less likely. it is a real possibility. for example, the work that we've done with the standard of micro economic mod tells we use inside the reserve. looking at the incidents of shocks that have occurred. there remains a real possibility that we could be hit by the zero lower bound. recently we've had many discussions of secular or whether demographic trends that so called equilibrium real interest rates may be at a lower level than we've seen historically. that's one of the factors that i think will be important in determining how frequently and

naked of shock could push economies against the zero lower bound. if it is correct that equilibrium rates in the united states and globally may be lower going forward than they have been historically. i think we will have to worry about these episodes more often. of course, often there are other tools besides monetary poll 60 mime monetary policy has bore the brunt of responding. i think if greaters had more fiscal scope than there would be a large tool kit to respond to the zero lower bound. >> it seems to include nor structural bands although the

situation is improving slightly. on the tendential interest rates. research has been done to the one you're alluding to and points to that direction as well. >> let me take you one circle further, you've beautifully demonstrated the efforts that have been undertaken from a macro prudential view. this universe being restrictive and well supervised as it is how generated the creation of parallel universes. i'm just thinking of huge janet with the tool box with all the adrib attribute that's you have, what can you do about thatted oi .

there have been development of funding mechanisms outside the realm of central bakernkers. what can be done about them in order to make sure there's no creation of significant threats that are out there that are not covered by macro prudential tools? >> i think you're pointing to something that is an enormous challenge. we simply have to expect that when we draw regulatory boundaries and supervise intensely within them that there is the prospect that activities will move outside those boundaries and we won't be able to detect them and if we can we don't have adequate regulatory tools. that will be a huge challenge to

which i don't have an answer a. as we think about that. i think it is particularly useful to focus on those that they have the potential to control risks, not only among regulated institutions but also more broadly. that's when reason in the speech i gave i messenger margin requirements that can serve to limit leverage not only within the banking system but more broadly by any institution that would be borrowing short term to take on institutions.

this might have more universal effect. i tell you also, we have developed as many as you have, as many central banks have very active monitoring programs to try to be on the look out for what will cause the next crisis. hopefully many, many years in the future. >> we will both be retired by those. >> i certainly hope so. >> what are the new threats. we're trying to look for those and particularly to look outside the regulatory perimeter to see where threats are emerging but this is a real challenge, i think, for all of us. >> we share exactly the same concern. we look at the horizon and we know where -- what could be the traditional risks bases on history but what i'm obsessed about is what do we not know from history that will arise and

will be the risk of tomorrow. >> i think we have a much more active program of monitoring for those risks than we did before at the kies is. >> you have taken examples of canada, switzerland and a few other countries, i'd be remiss in the to address the issue of spill overs. we are a institution that is concerned by 188 countries. they are the members. we are doing as much research as we can to identify the spill over it's from monetary policies sf . we have seen a strong ep episod. i know it is not directly in your mandate to worry about

them. it is mine. we compare our notes on a friendly basis. how do you perceive them? how do you integrate them in your way of thinking? are you attentive as well so to wh what we are working on which is the study of the spill backs from the spill over. for those not so in tune with the spill/spill business. it is the understanding of decisions made outside. the spill backs is the consequences of the spill overs as they bounce back to the demede domestic markets where the decisions were originally made. i'm sure you pay attention to it. >> we certainly do pay tension to spill overs. although the fed -- this is true of most central banks, the mandate that's we're given by

congress or the relevant legislatures tend to focus on domestic goals. we certainly strive to avoid generating spill overs when we use monetary policy. of course we are very much effected by the global environment. the spill backs which you refer are central in our analysis of our own economy and what the impact of our policies would be. i think if you look us monetary policy generally, given -- of course there are spill overs. in global financial markets that -- where capitol flows are as large as they are in the global economy today and financial markets that are so interconnected. of course there are spill overs

and no denying that. i think when you've seen significant impacts so emerging market economies from i think most studies, hours and other researchers would suggest that there's many factors that are causing it in which movements in global interest rates would be only one. so for example, when we instituted qe two which generated in that period after that, there were capitol inflows into many emerging markets. there were other factors. stronger growth in the emerging markets were an important factor and shifts in risk attitudes among globally that are not necessarily driven by monetary policy. i guess the other point i would

make is that the studies that we have done, i believe this with would be consistent with the imf's analysis. when the united states is as important as they are in the global economy, when we adopt policies in pursuit of price stability and full employment. given our importance as a purchaser of goods from other countries, generally, these are not bigger than your neighbor policies. we are effecting foreign countries by pushing down by can expansionary policy our exchange rate to their detriment. when our economy expands, we buy more. on balance, i think the spill overs. they are typically positive. you did refer spes cifically to the episode a year ago. before there had been necessity

real change in monetary policy but a shift in communications about future monetary policy. a very pronounce iffed jump in interest rates. i think they were tip typically emerging mark echts with greater vul n which caused those countries to tight en monetary policy. >> just to give you an example because michelle bashley was here exactly where you are now. she said at that time the currency of chile went up 30%. it had a immediate strong effect on those countries. new zealand is another point in case. >> i think in there what was happening is that traders had built up positions that were premised on unrealistic

expectations about interest rate paths and about the appropriate level of volatility. it wasn't just a shift in monetary policy but a rapid unwinding of leverage positions that had build up that caused that damage. i've pledged often and we will continue to try to conduct our monetary policy to communicate about it and to conduct it in the manner that is understandable to financial markets to avoid the kind of surprises that could cause jumps in interest rates that cause such capitol flows. you know, to some extent -- to some extent i think such spill overs are relly unavoidable of

global capitol markets. my own assessment is that most emerging in e market has have stronger systems. >> because they went through the crisis with the support of her an her team that they felt a lot stronger afterwards . all the things that were put in place the kinds of shocks that we may see as spill overs as hopefully the global economy covers and we are in a position to tighten upon monetary policy. we will do everything on our side to make sure it goes smoothly. >> thank you so much for the

support. i'm sure they are particularly interested in your views as to how you can best communicate and they can best anticipate how to limit the volatility risks that arises interest that. >> i will ask you a final question before we're off because i know we are pressed for time. michelle referred to napoleon who said that the central bank should be independent but not too much. with that enlarged responsibility -- >> well purposely i changed a little bit. monetary policy, macro prudential tools that should be used for financial stability, are you independent? >> well, i think we are independent and appropriately so in the conduct of monetary

policy. congress established the goals we are to pursue. i think had true in most countries that there's no goal independence but there is independence on how to carry out monetary policy. there's an awful lot of research that macro economic outcomes are better when central banks have the ability to decide how to use their tools. they have to explain them. they have to be accountable to congress. i think that is very important sometimes when central banks take on financial stability mandates it becomes harder. i don't think independence is appropriate in absolutely every sphere of conduct central banks become involved in.

i think it's really the conduct is what's really important. we had had the experience during the crisis of putting in place a very large number of liquidity programs. when banks become involved in lender last resort activities for example the lines between what a central bank should do and what's the responsibility of government can become blurred. >> right. >> and, you know, these are times when i think the activities of central banks can become quite controversial. one of the things that we it during the crisis to try to clarify what's the dividing line a central bank shouldn't be dragged over and if it is the fiscal authority should clearly be taking responsibility.

we actually had a kind of accord with the treasury that was signed. they kind of interested we may use our balance sheet to lend but to the extent we do is the responsibility of the government. once cooperation become very natural, the lines do get blurred and there is a potential threat to central bank independence but i think it is important. >> from a monetary policy there is complete independence. >> at least tool independence. >> well, chairman yellen, as a token of our appreciation, i would like to hand over a book that celebrates the story of the imf plus one day because the anniversary was yesterday at the beginning of the imf.

you've been a terrific speaker in this. thank you so much. >> thank you so much. [ applause ]

>> on the next washington journal, we'll look at some of the key issues before congress, including immigration. with grofre northkwift president of tax reform. we will take your questions about recent supreme court rulings regarding abortion and contraception and we will look at global oil production and a report the u.s. has surpassed saudi arabia and russia as the world's largest oil roe deucer. >> the washington journal is live on cspan everyday and you can join the conversation on facebook and twitter. facebook. >> now you can keep in touch with current events using any phone any time on cspan call to hear congressional coverage, public affairs programs and

everyday listen to a recap of the day's events at 5:00 eastern on washington today. you can also hear audio of the five public affair programs beginning sunday noon. call 202-626-8888. long distance or phone charges may apply. >> according to the head of the national institutes the health, a lack of funding is hurting the ability to cure diseases. dr. francis clins was on epoint. >> thanks for coming on time. i'm fred upton. welcome to the first of what will be a number of round tables of our 21st century cure's initiative.

a collaborative, bepartisan effort to names to accelerate the pace of cures of medical break-throughs in the united states. as my colleague in the video that we released last week, as part of this bipartisan initiative, we are going to spend the next number of months, 6, 9, whatever to review the fulling arc that determine what steps we need as a nation to accelerate new treatments and make sure we keep america as the innovation capitol of the world. we cannot do it alone we need the support of those here today and watching online. we are going to hold round tables in washington and perhaps around the country as well. we will solicit feed back from experts in here.

we need a lot of answers and we need to listen. no idea is to too big. no idea is auto small. the only way we will akblish our goal is if work to cover this conversation. we hope to hear from you during this process. for those of you who are waufinwaufin watching you can mail it to cures@white house.gov. >> we're lucky to have joined by some of the nation's greatest thought leaders in medical innovation. dr. francis collins, dr. janet wooddock, dr. jeff shurner, dr.

james whilsce. dr. jill gray. dr. andrew veneschenbauk. marri margaret anderson, dr. peter uber, dr. ellen seagull. >> sara dupray, jonathan lef partner and chairman of the deer field institute. thanks for being with us today. to get the most out of everyone i'd like to keep my remashes short. i would like to get my cochair on this effort to say a few

words. we will introduce eric from canter the majority leader. in essence we have the number two republican and number two democrat on board in terms of whach we're trying to do to show bipartisan forward marchs. >> with that diana. >> it's still fred. >> thank you. i'm happy to partner with you in this important effort. the 21 century cures initiative is an exciting effort that has the potential to impact bio medical research. the united states has been a leader for decades where we can work together to improve health and medicine or we can round behind.

they we bring experts to the table to dig into how we can more effectively and efficiently tackle some of the complex challenges in medicine. as fred noted, research and innovation runs on a short of cycle, development, dlify. it's in those areas that we want to focus our attention and kese input of the distinguished leader in our panel today. the questions we're focusing on will be key to beginning our work toward possible solutions to these complex challenges. first, we need to take a look at the current state of bio medical research and innovation in tuni states. where is the u.s. leading, where are the drivers and barriers and where are we concerned if we're falling significantly behind. >> second, how does it translate

to patient care and outcomes and better health and medicine. we know there are pockets of fantastic progress and resoif being kop duct, research across the country. where can we focus our attention to reach more patients. third, are there other countries we can learn from. the u.s. may be in danger of falling behind. what strategies and resources are the other countries doing to excel in innovation. are there concrete viable actions that we as lawmakers can take to enhance innovation in the u.s. how can we help the fda modernize the drug approval process to take advantage of the cyclical nature of research that we mentioned.

discovery, development, delivery. all of these are important questions but they are also. i think everybody in this room and on the panel is up for the challenge. i know we can be productive and i look forward to the discussion. i'm grateful to fed and everybody from the kmi ee who is here today in jaoining us in ths effort as well as the experts who are taking their time. thank you very much. >> thank you very much. i want to first acknowledge the leadership that opton, diann diannad deget in a bipartisan. >> thank you for that. thank you for the commitment. some of you for decades in this arena of allocating resources,

decisions behind that and than effecting good policy to promote. what i hope will become common parlance which is a culture of curers. we ought to be a country that promotes cures. i know all of us are about maybing sure that there's access to treatment for everyone. i will say that mar marring we to make it faster to get to cures and make cures more of a reality. good treatment is just not enough. so thank you for the emphasis here. the 21st century cures initiative by the energy committee and its members i think will be a tremendous story of accomplishment for this congress. if nothing else, this congress

should be known for setting the right priorities. promoting cures, treatment for a better life, saving her life first, ultimately is a win/win for everybody. a lot of the discussion on the hill has been about fiscal restrar restrai restraint. how do you deal with limited resources there are i think all of us here, joe has been active on the cancer side in terms of research. what can we do to do more? all of us want to do more. sometimes first is starting to make the right choices with what we have and setting about how we're going to do more. i would congratulate all of you.

i think all of us can sit here and talk about breaking down the barriers that die aprana talkedt in terms of promoting a culture of cures. i taking ten years, spending a billion dollars to develop a drug and bring it to market is not senl. not while people are dying. yes, it's improving fda processes. yes, it is making choices like the first steps that we took with the kids first research act. that is demonstrative e ivive o choices. 123 million is not the $30 billion that we got to protect and grow with nih but it's a step that demonstrated that need to set priorities. i really look forward to the

initiative here whatever that may bea cording to the desire to help promote success on that. the panel that has assembled here. we appreciate your work and than look to the outcome of this initiative. yield back. >> thank you very much eric for your 10 atenance. we will keep you in the loop. >> i will ask former chairman bart yoond and chairman amarten. >> i want to introduce some of the mefbs that are here. cha chairman joe pits, frank palone. kathy morris rogers and a member of the health subcommittee.

vice chairman mark bugess from texas. ms. castor from florida who joins us. marri morgue inn griffin and leonard lance, a committee as well. >> thank you mr. chairman. i have witnessed this today, i think it's very important for us to figure out ways to develop cures more rapidly. we spent an enormous amount of money on research in which the pharmaceutical companies make advantage and are able to produce product that's are life saving. we've got to encourage more development of medicines but we also have to make them affordable. we don't do anybody a favor if we have a drug that cannot be bought or that the health care system cannot pay for. so as we think about new

products, new drugs, new therapies, we must evaluate them to see if we're adding more to helping the american people and man kind or whether we're just lowering on new efforts that will cost a lot more but may not add to the therapy that people are so desperate to have. thinking outbox. it's interesting. i've never seen anything like it since the time i've been in congress. i look forward to this group figuring out recommendations, i assume, to the committee so that we can consider that legislation if it's necessary we all want to work with you. it's worth while to hear from people in a setting that is different because don't know if we can even make a transcript of the proceedings but it's --

anytime we can exchange ideas it's all for the good. >> well, congressman waxman is uncomfortable being to my right. that's -- but it is very good to be here. we're going to show our system at its best bipartisan under the leadership of chairmanupton and mr. pelon, two, experts on the democratic side. our system does work. over the next however many months, the country will see america's political system and medical system at its best as we woe work together to decide how to take things out of the laboratory into everyday life. some of you i know very well.

some of you i worked with professionally but chairman upton is an honest broker and he sab shutly ma-- absolutely maki this a top priority and the american people will see real results. i commend you plr chairmmr. chai look forward to having the dialogues and ultimately coming up with some common sense solutions for cures that make america and the world a better place. so thank you chairman. >> thank you. when when he send out the invites, we send a couple of questions to spur some thought. i'd really like to see where that takes us over the next couple of hours perhaps. we use these questions. innovation in the united states? what does bio medical innovation

men for american patients and jobs. three, how does the u.s. compare to other countries with respect to buy oio medical ip investign how can we make sure we lead the way and what steps does congress need to take to foster innovation, bring new treatments and cures to patients and as we know keep more jobs in the united states. it's been a nice afterthought in terms of where we want to go but what family isn't impacted with something we can do here whether it's in this country. why don't we start with number four. i know as i sat down with many of you over the last couple of weeks and even the couple of months, hopefully the ideas have been working and have been able

to come up with cures@white house.gov is a way that people can weigh in. maybe dr. collins, we will start with you but then we are really going to use a discussion. feel free to use the mics. let's go at it. >> thank you will mr. chairman. it's amazing to sit around this round table. i figured when i walked in i've never seen anything like this but when mr. waxman said he's never seep anything like this, i know this is a unique and special moments to you mr. upton and you mr. gett for convening us in what i hope would be a series of conversations.

to try to answer your question, certainly what desperately need to get a study predictable project ri ory of support. we've not seen that. we have lost over 20% of our purchasing power. it has put the system under tremendous stress. it has caused the loss of jobs. maybe most importantly and most worriso worrisome. if we want to see innovation continue at the level that it could need to have confidence that there is going to be a panel for them that their dreams are going to be possible to

pursue. we're not lacking their ideas. this is a unique moment in terms of search potential. it is also perhaps an occasion where we're missing out on the kind of return on that investment that might be there. i want to mention that as well because i think your questions reflect an interest in that. don't know if you saw just today a publication that did an analysis of the economic returns of the women's health initiative. an effort which was started 20 years ago in which nih spent $260 million on it. the estimate was that the return was 140 to 1.

in materials of what it is and where we're going. the innovation opportunities -- we're extremely energized by the kinds of technologies that are possible and wishing to have that unleashed but again, i think being held back when it comes to things like personalized medicine where you now do dna sequencing on a chip and i brought with me on a proje project, this is actually a human kidney made up with stem cells that are placed that you can basely stud ky the kidney. we are in fact trying everything we can to try to use this crunch as a motivator in working with

indust industry. working in other ways to try to cut down that ten year period of trying to go to an idea of approved we are pretty bullish about the potential of the just going along with what leader kantor just. we are just as excited about curing things as you can imagine. we want to cure alzheimer's disease and cancer and hiv. all of those are currently within reach. the current system isn't working. nin wasn'tic nin, the ten year loss of purchasing power is in order to

break it. this is an investment that pays rewards for human health, for the economy. for everything in fact that the government does well. recent analysis by economists indicating that neighbor the most important entrepreneur in the sic the system is the federal government. bottom line if we could have the confidence for a stable project ri of support that could would mean the world. finally just as a point of the real consequence of this, i don't if you saw aol today in the last couple of days describing a situation who sudden in any other era be fought over by ten institutions in the u.s. to find this next

creative faculty position. because the squeeze that's not happened. he's going to china where he will find himself where china continues to increase medical innovation 20%. we can fix this. it will take the will power of all of you and the recognize that this neds eds to be. >> so i have the privilege as dean of the university michigan medical school -- so i have the privilege of serving as dean at the university of michigan medical school and actually being involved in all aspects

from training of the future scientists and physicians to discovery to application in patient care. auto so seeing that whole eco system as to the anger that is instilled by lack of reliable funding levels by nia is absolutely true. houf, there are other things that would be helpful. the regulatory burdens that have been laid on our faculty and staff are ever growing. these are unfunded mandates. like depending on what institute or branch of government there are different conflict of interest regulations.

keeping up with that and being compliant an administrative burden that has no val interest is it. asking congress to come up with a uniform approach would be very helpful. as we look to move our discoveries into commercialization, we find that there are gaps in the eco system. basic researchers can discover mechanisms. we can come up with targets. we can actually develop medicines. we can develop devices. than it requires a large number the other individuals partners with industry. partners with government in order to move that forward because we don't have all of these expertise in the

university. unfortunately those partnerships are sometimes difficult to vefl because of regulatory burden. at a very basic level within the fda if there would be a check list. our faculty as they move devices forward have found a lot of cooperation from members of the fda that are really trying to help them do their job but at least at the initial stages, what we've had to develop are navigators because the complexities of interacting with these agencies are such that the faculty have to be educated. potentially there are ways to partner with government in a different way to facilitate that interaction. i think it would be very helpful if congress could help move

agencies forward. there are way that's we can access the regulatory bureaus in a systematic way that's more transparent. yeah. i'm janet wooddock head at the center at the fda. i want to talk about pharmaceuticals in particular. if you step back and look at the whole eco system. i think there are some major barriers that developers face when they try to go from a discovery that they make in a laboratory to an actual product that is given to patients. in order of perhaps ability to deal with this, i think number one, the clinical trial system that we have is not a stunned right now is for every product.

they get a clinical trial. that takes about a year to get the trial tgt. if it's suck hes maybe trial to stir it. it takes years. it exhausts the investigators, right? much paper work. often many lawyers. all right. what we're starting to do and maybe ellen may talk about but we're starting to look at clinical trial networks, you turn the dareparadigm on its he when you have a clinical trial that is funded. you get the invention and you can test it right away. basically. you have multiple drugs and even drug devices all can be tested by this network. much faster and more independent because the perfected ukt, whatever is given to the network, they pea valuate it.

there's no difference there between the evaluators and inventors but it saves a lot of money. you get to do head to head comparisons because you're testing mult tipple products as well as improved therapies. that's something that could really be advanced. start group that's have done this. like cystic fybrosis because they have patients ready. they have the gene oe types. that's one thing. another thing i'm interested in because it has to do with with drugs is drug manufacturing that's a lot of innovation in drug manufacturing. we're having a big meeting about this. right now we have drug shortages that are affecting hospitals across this country.

we buy many of our drugs from other countries, all right? if something would happen we wouldn't be able to get those drugs anymore. either hostilities, natural disaster, whatever. thirdly, that's another thing that is faced by developers, they have to continue to try to scale up their manufacturing. it's very much like the clinical trial system. it it is very outtated and cumb cumbersom. it is environmentally friendly and the wave of the future how drugs should be made where they are needed. i think that's another area. under critical path initiative, there's a whole lot of translational research that needs to be done on bio markers and many other things that would really aid in getting products

from that gleep in tgleam in the of a person that really should we worked on is a trem ebbedous opportunity. once again i want to thank you you for your leadership in bringing youing torgus together. i tell you what a great pleasure it is to get back in this hearing room. there have been a couple of words that have been placed before you such as eco system and francis alluded to risk. it is important to keep in mind that this process of discovery, development, and delivery is now a very cyclical one. it really lends itself to typical regards of acceleration of that process if we do pay

attention to what celebrates it such as financial capital. francis has now alluded to some of the risks that are associated with that investment. there are also the risk that's have been raised in regard to the regulatory components of this. we're on the other side of the spectrum meaning reimbursement and the challenges that are coming from that t. as congress makes a look one of the thiems will be abl to look at the initiative and that will promeet in a greater investment in accelerating the cycle. one of the particular things that needs to be addressed is the transfer of data across this cycle and the opportunity for

greater data sharing and greater data integration. there are data challenges on the front ends we see the transfer of data from investigators to developers. the challenges of even data sharing among developers is they now need to integrate products such as diagnostics and therapeutics. take a look at the clinical trial designs and the way we are looking at data. you put in place an enrmous procepro process and reduce the risk that is currently growing and slowing down the process.

>> thank you so much for inviting us to be a part of it. it's really an honor and privilege. i came out of graduate school and worked in technology assessment. although you described it as unusual it certainly was the norm for a long time to come together and talk about these critical issues. in terms of answering the question what can congress do? i think you're doing part of the work which is putting a spot light on research, science and innovation as a national treasure and as a national priority. so if you are pry or itizing the research system, i don't think you can escape the responsibilities of congress to make sure that these agencies are adequately funded. united for medical and alliance

of the fda is a group of the all of the different stakeholders coming together to say the appropriated dollars that go to the did fda are extremely valuable and they are not enough. so i think that prioritizing the infrastructure has to happen. it's a critical necessity. i think if we're not listening to that bell being rung than i do believe that as you're doing this in terms of your leadership function we rup the risk of really losing an enterprise that the united states essentially pionee pioneered. in terms of another priority that you're starting to hear about. we have to put patients at the center of this. we have 7,000 patients and dr.

kol i collins has 500 of those. the system is doing its work. the fda is doing its work. we get some approvals aprnd we t that out into the system. at the rate we're going, i don't think any of the diseases that we're going to be afflicted with at some point really stand a chance of being covered in the near term. so i think the speed issue that has been articulated by many of you is of critical importance. i think as this group does its work, figuring out what are those points to rerisk the system. that becomes a place that it will be of critical importance for all of these different stakeholders you gathered here today and going forward to come to some agreement about what are some of the pressure points? we have seen in the world at faster cures we've had the privilege and the opportunity to work with a variety of different disease foundations. so the system fybrosis

foundation, the melanoma research alliance. what i think the system can learn from these groups is that they are one stop shopping in terms of what sighins do we know, what need to be getting prepared for? where is the puck going to go? how do you bring the patient into the center of all of that. i couple of points that i wanted to make sure -- there's the rail need for that stability to come and putting the patient at the center of it. i want to make sure that as you do your work we're making sure that happens. thank you. >> first of all i want to thank you for convening -- can you hear me? i want to thank you for convening this important committee and i wanted to thank you congress for their work

actually essentially through the re-authorization of the act -- we had -- i'm trying hard. we had a mechanism that was sponsored by friends of cancer research. it was bipartisan. it was sponsored on the senate side, on the house side. it had support of industry, patients, companies, a mechanism that get patients drugs faster but better. where there is evidence and unmet need. this was an extraordinary vehicle. i know diana sponsored it on the house side and it was sponsored on the other side. that's an example of coming together in a bipartisan way

with not just aspiration al -- there are other countries. it is a little bit lick a dickens novel. it is the best of times and the worst of times. we have an extraordinary structure. it is in danger. we do have foundations at the nih and the fda that can be empowered and are should be but doi convening with the fda on a privaef protocot all over the united states. nci are putting $125 million. it's more a deadly disease.

it's. it is nextjen sequencing between the fda, and there are novel ways we can get there and there are things question do but we cannot take what we have for granted. if we don't really get this science there to the patients, we will not benefit and mostly patients won't benefit.