward to your testimony. thank you, again for being here before us and i look forward to the nih plan for the coming year. >> i think the gentle lady. your full statement we will be entered into the record and you are recognized for whatever opening comment you care to make. >> thank you and good morning, chairman ranking member distinguished members of the subcommittee. it is an honor to appear before you today. this panel has a long history of supporting the mission of nih to seek fundamental knowledge and applied in ways that enhance human health,, lengthen life, and reduce illness and disability. breakthroughs generated by in i it supported research are behind many of the gains that you see here that our country has enjoyed in health and longevity. over the last 60 years

deaths from cardiovascular disease have fallen by more than 70%. cancer death rates have been dropping about 1 percent each year the last 20 years. hiv-aids has greatly extended lives and torrential strategies enabling us to envision the 1st aids free generation. allow me to tell you about just how few of the many exciting opportunities being pursued today. let's start with vaccines. thanks to research two different vaccines against the deadly ebola virus are being tested right now. also making exciting progress against the virus that nearly all of us entangled with, influenza. a knew vaccine must be produced every year but that approach is not ideal. nih funded researchers are working to design a universal a universal vaccine that will protect

against virtually all flu strains. such a vaccine could eliminate the need for annual flu shots and reduce the risk of a global pandemic. i am excited to tell you that universal flu vaccine candidates have now moved into the early-stage human clinical trials. basic trials are fundamental research that serves as the foundation for discoveries that have long made america the leader. one exciting example is the brain initiative. this bold, multi agency effort is enabling development of innovative technologies to produce a clearer, more dynamic picture of our individual brains, sales, and neural circuits interact in time and space. this will give us the tools for major advancements and brain diseases from alzheimer's

and autism to schizophrenia and traumatic brain injury. scientific advances are accelerating progress toward a new era of precision. historically doctors have been basing recommendations for treatment on the expected response of the average patient. recent recent advances including the plummeting cost now make possible a more precise approach that takes into account individual differences the multi agency precision medicine initiative. the the effort support research and an understanding why cancers develop drug resistance using noninvasive methods track therapeutic responses and exploring knew treatments targeted to the genetic profiles of a wide range of adult and pediatric cancers. as a longer-term goal of this initiative nih we will launch a national research cohort of 1 million or more volunteers who will play an

active role in how the genetic and environmental information is used to prevent and manage a broad array of disease. a project of this magnitude we will lay the ground for knew prevention strategy and novel therapeutics. there is no better time than now to embark in this enterprise to revolutionize medicine and move this precise personal approach and everyday clinical practice. let me share a story that highlights the early promise of precision medicine. diagnosed with stage 3 b adenocarcinoma of the lung in 2,008 it was completely unexpected. never smoked a day in her life. the life. the tumor was very large. as the recommended standard chemotherapy was began her dr. suspected she might have a a particular mutation in

the gene called epidermal growth factor receptor. confirmed their ranch and was prescribed tarceva, a drug tarceva a drug that precisely blocks egf our signal. after three months of treatment the large tumor shrunk dramatically. this was this was followed by surgery to remove cancerous tissue plus retreatment. today seven years after her diagnosis are doctors can detect no signs of cancer. what's more cancer. what's more, during the extra time provided by this approach she completed a triathlon and a triathlon and landed her dream job as a biology professor and welcomed a healthy baby girl clearly we need many more stories like hers. with your support we can realize our vision of accelerating discovery

across the vast landscape of biomedical research from basic scientific inquiry more precise personalized approaches to treatments and cures. thank you, mr. chairman. my colleagues and i now welcome your questions. >> thank you very much. for the members of the community we will go 1st our chairman, ranking member and then our normal order in terms of questions. you are recognized. >> thank you mr. chairman. thank you both for your special interest in prescription drug abuse. as you know everyday about 105 americans die from overdose mostly prescription medicine. sadly as we have taken strides to address that challenge we have also seen a rise in heroin use. as consequences as people

are addicted to painkillers graduate to those drugs that are cheaper. i i have long advocated for a multi- pronged approach to addressing this unique challenge and, of course, research is one of the main prongs of that approach. i am particularly interested in the development of knew technologies that will make these drugs more difficult to abuse and we have seen some real progress in the field. effective abuse deterrent technologies that will ensure that patients truly in need of these therapies can receive treatment while also ensuring that these very powerful and addictive medications can't be tampered with or abused. let let me ask you, what investments has nih made to advance the science of abuse deterrent technologies and

can you comment on the fruits of those labors? >> mr. chairman, thank you for the question and for your lead in this area which is quite remarkable, the way in which you have shown a bright light on the importance of addressing this. i we will ask the internationally recognized expert in this area to address your question. >> thank you very much, mr. chairman. thank you for asking the question. as you describe it we use a multipronged a multipronged approach to address the issue of prescription abuse problem. one of the effective ways to develop medications that are opioid -based have the deterrent formulation so that they cannot be diverted and abused in ways they can produce addiction and harm.

relate to a combination of drugs. others relate to inserting the the drug into a polymer so that it cannot be diverted. we partner with the public-private partnership to enhance the likelihood that the products we will be -- will get into the market. again hear innovation has very different ways of solving the problem. there are antidotes. we have partnered in order to be able to provide in ways that are user-friendly. thirdly, as importantly we cannot underestimate the relevance of developing medication to treat those

individuals that become addicted to opioid medications. implementation research to ensure that people will and practitioners we will provide better screening minimizing risks. >> we are working to develop an abuse deterrent formulation of oxycontin. using what i understand is called. [inaudible] >> the technology, you administer a medication that is not active until it suffers a 2nd conversion.

in this case in this case the medication that we are working with we will not become active until it gets into the gastrointestinal system and the enzyme trypsin activates it. the advantage therefore is somewhat if they want to inject the drug the way that these drugs are abused they will not be any formal logical effect because it will be an inactive drug. requires the enzyme. >> what you think about it? >> very promising. there is evidence in the past. they're much less likely to be diverted and to produce problem of addiction. >> a personal interest a personal interest in that particular approach and has worked closely.

>> it we will be a very important breakthrough. we hope that we will be hearing soon. we they are expecting hopefully some results in the very near future. >> about when? >> well. [laughter] i'm under a confidentiality agreement, so i can't give details. we hope we hope that we will be hearing soon. >> well, it is an exciting thing. oxycontin like many other opioids, our wonderful drugs for critically ill cancer. -- terminally ill cancer patients. if it can be questioned injected all of a sudden you get a 12 hour release a split 2nd and thus the

addictive power. so if you can't find a way that it can -- we can use its great qualities while preventing it from being abused that would be extremely well-liked life-saving development. 105 people a day dying from drug overdose. how can we incentivize private companies to invest in the development of these technologies? how could we make it so that there is something in it for them? >> to start with -- again, an example the science and policy needs to work together. there is research invested in dollars invested. we want we want to ensure that was the problems are developed physicians we will be able to prescribe it and companies we will pay for those prescriptions. i think

that ensuring that by innovation that result in safer medications that however may be slightly more expensive is supported by the resources that will make it impossible for patients to get access to these medications. >> i thank you for your work and your dedication. >> thank you, mr. chairman. >> thank you. doctor collins, the example you gave us this woman with a growth on the lawn is really extraordinary. what i. what i thought of immediately was every person who goes to the dr. with i have heard inoperable tumors in her lungs do they all get that test? >> that is a great question. one of the things we hope to achieve is to make that kind of experience much more

available. increasingly individuals increasingly individuals and develop cancer are having some kind of analysis to to see what is driving it is we're developing a long list of reasons why good cells go bad and start growing when they should not. the ability to be able to the individual to determine what is going on in that person and in connect that up with the appropriate choice of drugs this targeted therapy approach is extremely exciting. the national or to the national cancer institute study the protocol, one map which aims to do that and another for pediatric cancers and for adult cancers. so far the development of these approaches and the implementation across all of healthcare is not there yet

in part because we don't no quite enough to know what is the best strategy. the precision medicine initiative should make this kind of opportunity available to many more people with cancer. it should teach us things about why it does not work when you think that it should. i give you a beautiful example of a remarkable cure, but we do not always see that and we don't know why something is responsible for why when it seems to reduce to remission and then come roaring back. another thing is the opportunity to find out if we could combine more than one targeted therapy are perhaps combine a drug therapy with immunotherapy and have a higher a higher likelihood not just of remission but of cure. all of those are right for investigation. >> is still not widespread.

i just recently have two friends who had inoperable lung cancer. i just wondered if those tests were available to them. you are saying it's not. >> increasingly they are. i would increasingly say go to clinical trials .gov to find out what trials are being conducted to find out whether you qualify and an opportunity to match that up with the available therapy. >> i am particularly interested in how precision medicine due to this initiative could bolster treatments for breast cancer we already know that white women are slightly more likely to develop breast cancer than african-american women. the women under the age of 45 for breast cancer is more common common african-american women in

white women overall. these factors likely evident in our genetic code by advances in precision medicine are so very vital command i know there are many studies. i was part of an initiative years ago. environmental factors that never led to very much frankly. so if you could share with us the breakers have been seen and how will the precision medicine initiative improve the chances of finding a cure. >> thanks for the question. breast cancer question. breast cancer obviously is an area of major priority. the ability to be able to look at thousands of breast cancers and see exactly what is happening at the molecular level has taught us that this is not just one disease. it's many different diseases

with many kind of pathways. does those letters to insights about therapies. we have a longer list for hereditary risk factors and i would've thought possible. of course what of course what we really need is better means of prevention and early diagnosis and treatment. here is why i think the precision medicine initiative has a lot to offer. we have put together a cohort of a million or more individuals who are participants in the study that collects all of the data you could imagine about

their medical experiences the medical experiences about their dna, about the environmental exposures, we might have sufficient power to really be able to get our hands on information that has been rather elusive about exactly what is the interaction between genes and environment that results in this disease it is not. electronic health records now becoming the norm. that is why this is the right time. now we can't. between electronic health record environmental centers environmental centers, dna analysis and increasingly affordable costs and the willingness of the public the enthusiasm of the public to be part of a national effort of the sort we could do something really groundbreaking and historic which is what this initiative aims to do for breast cancer and many other diseases. >> i see the red light is on, but i just have to tell you this is why our investment in the nih's ocracoke. i find the information we gather very exciting and am ready to double it again, as john porter did. we could bring groundbreaking.

thank you. >> i am tough on the clock except to my chairman and ranking member. let me quickly ask one question. one of the areas that i know concerns you and me is the pipeline of talented young scientists and researchers. i recognize we are not as generous as we would like to be in terms of our appropriation. you have fewer grants to award. our success rate this was made aware of this recently by a good friend of mine the president of cornell. i asked him why in the world you were leaving a wonderful place like cornell. but actually it was exactly this.

they enjoyed teaching. they want to get things done and they are not getting the opportunities they need to have. what are the things that we ought to do. make sure that we engage the next generation of scientists that we will hopefully match the congressman's. >> thank you for the question. question. this is the issue that wakes me up at night. we have such amazing scientific opportunities. we we will continue to discuss during this hearing. our most critical resources not pieces of equipment or buildings but the people in particularly this next generation of researchers. they are full of ideas and

are finding themselves facing a situation that is the least supportive. they look ahead and see the more senior scientist struggling and having rejection after rejection of grants the previously would've been supported and wonder if we really want to sign up for the. many of them many of them regrettably are making the decision to walk away. the rest of the world has already been mentioned is picking up steam trying to be what america was 20 years ago as we seem to have lost some of our momentum which will have significant trickle effects downstream. what are we doing? know real magic to solving what is a very difficult equation of supply and demand with the demand for resources to do research is not currently being managed by the supply. we're trying to adjust the things that we can adjust. we have had many interesting conversations.

one thing we're doing is to try to be sure that that 1st application from a knew investigator gets a special effort beyond what would happen if they simply competed with people. some knew some new investigators, early-stage investigators compete against each other not against the experience once which gives them a bump in terms of the likelihood of getting funded. many of the institute on top of that get an additional bump in terms of the likelihood of making the cut that is helps to some degree, but we don't want to set people up for that 1st award and then when they come back for renewal we lose them because the edge is no longer they're. doing a number of other things for funding a program that provides support for postdoctoral fellows ready to go on and a in a couple of years to independent position to compete.

we are increasing the number of those because it does seem to be a good mechanism. a number of other things are being done to try to free up more of the proportion of funds for more applicants. i will quickly ask the director of the national institute for gen. sciences and general sciences and a major part of our training initiatives to say something about some of the ideas they are pursuing. >> thank you. you. this is an area we are very concerned about. starting a new pilot program which has as a fundamental goal to improve the efficiency of our funding mechanism which would increase the ability to distribute funds, especially to young investigators. it would also have several targets. one would be to improve the stability of funding because of there constantly at risk of losing they're funding. clearly clearly that is not an ideal situation.

it would improve it would improve the ability to follow new research questions. it would improve there ability to take on ambitious research projects. efficiency is the key. ..

>> that leads us when we double the amount of money for the nih along with mr. porter. [inaudible] and it has been of interest to me for it while. and i know that this is as well. and that is the gender balance in preclinical research. and so we have looked to make sure that women were represented among the subject of i'll medical research and i don't have to tell you that men and women differ in responses to medical treatment. and i oftentimes using the

models can lead to serious harm. women experience a higher rates of adverse drug reactions were example. in may 2000 working you co-authored an article with the director of the office or research of women's health. you said they would require applicants to support their plans for the balance of male and female selves in the clinical studies and future applications. so we know that the new policy would be rolled out in october october 2014 and doctor clayton noted that the exceptions would be the exception and not the rule. let me just give you the questions i have. what kinds of responses we received from the research community. and are we seeing an immediate

impact for funding in fiscal year 2014. will you consider requiring the analysis of data by sex and other subgroup demographics as part of the progress reporting. and what are you doing to encourage journal editors to require an analysis of results by sex, how are you holding institute directors accountable for funding studies on sex differences and conditions are predominantly impact women. and so can we expect all future funded research to include this unless there is a specific reason not to include them such as the focus on ovarian cancer or prostate cancer. a lot of questions i know but i think it is imperative at this

moment because you are moving and we need to make sure that we get all of this as we move forward and i know that we have worked in this to address the issue again. >> i appreciate the leadership of bringing this to the attention of the public and certainly i can assure you of my strong personal commitment to addressing this issue as was documented in that article that i wrote with the doctor in nature. the update is that we have now had extensive conversations with all of the institute directors in the scientific community including my advisory committee to the director which is my senior advisory group about this and i think that there is generally broad and brace for the need in preclinical studies to include males and females unless there is a compelling

reason, not that it's just not traditional or convenient. responses on the negative side have inflicted anxieties and it now has to be doubled in size in that well result in fewer studies being done. the idea that you should include males and females seems really compelling and he will have to decide how subtle a difference between the sexes are you willing to miss because i will determine this and that is called power analysis and can be applied in the situation quite handily. the institute directors are in the process now of finalizing their approval in the way in which we are going to implement this with community input.

this will be something that is not less neglected. we will have definitive guidelines for doing this kind of study about what their expectations are and it will be made very clear that that is part of how you are to review this and we have had great interactions with them about the general area of reproducibility and this fits within that that is called interesting new data the you would want to follow up on and they are in this mix as well. and i think it's fair to say that this is across the board and its overtime. >> absolutely, i want to thank you and i want to try next member from idaho.

>> thank you for being here today, the bipartisan nature of the subject with this committee is pretty obvious and has been in the past and that is good and it would be the desire of everyone on this committee to substantially increase the research if we didn't have this deficit or dead end or we are having to deal with at the same time which makes it more difficult. but it's something that we put priority on and try to do in a bipartisan manner. i would like to ask you a bunch of different questions and i would like to come out and visit with you for a day and with different things so that we can get down and have good discussions. but there is a couple of things in this personalized medicine that you are talking about is fascinating to me. and i understand that this is the collective use of technologies such as genomics

and protein medics and stuff like that. that explains how cells and organisms have a problem with. so is there any plans to look at broader maybe not as lethal diseases and the effects that personalized medicine can have? >> absolutely, let me be more clear than i was, the initiative has two components an early focus on cancer because this is so ready for this kind of really expanded effort and what we can do about it. this includes a cohort of a million or more americans were treated be studying. knowing that you are a dennis, i would certainly includes that.

we know the genetic risk involved in. [inaudible] so they should be a way to go there. >> that is true for diabetes heart disease alzheimer's disease and every common condition and you should really be able to be a part of this. what would be environmental factors playing a role. >> i could really be a part of this. >> this includes translational science from some advocacy groups who expressed concern i

don't believe that to be the case, but do you request this 27 million-dollar increase and can you update me on how things are going and some of the benefits we have seen from this? >> i'm happy to this was the first new center at the nih in quite a long time. there were some concerns about them becoming a plan. but instead we are identifying areas of technology development that no single company could undertake that working with them we can give you just one example. the effort to try to figure out

when you are developing a new drug whether it will be safe in humans are not has been a real difficult one and we use animal studies, small animals, large animals it's slow it's expensive, we probably lose this along the way because it probably would've had would have had no relevance to humans but we sort of loses at that point. wouldn't it be nice to not put humans at risk. basically representing liver or heart or brain or kidney, muscle, on a three dimensional biochip, we can begin to do those experiments without putting the apparent risk and give very interesting data. it is now three years along and this is a very a procreate thing. because if it works it could

greatly improve the likelihood of knowing whether something is safe for you get into that clinical trial. i could go on with many other things that they are doing and it's quite innovative and they would not have probably happened without them stepping into this space. we have high hopes and high risks and i think that it will be a high reward. there is a network of 62 were not a lot of research. >> as i said for many years and i will continue to say it the nih is for good and back him in the best kept secret in washington dc and we need to know what has happened out there. >> we now recognize lady from california and she has been in

our thoughts and prayers and it's wonderful to have you back here with us today so that gentlelady is recognized. >> thank you, mr. chairman, for your condolences and support and your expressions of sympathy during this difficult time. i'm so glad to see everyone here today and i want to make all of you for your work and for your effort to ensure the quality of this. my mother died of copd which is the third-largest disease and i have spent many nights and days in the emergency rooms and hospitals. she lived to be 90 and she lived with copd and my sister has multiple sclerosis and again

because of this work of this committee, my sister is 67 years old and she is the leading a very healthy life as a result of this and so i have to personally thank you all so much for the work that you do and of course i want to see the budget doubled so that everybody can personal be free of these diseases and i wanted to ask you a couple westerns with regard to this research in terms of prevention and new treatment. also with regard to how this will impact people with ms sickle cell, have been working for many years. and this includes how we are fully aware that that could give a false positive with what you

are doing around not in terms of research, also in terms of the budget, delete pleased to see the increase and i want to see if you are close to a vaccine what types of new treatments do you envision what this and finally just as it relates to the national institute on minority health and disparity. really pleased once again for this and we want to look at how you are focusing on social determinants of health care because we know many of the minority communities directly relate to the social determinants and how this is being framed and research and so i just have to thank all of you very much for your time and support during this period. >> those are great questions.

>> as you mentioned copd one of the leading causes of death in this country and one in which they have provided a better course of life than the nocturnal oxygen trial, but we need to do more that challenges are often towards the latter stages and a lot of the damages have already been done and is primarily supported. to really prevent a lot of that deterioration occurs and we are excited for this and we are

deciding to promote that and we have some exciting opportunities in that regard. >> maybe i will ask the doctor about a new trial. >> thank you for this question just a few weeks ago there was a very exciting study, one of the most important studies that we have been in which 25 subjects were involved to open label studies in individuals who had rabidly aggressive progressive multiple sclerosis. see you would expect by historical control over a period of months would continue to deteriorate. the study was a resounding

success without any progression for a period of up to three years, which is really quite unprecedented. if it was not controlled in the classic sense but the historical control is so compelling because when you get those patients they almost invariably progress in these individuals did not. as we are going to move onto the next phase of the study. of all of the things we have been doing over the last several years, this is the most exciting. there are so many aspects of hiv as you know throughout the world and we are seeing several taking this tipping point and including those that we are starting to see a deflection and the thing

that would nail it down with regard to prevention and treatment of prevention programs that you are familiar with in which you can decrease by 96% transmissibility by in fact treating them, there have been several studies that came out at the meeting in seattle last week that showed the preexposure prophylactics that are superimposed then have provided a substantial decrease in infection rate in certain areas. there are other situations that are being pursued and one is the successful situation and it was 31% effective. not enough for prime time, but enough to give us some insight

into the next stage that we will pursue, we started a trial in africa and it looks like the response is quite similar to those which means that that is a glimmer of potential success and there's a bunch of research that is led by the research center as well as a number of centers throughout the world and i'm looking at the ability to induce broadly neutralizing which is difficult to induced with this infection. thank you. >> yes you can see to your comments can be great questions and so with that, i'm going to move to my good friend from arkansas. spirit i will try to be quick.

i was one of the people the lamp on the tour and thank you, i am in awe of the presentation of his being made here today and i am grateful to you guys and gals are doing great work that you are doing and i'm going to follow up on a question from the overall chairman from earlier and when you said that you needed to make new medications and treatments combating prescription drug abuse i had completely agreed with that. but right now the regulations prevent us and only push to medications. and so can you follow up on what they are doing to make sure that patients can access these medications and are you working with other agencies such as dams on to ensure that they are not

distracting from but instead complementing the efforts of the nih? >> yes indeed. we must work in partnership with our sister agency by which we actually bring together this to ensure that the development in the area are implemented in the treatment. having said that they are always a problem in terms of ensuring that they have made the point before including that insurances will be covering and providing this to them. with very good outcomes and now

we know not only are these medications effective but in preventing hiv. so we need to implement it. >> i would expect that you have in question about idea funding. arkansas is one of the states that benefit and i know that a lot of our applications we would like to improve that. so in the budget, the budget request level funding i would like to know why the program

can you walk me through that process? >> very big fan of the idea of programs and certainly what has been a part of this are truly exciting. in terms of the budget issue there was a 50 million-dollar increment that was received in 2011 which over a five-year time frame has grown more rapidly than the rest of nih. this did not particularly change in the total dollars but i do want to ask the doctor because this is now managed which i know that he is also quite enthusiastic about. >> the idea program is now howison we are very proud to have it there and are committed to the goals of the program and i think that the key is that

whatever the budget we are going to do whatever we can make sure that those goals increasing the geographic distribution, all of them have cutting edge biomedical research on that. i recently traveled there in the southeast region, including in the district or the university of arkansas, we have this that focuses on the three-dimensional structures of proteins from viruses and bacteria using that to try to develop drugs to treat a variety of different diseases. so we continue to push the goals of this program forward the best that we can. >> let me just finish by saying in my opening that i am grateful for the work that is being done by this agency and it gives me a great deal of pleasure like we

have here, a panel of experts. >> thank you mr. chairman. let me ask about the joint programming that the eu has debated and another has been some discussions about american participation. can you tell the committee as we plan on engaging in terms of this through degenerative diseases? >> we really appreciate your strong leadership in the area of neuroscience, also a major figure to respond to your question. >> thank you for your response and for all you are doing in

this area. this is the joint program that has reached out to us and this is something that is going to be sitting under the g7 authority to mention more specifically and that is something we have become more involved with and i suspect that there will be joint initiatives that have not happened yet but that is in the discussion that we are looking forward to working closely with this. >> i would like to get a particular review on whether this is something that we are not going to join in so you can provide that. and so let me ask a question while i have you. and i would also like to talk

about this helping to implement programs in terms of the first efforts. in this way is a recovery after the initial episode, could you tell us where we are right now right now and what the future holds. >> the recovery after this has been going on and bolstered by the time the funding from 2,092,010 in terms of feasibility in december 2013 and soon thereafter in january 2014 to ask them to implement the

findings of this study in all 50 states in terms of science to service science to practice and in this case it happened in 2014 and there are pilot programs that were developed in collaboration and we are watching that now as it continues to grow and what we would like to do is to create a learning health care system out of these kinds of programs that are not so much research to practice the practice research and we are learning from experience on where this is being delivered and how to improve outcomes for people who have a first episode and most importantly how to prevent that first episode as we try to move in the cycle and this has a great conventual situation as we

move forward. i know that you have cochaired this working group which i established their language and the fact that i can just be in the same room with them. [laughter] >> we both share the working group and the brain initiative. there are a number of other things in terms of this industry and so this is just a lot of things that we have terminated. if you can help us understand the budget request an