because 50% of the drugs in our country originate from columbia. what will the commission propose and what should happen at the source? these former presidents who admit that the war has failed presumably where the commission report, what was their recommendation as to what should be done to and these people right at the source? because if the drugs continue come from columbia, then they don't enter the united kingdom. >> well, i mean, if you say -- if you take heroin as an example and you have clinics where people go to get their methadone or heroin fix which is supplied by governments, and let's say that that methadone is, you know, bought by governments f m from -- i don't know, afghanistan or wherever, then you have effectively pulled the rug out from underneath the drug barons who would have been supplying it to the people on

the street. you avoided the people on the streets breaking and entering to get their money and hopefully when they're ready you can send them to clinics -- >> you are advocating the legal purchase of drugs from countries like columbia, are you? >> i don't know where switzerland got its heroin from, but in order to have a program to help wean people off drugs initially you're going to have to supply them, you know, you're going to have to give them the methadone fix or whatever until they're off the drugs and by the state actually administering it that immediately pulls the rug under the cartels. that they of this don't have a market anymore. >> it's an international approach, one country can't do it on its own. from your level as a former president and someone who deals with these issues for over ten years in switzerland, do you think the mood is changing

amongst the international leaders? not just former leaders who have signed up to the fact they may have made mistakes but do you see a culture shift amongst the present leadership of these countries? >> yes. i think when you listen at the president now of columbia, if you listen what the president of mexico is saying, there are all -- they all agree that the debate should take place. they do not agree with a change at this moment, but they know they cannot just continue as they did without putting in question what they did. because i mean, one of the members of the commission, former president of columbia said i worked with -- i was a chief of the war on drugs in my country. and we did very well, but we didn't solve the problem.

the fight was hard. we could fight, but we have harsher war now in the country and mexico is just now in a situation of quasi war, so i mean, they know that this is not the solution. they don't know exactly how to change, but they want this debate. and with this change is existing. now, on the -- in the political discussion in the u.n., we are looking for more consistency. because, you know, every -- any of these specialized organization has another constituency. in vienna, you'll people in the law enforcement and in company the people from public health and in new york the people for development and it's not consistent, the policy. >> of course. >> i think the general secretary of the u.n. is really aware about that and tries to bring

together this different approaches of the drug problem. >> thank you. finally, sir richard, as far as the u.k. drug policy is concerned what is the quote of a young member of the home affairs select committee in 2002 who said this after the publication of our report. drugs policy has been fading for decades. drug use has increased massively is and the number of drug related deaths have risen. he's now the prime minister. so you must be heartened that government policy is going to be moving in that direction. >> yeah. i mean, i think that what it illustrates that if you talk to any individual in positions of power or responsibility, they know that the current system is not right and they know that the health-based system is right.

and they're just worried whether politically, you know, they can be brave enough to, you know, push it through. and, you know, so david cameron then was not prime minister. he's now prime minister. obviously, you know, we hope that we can give him the -- we hope we can get him the facts to make him brave and actually changing current policy for the benefit of the society as a whole. since you gave me one quote, the head of interpol 18 years ago, western governments will lose the war against dealers unless efforts are switched to prevention and therapy. all penalties for drug uses should be dropped. making drug abuse a crime is useless and dangerous and we arrest more and more dealers, but at the same time, the availability in our countries is increasing. police are losing the battle

worldwide. that was the secretary-general of interpol in 1994 and also i think was a very well respected policeman in the u.k. >> i have no quotes to match that i'm afraid. the battle of the quotes is over. i should declare -- >> your quote was, however, actually fine. >> we should declare our interests, we will be traveling virgin when we go to columbia. >> thank you. >> that is not because of your interest in the commission. >> i'd like to say that we do use fuel on our planes and we don't just fly high. >> well, you wanted to know if this was going to be proposed for when people went to mars at your suggestion. >> we'll see if we're allowed to at first. >> richard, federal counselor, thank you very much. we kept you longer than anticipated. we're most grateful and if you can send us the notes we'd be most grateful. >> good luck on your research. >> thank you. thank you.

order could be called. call the next witnesses. thank you. looking ahead n a few moments a senate hearing looking at preventative treatment to help with pain. and after that, tom daschle and trent lott on their time many congress and how things have changed. later, the launch of the ten-year campaign to double the number of women in congress. earlier this month, the president sent his 2013 federal budget proposal to congress and over the past several weeks members of his administration have come to capitol hill to discuss their agency's requests. tuesday we'll have live coverage

on c-span 3 of two of those hearings. the first is at 10:00 a.m. and there will be testimony from lisa jackson. under the president's plan the epa budget would decrease by a total of $8.3 billion. later in the afternoon we'll hear from secretary of state hillary clinton before the senate foreign relations committee. the president is requesting $51.6 billion, a 1% increase over 2012. this includes $8.2 billion for civilian-led operations in war zones and other overseas operations. you can watch live coverage of both of these hearings, tuesday, on c-span 3. there are millions of decent americans who are willing to sacrifice for change, but they want to do it without being threatened and they want to do it peacefully. they are the nonviolent majority. black and white, who are for change. without violence. these are the people whose voice i want to be.

>> as candidates campaign for president this year, we look back at 14 men who ran for the office and lost. go to our website, c-span.org/the contenders to see video of the contenders who had a lasting impact on american politics. >> can you remember those in the depression when times were really hard and we left the doors unlocked? >> yes! >> now we have the most violent crime-ridden society in the industrialized world. now, i can't live with that. >> c-span.org/the contenders. >> more than 100 million adults suffer from chronic pain. the senate health committee recently invited medical doctors to capitol hill to provide recommendations for treatments. iowa senator tom harkin chaired this one hour and 35 minute hearing.

>> the senate committee on health education will come to order. chronic pain is a significant public health challenge that has yet to receive adequate attention. given the tremendous impact it has on people all across our nation. it's estimated that approximately 116 million adults in america more than the number of adults affected by heart disease, cancer and diabetes combined suffer from some form of chronic pain. these often debilitating conditions have a tremendous impact on many daily activities. making it difficult for many individuals with chronic pain to even meet their own basic needs. chronic pain fprofoundly affect quality of life. it remains one of the most

challenging conditions to assess and effectively treat. it remains one of the most challenging conditions to assess and effectively treat, even though it's one of the top reasons for doctor visits. because of the pervasive impact of chronic pain, we have convened this important hearing today to explore the current state of research, care and education with respect to chronic pain. to examine barriers associated with treatment and to discuss opportunities for further research and prevention strategies. as the chair not only of this committee, but of the labor health human services subcommittee, i have encouraged emphasis on pain research at the national institute of health. nih took a huge step by creating the nih pain consortium. despite the fact that every

institute and center addressed some aspect of chronic pain, none had the sole responsibility for this critically important issue. nor were the various institutes coordinating the pain research. this lack of coordination limited the attention given to pain research. and despite advances made by the nih pain consortium more needs to be done across the federal government to address the unanswered questions. the unanswered questions surrounding diagnosis, treatment and prevention of chronic pain. today's hearing will largely focus not exclusively, but largely focus, on the recently released report by the institute of medicine. titled relieving pain in america, a blueprint for transforming prevention, care, education and research. this crucial report examines the

issue of chronic pain in america. identifies some pairiers to more effective research and suggests a plan for addressing these barriers. the report advocates for enlightening health care providers, patients and the public on the substantial burdens of living with chronic pain. and it highlights areas for improvement in pain research, care and education. education. we need to do a better job of educating in medical schools and residencies about the different forms of pain. and how they should be treated. the so-called physiological pain that everyone recognizes right away from a sprained ankle, a burn, broken arm, cancer. where we know the physiological source of that pain. but then how about the physiological pain for which we don't know the source?

irritable bowel syndrome, fiber myalgia and back pain. we don't know the source. how do we educate, how do we educate our doctors? to understand this. and to make -- as they say, the right type of assessment and diagnosis. so i look forward to the testimony of our expert witnesses who approach the issue of chronic pain from a variety of perspectives, all with the goal of addressing this often neglected public health issue. this is a public health issue. and what it costs this country, both in terms of dollars, but in terms of lost productively and loss of quality of life. so i thank you all for being here today and i look forward certainly to your testimony. we'll have two panels.

on our first panel we'll hear from dr. lawrence thaiback from the national institutes of health. he serves as the director of the national institute and coleads the pain consortium. thank you for your service at nih and your statement will be made a part of the record in its entirety. if you could sum it up several minutes or so i'd appreciate it. thank you very much. by the way, i ask to have the record left open by opening remarks by those senators who may be coming in later. please proceed. >> mr. chairman, thank you. thank you for the opportunity to testify about pain. one of the most important public health problems facing our nation. i will highlight what the nih is doing in partnership with other federal agencies to advance pain

research and treatment and i also hope to convey some of the promising opportunities that science offers to overcome the challenges of preventing and treating chronic pain. pain can provide useful information warning our bodies of potential damage. however, chronic pain can be debilitati debilitating, like arthritis or canner. this is not only a current public health challenge, but an increasing problem for the future. perhaps the most important modern insight about pain is that chronic pain, however it begins, can also become a disease in of itself. this recognition of chronic pain as a disease has important implications for how we study pain, treat pain and structure our healthcare system to provide care to those suffering from pain. congress took steps towards advancing research, education, and care for people with pain through specific provisions in the affordable care act.

the act directed the secretary of the department of health and human services to establish the interagency pain research coordinating committee, the iprcc. iprcc's responsibilities include summarizing advances in pain care, identifying gaps in duplications of effort across the federal research portfolio and recommending how to disseminate information about pain care. the iprcc will hold the first meeting on february 27. the secretary also engaged the institute of medicine to convene a conference on pain to increase recognition of pain, survey the adequacy of pain care, identify barriers to care, and recommend how to reduce these barriers. the iom report noted that progress will require a better understanding of the biology of pain, improvements in the therapy, development process, and removal of barriers to

optimal care and the healthcare system at large. nih activities drive improved scientific understanding, compliment private sector therapy development and inform the societal and care delivery issues that ultimately fall within other agencies' missions. the nih pain consortium coordinates pain across the institutes and centers and others of nih taking the lead on the programs as is appropriate to their mission. for example, the nih blue print for neuroscience research is soliciting interdisciplinary research to see how circuitly underlies the pain and addressing the pain care, professionals and researchers which was another key issue highlighted by the report. the compliment and encourage

investigator initiated report on pain, nih has undertaken many initiatives. this is models, measurement and management in pain research which the iom commended for the comprehensiveness. others target specific conditions including recently ocular, joint disorders and those from cancer therapy to name but a few. the alternative medicine recently funded through centers on chronic low back pain and is spear heading a trans-nih agency effort under the aegis to develop diagnostic criteria for back pain. the national institute of diabetes and digestive and kidney diseases multidisciplinary approach to the chronic pelvic pain research network is another example that embraces the whole body approach. in conclusion as a scientist i'm encouraged by the opportunity

for success. as a clinician who treats people in pain, i look forward to treating it as a complex multifaceted syndrome of its own and we need to work together to deliver new and more effective treatments. to take full advantage of what medical science can provide now and in the future, the report called for transformation of how we as a nation understand and approach pain management and prevention. next month, the committee will develop a framework to execute the transform within the research community. thank you, and i'd be happy to answer any questions. >> well, thank you very much, very much, thank you for your leadership on this issue. i just have a few questions. i want to delve into the department's strategy with respect to coordination of pain management.

ask you elaborate on when we can expect the department to provide us a full report on them implementing the iom report recommendations and is it recommended by the iom to be completed? >> first step in this process of course was the establishment of the interagency pain research coordinating committee. the secretary established this in july of 2010 and selected a final roster of 19 members. this includes seven federal members, six academic members and six public members. this committee will hold its first meeting on march 27, on nih campus with the director of ninds who will act as the interimchair. the nih is working with other iprcc member agencies to gather and analyze the agency's pain related scientific advances,

scientific portfolios, get an overview of their public/private partnerships and their individual efforts towards education and dissemination so that these may be reviewed and discussed at the committee's first meeting in march. >> okay. secondly, i'm interested in initiatives in prevention wellness. as you know, we have a large segment of the part of the american -- of the affordable care act is prevention and wellness. what about the role of prevention? i mean, it seems liked you have chronic pain, but how do you prevent it? are there prevention strategies? >> so obviously this is a multifaceted problem, and so the first portion of course is to p. the first question is to delineate those people that are most at risk to develop chronic pain. and there are a number of

ongoing studies which seek to identify so-called risk factors that individuals may have, which make them particularly susceptible to pain. this can take the form of studies of their genetic backgrounds. for example, in the oral-facial pane and risk assessment which is termed opera, and perhaps we'll hear more than in the second panel, individuals have been studied in a perspective manner, and a number of genes of interest have been identified with those that associate with pain. and these give you clues as to who might be particularly susceptible. another gene variant has been discovered, which seems to be protective for people from chronic back pain after back surgery. this gives you insights as to who may be more or less

susceptible to these painful conditions. another option are to begin to dissect the molecular pathways which underlie a chronic pain, and in so do identify new and novel targets that would allow you to intervene to either reduce or indeed eliminate the progressions from an acute situation to a more chronic one. so for example, scientists have identified several specific molecules from the omega 3 fatty acids which are certainlied resolvents, and what these are able to do is they're able to reduce pain associated with inflammation, which as you know is now generally treated with opioids or cox inhibitors. so finally, there are a series of studies that are ongoing

using real-time brain imaging, which will allow us to understand how one is able to control one's reaction and sensation to painful stimuli. and in so doing this, once again we may be able to come up with a biomarkers that will allow us to identify the subset of people who are most at risk. >> very good. well, dr. tabak, again, thank you very much. i'll leave the record open for any other questions that senator enzi and others might have. >> thank you. >> we'll call our second panel. dr. philip pizzo. i hope i correctly pronounced that who is the chair of the oim report that i just referenced here. dr. pizzo is joining us from stanford university where he is a professor in the pediatrics and microbiology and immunology

department. dr. pizzo will focus on the oim report and target areas for future research. next we have dr. william maixner. will you please come up to the witness table, please. and same with ms. veasley and also dr. sarno. so dr. maixner, and then ms. veasley and dr. sarno down here on the end. there you go. we welcome dr. william maixner. dr. maixner is the director for the center of neurosensory disorders for the university of north carolina at chapel hill. dr. maixner comes to us today with specific experience in pain management research. he has developed an oral facial pain management program at chapel hill. kristen veasley the director of the national vulvodynia association. recently she was appointed to search on the pain research coordinating committee at nih.

the committee was created to coordinate pain research facilities across the federal government. and next we have dr. john sarno, a professor of rehabilitation medicine at new york university medical center and practitioner at rusk institute of rehabilitative medicine. dr. sarno, the author of four books on pain will share his work with respect to treating chronic pain. so i thank all of you for coming here. your statements will be made a part of the record in their entirety. and i ask you if you could sum up in five or seven minutes. there is probably a little light down there. i don't get too nervous if it goes over, unless it guess over a long time. but if you're summing up, five, six, seven, eight minutes, that's fine with me. and like i said, your statements will all be made a part of the record in their entirety. dr. pizzo, again, welcome, and please proceed. >> thank you very much. >> punch the button.

>> thank you very much, mr. chairman. it's an honor to be here with you today, and i appreciate very much your interest in this important topic. today i'd like to share with you the results of our institute of medicine committee that i co-chaired with noreen clark from the university of minnesota. the -- michigan, rather. excuse me. the important findings from our committee alluded to earlier as follows. the number of americans suffering from chronic pain number 116 million, which is actually an underestimate, because this doesn't take into account children, individuals in chronic custodial facilities, people in the military and others. so this is a huge problem in terms of magnitude of numbers. but it's equally shadowed by the financial impact of pain in this country as well. currently, we spend between 560

to $635 billion a year on pain. that's more than we spend as a nation on cancer, heart disease, and diabetes together. it costs us $100 billion from our state and federal budgets to cover the cost of pain care. and the reality is that those expenditures are not alleviating pain in america as we know it today. our committee was mindful of the fact that there is much to be done in developing cost-effective methodologies as we go forward. but the magnitude is simply astounding. we recognize that we had five charges from the affordable care act through hhs and to the nih in our work. the first was to delineate the public health patterns of care of pain, the magnitude of the challenges and problems as they stand today. the second was to review the impediments andar