the disease and alzheimer's. there are vascular changes in the drain that can cause all strokes that can contribute to dementia we often see people who have some vascular damage in alzheimer's disease as well. the connection is not well-established, but you also see things like amyloid deposited around brussels and we don't understand that aspect as well as we should. >> it is a risk factor for dementia as well as some people trying to understand is that an amyloid pathology, cardiovascular is a risk diabetes is a risk.

.. right here. >> thank you for the excellent dialogue. so i question and forgive me i might be putting on the spot on this. the discussion seems to have turned a path over the last couple of years emphasizing on the early end of things, intervening early is there

still a pathway are there still therapeutics being looked at for those who are already afflicted something for families that deal with is and has been a difficult target in? thank you. >> i'll start. i don't think people who think we are not interested in people who have or continue to get it. there are companies that still looking at intervening at later stages when somebody has mild impairment so there are treatments. things looking at are education. there's still a lot of work on that. regeneration is a way to actually have cells regrowth.

there's a lot of things that we're looking at late stages. it's important if we get something to prevent, it's going to help a lot of people. we'll still have people that get the disease. research is ongoing across the whole disease continue. thank you for asking. that's very important. >> scientists continue to refine, is it possible that the same drug as it continues to be refined would be of use to somebody who is five years eight years after diagnosed with alzheimer's in. >> i think richard, you can talk about the way the first drugs were tested. >> even if we can slow the prevents, we're going to have a lot of patients with alzheimer's, and there is work

ongoing to try to make better inhibitors that are not part of the treatment. i think it's a further down the line but i do think that there is the possibility that if we could slow the degenerative process. people regenerate. that's how we grow. if that process could be restored you could actually imagine some where down the read we could get recovery. you stop the bad part and augment the good part, we can have recovery. it's an important matter to pursue as well as prevention. >> i had the opportunity to attend alzheimer's conference in

february. what steps do you see important to take in terms of diverse participants in trials of particular sector? >> i think that's an important question. how do we reach out and make sure we're having a diverse population, everybody be included in trial. so i'll mention against alzheimer's, african american network against alzheimer's women against alzheimer's. they are try to go reach out to make sure that we are including everyone in the trial and not leaving anyone out. so it's very important. >> just to give you an industry perspective, when we develop a new medicine we develop for the use around the world.

we would not generally generate a medicine just for the people in the u.s. many have a requirement we include people from those countries in our trials, japan china, european union couple of south american countries. we as necessity have to go to those countries. in the u.s. to get a patient population in the trial is kind of representative of patients as a whole is an ongoing struggle. it's not unique. it's a constant struggle and we are looking group nia and alzheimer's association to help recruitment into clinical trials. >> that touches on a point talking about all the meetings and gatherings focusing on alzheimer's, you mentioned that you were surprised people

attending from asia, china japan. >> well, you know the aging of the population that we see in the u.s. is actually even ample japan, korea etc. we know this from our own clinical trials, it's a great dye sire to have treatments in all the countries around the world. i was just impressed as i walked at aa ic how many were researchers from korea china japan, et cetera, who were come to go washington to share knowledge and perspective on disease. >> t a global disease for sure. it's not just affecting western countries. >> one more question in here in terms of having a national plan

harnessing all the communities government, et cetera, three years ago the obama administration released a national plan to address alzheimer's and the goal was strictly ambitious. by 2025, so in ten years to be able to prevent and effectively treat alzheimer's disease. does that strike you both as realistic in. >> the way we look at it is an aspirational goal. >> it's an aspirational goal -- >> it has to be -- let me just say, it has to be realistic as well as aspirational. so we understand that it's really going to require a push. i do think there's a lot of momentum, and you heard harry talk about from both policymakers and appropriators

that this is important and we need to put the dollars for the research. we do have to have funding to do the research. everyone gets it. we want to be there at 2025 or striving to get there. >> i would just add that the time of development is longer. it's just part of nature. it's about 15-20 years. it has to go through lots of steps. but i think there's things in the pipeline now that are being tested that they won't cure disease, but if they slow the progression for at least a few people that's essentially a cure. you take somebody who is 70-year-old who have normally gotten the disease and push it out ten years that's almost a year for many of those folks. what we need to recognize that this goal is a call to action about how robust this whole

research has to be in order to have that steady flow of new medicines. it has to be higher than it is now. it's just not enough to keep steady flow. >> right in 2025 won't be the end. that's where we want to have something that's going to have an effect on the disease. >> thank you both. >> thank you. [applause] >> you can stay right there. i'm not going to let you go. as we chemounderscoring this morning across the country 5 million adults have alzheimer's, 15 million are shouldering care. feeding them, transporting them, paying medical bills making sure they don't waunder away and don't get lost. it's a heavy responsibility, one that dwayne johnson has been

undertaking for his 92-year-old for more than ten years and tiffany wrote about her experience and covers stories in the national journal last year. take it away. >> thank you. and welcome to you both. we -- i don't know how much you were able to hear back stage. we spent the last hour talking about research for a cure for alzheimer's, technology, early detectors, try to go -- trying to figure out how to prevent the disease. there's the race for the cure and then the figuring out how you help care for people who are suffering from the disease now and so dwayne and tiff --

tiffany, thank you so much. i would love to hear some of your stories. you wrote as a journalist. i want read something you wrote. i'm quoting lost too often in a discussion about the cure, more basic and more important question, how can we better care for those who suffer from the disease, and you go on dementia comes with staggering consequences but it's not the drugs and medical interventions that have the biggest price tag, it's the care that dementia patients may need. i know as you reported for the story noter national journey you learning very quickly medicaid

can help medicare often doesn't. can you give a sense of the landscape in terms of care options and how much people are getting. >> i think when i came became a care giver and what to do. my dad had been taking care of my aunt. when he became ill i took over. it's a very common experience. one parent has been the care giver and the other can't do it anymore. so i was shocked that, you know, medicare and medicaid really don't cover long-term care costs in the way that a lot of americans believe. i think there's a poll 40% americans over 40 don't realize that long-term care isn't covered by medicare.

we found ourselves in the middle. she wasn't technically to qualify, so she needed nurses at home or assisted living. we couldn't really afford the quality care that we wanted and there weren't a lot of public support. >> you described when your aunt jackie reached age 65, you breath of relief medicare is going to kick in. >> if she has alzheimer's now she's covered and the social worker said she needs help with bathing, dressing, she doesn't need ivs and so she kind of took

me through this, this is what this covers. here is what i'm thinking, we are going to be discharged in three days and i have no idea what i'm going to do with her. >> your moir is 92 and suffered from alzheimer's. >> i moved her up from jacksonville florida. >> okay. >> i got a call that your mother needs help. >> you were living here? >> yes. >> you had a home where she had another bedroom? >> right. >> she's been suffering for alzheimer's for ten years. >> yes. >> what is a typical day like for her what does she need? >> she needs minimal supervision. we know about different stages. she seems like she's still in stage one. i have to get her up but other

than that, she pretty much gets around pretty good. >> how does that work with your own work? you work a night shift? >> yeah. she has pcs services. >> what do they do with her? >> make sure takes medication, take her out now and then. >> in terms of what kind of help or guidance you have gotten from various federal agencies, health provider, tell us the process. >> i had endured everything myself. i got to be a little too much. my mom qualified for medicaid. >> you must have a network that

helps you too. >> family and friends chaurnlg, -- church, the community. >> for you you described you tried to work full-time your aunt was in south carolina. tell us about the moment, she's going to be released from the hospital and you don't know what to do. >> yeah, on my father's side it was just my dad and my mom. i thought this is it. am i going to quit my job. and you think all of that could disappear in a moment if i'm going to be a full-time care giver. who is going to pay for all the needs if i do quit my job? when you're in 40s 50s trying

to decide. when we were in the hospital, i thought i need to get her some where safe. i'll fig year -- figure out the money situation later. you're in survival-mode. she might get too sick for you to keep her at home. what are we going to do then? a crisis point where he he was hospitalized. >> you made a decision and difficult one to put her in an assisted facility. you're just heading up in terms of costs from there. >> definitely. one of the things i found at

least with quality care, i think the assisted living facilities, there are some that really specialize in dementia. the first one was based on price. the price is much lest than -- less than some of the others. people talk about the roler board generation. i sent my cousin, mom aunt on the other side of the family, can you go over to make sure she's okay, do i need to go home. it takes a toll even though you're not doing the actual physical labor. >> dwayne, you watched your mother for ten years and helped her through the disease where are you getting the information from in terms of what resources you have, in terms of knowing

there's a helper that can come during the day and keep an eye on her? i can imagine you don't have enough time. >> when i moved my mom up the social services, asking them what was available and what i needed to do. >> walking into the office? >> just like that. joined a support group. that's how i learned to maneuver and get the thing that is -- things that she needed. >> is there something that you needed to know that you now know that you didn't then? >> i thought i had to do it all myself and i realized that i couldn't. it became too much. start the ball role with social services with my neighbors

support groups. >> you described tiff -- tiffany what what you needed most was access, oklahoma if the doctor, nurse, social worker, some where where i'm not taking this on myself. >> in terms of i wished my dad had known sooner. i wish that i had done the research. you know, and then when you're put in that survival mode and try toing to make a decision, you kind of want a point person to say, this is where you need to go, this is who you need to call, this is a person that can help you with the benefits. i think that too often -- i think there's a gap in their

knowledge about alzheimer's and resources. they're busy and don't have time to walk you through things. >> you sound like you didn't know some things that were useful to know that she was eligible to military benefits. that would have gone a long way toward assisted living and even -- medical care. it's a whole lot cheaper than farm -- farm >> how was that for you what would have been useful? what would still be useful as you try to balance your own life and try to take care of your

mom? >> a little more proactive. i'm coming from my situation having to ask the right questions and hopefully pushes the process along. when my mom here is where you go and need to do. >> more information earlier without having -- >> for sure. you get information from a lot of different places. if the social worker didn't have time -- it was a bit of a rough process. >> questions if our -- from our audience. i'm assuming that a lot of us are dealing with or have dealt with our own families. any questions for the care

givers or the challenges or anything that might be useful? mic come to go you over there. >> and -- andrew carl, i specialize in nana technology, it's technology for your grandma. but what we are hearing is people don't know that it's out there. i develop a gps shoe, it goes in your shoe, track you and locate your mom within 3 feet, anywhere in the planet where there's reception. we know that there's technologies out there that can help. we need to know what the -- about the things that are out there. if we can locate them, 60% of them get lost. number one stress is fare of

their loved one getting lost. so everybody is losing here. i just want care givers and audience that you can be looking at technologies, not just gps shoes, door alerts, these kinds of things. so there might be questions but i just want to put it out there that this is the stuff that we can put out there technology is one of the answers. >> thank you great point about how very simple technology in tracker in the shoe -- i could use that for my toddler as well. [laughs] >> another question. yes, ma'am. i want to make sure everybody can hear your question. there you go. right in front of you.

>> hi, i'm just curious if there's a care giver.org or or.com blogger, has a list of how to proceed. i mean, when i went through the cancer i tried to navigate the process was just crazy by myself. finding a navigator it seems so key in something that i experienced with my father, if there was a way to centralized the result and by state by locate points of call, maybe it

can be. >> thank you. i don't know if you want to respond to that. i was struck by something you said that i think raised -- just knowing which questions to ask somebody may have the answers when you're coping with it trying to figure out which question to ask to get help, it can be a challenge in and of itself. >> that's why a support group is so helpful. that really helped a lot. >> lets see. right here. >> i work with home care.com. i find it striking that we kicked off kind of talking about the business of alzheimer's we shift to scientists, we are talking about what's going on in the community, when we talk

about tools and things that are available for caregivers no one up here talking about what tools are available we're training 2,000 caregivers in the mid-atlantic. a third of the families are dealing with alzheimer's families. we're looking for tools so that we can better train our care givers in dealing with dementia and alzheimer's. there's really no place -- we have have searched on the internet looking for the latest tools be it how to interact with people with then shea, how -- dementia, how to create familiar surroundings. i'm interested in learning tools so i can help out people like these people. it's not as obvious right now.

>> so specifics in terms of tools for care givers. thank you. >> yes, good morning. sandra charles. as i was listening to the discussion several things surged in my mind. one person is talking about giving care at home and one person is to utilize what's out there in the community. some of the caregivers we'll need to focus on as well as those who work in the facilities to see how they're paid, how they're trained and jobs that they do. if we don't it's hard to recruit the people in those situations and require a rate at

which they're paid. there's a whole idea of assisted living. it's not a very well regulated -- it's not regulated really. not particularly for those. they do vary a lot fr. the point -- from the point of view of education and awareness for the disease itself, there's a lot that could be done. so you wouldn't be so surprised that medicare doesn't take care of long-term care. medicare has been used for but it was not what it was intended for. >> thank you. i know that's something that you observed firsthand as you watched your hand in assisted living and various facilities. people don't have the training. >> i think what we thought -- i felt like the nurses in the aid that we were working were amazing in so many ways.

they were overworked and made barely over minimum wage. i felt like it was the structure that had issues in the given training and charging so much. clearly that wasn't going to the staff. it is definitely a justice issue there that i felt strongly about. >> do you feel like your mother is safe when you're not at home? >> yes, i do. by keeping my mom home, what they call a person care assistant coming to the home, i asked if they dealt with anybody with alzheimer's and dementia, a lot of them didn't. how do you teach a person to redirect if my mother gets

agitated? how do you -- a way to communicate with people with dementia. there's resource in the page. i try to tell them her personality, what he likes so they know about her. exactly. you just have to be around people. resources available in websites. all the organizations have about how to do it. >> i'm chris i'm the local chapter president of the alzheimer's association and we do -- we think we do a lot of work trying to reach out to people. we pay for advertising. but i'm wondering if you can recommend -- it sounds like we're not doing enough we're missing it a little bit in

having people find us. we are not hinding -- hiding but if you can recommend ways that we could be more helpful in being found. >> i definitely thought that alzheimer's organization had lots of information. everything is so different by state. but i also felt like there was one clearing house these are all, medicaid, nursing programs, different aid programs. those are so state and county specific sometimes. it was hard to find that information. >> i would recommend maybe also reach out to the different --

district of columbia. maybe you can look up with them so people would know. >> okay. tiffany and dwayne thank you very much for sharing. [applause] >> thank you tiffany and dwayne. in answer to some of the questions that emerged i'm sitting with one of the leaders of the alzheimer's association in fact, they have a 24-hotline that's available by people by phone, e-mail and resources to that state or community. we are noting that. we keep talking about the millions of people affected, whether the people with the disease, caregivers, hundreds of billions of dollars with costs the emotional impact. so clearly the strain on the system is just going to get worst and is by all accounts the

foremost policy out there. both believe that a coordinated approach is essential. she's a republican. she's going to be with us in a moment. first i want to welcome illinois democrat leading to fund biomedical. joining him the editor at large. >> thank you. hi everybody. wake up. you all look really foolish but we're going to have some fun here. i know it's been a long intense morning. glad to be with you. we're going to be joined by the other great political leaders policy leaders people that are

thinking deeply about challenges the people are facing. i wanted to start out, we were just talking about animal house. how many have you seen animal house? this is the guy -- you kind of graduated beyond it. you're living alone. has anyone bought the rights to living alone? >> no section -- sex or violence. >> i think it could be fun. there's a story there. atlantic cover story. investment in health science investment in making the nation a healthier place. is you more than anyone took an angle, the lack, deficit in spending has strategic consequences in the united states. i would like you to take us on

that path. >> an early experience in the house, a fellow man porter from the district of illinois joined up with tom all in the inspector. they did it. i thought to myself, that is an extraordinary feed. i meet with dr. colins, which i think is one of the best. i said i can't do. what can i do? he said 5% real growth a year in ten years and i'll line up the score board. let me tell you what happens if i don't. if we continue to fall behind as we have in the last ten years when it comes to research, i won't be able to recruit young researchers. they are dropping off. they lost faith in the federal

commitment to biomedical research. many countries around the world are going to seize the leadership. china, others. not that there's anything wrong with scientific advancement. but from a selfish point of view biomedical in this country is a dramatic force for economic growth. so i introduced the american cures act and the notion behind it 5% a year growth for ten years. nih, bia, department of defense. there's another piece of the story i might as well add. i had breakfast with the secretary and i told him this. what do you think the folks get

the technology they need for diagnosis? the department of energy. so that's what the motivation was. >> when you mention china increasing the area of rnd. throw the government behind that and we are walking away from that. how would you rate our -- i know -- i worry. >> it turns out that if you stick with it, this is one of those amazing political issues. i've gone to extraordinarily

conservative republican colleagues and said, test it go into the most conservative audience you can and say lets talk for a few moments about biomedical research and see what happens. every single one of us knows how vulnerable we are. the as a vulnerablability of our family urges to spare lives. before you reach the dollar sign it's a very human element. more and more from the conservative republican party are joining me. lindsey and i have a lot of differences politically. susan colins and she is passion

ly committed. >> any luck with ted cruz? >> i haven't given up. [laughs] >> conservative and so forth. just kept at it. look what happened when he did his markup on the appropriations bill. he gave a bump of $2 million to mih which is more than 5%. it's 5% plus inflation. pretty darn good. better than the house better than the president. he did it at the expense of a lot of other good things in the bill. i'm not happy with the way he pushed it. he was sensitizeed to the need for medical research. i believe this crosses the spectrum. we have to reach the point where we take research, this is a

special consideration of the united states and its future. it's not going to be serving to the same basic control rules. >> last night steve had a quick interview. he talked about you were gym buddies. you used the gym as a huntingground to turn people over. who are some of the your targets that you might like to bring. was he lying -- or i go to the gym daily. >> he also said that you said that republicans go early and democrats go late. >> yes. i try to get there first at 5:30. i go there everyday for no obvious reason. [laughs] >> to relieve stress. either right before me or after me surgeon from wyoming.

we talk about these issues. there's an opportunity there. your guard is down when you're sweating to talk about some of the issues. i settled some big problems with my colleagues. i caught them in a vulnerable moment. approaching this issue on a human side makes a big difference and try to go -- try to go get beyond the dollars and cents. he and i met many times to talk about this issue too. this is reaching into so many families across america the alzheimer's challenge. we see what's coming. not only cost to the government but the cost of the families with what they're going through. i think there's ground for political coalition. >> sounds great. susan is going to be joining us mid-way through. she has targeted 2025 as the

target date that she thinks a an alzheimer's treatment should be targeted vital issue. and you have a different approach sort of looking at prevention and treatment. is there a different in time horizons? we had an incredible woman named stacy this morning. stacy basically raised $250 million. when you see that amount of money coming in from private sector scientific research, you look at technology, are we being too modest with the 250,000 target? would we be able to achieve more than what we have been able to achieve? we see a 1% decline on an annual

basis. politicians like to set target dates. it gives us some way to measure how we are doing. an honest answer is just we don't know. honest answer. did you see a fortune magazine about alzheimer's? it jumped right off the rack. it's promising. there have been promises before. it is promising. two different drugs two different approaches. what we know is for example when it comes to lili in chicago, lili virtually has a full-time office there trying to figure out how to mesh the drug with the protein. i do get it that there are certain things that we have

diagnostic tools i i can't remember exactly what it stands for, a computing translational science operation. they're now using computers to do millions of tests in a short period of time. the pace of discovery is almost impossible to predict. to set targets and hold politicians to targets that makes sense. i don't know if that's the right number or what, but i know that if we move toward targets we are not going to fall off and forget our responsibility. >> you know i heard you speak on so many topics. you're always passionate. i got an e-mail a while ago and i just -- this is going to be out of left field folks.

it has nothing to do with what we are talking about today. a car can be hacked remotely, most likely to kill somebody. it was hacked, this is a really sensational text where are entering, you know, throwing a bill on the autosafety act. it made me think that in your world to sustain interest in one topic must be so hard. we have a lot of folks today not only in the room coming to elevate on what's going on with alzheimer's research. tomorrow is hacking a car. i'm interested from inside what advise do you have for people who have been struggling for decades with such a traumatic

problem to sustain interest? it seems like a difficult challenge. yeah yeah. >> a man who worked and became head of motion picture association. he says, there's six words which i always put in a speech which i think make a difference and those six words are let me tell you a story and when it comes to my world of politics, i have to get beyond the numbers and statistics and tell you a story about a person affected by something. i found that to be the most dram -- dramatic way to bring stories to people. how many stories do we have in this room? thousands. what you need to do is make sure that your member of congress or trusted staffer hears those

stories and understand what it means to a family. when we debated obama care and i stood up in the streets in springfield, illinois with the tea party waging away. they finally said, stop telling stories. [laughs] >> i had them. let me tell you about the person who couldn't get insurance. stop telling stories. the point i'm getting to is no matter what the issue this one specially, the story of medical research has so many different chapters, make sure that member of congress understands one. i worked for years and still have on the dreamers trying to help hoes undocumented kids to the united states who brought up here. it's bipartisan. i recall sitting with kay bailey hutchison. would that help maría if we do it this way?

it was a story that she heard and remembered and brought her to the negotiating table so never stop telling the stories. >> you're a member of the bipartisan task force on alzheimer's disease, how many members are there? >> i can tell you i don't know the exact number but in excess of 40. when we had the budget resolution on floor i took all the medical research amendments and all the democrats and republicans, lets put all in one amendment. susan went along with it. she had the alzheimer's amendment specifically. we had 42 or 43 who cosponsored amendments when it came to medical research. that's the way it works. that's the way you build the coalition. >> what is going on? when you look at other chronic disease, heart disease, alzheimer's has got the

footprint and the costs are the highest, among the highest of all these. but the level of research dollars that the federal government spends is pa -- pathetic. what do you think is happening in the alzheimer's field to step up those numbers? >> that's a good question. i've asked it as long as i've been in the house and the senate. how do you pick your research projects? it's a deadly disease. it affects children. things like that. and by in large it's sounds like all of the above when you get right down to it. i don't know -- are you familiar with the program? medical diseases that we're

going after in this new partnership. that's a pretty good sign. this kind of directed-specific investment research may turn out to be more productive than other things. also understand when i talk about the source being so important to lili in developing it's so important to them, who would have guessed that was biomedical research. but it is. so what is there -- >> you talk about conservatives. i would imagine that would be very compelling. my family is from oklahoma and kansas. who is the opposition that needs to be taken down? >> the opposition is not specific. the opposition is not specific. let me give you an example.

my bill, the american cures act, over $10 billion. 150 billion, wow big sum of money. gets smaller when you put it in comparison. how are you going to pay for it? for the longest time i had this viking thing against tobacco. >> i knew that. [laughs] >> the fact that you face no smoking on planes. >> around of -- a round of applause. [applause] >> it pays for half that i just described to you. i went to a -- i'm not going to name names conservative republican senator who by this

-- i'm going to give it away. by his religious preference hates tobacco here is the thing, medical research, 5%. i'm with you. i'm with you. it's people who sign this pledge. >> even on tobacco. >> but your state and other states are doing this already. republican legislators and governors. i took the pledge. it isn't that people are oppose to science they are signing for restrictions of their powers as senators. i think you need to have the flexibility to make the right decision for america's future. >> do you think that attention from your perspective you have been talking about research,

there's also about living with this caretakers. i'm interested in what the affordable care act what is the social contract as you feel it between our government and civil society and those people living with this disease? does that come up in discussion? >> each of us -- i guess i'm going to tell you a story. each of us come to this with our life experience. if you have ever been a new father of a sick child and didn't have health insurance you'll never forget it as long as you live. i was one. i was a student. brand new wife and baby and no health insurance and my daughter had a problem and i set, leave my law school classes

and sit in a room with people who had no health insurance and waited to see who walked in the door. i was hoping whoever came through the door was a competent medical professional that would save my daughter's life. you will never forget that as long as you live. it's a basic right that we should establish in america. it shouldn't be a question of whether you're lucky or rich, it ought to be part of who we are as a nation. so when you get into this conversation about the rule of government, that's where i come from. it comes from a life experience. 16 million americans now have access to health insurance. the number of unsured down by 30%. [applause] >> the rate of growth is still an incline but it's flattening just enough to gets 3 more years of solvency to the medicare

system. this is working. it's transforming the delivery of medical services, and there are 16 million, i'd say 10 million praying that the right doctor walks in the door. >> i want to ask questions. i want to ask you one unfair question. >> that's a first. [laughs] >> if you were in the seat that president obama has, how would you deal with this political environment differently than he has? what would you do that he's not? what needles would you move that he has not? how would you deal with the task of making the nation healthier? >> i think he will be remembered by the act having surviving challenges in the supreme court. all the things we went through

there. i believe this is going to be right one and two in terms of legacy but we still have a year and a half to go. good question. i really encouraged him to take the american cures act and make it part of his presidential platform or budget but he is moving in more research. he's a great communicator, i would hope that he spends more time on this medical research issue. >> good answer. who is it? senator colins. [laughs] >> come on in. come join our living room here. [applause]

>> thank you for joining us. how about we mix it up. we're going to get rid of him. he said such nice things about you. let me just take a couple of quick questions for senator because he needs to run off. do we have a microphone? can we toss it over fast? how are you? >> fine. >> i am on both sides of helping the alzheimer's association raise money but i'm also a care giver to my father that is 88 and has alzheimer's. my challenge is we are raising money, i think it's wonderful for research. i want to be able that my father live a life of dignity. where does the money come from and how do we get the different

nursing homes and care facilities and in-home care to meet the requirements to continue to treat people with dignity because i feel that as we've been talking to the other caregivers, that that's one of the things -- there's no standard and high turnover in rate. ..

there's no better advocate in the united states said ben dick durbin for biomedical research, and it's been a great pleasure to work with you in congress come an issue both of us care so much about. just a week ago senator baldwin and i introduced a national caregivers act. and the reason that we did so is exactly to answer some of the concerns that you just raised. we are spending $225 billion on caring for people with alzheimer's. the majority of that is for uncompensated care that exhausted family members are

giving. frequently and elderly spouse. and we don't have a strategy for trying to ensure that caregivers have the support that they need whether it's respite care whether it's home health care whether its support groups. and that's what our bill is aimed at. it is modeled on a national alzheimer's plan act which i co-authored with former senator evan bayh, and that has produced a national strategy for alzheimer's. because brought together all the federal agencies and its most important recommendation has to do with the appropriate level of funding for biomedical research. >> let me get this gentleman right here. >> stuart rosenthal. senator, i commend your

legislation to bring more money to federal research and i think there will be a breakthrough in the next few years. my question is are asking have to pay for it. why is it when the government developed these kinds of basic research things that the drug companies pay for little in terms of license fees and they give no break to medicare on the cost and they are ultimately provided to -- >> there's a reason why farm should me more. investment they're making his modest, modest in terms of real dollars. we hope that even a modest investment will be to some public-private breakthrough here on alzheimer's. but i think there are places to turn that are not unreasonable and certainly pharma is large important but its revenues and resources such as that it could be part of the solution when it comes to medical research.

people benefit from this research but usually pharma will benefit first. they will develop new products. when i read this "fortune" magazine piece i sent a copy of a doctor francis collins and i said it never mentioned in h. once in the entire article. did you of anything to do with what's going on at biogen? he sent me a memo with 10 different elements of a basic research at nih led to these developing these new excremental drugs. so there is a linkage and i think engaging pharma in funding some of his research -- >> if i could we had a pre-session display with stacy whinger was the person who raised $217 million for this first round working on neural degenerative research. what interested me about the amount of money which is very large is one-third of the entire budget up with a six under 66 monday put in but when you talk to her about this funding gap

between those in the lead to develop innovative research and getting to market those who invest earlier usually wiped out in what equity is diluted. there's a structural bridge that's not being met by most. to just say that farm should do that doesn't necessarily think that the incentive problem. >> i'm not saying do it alone that they would be an in this would be important to make sense from their business model. but i really viewed this will research question not just biomedical research by present research to be the kind of commitment and america needs to invest 21st century. look at our competition. they did it. what china is doing a in -- >> china fills the bridge with a lot of concrete. >> they see this coming. they want to be dominant. but what the 21st to be the tiny center. we better wake up to this reality.

what we did in mapping the human genome products have been payback is 150 times over for every dollar spent. and it will continue. it is economic driver, not just -- >> did you want to comment? >> yes. i just want to encourage us to look at this in a broader way. alzheimer's is our nation's costliest disease. it is going to bankrupt medicare and medicaid if we do not advance the research. the alzheimer's association has said that if we could delay the onset by even five years, it pays for the increase in research. so i think this is one of those issues where we are looking at it far too narrowly.

because if you look at alzheimer's as our cost is disease, if you look at the return on investment, if you look at this and only we are going to be facing just because of the changing demographics of our country we can't avoid not to make this investment. [applause] >> yes, waiting for senator durbin? okay. senator durbin, thank you so much for coming. thank you so much. [applause] >> great to see you, dick. remember arguing about the rights on your living alone. i think there's a story there. we were just talking attending from animal house into his own place. and the the subsequent about a sort

of daily routine. we were talking about last night's, steve had done an interview with chuck schumer and he talked a little bit but is going to the gym with dick come and they would target republicans at the gym to sort of cities over to whatever legislative and they had. do you work that way yourself? [laughter] >> i of course have a far more direct approach. i just bring people facts and then badger them until they agree with me. [laughter] >> i spent much of last light reading about the point the things you have done, not on alzheimer's research but in aging and aging in place. i was just reading tweets of yours on diabetes and the whole brought to me that he think about designing homes differently for the aging. you must know more about the subject than any other colleagues. i'm convinced that that's the

case. would you say that's the case? >> no, i wouldn't be that presumptuous. >> you have invested heavily. what has driven that? >> i have. first of all had the privilege of sharing the aging committee so it's my responsibility. >> you wanted that job. >> absolutely. i represent the state with the oldest median age in the country. >> if you're the youngest median age you wouldn't do this? >> no, i would still do it but that is an added incentive. but also but also i meet constituents every day including members of my own family who are struggling with the issues of one of the questioners brought up. name is a low income state. we have a lot of rural elderly -- main. who have moved away.

we need to figure out a way to make sure that their needs are met. the statistics on alzheimer's are really a call to action for all of us. what we are learning from experts is by 85, and many of us are going to live until at least 85, nearly one out of two of us will develop alzheimer's or some other kind of dementia. and the other ones will be taking care of that person. so to me that's a real call to action. >> are people hearing it? >> finally, due to great advocacy and to some of the stigma which i've never understood that's been connected with alzheimer's. >> what's with the stigma thing? >> i don't know. i don't understand it. i grew up in an era where people

didn't say that they had cancer. it would be whispers that she had a big see. i didn't understand that either. with alzheimer's there's been for some reason this desire to keep it hidden within families. and i think that's really changed and that's what has helped us make progress. as dick may have already said we made tremendous progress in the appropriations bill this year. we've only been funding alzheimer's at the highest level it's been about $600 million. this is for a disease that costs our society as a whole $226 billion, 153 billion just have to medicare and medicaid. and get we are only investing 600 million. this year we've got a 60%

increase in the senate version of the appropriations bill to bring us up to 950 million. we should be at 2 billion. that would be, that's what the experts tell us. that would still be less than 1% of what we are spending, but the huge progress to have a 60% increase. >> dick durbin was sharing with us i asked him at a different inflection point in technology and history, and he was pretty modest because i was sort of looking at his target for giving entry with alzheimer's a 2050 and use of 2025 you got your colleagues to basically passed something think this is a vital national priority and you can't wait i vital national priority. let's move of the day. it occurs to me you served in the senate for 18 years. i think that 18 years ago we didn't have gadgets like this. we didn't have all of the embedded sensors, the wearables

all of the data management and we see happening today. do you feel in your long service to the country that all the stuff you sit inside the center of the "wizard of oz." do you do you see in the crystal ball something very different and the next six to 10 years? >> i do. >> tell us why. what are your benchmarks? >> because i've talked to so many researchers, i spent a fascinating two hours at mass. general one day with a top alzheimer's research, and they are making real progress. it takes money. it takes money. but no matter where you look whether it's jackson labs in bar harbor maine or mass general of university of pennsylvania, all across the united states they

are finally -- therefore it is a focus on alzheimer's in a way that leaves me very optimistic that we either going to find more effective treatments that will probably come first but ultimately either prevention for a cure. it's the only one of the top 10 most deadly diseases for which we don't have -- >> so -- >> and choose what makes the optimistic. when hiv/aids came on the same we really invested and focused like a laser. and look at the breakthroughs that we have made in treatment of people with hiv/aids. it's just amazing and could happen if you think about it really pretty quickly. but it was because there was

this constant -- concentrated effort and national strategy and investment. we still spend $3 billion a year on hiv/aids, compared to the meager 600 million since i hope to be 950 million for alzheimer's. so to me that shows the effectiveness of the concentrated effort. >> i had a wonderful conversation with a will but i just mentioned who raised all this money for biomedical company called denali. she said she was sort of sick of mice and which we face is that in mice we can show that we have cured mice of alzheimer's of the translated the of that to what we did with is limited and if so many problems and should make you really interesting points was the statement the stigma is

limiting those people willing to step forward given the population of affinity. she said hundreds of thousands of people is what they ideally within over a period of time. and the second is we have ridiculously low tolerance for risk in the alzheimer's area. if you're having a heart transplant, hard about procedure or having other procedures in which the risks are high, people taken. but in alzheimer's there seems to be a barrier. have you thought about that dimension of both risk and population both? >> i have. one of the things that we held on alzheimer's, we had the smith, the restauranteur model can testify. and she sadly has early onset alzheimer's. one of the wonderful things that she has done is to public service announcement reaching

out to african-americans in particular because they are not participating in clinical trials. she is encouraging their participation in clinical trials. i've had members of my own family anticipate in a very unsuccessful clinical trial for alzheimer's. but we need people to think not only about themselves but the next generation. yesterday i met with some constituents who are struggling with early onset alzheimer's, which is the saddest times of alzheimer's and there are genes that have no been identified for early onset so that you can get tested for it. and they talked about the dilemma of their 29 year old daughter who is about to get

married, and she can't decide whether to get tested or not. she can't decide whether she wants to have children or not because she feels if he doesn't get tested she shouldn't have children. that's a horrible dilemma for someone to be in. and i think it causes people when there isn't an effective treatment for a cure to be hesitant about getting tested for genetic markers. because they think nothing can be done, do i really want to know? and i think that the more that we can get people to participate in testing and clinical trials the more we will know and the sooner we will get to -- [inaudible] >> absolutely. i think also though helping

people understand the benefit for the next generation. >> i was thinking about the senator one of the things you think about pete domenici stepped forward on brain research and is a difficulties, former senator dimension is what i have the privilege to know well in the 1990s. but when i think back and you go back and look at a number of senators who have passed, a number of them likely had alzheimer's but not reported that people hated it. they didn't talk about it. it wasn't disclosed but i know some cases. the senate is like a family after certain breed of time whether you like -- sometimes unwanted family. [laughter] but they are family nonetheless and you think more of those stories propagated and efforts enough for people to come out with their stories?

would that be healthy think of other people around the country do something you're talking about? >> it would be. i don't have a person i so greatly admire is maria shriver who has been very vocal about her father's fight with alzheimer's. and i remember when she testified. it was so poignant because she said that he remembered every word of hail mary, the prayer that we catholics say come and yet couldn't remember her name. .com when i heard that it was so heartbreaking. but having people like b. smith like maria come forward and tell their personal stories, their families stores is very important. but it's very hard because sometimes those family members still want it not to be known.

part of our job is to do more forms like this than to encourage people, particularly celebrities to tell their story. we had glen campbell come and testify before us. and that was wonderful. he played some of his music for me before going on with his daughter's help. and music have stayed with him and i seem to with members of my family struggle with alzheimer's, that music seems to still stay within. >> i don't of alzheimer's is part of the, you would richard. after playing an older man who is homeless as well. so there's an element of homelessness being lost nothing connected as part of this as well. so working through those celebrities helped to broaden of the story. let me ask you a couple of unfair questions. to be honest there's probably some democrats who are not big

on science but there seems to be a lot more in your party last [laughter] >> that's not right. >> i exit the. my point is science ago, the solvency aside from the investment in science, the belief that science can deliver something they're, it seems the point of contention with some of your colleagues. is about to? is there a way to bring overcome dick durbin was talk about going and taking the most conservative members of the caucus, i know he wanted to see anti-science but he didn't, taking and to talk about biomedical research with your constituents and you will see them come alive. i'm interested in this debate about science and health benefits that have whether it that is the challenge for you with your colleagues and your caucus? >> the best answer i can give you is the republicans are in

control of the senate and for the first time ever we've had a 60% increase in alzheimer's funding. [applause] >> a very good answer. so who is coming to make such a compelling case about the footprint of this problem about really a national security issue for the nation, lease on the domestic front. dick durbin talked about it being a area strategic necessity. what's the problem and bring more colleagues on more quickly? what is the barrier? what i get distracted from? >> there are a lot of serious diseases in this country and it took a while to get a focus on cancer research, which we spend $5.4 billion on a year and it's

paid dividends. i think we need to look at the successful investments in cancer research, and hiv/aids, in cardiovascular disease. there's not an awareness of the prevalence of alzheimer's. that's partially because people used to die earlier and also remember when it was people would say she's just got see now. remember that term? and people didn't realize that alzheimer's was a disease. they thought it was just something that happened as people got older. so that's why i commend all the advocacy groups can the alzheimer's association and in many alzheimer's u.s. against alzheimer's come alzheimer's cures, and all these groups. because raising public awareness

is absolutely critical to getting the kind of support that we need and that has been there for other diseases that have organized powerful advocacy groups that are willing to speak out. that's what we need to do. but it's changing. i've been the chair of the alzheimer's task force in the senate four years. secretary clinton was my first co-chair. i've always made it bipartisan. it's been quite a while because in the senate, and so back then it was really difficult to get people interested. now i have people clamoring to be the co-chair. now senator warner is the co-chair. senator toomey is a co-chair. senator markey is co-chair. that's the real difference.

that matters in terms of our ability to bring bipartisan efforts. >> you mentioned hillary clinton. we are entering a political season at about and what you know is running for president. [laughter] do you think there's a chance to dish i don't know donald trump. i want that on the record. [laughter] [applause] >> but do you think there's a responsible way to elevate something like alzheimer's research into presidential and we seem to be talking about a lot of silly stuff works is there a chance to bring some of these health issues into broader discussion speak with yes. let me give you a great example. jeb bush calls me and asks for my support. i am endorsing jeb bush but i took the opportunity to talk to him about alzheimer's disease

spirit i just want to say for those of you tweeting, that is a readable moment. jeb bush is out there i would link to him and ask jeb bush to comment. >> and here's the good thing. just a few weeks later he talked publicly about alzheimer's disease, about his mother in laws now with alzheimer's and the need for more investment. so see it works. [laughter] but in all seriousness, regardless of who you're supporting for president, ask them what is the position of alzheimer's. encourage them to make it part of their hud form, their agenda, and pushes them to speak publicly about it. that's what we need. it worked in my case.

>> that's greater than they go to the audience in a moment. the other thing you spent a lot of time thinking about which hasn't really entered our national discussion as much as is aging in place to i'm interested in how you think about that. what do you think we as a country need to get right in that everybody. what are the google things that we should try to check off the box? is beginning to percolate is not widely discussed. >> i'm going to get my parents quit on this. when they built their house two-story house in 1957 they were smart enough to put a master bedroom and bathroom on the first floor. and i'm one of six children, and they closed off the top floor. they left one as a guest bedroom when they come visit but i cannot imagine how they had the foresight act in 1957 to think about their ability to climb

stairs. and when my father had his knees replaced, 11 year and one index, it wasn't an issue for them. i happen to broken my ankle last december and the house i live in, thank goodness, has one of those automatic chairs that goes up a back staircase. little what i'd guess that i was going to be the one to use it. but it was going to the university of maine which has a whole program to the people age in place. they went out to assisted-living houses places, and in it he seniors. they interviewed 50 seniors and said what do you need? it wasn't just bears by any stretch.

it was census, all sorts of indicators where they could be connected to their loved ones. i've what you they were privacy issues that have to be dealt with. but we are a long ways from the old iphone and i can't get a medical alert button. -- you could redesign living spaces and renovate living spaces so that they would be a sense of if he didn't close the refrigerator door or if you left the stove on or just better pathways through your house if you are losing your vision through macular degeneration. so it's a really exciting area,

and let's face it. most of us want to stay in the comfort, security, and privacy of her own homes. we've got to do a better job using technology to make that possible. the are also huge cost benefits to be able to live in your own home. residing on this issue. we had someone come in who compared the cost of institutionalized care in a nursing home versus redesigning and putting sensors that would allow better connection to an adult child. it was wonderful. >> i was talking to amy klobuchar are about you and she said there's just no one who knows this world but i can't imagine anyone telling you don't have to ask you to work on a bill to that they opened the floor to our guest. this is -- desktop right in front. we will get you a microphone.

>> i'm with next avenue. yesterday had a nice conversation with dr. david satcher, the former surgeon general. he was a member of the alzheimer's study group which came out in 2009 with the report that was supposed to be a wakeup call, a call about all the statistics that you mentioned and dr. jones mentioned that other people have mentioned. and i asked a question that steve just asked you, which was if all this is true inward facing this tsunami of cases and we have a fraction of the research money that's going to this case, why is it that? what's the problem? he doesn't know the answer but 130 s. and i would love to get your opinion is unlike hiv/aids, which more or less affected younger people his theory is

that one reason for the slow response is this disease unfortunately, affects older people. he also made the point that many of those older people who are afflicted with the disease don't vote. to what degree doesn't explain everything, but to what degree do you think it explains some of what's going on in terms of the slow response to the need for funding for alzheimer's? >> can i piggyback on that? with the self-awareness we're all going to have at some point about our own health friend our genetic makeup, i'm thinking of having my genes sequenced, it's about $1000, question whether the changes to stay cold and are not. if you 15 to 30 years before you were in that, doesn't change that? >> first i have to tell a story about doctor thatcher.

whom i got to know when i first came to the senate and he was surgeon general. it turned out that he has done an institute of medicine study with michael cole who practiced in maine for many years, and to us since died of alzheimer's. so i think the world of dr. thatcher. i don't agree with them in this case because any of you who have had a family member with alzheimer's note that it affects the entire family. it does not just affect the victim. it affects the grandchild whose name is no longer remembered it affects the spouse who's trying to deal with a husband and wife who for the first time is yelling at them. it affects everybody.

so having seen the very close up front and personal, i don't think it's because it's a disease of the elderly. i think it was because for years it was hidden or people died earlier, or it was well, she's seen it all. we didn't understand that it was a disease, even though that work had been done for years. but think of the difference. doctor john's wood county, the difference in the last five years on public awareness is remarkable. and the alzheimer's association brings those purple plaid advocates to town, i always have a hearing that the because it fills up the entire hearing room and it's important for people to

know it. i'm sorry you -- >> you answered my question by saying we are all in the gang. let me take one last question. right over here. >> i along with some of the people envision what you personally thank you senator collins, for everything you are doing. you just an amazing advocate. i also want to ask you and knocked it up a notch, harry johns this morning talked about presidential candidates. steve brought it up again but i'm wondering if in the words of jim pinkerton is a wonderful journalist, he said that we need to declare war worldwide war on alzheimer's. i'm wondering if they have worked with any foreign leaders or your other counterparts in trying to address this in a much more global way? >> excellent question, and the answer is yes.

great britain had an internationa i wasn't, but last year i was invited to it didn't speak at it. i desperately wanted to go but the senate scheduled, mike campaign schedule included me from doing so. but george has brought in people to meet with me internationally. because we do need an international approach. and we need to pull resource, resources and research. one issue i feel strongly about is that if you get federal funding for alzheimer's research, you should be required to share your results south back. >> not always. i don't pretend to be an expert on this but i'm told that some

of it it is proprietary if it's in conjunction with a pharmaceutical company which it often is. and, of course there's then you initiative also would there's modest, pretty modest investment from both sides. and that one is going to be published as i recall. but it seems to me that ought to be a minimum. but i agree we need an international approach. this problem is only going to grow worse across the world. there are countries like in western europe and japan with a population is aging. that should be particularly interested in a collaborative approach. >> i would just say in closing this last point about the sharing of data of research, as long as the privacy issues are worried about come in the

atlantic many forms and health care to its the single thing that comes up the most whether hospital to hospital. we did a thing prevent several cancer researchers from harvard sank we don't share in the way the sugar davos a the absence of protocols and commitment to shareware product is the biggest inhibitor. everybody says it's getting better but not should be what it should be. i would've wished that last comment. susan, thank you so much for joining us. ladies and gentlemen susan collins. thethey also have senator from maine. good to see you. [applause] >> senator thank you, steve. this has been a remarkable morning. we talked about the critical topic of the economic and emotional costs of caring. before you leave today i have one request, which is in your e-mail you have for me a survey

about today. we would love your feedback on your experience. is also a hard copy implement the i want to thank steve and mary louise are monitoring. -- moderated giunta thank all our speakers dr. johns and alzheimer's association for supporting this important conversation. even if one of audience engaged. thank you so much. give yourselves a round of applause. [applause] and have a wonderful, wonderful day. [inaudible conversations]

>> earlier today during a senate foreign relations committee hearing on human trafficking chairman bob corker and democrats ben cardin had comments on the iran nuclear deal and yesterday's speech by president obama. >> the white house had a veto threat against us weighing in on the iran deal veto threat. up until an hour and a half before that vote took place. because they did not want a

public debate on having. the committee chose otherwise. we passed it out on a boat to everyone who voted for it. but they did not want the issue debated. what the president did yesterday by saying that senator cardin ranking member velazquez to about the iran deal senator menendez who has questions about the iran deal. by the way both of which vote against the iraq war if i remember correctly senator johnson who has concerns about the iran deal. we are being compared to the hardliners in iran because we have concerns. concerns that we are trying to have answered the just a few months ago the president publicly was talking about what a thoughtful and civil person i

was. i have to get the quote someplace, but now because i have concerns, and i think everyone has concerns and people have to make a decision that this is going to be one of the toughest decisions. but he's trying to shut down debate by saying those who have questions, legitimate questions legitimate questions are somehow unpatriotic, or some have compared to hardliners. and again is to shut down debate, is to make this about something other than arguing it on the merits of either i'm very disappointed. i'm senator cardin was beating with the president last that i do want to say i wish richard binder last night to hear, to hear the discussion about parchin at wendy sherman said yesterday and thinking she would come share with us how parchin that arrangement was working.

i called her early this morning to ask her if she would at least at a minimum let us have her notes of when she was briefed by the iaea. and i'm beginning to believe that one of the reasons they do not want people to know it's not about iran's confidentiality. i don't think it would stand the test of late-night comedy if people understood how parchin thing was being done. so i just hope that today we thank sarah sewall for being here, the fact that we have concerns about trafficking. that begins on a unanimous vote. we voted to end modern slavery in this world, that somehow we will not be viewed as people who are unpatriotic. be viewed as some other people are not serious about this issue

spirit first, thank you for convening this hearing. in regards to your opening comments i want you to know i think you are a continued and always have been a thoughtful principled person but i want you to know that and i respect greatly your leadership on this committee in the matter we been able to work together. >> hopefully if i disagree with you once you will not compare me to the hardliners in iran. >> that's -- i want to i'm still going through the review process. i have not reached a decision on a boat that will take place when we return in september. i want to underscore a point that senator corker and by working with our leadership encouraged our leadership to provide for the debate on the floor of the united states said that we think is befitting this critical issue.

so yesterday without any objection we moved on to the bill. when we come back on tuesday we will not have to go through september, new mexico three cloture vote, not go through any procedure hurdle to we will will be on the belt at that point i suspect the majority leader will put forward a bill that will be voted on and will be ready on that debate at each member of the senate make up his or her mind as to what he or she thinks is in the best interest of this country. i did not entry from the president's remarks at his challenge in a part independent judgments on this. you are correct. i voted against the iraq war. i do not see a comparison between this vote on the iraq vote. interesting thing just to make a sidebar on this. i voted against the authorization for use of force in iraq. and in my district, congressional district, not state at the time it was overwhelmingly unpopular,

overwhelmingly. it was not a close call. and it was one of the most consequential votes that i cast my career in the house. and it was interpreted to impact on my reelection. this is not the case when it comes to this vote. there are divided views. this is not a clue situation withwith the popular. is support the president or a post depression. there are strong views on both sides, don't get me wrong, and that was a clear use that we're going to go for force here. we are not authorizing the use of force but i disagree with the president and trepidation on the issue. having said that i don't disagree with the president's strong statement. he is clearly doing what we expect the president of the united states to do, to strengthen his position and

taking the case to the american people as i expected would. i don't join my good friend and principled leader in the interpretation of the president's remarks. >> this weekend on the c-span networks politics, books and american history.

>> you can watch the entire hearing on our website at c-span.org as well as read the iran nuclear agreement. today's senate foreign relations committee hearing will also read air tonight on the c-span networks.

>> next the threat of foreign fighters from europe and the u.s. traveled to syria and iraq to join isis and other militant groups. academics from the uk, spain and the u.s. discuss the motivations online recruitment techniques the differences among european and american law enforcement strategies and the dangers fighters pose when they return to their home country. george washington university posted this forum. >> good morning. if i could welcome everyone to george washington university. thank you for joining us today. let me all so welcome our viewers watching at home at c-span. obviously, this is a timely set of topics and couldn't think of three but of people anywhere to shed some light on the foreign fighter challenge. clearly is not a new phenomena but in terms of scale and scope

it is unprecedented. the numbers are staggering. the numbers continue to grow. and the various forms in which it takes is relatively new. we did a major study on this for about five years ago and at that time it was a challenge but by no means in terms of the scope we are dealing with today. we were looking largely at americans in the somali diaspora in particular joining up with al-shabaab and also dozens at the highest point of americans joining up with the talibans and al-qaeda and we saw al-qaeda in the arabian peninsula in terms of human. but those numbers -- yemen. those numbers are dwarfed by what we're seeing today. import enabled by technology, in part enabled by ease of travel,

and in part enabled by other motives which we will learn much more about. i have the privilege also of introducing for the first public session lorenzo vidino, lorenzo is leading a new program on extremism. he is an amazing scholar who has looked at counterterrorism issues or a very long time. he's not only studied in the united states and shared his insights from the u.s. perspective but also overseas. it is absolutely critical to be able to learn the lessons from other and also to be able to share some of the best practices to make sure that all of our countries can better address these issues. thrilled to have lorenzo with us. we also were able to lower a way is a deputy from the national counterterrorism center who has

been phenomenal work in this space. prevent duplicate a quick snapshot on the u.s. challenge in terms of scale, scope and trajectories and wondered if we need to be thinking about. following lorenzo, i have the privilege of looking at good friend of mine peter neumann, who has done groundbreaking work on the foreign fighter challenge in the uk which has been directing for how long now peter? for seven years. peter velits in germany but has been living in the uk and has been one of the go to guy's on all things national security counterterrorism and has done some phenomenal in berkeley-based research and also policy related research. last but not least delighted to also welcome fernando not only

the fourth phenomenon in spain but also more generally speaking counterterrorism. so bottom line here you're not going to get three better scholar practitioners shedding light on this issue. at our hope with all of our events is to shed more light than heat on the topic and it is a lot of fun and it is a lot of heat. some couldn't turn it over to you, lorenzo, to kick us off. so thank you. >> thank you very much frank. it's a real pleasure to thank you all for coming. this is a wonderful turnout. we were reluctant to have an event on a friday morning, almost august. i have to say peter was more optimistic about the turnout. the star power and we got here from peter and fernando public health is to have a wonderful turnout. so thank you very much for coming. it's a pleasure to have what is the first event, the program i

had the pleasure to direct your at the center for homeland security. so the first event on such an important topic with wonderful colleagues and personal friends. it's really important for us. so thank you all for coming. we are here to discuss the dynamic that is that you basically every country on the planet. we see countries and regions that have been affected by dynamics of foreign fighters, are seeing even small numbers of their citizens can of residence going to syria, went to iraq despite also going to libya and other places to join isis and isis affiliate groups. as we said frank is not first time, not a new phenomena but it dates back to the early 80s at least but the numbers are great pick up a look at it from a comparison point of view we are here to talk about the u.s. and

european perspective of this. the numbers are allegedly the first big difference between the two sides of the ocean. european numbers of foreign fighters and of course, the problems in the empirically determine the numbers and find the correct numbers, peter has done groundbreaking work to try to determine that but it's extremely public effort with law enforcement intelligence agencies have a problem with it. foreign fighters numbers are much, much higher than american foreign fighters. size of the public is completely different. if we're looking at a european setting we see countries like france with an estimated 1200 individuals. germany, the uk and the six 700. even smaller companies -- countries like 600. kosovo, very tiny country three, 400 individuals. these are completely different numbers from the u.s. where the

latest numbers even by the government, given by the fbi, talking 200 individuals who would be the traveled or attempted to travel to syria. so we are talking about and much, much number because a lot of people have been intercepted. so people who went and fought their, that 200 number should be further reduced. i think the numbers are also deceiving from another perspective is that here in the u.s. that are legal tools are more in general a certain attitude for law enforcement which is more aggressive than in most european countries. a lot of the very effective tactics the fbi uses are not really used in europe. i would say they skew the numbers synthetically. i would probably suspect of any european law enforcement agency were to use those tactics the numbers of people there would sky rocket, completely

different. why are the numbers so different between europe and the u.s.? i don't think there's just one explanation but i think the combination of factors. the first with his logistical difficulties are duplicate from europe is easy to reach turkey and then eventually syria. some people call it an easyjet jihad from the local airline. it takes 100 euros usually in the morning, from any touch as you'll need a passport. you just need to identity card and to reach the turkish border with cedar key. it is slightly more complicated and more expensive from the united states. there's a second reason that has to do with the fact that india's we do not see the recruiting networks that we see in europe. i'm not saying completely nonexistent in the u.s. but i think in europe we have significantly more established and sophisticated structures of recruiting networks that do not

exist in the united states the event of the internet, social media to some degree substitute itself recruiting networks. a lot of people would argue that it doesn't completely substitute the face-to-face interaction. you did not join isis just buy an online interaction with somebody. it does happen in some cases but in the vast majority of cases you join isis and other groups because you have some personal connection to someone who has connection affair. ..

>> are significantly higher than in the united states. we do not see in the united states the groups oldest groups that have been instrumental in european setting in radicalizing and mobilizing a lot of people from syria. we barely see them in the united states. we actually do not see them in many cases. the number are a significant difference. there are a lot of differences in terms of dynamics between the two sides of the ocean. in europe, i'm simplifying things a lot. i think we see a lot of clusters and a lot of peer-to peer radicalization and mobilization. as i said, the on --