o pick winners and losers with the 26 institutes. what is it that will you need to do to serve america as we are trying to do ours? very sobering indeed much the stories that have you shared about what is happening in baltimore:.

>> well, certainly if you look at that diagram you can see we are down more than $10 billion over where we would have expected to be if we had stayed on that dotted green line which is the

trajectory for nih going back to 1970 so it will take quite a bit to make up that ground. the other thing the other thing i might show you a consequence of that for people trying to get research funded that is the success rate, an investigator who has sent there grant in is facing. you can see going back a couple of decades that has been in the range of 25 to 35 percent. more recently we are down in the zone of 16 to 16 to 17 percent, which is very unhealthy and has caused a great deal of teefor. >> what is the number? >> one out of six would be funded at this time. >> how easy you turn away? >> five out of six. >> what does that mean? >> i see where you are going a number of grants we find

each year at the present time is about 9,000 which means we are turning away about 55,000. i do not think i can tell the difference between a grant that just made the cut and get funded and one that misted because in that zone they are all terrific. we are leaving a lot of great science on the table which we would not have done in past years. >> a stunning number. my time is up. you need at least a 5 percent increase to stay in place. >> thank you. >> i yield to the next republican or democrat. >> thank you, senator moran. >> the problem is, i cannot find my glasses. [laughter] [laughter] >> before he finds his glasses -- [laughter]

>> i think we have just seen a parable about the importance of precision medicine. >> i was trying i was trying to think of how to do that and i want my 30 seconds back. when we get to one minute i want to switch to a red tape topic to begin with, let me start with where the other discussions are. i i went to the precision medicine announcements of the president made. senator murray and i are incorporating the president's proposal by the effect i effect) for -- a properly functioning electronic medical system be to your effort to develop a cohort of 1 million individuals so that you could sequence the genomes? >> it would be enormously important. we are counting

on being able to utilize the advent of electronic health records /to make this possible recognizing that at the present time there is a lot of work yet to be done in terms of having is become truly interoperable. >> but the faster we get that going the easier it will be to do. and i would assume if your dr. and are prescribing medicine you want to find the genetic information the electronic medical system is not operating well since is an explicit shop which they do a terrific job. we're going to work on that.

identified and that i will tell you. >> last week on the same day doctor ventnor came by which i thought was interesting because the two of you that parallel efforts to sequence genome. he said to me that his institute in california also plans to identify and million individuals and sequence the genomes. based upon the experience that you had earlier when you were working parallel side-by-side is there anything comparable about what he is planning and what you are planning? is there anything to learn from the early experience about collaboration? 's are they completely separate? >> there are wonderful ways

to make this a collaboration. i have been in touch with him repeatedly and recently made a plan a plan to come and visit is human longevity is to. exactly exactly what his plan is in terms of to the million people are he will be sequencing is not fully emerged. everything is a bit of a work in in progress but i promise you, there's so much be gained by working away. one thing that we will be clear about his we want this to be a project for scientists, researchers with great ideas to the old to get access to data as quickly as possible as this will be incredibly possible and -- probable as a resource. >> but it is interesting is a development and huge. i mean,, million, million individual cohorts.

>> we have to be bigger. we have a very different kind of population. the british cohort we are fortunate to have a robust private sector that is ambitious. what i want to invite you to do is the event that senator murray and i cochair your list of regulatory obstacles or administrative obstacles that make it harder for you to succeed, you succeed, you mentioned that you would like to have the money we appropriate for one year carried over into the next,

like other agencies. you mentioned the amount of paperwork you have to do. you actually mentioned five or six or eight or ten other things some solve them having to do with what the office of management and budget requires the some has to do with things that we do i invite i invite you to give the specific recommendations to see if we can fix them. we will have a law passed and i would like i would like to include whatever we can do about the national academy of sciences finding that 42 percent of the amount of time investigators spend on a grant is on administrative work. you get $24 billion for research you give to universities. if we can reduce by five to 10 percent the amount spent on administrative work my back of the envelope math suggests there is a billion

dollars which could be used for more grants. i simply invite you to work with us on that. while we are trying to appropriate more money we might be able to save some money which would double the amount of money available. >> i would be glad to submit that list and appreciate what you are doing with this innovation project. this could help us a lot. >> i said double the amount of money available. >> thank you. you got your 30 back and a a little more and everyone is doing a good job holding to their time. people have a time for a 2nd round of anyone can stay and we would like information if you can put it together. senator durbin. >> thank you very much.

gathered in this room at this moment are the key players in the united states senate when it comes to this whole issue of medical research. senator alexander is chairman of the health committee, whatever the nomenclature is these days with his ranking member, senator murray senator blunt as chairman of this appropriations committee again, senator murray my overall chairman of the committee, said cochran and chairman of the defense appropriations subcommittee which i am are to serve on his ranking. we have an opportunity's. we have an opportunity. the american people are skeptical, if not cynical about who we arm over do. my guess is my guess is if you had to pick one hearing ramón l-uppercase-letter this morning at virtually every visitor and family would be interested in hearing what is going on it would be this room at this moment. there is not one of us who is not vulnerable. we pray when we pray when we look in the eye of the dr. and say, is there anything you can do you are

in luck, a new drug a new surgery, new approach. can approach. can i suggest would it not be significant in our lives and in the history of america if we decided to be the driving force to make certain that we make a statement a statement once and for all the biomedical research in the future of this country rather than let it be tossed about by the whims of budget year in and year out? i look at senator cochran and our defense appropriations subcommittee. i said i am going to focus on medical research. the 1st year we increased medical research by 28 percent. and i contacted doctor collins and said are we able to coordinate this? is's the flagship nih can work with the department of defense, cdc the department of veterans affairs to maven the department of energy to make certain we move in that

direction. i hope that as we think about an infusion of funds strictly limited to the defense department that we stand our ground and say it will not be strictly limited there are things that need help, and this is one of them. we want to put in our bid and make our stand to make sure that biomedical research starts moving forward again. 5 percent real growth for ten years. i wish we could do more but i urge everyone here. gathered in gathered in this room at this moment of the people that can make the decisions. i hope that we can reach that. incidentally congratulations having been chosen to be a member of the irish-american hall of fame. congratulations. are we coordinating research going on across the federal government and medical

research? >> thank you, sen. i think i can say with considerable detail and confidence that we are's. you mentioned the interactions of the department of defense. we spoke and went back and looked carefully at our portfolio and there's to identify whether there were areas that were duplicative. we found synergy, great examples of places where in particular the problem was getting funded by both agencies in a way that cover different parts of the problem and are working more closely than at any time in history between agencies like fda, cdc the cms where we just recently last week at a meeting of senior leadership and with job overall we are working in a variety of interesting ways to develop a combination of engineering and life science approaches carrying with me today three different organs

this is a blood brain barrier to my's to my kidney, along. all basically taking advantage of the stem cell. i just happened to have it here. that is a collaboration of trying to put a lot of human biology our chap to enable us to be able to test new drugs to see whether they are toxic or not. >> i don't have enough time for you to give an adequate answer, answer, but yesterday i was visited by a pretty well-known lady pushing for this area of research to make sure that women are included in hard research and trials. she believes adequate attention has not been paid. i hope that we are thinking about the appropriate diversity in the testing to be able to come up with the results that help all of us across the country. >> i totally agree.

she is an effective advocate for the port poor -- for the importance of paying attention for the needs of women's health. we insist people who are funded by the nih like an animal models of disease have to study males and females, traditionally many have studied only one sex's. >> thank you, senator. >> i can see you earlier but not what was in front of me. thank you very much. thank you for being here. you were in my office late last week i guess it was. we had a conversation. i want to ask you to follow up on the conversation. if someone can humbly give you an admonition you talk about in your testimony the stewardship initiative at nih. in my view they are related. i want you to tell us again in more detail about what

you are indicating your testimony stewardship at nih. i want to reiterate its every disease to ask members of congress a solution to the health of their lives. the prioritization medical research. the theory has been before i arrived in the senate that scientists should make the decisions about where the most promising opportunities are's in finding the cure or the treatment. but what i want to know from you is that you are filling out responsibility.

>> and overarching document. we will have that had submitted by next december. we can use you. currently going. gaps where we piled up things. we will look closely at our portfolio's and see whether in fact we desperately need to find an answer to this disease and in this epidemic. comorbidities. we have an active grant by grant review going on right now to see how that matches

with the priorities that should be most appropriate at the present time and make sure we have best practices for our funding decisions are made within the institutes because peer-reviewed is part but not all of that. we want to be sure we are making the most of those opportunities. we continue to look for partnership so that we can find other dollars to pursue important scientific projects with other agencies with the private sector and will certainly focus intensely on early-stage investigators which have been raised is a major issue and when we are concerned about how we can enhance the opportunity to give those early-stage investigators the confidence that there is a career path and they can do innovative research without fear of

losing report's -- losing support. and we will look closely at administrative burdens. we will try to do everything we can to reduce those and gives scientists more time to do sciences to the paperwork. it is a partial list of a vigorous away -- a vigorous array of activities. i want to assure you we are taking this with great seriousness. we do not expect people to say you are nih to my so you deserve dollars. there will be much more to say about that in the coming months. >> as you heard from sen. durbin and every member that has spoken we are interested in finding additional resources for you and understand this issue cannot be resolved only by your efficiencies but as we find additional dollars the assurance that i am looking for is that you then have the capability to make the decisions where those dollars can best be spent for the best outcome for the

health and well-being of our country and i thank you for your answer. >> thank you. >> thank you, mr. chairman doctor collins. i have been -- become increasingly interested in telehealth. they are doing great work in this space. cms has some work to do. some of do. some of that has to do with their statutory challenges and some of that. they could push authority more's. nih is doing a number of research projects. projects. i wonder if you would not mind taking a minute or two and letting us no what you are up to and what you have found. >> i appreciate the question. many institutes have investment in this space. more recently what has emerged as a hot area and promising one is the idea of using cell phone technology to make this even more transportable where people

are walking around with their own potential telehealth gadgets in the product -- pockets. i will be a significant part of what we want to test. i can think of a telehealth method the eye institute is using. developing a retinopathy by taking photographs and sending it to an expert across the country. doctor gibbons has a telemedicine application. >> certainly one of the areas of concern with asthma chronic condition affecting children relates to transcending geographic barriers between rural communities where there is a particular problem. a lot of times it is getting a sense of the disease were there is an opportunity to use leverage technology enables information to get to the experts necessary to manage care of the technologies that existed on

a smart phone now. there able to assess the breathing capacity of the child. ever program being funded that leverages resources that are mobile such as schools where this information can be ascertained, child symptoms and disease course developed and a treatment again, transmitted in that local environment, leveraging local resources. looking at using new mobile technologies in different ways to enhance care for both children and adults. >> thank you. let me make a small.about telemedicine, telehealth you know this is been something of he won the working on for decades. as decades. as a result people think of btc or telemedicine center -based delivery of care, and care, and i think that it is entirely possible it's for at least some treatments that the mobile phone just sort of outpaced all of it. i want to make sure that

when we do -- the center for telemedicine, enabling people to get out here that they need through their phone, have a compliant and all the rest of it. it is important to say because we have statutory infrastructure and some inertia it is based on what was possible ten or 15 years ago. >> i'm glad you.this out. our nih portfolio has shifted dramatically in the direction of mobile health, using mobile technology which is bursting with potential for either maintaining health work, perhaps from using this to monitor chronic illness. many of us walking around with wearable sensors. that is such a great opportunity for medicine. we're all over it. >> one other question.

were going to come up is the question of scoring with respect to medicare reimbursing for telehealth services. there is an ongoing discussion about whether or not they will increase total cost to the system. my strong belief is that it will think -- decrease in cost. that does not mean it is scored accordingly and i'm wondering where you are doing research that gives us any insight as to what would happen to the total cost within the healthcare system utilizing m health. >> we are interested in rigorous studies to assess whether they are improving outcomes. there are potential outcomes but many have not been put to the test. nor to decide whether you are achieving cost savings you have to figure out the application improving the long-term outcome, reduce illness, manage it more effectively's.

>> thank you. >> senator, thank you. >> thank you. i want to thank the panel. very interesting to everybody. make a quick comment about the ibe a program. i believe i believe you are in charge of it. two of our institutions and west virginia are the recipients of grants. i would like to invite you to join me in west virginia to show me what is going on and the possibilities. >> i would be delighted to come. >> good deal. my passion in the area is alzheimer's. both of my parents recently passed away both with increasing dementia. i we will go back and look at the death certificates and see what was actually listed as the cause of death. it's that may be decreasing

my eyes almost popped out of my head. i cannot imagine that is the case. it could just be poor data. i no that you are getting ready to revise research milestones. could you talk a little bit about that. >> alzheimer's disease is an area of intense focus and has, of course enormous consequences that we need to find answers to. 5 million americans currently affected. the caused they caused personally to those individuals, to their families is enormous. the economic cost is approaching $200 billion year's. we need to find ways to prevent or delay this disease, and there disease, and there is an effort across many different parts of nih to do so. this this extends from basic science studies trying to

understand what is happening in the brain that leads to the deposits of proteins. and an interesting recent development has been namely the ability to take stem cells and an appropriate cocktail to convince them to become neurons put them into a petri dish but not as flat cells but in a three dimensional space where they act more like they would in a normal circumstance. you can then tell the difference between those cells if they came with someone. that is an enormously powerful development because it gives us a chance to look in human cells and what is really going on in a way that does not put people at risk and allows screening drugs to see which of those might be most promising. promising. that is the basic part of it. the clinical side, one month ago the report by bio

biogenic off what appeared to be a possible positive result 1st time after dozens of failed trials from a monitor flow antibody has gotten a lot of people interested in whether we might be onto something. very small very small trial 300 patients and have to be careful because it is so easy for them not to end up being replicated. the initial excitement is something that people are feeling more optimistic about. one thing we one thing we are doing is to partner with industry in an unprecedented way. >> is that the accelerated medicine partner? >> estimate is. it's then i personally cochair the executive committee of that group. we have only been added one year. that also is showing some considerable promise all the way through the basic to the clinical.

we are on a roll in terms of tackling what has been for most of the years that we have studied a really frustrating disease. starting to get a much better handle on what is going on. it is clear one thing that we need to do's is to start early. i assure you this is an intense area of focus. >> i anecdotally read an article about a clinical trial or a small area in south america that identified a pocket of early onset alzheimer's in the 40s age bracket very interesting because it mentions some of the same things you mentioned. >> that is an nih sponsored trial in columbia for families that have a predominantly inherited form of also is. >> they are involved in a significantly. >> having lived through it

makes it more difficult in terms of researching. there are families. thank you for your work. >> thank you. >> thank you, mr. chairman. thank you and welcome. i want to start by asking questions about chronic brain -- chronic pain opioid treatment and alternatives. think of the little bit of context. a condition for some individual prescription opioids are important. it's also it's also clear if your following any of the trends in the nation that were in the midst of a national crisis as a result of significant over

prescription of opioids and misuse dr. collins, you recently stated in a blog post that when it comes to chronic pain opioids are not always the answer. speaking to the lack of evidence -- well let me see. what did you say? there is an absence of unbiased scientific review to examine evidence of the safety of long-term prescription opioid use and the impact of such use on patients. i would like to talk 1st up, to questions related to that. the 1st is the 1st is please tell us about the collaboration you are doing with the va on inquiry into alternative pain management strategies not just for physical pain but also ptsd

and then in what time you have remaining, if you do what potential does the research on the effectiveness of the use of opioids to treat chronic brain -- chronic pain and what is the nih doing to advance our understanding of chronic pain management. >> an enormous public health problem. 17,000 people lost their lives last year to opioid overdose, most of potential. the number of prescriptions written for opioids is dizzying adding up to basically one prescription per american per year which is not sound like what we need to do in order to deal with the problems chronic pain. it is the case the studies that have done on the use of

opioids and quite pained him up and carried out for more than four to six weeks. there's a lack of data, but the but the data we do have certainly because anybody to conclude that opioids are probably not a good choice for chronic pain unless associated with severe tissue injury as in the case of cancer's. we have a lot to come up with in terms alternatives which is what these 13 projects we are doing jointly with the va and the national institute for drug abuse working together on this there trying to assess the various types of pain, particularly what you might call central pain coming from conditions associated with ptsd with the use of a a drug like an opioid which is better suited for peripheral pain does not

seem to work and carries risks. alternatives such as cognitive behavioral therapy interventions that involve something that might seem new age but actually seem to have some value yoga, those being looked at as alternatives putting people down a different path of opioids deeply engaged in looking for other alternatives and travel to atlanta the rogers chair appropriations thousand people there from all over the country working together to try to tackle what everyone else sees as a major and growing health

problem. we will do everything that we can to help with that. >> i have a couple of seconds remaining. hopefully will have you follow up in writing. one of the highlights that you focused on in your testimony was shared priorities to improve priorities for the next generation of innovators and researchers across our nation. i no you have initiated, we talked much about the initiation of a number of policies to promote the researchers. we identified a significant in the data on existing research workforce. we have a lack of comprehensive ways to track the success of the careers of researchers. i have been i have been

working closely with you next generation researchers act which would ensure nih accelerate current and new policies to address this and foster new researchers. so let me just say i would like to hear more about why we do not have a good system in place already to track this information on our biomedical workforce and what additional steps nih is taking to address this. >> we will take that for the record or when we get to a 2nd round. senator cassidy. >> gentlemen, i am a dr.. i no so much of what you have done. in 1985 when i was a resident the diagnosis of aids was 100 percent. now if you take your medicine you are more likely

to die of alzheimer's and aids. for now 1st and what you have done i want to build upon that. when you said the report will be available next december community you mean 1215 at 1216? >> december of this year. >> an article suggesting the principal variable in determining funding which accounted for 33 or 39 percent of the variance in there was no correlation. what other factors will be using? >> generally we look at the public health burden. a very well established way to do that. we look at scientific opportunity. it will not be successful to

throw an idea. we look at our peer review process. >> to a certain extent there is a certain sort of the past is prologue's. i we will tell you my concerns. concerns. i have done back of the him will figure. you mentioned the work being done for vaccine for hiv-aids. spending about $400 million less than 600 million in total. so for just the vaccine aspect we're spending two thirds as much as we are. on a per death purpose we're spending almost $190,000 per

hiv death and spending $6,700 for alzheimer's death 10 percent of our budget on hiv-aids i can go down the list. i am a hepatology is. alzheimer's, you mentioned 200 billion per year for liver disease, 51 billion and for hiv-aids 16 billion. there seems to be a total out of whack in terms of the burden of society death, and alleys, cost of medicare, medicaid, etc. and where we are spending right now. we're spending right now. can you correct that in a short amount of time? >> our goal is to end the 8th step -- epidemic. we are not there yet as you know. >> i accept that.

there is far more incidence of alzheimer's and hiv. the need is are we going to wait -- i guess my i guess my question is we have this balloon note, 200 billion climbing. it's will we wait until we figure out a vaccine for hiv-aids before we begin shifting to the new battle? we're looking with more scrutiny than ever. he is the expert. >> & & the.you are making. one of the other variables that was not mentioned we talk about scientific opportunities is the ability or not to completely and something. when you're when you're dealing with an infectious

disease that has epidemic and pandemic aspects that is a different story in some respects from other diseases which are equally as serious and have impacts on society that do not have the potential to actually be completely ended the way we did polio in this country and infectious diseases. i fully understand and appreciate the.your making them i am looking forward to a time i am sitting in front of this committee and have ended the aids epidemic. it's. >> i accept that and it is a good. does that mean we increasingly consume because in 2,011 the budget is about two-point five or 4 billion. and now it is almost 3 million. and so we have to set priorities.

it seems like a prioritization which is not affect very spending. if you do type of calculations of how much money you would save per hiv infection prevented and do the math on that you are talking about even a vaccine that is not the best vaccine in the world that is 50 percent effective we would save about $6 billion per year just on that. those are the things that we are aiming at. the other.i want to make is that when doctor collins was talking about every looking at the portfolio's, one of the 1st important effects

is to look at the portfolio itself and to say are we actually spending money on the most high priority within that and make that as the 1st shift and then take a look after them and determine about redistribution. so we are looking at that and taking it very seriously >> thank you. senator langford. >> i appreciate the conversations ongoing and obviously this is one of multiple diseases. a great deal of financial cost. last year congress passed the alzheimer's accountability act and

alzheimer's budget in order for that to be applied. in the next 24 hours we wish you will issue a new set of recommendations about alzheimer's research based upon the summit i watched my grandmother. we have all for this. we walked through this life together. >> we have this conversation. i would say we have increased alzheimer's pending by 40 percent, more than any other disease specifically because of the scientific opportunities and the enormous.

>> thank you. it's talking about telemedicine will work to do but let me do one caveat is not to not to belittle them. so i will not pick on someone that is not here. the census bureau spent $3 $3 billion developing a handheld device and that the end of it had to punt it. we lost $3 billion on the handheld device and eventually they went back to pen and paper. as much as we can use current technologies and the private sector to take the lead. please continue to take the lead. we go into these technologies. do not reinvent the wheel. >> with precision medicine there is enormous interest from private sector developers. we have no we have no need

to develop any of our own because they are chomping at the bit to have their stride out. >> please press on. let me ask you a philosophical question. it seems to continue to accelerate. can you can you help me understand what is deriving the increased cost between basic research and clinical research all the way from concept to actually getting to the marketplace? the key factors increasing the cost more than anything else? 's if you can give me a couple of ideas. >> a lot of it is the high failure rate. very troubling when you consider how rarely a new idea about a drug makes it through the process. all process. all the cost of failure must be added into the overall enterprise. the formation of the formation of the national

center for advancing transit is -- translational sciences which aims to identify some of the failure and develop knew technologies in concert with the private sector. another was the idea precision medicine. this subset of individuals. you run you run a much smaller trial and have a much better cost of success. cost goes down. success goes up. i share with the concern's. >> is there any one spot you identify bottlenecks and see the cost increasing more than any other area?

>> the clinical trial of courses the most expensive part when you look at where the dollars really start to build up. if you have to do a clinical trial of thousands of people that will be expensive. we have to come up with ways to do smaller trials. waiting for five years to see what is happened. >> thank you. >> mr. kirk. >> dr. collins, i wanted to ask you about your opinion about work that i have been doing to derive this senate appropriations committee to have one unified federal electronic health record between dod and the a. my my hope is to make sure that using the 25 million patients in the 2 million patients one unified record my hope, the open code and

open source to repeat the success that motorola had with the android system where they had 70,000 apps 70,000 apps from the industry that was written to the open coding android. can you give me a comment on that? 's i will say including george bush which is particularly good. >> my hat is off to you for what you are doing. all people are anxious to see that happen. it's this fits together. you can walk around from one state to the next and have your health record

accessible when needed. there is a great need for this electronic health record to be usable in the best way. we are working with the office of the national coordinator : meaningful meaningful use, the white house has a new chief data scientists working with us on precision medicine's but is also involved in the dot va effort to get electronic health records to talk to each other. you would think this would be easier than it is. quite a challenge because of the way health records are standardized and information is textbased. >> i will interrupt you. all imagery via jpeg and all documents the ms word because those they are

certain providers'. because the va represents about ten times the patients that dod has really go with the va standard. >> i i appreciate your idea of a good plan. for.

the 1st time you evaluate and try to prioritize where you want to go as you look at all of those 27 centers to come up with an overall strategic plan. >> that is absolutely right. >> and you hope to have that available by the end of this year. >> it would be helpful. i helpful. i want to encourage you to do that. i am supportive of it. the questions are better asked by you to start with. you have those 27 plans to look at. it's the internal arguments that you need to have about why this is a bigger priority. let's sit down and hear from you about how we are

prioritizing this. only alzheimer's discussions in the bill last year's the objective was for you to have a plan that would be to go by 2025 broke the brand-new. >> am sorry. >> in terms of our we asked for specifically. a bypassed budget of what it would take to get their's the plan is refreshed every year we will attach that to estimate of what it would take to accomplish that because of what it would take. >> seeing something tomorrow

>> the outcome of the summit right now for research no space. this will be the 2nd time you've had such a summit. >> the researching medicine discussion in the strategic plan the session would probably make enough news. why can't you tell us today. alex forward to that. i've been interested in how we prioritize mental health of bring it to the same level of all other behavioral health issues of these statistics generally use of one out of four adult

americans have a behavioral health problem to a diagnosable behavioral health problem is almost always treatable. do's. do you have a better number that we should be using? >> in this case we tend to focus more on those who have the most disabling serious mental illnesses. one in 701 in nine. the total number rose to 17 million adults. what is critical to remember these are chronic diseases of young people that 75 percent of that number of onset before age 25 making it a particularly troubling issue. >> we all heard his story about how when talking to people in schools the single biggest thing that we could

do to help. obviously-the area you are working. if one out of nine is debilitating a serious we will be the bigger contextual number plays across the board about one in four is the number we think about. >> the armed service community armed services as opposed to defense approach. i asked the surgeon general if they thought one in four statistic was how to apply to people the military the answer i got was we have no reason to believe it is not about the same. what has been happening in military as it relates to how we deal with behavioral health problems. >> as you know the suicide rate has gone up

significantly and surpassed the civilian rate. it is beginning to come down slightly but we're gotten new numbers. have been have been very focused and help the public are. working through this project over 100,000 soldiers which is given as much better sense of out of focus efforts on those who are at highest risk. thank you. ..

for multiple sclerosis, so the neurology institute did the screen using the kinds of cells that make milin to provide insulation forkers in and we were able to show in a petery dish two drugs

in the fda collection to seem to show the benefit in terms of stimulating cells to make the milin which is what you want for them to do. they tried it in the mice model. both appeared to have activity in the best model we have of the next step would be to think of how to move this into a human clinical trial. one of the drugs is anti-functional of all thing and the other is steroid. neither had been thought of in this circumstance so we are excite about the that too. and there is another exciting finding in simultaneous many sclerosis research in the last month. dr. falchi's institute quickly saying something about that that was a human trial that seemed to be promising. the study that dr. cole sins referring to that we fund. the infectious diseases. that was a based study would be from the immune tolerance network that was exciting. we took 25 individual that's had multiple relapsing multiple sclerosis and stem

cell transplantation preceded by aggressive suppression the same way that will you give a stem cell transplant for somebody with the neo plastic disease. as it turned out to our great surprise and gratification, that the numbers were extraordinary 8 0% of the people in trial went into the remission in the sense of none of that have multiple relapse that was followed now for three years that is quite impressive. though we have a caveat that the inis small. 85 pe is impressive so we will aggressively pursue that approach. i am very excited about. that thank you. looking forward to more on that. and finally. i would note that we have been here almost two hours mr. chairman. how things have changed. the entire discussion would be on ebola. and nobody has asked but that today. that is good news.

we will not have to worry anymore or the sign of the times attention span is way too short. can you just update us quickly on the status of the clinical trials to test candidates on vaccines and theraputics. thank you very much for the question. it is good news. good news in the sense that from the public health standpoint. west africa has diminished. no case in like year in 40 days. that means that the country of liberia likely will be declared ebola free very soon. and oginni is smoldering and as we have always said you cannot claim victory until the last case is gone. we are not there yet and from the research standpoint. a couple of trials are going on that were pleased about. and one is a theraputic trial to which we have taken the most prom iing of the multiple experimental

theraputics of ebola and launched the random control trial involving centers that we have had here in the united states we had one of our own patients that we had recently released healthy. and following ebola. that was on the trial. and as well as in the west african countries we have 12 people on that trial. ten of them. in sierra leone. one in liberia. and one in fact united states. the trial of the vaccine research center together with the vaccine developed and collaboration with the canadians as well as an american company. as a matter of fafkts launched in february. we now have completed earlier phase two trial of 1500 individuals. good news is that this is safe. this is silver spring this. very proven to be the case in west africa. no adverse signals that would be caveats to stop a

study. and importantly, this is inducing the kind of response that you would predict would be protected. it matches the monkey response. that is no guarantee that it will work but it is a strong indication that it would be likely to, would. the thing that is complicating it senator is that we are launching the trial good news is that infections are going down it. may be difficult to actually prove on the incident basis that the vaccine does actually work. every indication that we have from the type of response that it is inducing will suggest strongly to us that it will work. thank you very much for the up day. thank you for all of you for working on that. i tell everybody that major mental illness is so drastic under addressed in society. and that the same article referenced earlier.

of the thing that were over funded and mentioning aids and a couple of other condition that's which was unfund was depression. as one example so first if the criteria of which going forward they will determine funk levels includes the possibility for clinical advance. and asking the. i don't know. and major mental illness is. that something of which the increased research dollars will be likely, is it there is a potential for the major advance that would help a child with schizophrenia. or you see where i am going with this. of course. excuse me. i appreciate that. the question senator there. is no doubt that um greater investment will give a better return this. is an investment. and not a cost in our end. and i think that you know. to go back to your earlier question. i just think that we will need to frame this a little bit broadly. and one of the issue that's we will deal with particularly thinking of

schizophrenia depression, and bipolar illness is that we do not know enough about the basics. so a lot of what we have talked about. with the dollars for dowries and disease burden is what we are spending on a particular disease issue understand that perhaps half of the budget will go into the fundamentals. i am so totally in agreement with you in fact one of the frustration that's seems that if we are going to fund things that have been successful. we almost say we will fund it that we previously funded and as opposed to maybe funding things we never have before. otherwise we will never get to the point where we are successful. if looks like that is under funded and it seems that there should somebody you know. $3 billion going for the brain initiative. and $300 million that the society spends upon mental illness. does that include

alzheimers'? that is inof alzheimers'. so $300 billion. on schizophrenia. bipolar depression. that is flabbergasting. the previous work that i dl in prisons i learn that had jails and president onlies are the number one setting to treat mental illness. so if you include the cost of independence cars relation, and the number to be drastically higher. we try i'd to put it into the calculation that we could not get a full accounting. so $300 billion will not include of the budget will go into the research inform find a basis for the major mental illness? 50% that is the total budget. 1.4 5. now 12% of the dollars will go to hiv. i hate to make a type of litany about this. by the way. my state has a high per capita incidents of hiv and the patient population had a number of hiv. i am absolutely aware of the nature of the issue of hiv.

but it seems as if we have two too few dollars going into the brain ininitiative and have you $800 million dollars going to the basic research for something that is costing us at least 300 billion or more as important as. it seems like we will throw everything that we can. and understanding the basic sort of science regard that can. $12% where did it come from? i guess in the priority. when i go back to look. we are spending $19,000 per death in hiv. i have a sense. we are spending $2,000 per death of the major mental illness. >> ballpark. i will give you help there. there are 40,000 suicides. each year in the country. that is the most recent number that we have. 90% of them are due to mental ill me and the

mortality here. ex-tree. higher than most forms of cancer. traffic fatalities. just triple the rate of homicide deaths. they begin between ages of 15, 20 something like that that's right. i happen to know that the death rate even if it is not suicide among those of the major mental illness. the average longevity is the mid- 50s as opposed to trauma and beat up. et cetera. they are not going to die from suicide. when you make a point. have you a tough job man. with a guy and an irish last name. congratulations for being in the irish hall of fame. when i hear about this and again. i am guess that can we will spend $500 per death. if you want to talk about dying before the age of which someone should order narrowly die. and i would hope that rebalancing would invest dollars and basic sciences that we can say there is so much success to fund that

success as well. to say that as a policymaker. that every one of us with major mental illness. the fact that the funding for that is which willfully less and documented relative to the other diseased will put onus on that to address that. thank you all for your work. i yield back. and budget requests talk about the new program to less expensively identify patients in clinical trials. how will that impact your work? how does that work and how will it work and heart blood and long research. thank you for the question. and adds public servants it is our stuart for taxpayer money.

we are vigilant for the tune its to be more efficient. effective and economic with what we do to make the investments. and unof the more expensive aspects of the biomedical research will relate to clinical trials we are looking for different ways to ask and answer the important questions that have transformed an advance medicine. one of the aspects that we are looking for recently is. that as you lewded to are sim and practicing make the trials. many cannot fit the category. and they go up to the traditional way. we are taking advantage of the transformation and the biomedicine. there is so much information in the digital format. and with the health systems. we can track and identify patient that's may be eligible for a trial them. are embedded within the system where we can recruit them and data is collected

that identifies their trial that could be then launched in order narrowly could get care. and indeed captured and perhaps in the electronic medical records again with the health systems so we will leverage that continue infrastructure for patient care. and that will enable us to do the big trials. and one for example will relate to chronic kidney disease and high incidents. and coronary deaths and more by theity rela its to that. and they could spend a hundred million dollars to do a clinical in point stud y for the cardiovascular disease. by taking a strategy of embedding this within the health system we will track the patients with kroing kidney disease that are often making touch points

within the health system to do the random trial to look at the effect of vitamin d. that is thought to influence cardiovascular outcomes to do a study on a large scale 5,000 individuals. that could be done for a tenth of the pharma trial to be done. so that is how we can be more economical in research. on mobile health and technology. don't think that you are in the approval process business if at all. and you are in the discussion business. and you will be about how to let this develop and what way should it develop. you know. you mentioned that fit by the that so manich of us care sxeecht if is helpful and it will not be life threatening.

i think there is a lot of other things that could be helpful and not life threatening that would quickly improfit capacity and report for monitoring their own health situations. i would jivent courage the discussion as much as possible to -- while we will want to look at thing that truly can be life threatening that otherwise let this develop on its own there. is a market out. it will develop somewhere. the only question is whether, i think that the only question is when we put enough obstacles it will not develop into the united states. and with we are trying to get to another country. and a blood pressure and monitoring thing that is easier than the current way we monitor blood pressure. and just comment you may have here dr. collins. there is an enormous

opportunity. and we need not to screw it up there. is a possibility to do this if we are not thought full. and the role that we would be very helpful is to collect data that the various types of wearable sense ors would improve health. by improving the likelihood of staying healthy and managing chronic illness like hypertension. diabetes. you are right this. will get more complicated if the monitor is doing something that could potentially be harmful. if have you an artificial pancreas on your wrist. instead something telling you how many steps that you took, the difference will become a cute. and we are aware of that obviously, the fda has an incredibly important role here. we are working closely with the fda in space like this. and we are having an of the four work shops here on the precision med since. the fourth in late july will be from intest. and california. we are inviting a lot of the people that have most inspiring ideas about health to come and talk about what

they need, and in order to have the precision me sin to be a platform. for the testing out what they are developing. and to get answers as quickly as possible in the real world and a well monitored situation so you will node what is working. senate. thank you. thank you to you and the whole team. and the record will stay opened for one week for the additional questions. and the subcommittee is in recess until 10:00 am on thursday may the 7th thank you all.

a grieving nation gathered along the route of the funeral train make its way from washington, d.c. to the final resting place in springfield, illinois. this sunday afternoon at 2:30 on american history tv. c-span three. we are live from oakridge to commemorate president lincoln's funeral with a thousand reign act ors and 1865 you'll gee. as well as those for the tour of the newly re-created funeral car. and also on c-span this weekend. 10:00 am. the student cam documentary competition. and the visit of shinzo abe.

announcer: "washington journal" continues. host: and we are back this

morning. we are focusing for the remainder of >> we are focusing on suicide prevention. we welcome to the conversation, judy collins. award-winning singer and song writer and author of the book sanity and grace as well as other books. welcome. and thank you for being here. joined also by vice president of public policy from the american foundation of suicide prevention. thank you sir for being here as well. i would like to start with you first judy collins. why is this an important cause for you personally? well. i am a suicide survivor of my own suicide attempt as well as a survive out of the suicide of my son. and i am here because i believe that education is the best way to deal with suicide. and breaking the taboo of discussion for it has been occult you are. and part of the history. and part of the human history. and for so many decades to breakthrough that and

because this foundation has been so helpful in bringing it into the public view. and the thing to do is to talk about it and to be apart of the solution. what do you hope to accomplish through that by educate something how do you go about that do you think would i like to have people on the case of the insurance companies. insurance companies have decided to be a doctor and tell the doctor what they will pay for. and what they will pay for. my old friend ed whom i became very close to at the time of my son's death. he started the first suicide hotline. and they said to him. you will want to take the word suicide out of there. we can't say suicide in public. that is how bad it was. and also he says that what happened is that the insurance company and medical communities hijacked the brain. i was lucky.

i had therapy. i had talk therapy for as long as i need it had. when i need it had, and it was paid for but by my insurance. people cannot get that and they cannot get along term therapy that one would need so. my view is that you know. lob eet insurance companies and tell them that they would have to stop living up to their ideas which is to make more money than god and to pay for the health that people that need help with mental health will need to have. that is my purpose here. and the only thing that i know about suicide prevention is how to prevent my own suicide. i will share with you that if you would like and absolutely. i want to welcome our viewer here's to, start dialing in the number phone numbers are on the screen, we will divide them. regionally. eastern and central. part of the country. and we know of 40,000 plus

suicides every year. this is the second leading cause of death for 10 to 24-year-olds and it is a big, big problem. i fought the cancer wars and the alzheimers' warses and to judy's noinlt is the time that country realize that's you cannot separate the mind from the body. and the mental health law that within into effect july 1st. so the insurance companies by law have to now treat physical and mental health issues equal sxeechlt to judy's toint point it will take time and the insurance companies are studying the rigs. and so basically, if you are allowed to visit your heart doctor for ten visits you will be able to visit your mental health patrol divider

for ten visits. and the final public health issue in the country. and we did not talk about cancer in the 60s and. if did not talk about aids in the 70s and alzheimers' frankly until ten years ago. so i think that it i clear that we would have to let people understand that mental health issues are no different than diabetes heart. and whatever. and it is okay. to talk about that and better yet it is okay to get help. and what are challenges. and the law was put into place. and judy collins is talking about that as well. we are not seeing this yes yet. there is a challenges. the place is the first building block. and mental health professionals for example. some feel that they will not be reimbursed in the proper rachlt many of them do not take experience. so you will have to go and pay for their care up front and submit your bill to your insurance company and to get reimbursed.

for some of the families on a tight budget that, is a real problem. a multi-facetted issue. and again. we are working on it and congress. the good news is that mental health is a bipartisan issue. and we have friends on both sides of the aisle. there is going to be a major bill, that is introduced, to congress. tim murphy from pennsylvania and senator cassidy from louisiana. and senator murphy from connecticut. major mental health care reform. and the first major bill in 50 years. what will it do? it will look at the whole range of the mental health services and delivered and reimbursement fees for doctors and how patient left side need to be treated. it will be monumental. absolutely. long time coming up. and i think that we will make major strides. judy collins. before we get to the calls. we will tell the viewers this is your personal story. and your struggle with the depression over the years. when did it begin? it began as a teenager. i was in a pressured life. and even then. i am afraid.

and i had a lot of demand on me. that is not -- there is no reason for suicide. and anybody can have any reason that they might have in life. and life presents. terrible problems that have to be solved. my parents. i do not know. this would have destroyed them if i would have succeeded. i know that now. and of course i was 14. and i took a lot of pills. i survived. and nobody then talked about it. you know my son was as i am. and an alcoholic. and he was recovered. recovering. and i am recovering for many years from holism. active holism is a good path to suicide. so is active drug addiction. i would say that in one way of course my son had 7 years of sobriety before he relapsed. and in the relapse he took his life. in the same way that his -- his father's father had taken his life. you know, would i have to

say something about things that are available. that do not cost money. and that do not take insurance. there are a lot of thing that are available. people talk to. people friends to talk to. and the groups free to talk to the being go online to find recovery groups that you do not have to pay a penny for. and you can look at the diet. you can clear out the junk. being clear out the booze and go to the place to teach you how to how not to drink. how not to use the kinds of things. i mean. people that have diabetes they have to face it on a daily basis. sugar. and carbs. and grains. and junk. they are dangerous for some of us that are allergic to sugar and grains. carbs and junk. things that constitute alcohol it. is a depress enter. and it means. you are liable. and i mean i always thought. one of the options when you are drinking frankly. and i was suicidal. and bent all of the years

that i was drinking for 23 years. so i into know that there are things that are helpful and free. i think that the combination of getting help from the professional and doing whatever things are that you can do to save your own life, are vital. and to suicide prevention. and as i said i know that the most about my own suicide prevention as a suicide survivor. i don't no. i am dozens times more likely to take my own life than somebody that has not survived the suicide of a loved one. so i would have to treat that as a first and foremost. >> i know our viewers want to get involved in the conversation. phone lines are lighting up. john, good morning. good morning:.examples.

back in 2001, i took a whole bottle of xanax. the reason for that was -- and i was a survivor. i didn't die. they took me to the hospital and i got there in time. i got an trouble with the law back in 1994 i serve five years probation. but i have a criminal record that is overshadowing me. every time i go to apply for a job, my application gets thrown to the side because employers can use your past against you. to me, that is discrimination. there are a lot of people in this country that are in the same predicament i am who can never get ahead in life because our system has pushes down and here we are trying to better ourselves. i went to college and got to college degrees and i still to this day cannot get out of the rut that i'm in. because of my criminal past. host: i'm going to have john madigan take that up. guest: i feel for your

challenges. i think part of >> part is the stigma around mental illness and addiction dis disorders and that combined with the criminal background. that is why judy is in town. if you are diabetic you have to deal with diabetes every day and with your mental health disorders you need to do the same thing. we need to empower your family and friends that you need help and that is okay. reach out to me after the show and i will figure out where in texas weekend get you help. >> daniel in bellevue florida, you are next. >> caller: good morning, ladies and gentlemen, john madigan, pertaining to let me get this

out of the way. judy blue eyes you are as beautiful as ever. >> thank you. >> reporter: i am about your age. i guess i am a suicide survivor in a sense. i one time went to blast my head off and it turned out i didn't. and my nephew and god rest his soul, he came up against a crisis he could not deal and with he killed himself. that is the only detail i know. i never asked about precipitated how he did it. but judy blue eyes i wish younger people of the current generations were familiar with your music, your accomplishments, and the soul is

eternal. as i recall you are from denver or there abouts. >> yes, i am from denver. >> caller: if people endure such an inconvenience to consciou way. >> good way to put it. >> you were not successful with your suicide attempt and had you been it would have destroyed your parents. >> absolutely. >> your son committed suicide and it didn't destroy you. >> i had a lot of help and i understood. suicide is the philosophical quandary for everybody on the planet. those of us who have suicide ideas and whether that is a condition, whether it is acquired, whether it is genetic

we don't know that but depression is genetically transmuted dealing with imbalance and the depression led to attempt plus range, resentiment, and anger. a lot contributes to this. having someone to talk to is essential. joan rivers called me after the suicide and said first of all there are no guilts. i knew this but it is important. it is important to hear you could not have controlled it stopped it because it is not your issue. it is the individual who does the act who must bear responsibility for taking action in his or her own behalf. you try to do the best you can. but unless it is a person who is under 18 and you have control under where they go and what they do and if you put them into treatment you don't have a lot

to say with adults. i will say, the other thing joan said, was you cannot stop working. i wanted to stop my life. my conferences were on hold. i said cancel it all. i am finished here. she said you cannot do that bah you won't recover. she had a suicide in those days that was recent. she said you cannot stop working because if you do you will not heal. and what i do is make music and music is healing. people who come to see me often say that they have gotten through difficult times because of my music. well i have gotten through difficult times because of my music. >> john madigan, i want you to pick up on genetics. your group did research and funded into what causes suicide

thoughts and attempts. >> we have a goal of reducing suicide by 20% by 2025. we will accomplish that by having people like judy collins come on here and talk about it. and by the government investing more money. the government spends $40 million a year on suicide research. compare that to $3 billion for hiv/aids and $2 billion for cancer. capital hill has to increase research dollars. 90% of people who complete suicide have an underlie -- under lying depression. there is no one cause. but in the end as you look back you can probably connect the

dots. we have to get people talking about it which is why judy is here congressional spouses getting another to elevate the conversation and say mental health issues no different than heart and diabetes. >> john madigan saying the figure for research from the federal government is $40 million. the cost of suicide is $44 billion and that is the combined medical and work cost each state. berny in new carwile, iowa is next. >> caller: good morning. i am the author of a book about a mime. i am a suicide survivor byself. i am diagnosed bipolar. i get concerned when prevention

and intervention are interchanged. you don't prevent a disease when you already have it. that is intervention. and i would like to see people start prevention by doing something -- my book is about attitude control. i really believe an alcoholic, we have to fight every day to count our blessings and see the positive side of life instead of the negative. i think it has to start when we are children. i would like to schools to start an attitude program and prevention. once you have a cold you don't take orange juice then. you take the orange juice to prevent the cold. >> john madigan, want to jump in? >> my friend patrick kennedy talks about everybody has to have a check up from the neck up. and we are advocating when you go for your kids' kindergarten

shot the doctor should ask how your kid is dog meant-- doing mentally. we want to train teachers administrators, school bus drivers to look at the signs of a kid being depressed and report that right away so kids can get the help. and whether it is intervention, prevention it is all the same and for the right reason; to elevate the conversation and get people talking and the help they need. >> david in new mexico. >> caller: hi i want to get both of your opinion on the hereditary factor. i have bipolar and i was homicidal and suicidal but because i have an optimistic side i didn't go through with it. my father had depression and used alcohol as substance abuse and my brother had depression

too, and he committed suicide. i want to get your opinion on the hereditary factor. >> i am jumping in with all four feet. yes, hereditary it is something we know a lot about. and depression of course is a chemical imbalance and it is hereditary. my father was an alcoholic like yours and depressed like yours, i have the inherited alcoholism and depression. thank you god i have not had a drink for many years. there are a couple things i have to point out since i have been sober since 1978 i have not taken an opiate since shoulder surgery. i don't take anything that is coming in between me and my attitude. i believe there are things we can do for ourselves. staying away from negativity. it is good thing you are an

optimistic person. my father was an alcoholic depressed person but he woke up singing and happy. i believe in exercise diet management, in keeping clear of all opiates and drugs. we cannot be handed a bunch of anti-depressants and depressant relievers to avoid the situations that come up in life. i don't believe in controlling our issues with drugs. i think that is a load of trouble. i would be dead if i was taking any kind of drug for any of these conditions. i take a little advil i admit. we can involve ourselves with life, we can cooperate, coordinate

coordinate, join an organization that helps people try to make our lives an example of what might do good for someone, get interested in one another, do things for kids there are a thousand things to do keep your mind on the solution, and for me these are physical, mental and spiritual situations. >> i want to add to what judy says and that is one size doesn't fit all. if you are a diabetic through exercise and diet you can take care of the disease and not take insulin. in judy's case she looked at her life and what she can do. our recommendation is you visit with a medical professional have an open and honest conversation about your situation and figure out what is best for you and your family. >> lee in minneapolis, good morning. >> caller: i would like to suggest mental health history if i would to take up.

and that is everybody who has been in counseling if they are suicidal, or depression knows that you are asked if you have a plan and they are talking about do you have a plan to kill yourself. i would like for the industry to turn that around and they can use that but the question needs to be asked do you have a plan and you need make a plan to live. >> absolutely. wonderful. thank you. john madigan? >> i agree. same thing. every other disease there is a plan and protocol get a plan together to live and figure out how you will stay on this earth and be all you can be. >> yes. yes. >> harry in memphis, tennessee you are next. >> caller: i would like the guest to address the issue of veterans who have twice the rate of suicide the general population has. it seems congress has tried to

address this with the clay suicide prevention for american veterans act. they said it would cost $22 million but congressome approperated -- congress only -- half that. >> we worked on the veterans act sponsored by senator mccain from arizona, and others and as i spoke at the top of the program, congress is now finally recognizing that mental health issues are a big national problem. i urge all of c-span viewers to call their representatives and urge them to quadruple the funding for veteran mental health programs. last year we got $900 million in

the mental health bill. so in some cases in your community there is paid stuff you can get. there is also lots of free stuff. go to apsp.org. you can find out your local chapter and i can hook you up with people in your home state. >> dennis in santa rosa california. >> caller: who am i talking to? >> you are talking to judy collins award winning singer and authorer and john madigan who is with the american foundation for suicide prevention. go ahead. >> caller: it sounds like you are a couple irish people. and i happen to be a pretty good singer. and judy i am a song writer, too. in fact i put words to the en entertainer in the movie the

sting. they are professional words and if i had had them out there when the movie was on the screen i would have been making money. and anybody that is considering knocking themselves off, first of all they are a little goofy because you cannot knock off god and god is the one letting you breathe and walk down the street every day. >> i want to jump in and show the viewers this statistic your group put together. and that is 90% of those who die from suicide had a diagnoseable disorder at the time of their death. how important is that and what can be done because of that figure? 90%? >> it is very important. i think my sister was diagnosed with manic depression at 14 and died at 37. the people i talked to and judy

can probably attest when you are living with depression the pain is so umbearable that the physical pain associated with heart and diabetes and in man cases my sister and her son made a decision it was better to free themselves from this pain and to die and that is a tough decision. we have to get the help and to judy's point one size doesn't fit all. some cases is counseling, some changing the diet and exercise and some is a combination of that along with medication. i agree physicians far too often medicate first. >> it is cheaper. >> you to have look at the whole picture. people with the internet now you can google everything. you can type in your situation and get ten different things

that might work. you have to talk to people to figure out their case. >> there are viewers that want to talk to both of you. good morning in maryland. >> caller: good morning. >> turn your television down and talk to our guest, please. >> caller: okay. >> all right. you are on the air. give us your question or comment. >> caller: my question is i am concerned about people that teach people's children to confuse them where they get disoriented and divide themselves from their family and community. we saw these children to end up you know committing a crime on themselves and they don't want families -- what i want is the telephone phone number i can reach you because i came here

and i have got my son and i don't know his whereabouts. >> caller you are breaking up. for those that want help, john madigan? >> go to afsp.org type in your zip code find out your local chapter and we can hook you up with providers. >> the 1800-273-talk that is the national suicide prevention. veterans hit one and they are connect today connected to staff that know how to talk to veterans. >> rockford illinois, mike. >> caller: good morning. my question is more about

military suicide rates. if you are watching a movie on w tty a public station, and we had four soldiers from the iraq war talking about during war time how they would have to become a made person or made soldier by a kill. and i am wondering after watching that film if that carries on when they are back in the civilian life? if so, is there a way we can help, if you know what i mean? >> there is a great new group in town called the iraq-afghanistan veterans of america and they focus on four areas: health housing, employment and setting up a safety net. we have 1-5 suicides among veterans now and we have to stop that. the way to do that is to judy's point of connecting with your community, your church whatever

your spear of influence is there is help out there. i love iava.org. >> wonderful to know about that. i didn't know there was that. >> they are based out of new york city. they were going to give them an award in june. it is all free. and they connect the dots. that is the most important thing. thousands of people in groups are providing services but we have to connect the groups. >> we have had that group on the program. we go to keith in fredrick, maryland. >> caller: good morning. i want to follow up on the gentlemen who called about dealing with being locked up. you talk about how you can't stop working, not sit-in and yet society uses that to do define you.

it is in your face every day. i toil with depression and suicide every day. if it wasn't for my son i would have done it already. when you are labelled a felon society has to get away from using that to define you and put you down and keep you down. >> do you any have thoughts on hat -- that? >> the taboo of being mentally challenged is an old challenge. having a group of people to talk about it and share experiences is vital. that is why i love the idea of the iraq veterans groups that people are connected to others who had the same experience. if you can sit down in the room and hear somebody tell me this is what i am dealing with. >> i felt this way before. i know what you are feeling.

how does that work? it is magical. we are here on this planet and not alone and there is a reason; so we can help each other get through these things. as far as the governmental ideas about who should be in jail for what, i think that is a whole situation that is being slowly but surely examineed -- examined. we decided we wanted to put everybody away. the tree strikes you are out is against us. it strikes people where they are vulnerable and committed minor crimes and put in jail. >> our jails are our new mental health hospitals. >> if anything is going on for recovery we don't know much about it.

>> jeff in maine. hi, jeff. >> caller: listen we made a big mistake a long time ago in this country by doing away with facilities and again those facilities need to be done away with but i have to say that in my opinion, they should take all the da's in this country and because the state has to have them and turn them into facilities people who have alcohol addictions drug addictions and what other types of addictions because they don't work with veterans and let the veterans go to the civilian side of the house and do whatever has to be done and turn all of the va's into facilities and man them with the best people we have. >> let's talk about that. >> jeff, you raise a great point. there is a group call triwest

and they have been hired by the va to connect veterans to mental health professionals outside of the va system. we are making strides. it is important you call senators and representatives and urge them that mental health is the tenth leading death in this country, or suicide, and until he get a handle on the mental health issues addiction, alcohol issues we will not turn the tide. this is really a war on mental health much like the war richard nixon commenced on on cancer hiv, and alzheimer's. we have to mobilize in the street. people are there and want to help. >> marilyn is on go ahead. >> >> caller: i want to comment and say i thought it was important

you are emphasizing this issue because like you said not much money is being put into this issue. i just wanted to say i am 20 now, diagnosed with depression at 13 and i made a suicide attempt and since then it haunted me for many years. i think about doing it again when i have issues going on in school or friends. so yeah just wanted to say teenagers/adolescents definitely struggle with this a lot and suicide attempts do go through most of the time. i think no matter how much money we put in it depends on the individual to seek help if they want it. and that is just what i wanted to say. >> there is help out there for you i want to tell you that. there are other people having these issues and i am so impressed with my friend here.

i am getting educated and finding out resources that i didn't really know were there. so there is help. the point is there is help and other people who can be helpful to you. don't give up hope. that is the idea. >> thank you for calling in. think about your situation is no less than you having diabetes or heart disease. and you are speaking out and getting the help you need and we love you. >> thank you. i am going to try to get in one last phone call. we will have to make it quick. steve in ohio go ahead. >> caller: i am steve and i have a comment. my comment is about the one caller who was talking about the stigma with the jail and being a felon and everything. the way i look at stuff is life is about choices. he chose to go down that path and live the lifestyle or whatever. my childhood was rough.

i knew what i didn't want to be when i grew up and those were life choices i made. >> steve, i am going to jump in because we are out of time but i want to end with having judy collins and john madigan give us their final thoughts ending this conversation. >> well you know, i understand what a huge issue this is. i particularly feel -- my heart goes out to the vets who are back from an experience that is inconceivable and find a limited view of how to proceed. but i am so glad there are organizations trying to help. and with teenagers. teenage years what we go through as teenagers which is hormonal and not distinguishable from major mental illness. i think counseling in the education system. let's intervene in ways that can

be helpful, positive healthy, let's make a plan to live, a plan for life. i think that is very good advice. >> two things. help asfp reduce suicide by 2025 by joining our cause and come see judy collins at the organization of american states from 6:30-9:30 and she will tell more about her story, clark and her battle. it is going to be an intimate evening. >> afsp.org is the website for more information. thank you both for the conversation. >> thank you for take the time to have us here and all of the viewers who called. >> they are awesome. >> c-span2 providing live coverage of the senate floor. and every weekend, booktv now for 15 years, the only television network devoted to non fiction book and authors.

c-span2 created by the cable industry and brought to you as a local service by your cable or satellite provider. watch us on hd. like us on facebook and follow us on twitter. >> a discussion about global risks with tony blare, lindsay grahm and japan's prim minister. they challenge oklahoma's method of legal injection and ashton carter discusses sexual assault in the military and a talk with britain's head political parties ahead of the elections. now a discussion about global risks with senator lindsay grahm, tony blare, and japanese leader discuss isis russia's