back on the field? in in the second question is repeated. but it could be a long history of repetition i am not a doctor but i am not sure we have that scientific data to support all of that. so what you are looking at in the movie was all about. to see we were looking for.

but we cannot see what we need to see. with the end stage for disease the brave and is severe the degenerated that will shot of the mri skean as severe atrophy. and the culprit is an abrogation of the protein in the nerve cells. ed is the signature of the ct with multiple different diseases in to be a bad actor. in those that are not severely dented it becomes tricky to narrow those differences.

and you can only make bad diagnosis and then try to image the brain for the mri signature than the next page is to move until longitudinal study to see when those images and it appears that this is an accurate diagnosis the bad is the situation you're in now. >> let me just finish shot. [laughter] the problem is initially had thought this would be a rare

event. for those that have a thousand hits not that much of a revelation the high school or college to mention a look at the mayo clinic in we don't know how common this is. if everyone will progress, we doubt it. have a couple of clicks but need to work that out. >> there are ways to diagnose early. they don't involve in regina the present time they may not.

we have narrow psychological testing that dr. collins is a leader there is plenty of ways to diagnose if you believe this guy is falling the intermodal approach is never a $1,000 mri not in the short term. but we have conditions that know how to do this and researchers can put together the intermodal assessments. and that is how we diagnose alzheimer's we don't wait until they expire and look at the of the stage but whatever the evidence of dementia and that involves

other testing which we all do. >> is a the lesson we have taken 30 years to learn with the dilemma that we currently face. we have been fascinated with the of magical discovery of a single solution theory to predict outcomes across individuals. one of the burning questions it is no wonder how can it be that two individuals with seemingly the same injury have much different short-term outcomes? how could it be that two individuals are very similar exposure profiles with a drastically different lives?

it has to be a complex matrix. this condition in short-term and long-term with the single predictor variable. what are the risks? who is a risky and why had we interrupt your protect those risks and its exposure to say how many or how much total exposure? is it necessary or sufficient to predict a long term risk? all of those remain unanswered.

>> i.m. concerned to deny n discredit with the risks of playing football pro -- publishing evidence from former player mike webster doctors went on a campaign to undermine the doctor to go as far as to debated a retraction of its peer review research over the next 14 years the nfl pursue a strategy to vehemently denied mounting scientific evidence. with bias to 9p review research with a growing consensus and that is linked

to chronic brain damage. in as recently as february february 4th 3 days before the super bowl a member of the nfl tonight there was a link between football and the ct and only grudgingly admitted that there can be found in association between football and the ctc because what some former players have developed but the disease to hear the affiliated physicians waffle about such a basic scientific reestablished connection is truly astonishing. the league may highlight the rule change of the narrow, a

specialist on the sidelines at every game and the nfl has committed to reducing in managing concussions as laudable as it may be to focus on concussions football is a high-risk sport not just diagnosable concussions what the public needs now is honesty of the health risks having clearly more research with that risk in the eric from the football. so a yes or no question question, doctor do you think there is a link between football n degenerative brain disorders

and cte? >> unequivocal. we have seen and out of 98 of 94 players and 45 fatah 55 college players and six out of 26 high-school players. immelt think this represents how common this disease is in the living population but the fact that over five years i can accumulate this number of cases it cannot be rare in we will be surprised at how common is. is not about confessions of an in head injury that occurs on every single player the game every single level. we have to eliminate some called the accumulative head impact to have sensors to gauge the number of impacts to limit to maintain safety

for all the athletes especially at the youth level. we have seen many times and mature athletes come down with this disease is devastating when you see this and a 25 year-old we have seen it over and over and it cannot be rare. to maintain the health of the shona athletes fifth there is something we can do to limit the risk. >> is there a link between the ball landed generative brain disorders like cte? >> research shows nfl players have been diagnosed with cte so the answer is yes but there are a number of questions that come with that. >> is there a link?

>> yes. >> i feel that was not the unequivocal answer three days before the super bowl. >> i will not speak for the doctor. >> you are speaking for the nfl? >> you asked and i definitely think based on the research there is a link between those football players but what that necessarily means and where we go with that information so to talk about the link that those medical experts are on the table. i do feel limited to answer much more than that but what does that science mean? >> i have another question

with saturday's tribune the famous soccer player with her, she is donating her brain to science because she wants more research in the knowledge is she has suffered many concussions but "new york times" and no female athletes have found to have cte but the article also talks about female athletes at greater rates above concussion in demonstrate greater impairment during psychological testing when compared with the male counterparts and there needs to be more research.

nih just now 2016 says that gender has to be a consideration with all pre-trial in clinical trials and the clinical trials. do we need to reconsider whether or not it needs to change for minders? . .

the study did for heart disease. what we need today is a longitudinal study to understand what is the incident of this. we need better diagnostic tools. we need better ways to predict who are those people that aren't going to do so well. i think really it comes down to

funding. in your pamphlet here, you highlight in fiscal year 15, they are spending $93 million to understand a problem that cost $70 billion a year. there are professional athletes that make more money than he had to fund research that were all asking questions about today. in many ways the gap to be closed by better care, better follow-up, follow-up, better screening. we need to make a bigger investment in this. i'm overjoyed that the american public has turned this into something they're interested in. there has to be a more sustained and powerful investment to understand the problem. >> definitely. >> i'm want to speak with

cautious optimism about where we might be. we joined forces about a year ago and we will be getting results real-time. this is a study that is involving 30 schools. each school whether your a male or female athlete goes through of rigorous examination. seven sports, three of them women sports, soccer, lacrosse and ice hockey and then same thing for men as well as football, they're getting blood testing, biomarkers and they're getting brain mris. just in a year and a half, we have done studies on 18000 student athletes and we tracked over 700 concussions. a large study before that may have been somewhere around 20's

concussions. i'm happy to say the people at the table is a participant in the study. he is a principal investigator. we spent maybe a year putting this together. we are now working in a cross functional way. that has never happened before. what we are doing, and i'm not allowed to evaluate the results firsthand because that would be a conflict of interest, we are on the executive committee of the study. we have oversight on this, but we don't have any voting power so it's really set up in a way that is a non-conflict of interest study, but we will be having a few things. one. one is the study will provide definitive evidence and in the short-term, within two years on

what is the natural history of concussion. just concussion. we will also be defining neurobiological recovery which is exceptionally important. that's different than symptom recovery. we will have that data. mike can speak better to that but closer to another year from now. it's very definitive data. what does it mean to be neurobiological he recovered? we are coming back to washington in three days. we are laying the foundations to put this into a five-year study. ultimately, we are going to make this the study of concussion. it will be a 35+ year study. it doesn't mean were waiting 35 years. it means that in very, very active five year increments we are going to be coming in with new tools including pet scans and more brain imaging to understand what we are seeing in these increments. are there problems for -- it's

not just for athletes. every cadet in west point is enrolled in were studying these individuals as well. in addition for everyone who has a concussion, they have a control in their contact sport and noncontact sport. for the first time we will have real data on those who have and have not been concussed. that's ongoing and very real. the first wave of analysis will be reported in the late spring. it will go on after that. even while we are waiting for these results, just two weeks ago there were 15 of the most prominent medical organizations in the country. we looked at the first round of the results including very, very detailed head sensor data. i'm not putting out a specific date, but you will see coming in the next three months some

recommendations that will be called in her association guidelines. it will be equally endorsed by the american medical society for sports medicine. the american academy of neurology on concussion diagnosis and management, with regard to our football practice, the ivy league was in the room with us. their information was leaked earlier than they wanted but there will be a new emphasis on absolute recovery. i'm a little optimistic that we do have something hot in the pipeline that is very real. we are getting active results. >> does anybody at this table think we should change the rules of the sports for our student athletes? that's what i wonder? is there any way we should change football? >> i just feel, and brian you

brought so much to this field with the research you are overseeing and managing. i think we need science to lead the way. i think it really behooves us to put science first in understanding these issues because if we make sweeping changes on sports without having the science, there could be unintended consequences that i see everyday in the clinic. >> i just want to make a pitch for science to lead the way. >> if we don't fund this for the longer than the two years that it's going on now, we'll be back working back here in five years. this is not a five-year problem. headers are not the problem in soccer. >> i have a question. >> did you want to say something to? >> i'm sorry. >> i would just say, i hesitate to to want to wait on the science when we know this can

have such a tremendous impact on the safety of children. i would say, absolutely there could be changes and absolutely we should be having a conversation about the wisdom of putting our kids in activities where their heads are getting hit repeatedly over and over when we know for some individual , those consequences can be very, very dire. we don't know yet about the risk factors. we don't know yet about those that will ultimately have the consequences of something like head trauma but we know that no head trauma is best. we can make changes without toying with the fundamentals of the game. soccer, absolutely they just changed when they will allow heading in soccer. the usa hockey change the age

for checking. all of those changes will make things safer for children. i think we need to explore each and every opportunity to make every sport safer in ways that don't change the game, but absolutely that conversation should be had. >> i want to make sure we get our questions in. let me go to mr. hudson. >> thank you mr. chairman. thank you for this hearing. i represent the home of the carolina panthers. i did marry a girl from denver so i do have to congratulate you on the super bowl victory. >> i appreciate you wearing the jacket today. [laughter] i've become very interested in the area of pediatric trauma. when we look at this issue, my interest was piqued by the children at the medical center in north carolina. they are doing a lot of work in trying to look at these questions. they have a study where they put sensors in helmets. one of the things that struck me is the disparity of care. if you are child suffers a trauma incident and you live near a pediatric trauma center your kid has a great chance of

surviving and being healthy and not having long-term problems but if you live in another part of the country that doesn't have close proximity there could be a lot of problems. that is one of the things that really nags at me. they have help me get a jo study to help me look at this study across care. it was neat when you brought this issue of awareness, and also how do we take the research and understanding that you are developing and have it available where the rubber meets the road and where the care is happening. i'll just throw that open. >> i mentioned the mild dramatic brain injury guidelines. another thing is clinical decision support tools within the children's hospital of philadelphia that's been leading the way where they are integrating and moving across their health care settings from their primary care's to the

urgent cares and all their clinicians. whether or not they have advanced medical education in concussion management, the protocols are built-in to their clinical decision support so the care they receive regardless of the setting they show up and is identical or near identical. i think that is really critical. since i have the microphone, the other thing i wanted wanted to mention is another active area of inquiry that mr. miller mentioned earlier of all 50 states having returned to play laws, we are interested in the best practices in the return to play laws as well is the return to learn protocol. we are actively evaluating if they work and how they work and what the components of laws that need to be in place. those are couple things. thank you. >> just to recognize what brian and that organization are doing with the dod, i think it's laudable and it's 18 years to

advance point we need to do that with kids. we need the same kind of focused research forum for kids below the age of 18, below college level. part of the reason that we haven't is because we haven't had both advocacy or the organize advocacy and organize research systems that are set up to some extent, by the way the ncaa and dod potentially have them. the children's institute is part of the consortium that we are developing on pediatric brain injury. dallas knows about this as well. it's really trying to model what is happening at the collegiate and above level for kids. really to look at that question, what are the risks, exposures and what are not. how do we understand the science of this and the treatment. i do think priorities need to be reset, not just to start with collegiate athletes but also to start with our youngest kids in moving that forward we can link with what is going into the ncaa and the dod.

that means the cdc, the nih and others need that funding support to really make that happen. >> one of the things that has happened in sports over the last 20 years that has made this more difficult, and i think there's ways to overcome that, in that the participation in school-based sports is actually declined while the club -based sports has increased radically. that becomes the wild west out there. we need to have some way that even if the club -based, of course they get incorporated into the systems that we develop >> i wanted to just make one point that at nah we have looked at our portfolio and we agree that this issue of understanding these issues in children is a gap. we are trying to fill that gap with our research. thank you for that. >> to that point, i appreciate brian mentioning the care

consortium. all of these things start to hang together with the four corners initiatives and other initiatives. within a year the care consortium will have 25,000 collegiate athletes enrolled. we estimate we estimate we will be over 1200 concussed athletes who have arguably represent the most richly characterized cohort of injured athletes ever enrolled in a study. that provides a unique opportunity and i hate to keep coming back to this point, but the reason we are sitting here debating a number of very fundamental issues about long-term risk and outcome is because in large part, there has never been a truly population -based prospective longitudinal study of outcome after injury. the military and virginia has invested in the sense he to do

exactly that in veterans but to date we have never done that in the civilian setting and they provide the most richly group of cohorts affected by brain trauma. as brian pointed out, we not only have detailed data on clinical recovery but we have blood biomarkers, genetics, imaging that tells us about the neurobiology of this injury as the doctor was pointing out earlier. the fact of the matter is, again i keep preaching to the choir, the likelihood that a single variable, whether it is injury or exposure protects outcome, i think it has already fallen on failure because again, we look at two individuals with seemingly the same profile of exposure or injury with drastic different outcomes in the short

range over ten days and over an entire lifetime. it will take a monumental effort and there are some low hanging fruit that we can grab early on that would answer some of the fundamental questions in terms of what is the risk associated with exposure, whether it is sub concussive or injury but what's the multiple or the multi dimensional factors that predict outcome. we been chasing the single solution for decades. it's destined to failure and that's the lesson learned and the dilemma that we face at present. >> dr. you had something on that. >> yes, one of the things i want to make sure we do not miss and i think people are all very passionate about youth sports. were passionate about what happens with kids. we've talked a lot about the community impact, but, but i don't want to forget about the

elderly. the fastest growing population of brain injury is in the elderly. there has been a 50% increase in the last five years. in california it's been higher than that. less than 1% of the literature has spoken to this. we've excluded these people from all prior clinical trials. as best i can tell, we are all moving in this direction and the cancer doctors and heart doctors have done a wonderful job. this is going to be an ongoing problem. i know this is a big problem and there's a lot to chew. i'm glad that were at least talking about this but i don't want to forget the elderly because this is also a population we need to be very mindful of. >> thank you for re- directing us. that is incredibly important. >> thank you mr. chair. all the talk of ct and i'd like to take a step back and just focus on that for a moment. dr. mckie or whoever around the room, when was it recognized as a unique disease? is there a distinct quality to

it that separates us from alzheimer's disease or other neurodegenerative diseases and what likely is the biggest cause? i heard you talking about extending beyond concussions and head injuries. the final item i throw out as a question for observation, there is talk to of clusters of depression and suicide. are there things that we are already learning about the impact as it relates to suicide? or how it relates to mental illness or mental health disorders? >> so ct, i can't say what it exactly identified as a unique disease because it's been known since the 1920s.

there was information in the studies about the characteristics, but actually i do think it was the ni nds conference that was held just a year ago that established this is a unique disease, it can be distinguished pathologically from alzheimer's disease. it can be distinguished from aging or other diseases like super nuclear policy. it was done by a panel of expert pathologist who were blinded to all information and they got a box of 700 slides. they sifted through them and took about 100 hours each each. over 90% of the cases, they correctly identified cte. there is a character -- they even went further and said there is a characteristic lesion in cte that they never have seen in any other disorder. this panel of experts even said in their combined experience they have never seen this

disease in anyone who hasn't experienced trauma, typically multiple episodes of trauma. that is about as distinctive a disease you can hope for, at least at least pathologically. we are struggling with the specific clinical characteristics. there is a lot of overlaps with alzheimer's disease when it presents later in life. when it presents early in life, in the 30s, it can be depression or personality disorders or a lot of rage and aggression, domestic violence and suicide. it is very hard to sift through those symptoms because they are nonspecific, but we are certainly seeing that in many individuals with cte we found it postmortem when we look at their clinical characteristics during life. depression, very common, aggression, violent behavior, short fuse and memory problems would be the most common

clinical disturbances. >> thank you. the advance research or additional research that goes forward? what's the most critical step as you go forward? >> i think the new funding of the long term prospective cohort that will be following former nfl and some college athletes over time, they'll be collected and evaluated and yearly evaluations, yearly imaging, they will be doing blood tests and then they will follow them to death. hopefully we will be able to develop a way to image the disease with certain pieces to diagnose it during life. we want to diagnose it during life. if we can identify it in the young athletes we could pull them out of the game or have a good shot of treating it. we really want early identification during life. i think this seven year nih study will go a long way toward answering some of those questions.

>> thank you very much. do you have follow-up you want to ask? then i want to ask a question to everybody here. >> you mentioned some of it, diagnostically, what blood tests are out there that you can help diagnose the acute brain injury? obviously cardiac disease, you can tell right away in combination with radiographic studies, but i'm not aware of what there is with regard to the brain. >> i've funded most of the work in that field when i was at dod. there is nothing that's approved at this point. there are more than 20 different potential targets, two of which have actually been through the trials and are being analyzed and hope to be submitted to the fda by the end of this year for

approval. the data that i've seen looks very good on it. the idea that you could in fact measure in the blood something that happened in the brain was denied for most of history until 12 or 15 years ago. the blood brain barrier was the issue that you couldn't cross. we've actually shown with very high sensitive instruments, there are breakdown products from brain injury that seem to get into the blood, and i have strong hope that in the next year we will see approved tests and that will get better in brain injury just like it got better in heart disease. >> or cerebral spinal fluid. >> right, but just as in stroke or heart disease, awareness to the clinicians on how to make awareness when they come in without using a blood test blood test is a lot cheaper and a lot easier. i truly hope the years of dedication and funding will result in blood test, but we actually have test now just when a person comes in the er or on

the field, battlefield or ball field, we can diagnose them now. >> i think as they do the research they should take blood and try to develop it. >> sure. if that's part of the program protocol and it's being done quickly, and we do, but in the meantime the rest of the world is treating these people and we've been doing it with pretty good rigor for years. we. we are trying to refine that an object if i it, but clinicians can actually manage these folks and diagnose them fairly easily and acutely. months out, not so much. >> i'm going to ask a question i want everybody to answer as part of the panel. this is the oversight and investigation committee. our job is to gather information which can be forwarded to make legislative recommendations from budget issues and jurisdiction over health, hhs and jurisdiction over nih and professional sports. i want to ask this question i

want each of you to answer it in whatever realm you want to come from. what do we need to know. this committee is the key committee that will deal with it. what does congress need to know, whether it's a recommendation or information we have to have in the areas of causes, prevention, diagnosis and treatment. what is your take away that you want to make sure this committee knows. i will start here. >> so i would say. >> you need to do this and 30 seconds. >> we need a dose response, given the individual, what is the risk? almost like a risk score that they have so we can advise parents and people what their risks are long-term. i think that will take a while. before i lose my chance i want to say one other thing which is we should actually put on the table trying to understand the

effects of last injury. many people around the table are studying sports injury. they're not to get the problem of the blast unless there is particular focus on that type of injury. we have over 100,000 veterans who have been exposed to blast. we know very little or nothing about what happened to their brain. >> i think the recurrent theme has been that there are a set of fundamental questions that remain unanswered per the positive position right now is that were not starting from scratch. we have made enormous strides over the past 20 years that put us in the position where the people in this room and a number of our colleagues around the country and the world can design the studies to directly answer those fundamental questions. those studies are going to be major undertakings that will require significant investment on the part of public and

private partnerships. then we can come back to the table and answer the critical questions that the public domain wants to know now. we can answer those with science. >> thank you. >> what we need our successful clinical trials to do something about this. we've had 30 some failed clinical trials. we've had multiple analyses on why those have failed but we keep doing them the same way. as much as i am the strongest avid advocate of the longitudinal study, it feels as though they're just admiring the problem. we need to find solutions to the problem. we need to find out why the studies have failed. all handed over to jeff because he will say what i was going to say. >> so yes, we have 40 some definitions definitions of concussion. that means no one knows. what we need, we know there are multiple forms of injury and we need better diagnostic tool

whether there imaging or blood based bio markers. the heart is a great model. it's going to be more than one thing. it's not just a clinical exam, it will be several things. until we have a diagnosis we cannot have a targeted treatment. until we have targeted treatment we won't have a good outcome outcome. i think the work that we've been doing, and the good news story is that were working together on common data elements and databases which we are all sharing. we know not one person will be able to solve this one problem per we are working together in public and private partnerships, bringing in the industry to try to figure out how to make a difference here. one of the things we definitely need is we need more funding. $94 million is not going to cut this. this is a very, very big problem in the united states. there's lots there's lots of money floating around in different places. i know there's a lot of problems but we have heard from everyone here that this is a major public health issue. the weirdness is here. it's now time to put some money where the mouth is. we need to fund some of this stuff so we can make a

difference for these patients and their families. >> we don't enroll the right patients in the trial. it's just like cancer. it's not one single entity. right now we treat it like one entity. its multiple diseases in one. we don't enroll the right patients and the measures that are currently used to assess whether there's a difference in those patients is fundamentally flawed. what's your recommendation? what does the committee need to know. >> it's clear there is a lot that is known. there's certainly a lot that needs to be learned about concussion. of that that is known, it occurs

to me that had this tragedy never occurred to my husband, i would be very much in the dark about concussions in general. i find that ideal every day with parents in children's whose lives have been derailed when concussion treatment and whatnot goes wrong. there is so much more prevention that could happen by just this issue of awareness. so much more can and needs to be done about getting this critical information into the hands of the people where it will make a difference. that includes not just the coaches, not not just the athletic trainers but absolutely the parents and the athletes themselves. >> thank you. >> so i think we need to be able to diagnose the acute injury, the concussion with a better test. in an ideal world we would have a blood test and be able to monitor that brain injury until it was recovered and then we can let them go back and play safely. in an ideal world the diagnosis for concussion, we need to start measuring the number of

infections are getting. we need to address this cumulative had impact and measure it so we can establish the response. we need to diagnose cte during life. blood tests or maybe the pet scanning, but we need to be able to make the diagnosis during life. that will give us our best chance to monitor treatment and develop a treatment. lastly, we need to follow our youth athletes until middle age and maybe beyond in order to understand the variables that play into the risk of contact sports but we know sports are important and we want our kids to play sports but we need to understand the risks. >> thank you. >> around this table there are five massive studies going on that have all these questions embedded in them. all of them. they overlap and the studies are actually integrated. we actually talk to each other. most of us are on all of the studies together.

we need those studies to just continue and finish as they are. we don't need 12 new studies are 5000 new questions. all these questions we've all heard at every meeting. were all aware. we even have little mice with helmets who are getting injured and were asking the same question. they go from children to elders and everything in between. what we need is to raise awareness, raise education because a lot of us are managing these folks effectively, but we need to continue with the path of the science we are doing and not overreact or under react but just have the folks that are all linked together work on it for the next five years, if not longer and then we will have the answers. then we don't have to have this meeting again with same level of basic questions. i think we need to just steady as she goes and push forward. in the military, in the sports

association and with kids. >> i'll just reiterate, i think we are getting the answers and the funding will be important moving forward in five-year increments. i think what the world needs to hear, and i truly believe this, is there is unparalleled collaboration working on this. i've been in sports medicine publicly for over 25 years. i've never seen this degree of collaboration before. it leads me to be somewhat optimistic. i will end by saying that the thing as a public health advocate for sport and i truly do believe in sport, it's much different the exercise, we need to focus back on youth and understand that where there are most vulnerable is in the lack of coaching education. it's great to empower parents but the coaches need to be educated as well.

i truly do believe that we need athletic trainers. we need to empower them to make sure they are a part of every part of contact sporting events. >> thank you. >> i would like to think you for the invite to be here. i also want to echo what i've heard many folks say here this afternoon which is we really need patience. i agree completely with the others that we have never been more collaborative than we are now. we never known more than we know now. we need to evolve the science before we make any rash decisions on these issues. i think the science is coming very soon to help answer those questions. i also want to stress that in pittsburgh we should see 20,000 patients a year and there's very few kids that i see that don't get back to play safely and enjoy the sport that they love. we don't see the morbidity that is being discussed here.

i feel we need more research on cte to better understand that construct and to bring this all together. a lot more work needs to be done. i don't think we've ever been more collaborative. i think the science is maturing and i think we need more time before we make any large-scale decisions. >> mr. miller. >> we take our lead from people on our midi who advise us we should be investing in our scientific research. we collaborate with the number of people around the room. you will be surprised when i say that my suggestion aligns with many of the others in the room. we have diagnostic concerns, prevention and treatment.

we have a research portfolio with collaborators in excess of $100 million. those things can things can drive change. it's the people who are here and many people like them who do the hard work who are going to move the science forward. i would suggest some of the things i've heard today like a prospective longitudinal study, more money being invested in the treatment, better education and advocacy. all of those things that this fine group of people is doing. maybe just more of the same will get us to a better place relatively soon. >> thank you. doctor joanne. >> last but not least, the kids. i'm going to reemphasize that the collaborations that are happening now are studies in the teens. we need to focus on younger ages

as well. what can we take or not take, what do we refresh, how do we manage and keep kids active and have fun and competitive. we have got to prioritize the fact that it's a full-spectrum injury that we have to understand. >> thank you. i'd say that we need to balance risk and benefits. anything that we come up with universal prevention strategy needs to balance those risk and benefits. not moving is bad for your brain. it's bad for your cardiovascular system. that's also bad for your brain. so right now my two-year-old is not hanging out in a crib. he's not wearing a football helmet around the house. he's moving. i think that's where the sciences right now. we need to move the science. i don't think we can answer the fundamental questions about

dramatic brain injury and cte without longitudinal studies. we have a handful of papers from the first five years and then it exploded. i think certainly we have our research priorities in order. i know my colleagues in dod are very attuned to this problem and i think we are going to move in these next decade. thank you. >> thank you for inviting me as well. from cdc's perspective we need better data. we need a cross mechanism and across the lifespan to and understand outcomes including disability and recovery. that will help us understand the problem better even at the state level and understand all the prevention efforts and if they're making it difference. >> thank you mr. million or i'm not a doctor but that never stops me from giving my opinion.

i want to thank all of you for coming here today and sharing your knowledge. it's really instructive and that's why we like to do these roundtables from time to time. i am somebody who works a lot in my career on issues of biomedical research. i'm really shocked at how little evidence we have for something we've known about. i've known about it since i was a little kid. it is really shocking, and i also happen to be a person who thinks that we shouldn't be doing public policy unless it is evidence-based. i look forward, i'm glad your all working together on research studies and i look forward to getting the results of that research. i just want to say one last thing as a mom. we don't have a a lot a mom sitting at this table. if i have a 5-year-old, i did

try to get my two daughters to play ice hockey, but they decided to take ballet instead. there's not a lot of head injuries. you can probably get a concussion in ballet, but if i had a five-year-old, girl or boy, who i was trying to get to do peewee hockey, having people come in and say we need to get more data before we can tell you, mom, about what kinds of play they should be having and when should they start checking and all of that, so don't worry in 7 - 10 years we will have some data from our longitudinal study. that wouldn't satisfy me as a mother. so as i say, i really hear what you are saying about the studies and i agree with that, that, but at the same time i think it's important to take some of the initial data that we have and

start to at least put some protocols in place for kids, just like the nfl has with its players. we need to try to prevent some of these concussive injuries that really can have long-lasting effects. i guess my sense would be better to err on the front and for prevention of something while at the same time you're studying so you can really drill down for both diagnosis, treatment and development of protocol. thank you mr. chairman. >> thank you. i want to thank everyone for being here today. this is quite a bit that we have learned. i feel like we should of gone continuing education credits for this. it's amazing to have everyone together and i'm sure you will continue to work in collaborative ways as you proceed. from a standpoint here, we've we focused a lot on sports and military and you mention some other things, whether people people are watching this on c-span or what our members are

taking with us, most cases are from falls. crashes is a leading cause for younger people, assaults is another reason. we have a lot we can learn here. being near a trauma center makes a big difference. having people around in the right place. i did see the movie concussion and it's one of those strange movies i know just about everybody in it. also knowing the people i know and how much things have changed in the last few years. things were entirely different just ten years ago than they are now. things like moving where you kick the ball on a kickoff has made a tremendous difference.

i work in an inpatient unit and what really struck me is how little we know and how we've got to learn more. playing a sport is a choice. we've changed sunday to be football day and not church day necessarily. the 1% who volunteer to wear the uniform and take the oath, it's pretty amazing. to watch and know that special forces are still out there and the patients are still there. whether their air force or green berets or the seals, they're they're still out there. people who have been in close air support and around bombs, for the longest time we would get back results from narrow

radiologist that would say no problem, they must be faking it and they would have the very problems you were describing, the problems at home, the isolation, the nightmares, and in many cases suicide. we have a lot to learn here. you are helping us tremendously along these lines. we deal with many things on this committee, but some things will lead to lifesaving efforts. this is helpful. we want you to stay in touch with us as we move forward with a series of hearings and where we go whether it's to make sure the brain initiative is fully funded. i know a lot of symptoms are things we have a lot to learn yet. we spent half a trillion dollars on mental health related problems. we are trying to find one or $2 billion a year to dedicate on this. to me that almost disgusts me that were at the level were at trying to find funding when we could be saving a lot of lives.

it's the will, we have to find a way. inc. you. i'm impressed with your knowledge. please stay in touch with all of us. with that, this particular form is closed. thank you.

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>> washington journal continues. desk,ken burns is at our who will release a documentary

on jackie robinson. the baseball legend jackie robinson is who we are going to talk about. i want to go back to what -- when jackie robinson broke the baseball color barrier. guest: there has always been a civil rights movement in america. 1619, people that have been held as slaves have wanted to be free. after the civil war, there has been attempts to make that happen with reconstruction. jackie is the beginning of the modern civil rights movement. field, walked onto the

martin luther king was a junior in high school. jackie as a teenager did it on his home -- own. rosa parks is a decade away from giving up her seat on the bus. jackie had done it earlier in the army. -- that iso realize an important part of understanding the significance of african-american champions. jesse owens and track and field -- in track and field, mohammed ali in boxing. the republican mayor of new york was pushing for it. jackie had to actually do it. host: you mentioned the martin luther king quote.

there is also a quote from his wife, who said baseball was a bridge to the civil rights movement. why did jackie have to come first? guest: it's interesting. baseball seems like one tiny fraction of our entertainment spectrum. it was the national pastime. baseball was it. it was a huge, important significance. unfortunately, it has been smothered in myth. we have spent the last several aars producing the last -- documentary. it gets at a more complex just the year he

started playing. it is a complex story of an african-american family, also a spectacular love story. when you realize his widow 93, she spent more of her life without him than with him. she is been carrying the torch in and impressive way. host: we're going to be talking for the next hour. can burns is our guest. -- ken burns is our guest. robinson.ned rachel i want to show the viewers one of the clips from the documentary. >> we never really had a honeymoon.

planes.bumped from two , you may needthis it. we were embarrassed. we were bumped in new orleans and that the cola, florida. in passengers were put in our place. i went to the white ladies bathroom just so i could recover my own sense of myself. we finally took a bus to spring training from jacksonville. on our honeymoon. busent to the back of the and when it got dark, i started to cry because i had felt my great husband, who had been a fighter and a