what we need is community control over the police. citizenry are basically unaware of their rights in dealing with police officers. we don't have civic education in that regard. police officers take advantage of that. they are trained to take advantage of that. there's two types of policing. there's policing for people of color, and there's policing for those who are not. unfortunately a lot of people not of color don't have a reference. they have not been verbally assaulted by police officers they have not been thrown to the ground. they have not had their car searched or thrown to the ground during a traffic stop. 90% of the rests in d.c. is nonvile en. broken windows, this is basically acting as a domestic occupying terror force for communities of color for the safety and comfort of those moving in. their comfort supersedes the

quality of life of people of color. we're here because no one has put a leash on killer cops, so i have five recommendations. they are, here we go. number one, we need to have a legitimate citizen review board with the power to fire officers for misconduct. most cities have police complaints as we do here in d.c. but they do not have these powers. they are paper tigers and we need to give them power so they are actually responsible to the people they are serving. we should require significant number of police who work in that community to live in that community. that has been found unconstitutional to live in designated areas, how can overcome challenging rulings in court to reflect similar requirements for local politicians forced to live in areas they do represent. the mayor must live in the area he or she represents, councilman must live in area he or she represents, why not police. three, automatic expulsion clause any officer caused the

loss of life of a person unarmed or innocent wrongdoing to be automatically fired and subject to further prosecution. four every year in every city in this country, millions of dollars are awarded in civil lawsuit to settle cases of misconduct. all of this money comes out of the city's budget. the financial liability should be shared with both the budget of the police department and salary of the officer in question. i assure you this more than anything else will immediately alter the behavior of rogue cops. five engage community input into the city negotiations with the all powerful police unions for any future contracts and add transparency to this procedure. therefore, we need to get rid of the grand jury system because it obviously is not working. we have not seen one indictment in years with all these cases and this is why we're here and this is why the president convened this task force to put a leash on rogue cops. thank you. >> thank you mr. freeman. i'm going to turn next to a

comment from only. >> right here, ron. collecting throughout the day comments that have been produced online from the website ant twitter messages. the first comment i would read was submitted online. there's no doubt that all agencies have had issues of bias, even discrimination. these issues do need to be addressed. even so it appears law enforcement is going painted with a broad brush, and i don't believe this is fair to agencies that are more progressive in combating these issues. we must work together to solve this problem. frf thank you. once again, forgive me the name pronunciation, dr. li young. no, ma'am. they will bring a microphone to you, right to your left. stay where you're at dr. young. they will give you a mic. thank you. >> good afternoon. thank you for all your

participation. but i request for testimony and comments since early this morning, of course before 8:00. also index card request again in writing hopefully we have enough time so you can digest what i'm trying to say. i've been here all day and thanks for all the panelists and all the speakers but the problem what i heard is policing. but i really heard about social justice. police secure people by guns gunshot, brutality, by punch. police have all kinds of misconduct. they involved with foreclosure eviction. they send people to -- dragging people on the ground poor people hair, punching, give people blood and probably this

one of the reason i opposed the death penalty because they -- black more targeted. they don't get approval. so you seem you can imagine they can plot all kind of murder to victimize somebody they don't like. in prison or mental institution because they are political prisoners or some kind of dissenters. somebody anti-wars or somebody who opposed their political view or opposed their political budgets. so all kind of things the police will go to city hall, go to the council meeting -- of course

broader speaking law enforcement, security guard things like that. they maybe the people who want to testify abduct them out of the hearing room or allow them to listen, just listen, testify. just listen to other people's comments. now, one reason is a lot of people who support a politician is to have the benefit so always have legislative proposal. so that's why against those, especially everything about. i am from montgomery county, maryland, montgomery county is supposed to be famous for education, famous for intelligence, famous for prosperity. but there's not a case when you consider the government function and the police. >> thirty seconds dr. young. >> how much time?

>> thirty seconds. >> how much you give to me? >> two minutes. >> i know you give other people 15 minutes or more. you didn't tell me how much minute i can have. >> yes, ma'am. thirty more seconds. >> how much time you give me. >> every speaker has two minutes. >> every speaker has two minutes. there's nothing in your testimony that says -- it says president's task force on 21st century policy. >> dr. young, are you finished with your comments? >> no. >> please continue. >> according to this 21st century policy, not even talking about the quantity of speaking time. okay. i try to say -- >> thank you, doctor. >> i'm trying to say i don't have time to argue with you. i would like to submit a written statement, some brief comments so you understand.

>> that would be great. yes, ma'am. >> thank you. >> what i have here, last night, this morning i get up before 5:00 so i can come here. so i agree a lot of people -- >> dr. young we're out of time. before you continue, dr. young we can continue afterwards. i will give you personally another five minutes after we close, and i will listen to it and take your written testimony. >> excuse me. we are in public hearings. >> you have 30 seconds dr. young. >> thank you. but i hate it. okay. now, i agree with this, what i try to say i have been for public offices what our system doing, resources to benefit you. we have 1% 99% inequality. there's the problem with our system.

the important thing is black, you've got to see how they suffer. how they suffer. everybody is thinking about how to we get money from federal. that's people's money. okay. now i try to make simple. social injustice, we have work to be done, we have to promote fairness, freedom justice, peace, humanity, productivity, well-being of general public, social political issues and budget, oppose so-called fair election act. that's a long label, nonprofit organization. public fund do more harm than good. just by that, that take away all my computers all my internet connection. my internet yahoo! account.

>> dr. young. it is time. we're going to proceed to the next person. >> one second. >> thank you, dr. young. there are people behind you that would like to speak as well. >> i want you to be sure to investigate murder for -- >> next -- dr. young, we have other people who need to speak behind you. miss comfort? thank you. we have the microphone. thank you. >> i will give you this written statement with six attachment. >> thank you dr. young. >> please be sure to read it. >> i'll take a copy. thank you. miss comfort. thank you, ma'am. >> thank you for having me. i never thought i would be in this situation. my 26-year-old was gunned down in montgomery county on february 16th -- february 19th, 2011.

by a police officer that said he told him to stop like 30 times in 30 seconds. i don't know how that is possible. my problem is accountability. if this police officer knows they will be prosecuted for a crime, god forbid if you and i kill somebody you know the consequence, but they can hide behind the badge and murder our children. i've been here all day listening to the police telling us they want their officers home. so do we. we want our children home. okay? we send them to school, not to come back in body bags. there's good cops and bad cops. i want to take this time to

thank -- i was a vendor in the district of columbia right by the white house. that's how i sent all my children through college. you did a fantastic job. you stood up for the bad cops that were taking brides. 2011 them were convicted and i watched, and i thank you for that. there's a lot of good cops out there, too, like sergeant scott of montgomery county. he did a fantastic job. but officers like christopher jordan who murdered my son should be held accountable. there's a whole lot of women out there, black, african-american children that are being slaughtered by the people that are supposed to protect them. please help us look into this.

my son did not deserve to die on the street like a dog in the hands of somebody that was supposed to help him. yes, i'm mad about that. he was a law abiding citizen. it was captured on a video. thirteen eyewitnesss video somebody tell me somebody mistakenly deleted that video. how do you justify that. that was a murder not a justifiable homicide. help us to keep our street safe for our children. they are not supposed to be slaughtering them they are supposed to be protecting them. thank you so very much. >> thank you. >> online. >> before i go online, people have been waiting patiently so we apologize for that. mr. george faulkner. >> thank you.

>> thank you. i have one small but very important comment for the commission regarding any recommendations, forthcoming data collection efforts regarding deadly force on a national scale. that is that fatalities make up as little as half of the number of officer-involved shootings that actually occur. and the distinction between a fatal and nonfatal incident is not the intent of the officer per se. as many on the commission know police are trained, with very few exceptions trained to shoot for center mass. whether or not the suspect dies could be affected by a number of factors such as proximity of a hospital or trans location of the bullet wound. therefore if we want to

understand the phenomenon of deadly force, police use of deadly force we should stop referring only to deaths in custody and expand our call to collect all uses of deadly force, all officer-involved shooting incidents on a national scale including missed incidents, injurious and deadly force incidents. thank you. >> i'm going to pass the mic to chip stewart who is going to be next. before james stewart goes, i have this card i want to remind the audience that all your comments are actually being captured. they will be presented to the task force in a written format as well. if you don't have an opportunity to talk today or not talking today, still feel free go online and provide comments as well. so james stewart. >> thank you very much. and thanks to the commission. you're talking about building trust and legitimacy with the community. the one issue that stands out, has been brought up a couple of times today is when a critical

incident occurs where you have a shooting of typically a suspect and that suspect is unarmed. that suspect is african-american or latino. one of the issues that the community has complained about the most that i've seen is the fact is that when the police disclose any information they say there's ongoing investigation so we can't release any more information other than the name of the person that was shot. and they move on. now, there's a criminal prosecution that can occur subsequent to that, but i want to direct your attention to something i can more important because it is the changing of a police department. that is that the internal investigation or the independent investigation of that shooting to see whether it is not, whether it is justifiable or nonjustifiable, that is a legal finding. that should be left up to the

prosecutor, the coroner. what the police department ought to take a look at is whether it's in compliance or out of compliance with the dental policies, training procedures and best practices and tactical judgments. that has not been the case by most police departments. they merely look at the situation. they say at the moment the trigger was pulled it was justifiable. and what i suggest is an independent investigation to show what the precursor incidents were that brought contact with the individual, the circumstances that happened and whether there was any moments to deescalate or alter the tactics that occurred. that can only be done by separate and independent investigation. i want to direct your attention to two locations -- >> thirty seconds. >> let me say the use of force review board can make that finding or an independent investigator can come in and make that finding. it doesn't have to be a special prosecutor.

the role model is las vegas police department which actually has four civilians who are voting members of the use of force board and three sworn officers. i don't know of any other department in the united states that offers that and that's why i'm bringing that up. but in order to make an informed judgment, they have to have an independent investigation. thank you very much. >> thank you. >> go to online. >> we have a twitter message from national council of churches. mass incarceration is the civil rights issue of the 21st century. >> we recommend body cameras for police and federal funding for communities that cannot afford them. >> next in the audience i have a dr. stephanie meyers. thank you, doctor. >> thank you very much for this excellent session.

all of the panelists have really been outstanding. i represent black women for positive change, which includes a volunteer network of women and men of all faiths and gender and race race. we really believe in addition to the operational issues that have been beautifully presented today, we must step back a little bit and address the entire culture we're dealing with. our overarching theme is we really need to change the culture of violence in america and really throughout the world. we know that america is the standard bearer for so many issues. so we urge the task force to address some of these larger issues. we urge you to call on hollywood and the media to stop promoting violence in hollywood and media and look at different ways to communicate. we call on the task force to find ways to give youth a greater force. through the use of technology social media film, we know that

our young people have incredible things to offer and engage with us. we must do that more effectively because they are the ones in the body bag so often. we must find a way to make them part of the solution. we also propose you support national week of nonviolence. there have been two years of this already supported by 12 governors, 50 mayors and that the task force consider calling on the nation to have a national week of nonviolence next october 2015 and call on neighborhoods, churches, schools, police departments to sit down and talk about conflict resolution nonviolence, building partnerships building trust and all the issues you have addressed today. finally, in terms of best practices, our organization is partnering with pittsburgh police department and we would like to recommend you take a look at what they are doing the police chief is having public conversations in public housing

communities, at churches sitting there for hours letting people ask any question they have. we urge to you call the nation during this week of nonviolence. ask the leaders to do it. they can do it. they are ready. they just need leadership and direction. we propose you contact and explore this whole issue of how to get the nation in a conversation. los angeles is doing great leadership, sacramento, all the things we've heard. let's have a national conversation using social media and change the culture of violence in our society. thank you. >> keith great. >> good afternoon. that everyone for being here. this commission, it's been a good day, it's been a good day. i'd like to say to you thank you for coming and being able to maintain composure and see there

are good officers and bad officers as well. we're very sorry for your loss. my name is keith gray, a former d.c. police officer, also former educator. prior to entering the force i was educator k-12, also taught university hillsboro county university of south florida. my background is unique in that i come from a small town in longview, texas. i hated cops growing up. i always like this one cop a detective. he came to my class one of my classmates' father. i said i want to be a detective one day. that's exactly what i did. spent five years in the department. we benefit freddie everything. 8th street corridor. when you take a visit to 8th street, you're able to walk the streets at night that was my work. that's why. that's why it's so important for us to have a police force who is competent, able to work with the community and able to change

things because of what you're seeing happening in d.c. now. this man came and changed the culture of d.c. i want everyone to know that and now he's changing the culture of philadelphia. we thank you for that. again, from a small town in longview, texas, i came here and joined the police force. since i was part of the police force, i joined at a later time. so i came in after a career in higher ed. i had been a professional recruiter of students. i had been a manager of programs at university level. i started to work on my phd. i said i want to be a cop. i still want to be a cop. it never ever went away. after i graduated from american university undergrad. i spent time, blessed to play basketball professionally, traveled the world. every police department i paid attention to they were all centralized. this is the only country first world country, where you have a decentralized policing structure. having things like this in place, where you can bring a uniformity to police work is very, very imperative, just like for example, a gentleman

mentioned tsa, formation of tsa. what happened before 9/11? every single airport had private security -- >> thirty seconds. >> now you have uniformity you know what to expect. i can take my flask, i capital take my flask. you know exactly what you can take on the plane because of the uniformity of that. i wanted to make three quick recommendations. first change the culture of law enforcement. it has to be changed from the inside. we have to put it on our shoulders, the gentleman chief canterbury who was sitting here made me cringe to say we did not have responsibility or it was not important enough for us to put on our shoulders as law enforcement officers to be professional. it is our profession. all right. we don't expect the community to be as professional as we are. we are the professionals at being police. so we have to put it on our shoulders. so the culture of police work

has to change officers can no longer be subjected to minor backlash and minor offenses because they are doing something out of the realm. what happened with me on police work i got tired -- >> you're down to ten seconds. >> sorry? what happened to me i got tired of enforcing laws i did not believe in. i changed. i'm now a small business owner. this is what i plan to do as a work of mine. this is my civil rights movement connecting the community with police again. thank you for your time. >> edmond raymond. >> want to hear me? first i'd like to thank the president and everyone involved for providing the platform this essential and overdue dialogue. i came here today with my good

friend jim st. germain. we are both co-founders of a nonprofit that's just starting up called plot preparing leaders of tomorrow. earlier one of the panelists stated the way in which community members are treated, why would a young black man want to join the police force. theoretically it makes sense, statistically it's accurate. i'm one of the few black men that decided despite the treatment to join the police force. i've been a police officer for seven years and i do my job honorably. one of the things that all the panelists mentioned was diversity, the importance of diversity in our police departments. it is important. but unfortunately it's completely undermined if there's existing policy that doesn't allow it to flourish. i'm speaking as someone with

front row seats to the madness where i work. it's the most diverse police department probably in the world. and the beauty in that is completely taken away because it's an inherently racist policy. stop and frisk recent policy. 2011700,000 stopped and frisked. 215. existing administration then said those stops were the reason for the decrease in murder. last year 2014, less than 50,000 stops, 326 homicides. 37% drop. the critics said, they will eat each other in brownsville if we don't stop, question and frisk them. obviously that's not true. 600,000 less and homicide still drops. the broken windows theory is another thing that is counter-intuitive, the truth.

theoretically it seems to make sense if you go after the small things, the big things will sort themselves out. but the last two weeks in new york city has exposed the truth which is you know, what the media refers to as a slowdown. homicide, nothing increased. no anarchy in the streets, despite -- >> thirty seconds, sir. >> all right. i want to finish with critique now, i want to finish with recommendation. critical race theory. i recently took a course at jon jay college anthropology course policing multi-ethnic society in which critical race theory is what's being taught. i want to share quick testimony from one of my colleagues who took the course. he said, my name is raymond shea i'm a member of the new york city police department as well as a current student at jon jay. during my fall 2014 semester in jon jay, i attended anthropology class called policing multi-racial society where

critical race theory is learned. i found the class i took was exceptionally beneficial toward my work as a police officer. learning about the culture and history of black discrimination allowed me to understand why members of underprivileged black communities distrust the police. although many police officers see themselves as racially color-blind, governmental policies promote racial discrimination and targets impoverished neighborhoods. prior to take this class, i had little to no knowledge of discriminatory actions against black people. as an asian-american growing up in predominantly white neighborhood i was never exposed to what this caused. i used to believe everyone arrested were perpetrators of the law and hardened criminals should not be reintegrated back into society. now i try to communicate and connect with the offenders on a more personal level. after learning about the history of black discrimination and being more consult really aware i've used some of these individuals as victims of an

imbalanced judicial system. this class has been exceptionally beneficial to me as a police officer and has allowed me to understand and communicate with the communities i work in. i strongly recommend this class for officers to expand their knowledge of various and diverse neighborhoods in new york city. thank you. >> thank you. i have one card here, marie, no name but there's a comment. whoever wrote the card i'll read the comment publicly. it states, more training is needed to better integrate soldiers into community policing. they often can approach their job and the community from a high intensity, high danger perception instead of a police position. we'll take two more online and then we'll turn it back over to co-chairs. >> the national association of school resource officers trained sro, force, de-escalation training combined with body cameras is the solution. next comment on twitter i haven't heard anything about the

new threats, isis et cetera, upgrading policing strategies for this purpose in addition. >> thank you. >> thank you both ron, and jim. at this point we're going to be turning to our task force members for a very brief two-minute concluding remarks, and i'm going to start down at the end of the row with cedrick alexander. >> thank you very much, madam chairperson. let me just say, i think today for me has been enlightening in the sense that this country, this nation, and those that were present here today had an opportunity to share their thoughts and ideas. about where we need to go in terms of enhancing and promoting policing as we continue to move into the 21st century.

i think this is only the beginning of our journey to seek those recommendations that we'll forward onto the president. but what is clearly very evident here today to me is that i truly believe we're on a trajectory to do something different here. for me to sit here and listen and take part in this has been educational. in spite of the fact i've been in this profession 37 years, 38 years now, i am still learning more and more every day. the issues that confront us have been long-standing and have a lot of history attached to them. the moment -- the prentice where we're going to find solutions, i believe, to the issues we're all confronted with. and for me this is not just totally a black or white issue

this is an american issue. it's america's problem. and it's going to take all of us in this room and across this country to find resolve and seek resolutions that i think will be important to the advancement of our country. let me add one other thing. it was just noted by one of the twitter persons that nothing was spoke in regards to threats from isis. that brings us to international scope in terms of how we see this. we think about the issues that confronting this country when i think about it, this is an american issue which we are going to solve and we cannot allow ourselves to become divided because we do make ourselves a target for those that want to see us divided and to work against us. all of us as americans in this

country, regardless of what our history and experiences have been at the end of the day, no matter how much pain we may have endured and how much we may have put on others, i think we all will come to a conclusion that whatever issues need to be solved, we will do what we have always done in this country and that is to solve them ourselves. thank you all for being here and thank you for allowing me to be a part of this as well. >> jose lopez. >> echo a lot of the same sentiment. there was a lot of food for thought today. i think, you know, in conversation with all of the members but folks in the audience, folks on the panels folks i'm able to talk to during breaks i'm eternally grateful to the time, especially the folks in this room those that tuned

in, the amount of time folks today and over the course of all our work have committed to this issue. i've done a lot of listening. i've taken a lot of notices and i think all of us as members have. so we have a lot to think about and a lot to talk about. but this is the first of a couple listening sessions. so we will be moving these around to be able to listen to more and more folks. so i encourage everyone who is here and folks listening to continue to share their stories and to make that public to submit testimonies and to talk to us about not only the day to day experiences that folks are facing with police officers on the ground and some of the consequences of that interaction but also to provide recommendations and to be able to take those recommendations and put those in the order in

which you see fit. one of the hardest conversations i think for us over the course of the coming weeks, will be how do we prioritize everything that has been put forth. that is obviously not only up to the members who are sitting on this commission but up to every single one of you when you're putting your testimonies and your documents forward. the one thing i would say is that i hope that we will have a better balance and that we will hear more from young people across our country. i've had the privilege of working with young people between the ages of 13 and 25 over the course of the last 15 years and understanding the complexities of relationships amongst those young people and police officers on the streets of new york city and bushwick and jackson heights to be specific. i do understand that there is

absolutely a need to make sure we elevate the platform for young people to be heard. it is those stories that will be able to change the hearts and minds of folks who have turned to this issue as one of the most important issues pressing our country today. so with that being said i'll pass the mic over to tracy. >> i just want to start my remarks by thinking for myself personally all of our witnesses who came and shared with us their testimony. i really appreciated they were clear eyed and generous and willing to acknowledge the complexity of this issue. but also clear eyed with recommendations of how we can make progress. i also want to thank all of you

for sitting here supporting the witnesses, supporting us, offering your ideas whether in this forum, online, or if you were going to be offering ideas subsequent to this session online, you know, through the website, et cetera. we've only just begun our work. i'm very cognizant of that. i have so much to digest. we have at least, i think four more full days like this to cover more topics other than trust and legitimacy. i'm very glad we started with that because that does seem to be the cornerstone of the work that needs to be done here. the final thing i want to say on that i've spent decades of my professional life researching that issue of procedural justice and legitimacy from a social science perspective and from a legal perspective. the highlight of the day for me was seeing all the ways in which

real life stories motivate and make clear and salient that research. so thank you. >> so today has been extremely enlightening and informative. i think one of the greatest things about democracy is our freedom and truthfully our responsibility to examine ourselves. in particular to truthfully and proactively examine any system that has an impact on our children, especially a life or death impact on our children. i believe education that has life or death impact on our children and that's why i became an educator. when i heard from ke vaughn, a fifth-grader in the district adjacent to ferguson. he missed a week and a half of school during the first weeks of chaos. when i heard him talking about wanting to be a police officer and being enrolled as an african-american young man in a program for people who want to

be police officers one day and leaving the computer lab a few weeks ago and being accosted by a police officer, being stopped and frisked while he was walking home, i recognized the same responsibility to truthfully and proactively examine this system that he wants to be a part of but is also policing him right now. so i am deeply thankful to be a part of this task force because it is clear we are not about platitudes but about the real work. there is clearly a great deal of work to do. but the witnesses and all of you have and will continue to enable us to do that. in particular i'm thankful for all of the perspectives that are unlike mine that i heard today. perspectives like lieutenant peralta and mr. ray and raymond as folks involved in law enforcement, which is a profession i'm not involved in but who had very thoughtful and proactive suggestions how we can move forward. those are the things i'll be turning over in my head tonight

because we want to make sure this is not an echo chamber but a diverse compilation of ideas and thoughts. thank you for all the folks that contributed and i'm looking forward to get the real work done. >> thank you. well i have to thank the co-chairs again for giving me this opportunity and the president. it's been an amazing day. i've been in law enforcement for 35 years. i've heard things today that really reawakened some thoughts i had. one of the things that was so clear to me is there's so much pain out there and there's so much frustration. i think that resonated today and i think that's why we're struggling so much because there's so much pain on the part of mothers who have lost children and there's pain on the part of police officers who have lost partners and loved ones. we start from that position of pain and i think that makes it more difficult to approach this in a clearheaded way. but i think the structure of

this panel is going to help us work through that. i also have heard a lot of hope and a lot of good ideas, so i feel a tremendous responsibility not to let you down. there's so many of you who have devoted your lives to this cause. so i feel that sense of responsibility. i know the task force is going to do good work. in addition to that i am looking forward to taking the insights i've gained even just today to apply it to the next generation of police officers that i'm responsible for training in the state of washington. i really appreciate this opportunity. >> connie rice. connie. >> thank you, madam co-chair and thank you chief ramsey. the two of you have led us very, very ably. my biggest thanks, however go to you for sticking with us and lending witness to this work. i am concerned.

i want to hear more from the police because i'm afraid i'm completely missing that perspective. it would do me good to hear more from the cops about what we're missing. there's enormous pain in the community. i know that pain because i've represented families forever. i think that we have to start there. but i don't think we're going to end there. i think we can end in a place of hope and a place of moving forward together towards safety and the elimination of these kinds of deaths. i don't want to hear about any more kids being shot by the police. i really don't. it's time for that to end. it can end if we really, really focus and help our cops train the right way and get the community to back the police. when the police feel backed and they feel safe when police feel

safe, the community doesn't die. that's been my experience. the community does not die when the police are safe. when the police feel supported. so i think it's got to be two ways. it's got to be both ways. so thank everybody for sticking with us. help us piece this together. i think we'll come out with a report that you'll be proud of. >> thank you. shawn smoot. >> i would like to just echo my colleagues' comments. i especially want to thank witnesses who traveled to testify in person and those who took the time to submit written testimony. to co-chairs and director davis thank you so much for your leadership today and the lead up to today and especially to president obama. thank you for convening this task force and honoring us by allowing us to serve on it.

thank you to those of you who did attend today in person. i know there are literally thousands of people who attended this -- listening hearing online. your comments will be summarized for us and provided to us and so you will be heard as well even though you maybe couldn't travel here to testify before the task force. speaking for myself, i certainly learned a lot today and also recognized, as i think my colleagues do as well that we have a lot more to learn. i really appreciate solid recommendations that i got today. i think we've probably been able to identify some areas where we didn't get solid recommendation s s. we encourage those watching online or television, if you

have one, you can certainly submit one through the cops' web page. i was really struck and thank you for your comments connie. i don't think we're going to end with hope today was the first real day of hearings. i'm starting with hope. i was very struck by the last panel we heard from, the mayors which is surprising for anyone who would know me. not only for recognizing the importance of working together with police officers their elected representatives, but also elected representatives of the community and community leaders and mayors. to the point not only was it recognized but exemplified today, when the mayor of sacramento actually brought the

police union president with him as his companion to the hearing. very striking and also i think, a great example and great cause for all of us to have the hope that moving forward together we can make good progress reestablishing trust and strengthening trust in communities where we need to while we continue to do the work of ensuring everyone's safety. so thank you. >> brian stevenson. >> i'd like to publicly thank the cop taaffe for getting this really diverse and i think thoughtful group of witnesses before us and before the people watching this public hearing. i was really pleased by the testimony we heard. especially the witnesses who provided us with specific recommendations. i would just like to underline the utility of that because we're on a very short time line

when we get very particular specific recommendations, it does elevate our ability to advise the president and our nation's leaders on how best to get out of this place of pain and frustration into a place of more hope and health. i'm very excited about that, hopeful about that. i think we had a productive day. i want to add my voice of thanks to people who are here particularly these police officers who came to provide us direct perspectives of experience. several african-american police officers who said thoughtful, in sight citeful, hopeful things for me to hear about experience as well as family members who lost loved ones to violence. those perspectives are critically important as we find our way through complex and difficult issues. i'm grateful everyone has put so much time. i think it was an engaged day. that engagement is energizing to those of us on the task force

who want to produce the best recommendations we can. i thank you for energizing our work and time together. >> thank you. chief. >> i'll try and keep my comments short because i know i'm the last one here. i've heard a couple of my fellow panel members talk about pain and i heard the pain in some of the voices that were talking today. i think that's apropos because as a parent i know that you can't have growth without pain. we need to grow as a profession. we need to make sure we're listening to the pain out there and incorporating into our process changes. those process changes also need to be based on fact and truth and not merely anecdotal information. we need to look into all the issues. i heard out there earlier it has floored me since this conversation started that we as a profession don't track all lethal use of force data.

when i found that out that was a shock to me as well. so there's changes that need to take place and we need to be responsible as a profession and lead the way on those changes because that's our just thank you for taking the time to spend with us today and i thank you. >> commissioner ramsey? >> well, let me start by first thanking all of you for being here especially those of you that have been here all day. because i know it's been a long day. but it's been a very good day. and whether you were here personally or whether you watched on television, or online thank you so much, because your participation is crucial to the work of this task force. we need your participation. we need your thoughts. i've been in policing now for more than 46 years. and i learned a lot during that period of time. and i learned something today. and i learn eded something because

i had an opportunity to listen to many people from very diverse backgrounds that have different opinions, many opinions that are different from mine. but listening which is a skill that all of us could probably use a lot more of, listening, opening up our minds, and re-examining how we think about things is very, very important. the events overed past few months have brought us here today. but it's also the events over the past few months have given us an opportunity to create a better police department across the country. to create better stronger relationships to bridge gaps that have gone unattended for far too long. so we need to hear these voices, and as we proceed in this work that the president has given us, we need to continue this dialogue, and you all need to continue to be involved. whether you can attend future meetings or not.

there are ways in which you can stay involved, and we encourage you to do so. we had a lot of very specific recommendations. we had people that came with grievances, but even though they came with grievances they also offered recommendations. i can't tell you how much that means to all of us. now we have great staff here. we've all taken copious notes but they've been recording every single thing. so even information coming in on line we will see it as task force members. and be in a position to be able to start prioritizing and start formulating the report that's due to the president. so i look forward to it. i think this is a great opportunity for change significant change and i can tell you one thing, on above of this task force none of us would be here today if we did not believe it was possible and if we weren't serious about this work. status quo is unacceptable.

and i think we all realize that and will move forward as a result of that. thank you. >> brittany raised an important point. that is that in a democracy we look at the need for change. thank you brittany for raising that. one thing we need to reflect on is that kind of self-examination is really tough. think about it in your own lives. it's very hard to be self-reflective. and to do that in an honest way. today was tough. it was tough in many of the panels to look at our own institutions, and look in criminal justice. and i think for many of us who've been involved in criminal justice for many years we've seen that that kind of self-examination, as the commissioner referred to is very difficult. so today has been a long day. and i also want to join my colleagues in thanking all of you who've been here throughout

these many hours, and those online who've been joining us over the day. but i think this kind of endeavor is very worthwhile. and this kind of investment in looking hard at very tough issues. i join my colleagues again in thanking all of you. in thanking the cops office ron davis and his greatñ helping us in going down this road. and with that, ron, let me turn to you for your final comments. >> okay. thank you, madam chair. thank everyone for being here. let me start with something that brian said, i just want to reinforce and say time and time again, and that is thank you to the cops office staff for putting this together. obviously the president announced this december 1st. the executive order was signed, and the task force members named on december 18th. here we are today, the first the second week of january. and i think all that shows the sense of urgency. the priority the importance of it. so i want to thank my team for the outstanding work that

they've done. and just to give you a sense of for those who have been here most of today, this is the first of six. there are five more listening sessions like this. and so when you think about the robust -- the testimonies the discussions, how much in my 28 years of law enforcement, now year at the department of justice, how much i learned just today, i'm really excited about the future, public sessions and hearings. brittany mentioned something about the self-evaluation and i've always had evaluations the cops office does evaluations around the country. that is the truth hurts. selective ignorance is fatal. those who fail to want to identify what's wrong with them eventually will kind of sense toward -- they're set up for doom so we do want to know the truth. we do want people to come forward. it may make us cringe depending on our perspective but the truth does hurt and selective ignorance is fatal. let me tell you what was coming

down the pike. we had the robust discussion today and co-chair mentioned that this is all taped. so what will happen now is january 21st from 5:00 to 7:00 central standard time we will have another public hearing but it will be a teleconference which is a public hearing open to the public if you go to the website, www.cops.usdoj.gov when you go to the website there is a president's task force icon and it brings you right to the site where you can see the call-in number that we'll have. they can give you the information. that will be january 21st, 5:00 to 7:00. the purpose of that call is the task force will be able to summarize this, the recommendations, have the ability to go over what has happened today. for those who sat here there's a lot for these great thinkers to die just.

we will also be january 30th and 31st, we'll be two additional public hearingses similar to what we'll see today at the university of cincinnati. you can go to the website to hear more about those two hearings as well. then we will have hearings in february to complete it because because if you don't know the interim report to the president is due march 2nd, and if you could tell by the hearing we had today the schedule that we have, and by the obviously the tenacity of our co-chairs and this task force we will definitely have a report to hand to the president of the united states on march 2nd, with recommendations on how we as a country can move forward. it is a great honor for me to be able to support the task force, my office is very excited about it. i want to thank them again and turn it back over to the chairs and thank you guys for doing that. let me turn to jim real quick if i may. do we have hashtags or things like that, people to go to?

>> we do in terms of the task force, to add additional comments. all of this information will be collected digested given to the task force nothing will be left out. feel free to tweet us i think that's the right word. those kind of announcements are online. >> okay, with that once again thank you all for being here. and the president's task force on 21st century policing is now adjourned. thank you. here are some of our featured programs for this weekend on the c-span networks. saturday night at 10:00, after words, "wall street journal" editor brett stephens argues

that our enemies and competitors are taking advantage of the situation abroad created by the u.s. as it focuses on its domestic concerns. sunday night at 10:00, democratic representative from new york steve israel on his recent novel about a salesman and a top secret surveillance program. on american history tv on c-span3, saturday at 8:00 p.m. eastern on lectures in history, george mason university professor john turner on the early mormons and their attempt to create a new zion in the american west during the 1830s. and sunday afternoon at 4:00, on reel america, nine from little rock. the 1964 academy award winning film about the forced desegregation of little rock, arkansas' all-white central high school. find our complete television schedule at c-span.org and let us know what you think about the programs you're watching. call us at 202 dr. 626-3400. e-mail us at comments@c-span.org.

or send us a tweet@c-span. like us on facebook, twol low us on twitter. >> live now to capitol hill where a number of health experts will be discussing relationships between physicians, and drug companies. in particular the physician payment sunshine act which requires drug companies to disclose certain payments and gifts given to doctors. this is live coverage on c-span3 just getting under way. >> -- on health care. i think this is a really important issue that a lot of people don't know about. section 6002 of the affordable care act was known as the physician payment sunshine act. it was a bipartisan piece of legislation introduced in the senate by senator chuck grassley, republican from iowa, and senator herb cole a democrat from wisconsin. it also had house sponsors with peter defazio and henry waxman.

and the bill sought to lift the veil on the relationship between industry and physicians. it was a true piece of bipartisan legislation that was founded on a lot of the research that you're going to hear from some of our great speakers today. it was written in conjunction with the information5athat we got from the research community, and the consumer community, represented by pew and allen here today and aarp and amsa and many other groups that were concerned that these relationships, the financial relationships, were impacting both the quality of health care, and the cost of health care. and i have to say that the process was long and tireless. at the time i worked for senator herb cole and we had with my colleague chris armstrong from senator grassley's office about 300 meetings with consumer

groups, and industry groups to understand comprehensively what these relationships were legitimate concerns from industry about context about how we present the information to consumers. and how usable it is. and i'm very proud of this legislation, because i think it will go a long way in to helping lift this veil of uncertainty. now also as background, many states had started passing laws in this area, so we learned from state laws in minnesota in vermont, in other states a lot of information about what these relationships, were, but because there were different reporting requirements in each state, there was a lot of chaos for the industry to actually make sure that they could report to those individual states. and so there was kind of a pressure to have a federal law where things were more cohesive

and reporting requirements were more standardized. now, this law, as i said came from state legislation, went to a federal legislation, and actually has spurned laws across the globe. although they are not all implemented the same. the french decided that it's great to report the financial relationships, but we shouldn't make the money about public. so the actual usefulness of some of the global laws are probably even going to be less than the united states laws. we also saw in the fall that there were a lot of bumpy implementation issues. implementation had been delayed by delays in regulations getting out. websites had issues. we've heard that before. there were issues in actually downloading the data, and using it in a usable form. and there were concerns about whether data was both accurate

and also given the proper context. so these are the issues that we'll be talking about today. and i'm really delighted because we have an amazing panel of speakers. first we have rodney whitlock.çó who is just a real expert here on the hill. he has 21 years of experience and he's currently working for senator chuck grassley. as the health policy director in the senate finance committee and he's previously worked on a variety of staff, including representative charlie norwood. and he also is a part-time teacher at george washington university for health policy. so we welcome rodney. second we will have adrianne burrman who is associate professor in the department of family medicine in georgetown university medical center. she's the director of farmed out which promotes rational prescribing and is the lead

author of several articles on physician industry relationship. next we'll have allen koch will who is a clinical pharmacist and senior director for health trust programs. allen was very involved at the state level and the federal level. i had him on speed dial for this legislation and pew continues to be very involved in the implementation of the legislation. finally we'll have dr. william jordan president-elect of the national physician's alliance and co-director of the medical student education in the department of family and social medicine and preventive medicine so we have a great panel. we'll let them each speak and take questions at the end. rodney? >> so thank you all for having us today. i'd like to thank the national coalition on health care, and

john rother for organizing this today. thank you c-span for being here as well and giving my wife an excuse to dress me this morning. senator grassley has a long history in the subject of transparency in the public interest. he's worked in the subject of whistle-blowers, and whistle-blowers' role and their ability to provide information for the judicial process, medicare transparency of data working with senator widen and seeing that medicare data could be released publicly for research purposes and some of the work we've done in not for profit hospitals. and providing information as to what they're doing with regard to providing services for the uninsured, and the things that allowed them to derive their not for profit status. the public benefit they provide. senator grassley continues to believe that more information available to the public is in the public interest. and that motivates how we

approach -- how we come to this subject. if you look at it there's a significant amount of public disclosure also out there for participants. clearly members of congress. and staffers like me. are subject to financial disclosure. the freedom of informationability makes information available to individuals about what their government is doing. and tax exempt organizations have to provide certain information for their status. so the idea of providing information into the public forum is something that we have consistently supported. and bring to this conversation. about a decade ago we started looking at this. and it begins with -- it begins with investigations about what are the relationships between manufacturers of drugs and devices, and biologics and providers. and you have an early "new york times" piece on a provider who

is participating in a study on cerakwil and making recommendations for anti-psychotics for teenagers. and what are the financial relationships that that individual provider has. turned out the provider was receiving money from five different manufacturers of similar drugs. not disclosed as part of the research. we went and did further research. we did investigations there were media work where places like baylor and stanford and harvard. we have research going on, and financial relationships that are not disclosed with the subject matter that is under research. and so, we know that there is a there there. we know there's something going on. the magny feud of it is unclear to us. but we know. we have work from groups from pro-publica and pew out there showing there is something

worthy of consideration here. now it's important to note that what we're talking about, when we talk about these financial transactions, money moving between the covered entities, the manufacturers, and providers, physicians, group purchasing, hospitals, these are not illegal. make sure we're clear about that. these are not illegal. kickbacks, those that fall under anti-kickback statutes, are. but that's not what we're talking about here. these are perfectly legal transactions. transactions, and the medical community argues, rightly, w that they are legal. that we're not talking about things that should -- that are illegal, or types of kickbacks. these are particularly related oftentimes to education. and that for doctors to take their time to be engaged in the educational process for themselves and for their peers you know, is in the patient interest. and so these transactions are occurring around those types of things. and so, if you look at how you

approach this as a matter of legislation, now some people could come to this with a very purist approach. an absolutist approach. that we should make these types of transactions illegal. that's not the way we approached it p working with senator cole's office of wisconsin. we looked at it from more of a transparency perspective. that if these transactions remain legal and we believe that they should, then they should be reported and made available to the public. since they are legal transactions after all that there should be no qualms about making them publicly available. making them so that they can be seen by the public and can be discussed. so that was the genesis of the physician payment sunshine act. introduced i believe first in '07, and ultimately becoming statute through the affordable care act. now once in statute it went through the implementation process. it was turned over to cms to figure out how to make it work

and bring it to the public. and cms, i'll drop in my southern colloquialism bless their little hearts, they have trouble websites. so, you know the rollout didn't go as expected. and you know in their defense, that they -- the data available to them to be able to confirm identities of the providers out there, to make sure the data was right, was horribly flawed. and so that led to a rollout that was bumpier than anticipated. and certainly than we would have preferred. but they did get out the door. it is live. you can go in and start searching. and to cms' credit dr. agrawal and his team, that they have made consistent improvements on what is out there. their turning data from deidentified to identified, and their plans for moving forward. and so, from my office's perspective, we are very pleased with what cms has done. and this is important. because, moving forward in the

future this really needs to be commonplace. this needs to be something that is just part of the health care relationships out there. that we come to expect it. it's available, it's searchable, and it just is. that it's not controversial. that everyone is comfortable looking at that. because that's ultimately what we believe from our perspective is in the public interest. this transparency of the relationship so that we all know. and so that it can be simply part of a conversation. a conversation between a patient and a provider. a patient should be perfectly comfortable as an educated consumer looking at this ñ'c data and seeing what their provider is doing and then asking their provider. and a provider should be absolutely comfortable saying, why the data is in there. what it says. now we know as we look forward, again, that there are things that will need to be approved on the site. and that's going to be a collaborative process. and that involves cms.

it involves the reporting entities. the manufacturers, and it involves the providers. and everyone has to take the vested interest they have in looking at the data. and making sure it's always accurate. and making sure it is -- it provides proper context. so that the consumer then really gets to know what's occurring to make these conversations that occur between the provider and the patient more beneficial. but we continue to stand that this is a good thing a positive thing, and it is in the public interest, and it is in the patient interest. now, to the sort of elephant in the room the data is now out there and we went from having suspicion to having actual data. and the actual data, and this is as of the december 19 refresh in 2014 that the magnitude of what is going on out there, these financial transactions that the total value that cms published as of december 19th in these transactions was $3.7 billion.

the number of records, those individual transactions that are occurring, or over 4.4 million transactions reported. and it involved individual records for 366,000 physicians. and so there's a lot going on out there. now what that means, what can be done with the data. the research you can go into and find out about what's going on is turned over to the research community. and how that then informs public policy will depend upon the research done. that, then is again a subject for the folks doing research which is my segue to my fellow panelists here. again, ready to answer questions and appreciate you all being here today. >> >> good morning. happy to be here today.

physicians find/hmyikv)1e; pfw'g also for consumers. and just the fact the fact that it's really important. physicians don't like its existence or at least physicians who are paid by pharmaceutical companies don't like its existence. apparently it's quite popular among divorced lawyers, though.

pro-publica had put together publicly available information before the database released by cms. and they've continued to refine that database which has been really great. and they've also created several tools. not only dollars for docs but prescriber checkup. and they have a wonderful series of 32 articles, analyzing the data from the new database. it's really great. so if you haven't seen that please take a look at it. i want to make a plea to keep our state disclosure laws, as well. d.c. of course isn't a state. but dr. susan wood at george washington university is leading an effort that i'm involved with as well. we have disclosure laws in d.c. and we do an analysis of the -- of the disclosures from pharmaceutical companies of payments to all health care practitioners every year. and we also do a special report. and i can tell you that the ppsa

only picks up about 20% of what's required to be reported to d.c. so some states, or nonstates have reporting laws that are even more stringent than the ppsa, and i would make a plea for keeping them. our latest report, we actually looked at organizations in d.c., we're required by law not -- we can't actually name those organizations, but they may be represented in this room and we found that of the almost $20 million that was -- that was spent on d.c. based organizations, about a third of these organizations failed to disclose their corporate donors on either their website or an available annual reports. for the year 2012. anyway our report is available on the d.c. department of health website. disclosure should not just be limited to physicians, and to other health care providers. but should also extend to organizations.

also of seven physicians on our list who served in leadership position s positions or specialty organizations that received over $100,000 the individuals in leadership positions also received large gifts. so what happens after the ppsa. some kinds of promotion will stay the same, detailing drug rep business samples, the sponsorship of continuing medical education and other meetings. the use of kols or key opinion leaders, and direct to consumer promotion. which includes direct to consumer advertise inging and even targeting of individual patients. if you have an expensive disease pharmaceutical companies may send a visiting nurse to your home, or provide someone to help

you fill out insurance forms to convince your insurance company to pay for an expensive medication. one of the things that has gone away since 2009 is professional items. we collect them at pharmed out so i have to show you our collection. some marketing tactics have changed, however, some have become more subtle and some of the targets have changed. that to some extent physicians are less important in choosing medications than other people. than other entities. more and more formularies. pharmacy benefit managers payers are deciding what gets paid for or how much is spent on various medications. and pharmaceutical companies will always tray to affect whoever is affecting market share. if that's the physician it will be physicians. if it's the patient it will be the patient. if it's the payer it will be the payer.

and payers, there's a lot of shift towards targeting payers, especially with cost effectiveness studies, for example. because if you're a company with a really expensive drug, you're going to need to try and convince the payer that even though this drug is terribly expensive, out will save hospitalizations or save you money down the line somehow. there's a lot of cost effectiveness studies that are meant to persuade payers to cover a drug. disease awareness programs are very important, and pharmacists getting very involved in a very scary way in disease management. the pharmaceutical companies would like to help health care providers, and systems manage their patient. you should be very afraid of this. and there's a lot of partnering with government agencies with medical groups, with professional innovations and specialty groups et cetera. and also with consumer advocacy groups. some of which have been

invented, or have been created by pharmaceutical companies. and others that have been co-opted by them. there are very few -- there are very few consumer advocacy groups that don't take mon 234i from pharma. there are fewer than ten national groups in the united states that do not take money from pharmaceutical companies. for individual physicians, the shift has been away from cash and towards more services. we'll do a website for you. we'll provide web pads that your patients can fill out their information, their medical history on so that somebody doesn't have to transcribe that. that information actually gets sent back to pharmaceutical companies. it's deconfidentialized first. but it's a way for them to collect all this information, in fact all of your -- all of your medical records are also sold to pharmaceutical companies. your insurance company sells those records, it's anon mized so it's anon mized patient level data but pharmaceutical

companies know everything about your health history, your hospitalizations, last time you went to a doctor, your allergies, your medications, the zip code that you live in your body mass index. as long as they don't know your name, they are allowed to have longitudinal information on every other aspect of your health history. pharmaceutical companies also fund tvs in waiting rooms that have fake news stories on them. possibly pharm ads but often the messages are incorporated into the fake news stories. and you can imagine what a great audience this is. people stuck in a waiting room, with old magazines, are really going to be drawn to a screen in the room. there are new targets for pharma marketing and one that i think is really important to mention are nonphysician practitioners. so advanced practice nurses, which includes nurse practitioners, nurse midwives and nurse anesthetists, and physician assistants.

so these are practitioners who have prescribing authority in all 50 states. and one out of four prescriptions in the united states is written by an advanced practice nurse or a p.a. one quarter of all prescriptions. and there is no requirement in the ppsa to report any payments to these practitioners. the d.c. law does require payments to these practitioners the ppsa does not. a quarter of all prescriptions is a lot of prescriptions. and p.a.s are being targeted, and advanced practice nurses are being targeted. and another target that really flies under the radar is social workers. in many jurisdictions, especially busy city mental health clinics it's the social workers who are making the diagnoses, and choosing the drugs that their patients will be on. they're not signing the scripts they're not signing the prescriptions, because they're not allowed to. there's a health care provider signing them but it's the social worker who is choosing what medication someone gets.

this is?zdñ an ad from industry are you sure you know who is writing your brands? reach out to the prescribers who make the high targets the nps and pvgt a.s who write on their pads. gatekeepers are really important. the receptionist, the nurses who work in a doctor's office. so even a nurse who is not a prescriber, a receptionist, a social worker who is not a prescriber they can influence prescribing of a particular health care provider. and that's really important. so this is also from a industry magazine. this is also from a industry magazine. kol, again, is a key opinion leader. this shows the matrix of everyone who has to be affected. all the people that the kol can affect. there's very -- this marketing is extremely elaborate. it is extremely subtle. so let's say a physician doesn't see drug reps.

which about 4 out of 10 physicians in the u.s. now do not see drug reps. so pharmaceutical companies will actually figure out who their social contacts are in their professional networks. who do they refer to? who refers to them? who do their kids play baseball with. who is their spouse's best friend and they will try to target those people in order to try to get a marketing message to the targeted physician. marketing for a drug actually starts seven to ten years before a drug comes on the market. now it's illegal for a company to market a drug before it's on the market. so what they do is a market the disease. and that's done through key opinion leaders. and here's a company that specializes in building your brand before it's brirt. or what's called prelaunch marketing. so prelaunch marketing might highlight the severity of the disease that the new drug is meant to treat. or it might highlight the problems with existing drugs. or it might emphasize a particular mechanism of action

and there's a drug on the market that magically has this action. i think what we should really be watching for is the establishment or the redefinition of specific conditions. so pharmaceutical companies have actually invented some conditions wholesale. including hyperactive sexual desire disorder, daughter of the invented female sexual dysfunction. gird gastroesophageal replux disorder. this is what used to be called heartburn. we used to tell people drink less coffee drink less alcohol don't eat a full meal and go to bed right away. now you have to be on potent medications for the rest of your life. pediatric bipolar disorder. what we used to call the terrible 2s. excessiness excessiness. anyway. there's been many other conditions that actually do exist, but have been redefined. so restless leg syndrome is actually a rare neurologic condition but it's now been redefined to anybody who fidgets at night.

i won't go over these other ones. here's an award winning ad campaign for a tragic medical condition, severe underarm sweating. so apparently injecting botox in the underarm area could help with this. so now it's a serious condition. low "t." there are quizzes online as to whether you have low "t." we gave the quiz to everyone in my office and everyone failed, including the 23-year-old women. excessive sleepiness can be a real burden. anyone suffer from that? these are all conditions that have been invented by industrial. anyway pharmed out works with a lot of industry insiders and we have information that is unusual. and these are some of our

possible indications available on our website. we have promotional items available on the table outside. and we are planning our fifth conference. we've done four conferences on these topics. this will be june 11th and 12th. and i hope you all can come. it will be at georgetown. thank you very much.np good morning i'm very happy to be here today. i'd like to thank the national coalition on health care for hosting and deborah whitman for the kind introduction. as a couple of people have already said, the first version of the physician payment sunshine act was introduced in 2007 by senator grassley and senator cole. i think if you called your bookie in september of 2007 or your washington lobbyist and said what are the odds that this thing will become law they would

have said it was pretty unlikely at that stage. so what happened. a few things happened. some of them have been mentioned. we had investigations by senator grassley and by the senate agent committee of senator cole. we had high profile media coverage of the issue of conflict of interest and payments to physicians. we had state laws that required this kind of reporting at the state level and required a compliance nightmare for companies that made them more willing to entertain a federal law. but we also had leadership within the medical profession that i think was also important. the institute of medicine issued a very influential report on conflict of interest. the american association -- the association of american medical colleges issued a report calling for much stronger conflict of interest standards. we had leaders within individual schools saying we just can't keep going. our profession can't keep going the way it has.

so all those things came together and the law passed in 2010. but the other piece of context that i think isn't approximate malto the law's passage but is really important to understanding how it fits now is this sort of much wider recognition that we really need to understand in this country that derivers of health care costs, and where the dollars go and if you went back to 2007, i think it would also be close to unimaginable that cms would be publishing individual physician payment records. but that's happening now, too. as rodney mentioned this morning, we now have the first report from the sunshine act payments to physicians and teaching hospitals in five months of the first year of reporting. that's around $9 billion a year.

that's important for the public to understand. or going to drive uptake of particular products. that's also important and important to understand. so where are we now? pew has been involved in this issue in a long time as have the other folks on the panel today, and many other organizations. and since passage we have continued to work with a working group of consumer organizations and also individual companies to build shared understanding about how the data should be presented. and about some of the technical challenges in getting that data out into the public domain. data for the first full year of reporting has been collected. it will be submitted to cms in march. and in june we will have publication of the first full year of data that wasn't

released from the first five months of data. let me give you three thoughts. one thing that i think will happen, one that i think probably will happen, and one that's important, but will take some concerted effort on the part of stakeholders if it's going to happen. so what will happen is that the process of submitting data will continue and be refined and we will have this year the first full year of data. what i think, and providely will happen is center for medicare and medicaid services will continue to refine the way it presents that data and as rodney said in his remarks this morning, the first website was not very user friendly.

it was pretty difficult to go on there and find your own physician. but cms to its credit within a couple of weeks of launching that first website put up a much more user friendly tool to let consumers search find their own doc, and the agency tells me that they continue to work on refining the user interface, improving the search tool, but also thinking about how to provide the data in context by medical specialty by geographical location with time trends. so those are all things that they're thinking about as a way to make the data more useful. so they're working on that. and i credit them for their willing to continuously improve that. the third thing and this is the thing that i'm not sure will happen but is really important is the law creates a lot of descripters for payments, so is

it a consulting payment, or is it for marketing, or is it a meal. and those aren't defined in the law, and some of them are overlapping. and what we suspect right now and don't know is that probably companies are using the terms in fairly different ways. so if the data is going to be useful and comparable across companies going forward there will have to be a concerted effort by stakeholders outside to sort of sit down and say what do we mean when we use this deskipter category? and that will have to happen. there's also an ongoing discussion about how to provide context on this data. the law allows for individual essentially a comment field associated with each payment most companies haven't used that and from what i hear they

probably won't because from a compliance point of view the compliance officer at a company doesn't want somebody on the front lines to be just free texting into an individual payment field and we're talking about millions upon millions of payments here. so, we're left with how does cms, how does the public interpret the payments we've got. and there is some context language on the website saying what's meant by a consulting payment, what's meant by these other kinds of payments. but there needs to be an ongoing process of developing that. but there's also inevitably going to be a need for an ongoing societal process of understanding which payments are we concerned about, which ones are we okay with, and what do they mean? so that culture change in medicine that i talked that help to drive the move towards more transparency. we'll have to continue and so the data in the public domain is

really an incredibly important step in the result of a lot of hard work by the people here and people across the country in the industry. and believe me there are a lot of committed people in companies who are spending a lot of time and money to collect this data and get it out into the public. and by the way, learning some interesting things, too. i've had people from companies say once we started collecting this, we realized we were paying the same guy from five different budget lines. that was really interesting. there's a lot of work yet to go in terms of collecting this data, understanding it and then deciding as a society what to make of it. thank you. >> we're just going to pull up my slides. so i'm bill jordan president

elect of national physicians alliance. i want to thank the host for having us as well and also the audience for being here today. i'm going to talk about the influence of pharmaceutical companies on doctors and personally as a doctor but also as leader of an organization that has taken on this issue as one of our core issues around professionalism. i don't have any disclosures in terms of receiving payments. i am an employee of montefiore and einstein but the opinions with my own. background on national physician's alliance we were founded in 2005 to strengthen movement on behalf of patients and build a community that advocated for professionalism. and really restore integrity and trust in medicine. we don't receive any funding from pharmaceuticals companies or device manufacturers. so let's talk about some of the problems of the entanglements that we as doctors have with the industry.

so taking a page from 12 step. we admitted we are powerless. my name is bill and i am influenced by marketing. one of the key issues with physicians is they always think?rmu that everybody around them is influenced by pharmaceutical manufacturers but that we ourselves are immune to these influences. this was highlighted in the institute of medicine report. as was mentioned previously. talking about undue pursuit of financial gain or other secondary interests. the gray area is what is an undue pursuit. and you know many physicians would argue with the definition that was offered in this report. however, it is clear that these entanglements have an influence on clinical care, our research, and our education of up and coming physicians. and it really erodes public trust in health care. it's also clear as everybody

mentions companies target fid igss. drug reps -- oh, there's an error. there were 38,000 in 1995 and 100,000 in 2005. so this is old data but there was a drug rep for every eight doctors. and with a cost of about $12,000 to $13,000 per doctor in the country, which is enormous. you can see on the chart on the right that detailing doctors made up about a quarter of the professional spending budget. this is also old data but the percentages are roughly the same. and actually more than half of the promotional budget was connected to free samples. so i'm going to divert and talk about that for a few slides. just because i was asked in part to talk about what are the gaps that the -- that the movement forward in transparency are not addressing. i would say that it's mainly this budget that's going to free samples. so 94% of doctors have a relationship with pharma. that's all the red frowny faces.

doctors self-report that 83% took food or gifts. almost the same number took free samples. as i mentioned doctors are -- lack insight regarding this, as a general rule. and generalists, of which i account myself one, i'm actually a family doctor in the bronx, received two sales calls per day. i'm fortunate in that our clinic has banned sales reps, as was mentioned earlier, about four in ten doctors don't have sales reps at their offices. and samples do have a clear effect on doctors. this was a sample case that was offered to doctors in terms of a patient who comes in who is uninsured with high blood pressure who you tried lifestyle changes with and then you move on to prescribing medication. and 27% said they would dispense a free sample to this ishent. and about a quarter of them said they would give the free sample even though it was a different medication than what they thought would be best for the patient.

and even more troubling is if this patient went on to get insurance, 17% of the doctors would continue the free sample medication after the patient was insured. there's good data as well from clinics that banning samples increases prescribing of first line drugs like the most appropriate drug for that patient. so i would say that overall free samples are misdirected and unsafe. it's often thought that they go to the poor but only a third of them go to low-income recipients. and often they go to the friends of pharma reps or doctors. and to their friends and families. and there's really a lack of quality safeguards that was brought forward by the aamc report and they're more often subject to black box warnings that come out after the drug is released to market. obviously it's a major marketing tool that's very expensive to health care. it increased patients' out-of-pocket expenses.

accounts for a large portion of pharmaceuticals' promotional expenditures and really is a main driver to increase in spending. out of the huge number of medications that are on the market, the ones that are most promoted are driving most of the spending. this is a report from ims health talking about avoidable costs in the health care system. data from 2012. you can see $213 billion they tallied up. you can see that major chunks of this are nonyad herrance which is often due to patients not being able to afford the medications that were prescribed for them which is directly linked to advertising. antibiotic overprescription, which is also often linked to promotional activities. and underutilization of generics which is also directly tied to that. obviously there are a lot of alternatives to free samples. some of them are politically

challenging such as universal health insurance and government negotiation with prices, things that are good enough for the department of defense should be good enough for medicare. you know generic options and all of the other things that are listed here, including barring them from academic institutions. and using unbiased pharmaceutical education. i'll just flash up on the screen a few of these examples. a founding campaign is an organization that was called the unbranded doctor which was about getting pharmaceutical influence out of the doctor's office. we went on from there to actually found the top five list of things that doctors should avoid because they're known to harm patients or not be helpful to patients. but doctors are still doing them. that's out of the good stewardship project and became the choosing wisely campaign. this is one example of questions that came out of that choosing wisely campaign in terms of asking your doctor whether you really need this medication or

procedure. so definitely patient engagement is needed to engage in this issue. obviously a lot of the speakers have spoken about the open payment system at length which has been getting better as time goes on. this is just a review of the statistics that are already offered. as the data has been clean the number of individual physician records has come down. but, you know, hundreds of thousands of physicians, and over $3 billion. and that's just over five months. also i wanted to highlight 1300 teaching hospitals. and that speaks to the point of the formulary of particular hospitals being influenced by pharmaceutical companies. obviously press attention has played a big role in clarifying these issues to the public. making them more available, including pro-publica. this is one example that pro-publica offered of a doctor that was making $124,000 in

speaking fees. where physicians are already paid much higher in the u.s. that in other countries even accounting for cost of living. and then you'll see that amsa has been a great partner in this doing a score card for teaching institutions. the schools that also have academic affiliates which don't always have the same rules as the school that they're affiliated with. there is industry free information on drugs, including this example from consumer reports. there is conflict-free education npa has led national grand rounds that has been in part funded by an attorney general grant and we worked with partners like amsa and community catalyst to get information out to academic institutions around the country and practicing physicians to really change the culture, and become more aware of the seriousness of this issue. so we can use transparency for

good, and i'm hopeful this will continue. it acts as a shaming tool for better or worse. that's a speed bump for getting involved in these entanglements in the first place. and also allows for the possibility of loss of peer respect when people become aware of these relationships. also affects patient opinion. patients are often very concerned when they find out that the doctor that prescribed a particular medication has received payments from the manufacturer, and can have career implications as academic institutions increasingly have strong policies around conflict of interest. obviously we need to follow the money to know where most of the money is going and how to improve the situation. this is a quote taken from a panel around the iom report and i hope that this will be a springboard for action as we have better access to information on this issue.

thank you. >> i think we had a wonderful panel that has raised lots and lots of issues. i just wanted to highlight a couple key points. one is that there were a lot of different industry players both pharmaceutical and medical device manufacturers that embrace the idea of transparency. some did it because of consent agreements initially. but i think moved forward being very open to the issues around transparency. and some were real voluntary leaders, and so i really want to cite the fact that there wasn't massive industry opposition at least at the federal level to this legislation. as allen said, it has changed their business practices from what we've heard.

but that there really was a coming to the across lots of groups saying that this information can be valuable to the public. i also wanted to point out rodney's point on clinical research. and the value of knowing when researchers have conflict of interest. senator grassley's office did an amazing series of investigations that highlighted some of these conflicts that weren't being reported to medical journals. and several of the medical journals have as a consequence over the last several years, really changed their practices on disclosure. and you could hear that from the doctors as they got up today and announced whatever disclosures they have to make. that is a lot more common and we think that that's beyond the legislation itself. a good thing for all people to know who's funding what information. a couple other points we heard about the legislation that there were limits on coverage. the physician payment sunshine

act was targeted towards physicians, and as we heard different states have expanded that coverage to other prescribers, to nonprofits or other that engage in conversations around the use of medicine, or around health care decisionmaking. and i think that that's an area for further exploration. as we look for where this legislation will evolve. and information that is still missing. and finally, i think the amount of work that is being done to actually pull out the insights from this data, i do also want to commend pro-publica and others who have been, you know, really tirelessly trying to look at correlations. and then i want to finish with a question and then i'll open it up to the floor. which is to rodney, because i think his boss really has set the standard for transparency on a variety of different ways. and in particular, the

legislation or the push to cms to release the payments by cms directly to doctors along with the physician payment sunshine act transparency. my question for question for you and i want to remind all the panel to use your mic so the people watching this at home can understand, how do you think that will transform what we know about the industry relationship with doctors and about prescribing patterns and other health care utilization issues. >> we don't. but we will more. and that's sort of the value of at almost simultaneously having cms release medicare payment data to providers and the physician payment sunshine act, the open payments website coming online within months of each other that it does provide

opportunities to look at the payments and the patterns of practice. and so it will give us information particularly as research has done to see what is going on there that will inform us in the policymaking realm as to what might be necessary, what might be things of interest or not. and again, consistent with the theme from senator grassley that we're better off with more information than less. >> and then my next question to allen and the doctors on the panel, if i'm sitting at home and as a consumer and want to know what are these relationships for my own doctor. how do i go about getting that information? what's the best resource that you think is out there for consumers to understand this new

disclosure database. allen, do you want to take that one? >> i think right now there is some context information on the open payments website that is very general descriptions of what's meant by the different payment types in there. beyond that, i think you need to look to a variety of resources. and i think different people will make different decisions about how they interpret and value those payments. but you can look to organizations like npa, consumer reports, consumers union as well as to industry websites and continued medical education companies and so on. so i think right now people need to read broadly so they can make up their own minds. >> do you want to add to that? >> patients shouldn't see physicians who see drug reps. . it's easy to tell whether they

see drug reps or not. they should be looking up their doctors on dollars for docks to see what money they are taking from pharmaceutical companies that can be really useful. it's less useful to figure out the effect on individual drugs before marketing starts seven to ten years before a drug comes on the market. a patient isn't going to know what's in the pipeline. but they should have a conversation with their doctor. if there's payments on that website, they should be talking to their doctor about it. but i think patients shouldn't see doctors who see drug reps. i misspoke about the 40%. 40% of physicians limit or forbid drug reps to see them about 1 out of 4 doesn't see drug reps at all. but that still leaves plenty of doctors out there. >> bill, a similar question. you talked a lot about samples. i have been offered samples by my own physician. what are the questions i should

ask as a consumer in the doctor's office when that is offered to me? >> say no. >> yes just say no. i think that all patients should ask their doctor do i have other alternatives to what you're offering me? what are the pros and cons of this and any alternatives including the cost. and that that often leads to a better decision both for the patient and the doctor. i think that it's great for patients to become more aware and to think twice about seeing doctors that have clear reps coming into their office. it's not always possible. but i think having more of an act activated patient makes a huge difference in terms of thinking about these issues. >> samples are the most effective marketing tool that

pharmaceutical companies have. hand back a sample and say, i'm sorry, can i have an older time tested medication please. and really it would be the best thing for your health. >> you also mention consumer report says another place to look who do studies of drug costs and effectiveness and that there are good rate resources that they have. i'd like to open it up to the audience to ask questions. wait until the microphone is handed to you by mr. mcneilly and raise your hand and we'll get your questions for this amazing panel. right here in the front. >> joyce freeden from med page today. i was interested in what you said about how pharma companies have different marketing targets now and that they are get ingting

into who does the doctor's son play baseball with and all that. is that a relatively new thing and can you give examples of what they are doing. >> target inging people around a physician is not new. it's called molecular targeting. so the targeted doctor is the a tom and everybody around them is the molecule. so that's not actually new. while physicians know that a drug rep who comes into the office is there to sell them something, they are not really being suspicious of their receptionist or golf partner or their friend. so if a marketing message get. s conveyed through that -- through another person who isn't a sales rep, it's much more effective. marketing messages are not necessarily about using a specific drug. it might be that the marketing message might be that excessive sleepiness is not a joke. it's a a real condition. low tea is a tragic epidemic.

or that a particular competing drug is so problematic no one should prescribe it. so every drug on the market is associated with it. many of those marketing messages have nothing to do with the drug itself. it's a very difficult to figure out. >> other questions from the audience? yes. >> thank you. my name is shea mccarthy. you raised an interesting point during your discussion about marketing practices and one thing you mentioned is one place that might go unchanged is the practice you see around continuing medical education. and as you on the panel likely know, there are many fire walls in place to ensure that accredited providers are prevented from allowing pharmaceutical companies or commercial supporters to have undue influence over the content

of those cme events, the speakers or influence on the attendees. but as you also may know, this is an issue that's kind of come under a little consternation during the rule-making process. the "wall street journal" recently reported that cms has essentially changed their position or interpretation as many as five times on whether cme payments should be reported. so my question for rodney and for the panel, you may be able to provide some context on the congressional intent around the reporting for accredited cme payments, but especially considering the unique reporting challenges considering that that firewall is in place to make sure that the medical device manufacturers or the pharmaceutical companies don't have any influence and they don't know for example, who the speakers are that are being recruited for those events. how could we overcome some of these challenges?

was there any conversation on the political side about whether those payments should be reported. are there any other thoughts on the panel about reporting for continuing medical education? >> we'll start with rodney and then allen. >> cme, the conversation there is ongoing. that we spoke to cms we talked to folks who were from the cme side of the world throughout last summer. cms, they issued their regulation as it relates to reporting there. we encouraged cms to go. slowly, be deliberate, most importantly get the initial reporting right. have that to become more substantiated, expected that the questions about how the report ing there worked prior to aggressively trying to get into the world because the cme world

is much more complex because of the nature of the blinded transactions that occur there. so we are open to conversation about that and we consider this an ongoing conversation. but we right now are in the position that i think cms is moving at a a appropriate speed where cme is concerned. we know they bounced around a bit. it's challenging because they issue a regulation that says one thing, then they pull it back slightly that says another. so "the wall street journal" pieces where it seems somewhat confusing to us, but it's because of the back and forth. but ultimately, this is one that's ongoing, but in the main it's getting where we are right first before fully jumping in on cme. that's where we're standing. >> i would just add to that. i think cme has always been a tricky issue. for