structures within their that have been effectively able to sort of bridge from their local experience to the national conversation. .. we're talking about something happening in the u.s., also, on the other hand, which we are seeing and noticing in college campuses these days, and it's been many of the islamic groups

are taking places and they have their own organizations and clubs on college campuses. they encourage muslims who are native muslims to become more radical and more extreme, and to convert to islam, but which teaching of islam, the extreme way of teaching that, and encouraging many young people to even go overseas to join many radical and extremist groups, and this is a problem we are noticing and seeing. we have a program on college campus to work with young people, muslim people, on college campuses, and these problems that we are detecting in many campuses here and seeing a lot of young people being harassed by the radical groups on campus and not being able to practice their life like any ordinary american young student. >> over here.

>> i'm glad we moved toward muslims -- because we were talking about them as though irthey're mutual lie exclusive categories. prime minister cam ran and -- cameron have spoken about being more pro-active. i read about radicalization and recruitment. about the ideological component of countering retruittment by extremist groups and so on. i think there's already a consensus, a disagreement on the panel, rather, that it's difficult for a government to enter that ideological sphere, especially when it's dealing with it within it's open border. so law enforcement certainly has role to play, but what in the panel's opinion is the role of government, the extent of the government's ability to work with its own citizens on the

ideological stage? >> i think -- look, i think it's different -- hold on. he's not a citizen. so you can comment. look, there's no one answer. there's a lot of debate now about the cve program, obviously -- >> counselor vieline extremism. >> and those that aren't familiar, the debate is you're not being as specific as you can about the fact it is muslims who are committing the acts we're trying to stop. on the other side, people are saying, well, only inviting muslims to a summit that is just blandly called -- sends the message that -- i think that debate is holy unhelp -- wholly unhemful. it continues the back' forth about where the condemnation on one side, which is ludicrous, because in any muslim

organization web site today there's nothing but condemnation on it that date back a decade, and then on the other side, muslims are islamist peace. this has nothing to do with islam, leave the muslims alone, it's different in different places. i would say local more than federal. that's the real issue. how does a kid like the young person we had in chattanooga, who tragically murdered innocent civilians -- how does that person create an environment in their society -- how do we as a mayor, as school, as a mosque, as a church, as a synagogue, create an environment where that person has somewhere to go. that person has somebody who knows something about literacy, to go and test the ideas. not just the night on twitter figuring it out or dealing with whatever we're going to figure out with this kid and personal issues and then connecting that what is happening with isis. so local more than federal, and

the food fight conversation about muslims are really terrorists, no, they're innocent, i extremely unhelpful. >> one quick line from cameron's speech: if you say, yes, i condemn terror, but the nonbelievers are inferior, or violence in london isn't justified by suicide bombs in israel are a different matter, then you, too, are part of the problem. i think that approach certainly needs to be adopted here in the united states. >> this is what we are seeing unfortunately, there are a lot -- besides all of this condemnation we see on web sites and on tv and all of that, the reality that when -- a small group or meeting in a mosque or somewhere else, you see people -- all of this does not apply, all of this condemnation. we're here in the u.s., we're discriminate against, we're this, we're that.

in fact, as muslims living in america we have all the rights and just like any other citizen, practicing and doing whatever we want. but when you hear these -- in closed conversation you hear dehumanizing the west, dehumanizing people who are not muslims and making them -- because they are not believing in the same religion or the same ideology, even if they are muslim but not the same ideology, they deserve to be killed for destroyed or beheaded. this is a problem and issue we need to be focusing more on as the problem. also, modern technology now, it becomes another threat. social media, recruitment of young people, men and women, they have been brainwashed by the different web sites, individuals who are working very

hard to recruit people from the west specifically. highly educated, to go and fight alongside with all of these radical groups, isis in the middle east. these are issues we have not found any solution for yet. nor the government is really paying that close attention to. no in fracture they have defunded almost all the efforts going toward going after people who are looking to go to syria or to yemen. so, it's even worse than simple ignorance. one last word from me. this is the one thing i want to leave us with. i wish i understood our government better in this regard. we embrace certain values. david cameron, the speech we keep quoting, talks a lot about liberal values, and that is what our country is founded on. it this fight that we see every day. not about terrorism but about women's rights or gay rights or -- and yet when we look

overseas, it is the ideas are suspended. oh, no, no, no, we have to be respectful. the answer is, no, we don't have to be respectful. with our foreign policy we don't have to be respectful. these are our values and we can stand by them, and i never understood why the bill of rights is not our plan for how we manage foreign assistance to other countries to other groups. it seems to me to be a quite simple dictate, and as usual, as the moderator, i stole the last word. sorry we didn't have enough time for questions about let me thank our panelists. this conversation is so much bigger than the hour but they were wonderful. [applause] >> and let me just say a word of thanks -- who did so much work to make this conference happen. i hope the conversation can continue, thank you all for being here. [inaudible conversations]

>> why did the write brothers fly first and what was the process they used because they weren't the first people to have the idea of building a flying machine, and they weren't the first people to try. so why did they succeed where everybody else failed? and the answer is, they understood the problem they were trying to solve much better than anybody else. at the end of the day being creative is not about having ideas in the shower or ah-ha moments or lightning bolts of inspiration. it's about solving problems one step at a time. so, understanding the problem or the piece of paper which is a problem of balance, was the key

for the write brothers starting on their course that ultimately led to them flying. >> kevin ashton, tonight on "the communicators" on c-span2. >> next up on c-span2, a discussion on efforts to come bat boko haram, the islamist militant group with ties to islamic state. active in nigeria, chad, cameroon, and niger. it's hosted by two of the university of southern california's public policy institutes. live here on c-span. >> i see many newcomers. we hope you become regulars and we can welcome you again. my name is adam powell, the president of public diplomacy council and a senior fellow at the university of southern california. our program today, as for all of

our monthly programs, is a partnership of two entities, the -- i should say -- underwriters, the usc center on communication, leadership and policy, and be public diplomacy council. we also produce these monthly programs in association with the usc center on public diplomacy and also grateful for the support of the american foreign services association. a bit of forward promotion, next month, september 14th, monday, 12 noon in this space, once again, a tour of u.s. embassy on social networks, how they're using social media. on to today's program. combating boko haram. we have a number of programs that are in your folders and you have detailed speaker biographies. those watching on television or

listening, you can find these on the public diplomacy council.org web site, and go to august 10th program notes. but i'll just summarize. you have the full bios in your folder, leo keyen, theaves of hausa service. he directs the planning and production of voa programs. also has recruited and supervises the voa staff, including overseas stringers, opened reporting centers to expand voa journalism, and to stand the broadcast reach the direct as i fillat programs in west africa and mobile media 24/7, audio, video, and web platform, and hausa dieup radio. mardot shorey coordinates policies and programs in support of the u.s. strategy to counter boko haram, and supporting usaid

and department of defense planning in the chad region. the brings an interagency perspective to this position. at the africa center for strategic studies she managed programs on u.s. security programs in africa. margo shorey is going to speak first, and margot, if you:come up, i'll load your power opinion. >> thank you, everyone, and thanks to the public diplomacy couple for having me here. it's great to see so many people who are interested in boko haram, and i'm happy to be here to talk to you today. i just like to start with a

disclaimer. these views are -- i'm here on my personal capacity. these views are my own and do not represent the united states government or the state department. so, please make that note, and i'll go from there. i'd like to start just with a permanent anecdote about my -- how i got interested in this matter, and sort of what motivates me every day to continue to work on this. a very challenging issue and sometimes it's difficult to remain positive. so, in 2009, in june and july, 2009, i traveled to nigeria, and i went to bachy state, which is on the road from -- towards the heart of where boko haram has been. and while i was there i had the opportunity to meet with government officials at the state and local government area

level, traditional leaders, civil society members, community members, and others, and we talked about the governance structure and the -- many of the challenges and grievances they face and what really sort of spoke to me and what was the most marked was sort of how simple many of these grievances were. for example, the road to a village or town would always flood in the rainy season and so it was inaccessible, or that the same road had so many holes in it that you couldn't get by on motor bikes, and that was the main way -- the main method of transportation. and just hearing how people -- the challenges and the challenges that the government faced and that people felt that the government just wasn't really responding to these issues. a week after i returned, there

was uprising and i'll speak a little more about later in july, township, that really -- july, 2009, was really the most, if not -- probably the most important turning point i would say for boko haram in which the leader was killed, and so personally i really was able to juxtapose this -- the experience of hearing about these grievances and then putting them into context and understanding why people would join that ideological group that did have violent tendencies but mostly an ideological movement at that point. then another thing, as i mentioned, this is just a reminder why i do this, and just thinking about the fact this is not -- this may be a far away from here in d.c. but these are people who are being killed, who are affected by this, and so i just try to think about sort of every day the people i met and

put that into perspective, that it might seem like we're just moving a lot of papers around here in d.c., but this is real impacting people's lives. so that's just where i wanted to start. the main point that it want to make today is that while boko haram started as a nigerian problem it has expanded into the lake chad basin region. here's a map. and any solution will certainly center on nigeria but must be regional. just a brave overview of what i'm going to talk about today. i'm going to go through a brief background on boko haram. that's may be old news to many of you, about i just wanted to make sure we had that information. some phases i see in the development of boko haram. the recent regional expansion,

the need for regional approach and then the multinational joint task force that is developing. a focus on chad specifically as one of these regional partners, and then just a brief bit on u.s. support to counter boko haram. so, who are boko haram and why do we care? boko haram is a radical islamic extremist group that started in nigeria in 2002. by a man named mohammad you receive. it was more of a ideological group with sort of violent extremist tendencies but didn't -- it wasn't the same -- the original ideology for all of nigeria to be goshed under struck islamic principles document apply today in the face of the violent tactics, forced recruitment, et cetera, we looking at a very defendant group now 2015 than when it

started in 2002 and as it was developing. why should we care the first reason i the humanitarian perspective. people are being killed and as the international community we need to focus on this in terms of people who are dying and also people who are displaced. the second rope is for geopolitical purposes. and that's basically that nigeria is africa's most populace country and the largest economy. what happens in nigeria impacts the rest of west africa and also africa and the world. so those are -- that's another important factor. the third is just the counterterrorism perspective. boko haram is certainly a problem in the region, but that i was also linked up we other groups, al qaeda, and most recently isis, which they pledged allegiance to and isis accepted. we need take that into account when we are thinking about this

is just a small corner of the world, but really does have a regional and international potential and -- that we need to be aware of. i'm going to go through just a few phases of boko haram. bear with me, this slide is a little long. so, the -- the first -- as i mentioned before, the initial phase of the group forming in 2002 and then until 2009, really when it became very violent, and i think as i mentioned the ideology of a strict islamic state for all of nigeria, functioning under zaria law. this didn't occur in a vacuum and we have to consider the long history of political islam in nigeria. the marginalization of the north and the people who are really the -- really originally the base of boko haram in the far northeast.

socialow economic grievances. the use of political islam -- excuse me -- the use of political violence in nigeria as a means of achieving goals, and this is not just with regards to boko haram but in many other cases, you have seen political violence as a tool rather than using governance structures, et cetera. and then all this is in the context of the global rhetoric of jihad happening in the post 9/11 world. finally, just having a charismatic leader in muhammad youssef, so he was kill in 2009, sparking a wave of violence. he was killed be the niger january security forces in an extra judicial manner and there are some videos showing this and it sparked this massive wave of violence, which i luckily very narrowly avoided. and as i said this is really one

of the mose important turning points when we see boko haram going from more of a ideological religious movement to a violent group. and in this phase between starting in 2009, we see an increasing use of violence, attacks on religious and government institutions, schools, and really indiscriminate attacks against muslims and christians. i don't think -- sometimes in the media say this is a war against christianity and that's not true. it was pretty much against all nigerians or all people who didn't believe what boko haram was espousing. and one particular thing i'd like to highlight was that 2011 attack on the u.n. building, one of the most sophies sophies tick indicated and most concerning because it had a move of boko haram to the capitol and this was done threw a vehicle based

eed or car bomb, particularly worrying. the next phase is between 2012 -- these kind of merge together but 2012 and 2014 when boko haram became linked with another group or a spinoff group, and they really start getting into more kidnapping, including high profile kidnapping of westerners, really drawing out the international attention. there was a family in northern cameroon, and then it seems now like it was either disappear, broken off or merged back into boko haram and you don't hear people talking about them specifically. at this point we're seeing links to aqim, all quite in islamic and people are becoming very concerned about the regional expansion. and in 2013, the former president of nigeria, declared a state of emergency in three states but this really didn't

change the nigerian response, which was always in many cases very heavy-handed and i think a lot of people would say not very effective. and i'm sure then you all know the major -- probably the next major turning point, and that would be especially in terms of international attention and that would be the april 2014 kidnapping of the school girls. and that really especially with the bring back our girls campaign, which became international movement, but also started in nigeria galvanized the nigerian attention and also the international attention. we had all the way out to the white house, really, getting more behind this, and so i think that was a major turning point in terms of the response. but despite the attention, the nigerian military was largely incapacitated by what many people would say is massive,

high-level corruption, and there was very little that was done to fight boko haram at the point, and the nigerian military in many cases didn't have the right equipment or arms or protection, and so a lot of them basically retreated and kind of allowed boko haram to hold and control territory, which was a new development for the group. so, in early 2015, security was at a peak, chad sent in troops, the president at this point took action. i think you have to see this in the face of the upcoming election. he was at that point quite unpopular, and so take that for what it is, given the timing. and -- but there were real military successes, taking back territory from boko haram and forcing boko haram to retreat. but although this upper trend seemed great, boko haram has proven its resilience.

we were just talking about this. i think probably all continued to see the many attacks since this sort of pushback in march. and went back to the bread and butter, retreating into the community, and going -- conducting raids, suicide attacks, forced recruitment, et cetera. so i think that's kind of where we are now. the election of the president in nigeria, we're seeing a new commitment. he demonstrated, at least in what he is saying, commitment to combating boko haram. he is nominating new service chiefs for the army, but today there's been very little actual action on the ground. we're still seeing a lot of attacks. so it's concerning and i think there's just a lot that still left unknown about how this is going forward. so, i'd now like to talk about regional expansion. boko haram or regional shaw

shoots have been conducting more and more attacks in the lake chad basin countries. i list aid few just illustrative attacks taking place recently to show what is happening. i think this is really an indication of the vulnerability of the whole region, and shows some similarities between nigeria and its neighbors and this is a very worrying trend. but the regional concernes not just about attacks. this includes humanitarian crisis with refugees and idps through the region, and last week cameroon said or -- and is expelling many nigeria refugees. they claim a fear of infiltration by boko haram and this is happening as we speak. very concerning. these people have nowhere to go. there's also the economic impact. there's a trade road that runs through northern cameroon that

supplies chad, and this has been threatened by boko haram. so, you're seeing sort of a loss of supplies to chad, and that's very damaging to their economy. there's also been sort of long-standing regional tensions. i would highlight particularly between cameroon and nigeria, over the border, and although this has been diplomatically resolved and especially it was highlighted again during the president's visit to cameroon, this is still going to be a concern, especially when it comes to the question of hot pursuit or how this regional force i'm going to talk about will deal with sort of operating among international boundaries. so, just hot pursuit means if a military is chasing a suspect, can they cross borders or have to stop at that line? that's a real challenge as we get to a regional solution. just finally as i mentioned

before, just the fact that duda is important in nigeria, what happenings in nigeria impacts the rest of the region. so, i'm just going to talk about the regional approach, and this multi national joint text force. there's an obvious need for a regional strategy. the neighbors have a stake in the security interests but nigeria needs to lead. that's clear. so there's a need for regional coordination, for cross border activities and to have joint operational planning, intelligence-sharing, and so they're there needs to be some sort of regional body to coordinate that. the multinational joint task force was an existing structure that the african union put forthothers a way to coordinate between different military forces. one thing i want to stress is that this is not a u.n. peacekeeping force. it does not have a u.n. mandate.

there was a u.n. security council presidential statement in support of this but that doesn't mean it's a u.n. peacekeeping force itch want to make sure that's clear. one thing forgot to put on here that it can do is help ensure that security forces abides by human rights standards, and -- so even though this force exists and with troops that will be contributed by nigeria, chad, cameroon niger, there are operational capacity questions that remain. so, the -- skip -- i'm going to long -- just one particular question that remains is how is this force actually going to be structured? is -- what this command and

control structure going to be? are we going to see one commander who will we -- who is a nigerian, and that's one of the important decisions that was made, that command we're be nigerian. is the in control of all forces or will they report through their country's structures and then report back to the commander? is this an operational force or more of a coordinating body? i think that's yet to be seen. supposed to be -- operational effective july 31st. but we're still seeing some challenges in getting that moving. so one of the things to do is really push for that. i i'd like to focus briefly on chad, country that i think deserves a lot of attention that we need to pay attention to. chad has displayed the political will to fight both boko haram and in mali. it has a strong military, including this special antiterrorist group and does

have proven counterterrorism successes. on the other hand, there's really the potential for political turmoil, and the president has been in power since 1990 and there's uncertainty what happens if -- what happens after that is unclear. there's threat to the capital, which i the klose capital city to where boko haram is operating, and there have been attacks in the city so this is concerning about what is going to happen. there's also some complex relations with the neighbors, and then a similar socioeconomic drivers or violent extremism, chad is acting a as a very strong partner. we have to keep this in mind and make sure we're not overreline -- we as the international community are not overrelying on a part that doesn't have some of the same vulnerabilities that nigeria has, and i'm not sure we're all

paying enough attention to sort of the regional dynamics in this multinational joint task force and the countries on their own. finally, just briefly, on u.s. support to counter boko haram, there was an interagency strategy to counter boko haram which was approved in october 2014, so that's what we're operating with right now. we work on that over the state department and also with our interagency partners. and thing extra in many ways focused on nigeria's regional partner with the previous administration, both siteses. it was a difficult relationship, kind of over the past year or so, but with the new administration, particularly following the president's visit to washington last month, i think we'll see a renewed relationship and that's part of

how the strategy evolves and changes of working with nye year gentleman and working as a partnership. then we're also through a variety of mechanisms providing equipment, training, advising, and logistics to the contributing countries and then also to them directly. finally i just like to circle back to where i started. the strategy focuses, and we need to think about not just the military solution but these underlying grievances driving boko haram and because if we don't address those, if we don't work with the nigerians and the other lake chad basen countries to address those, and really their responsibility to address these issues and we can support them, but with we don't do that we might not have boko haram in five years but there will be something necessary this region.

so that's where we i think have to think about -- it's much more challenging than a mail at the solution to address long-standing drivers of violent extremism, but that's probably the primary or takeaway of looking at this from a regional perspective and looking at these drivers, and figuring out how to work with our -- these partners and address them. that's where i'll stop. thank you very much. i look forward to your questions. [applause] >> thank you, margot for a sobering and up to date through july 31st update on what is happening with boko haram. now, someone who has just returned from northern nigeria, is going to be our next speaker, and i will put up just so we have a sense of what his work

looks like, here is the voa web site, and so leo, the person who is in charge. your turn. >> good afternoon, and thank you for having me. first of all, let me say that i was just back from nigeria, and the republic to do what we do best. reporting centers, recruit and train strings and correspondents, install radio studios for expanded programming, cameras, air time with local broadcast affiliates, and finally, nose around for news. i think that's the aspect i'm

going to talk about now concerning boko haram. while on this trip, the president was out of town, he was in america, visiting president barack obama. for the first time since the election. it is not difficult for me to really feel the wind of change blowing in knee niger and nye year ya about how boko haram is ending. do not speak for the president's government or the administration, but the changes begin to occur, when we who cover these things daily see these changes happening, we can't go to sleep. in particular, have been chronicling boko haram right

from its inception. and today, we are several platforms addressing boko haram atrocious activities in the area. but i want to talk basically about this new wheel of the people of nigeria in particular that it noticed when i was on this trip to end boko haram. first of all, started warring himself. president muhari has resolved to tackle boko haram head on. why is that so? that's because he was on the hit list of boko haram even before he became president. he was attacked in broad daylight, on the 23rd of july 2014.

he escaped the bomb blast. then he was sworn to remain alive and supervise the ending of boko haram. now, through that incident, he has become president, and more empowered to deal with this situation. therefore i read his body language, both in terms of diplomacy and administration. on my trip talking with clerics, possession -- politicians in nigeria, it was clear the people's will power to confront both both in the churches and mosques and streets where free readers engage in rigorous debate, a fresh wind of hope to end boko haram is appearing, at least i went to lagos, -- on

this trip. so far, i can tell you from what i notice that there are certain actions taken which tend to move into a new phase of the fight against boko haram. for example, the immediately after his swearing in, in a quick -- took a quick visit to niger and chad, followed by the first appearance in south africa. he then relocated nigeria's command center. meeting of the defense chiefs and the heads of government of nigeria, cameroon, chad, his visit to the u.s., talks with president barack obama, appointment of new military chiefs,. new battle operations in the headquarters or boko haram

itself, the military fully in the forest now, engauging the insurgents. because destroyed bridges and re-opening closed interstate roads in the area. advice is by the vice president of -- -- the trip to cameroon and two countries to step up their fight against boko haram. chad and cameroon, as i speak, are already engaged in strategic planning. and traditional rulers have met in aboud. these rulers are key to the peace effort in northern -- not just northern nigeria but cameroon and chad, all the firsts class chiefs very important.

that is not known by many people. so, what do we do at vou that makes boko haram such a friend? we report daily what boko haram does with quality of life of victims, especially in northeastern nigeria, other states. we brought 16 hours of newscast and radio,. we bring breaking news of boko haram attacks on innocent citizens on our newly created 24-7 mobile web stream and this is simply phenomenal because it's 24/7. we don't have to wait for the regular news broadcast. we break in any time and report what they're doing to people. there are more than 20 active in

nigeria who rely on their cell phones for breaking news. a now radio program, the 30 minutes daily monday to friday, program that counters boko haram terrorism ideologies, promoting girl child education, giving voice to person that all that both both -- boko haram represents. web prince was six million in four days. this is why we're preferred by visiting presidents for interviews. winning hearts through town halls and roundtable discussions to eradicate polio, eliminate malaria and reduce infant mortality. teachers, call insure shows, expert analysis, documentaries, incisesive interviews with the common man, all revert both boko

haram -- boko haram's literature. bbc coming in. the point i'm trying to make here is that nigeria is very important to particularly the u.s., for obvious reasons. as the most populace country, black country in africa, we know that anything that happens in that country affects the whole of the subregion of west africa and africa as a whole. the economy is enter twined -- intertwine evidence with the american oil economy. and the population of nigeria is such that whenever anything happens, the idps tend to swarm the whole of west africa.

so the important issue at this point is to be sure that country is -- from the aggression of not just boko haram but any other insurgent. thank you. [applause] >> thank you, leo. we are going to now begin the interactive part of the program, where we will invite your questions and comments. please wait for the microphone, and please identify yourself at the beginning of your question and comment. i see one right here in the front. so, max, if you could begin with john. >> thank you, adam, and thank you to both of our guests today for a most enlightening presentation. i'm john bizzy of news max, and i just completed reading and writing a review of virginia

comolys new book, boko haram, nigeras islamist insurgent general si, which is very revealing. it has been said in the past that taking out a leader of a group could lead to its destruction in short order. it was said in vietnam. just don't bomb the rice paddiesor, take out ho chi minh, which we didn't do. but in the case of boko haram, as part -- [inaudible] -- hand picked successor -- killed by the president -- re-emerges on

the video stronger than ever. in the leadership of boko haram, taken out by -- [inaudible] >> let me say this. that -- who is the proclaimed leader of boko haram has been killed like three times now. and to be honest with you, it's an embarrassment. that's one of the things that made nigerians lose face in the whole attempt to take down boko haram. what we see today is a youtube video released last

week without him. now, is that means he is gone, did that happen before? so this is strategic. disappeared like that, we have some videos and then came back and said i'm very much alive. so really we do not know exactly what is going on, except what is happening inside the for rest. the nigerian military are engaging the forces head on now and need to come up with new information about broadcast, some command centers, training centers, in that forest. some people -- it's a very large forest. i think about 70-kilometers square. so, if the leadership of boko haram centers around shakou and we don't have anything other than the bombing going noncities

now, and there's no video released, think he is gone. >> margot, could you comment on the role of public diplomacy in either the interagency process in washington or the cooperative military effort. >> touched on that briefry with the caveat that public diplomacy -- although being here is quite exciting is not my personal specialty. so, i'm happy also to direct you to our public affairs team over across the street if you want to know more specifics. i think in the interagency

process and the strategy, we really have faced some sort of challenges about how to address, for example, these constant attacks and how to respond to them and how to get out our message, and maybe that's something leo might be able to talk about a little bit more. but -- so this has really been a challenge, and i think we are trying to use a variety of different mechanisms in terms of public statements and using social media and all of that. so, i think we're trying to respond to the context, but also it does remain a challenge. but i'm happy to direct you really to the public diplomacy specialists as well.

>> thank you very much. -- [inaudible] i want to go back to the statement that most both of you made. mardot you talked about the need to change the conditions on the ground that led to boko haram, and leo, you talked about political will in nigeria to defeat boko haram, and we have seen with president barack obama a renewed emphasis on africa, chug the young african leaders initiative, and i'm just wondering if you think that that kind of a program can be helpful here. of course, -- [inaudible]

certainly very important part of the public diplomacy effort, but what other things the united states could be doing, both to help with the political will issue, but also with changing the conditions on the ground. >> let me start with the last issue stated about the -- that is a very important program to africans because it teaches them -- if you recall -- northern nigeria, especially northeast, to youssef was because most of them were not employed. most of them are poor, young, energetic men that needed jobs and didn't get it. so they quickly joined that

movement. but you know, the transformation between that -- then, not the west african forest but there's an enclosed -- who was killed, both thugs, became thugs out of necessity because they were paid. they are on the payment list, who pay them to campaign for him and then after that, appointed one of them as commissioner. now, after a while, they are not paying them the salaries they promised them initially. that was the beginning of the division or the movement into the real terrorist. so that is a very important program that -- i think that should be supported fully. secondly, i think there are other aspects of the nigerian

society or educational structure that need to be looked at closely. for example, you have a system that -- students in the final year, and if you recall very well, sometime in 2003 there was a meeting of all the representatives from all the universities in nigeria who went there to meet, and at that meeting they said -- the police said they had no place in the meeting. they were juveniles. that was in the first attempt at taking away the police station by these group. now, i find that education section -- that is still going on. how could you imagine -- for example, final year, seventh year but because of therefore as you go. leave the campus. go away. you cannot change this by moving

around and discovering talent, maybe in nursing, or lab technology or something. the educational system is still encouraging this kind of extreme thinking but youth who are educated, but at the end of the year, and become recruitable by boko haram in the country. so these are issues to look at very well. >> i'd just like to add a little bit on that and also just a reminder these are margots opinions. so, one thing i think that he just touched on is job creation and job skills training, but if there are no jobs, and if people are getting all this training and experience and all that, and then have nowhere to go, that's probably just as big of a problem in terms of recruitment and sort of feeling this marginalization, so something that is important to address and

i think anyone would tell you the political will on this is there, is the aspect of corruption and finding -- so i think the president mentioned this as his number one or number two priority and has been strong-willed on this. so i think the political will there is, now it's a challenge of making that happen. and bringing about sort of reforms to allow the police and civil administration to exist, and really use some of -- funds that have been lost to corruption to invest in the economy, and to invest back into making an effective government. so, those are, like, easy to say, things that are easy to say but really challenging to do. the most important thing right now is the political will is there and now it's just a question of how can we as the u.s. government or international

community support the nigerian government and bouhari to get the country become on track. this world bank has spoken -- when the president was here, he announced i think 2.1 billion loan from the world bank, and so it's a question of how that is going to be still implemented, but to really work on sort of economic improvement in the northeast. so, that's a potential way that the international community can support bouhar and i the nigerians on this. >> the bbc runs vovoa. i know why -- [inaudible] working closely with -- to

establish relationships with universities. very -- [inaudible] we have relationship now with the state university. they, too have an entrepreneur ship angle. the state department funded a $6 million television network, which is on the air right now. the embassy is starting a very interesting project called -- essentially a web-based platform to start getting information as leo and margot said about entrepreneurship and business. so very active embassy. the problem they actually have a dedicated public diplomacy officer. the problem is they can't get there so nobody from the embassy is going anywhere on the north at all and that includes usaid people. so, that is somewhat of a challenge for the embassy right

now. they have had to bring in leo and the journalists can travel because they're not under chief commission authority. so they're frustrated they can't get out. i have a question for you, margot. you said at the beginning is a not muslim christians, but actually muslims on muslims. can you elaborate on that? >> sure. i guess maybe just to clarify, thick it's really boko haram versus anyone who doesn't agree with them, who doesn't ascribe to their -- this radical belief, and right now we're seeing a lot of forced recruitment. were they killing christians? yes, but also killing muslims. they were killing indiscriminately, and there's obviously a religious dynamic to this conflict but it's been so -- at this point, i think

adulterated in many ways. my personal thing is this is not a religious conflict right now. it's really now focusing on just anyone who doesn't agree with boko haram and we're looking at insurgency. >> i think we need to know that right now in nigeria, the mainstream muslims and the mainstream christians have come together, bond moreed more thanr before because they now feel that both both is not an organization. it's a group of killers and -- everybody, they kill muslims in mosques. they kill -- they slaughter them at the grounds. they bomb churches. they stop anybody on the road, remove you and decapitate you. so there's nothing religious about what they're doing. that comes in very clearly to

the rest of nigerian at the moment i speak to you. i believe i heard that in churches and in mosques, i heard that from clerics in nigeria, when i was on this trip. the same thing. ...

does it use social media? how does doa use of that information into either address those issues, counter act of them. how do you engage with them on that front? >> that's a tough question. so i think just to start out with, i think really the primary thing i'd like to say about how we are countering boko haram is we unprecedented stress this enough, presentation, the u.s. government is working with its african partners who are really in charge of this fight, you know, issue. so we are supporting them to do that. i think this is kind of an unprecedented way of these countries coming together and saying we are going to commit

and fight this and work together and talk about is really challenging border issues. with regards to the ll are, i'm sure there are some similarities but i think in terms of really just putting our support and focus on working with these other countries, that's kind of a new sort of development in terms of how we address conflict and a violent insurgency. >> yeah, about propaganda, the boko haram is not -- [inaudible] because they deployed a lot of media strategies. we need to effectively -- you see them on websites. you see them even on the radio.

the colors. sometimes -- sound like they want us to know what they're doing. so what we do basically is we come up with a new platform. for example, on radio you have to wait for four hours to get our newscast to know what's happening. [inaudible] now let me take how it works. boko haram -- goes on air immediately. then the soldier starts to move towards that area. this is really, really the point i was making when i said it was phenomenal. we do 2007 broadcast on cell

phone everybody has access now. we have data problems, battery problems but -- sound -- [inaudible] all on cell phone. 24/7. what we need is -- [inaudible] interrupt with programming every now and then. anytime there's breaking news we just go in. that's effectively working on reversing some the messages they are sending out. secondly, you know, we are just about to start television. that's what i traveled. the idea is to show these people, to show our view in perfectly graphic ways.

because the radio does not carry the kind of message. we found there is a gap there. that's why we are starting television. these two are going to combine with pictures and sound together for the benefit of the origins. [inaudible] >> -- but i've had the occasion to go to niger and discuss these issues with people there. and two things in particular have stood out. one is present although boko haram does recruit to niger which they can do because of the ethnic groups are very similar across the border. their appeal is not a religious one know isn't about grievances. what they target is our young men who are already in state

gangs or who are petty criminals and their appeal is offering them a little money, a down and a chance to order a big round them, but that's the real appeal of boko haram in recruiting people. the second thing i heard was a real trepidation there in niger about cooperation with the military in nigeria. because they feel the military their is so egregious in the human rights violations that they make the matters worse rather than better. >> well, concerning the human rights issue, you know, that might have come up several times and that's why the obama administration didn't have any strong relationship with the government. and secondly, yeah, you know,

when youth are unemployed they are not educated and -- what do you expect? they become very, very, you know, recordable by boko haram. but if they go to, go down to the rural areas and talk to the provincial louisville point out thousands of young men who, you know, farmers, they do a lot of things. now, that's not to say that they going to expose -- [inaudible] cannot come back to society. -- [inaudible] that is possible, too.

the problem of poverty, illiteracy and lack of industry and stuff like that. [inaudible] >> margot, as we talked about the change the relations between our government, how things are hope the going to be getting better including our security assistance and this goes off the last question, as we both of our security systems inside track to how much programs will be addressing human rights violations and training police respecting human rights? how much is this part of the conversation going forward and working with the nigerian military to try address those grievances you're talking about? the second question for leo, what is your opinion on citizen

journalism, like the reporters and breaking news stories and some is more rural areas very quickly? i know there's many arguments for and against it and i'm interested to hear your perspective from voa. >> as a matter fact i was recruiting some citizens right now but with a different kind of practice ethic. compared to -- [inaudible] because they are seen as some ugly face of journalism in nigeria but they do a good job by bringing in those things that people don't report generally. but journalism done in the right way will help you pick is right that everybody has a camera. everybody has some cell phone and they send pictures.

our website right now at voice of america is basically using journalism. so we're going to project that in covering whatever is happening to boko haram moving forward. >> so i think it's probably a little bit too early to say what is going to happen or what is happening in terms of renewed security cooperation. i'll just say something that i personally think are going to be sort of, you know, might be part of the renewed relationship. and i'll just say, like i think human rights is going to be, dealing with human rights violations and allegations is going to be part of our relationship with nigeria. and probably in the spirit of public diplomacy public everyone is aware of a little perhaps

slip up during president buhari's visit we talked about the way he is betting the mms, house that's been a challenge, to produce raising slightly, encountering boko haram. we've actually seen them kind of walking go that back a little bt in the nigerian government saying well, we know we have to deal with this and we're working on a process, and all those things. i do think that that's really important, but i would say, you know, my opinion is that that's going to be sort of a the forefront of working with the nigerians and it's not just come to be like okay, sure, here's some training and equipment without the other side of human, dealing with human rights violations. is a very challenging issue, you know, and it's something that is going to have to be worked

through both on the u.s. government site and on the nigerian side to find out how to make that cooperation work. >> let me just piggyback on that. because this confusion between human rights by the nigerian army forces and put boko haram is doing to the people. in nigeria when you talk about human rights -- boko haram first. who are they sparing? they tend to equate thinking of human rights organizations as unfair. they believe that boko haram should be -- [inaudible] so when human rights organizations begin to look at just that part, from the other

angle there's a confusion going on. which is human rights is different. obviously, -- [inaudible] but let me say this. the soldiers that were involved in those, amnesty international group, were not trained. what i think the american government is now going back, -- so if that happens then things can straighten out. >> well, thank you to you both for our time is up. we have a set of books, partners for each of you, one for each of you. and please join me for thinking our analysts for today's discussion. [applause]

next month september 14, same time, same place, a tour of u.s. embassies on social networks. until then we are adjourned. [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> a reminder if you missed any of this discussion you can watch it anytime on our video library at c-span.org. with congress on august recess we are featuring bookt both tv n prime time each night on c-span2.

>> over on c-span reverend al sharpton, arne duncan, are at the national urban league's annual conference in fort lauderdale. the 2016 election, but what is fact and education. here's a preview. >> we must begin to prepare now, whether it's national urban league, whether it's naacp, that we are on the brink of a post obama era. we've had for seven years a black president and a black first lady andy bloch first family. whoever wins this election will be the first one in history of this country to succeed a black president. we've never been there before. so we need to see who is the one

that we feel is qualified to follow eight years of pay person sensitive to us that comes from us that will not turn around what he has began. we don't intend that when the black family leaves the white house that black concerns me the white house with them. [applause] >> alall of that national urban league event tonight at 8:00 on c-span. >> tonight on "the communicators," author and british technology pioneer kevin fashion on the creative process and how that process takes work. >> why do the right brothers flight first of what the process they used? because they were not the first people have the idea of building a flying machine and they were

the first people to try so why did they succeed were everybody else failed? the answer is that he understood the problem they were trying to solve much better than anybody else. at the end of the day being created is not about having ideas in the shower or and aha moment or lightning bolt of inspiration. it's about solving problems one step at a time. so understanding the problem with the piece of paper which is a problem of balance was the key for the right brothers starting on their course that ultimately led to them flying. >> kevin ashton tonight on "the communicators" on c-span2. >> next, senate house committee chair lamar alexander, michael bennet of colorado, diana degette of colorado joined former senate majority leader dr. bill frist to discuss

medical innovation and recommendations any of bipartisan policy center report. >> good afternoon. today we are going to spend the next hour and a half talking about advancing medical innovation for a healthier america. how we accelerate that innovation to the future. the united states has been a global leader in medical innovation for decades. yet tens of millions of americans have neither tears nor effective treatment for their diseases. includes patients with alzheimer's, with parkinson's

disease, certain types of leukemia, parkinson's disease. in fact, we have about 10,000 known diseases that have been defined that have names and have signs and symptoms. but for those 10,000 we only have 500 treatment. we've got a lot to do. they know states has invested over time over the last 20 years approximately $1.5 billion -- trillion. if you look at those investments they have not resulted in a commensurate level of progress in that whole process of discovering and developing. and approval of medical products. expensive and lengthy development processes end up slowing down that advancement of medicine. and also slow down the access to new and effective treatments. we all know we are the

statistics which are accurate, that a new drug today takes about $2 billion in terms of investment and it takes about 10 years for the drug to actually reach the marketplace. for those individuals or those patients who are facing a life-threatening disease, who might be in clinical trials waiting for a drug that can potentially help or cure, that is too long. the clock is ticking away way too slowly. government we all know plays a vital role in this overall process working with the private sector but the vital roles in the discovery, development and delivery of drugs and devices is something that does need to be modernized with time as we've advancement in terms of methodology, treatment, the lightning speed, skyrocketing speed with which new applications and devices and information and technology is advanced. the government plays that. the government plays that role and lots of giveaways but a

fundamental is the one i'm focused and that is the food and drug administration which is that regulatory agency that oversees the safety and effectiveness of those medical products and drugs and devices before the american people in this country. as a former member of congress, we talked for good about it. we are very sensitive, very aware of the role of government. government can either incentivize and accelerate and lower the barriers or government can stifle industry growth and hold back and bring back those advances which science has out there which can be made possible if we get rid of those barriers. in a sense the easy way to think about it is we can't rely today on 20th century technologies, technologies of the 1900 at the time the fda was they regulatory

structure was put in place, when the world is changing so fast. and when the world is with on a cutting edge of new health technologies including medical science and including information technology. fundamentally we've just got to modernize, bring up to date the way the drugs and devices are developed and delivered in this country. it's time to act now and will talk about the global implications and the global competitiveness but the time is to act now which we do have millions of patients out of waiting for cures which are on the shelf and ready to go. congress, our legislative branch of government, plays a fundamental and critical role in removing barriers. stripping away and creating an assignment that fosters the dynamism, the creativity and innovation that we can excel the development and then safe delivery of effective products. senator lamar alexander,

chairman of the health education and labor pensions or the committee note as the help committee has given strong voice in advancing the united states leadership in medical innovation to improve our nation's competitiveness across the globe on this continent but indeed around the world. in january just about seven months ago chairman alexander along with senator burr released a report innovation for healthier americans identifying opportunities, specific opportunities for meaningful reform to our nation's medical product discovery and develop process get a little later that month chairman alexander and ranking member past senator patty murray launched a set of workgroups within the help committee working together collaboratively in a bipartisan way to identify those sound, this fundamental, those viable policies that will improve the development of medical products for america's patients.

through our new effort as a bipartisan policy center, fda advancing medical innovation, we seek to inform and support legislative efforts to accelerate the development and delivery of safe and effective medical products for patients. that brings us here today. it is my great pleasure to introduce chairman alexander who has joined us for a bit today, who's been in constant discussion with someone to stay cold over the last several months. senator alexander was first elected in 2002, engender 2015 he became chairman of the health, education, labor and pensions committee are his top priority which are laid out very early on were fixing no child left behind, deregulating and reauthorizing the higher education act, for purposes today modernizing the food and drug administration so that we can bring more tours and more medical devices to the market, to the patients indeed more quickly and at less cost.

he also served as chairman of the appropriations subcommittee that oversees energy water appropriations. as a fellow tennessean and get it is a tennessee mafia with bart gordon, lamar alexander and bill frist, it is just happenstance sort of. i took a look back at lamarche great leadership as a cover. is the only tennessean in history ever popularly elected to both the governor and united states senator. i played a tiny role in that as well in terms of him coming to the senate. he with a tennessee when he was governor on the map to become the third largest auto producer in america. the state with a top rated four lane highway system and the first state to pay teachers a little bit more if they were teaching better than other teachers. please join me in welcoming senator lamar alexander. [applause]

>> thank you, bill, in part. ladies and gentlemen, thank you for being here. bill had more than just all a bit of my being in the united states. i was retired from politics for the second time when he dropped around to see me in 2002, one sunday afternoon with people that should i did when is the that fred thompson with a gaping. as people say the daily care for politics with embalming fluid. it doesn't take long to get the old juices running again. here i am jumping into the united states senate. of course, bill was majority leader and a terrific leader of the senate. i had a chance into his leadership to be on this committee which is the senate h.e.l.p. committee, the finance committee has a lot of the jurisdiction but we have a lot, too. so i'm delighted to be here with you and with him especially. i want to tell you one other story which will explain why i

plan to speak just for a few minutes and then listen for the rest of the time. our former colleague senator john warner used to tell the story of when he was first in the senator he was sitting there wondering what to do and one of the oldest centers of overton, but is operated and said, look, don't worry about this, you get the hang of it in no time for all you have to do to be a united states senator is stand up, start talking and eventually you will think of something to say. so i hope to disprove that today. i may -- i am a recovering, as i keep having his outburst of executive leadership for trying to impose on the senate, which isn't that easy. when i had a chance to be chairman which has about 30% of all the jurisdiction in the senate, i wanted to do something useful with it.

so we set three big priority. one was to fix no child left behind which we failed to do for seven years, and thanks to patty murray who's the senior democrat, we are able to form a bipartisan working group and we got our bill to the senate 81-17 last week, which is pretty remarkable given the complexity of the issue and the difficulty, the difficulty of it. [applause] but it shows we are result oriented. the second thing we're going to try to do this deregulate, simple but because the be a better word, federal rules and regulations that govern higher education to a lot of well-intentioned rules from your address 6000 higher education institutions are struggling in a jungle of red tape. so we have a variety of bipartisan efforts going on to deal with that. ..

i was going to tennessee with president obama this year when we went down to announce his community college initiative. i told him about the three goals, and he told me of his interest in what he called precision medicine. as a result of that i went to white house when he made miss announce and imsaid to president on the plane, we'll take your

interest in precision medicine and incorporate into our work on innovation and while we're arguing about everything else, we'll work in a bipartisan way and pass this. and he thought that was a good idea. so i've been working with secretary burwell and senator murray, and i think it's fair to say i think this is a train that will actually get to the station. in other words, you have the house already having passed a bill, we're working on a similar bill, on a parallel track -- not in the same bill, similar bill. this president is interested in what we do. our timing is such that in order to get everything we want done, it will be thanksgiving or the end of the year before we finish our committee work. but that's not delay, really, because senator mcconnell wouldn't have time to put it on the floor anyway between now and the end of the year. but with the kind of support it has now, and i expect it to have at the end of the year, i fully expect it to be the kind of

legislation that even could be considered by the congress in an election year, something a lot of people can take pride in. at bill frist said, it affects certainly -- virtually every american so members of our committee, which include -- well, elizabeth warren, tammy baldwin, bernie sanders, and then rand paul, and tim scott, and others, we have -- let's just say a diverse committee. and we're all interested in this. we see the importance of it. we want to do the right thing. so the question is, how do we know what to do? the big disconnect in american life really is between those of white house are in public life, we're elected to do things, and then everybody else out there who knows what to do, or who is pretty sure they do, and how you get the two together. well, one person that i thought of immediately to help was bill frist. i didn't know anyone who

understood both, biomedical research and the united states senate, better than bill frist. now, i'm sure there's somebody who knows the senate better and somebody who knows biomedical research better, but nobody i know knows both better. so i asked him if he would be willing to help us design how to go about this, which he said yes, and then he came up with the idea of working with the bipartisan policy center, or they did with him, bart gordon joined him and we have this. so we have all that's parallel tracks and this is the outside track, and we're going to be conferring very carefully with -- about your recommendations. i have a specific request to make of bill and bart and janet and all working on this. i'll stay and listen to the panel because i want to devote more structured time to learning what to do, but i would like for you to take the excellent recommendations you have made in this report and boil them down to specific recommendations that

we can send to legislative counsel. now, bill and bart have a lot of experience doing that with something we called america competes, about ten years ago, which was a request that i made of the national academy of sciences along with bart, and a couple of others, to give us specific recommendations how to make our country more competitive. we asked for ten specific recommendations and priority order. we got back 20, and then with bill's leadership and the democratic leader at the time, we passed that in congress. we had 70 cosponsors and eventually, because we had that blueprint, it got doesn't. didn't all get done the first year, but my view is that most ideas in washington fail for lack of the idea, not for lack of the politics. so we needed specific recommendations for what to do. the augustin commission, rising above the gathering storm, gave us that. another example is i asked

chancellor kerrwin of the university of maryland, and zeppos of vanderbilt to give us specific recommendations how to simplify regulation of higher education, and they gave is 59, and ten in priority order, and arne duncan is working on some and we're working on 38 or 39 of them and will include as many of those as possible in our re-authorization of higher education weapon don't want to waste money on red tape when we could reduce tuition by hiring better professors or giving scholarships to students. so what's what would ask you to do. take those ideas and if you can -- here are ten specific things you should do in this senate legislation that would meet the objective of aligning federal policies so that we can get cures, treatments and other discoveries, through the whole process, and into the medicine

cabinet, more rapidly and at a lower cost. that's what we're looking for. now, one other thing. we stumbled across something dish say tumbled because it's true -- electronic medical records. electronic medical records are a project the government has been involved in, and went along pretty will while the government was giving out $30 billion to doctors and hospitals. nobody complained about that. but now the money is gone, and the system is a little bit in the ditch, and there's a lot of complaining from the doctors and the hospitals about the next stage of electronic medical records because the system isn't working very well. has variety of problems with it. so that's essential to the president's precision medicine issue in particular because, for example, dr. collins is trying to gather a million -- sequence a million human genomes and get

that information together, and precision medicine won't work well if doctors can't point and click or easily use the information from your genome as their make their diagnosis or transmit information. so it's important for that. and it's important if we're going to be able to do a better job for patients in the united states. so, as part of this we're looking for the five or six steps we can take to improve the electronic health record system in america and make it something doctors and hospitals look forward to rather than dread. and that is the goal, and i'm working with secretary burwell on that, and if we come up with a five or six or seven things and she can do them by executive order so much the better. that's easier and cheaper. if it requires legislation or we have this train running through that going to get to the station and we'll put it in there. so, i invite your participation. i thank you for what you have

done. i'm delighted to be working with the bipartisan policy center, and especially with bill frist and bart gordon, whom i respect and know very well, and i look forward to your comments this afternoon, and i look forward to receiving, if you can, take those recommendations your report makes, boil them down to such specific suggestions we can look at them, read them, consider them, and send as many as possible to the legislative coup to draft and include in our bill. thank you very much. [applause] >> i'm bart gordon that senator alexander mentioned earlier. i've had the good fortune to be' on a number of panels making recommendations, and i can tell you that when you put your time in, you put a good recommendation together, and it goes on the shelf, it's very discouraging. but for all of you policy

geeks -- most of you are or you wouldn't be here -- you know how much fun it is when you put something together and see it enacted in legislation or reforms. i feel even better listening to lamar alexander earlier today -- just then. bill frist and i had the opportunity to watch first hand governor alexander work with a pretty rowdy democratic legislature in tennessee, but he came furth with education reform, with infrastructure, and investments in industrial recruitment. and so i think that regular order is back in the senate, and we're going to be a better country for that. and he's fortunate he is going to have a good partner in the house, someone that it had the good fortune to set on the energy and economy committee with, diana, and when i think of her i think of a story my grandmother may have read about the little engine that could. i think i can, i think i can, i

know i can, i know i can. that's diana. just plowing on. she demonstrated that working with fred upton and having a world's record number of hearings here and across the district to come forth with a major bipartisan vote in the house. so, senator alexander you have a good partner here, and diana, tell us what is going on with you. [applause] >> thanks, bart. i'm so happy to be here. they don't invite to us come over from the house very often. so it's always really a treat for us. and i was really happy, lamar, to hear your reflections on some of these issues, because as some of you know, chairman upton and i worked really hard. when you were talking about all the hearings we had, bart, we had hearings, we had roundtables, we had white papers, we had, you name it. we worked for about 18 months

trying to get consensus, and many of the people in this room attended multiple of those hearings. so, you know what we're talking about. and i was really, really pleased when i found out that senator frist and congressman gordon were heading up this effort because they found many areas where we can make substantial updates to help bring new treatments and cures to patients. the good news is this similar to the consensus that chairman upton and i found in the house, and i think what i shows is that there really is a large amount of consensus about what we need to do through the regulatory process, but also the resources that we need to bring to bear on expediting biomedical research at the nah and then bringing us to approve at the fda.

across the until and research field, as fred and i found, experts from all different backgrounds and all different sectors really agreed about the meaningful improvements that we can make, and today's report that was released, haven't read it in detail yet but i've read the executive summary, and it really offers us a lot of the same proposals. it echos a lot of the things we heard in the house and then acted on in hr6. i just want to highlight a few of the similarities in this report to what we have seen in our house investigation. for example, in the report, there are recommendations to more effectively include the patient perspective throughout the drug and device development process. hr6 has several provisions that strongly echo this policy, and in addition, there are several recommendations in the report to

strengthen public private partnerships. this is something, again, that we really highlighted in the 21st century cures bill. further there's a recommendation to accelerate the development and approval of antibiotics. this is a provision that has been a little bit controversial in the press, especially since hr6 passed the house, but when crafted in a very careful way, hand in hand with the agency giving us technical assistance, we know that this is something really important, specifically to deal with those cases of antibiotic resistance, and so this was also included in hr6. i could go on and on but you'll be glad to know i'm not going to. i'm under the house rules today. but what i want to say is that i think that we can find a great deal of this consensus. one thing i do want to talk about very briefly is the importance of new resources for

our flagship medical research and development institutions. fred and i, as part of our quest, went all around the country. i was in san francisco, i was in michigan, in fred's district, fred was in denver in my district. we were all over the country, at biomedical institutions, and whether we're talking about the fda or the nih, they are working on multiple priorities, in a very stifling budget climbed, and they need to have the ability to carry out the ideas that we're circling around right now. i just want to give you an example. we were having one of our bipartisan roundtables over in the energy and commerce room, and francis collins turned to me and he whispered, diana, if we had had full funding for the nih, and we hadn't been under the budget cuts, we probably would have had a vaccine for

ebola by now, and i said that -- i said, francis, you have to tell the whole group. so he did. he said it on the record. and what he meant was, because of a lot of the budget constraints, what happened what men worthwhile programs like research on ebola vaccines, were put on the back burner in favor of diseases that inaccurately in this case, seemed to be much more of a threat, and so really with all of the great breakthroughs we have going on now, we need to also be able to research the innovation. now, as most of you know, we passed 21st century cures in the house at the beginning of the month. we passed it 344-70. but you can't pass the journal with that, by the way. so, we were really gratified bit our effort but we know that -- we hope that this bill will just be a resource to the senate as

the senate embarks upon its very important investigation this fall. i'm also really encouraged that our efforts have been joined by serious discussions and working groups at the senate health committee, and the bipartisan policy center's initiative really adds that substance, expert analysis, and further momentum to the conversation. we have a genuine opportunity to make important updates and reforms to our biomedical research and development systems, and after the last century of remarkable medical discoveries, we want to make sure that in the 21st century the pace of breakthroughs treatment and cures accelerates to meet the challenges of our times. now, some of you know, fred and i did travel around together for 18 months, and so i would be remiss if i didn't make the fred upton point right now, which is the appropriation under 21st

21st century cures begins in fiscal year 2016. so, that's october 1st. anyway, we're glad to be here. we're glad to be of any resources that we can be. we're just thrilled that the senate is taking this up and we're thrilled to be lower at this update. thank you very much. [applause] >> thank you very much, representatives. good afternoon, i am glad you all made it over here. we had a little bite shower coming into our event. i serve as the director of halve innovation at the bipartisan policy center, and on behalf of bpc, welcome all of you today. so, we're going to spend also built of time going through the report, and you should have it if you walked in, and with that we're delighted to hear from our co-chairs, and if i could ask

you to come to the table and our advisory committee members. and while they're doing so, i'm going to take just a minute to introduce each of them. you were able to meet with senator bill frist, who opened us up today. he is a nationally recognized health and lung transplant surgeon and also a former senate majority leader. on his left you also -- this is congressman gordon, representative gordon, former congressman who served as the chairman of the house committee on science and technology, and during his tenure in congress, focused a great deal of his time on improving america's competitiveness, and we have a lot of that in our report and we'll hear about that during our panel discussion. and let's see. all the way to your very left --

your very right, i'm delighted to intro dr. patrick jung, juice now from from los angeles, physician, surgeon, and scientist and has pioneered diabetes and cancer, published over 100 scientific papers and has over 95 issued patents on groundbreaking advancements spanning myriad fields. and then finally i'm delighted on my left to introduce mark bouton who i have known a long time. hi is a chief executive officer of the national health council, a really amazing organization. brings together over -- provides a unified voice for more than 133 million people in our country, patients and individuals. those who are sick, and those who have disabilities, and has

been a real strong support for medical innovation, and i'm sorry our third advisory member, mark mcclellan, who this senior fellow and director of healthcare innovation and value initiative ted center for health policy at the brookings institution, couldn't be with news person today. so, i'm going to move over here so we can get into the panel discussion. >> like to ask senator frist -- there we go. our first question, i thought, senator, folks have just seen the executive summary, the longer letter is on our web site, it's pretty long, but 80 pages. i wonder if you might be able to tell folks in the room sort of a broadbrush around what is in the report. >> thank you. and again, the web site makes it available but for those who are

here, the report is hot off the press from the final finishing touches this morning, and it's easily digestible. let me point out a couple of things. the first area of the report is focused on -- we have four areas, and just it's easy to think about it this way as we come through the process. first area is on improving the medical product development process. i spoke to that in my opening comments. there are whole bunch of issues covered here but to give you a sense of those with the highest priority is the following witch call for congressional action to increase in a generation in the use of real-world elfed. all the data is out there, accessible today but hard to get into it the fda in the consideration process, given the structure today. how do you take advantage of this data that information technology is generating on us and about devices and about drugs. not only post market

surveillance, which is absolutely critical, but also approval of those new indications for existing products, and ultimately into the clinical trials themselves that are used for regular la tour review. we also -- regulatory review. we also call for actioned that enable the dissemination of scientific information to support the whole clinical decisionmaking regarding something that is misunderstood, i think, generally, but for me as a heart and lung transplant surgeon was critical and that is for the offlabel use. very confusing but has to be addressed. more than one in five outpatient prescriptions -- one in five -- are written for offlabel therapies today. it is critical. it is fundamental. is it life saving and all of that is because to get the approval -- the approve process is set up, a drug or device has to go through an entire clinical

trial process, that doesn't necessarily mean a drug that you know works and has been shown scientifically to work should not be given to patients in need. the fda doesn't regulate the practice of medicine. people think it does but it doesn't. it's not in the business of regulating the practice of medicine and nothing prohibits physicians from prescribing drugs you know will happen that patient. manufacturers are generally restricted -- they can't share that information. good, accurate information, on offlabel use of their products. that inability to share information obviously is a huge barrier into effective and safe use of the drugs. so to balance the risks and benefits of offlabel use, the doctors have to have the reliable information, the up to date information, the accurate information, and right now it's being denied them. nobody is intending to deny it but it's an example of an antiquated structure, very good for the times, right now for today, where signs is moving so

fast and so eeffectively, such an exciting way, needs to be reforms. in here we also cowl for harmonization of international requirements and standards. i think bart is going to come to that because in every one of our discussions, we know that america is great, it the best, we are the most innovative, but there's good things happening around the world in a scientific way that need to be assimilated into our thought processes, and into our scientific and clinical data bases. you also see in -- i don't have the pages for how right now but we addressed the whole issue of the enter interoperatability of health information technology. lamar you did imply that there we have these different standardses which inhibit the exchange of useful scientific information to improve the outcomes for patients. this is the foundation, i think, for where we are today, and not

only improving the medical product development process from idea to clinical delivery, but also for the broad aspects of health care which lamar did mention, including delivery, getting into it the field, payments for that, strategies for empowering the patient who has all this information out there today that we didn't have ten years ago, that how they can use it means interoperatability of data. on -- in the report on page 14, we talk about the increasing regulation -- regulatory clarity. i don't have time to go into what that means but what regulations actually mean, who is for what, who is in charge of regulating and to get clarity. it's very, very confusing today. congressional action is going to be needed to improve the regulatory clarity and evaluation of things like combination products where you're putting different things, different stuff together, how is that? who is responsible for

regulating that? some of the most innovative product throughout today, unlike when dad was practicing medicine 40 years ago, is the able to combine drugs and to a certain extent devices in ways which heretofore had been impossible. drugs, biologics, this whole field. in my own field of heart specialty, an example would be the drug that began 15 years ago for the treatment of coronary artery disease, drug delivery on the stint itself which mechanically opens up a coronary artery, and inhalation devices for insulin delivery, instead of injection nor management of diabetes. transdetermineal patches for the treatment of early parkinson's disease. there's a lack of intercenter between center delenation of the roles and responsibilities and those of you who are -- follow

the fda closely know what i'm talking about when you look at cedar and cdrh, who is really responsible for them to lead on it and to be clear for the clinical investigator, you need no know who is responsible. when they tell you something that is the rules of the road. you get conflicting feedback, lack of clarity, chaos, which slows down the field. regulatory framework can give the pathway for approval and delivery or rejection. many believe there's little consistency and pretickettability in the decisions me a bid the office of combination products since the nonlead center, if you have the centers -- the nonlead center receives no user fees for the work, they don't get paid for it, yet they are part of the process that becomes very confusing. there's little incentive for a timely review of data and products by the nonlead center, just to conceptually paint the picture. another example, congressional

clarity regarding the regularlier to authority associated with laboratory developed tests, the ldt. it's very confusing. many of us have experience with it directly, but when it comes down to laboratory tests, diagnostic tests, when you're trying to figure out what is good, what is bad, what works for a patient, it's not a big part of the budget and spending but laboratory tesss determine eight out of ten clinical decisions made. so who is approving the tests and who is responsible is very important elm we also call for congressional clarification that health information technology, including clinical, software, our -- the things we're carrying on in our iphones around, the i.t. software, should not be regulate as a medical device. that software -- this can't be because the medical device is a device, it's a thing, and when we have regulatory framework you try to stuff stuff into it, its doesn't work. it slows down innovation.

the uncertainty keeps people from innovating. we have done a lot at the bipartisan policy center in that regard. we have a lot more to do. also, regulatory --...