too. >> stephen metcalf. >> thank you, mr. speaker. unemployment down 44%. 800 apprenticeships started in the last year. what is said about our long-term economic -- [ shouting ] >> delighted with the news that my honorable friend brings. it is remarkable how in almost every contingency in this house benefits are down. there are 224,000 people almost a quarter of a million more people in work in the east of england. those are statistics. every one of those statistics is about everyone going out and earning a wage and supporting their family and managing to achieve a better standard of living.

that is what we will continue with. and that is why we will stick to the long-term economic plan. >> eliminating the deficit, net migration down into the tens of thousands, no top-down reorganization, why did the prime minister make these promises, and why did he break them? >> we said we would get the deficit is down, and the deficit is down by half. from a disgraceful situation left by our neighbor. i thought the gentleman would take the opportunity to talk about the vital still interests in his contingency that we'll talk about later on today. i'm working as hard as we can to try to make sure we keep still production growing in our country. but i have to say to him, as he's introduced a political element, so might i. production is up. and to this government employment in industry is up where it was down under labor.

why is that? because we've got a car industry that's growing, we're got an aerospace industry that's growing, we've got construction that's growing. we're getting britain back to work. >> is my friend aware in the past 12 months, over 60 journalists have been killed in the course of their work, including those at "charlie hebdo" last week. i attended several other members of parliament to find in paris, of a declaration by representatives of every european country, recognizing the vital role of journalists in a free society. and pledging to do everything possible to protect that safety. will my friend reaffirm that commitment today? >> i pay tribute to my friend for the work he does in supporting the freedom of the press. i certainly reiterate what he says today. when this most struck me is when i visited jafna in northern sri

lanka, and went to see a newspaper office, that would have been shot up, bombed and burned. that brings home to you what journalists in other countries have for years faced in bringing the truth and putting in front of the people, which is a vital part of a free democratic system. and obviously the events in paris are truly horrific. i think the duty of everyone in public life is not necessarily to say whether or not we agree with this being published or that being published, they're all going to have their opinion. what matters is we should always defend the right of people to publish whatever is inside the law and in their opinion right to publish. that's our job and we must do it properly. >> mr. speaker, we're seeing a meltdown in emergency care. yet the prime minister's health secretary accuses us of whipping up a crisis. isn't it time for some honesty this government has simply failed? >> absolutely, we do face real

challenges this winter with the pressures on a & e. the university hospital trust proves what can be done with the extra resources that we're putting in, and the excellent management of that hospital. because last week, 96.6% of people going to a & e in her contingency were seen within hours. >> last week i met chloe, an apprentice who had started her a apprenticeship. the prime minister congratulates all those people who have jobs that started apprenticeships in my contingency, where unemployment has fallen by 30% in the last year alone. further evidence that the government's long-term economic plan is delivering better quality jobs and opportunities for people across the region. >> i certainly join my honorable

friend in congratulating chloe and starting her apprenticeship. nearly 4,000 people have begun an apprenticeship since 2010. the claimant count is down 42% since his election. young people on unemployment benefit month after month, that is down by 58% in the last year alone. this recovery is gathering pace. it is providing jobs for people. and each one of those jobs is the chance for them to provide a better future for their families. we've got to stick to the plan and a key part of the plan is getting the deficit down. >> under such pressure they're downgrading the cause of some of the sickest people in the country. in the east of england 57 people are believed to have died waiting for an ambulance that never arrived. isn't the prime minister ashamed this is what happens when the

torreys are on the nhs? >> a change was made without the knowledge of the trust. as soon as it was found out, the chief executive reversed the decision and ordered an independent investigation, carried out by someone from outside the trust. and the investigation found there had been no harm to patients. it is important to put this in context. he quite rightly says it's very important that we conduct this debate in a good and civilized way. now, the weekend, the leader of the opposition, was asked seven times whether he had used the phrase that he wanted to weaponize the nhs. seven times he refused to answer the question. everybody knows that he said those words. and if he had a shred of decency in him he would get up and explain, he shouldn't have said those words and apologize. [ shouting ] >> stephen lloyd! >> thank you, mr. speaker.

a few weeks ago a tragic event occurred in my contingency where a girl was killed in a traffic accident. since then the school have rallied around to support the family, her parents. they have raised money to try and bring the grandparents to join them at the funeral. the home office has refused to say, and said the relatives have gone. i have even gone one step further and said i would act as a guarantor that the relatives will return to zimbabwe. prime minister, will you intervene? >> it's absolutely horrific when children are killed in accidents like this. we all know in our own contingencyies that it happens.

i'll make sure the home office has a careful look to see what can be done. >> gregory campbell. >> mr. speaker, the prime minister will be aware that the public and small businesses across the uk have had to endure high fuel bills in recent years. in recent weeks, the price has been steadily dropping, and fuel prices at the pump have not reduced by anything like that. last week the chancellor indicated that some action would be taken against fuel companies. what action? >> i think we should welcome this fall in oil prices. we're beginning to see prices fall quite substantially at the pumps. but i agree with him, we want to see that go further and faster. some of it will depend op the buying strategies that the fuel companies have. but we'll make sure that the government does everything it can to make sure the fuel prices are passed on.

>> alex shellbrook. >> thank you very much. mr. speaker, on the 30th of january, i should be holding a summit in my constituency bringing together some of the fantastic work the organizations like why and peter smith in rockwell have helped di men sha. does my friend degree with my that dementia is one of the greatest challenges that we face in this country, and the strong economy fails to invest in di men sha. >> you're right, this is a crisis for our country. it's been creeping up. as a sort of silent crisis. because the diagnosis rates for dementia haven't been high enough. i don't think there's been enough action across our country to deal with this. there's a clear dementia strategy doubling money going into research. we're training more people in our nhs and care homes to deal better with people with dementia. and also we're making sure more

people in the community become dementia friends with a target of over 1 million people becoming dementia friends. every member of the cabinet became a dementia friend. i commend of what he is doing getting together all of the organizations that can help people. we spread the word about good practice. because people with dementia don't just need health care, they need help whether they're at the post office or banks or bus or train station. they need help in every part of their lives. we all have a role to play. >> according to the role college of nursing the number of nurses in london has fallen by 4.5,000. the prime minister said the number isn rising. who's right? >> the fact is, nationwide we have 3,300 more nurses. and i can give him some figures for his own constituency. if we look at the nhs red bridge commissioning group, this year is getting an increase in funding of 4.79% and the

numbers of staff in that are up. if we look at for instance, the box hospital what we had is last week over 6,630 people were seen within four hours. and performance across the london area has been very good. i'll make one further point to him, which he might want to bring home to his own local authorities, and i think this is important when we consider what is happening in social care. is that he's, two authorities, red bridge, who are seeing the reserves go up by 65 million since 2010 and forest up by 26 million since 2010. that is what is happening. and that actually was right. finally, let me give him the information on forest as a whole in terms of the funding of money. that has provided 22 more doctors, 27 more nurses, 146 more beds.

[ shouting ] >> there are over 3 million people with diabetes in this country. the report calls for education for people to prevent type 2 diabetes, education for people to know when to approach their gp with symptoms for type 1 or type 2. and education of people with the condition so that they can self-manage and take pressure offer the nha. will the prime minister look at the report and act on its findings? >> i will certainly look at this report. because i think of all the health care conditions there are, one of the ones which we -- if we act on it fastest we can have a huge effect on diabetes. if you look at the costs of things like amputations and other treatments because people getting diabetes you can make an enormous impact. he raises the issue about being

able to self-regulate. there's exciting new technology coming forward in terms of diabetes. and i want to make sure that technology is rapidly adopted by the nhs. >> mr. speaker, the independent obr says the government's long-term spending plan means capping 1 million public service workers. can the prime minister tell the country, which million public services he is planning to cut? >> what the obrs say is actually what the treasury say, which is everyone who last night voted for the fiscal mandate is committed to 30 billion pounds of adjustment in the next two years. on this side of the house my party has set out exactly how we meet that. it is 13 million of department cuts, 12 billion of welfare cuts and 5 billion from tax evasion and avoidance.

the labor party has told us did yly squat of how they will spend that money. there is a challenge for the labor party, if you're going to sign up for 30 billion pounds of adjustment, isn't it time you told us which taxes are going to go up, what you're going too do to debt and how you're going to wreck this country's economy. >> thank you mr. speaker. my honorable friend has the story of allison on page 6 today. under this government women are flourishing, 20% of businesses are run by women. does my honorable friend agree with me, women, especially from essex, are part of our great economic plan. >> absolutely. those wheels are turning. i think it is important, as the

point he makes, of course i look at this every morning. the fact is, under labor female unemployment went up by 24%. under this government, the number of women in work is highest since records began. the proportion of women that begin businesses in this country is up by a third. if we can get the same level of female entrepreneurship in england as in america, we would wipe out the female unemployment that we have. >> mr. speaker at 1:00 this afternoon, number 10 downing street parents and children is calling on the prime minister to personally get involved to get england to stop a bureaucratic internal prevention of the transatlantic which has an effect on young boys, that wouldn't have to go away.

will the prime minister get involved with this and get this resolved as a matter of urgency? >> i will try and find time to see these parents today. i was looking at this issue last night, where their child, exactly the same age as my son. i saw his picture on the local football team, and it made me think how vital it is to get these drugs through as quickly as we can. there's been a debate about whether these drugs should be licensed quickly. i will meet them. i will have a look at this petition and see what can be done. >> what is worse, to forget the deficit exists or have no plan to bring it back into balance? >> speaker, i think as it were in the three stages of manner, i think the final -- i think they have finally set in the deficit. they've voted for 30 billion

pounds of adjustment. but they cannot manage to tell us how much they're going to raise in taxes what they're going to do in spending. they've had four and a half years to come up with an economic policy. and they've got absolutely no plan for our country. >> my 94-year-old constituent was taken by ambulance to hospital where she waited six hours in a corridor before being admitted. the next morning she was moved to another hospital because there were no beds available. does the prime minister think asking the ale, the 360 inpatient beds as he proposes will make such an appalling instance much more likely in the future? >> 94% of people this year so far have been seeing a doctor within four hours. everyone who is a neighboring member of parliament knows that

he is absolutely instrumental in spreading disinformation campaign about his local hospitals. for once, he should take the truth and put it on a leaflet. [ shouting ] >> some people are very quick to criticize when there are challenges. it must also be right to celebrate its successes. the prime minister congratulates milton king hospital and university of buckingham for establishing a new medical school that will not only train the next generation of clinicians, but raise standards at our hospitals? >> i'm very happy to join my honorable friend in doing that. making sure we educate the next generation of doctors and nurses, and clinicians is absolutely vital. what we see under this government is 9,000 more doctors, 3,300 more nurses. we are treating 1.3 million more

people in a & e. there are 6 million more outpatient appointments. that's actually happening in rnhs. all credit to the hard working staff who are carrying out that vital work. >> mr. jim sheridan. >> mr. speaker, the recipients are often demonized. does the prime minister agree that the taxpayers have always been asked if you can afford above the minimum wage the hard working families, state dependency? >> i'm in favor of the living wage. i think those organizations that can pay the living wage should pay the living wage. i think it's a very good thing that should happen. but in addition to that, i notice there is opposition. maybe he could start it in his own backyard. [ shouting ] but in addition to that, seeing

min muj wages rise we should also be taking the lowest paid people out of tax. we'll hear more about the terrorist attacks in paris now from british home secretary teresa may who told members in the house of commons that allowing the uk government to have access to phone records is necessary to combat terrorism. >> order. secretary teresa may. >> thank you mr. speaker. with permission i would like to make statement about the terrorist takes in paris.

it will take some time for us to learn the full details but it's clear. 17 innocent people were murdered in cold blood and a number of others were injured. the terrorist who taked the jewish supermarket claim his actions were carried out in the name of isil. cherif and said the two brothers were associated with al qaeda in the arabian peninsula in yemen. the same al qaeda affiliate that had been in contact with men who earlied rigby in 2013. as the aweppalling events in paris were unfolding this house was investigating the security bill which is set by the independent

join terrorism analysis center and remains. this mean a terrorist attack in our country is highly likely and could occur without warning. three serious terrorist plots have been disrupted. nearly 600 people from this country have traveled to syria and iraq to fight. around half of them have returned. there are thousands of people from across europe who have done the same. as i said during the passage of the counter terrorism bill and on many preetrepeated occasions the government will do everything it can to keep them safe. as soon as the attacks in france took place the government increased security at the uk border. officers forced the police and other organizations intensified checks on passengers vehicles and goods entering the uk. we offered the french government all assistance necessary including the full cooperation of our police a intelligence

agencies. on sunday before i attended the peace rally in paris i held talks in counter parts for europe and the united states and canada to discuss what action we can take together. there was firm support and defeat the idealology that lies behind the threat. officials the security minister and i will keep up the space when it comes to passenger name records with other european member states. on monday the prime minister defense secretary and i held a security meeting with senior officials to review the paris takes and the risks to the uk of a similar attack. of course, we've long had detailed plans for dealing with these kinds of attack ps. the house will recall the attacks in mumbai in 2008 when

terrorists armed with explosives took the lives of more than 150 people. since 2010, we have improved our police firearms capability and the speed of our military response through range of other measures. we have improved joint working between the emergency services to deal specifically with gun attacks. specialists joint police ambulance and fire teams are in place with equivalents in scotland and whales. they are trained to equip to manage casualties in this kind of attack. the police and other agencies carry out exercises. these exercises include scenarios that are similar to the events in paris. we will ensure the future exercise is reflect specific elements of paris attacks. we can learn from them and be ready for them should they ever occur in united kingdom.

in addition, i should tell the house that the police can call an appropriate military assistance when required across the country. the attacks in paris were enabled by the availability of the assault weapons. although there's obviously a number of illegal weapons in the uk, we have some of the toughest gun laws in the world. as a result far on the fences only make up a small proportion of overall reported crime. the types of firearms used in the attacks in paris are not unknown in the uk but they are extremely uncommon. as the prime minister has said, we must step up our efforts with other countries to crack down on the illegal smuggling of weapons across borders. in particular, the member states of european union need to put together the vast number of weapons in the countries of the former yugoslavia and disrupt the supply of weapons in other parts of the world especially north africa. the measures we have taken are

in addition to the substantial work the government is undertaken an continues to under take to counter threat from terrorism. last summer parliament approved emergency legislation to prevent sudden and rapid loss of communication and the ability to intercept communications where it's necessary. parliament is skrooutcrutinizing the proposals as we speak. it will enhance our ability to deal with those in the uk who pose a risk. in familiar, it will allow the relocation of people subject to terrorism prevention and investigation measures to other parts of the country. in addition, the prime minister has announced 130 million pounds over the next two years for the agency's police and others in addition to the more than half a

billion pounds spent on counter terrorism policing every year. this government has done more to confront the ideology behind it. we've invested more time resources and money in counter narrative operations. mr. speaker we have always been clear that the police and agencies must have the capabilities and powers they need to do their job. they are reiterated that commitment. unfortunately, when it comes to communications data and the interceptive communications there's no cross party consensus to give the peace an security service the capabilities they need. let me be absolutely clear

every day that passes without the proposals in the communications data bill the capabilities of the people who keep us safe diminishes. as those capabilities diminish more people find themselves in danger and yes, crimes will go unpunished and innocent lives will be put at risk. this is not as i've heard it said letting the government snoop on your e-mails. it's allowing the police and the security services under a tightly regulated and control regime to find out the who, where, when and how of communication but not its content. they can prove and disprove alibis identify associations between suspects and tie suspects and victims to specific locations. it's too soon to say for certain but it's highly probable the communications was used in the paris attacks and establish the

links between the two attacks. quite simply if we want the police and security services to protect the public and save lives they need this capability. last weekend people of all nationalities faiths and backgrounds came out on the the streets of france and other countries to demonstrate their opposition to terror and to stand for democracy and freedom. we must stand in solidarity with them and do all we can to con front extremism and terrorism in all its forms. >> evet cooper. >> the attacks demonstrated the savagery in which they seek to divide us. paris has not let the terrorists win and we must not do so

either. the french police have been praised for their actions that they took. "charlie hebdo" is being published today. faiths have united and grieving for the victims of the attack on the kosher supermarket. muslims across the world have condemned the take and is not in the name of their religion. he's said my brother was killed by people who pretend to be muslims. they are terrorists. that's it. the prime minister and the leader of opposition attended the unity rally along with the prime minister. in the attack the terrorist targeted other peaceful religions. they targeted writers and whose job it is to keep us safe. in order they targeted liberty

and security. the response of democratic governments everywhere these sort of takes must be to defend both. governments need the keep our people safe so we can enjoy the very freedoms that our democracy depends on. i did not see the statement before coming into the house and i hope that she can set out what the reasons were and what has changed that meant that the statement was changed to late notice. i think the whole house will want to pay tribute to the work of our intelligence services and the police who do so much the keep us safe. it's important that they have the resources they need and i welcome the resources the home secretary referred to today.

as she said the government has a counter terror bill going through parliament that we have supported and continue to support and includes the relocation powers that she abolished four years ago as we called for to be reinstated. the agencies have appointed to the threat the ongoing threat posed by the estimated 300 people returning from the conflict in syria. could you tell us whether any of those estimated 300 have been prosecuted? could she also confirm that none of them are subject to tea pins even though they are supposed to be dangerous suspects restricted to keep us safe. all of those cases to see whether they could help especially with relocation powers restored or whether there was anything further that needs to change which are different

from the previous control orders. would she also tell us how many of the estimated 300 have engaged with the channel program and does she agree that we should now make that compulsory for those returning which is something the counter terror bill does not do. on the issue of access to dangerous weapons she will also know it's been concern about reduced custom and border checks. what action is she taking to increase border checks for dangerous weapons? the home secretary also raised the issue about communications data. technology is changing all the time. that means the law needs to keep up both in terms of the capabilities of the agencies to get the vital intelligence and in terms of oversight we need. this month they supported extending the powers to ensure that ip addresses are covered in the same way as telephone

numbers. in july all parts agreed to support a review by david anderson the review of terrorism into the powers and the oversight needed to keep up with changes technology. the secretary referred to the previous data bill. that was rejected three years ago by the joint committee that was established by the government to scrutinize it because they said it was too vague, too widely drawn and put too much power directly in the hands of the home secretary. they recommended that new legislation needed be drawn up in a far more limited way and the government should provide more evidence and clarity about what they wanted to achieve. since then the home secretary has not come forward with any revised proposal. she's not come forward to me to discuss them or put forward proposals to pardon even though we said we were happy to discuss details with her. given the urgency she says there

now is can i ask her why she did not come forward with revised proposals after the conclusions of the joint committee three years ago? this ask an extremely important issue and the details matter. the details a about the power and capabilities that our intelligence agency needs but also the details about the safeguard and the oversights that are needed as well. we agree that the police and agencies do need to get intelligence to keep us safe and need updated legislation. we also need safeguards and stronger oversight to make sure the powers are effectively and appropriately used. i would strongly caution the home secretary and the liberal

democrats against setting up a characterture argument and liberty on the other because we need to protect both in our democracy. we need a responsible debate on getting the detail right. the terroristss8& on that first day targeted both the writers and police officers. "charlie hebdo"'s editor had police protection to protect his freedom of speech. that shows the strong link between our security and our liberty in any democracy. mr. speaker, we know the most important thing to keep us safe in any democracy is making sure we have the cohesive communities to prevent hatred spreading. we have supported extendings. i hope the home secretary will also now listen to the concerns we have raised over some years have community led programs to tackle the hatred and challenge

the spread of extremism as well as local communities and organizations. i hope she will work with local government to that affect and i also ask her if she's working with the community safety trust on tackling and anti-semitism because we need to tackle all forms of extremism. we will not be silenced. we will not give into fear and we will not give into division. >> thank you. may i apologize for her late receipt of the statement. i apologized to her privately before when we came into the

chamber and i'm happy to reiterate that apology on the floor of the house. can i join her in paying tribute to our counter terrorist police but our intelligence agencies. i think we cannot say it often enough that these are people working day and night to keep us safe and protect us. many of them unseen and unknown and for obvious reasons if they are part of our security and intelligence agencies but we are grateful to them for the work that they do. i think we should, as i say, pay public recognition of the important role that they play. she asked me a number of questions covering a number of issues in this area. can i tell her that in relation to reviews there's no suggestion because a review was not mentioned in my statement that we have sidetracked that review. david anderson is doing his work. he's undertaking a number of discusses with relevant parties about the issues that he is looking at.

alongside that our own parliamentary is conducting its work in looking at the question of civil liberties and security. these key reviews will come forward in a time that will enable this house to be able to take account of those reviews when it does the job and will be necessary for it to do which is looking at the legislation which has a sign for 2016 but taking account of the aspects that have come forward in those two reviews. the question as to whether somebody shoultd be put on it is matter for the security service to initiate a request to me. i look at that request and if i agree there's a judicial process that's gone through in order to ensure the decision is reasonable.

it's matter for the security service to come forward with those proposalszkoí of that. the honorable lady raised questions. prevent does work with community groups. on relation to channel the decision as to whether an individual should be put into a channel program is one that should be taken on case by case basis. we're very clear and have been in the discussions on the security bill. if relation to the temporary exclusion orders will the people returning to syria are returning where it's felt to be appropriate and it may be the action may be sorting relations to those individuals in the uk. that doesn't need to be on case by case basis as to what's appropriate for the individual concerned. in relation to the question of far arms i think there is an issue for us working with others

if european youunion to look at the spread of it. we have some of the toughest gun rules here in the united kingdom. we have seen major exercises being undertaken in looking at the question of availability of firearm here in the uk. that started before we saw these terrible attacks take a place in paris. there is a difference of opinions among this house as to what powers should be taken by government. we did respond to the proposals from the joint committee. we did revise proposals in relation to those measures. i'm clear. the prime minister is clear this this is sawn that does need to be returned to and it is important that we have the right powers that are available to deal with these issues.

we speak with the cst on a rudy giuliani basis. i had a number of meetings with them but also the police have meetings with them and discuss with them the whole question of the protective security that is available and protective security had been stepped up when the threat level was raised but has been stepped up further. >> sir malcolm rifkin. >> there's been various press reports the speech called for white new powers of surveillance for the agencies. will the home secretary confirm that's not the case. in that speech which the home secretary, as well aen.>n i, attended in person the main concern expressed by the director general the changes in technology that people are using to communicate are making it harder for the agency to maintain.

is that not indeed the prime requirement at the present time to ensure the agencies will exercise the capability they have enjoyed for a number of years but because of new technology is increasingly being denied. >> absolutely correct in his description of what the director general of mi5 said in that speech. i think it's unfortunate that people mix of these aspects and sometimes believe what the government was trying to do was to expand the powers of the agency. this is not the case. the ability to access communications data is vital to our ability to protect our national security unless we maintain this capability or ability will be eroded. it's maintaining that capability. that's what the data bill was about. that's why we and others as

evidenced by that quote see it as so important to do so. >> as there's been a revolution in communications in the 16 years since i introduced the proposals that came with regulation seems beyond argument that the legislation including the respective kmooun communication data has to be revised. the serious debate is not helped by the party these powers aring with sort some kind of charter. may we see the kind of close

collaboration that my honorable friend is speaking for so that we can resolve these. they have the capabilities for today and tomorrow which they have had in the past which has freely been agreed by this house. >> the terminology that's been used about the communications bill being a snoopers charter has set all sorts of hairs running which is not accurate an don't reflect what was being proposed. it's important on all of us in this house to actually look at this matter calmly and carefully and consider the powers that our agencies need to maintain as

we're saying the capabilities which otherwise as they degrade make it harder to keep us safe. >> does she really want to join the small group of countries such as iran in frying to man inkripgs. >> we are determined as far as possible there sthould be no safe spaces for terrorists to communicate. that would have been a principle

held by everybody in this house of commons. as far as i'm concerned our manifesto will make it clear and that we will use all the legal powers available to us to make sure that where appropriate the police an security intelligence agencies have the maximum ability to intercept the communications of suspects while ensuring that such intrusive techniques are properly overseen. >> the pry youty is to speak up and stand up racism and the groups like the bmp and the derivatives which spread this poison and the vile prejudices of far too many representatives

and members. >> we need to stand up and send a very clear message from everybody in this house that we stand for freedom. we stand for the freedom of the press. we stand for our democracy and we oppose the vile views that lead to the sort of behavior we have seen and the incident we have seen in paris. we must recognize in this country that we have seen a number of terrorist attacks in this country in over the years. also the murder of muhammad and to plot bombs. we stand against terrorisms and extremism. >> the thing that's come out is the affection of the british

people for france. may i say as chairman of our meeting room between the two parliaments on behalf of the parliaments i would like to extend our greetings and support for our friends and say now as for the last hundred years our two nations stand shoulder to shoulder against tyranny. >> we agree with a comments made. it was a very moving experience to be part of the march that took place in paris on sunday, to see so many people. i think it was four million people across the whole of france. the estimate was two million this paris itself and also the reaction of the people along side the march who were expressing constantly their support for all those who were standing for freedom. freedom of the press but also

the freedoms of our democracy.efo >> the home secretary in her statement went into great detail, very welcome about the cooperation with european union partners and other countries. she didn't have the opportunity to update the house on the cooperation with the other jurisdictions within the united kingdom when it comes to policing and safety which is so important for all of us. she has taken the opportunity the speak since last week. could she update the house on what was discussed and how the uk govrt plans to cooperate.

the scottish goth last year in preparations for the games and joint exercises and joint work. i have to say the cooperation and the interaction between the scotland and these forces in england and wales is very good. obvious lifly sorts of cooperation is very important. we'll continue to talk with administration on every level. >> he did not set up a counter fate. rather under the charge of medena he created a multi-faith

society where jews and christians had rights to worship and able to proclaim their faiths. >> i'm grateful to my friend for pointing that out. i think it's very clear that this is not the attacks that we saw are not about islam. very clear these attacks were not undertaken in their name. that's a very clear message that we should reiterate. >> the home secretary satisfied with the capacity of the london fire and rescue service toçmdç respond to terror, any terrorist out ranlrages that may occur.

mayor tourist atrackstractions that may be the targets of terrorism. >> in the event that a terrorist attack should take place, work has been done as i indicated in my statement to bring together specialist teams from fire, ambulance and police across england england. jessup which is about ensuring it's easier for the three emergency services to work together in these circumstances and we continue to update and revise where necessary the protocols and the$$ñ operation the way in which these"!x operations are conducting to ensure our

emergency services are able to do the job we all want them to do should an attack take place.d÷ >> i seat on the committee three years ago, it lasted six months. it was clear this data is crucial. it will save lives. it will save those who threaten suicide and save children at risk and other types of incidents and dramas, accidents, crimes as well as terrorists and help us catch terrorists. >> i don't think we should be unkind to have the gentleman. he's a barrister. cut to the case. short question and sit down. >> thank you very much.

>> is she concerned that the labor party not made it clear that they would support communications data? who have made the necessity of communications data well known and public. i would say that as i've indicated i would hope that everybody in this house will understand and appreciate the importance of ensuring that there are no safe spaces for the terrorists to communicate. >> now from early reports about those responsible pr what happened in paris last week,

those involved were on the periphery of investigations that had been undertaken. will the home secretary give a commitment that she'll have urgent talks with the security service and the counter terrorism police leadership about how we can get smarter about reviewing those cases that appear those individuals of networks that have appeared on the periphery of previous investigations pose a threat. >>/"ofháhe gentleman is correct. it's matter on which i've had discussions with the counter terrorism policing. it's matter in which i continue to talk with them.

also the question of links between the potential terrorists and criminal activity of various sorts. can i invite the home secretary to use this as a case study. study what the journey is that a good islamic person might take that first name finishes them as a terrorist. what is the stimulus that creates that terrorist and how do you get inside that process? >> it's of course3txñ important.

we look at the factors that determine or in play when somebody does become a terrorist or indeed+d4t is radicalized. say say these are issues that are looked at. every opportunity is taken where we can learn lessons to identify what that journey is for individuals so that we can better ensure we're able to prevent that radicalization and prevent people from moving into terrorism. i say this will be complex. it will be factors involved and they will vary from individual to individual. >> terrorism has no boundaries. they're national boundaries. is she confident about the structures that exist in the sharing of information across europe and indeed across the

atlantic? what further action can be taken by the internet companies? should we be looking at an organization like the internet watch foundation that will deal specifically with co(#zr terrorism?:[#zv >> the sharing of information is a matter we ; it's matter where people have looked to europe while playing a role. we will be working with not om our other countries but also organizations such as europe to make sure that we can get the maximum benefit from the sharing of information that takes place so we can have the maximum

possibility to ensure they will not take place. >> i would?!g remind the house it's an opposition day. i'm looking for people who will ask a short question withouteq preamble. >> would she agree that our response to against those violently wish to take them away? >> i say not a rush against those we so violently wish to take away fromrespon many. >> i say i think it's entirely an right that we should respond in a very sober and0y;ç careful way.ris >> i'm sure the whole house is ryin

pleased to say that real islam had nothing to do with the attacks in paris. would she like to take the gr opportunity to decrying the o-cal state where he said that all muslims were to blame and ask bir him to get a grip of fox news and their terrorists experts who sat around] ÷ insulting birmingham london and everywhere else with their silly comments. >> i agree with the honorable lady that it is important that we do reiterate the message this the is not about islam.s it's about a perversion5 terrorism. their voices islam.ing there muslims in this country and around the world who condemn these acts of terrorism.sendin their voices are being heard. i think in increasing numbers their voices are being heard.edom they are sending a very clear message that this is not in their name. i also say to the honorable lady that freedom of the press means round

freedom of the press. >> i believe she w values and asu shared language under a strong society particularly that women t in such communities in emancipated with help pacify to my young men wh ho tend to copy what en they've seen last week. >> i say the government has increased the requirementsafpc in!çy relation to english capeabilityies capabilities. the ability to speak english and understand english. he mentions the role of women.rah wh i share it'szb do hear female voices from the muslim community.eople

she was running with muslim women around the country saying >> they wish to take stand against those trying to radicalize the ry rejecting new >> will the home secretary join fter me at rejecting the new imperialismours we hear that tend to in condemn the killings but some " were have excused the actions by plaming ourselves and saying the cartoons were unnecessarily terrori provocative. does she not agree. we must agree that responsibility for these actionsthe lie scarily with those who kill hank

innocent people. the >> the only people responsible for terrorist attacks are the t terrorists themselves. they are criminal and we should never let anybody forget that. >> can i welcome this statement as and impress uponk my friend that secu i welcome her words and n statement.m places of worship come up to be e margin marginalized. >> i share a concern we are dealing with extreme and be mindful of the issues he has raised. the government will be untert publishing in due courseer a new extremism strategy which will gobl2 by beyond the counter terrorism strategy that we published so not far. >> the acts that occurred were

not careried out by terrorist and not in my name. these people are totally totally condemn on the attack.w >> can i first of all commend the honorable gentleman for thesa comments he just made. when somebody like himselves stands up in this chamber and gives that very clearqc)=ñ message conde abouta1"3x terrorismmn and none of us p none of usre support terrorism in this chamber. we condemn it absolutely.&-rq

indeed we said we were boardqliñ all the comments that the joint committee made. b >> do you agree we can be promo serious about our internal,'e civility and the safety and@m f security including we need to promote integration and unity of integration an also it's important that we ensure nourab there arele properties strengthen in and security maintained.6ph >> it intensified the checks that were0qr5w taken place. v

t also important that we recognize that within this of united kingdom there are people of variety of faiths and people of no faith.e what is important is we all accept an toleratehe different faiths. not tolerate but recognize there are people of different faiths who have different police chiefs. if we disagree with them then the way to discusso that is through discussion. it's important to allow them to worship in the way they wish to >> and follow the faith they wish to be able to follow. franc >> the unjustifiable and horrific scenes in paris weren't just an attack on france but an attack on peace, freedom and indeed islam. this isn't a clash ofba urg civilizations. it's aut street fight between right and wrong and betweenh.t'÷ humanity and insanity. r on that basis can i urge6fyq caution

for the home secretary theith worst time to react is when it's wrong. you can't defeat extremism with extreme reactions. finally can i say that the2,$0 true ion muslim on that day was the policeman ahmed who lost his own life protecting the freedom of a publication to ridicule islam faith and the tragic story we see the obvious drift.ommen freedom isd the right to be it's never the right to do wrong. to >> i commend the comments that the honorable gentleman has spon made. the brother of these policeman who was murdered gave a dignified response and one that we can allare recognize anda@ it is important that we do e recognize that these people who carry out these attacks these are criminal they are terrorists. they are not doing it in name ofata any religion. the we should be very clear about

the message that we vñgive. of >> julian smith. >> will the home secretary peop confirm she'll be inspired by any the patriotism of the nobel lord the evans and avoid any consultation with the deputy prime minister on e these issues who during the it program interviewed put parties so disgracefully over national security. it's no surprise to anybody in this house.comm the prime minister and i have a l. different opinion on the matter se of the communications data issue and the communicationsn[(0 data bill. i believe it is important that we maintain those capables and i reiterate it's not the charter.lpeñ i >> the securits y measures must be paramount. in the long run one of the

things that will make us safe ishe to reach outñ2 alized communities in the came country that a mirror thei+fe& marginalized communities from which those killers came. they cannot become fishing rounds for people who pen violence ,3a;yhatred. >> if the reasons why people are become radicalized as i indicated in response to my honorable friend earlier are various and often complex. it is important that we do try to understand those reasons. of course it's also important that in any community in our country we are looking at the issues that matter to people. i think for everybody around the country actually issues that matter to people are issues like con available blt of jobs educationobin they are receiving. public services they are receiving and these matters that h we consider for everybody. >> walker.

>> as well as the muslim community which has been quick to condemn the atrocitiesin in th paris, the[újhñ longest running vents newspaper, does the home secretary agree that the b rr survival over 800 years and tribut recent events demonstrate the pen if properly defended can be has mightier than the sword?ery >> i pay tribute to my honorable friend and theñenç constituency he represents. it was a very important rds wi document. it's right that we celebrate the anniversarydocu of that document this year and i think we can all recognize the importance of iú the i thi words within that document and indee the fact it has survived ont? the those õprincipals. jou also the response to the attacks absol and the murders of thosetqç

cartoonists at "charlie hebdo." i think everybody to make absolutely clear that the pen is mightier than the sword. >> the lessons of paris o our real strength is in unity that we should keep together on this. there isn't a big political divide on this. we must keep together across then parties and also we must have a dialogue, conversation with the ter vastro majority muslim people2r in e g this country who are law-abidingth and helpis>í us defeat terrorism. >> i will8hij say he's right. the majority of peopleq part in this country do want to defend terrorism as well and want to in ensure that they are playing their full part in our society. it's right that we make every leap that we can with them inv@óu hether doing that. >> organizations2÷ir own independent professional judgment as to whether they

reprint the cartoons. while in their own eyes many were avoiding the risk of inti offending themi readers.for m some were viewed as being intimidated into j sensory and that was reason enough to righ reprint. does my friend agree that true free speech not>that is truly what we illusion includes the right to insult and offend. we don't defend free speech if that's what we want to do by casting aside those who push the boundary of free speech?publis >> i agree with my old friend. it should be the case. freedom of the press means the press should be free to publish what they want to publish. as the prime minister freedom ofthin the press which we believe means we an should accept they can publish what they wish to publish.vent we ya should not set artificial boundaries. >> home secretary update the

house on how we'll ?prevent is working and reaching with the pe people. whatever this hous e does to can protect the primary civil grou libertynd of people through newj>bs legislation the security sources can't be everywhereve and the network is the most important.authorit >> i'm happy to give the as honorable ladies some figures toocp$ more prevent. there are 30 local authority areas that are classified as prevent priority areas and there are 14 more supported areas. all are eligible for fundingen projects. this is an extensive piece of ety work. we continuely loo k at prevent and how to help ensure it's doing its( g job vúh(áer.j5hlá p

xys; >> thep raised. can the secretary relay the fears of those people and many other people who weren't in the meeting aboutho the rise in anti-semitic attack and how we can keep their children safe while in school.v we are t committing the work of the trust and others is supported in keeping jewish communities safe.0 jñv]+given. i understand it's extra patrols in certain areas to ensure thereey

is that greater support that is given. i'm very clear that nobody should feel that they are likelye to be subject to the sort of the anti-semitic attacks that we have beeren a seeing over the last ollow year. it's very important thatr fa people are able to live in this country >> to follow their faith and to >> last week while these men were rampaging through the streets of paris a leading muslim spokesman in northern ireland, >> leadingúdu muslimb?2 spokesman in ing th northern ireland was telling bbyc that the west brought this on themselves. would the secretary of statewi lea join with me in calling for all of those within theific withinatio the muslim community to ju say and do nothing vsr(r would give any justification for his people to believe that terrorism in the name of their faith is ever+ =q justified and to realize

that words such as this create plim it.5ofr >> it is absolutely right. i it's important for those8sañ in leadership roles in the muslim eir kplunts as community, as many have been doing, to make it clear that these terrorists attacks are not about their religion, their faith and not in their name. it's also8 p ensure that very clear message is sent that the only people responsible for terrorist attacks are thedq terrorist themselves. >> communications dat a is critical de to successful#%d counter nation, will my right if the liberal democratscft will not support what is needed for the defense of our nation would d a you confirms that legislation to very fillkh capabilities gaps will feature the manifesto and be taken soon possible. >> i'm very happy to give my

confirmation on that to my honorable friend. we're very clear we will take0je this legislation forward.can >> a significant rise in attacksn in london and glasco and belfast and stop attacks upon israeli have and jewish people of britain and north america. >> i'm very happy to have had, gs as i indicated, a number of jewis meetings myself but alsoh the police have been meeting with an jewish communities and representative groups and r particularly the cst with the role that it plays ina providing security. in a looking at this we've also s looked a a number of other aspects. i had a meeting recently which involved ]!cx director of prosecutions and policing looking at the advice and

guidance that's available to ensure the police and prosecution service respond >> tha properly when nkanti-semitic attacks are undertaken and it'súnvt taken 8w)dzforward. >> the government's on new radicalism and extremism shared by the prime minister recommended in 2013 a new order for groups that fall short of being legally termed terrorists586 ome and a new civil path the target those. bloc could they confirm whether those are excluded from the counter in terrorism bill and whether it's s because they are blocked by the loóq> it's not been possible to

take those particular poroposalsmç on a government basis. i was very clear. i said thithsopos in the speeches i gave last year that it is proposals"zsl forward. >> thank you, k madam deputy ven speaker. it's keyy todç1uy prevent w radicalization, and given roles and responsibilities of schools and colleges can the home secretary state what portion of pport the :]q implemented for that and what is being provided to the ñly principals? >> the funding provides have increased over recent]g

provide funding for prevent and po@tímg and obviously discussions y$nr taking place as to how that is most appropriately spent. >> thank you.he like a couple earlier speakers in 2012 i was a member of theh)pkñ joint committee looking for n but communications a data draft bill. we,ut the need for new y righ legislation and also d&íproposed a number of safeguards we felt e would improve the bill. would# future legislation, those th safeguards would be considered c >> i'mwith very happy tog$ñ consider ed respo that. the joint committee did come back with a well consideredrdvbwez detailed response and the commen government was leer thatda we would take onboard the 2 a recommendations, most of the recommendations the joint committee had put forward and that continues to be my view as nserva secretary and obviously as a conservative politician,ñf looking d. at the prospect for conservativemr. sp

governmentea legislation moving forward. >> referring to the capabilities04 of the peoplepaa diminishing, and the context of the security of the people of sh thee entirety of the united portant kingdom, how central does she nal think the national crime agency is, and how important is it that that national crime agency is fully operational in all of the united kingdom particularly in role. northern ireland?@.t >> i believe national crime on agency does play an important role.e, obviously, its clear focus is on organized crime and also economic crime border fy ui%5ñ and child exploitation, and online protection. i think it t is a valuable agency. agency and benefit of having set up the national crime agency and the operation it's under taken. i would i consider that it n would be appropriate, it would parts be beneficial ifof it was possible for that agency to operate in northern ireland as it does in other partsu.t. of the united

kingdom. >> thank you. a number of anti-semitic incidents on the rise, surveys publi demonstrate a greater public acceptance ofzxlg anti-semitic the right what further reassurance can my commu friend offer to the jewish community in particular for anti-semitism, we will.álñ zero ! tolerance of it and we need to uld no educate the public that such my ri attitudes should not exist in is this country. >> you're absolutely right. we should be very clear thats will not tolerate anti-semitism and i think weqs can deal with this in a number of ways. first of all, it is important in that we provide the support and advice in relation to protective security for those who may be atpnq/ñ im threatpo esn being subject to thosent incidents, but also, i think,q that we it's very important for us to give a claire message from a government and from this house that we will not acceptm0rñtr(t&háhp &hc% anti-semitic incidents, and the work led by the government and

the task force they have brought together on anti-semitism plays an important role on this. >> thank you. r i previously was on the civil libertarian side on these arguments, but given recent events, not just in france but t of elsewhere, i have come to5w!$n the conclusion that the secretary isr right in whatage she's doing. could i return to the subject of toda the jewish community? on the independent today, it shows hugeprehensi amounts of jewish people have ing real apprehension now of living in the united kingdom. m i welcomed the words she said in response to other members, but this c couldou she maketo the positivex#ú1uj jewish people bring to the country in order to make sure friend's concerns. i think it is would be a matter of d >> i share my friend's concerns. i think it should be a matter of deep concern to us all in this house when people from the live i

jewish community as surveys suggest, arek3&ñ feeling less easy to live in thej66÷ united kingdom. we have seen over theh% years people leaving other countries in the european union, as a result of anti-semitic incidents. i never thought we would see the day when surveys were showing this sort of feeling for peopløv jewish people here in the united kingdom. it is absolutely right, not only that we are clear in our condemnation of anti-semitism, that we give them security ÷ r and other support i have referred ant to, but also that we sent a very clear message that members of society. we should welcome them her important and significant role ud w in our communities and their contributions to our society. we should& eú welcome them here. we shouldqhãabsorb the ortant contributions they make and insure they all feel able to stay living in the united kingdom and making their important contribution to our society.(2ñ:] >> british prime minister david cameron is in washington for

talks on a range of issues. afz'< columnist in theficial times it's a preelection photo opportunity. sure, there's a full )-d5agenda for his talks with barack obama not least the terrorist 1÷outrages in france, the military campaign against the self-styled185wt islamic state and russia's armed intervention in ukraine. are @ lpre-election selfies÷aa the !)4ñpresident. standing shoulder to shoulder in a dangerous world.. z the u.s. may be a somewhat diminished superpower these days, but mr. obama still$ñk sprinkles star dust to visitors to the oval office.c7kañ >> dr. anthony fauci our guest this sunday on q & a, is on the front lines,vbjvñ battling against infectious diseases. >> we have drugs right now that when given to people who are >-h(t&háhp &hc%

hiv-infected if someone comes in, i could show the%f in th~3fú early '80s, if someone came vd1isinto my clinic with aids their survival would be six to eight months which means half of them wouldma> e dead in eight months. now, iz tomorrow when i9=i go back to rounds on friday and someone comes in to our 20-plus years old, who is relatively recently infected and i put them on the combination of three drugs, the cocktail of highly active antiretroviral therapy, i'd predict, look them in the eye and say we could do mathematical modeling to say if you take your medicinet 0ç regularly, you!br1 live ant5b1 additional 50, 5-0, years. to know from 50% of people are going tomp9ñ die in eight months8m to know figure you take your medicines,[7b//u could live essentially a normal life span eç÷tr(t&háhp &hc% just a few. normal life span that's a humg

advance. >> director of the national institute of allergy infectious diseases on c-span's q & a. >> president obama gives his state of the union address to a joint session of congress on tuesday. we'll hp7q8y the president's and membersf,i of congress. live coverage tuesday night begins at 8:00 eastern on c-span, c-span.org andhmyñ c-span radio and a bit of news. republican officials have announced newly elected iowa senator joni ernst will deliver the party's formal j$ nse to the president's state of the union. the national coalition on health care yesterday looked= w at how payments made by drug and medical device companies influence doctors and hospitals. the new data on payments is the result of the physician payment sunshine act passedá requires the companies to report

any items given of value. this is an hour and a half."vzv"b?yjvñí onea q of the key strategies to achieve that isn%; greater transparency today. we have a chance to look at the physician payment- and see how it's doing. this is one of a series of events the national coalition sponsors to lift upxóz&÷ what we see as promising developments in health care.pe today is one of several

congressional briefings, and so i welcome you today. thank you for coming. thank you:mc(tq(rp&lyzd7g c-span for being with us and those of you watching on tv i think you'll find this interesting state of play sunshine act. to introduce our going to turn to my friend and colleague debra whitman. she's the director of policy at aarp. and she's been heavily involved in this issue. debra, it's all yours.xcq>ñ1e6a >> good morning. i think this is a really important issue that a lot of people don't know section u&7l6002 of the affordable care act was previously knownz- the physician payment sunshine act. it was a bipartisan piece of

legislationó senate by senatorrófz- grassley. republican from iowa. and senator herb kohl a democrat from wisconsin. and the bill sought to lift the veil on the relationship between industry and 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 z>/ with the information that we gotrcd from the research community, and the consumer community, represented by pew and allen here today and aarp and amsa and m'e concerned that these r(b2bk@; relationships, the financial relationships, were impacting both the quality of health care, and the cost of health care.j2.sñ

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 (óa senator grassley's office, about 300 meetings with consumer a#d)z%tr(t&háhp &hc% groups, and ivj understand comprehensively what these relationships were, á

there were different reporting requirements in each state, there was a lot of chaos for the industry to actually make sure wz1wu 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.[am: now, this law, as i said, came from state legislation, went to a federal legislation, and actually has spurned laws across the globe.o]r0lg although they are not all implemented the same. the french decided that it's great to report the financial relationships, but we shouldn't qepñ 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 gettingz out.[v f1 o

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 ccñ 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.ci first we have rodney whitlock.zbl÷ who is just a real expert here on the hill. he has 21 years of experience and he's currently working for 6.byk senator chuck grassley. as the health policy director in5! the senate finance committee and he's previously worked on a variety of staff, including representative charlie norwood.k÷z3 and he also is a part-time #q$x teacher at george washington sú university for health policy. so we welcome rodney.

second we witdy haveml fugh-berman, who iso 7÷ association professor in the department of family medicine inclmñgeorgetown university medical center.:@$ñ 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 kokal who is a clinical pharmacist and senior)j"dç 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 c+r implementation of the legislation. finally we'll have dr. william bjgz 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 director of preventative medicine residency. so we have a great panel.

we'll let them each speak and take questions at the end. rodney?v y-÷; >> so thank you all for having us today.r7 g coalition on health care, and john rother for organizing this thank you c-span for being here as well and giving my wife an excuse to dress me this morning. senator grassle9n;dd 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 ¤8ç ability to provide information for the judicial process, medicare transparency of data, working with senator widen, and r3v seeing that medicare data could be released publicly for research purposes and some of the work we've done in not for profit hospitals.3ad and providing information as to what they're doing with regard to providing services for the

uninsured, and the things that êm 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.>jmgñ and that motivates how we approach -- how we come to this subject. if you look at it there's a disclosure also out there for participants. clearly members of congress. and staffers like me. are subject to financial disclosure. the freedom of óvn)[fñwáqr information act makes information available to individuals about wh [gát)áh @r(t&háhp &hc% government is doing.oqc and tax exempt organizations have to provide certain information for their status.7af 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.ief ñ

and it begins with -- it begins with investigations about what are the relationships between manufacturers of drugs and devices, and biologics and providers.da.z and you have an early "new york 2@ ñ times" piece on a pro x+hr is participating in a study on sareroquel and making recommendations for.q8ñ ñ! antisawcotics for teenagers, and what are the financial relationships that that individual provider has?@0÷ 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.0czm 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.@g ÷t+b the magnitude of it is unclear to us. but we know. we have work from groups from pro-publica and pew out there showing there is somethingëx worthy of consideration here. now it's important to note that what we're talking about, when we talk about these financialkjb÷+u transactions, money moving between the covered entities, the manufacturers, and bm 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, that they are legal.m% that we're not talking about zçzxñ things that should -- that are illegal, or types of kickbacks.p8@= these are particularly related oftentimes to education.ó and that for doctors to take 6(dñ

their time to be engaged in the educational process for wér$emselves and for their peertbñíñ 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 cwirz legislation, now, some people could come to this with a very purist approach. an absolutist approach.d!@ that we should make these types é l of transactions illegal. that's not the way we approachedvb6 ñty it, working with senator cole's office of wisconsin. we looked at it from more of a transparency perspective.r that if these transactions vjq remain legal, and we believe that they should, then they f@0t should be reported, and made available to the public. since they are legal transactions after all that there should be no qualms about nz([÷ making them publicly available. making them so that they can beoad seen by the public a.ñxák9 r discussed.hzv"w 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.ú÷1(r now once in statute it went through the implementation process.w5,jñ i!+.táháurned ovmdç+ cms to figure out how to make it work and bring it to the public.wañ and cms, i'll drop in my &>÷j southern colloquialism, bless their little hearts, they have trouble websites.÷f wad 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.ñ right, was horribly flawed.çg 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."7a=÷ and to cms' credit, dr. agrawal 21bg made consistent improvements on

wtd%3já$u$ere.a jys[m7÷ their tu deidentified to identified, and and so, from my office's pe#o u up)e very pleased with what cms has done. and this is important. because, moving forward in the future this really needs to be commonplace.@my 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 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. %tc"af1 o a conversation between a patientf;r0ç and a provider.tñ a patient should be perfectly adt comfortable as an educated consumer looking at this data and seeing what their provider is doing and then asking their provider.f)ñ

and a provider should be absolutely comfortable saying, +]9÷ why the data is in there. what it says. now we know as we look forward, n fg0l ÷ again, that there are things that will need to be approved on the site. and that's going to be a collaborative proce#sbszgknñ 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 l this is a good thing, a positive thing, and it is in the public interest, and it is in the cj patient interest.yd ÷ now, to the sort of elephant in the room, the data is now out there and we went from having @íh= suspicion to having actual data. and the actual data, and this is

is going on out there, these lf1- financial transactions, that the total value that cms published as of december 19th in these transactions was $3.7 billion.nq÷ the number of records, those 7p)ñññ individual transactions that areb;b÷ occurring, or over 4.4 million transactions reported.úc[- and it involved individual records for 366,000 physicians. and so there's a lot going on out there.rjn+ñ now what that means, what ck2úrñ done with the data. the research you can go into and find out about what's going on is turned over to the research community.k and how that then informs public poí3gi]%11"uu$u(on the research done.m that, then is again a subject for the folks doing research, k"da

whi(ef2p is my segue to my fellow panelists here. again, ready to answer questions and appreciate you all being here today.f5buç@" >> good morning.cúcti rp(py to be here today.. u physicians find it very difficult to speak without slides, and you'll notice both physicians on the panel have brought slides today. expert witness at the request of plaintiffs in matters regarding educational projects and&qç practices in the departments of pharmacologist and physiology at georgetown university.1"ñz>2zñt the physician payment sunshine act has been a success. it's been wonderful to have this information out here. reporters, for researchers, and also for consumers. hpñ

and just the f4ñ of@sé its existence is really important. physicians don't like its existence or at least physiciansn6.y who are paid by pharmaceutical companies don't like its existence. apparently it's quite popular zsy among divorce lawyers, though. pro-publica had put together publicly available information gz 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 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 4÷lgvé÷ 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 -.;qtgc washington university is leading$g6 an effort that i'm involved with as well.

we have disclosure laws in d.c. p and we do an analysis of the u of the disclosures from pharmaceutical companies of payments to all health care practitioners every year. and we also do a special report.xñ9 and i can tell you that the ppsa only picks up about 20% of to d.c. y so some states, or nonstates have reporting laws that are /@jx even more stringent than the ppsa, and i would make a plea for keeping them.r! w our latest report,0tw 5uu(s&y looked at organizations in d.c.,5lpox÷!4u we're required by law not -- we o-k÷ can't actually name those organizations, but they may be u@1ñe=z represented in this room, and we found that of the almost $20 million that was -- that was écib spent on d.c. based organizations, about a third of these organizations failed to disclose their corporate donors nm+ ph on either their website or an +t

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 bdç.d°çpabdlh]f>u5

later, and direct to consumer promotion. which includes direct to consumer advertising and even targeting of individual patients. if you have an expensive disease pharmaceutical companies may é send a visiting nurse to your >x you fill out insurance forms to convince your insurance company to pay for an expensive medication."!s 9 one of the things that has gone ímáub]ñ?s( away sincehv-fq 2009 is promotional items, but we collect them at pharmed out, so i had to showh 4 @r(t&háhp &hc% you our collection.!4;vf9ñé some marketing tactics have changed, however, some have become more subtle and some of the targets have changed. that to some extent physicians .;jdñ a medications than other people.z than other entities.n more and more formularies. pharmacy benefit managers,ùcf1 o payers are deciding what gets

various medications. and pharmaceutical companies :w will always try to effect 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 hxpz÷9!z(z effectiveness studies, for example.6 because if you're a company with[9ç a really expensive drug, you're going to need to try and though this drug is terribly expensive, it will save hospitalizations, or it will save you money down the line somehow. there's a lot of cost 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.+dh the pharmaceutical companies would like to help health care $av$p provideri'.nd systems manage dfmhñ their patient.

you should be very afraid of this.íz1oqkfil&vñ and there's a lot of partnering with government agencies, with medical groups, with ra0uc&ñ specialty groups, et cetera,.çf and groups. some of which have been invented, or have been created by pharmaceutical companies. and others that have been co-opted by them.k #+âáq re very few -- there are very few consumer advocacy groups that don't take money from pharma.tq there are fewer than ten national groups in the united states that do not take money from pharmaceutical companies.r9ñ#hctqgaezuhp &hc% for individual physicians, the réx f shift has been away from cash, and towards more services.u we'll do a website for you.we we'll provide web pads that your jjents can fill out their information, their medical history on so that somebody doesn't have to transcribe that.uqf]ñ that information actually gets sent back to pharmaceutical companies. it's deconfidentialized first.r but it's a way for them to collect all this information, in

medical records are also sold to pharmaceutical companies.lbzi those records,?a so it's anonmized patient ym+el data, but pharmaceutical companies know everything about your health history. your you went to a doctor, your zip code 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 ú+ç$ fund tvs in waiting rooms that have fake news stories on them.hoac÷ 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 the room. there are new targets for pharma

marketing and one that i think is really important to mention ryñ are nonphysician practitioners. so, advanced practice nurses, which includes nurse practitioners, nurse midwives and nurse anesthetists, and physician assistants. so these are practitioners who h have prescribing authority in all 50 states. and one out of four prescriptions in the unite$z practice nurse or a p.a. one quarter of all [n(g÷ 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.÷é&fxpmçzte 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 0

workers who are making make the high targets, the nps /tre) r pads. gatekeepers are really important.ç ñl the receptionist, the nurses whoécq1÷ work in a doctor's office.be#ç so even a nurse who is not a social worker who is not a prescriber, they can influence %d;q prescribing of a particular health care provider.; and that's really important. so this is also from a industry magazine. t] this is also from a industry magazine. kol, again, is a key opinion leader.bta this shows the matrix of everyone who has to be affected.

all the peopmpdgat t hg& 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.ykbp 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 ÷nb[y brand before it's birth. 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.x or it might emphasize a & particular mechanism of action and there's a drug on the market i think what we should really berf/t watching for is the establishment or t redefinition of specific conditions. so pharmaceutical companies have actually invented some conditions wholesale.o dñscá including hyperactive sexual desire disorder, daughter of the invented female sexual dysfunction. gerd, gastroesophageal reflux disorder. this is what used to be called heartburn. we used to tell people drink vqsñ less coffee, drink less alcohol, smoke less, don't eat a full meal and go to bed right away. now you have to be on potent ?5t life. pediatri tolar disorder. what we used to call the terrible 2s.fv[h

excessive sleepiness. anyway there's been many other conditions that actually do exist but have been redefined. so restless leg syndrome iyiki 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. i'm happy to discuss them. 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 condit'%e 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 q, have been invented by industry. anyway pharmed out works with a lot of industry insiders and we have information that is unusual. and these are some of our publications available on our website. we have promotional items available on the table outside.uáfñ# and we are planning our fifth conference. we've done four conferences on these topics. ç this will be june 11th and 12th. and i hope you all can come. it will be at georgetown.@g thank you very much.zqwjyu >> good morning i'm very happ[#qtñ to be here today. i'd like to thank the national coalition on health care for 0$ñ÷ hosting and deborah whitman for the kind introduction.u as a couple of people have already said, the first version of the physician payment

sunshine act was introduced in j!nx 2007 by senator grassley and senator cole.5k i think if you called your o@qíñqcñ bookie in september of 2007 or your washington lobbyist, and said what are the odds that this3 thing will become law they would have said it was pretty unlikelydfby at that stage.x ño zbbd÷ 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.xysrç we had state laws that required this kind of reporting at the 'eó¡ state level and created a kind of compliance nightmare for companies that made÷óh 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.46f8r

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(hb schools saying we just can't keep going. our profession can't keep going the way it has.shppjzìáhp &hc% so all those things came together and the law passed in 2010. but the other piece of context ?yñ8dlfb x5.pá i think isn't approximal to the law's maspassage but is really important to understanding how it fits now is this sort of much wider recognition that wi really,[z need to understand in this country the drivers of health care costs and where the dollars go.ffñ and if you went back to 2007, i think it would also be close to unimaginable that cms would be publishing individual physicia.? uv f1 o payment records. but that's happening now, too. as rodney mentioned this morning, we now have the first report from the sunshine act ydññ)