>> we'd love to have you come, speak before the house. >> your house has a little more history than ours. >> how many members? we're 120. >> 400? oh, my gosh. that's a lot of cats to herd. >> no kidding. we have a pretty good split 239 to 161. >> that's almost the size of congress. >> it is. >> and how big is the senate? >> 24. >> yeah, that's a big difference. >> huge. >> it's fun. >> makes it interesting. the house actually got up to 424 but they couldn't fit them in the room. it was based on population. so they -- >> are they in districts? >> yes. >> so single-member districts? >> great to see you. >> likewise. i wish you the best. >> you're in the middle of the session now. >> we're excited to have him.

>> good to see you again. thank you so much. thank you. >> look forward to be being here. >> [ inaudible ]. >> [ speaking spanish ]. >> senator, very nice to meet you.

>> [ inaudible ]. >> small world. >> very small. >> one more. >> good morning, senator. read your book. big fan. >> thank you. >> can i get a picture here? >> how are you? >> good. >> which way? this way? right here? >> great. thank you. >> looking forward to hearing you. thanks so much. >> here? right here. >> i got an extra egg. >> senator, it's good to see you again. >> are you sitting there? >> right next to madam speaker. >> the purpose of why we're here today of course is to hear from the junior senator from that very warm state of florida,

marco rubio. we truly had hoped that the senator might bring some of that florida weather with him but unfortunately, we are stuck with the new england cold and the snow. the senator is someone you may know. he's the son of cuban immigrants. he was born and raised in miami. he had started his career in public service in the late 1990s, not long after earning a law degree from the university of miami. the senator served as city commissioner to west miami before being elected to the florida house of representatives. and then was elected speaker. and as someone who served in the legislature myself, to know that just in a few short years he was elected speaker of the house says an awful lot about how his colleagues viewed him and valued his impact and his counsel.

that's quite an accomplishment. in may 2009 he announced he would run for the united states senate. he ran an impressive primary race, edging out an incumbent governor, charlie crist, to win the republican nomination and eventually prevailing in the november 2010 general election. during his first term in the united states senate senator rubio established his reputation as an outspoken advocate for issues he truly believes that are important to streamline our federal government eliminate the federal debt, and promoting job creation. he's called for a number of reforms that he believes will "restore the american dream," including reforming social security and medicare programs to preserve them for future generations, reforming our higher education system to make college affordable for young americans, and spurring our economic growth with policies that encourage american innovation. i will add that the senator's also been an advocate for updating our nation's broken

immigration system, an issue that's been a priority for the new england council particularly as it relates to highly skilled stem workers the science the technology, the engineering, and the math. he's been a lead co-sponsor of a piece of legislation that the new england council has been very supportive of. and that's the immigration innovation what we call the i square act. this bipartisan bill which is also co-sponsored by new england's own senator blumenthal, would increase the number of h 1 b visas available and would advocate a portion of that fee from those visas to the stem education initiative. it's a common sense solution to address the shortage of our s.t.e.m. workers. and the council is grateful to senator rubio for his leadership on this very important issue. i hope and i know that we're all looking forward to hearing from the senator about his vision. the future of our country. so with that i thank all of you

for joining us here today. please join me in welcoming and giving a very warm, warm warm welcome to the honorable senator marco rubio. [ applause ] >> thank you. well, it's -- thank you for having me. it's an honor to be here. by the way, let me just on the outset say that anytime i stand behind and i see the words new england together it triggers all -- connotes all sorts of horrible memories for me like, you know tom brady beating the dolphins and -- yeah. i know. when is he going to retire? [ laughter ] well, i hope soon because we hope to have a division championship like once for my kids to see before they turn 18. that would be great. thank you. but anyway. i appreciate the opportunity to speak to you. i want to thank the council for its invitation and all of you for having me today. it's a real honor to be with you. i told my kids earlier, this

weekend, that i would be speaking at an event called politics and eggs. and they immediately thought, well, is that because they throw the eggs at you if -- and i was worried about that. and then when i walked in and saw they were made of wood i was really worried about that. so i'll try to avoid being the target of your eggs. but thanks for this invitation and an opportunity to be here with you today. what i think is really a critical moment in american history. in fact, i'll make a proposition to you tonight, or this morning. and that is that the 2016 election will have nothing to do with what party we want in office or what individual we want to govern our country. as much as anything else 2016 will be a referendum and it will be a referendum on our identity. the fundamental question before the country in 2016 will be what kind of country do we want america to be in the 21st century? i can tell you what america was in the 20th century. it was an exceptional nation. and it's something i can speak to you about personally because i've seen it in my own life. imagine for a moment being born in a country or in a society where what you're going to be is

decided for you. that no matter -- imagine growing up in a society where you basically know that no matter how hard you work how talented you are, how big your dreams may be and how hard you're willing to work to achieve them none of it will matter because you don't come from the right people, because your family's not politically connected, because your parents aren't wealthy. because you don't run in those networks. imagine growing up in a society like that. it's hard for us to imagine it. when i say us, i mean me. i was born and raised in this country. and it's easy for those of us who were born and raised here to take for granted how special this country is. but you don't have to work hard to imagine what it's like to live in a nation like that because for all of human history most of the people who've ever lived in fact have lived in a place like that. and two of them were my parents. my parents grew up in a developing country in the 20th century, in cuba. my father lost his mother when he was 9 and left school and went to work. at 9 years of age. he's as old as my oldest son. and he would work for the next

70 years of his life. my mother was one of seven girls raised by a father who was disabled, having been stricken with polio as a young child. and he struggled to provide for his family in a developing country, in a primarily agrarian society in the early part of the 20th century. they met and they got married in havana and they had big dreams. my mother wanted to be an actress. my dad wanted to be a successful businessman. but they felt trapped. they felt like no matter what they did how hard they worked, for people like them it was almost difficult if not impossible for them to succeed. so in may of 1956 they made a decision that changed not just their life but the future course of our family. they came to the most exceptional nation in all of human history. they came to the united states of america. now, life in america was not easy either. in fact, their first few years here were difficult. they struggled. in fact, they were discouraged. they were so discouraged that at times they thought about going back to cuba. thank god they did not. but over time they persevered. my father found work as a bartender at a hotel.

primarily on miami beach. my mother worked at a factory. she was a cashier. she was a maid. she was a stock clerk at kmart. my parents were never rich. they never owned more than one home or one car at a time. they didn't even save enough money to pay for us to go to college. but working as a bartender and a maid, my parents were able to provide us a safe and stable home and the chance at a better life. my parents never made a lot of money and they never made it big. but they fully lived the american dream because the american dream has nothing to do with how much money you make and it has nothing to do with how many things you own. the american dream is about living the kind of life you want and achieving happiness as you define it. and what makes us different from the rest of the world is that here millions of people have been able to do what my parents did. now fast forward to today. where we now have millions of people in this country that are

starting to doubt whether that's still true. they read the newspapers. it says the economy's doing better unemployment's down the big corporations are making more money than ever before the stock market's going great, but they don't feel it. they're still working hard. they're still persevering. and they're still living paycheck to paycheck. they're literally one broken car away from disaster. there are millions of people living like that. these are hard-working tax-paying americans who have done everything they were told you need to do to succeed and they aren't getting ahead. and so one of the great challenges before us today is that there is a great concern in this country and a growing perception that in fact we are no longer the place where hard work and perseverance alone is enough to succeed. and that is a definitional challenge for us as a nation. because if we lose that it's not just that it hurts our economy. it deprives us of what makes us different. it deprives us of what makes us exceptional. so why is this happening? why is it so hard to do in the 21st century what so many people

did in the 20th? and the answer is because the world around us has changed. and we've been slow to change with it. first of all we don't live in a global -- we don't live in the national economy anymore. we are truly participants in a global economy. globalization is real. and what it's meant is that there are more people than ever that buy the things we make and invent. but it also means there are more nations than ever that we have to compete against for investment and innovation. globalization has also meant that many of the jobs that once sustained our working class have now gone overseas. and we've not done a good enough job of replacing them with better jobs. information technology and automation is also real. the jobs that once sustained our middle class many of which have now been replaced by machines, i mentioned to you that my mother was a cashier. well, the next time you go to the grocery store notice how many of those cashiers are now a machine. that never worked by the way. they're always stuck and somebody has to come and get their -- but anyway, that's another point. right now.

now i'll get a letter from the national cashier machine association. my point is that automation is real. it's replaced a lot of the jobs that once sustained the working class. and we've not done a good enough job of replacing them. these are the challenges of the 21st century. but there's also extraordinary opportunity embedded in it. you and i are 5% of the world's population. the fact that we can now sell to 95% of the rest of the world who can now afford to buy our things, the things we make, the things we invent, that's going to create greater prosperity if we're positioned to take advantage of it. it's true that automation has replaced many jobs but it's also creating new ones. the problem is that those better-paying jobs require skills and education and training tham of our people don't have. why are we missing the opportunity to capitalize on this potential? well primarily because we have government policies deeply rooted in yesterday. and yesterday's ideas don't work anymore. you cannot continue to tax and regulate with impunity, with the attitude that we are the only

economy in town, because we're not. there are now dozens of other countries that have reduced regulations and reduced taxes and are outcompeting us for some of this job creation and some of this innovation. so the first step in solving this challenge is to once again make america the best economy in the world to invest and innovate. that means tax reform that makes our tax code simpler and more affordable. that means regulatory reform that requires a cost-benefit analysis before we throw yet another regulation on the back of the american job creator. that means repealing and replacing obamacare which has discouraged job creation. that means bringing under control our national debt that threatens our long-term viability and security and discourages people from investing in america's future. and that means fully utilizing our energy resources. that won't just lower the cost of living in america it will make it cheaper and more cost effective to manufacture in america, creating millions of jobs along the way. that's the first step. we have to once again become the healthiest economy on the planet. the most globally competitive

economy in the world. but if i have one fault to criticize my party it's that it usually stops there. oftentimes the republican speech ends right here with economic growth, and economic growth is important. and it's the most important thing we can do but it cannot be the only thing we can do. for the second thing we have to do is we have to equip our people with what it takes to succeed in the 21st century. that begins by recognizing that in the 21st century it takes a higher level of skill acquisition than ever before to achieve the sort of american dream prosperity that my parents had. here's the hard truth. if my parents had come to america in 2006 instead of 1956, there is no way they could have lived the life they lived working as a bartender and a maid at a hotel on miami beach. everything costs too much and those jobs don't pay enough anymore. instead my father would have had to become a mechanic or a plumber or an electrician or a welder or a machinist. my mother would have had to become a dental hygienist or a paralegal or a registered nurse.

and that's the way forward in the 21st century. that we can create better-paying jobs but those jobs will require more education than ever. the problem we have is we have a one size fits all higher education system which is basically this. you either get a four-year degree or you get nothing. that is no longer acceptable and is no longer responsive. the solutions that come from the left on this issue, by the way-r let's just pour more money into the existing higher education system. that won't work. we need a new higher education system. one, for example, that graduates more people from high school ready to go to work. ready to go to work as a welder. ready to go to go to work as a pluchler, a bmw mechanic or airplane technician. you can teach people to do this when they're 17 and 18 years of age and they can graduate making $45,000 a year as a start. we need to do more of that. we need to by the way, have a system to help people who are working full-time and raising a family to acquire the skills they will need to get a better

job. imagine for a moment a single mother raising two children working as a receptionist at a law firm making $12 an hour more than minimum wage. the only way she is ever going to get ahead is if she acquires the skills she needs to become a paralegal. but here's the problem. she has to wake up every morning at 6:00, make her kids breakfast, drop them off at school rush to work, put in eight or nine hours, rush back to pick them up before after-care closes. rush home to make them dinner and do their homework. by the time that she's done it's 10:30, 11:00 at night, she's exhausted. she can't drop all this and go to school for four years or two years and sit in a classroom. and while there are pockets of innovation, for most americans facing those circumstances there is no flexible and affordable program available to them that allows them to acquire the skills they need to get ahead. we need to create the conditions for that. we need to stop discriminating in our financial aid programs against programs that allow her, for example, to get college credit for what she's already learned. she's been working eight or nine

years at a law firm, i'm sure she's learned something along the way that we can give her credit for. we also have to allow her to take courses online some of which are free. take courses on weekends, at night, at her own pace. package all of that learning into the equivalent of a degree that allows her to go from being a receptionist making $12 an hour to a paralegal making $55,000 a year. that will change her life. and that will change her children's life. i'm not saying the four-year degree won't matter. it will. it will continue to be a valid choice for millions of americans. here's what we can't afford to do anymore. we can't afford to continue to graduate people with four-year degree that do not lead to jobs but has saddled them with tens of thousands of dollar of student loan debt. i know about student loan debt. i owed over 100 thousands myself and i was only able to pay them off with the proceeds of my book "an american son," now available in paperback.

[ laughter ] it's not a joke. i'm serious. it's available in paperback. you're now paying my children's loans when you buy those. but all kidding aside, we can't continue to do this. so at a minimum i've proposed that every student before they take out a student loan be informed by their college or university this is how much you can expect to make when you graduate from our school with that degree. you're still free to pursue, it but you deserve to know that the market for greek philosophers is tight. again, you can major in anything you want. it truly is a free country. but before you saddle yourself with loans you should know what your job prospects are because student loans don't just hurt you financially. student loans keep you from entrepreneurship. they keep you from home ownership. oftentimes they keep you from family formation. by the way, in the realm of empowering people to what it takes to succeed in the 21st century there is still something that it's always taken to succeed, and that's certain values. hard work, discipline

self-control, respect for others. i don't care how many diplomas you have on the wall if you don't have those values you cannot succeed now or ever. the problem is no one's born with these values. these values have to be taught, and these values have to be reinforced. which is why we see what a devastating impact the breakdown of families is having on our economy and on our society. now, here's the truth. i can't pass a law to make someone a better husband or a better wife. if i could pass a law to make me a better husband my wife would run for office. we can't pass a law to make people better parents. but we should certainly not have any laws or programs that discourage marriage and family formation. that's why i've proposed a family-friendly tax code that helps working families with the cost of living. that's why i support school choice, because i believe every parent, especially low-income parents, have the right to send their kids to the school of their choice, not just the government's choice. that's why i believe we need to eliminate the marriage penalties that exist in our tax code and in our safety net programs.

in the realm of the safety net programs we have a record number of people living in poverty today. you know why? because our poverty programs don't cure poverty. they treat its symptoms. they alleviate the pain of poverty, but they do nothing to help extract people from poverty. the best cure for poverty is a good-paying job. and every single one of our safety net programs should be about helping people acquire the skills they need or the opportunity they need to acquire a good-paying job. but the federal government will never be able to do that. no one size fits all federal program will ever be able to do that. that's why i've proposed pooling all the fal anti-poverty money into a flex fund that we turn over to the states and local communities so they can design anti-poverty initiatives that speak to the root causes of poverty in their locations. and they're different in different places. even my home county of miami-dade. urban poverty in the inner city looks different, has different causes and different solutionses than rural poverty in south dade and the agricultural communities. but only states in local

communities and not for profits will ever find the innovative solutions to those problems. so if we do these two things, if we empower our people with what it takes to succeed in the 21st century with the education and strengthening family and if we make america the best place in the world to invest and innovate again, we will have set the template for another american century where the american dream won't just survive but it will reach more people than ever before. but what i would be remiss if i didn't point out that none of this would be possible if we don't do a third thing. and that is provide for our national security. a nation that is not secure cannot be prosperous. and there is no one that can argue that we are safer or more respected today than we were five years ago. a spshlgs quick tour around the world points that out. in asia china's acting aggressively on its territorial claims. they claim to own all sorts of chains of islands that if you add them up together give them practical control over the south

china sea. which is problematic because 50% of global commerce goes through there. in latin america, in the western hemisphere, after two decades of democratic progress we now see democracy eroding in nicaragua bolivia, ecuador, venezuela and of course cuba ha hasthat hasn't had it in almost six decades. in europe we see putin challenging eastern europe's order with the invasion of ukraine, before that georgia, before that the war on chechnya, not to mention all the murderous plots he's kaerdscarried out in russia and even around the world. and in the middle east it's never been more unstable in recent memory. first you have the threat of the iranian nuclear program, which they continue full speed ahead on. it's not just devising -- it's not just atability to reprocess plutonium or enrich uranium. it's the fact that they've probably already bought a bomb design. it's the fact they continue to develop long-range rockets already capable of reaching parts of europe and eventually capable of reaching our very own

homeland. add to that the uncertainty of non-state actors such as isis and al qaeda and al-nusra and boko haram, the spread of radical jihadists that now find themselves in multiple continents and in dozens of countries. and then the new threat of homegrown violent extremists including people that have never even left the united states who become radicalized online and are spurred and inspired to take action. the threats are real. and they must be all of them confronted. now, the question is what's america's role in confronting them? well, america can't solve all these problems on its own. and nor do i suggest that america should be involved in every conflict on the planet. but i also understand in the absence of american leadership none of these problems can be solved. none of these problems can be confronted. the absence of american leadership leaves behind a vacuum because no other nation or institution can fill the role we fill. not the united nations. not nato. not the organization of american states. and certainly not russia or china.

no other nation is capable of rallying the peace-loving freedom-loving people on earth to take action other than the united states. and when it doesn't play that role chaos ensues. and that's what you see happening in place after place around the planet. you cannot have a safe and prosperous world without strong american leadership. and you cannot have strong american leadership without it first and foremost being backed up not just with strong diplomacy but with the strongest military power on earth. and the rapid decreases in military spending are threatening, are threatening our ability not just to defend our country but to remain the strongest military power on earth. and it makes no sense. military and defense spending is not the cause of our long-term debt. the cause of our long-term debt are entitlement programs that are currently structured in unsustainable ways. i believe in these programs. my mother's on these programs. i would never do anything to hurt her or anyone on these programs. but these programs go bankrupt. then they bankrupt our nation if they are not reformed. that's the cause of our

long-term debt. meanwhile, every time in our history that we have radically slashed defense spending we've had to come back years later and undo it. and it's cost more money and been more chaotic. at a time when china now endeavors to build a 300-ship navy, at a time when russia is acting out aggressively and increasing their defense spending despite the fact that their economy's in shambles we cannot afford to dismantle the american military advantage, and we cannot afford to lose the technological high ground. if we do the world will be less safe and less prosperous and economic growth and empowering people with skills will not be enough. and so this is the choice before us. we must decide now what every generation before us has had to decide. are we willing to do what it takes to keep america exceptional? if we do the three things i've outlined here today make us the healthiest economy on the planet empower people with 21st century skills and abilities and values and make america the strongest participant on the global stage, then the 21st

century will be the most prosperous era we've known as a people. if we fail you and i will be the first americans to leave the next generation worse off. and to me and to all of us that should be an unacceptable outcome. let me close with this observation. america doesn't owe me anything. i owe america everything that i've been able to do. if my parents had not come here in 1956, if america didn't happen to be the nation that was 90 miles off the shore of cuba, i would not be standing before you here today. i might be a really good bartender or something else related to it in the hotel industry. but there's no way in the world that i could have the same dreams and potentially the same future as the son of a president or the son of a millionaire. the reason why that's possible is because for reasons i will never fully understand god blessed me and my family with the opportunity to grow up in the freest and most prosperous

nation that man has ever known. it's a deeply personal story. i often speak at events like this. and it's kind of early for a bartender. but in many of these events -- well, you never know. who knows what's in those eggs? but in many of these events there's usually a bartender and a portable bar in the back of the room. and it reminds me of my father. my father worked behind a portable bar like that at banquets for decades. i know there were nights he probably didn't want to go to work. the new year's eves he wished he was with us instead of with them. the thursday nights that he stayed there till 2:00 a.m. my father worked behind a bar like that into his 70s. he was grateful for the job he had, but that's not what he wanted for us. why did he do it? was it just to pay the bills? no. my father stood behind a bar like that all those years so one day i could stand behind a podium like this in the front of the room. and the journey from behind that bar to the front of this room that journey, that's the essence of the american dream. that in this country people from

anywhere can accomplish anything they set their mind to. that makes us different. don't ever take that for granted. and those of us who have lived, that which is basically all of us, those of us who have seen that experience in our own lives, which is basically all of us, i think have a unique and special obligation not just to protect it but to expand it to reach more people than ever before. for even as i speak to you now there are people trying to make the same journey my parents made and the same journey your parents made. because this story's your story too. it's the story of your mother that worked odd jobs so that you didn't -- could be able to finish school. it's the story of your father that did everything he needed to do to make sure all the things he never could do in his life could you do in yours. that's not just my story. that's your story. that's the unifying principle of our nation. and the idea that we would ever lose that is unacceptable and unimaginable. and that's what we're on the verge of doing if we continue on the path we're on right now.

every nation in the world has rich people. what makes us different is that here we've had millions and millions of people that achieved happiness by working hard and persevering. and i just want that to reach more people than ever before. and that's the chance before us. that's the unique and exciting opportunity of this 21st century. and i thank god every day that i'm alive at this time right here right now. because i believe that we are on the verge of another american century where the american dream won't just survive, it will reach more people than it's ever reached before. that's the unique opportunity of our time, and i hope we'll seize it. but to do so we must turn the page. we must be proud of our history but excited about our future. we must understand that the 21st century is over and it is never coming back. and we must boldly move forward into a new century with extraordinary opportunities and real challenges. and if we do these things in essence, if we do what every generation before us did, which is to confront the challenges and seize the opportunities of

our time then you and i will leave for our children what every generation of americans before us has left for theirs. the single most exceptional nation that man has ever known. so thank you for the chance to talk to you about it today. thank you. [ applause ] >> i know the senator has a tight schedule but he's been gracious in staying a few minutes to answer any of the questions. i think we have some movable mikes. and if people do have a question, just identify yourself. especially if you're a resident of the state. i think he'd like to know that. and maybe i could just ask the first question, senator. president obama earlier this month submitted a war power resolution to the united states congress and senate and there

were some members of congress that feel as thoughs it limits him too much in the language, and there are others who feel that maybe he will use this to commit troops down the road. your thoughts on whether this is going to pass. are you going to support it? >> two separate things. one is to authorize the use of force and the other is the strategy for the use of force. they are two separate things. the strategy for use of force is something congress can exercise oversight. ultimately it's the primary responsibility of the commander in chief. authorizing the use of force is a congressional action. they should not be intermingled with one another. so let me give you an example. in the history of the united states on only two occasions have we authorized use of force with restrictions. and both were u.n. peacekeeping operations. and my problem is i believe the war authorization should be we authorize the president to destroy isis. period. and then it is up to this commander in chief and a future one, because this will probably

not be over in the next year and a half to do what must be done to defeat them. and we can debate the tactics and conduct oversight over the tactics. but here's the reverse of that. so you're going to do the authorization for use of force that says we authorize you to fight them for three years. so what does that mean? that means if isis is still around in three years they get to stay? or what if we authorize them but we're only going to authorize you to conduct operations in iraq and syria. well, you just told them to move to libya or some other place not covered by the authorization. so i think congress should authorize the use of force to militarily defeat isis and then i think the president should come up with a strategy that can achieve that. and i believe the perfect strategy for that or the best strategy for, that not perfect the ideal strategy is a combination of american air power and local ground forces. egyptian ground forces, jordanian ground forces. sunni iraqi ground forces turk ground forces, kurd armed forces, the armed forces of the gulf kingdoms. they can send a 100,000 man

contingent collected from those local countries to confront isis onts ground and we would provide intelligence logistical support and air cover for that operation. there maybe the need at some point for some special operations forces to improfit targeting but i think that's the first step and that is ideal in the first step in the process. the ideal tactic to move forward on this endeavor. and i think it's the right one. it's not just about not entangling america in the ground war. it's about the fact that i believe those local forces have the best chance of success without triggering all sorts of collateral action that we haven't anticipated. >> my name is bob dens and i live here in new hampshire. getting to a domestic problem now, i noticed in a news article not too long ago that you were looking for ways of helping low

income buy prescription, drugs that could go into hundreds of dollars a month. with that in mind, would you support u.s. negotiating for prescription drugs with pharmaceutical companies brand name prescription drugs, the same that most western -- the western world does, and to go further, would you legalize the safe importation of prescription drugs from select countries? >> well, a couple points. the first is obviously we're always open to importing drugs so far as we can keep in mind the safety of the supply chain for those drugs. so just last week the fda -- i think the name of the drug was welbutin that was manufactured by teva and others was withdrawn from the marketplace not just for being unsafe but being ineffective. so we're always concerned about the safety of our patients. and while the fda's regulatory framework is often frustrating and i think overly complicated other times it keeps us safe from medication that's ultimately could harm people. so it's not just the importation of the drugs. it's ensuring the chain of

custody from production to user has not been contaminated along the way. in fact, even in the united states there are many pharmaceuticals, prescription drugs that people buy on the black market. and when you test what's in those drugs it isn't what they say it is. it's all sorts of things that can be damaging. so that's important. as far as negotiating prices, we do that already. for example, in the state of florida the medicaid program does negotiate a form larry with drug companies, particularly to get the lowest prices and to buy in bulk. and that's always something that becomes promising. i think the biggest challenge because in the commercial plans and their ability to ensure the price. the cost of pharmaceuticals is significant because of the research and development that goes into these drugs and the limited patent time that they have to make their profit. so i invest a billion dollars to innovate some miracle cure i only have x number of years to make a profit off that investment. and we substanceidize the world. they basically charge american consumers more than they do everywhere on the planet because they can. and that's a real problem we continue to confront. once the drugs go generic depending on the drug obviously

the price stabilizes a little more. but some still remain very costly. but those are options we're open to but neither of them are silver bullets in terms of solving this problem. >> other questions? >> senator, lenny gwynn from putnam investments in boston. first of all it's a fantastic presentation and i'm very, very glad your folks decided to cross the caribbean. i wanted to bring up the idea that our ceo has proposed a couple of -- numerous times. and that is if we are concerned about the shrinking of the labor force and people not participating and we want to have people hired and we're concerned about stagnant wages why don't we consider some kind of refundable tax break to

companies that show from one year to the next that they've grown their fica payroll? because we know the only way you'd qualify for that would be by hiring americans or by giving raises. nobody intends it. but that tax effectively is a tax on hiring people and on giving them raises. isn't there a way we could rebate some of that to the firms that have create the jobs and have given raises? >> it's something i'd have to look at. i haven't seen the specific proposal. i'd hate to opine on something i haven't seen the details. i'll tell you about the proposal i discussed in my book. that's called the wage enhancement credit. we currently have something called the earned income tax credit. children and they have ton working. it's a program that that's helped a lot of people it does encourage work but it also has a lot of fraud. what i've argued is that we should replace p with something called the wage enhancement. the way wage enhancement would

work is it would be open to all workers including childless singles. secondly it would basically incentivize work by saying that -- here's the gist behind it. the argument is that i would rather you be working for $10 an hour and supplementing the difference than have you not working at all and collecting the equivalent of $6 an hour in government benefits or $5 an hour in government benefits. and there's two reasons behind it. one, it actually saves the taxpayer money. but the other is when you were out of work for a long period of time it makes it very difficult for you to re-enter the workplace. it stigmatizes you in the eyes of employers. it demoralizes you personally and makes it difficult to re-enter. that's one of the reasons you why see a historically and alarmingly high low level of labor participation today because we've had a large number of people not participating in the marketplace. so our notion is a lot of people won't take the work because they figure, well if i can get the equivalent of $6 an hour from the safety net program why would i go work for $8 or $9 an hour? and our armth is through the

wage enhancement i'd rather enhance your income through the replacement for the earned income tax credit with an additional $2 than i would have you sitting at home and not working. there is nothing -- there is no such thing as a dead end job. there are jobs that obviously are not where you want to wind up at the end of your life. but there's no such thing as dead end work. every single job you have has value and merit. you learn values, pick up skills, you pick up discipline, and you acquire experience that will be useful to you in the future. and that's important for us to encourage as many people as possible to enter the workforce. our labor participation rate is far too low and its long-term implications are going to be extremely damaging to our economy if we don't quickly reverse that. >> other questions in the back? >> thank you for being here with us today, senator. appreciate it very much. you referred to a clean aumf, authorization for the use of

military force. why would not congress declare war on islamic terrorism included but not limited to isis al qaeda, and others? and would that not resolve some of the problems that we have trying to put these terrorists on criminal trials in the u.s. and elsewhere? >> if you're involved in hostilities with them they're enemy combatants which allows to you detain them. we don't do that anymore with this president so we can't do that anymore. but we should be doing that. as far as the declaration of war is concerned we only declare war on nation states. isis wants to be considered a state but it is not a state. and i refuse to elevate them to that standing. what they are basically is an armed -- that has an armed insurgency slash terrorist group that has taken on elements of an army. but they are not a state nor should we elevate them to that. and that's what they want to be recognized as as caliphate. i think we can achieve the same goal without elevating them the way they want to be elevated.

part of their strategy to be elevated in the jihadist world is the preeminent jihadist group on the planet. that's why me spend so much money producing videos, so much money on this propaganda they put out, which is very well produced. professionally produced things you never saw from al qaeda. the message they're trying to send is we're the preeminent most successful and inevitable radical jihadist group on the planet and that attracts donors but that also attracts recruits. and they're desperate for us to elevate them beyond what they really are. they're a significant threat to the world and they need to be destroyed and we should be highlighting every time that they face setbacks. but i fear that declaring war on them by name would elevate them to a status they desperately want that they do not deserve. but at the end of the dpa an authorization to use force reaches the same basically legal parameters but without the symbolic victory that isis is trying to achieve. >> thank you senator. i'm donna sitek in salem here in new hampshire. thanks for sharing your personal story, which is so inspiring.

and your vision for the future of the country. the future of our country is in doubt if we continue not to fix the debt. you mentioned the debt. but could you tell me how you're going to get bipartisan support to deal with entitlement reform which democrats are trying to preserve and the desire of republicans not to raise taxes. how do we deal with this major threat to our country which is $18 trillion debt? >> so let me preface it by saying the debt going to have to be dealt with. the question is not if we're going to deal with the debt. the question is how we're going to deal with the debt. here are the choices. we can deal with the debt now, in a more orderly and constructive way, or we can wait until we have a debt crisis and have to do so in a extremely disruptive way. so the cause of our long-term debt if you project out is not foreign aid which is less than 1% of our budget. it's the way our entitlement

programs are structured. and on the outset let me say i support medicare. my mother's on medicare. my mother's on social security. i would never do anything to hurt her. when i talk about reforming these programs i'm not talking about for me. i accepted and my generation needs to accept that our social security and medicare is still going to be the best thing in the world but it's going to be different than our parents. those programs were designed at a time when there were 16 workers for every retiree and now we only have three workers for every retiree. the question is how are we going to get cooperation on it and that's a great question. the answer is we need executive leadership that pushes us in that direction. this president has never invested any political capital in reforming those programs. he's never been serious. in fact, on the contrary -- when paul ryan made his proposal to save medicare, the president's response was not with a plan of his own. the president's response was to raise a bunch of money to attack republicans for wanting to change and take medicare away from other people. this issue's going to have to be dealt with one way or the other and the longer we wait to deal with it the more disruptive that reform is going to be. if we deal with it now we can

actually reform it without impacting anyone who's retired or on the verge of retiring. if we wait too long it has the potential of impacting future retirees, and that's something that we should not allow to have happen. so the proposals are out there. paul ryan's proposal comes very close to being the actual solution we need for something like hedcare. social security proposals are out there as i've outlined in my book. the political willingness to do it is what's been lacking. all i can say is i've been talking about social security and medicare reform since i was a candidate for the u.s. senate from the state of florida, a state with a very large number of people on social security and medicare. and fudge succeed politically in florida talking about it i believe you can succeed anywhere in this country talking about it because the american people are ready for the truth they know what the truth is and they want answers to it. and it isn't this demagoguery. and i'm say one more point. anyone, anyone who says they want to leave medicare the way it is forever, is in favor of bankrupting is it. anyone who says we don't need to do anything about medicare is in favor of bankrupting this important program. because that's where it's

headed. not 50 years from now and a little over a decade and that's an unacceptable outcome. >> getting back to global economics -- thank you very much for coming and speaking with us. you mentioned a couple of things i think are particularly important. i'd like you to highlight or expound upon them. first of all, the u.s. tax code compared to the tax code of other nations, certainly we're in a competitive environment, but an example, corporate tax rate 37%. corporate tax rate in asia is typically around 17%. there's talk about as much as 3 trillion u.s. dollars that's captured outside the united states that doesn't come home because we have a punitive tax on bringing that money home. that money continues to get invested oversxaezeas and continues

to help economies such as india and china and so forth because it has no place to come to. what do you suggest we do about that and what would be your plan, please? >> on the corporate front let me point out initially that the vast majority of american business activity is happening in the s corp. in essence on the personal side of your taxes. that's why personal tax reform is important. there's a lot of business activity happening through the pass-throughs. the s corporations, partnerships limited partnerships, et cetera. on the corporate side that tax rate is too high. the effective 35% rate makes us base clip highest combined corporate tax rate in the world. i think it needs to be closer to something like 25%. and then you talk about the issue of repatriation and that's an important issue. i've proposed that we have a territorial system of taxation. and what that means is taxes -- you will only be taxed once wherever the income is generated. so if an american company is generating profit in france, it pays the french tax. it doesn't then bring that money back and pay it a second time in the united states. because the practical impact of it is the money staying over there. they've already paid the tax

once. they're not going to move it here and pay tax a second time. and let me tell you how significant that is. estimates are that upwards of $2 trillion of american corporate cash is sitting in overseas accounts as a result of this. $2 trillion is the size of the russian economy. $2 trillion is the size of the italian economy. so what we're talking about, if you had a territorial system of taxation-s a lot of that money maybe not all of it, but much of it would return to the u.s. to expand and hire and create opportunity here. and a territorial system of taxation, which most developed nations on earth have, would make us more competitive. this goes to a broader issue by the way. for too long the attitude of our policy leaders was it doesn't matter, we're america, we can charge you anything you want. you have to pay it because we're america and you have to be here. that isn't true anymore. there are now many businesses in the world that can be headquartered anywhere. they don't have to be headquartered here. they don't have to be physically located here. and the evidence of that are these inversions you see every day, where more and more american corporations are buying foreign companies and moving their headquarters abroad to

escape the tax penalties that they face in the united states. and that's the ones we know about. those are existing businesses. not to mention new ones that are being opened up in those places and staying here. all that tracks back to the update for making us globally competitive. and the truth is if you make us globally competitive it will actually generate more revenue for government. not through more taxes but more taxpayers. that money will be brought back to the u.s., invested in new stilts and expanding productivity and creating new hirings. and you're going to be creating new american taxpayers that allow us the revenue we need to bring our debt under control. >> maybe two more quick questions. >> and two more long answers i guess. >> you spoke very clearly about your ideas for higher education. i'm wondering how you would fund a retirement program that trained people more extensively at the lower levels. >> first of all, a lot of that funding's already in place in essence. it's just not available today

for people to use. much of this is the state responsibility that we need to encourage more. in essence that -- for example, i'm not suggesting the u.s. government take over the high schools of this country. or anything like it. i do think that there's -- that the high schools for anything like it. we need our senior leader in washington to take over the apprenticeship programs at the local level. many programs are moving that watch the role the beg place higher education is the largest bayer. give you an example now. i decided to take a course in microsoft outlook from microsoft, could i not use federal financial aid for it if i decide to take that same course from an accredited school, it would pay for it. that makes no sense. my argument you can only use financial aid for accredited indianapolis tuesdays but they are accredited by the boards of the schools they are acrediting. not saying that the standards respect good. they are. that can't be the only system we have. i'm arguing we need an

alternative accredited system to backable learning from sources in the equivalent of a degree. those exist with things like u dashity and other programs that allow to you come forward with your bore the goal yo of learning, serve four years in the military worth ten credit hours. i have worked ten years at a law firm, worth 15 credit hours, ensure you bicced up some knowledge during that period of time but give you credit for all of your learning. and then if you're missing, if you're defish shelton in one place or another you know the courses you need to take, but the problem we have now is no matter what you already know you have got to sit through in most places 120 credit hours of classroom instruction. that sin credibly expensive. i propose an alternative accrediting process. mike lee has a proposal that does that as well in a different way. we having conversations about alternative ways to credential people as quickly and cost ebecktively as possible.

-- >> stop at repealing. you had mentioned replacing. could you take a moment and expand on that? >> sure. let me start out by saying i think the ultimate and pest solution for health insurance in america is to allow every american to control their own health care spending. if you think about it most americans are insured pie their employer and your everybody boy will beer tells you this is what your insurance plan is and i the only choice you get is your primary care physician out of a book. i'm arguing we should allow individuals to control their health care dollars so you can accept your enboy will beer plan or in lieu of accepting your plan, you can take that money into a health savings account or some protected account where that money, pretax is now available to you to spend on your own behalf. you can make choices what to do first, put in a health savings account and out of pocket for

primary care and perhaps buy catastrophic coverage that makes sense for my 28-year-old brother-in-law, healthy and single and thinks he is before in gonna die and doesn't go the doctor. if he ever does, god forbid, might be something bad. use that money say $600 a month to fund a catastrophic plan for $2 or $300 a month and put the rest away in a health savings account he can use every year to pay out of pocket for the minute clinic or whatever needs he by the have that year. alternatively, maybe myself, a father of four and family of six needs more comprehensive coverage. i now, instead of taking the employer plan take health care money, from them my own savings, pretax money and use it to buy any health care plan in america that makes sense for me from any company in america that will sell it to me, no matter what state they are located in. i should choose what health insurance i want maybe a high co-payment and high deductible but low premiums, maybe lower premiums, maybe choose this one because it has a better network than that one does.

once you empower the consumer to control the health care dollars the private market will respond pie creating products the consumers want and compete against each other for your business because you control the health care dollars, not your employer and not the government that competition will drive quality and bikes were and make it affordable for more people. what doesn't work is putting you the government in charge of insurance through the exchanges. the idea of an exchange is not a bad idea go to a place where you can shop among different companies is not bad. ma's barked injecting it with mandates and subsidies, that's what skews the market place. many of the ex-changes are nothing more than a high-risk pool, people signed up for it are disproportionately sicker and older than but what need for an actuarial sound pool -- a pool more sound insurance-wised the result is in order to save money and make it affordable, these plan also to do things like raise deductibles, raise co-payments and deny access to networks and prosliders.

it is not unusual to get a phone call at our office from someone on an obamacare plan figured out they had a $3,000 deductible, thought they were covered, went to the hospital getting a bill. why did i get a bill? i don't have $3,000. you are not insured and a tough time finding a specialty doctor people calling and saying i can't find an oncologist or a gain neck comelogical encome gist in my coverage area 200 miles away, 100 miles awake the only way these companies can chrome brycing is by limiting the networks, crushing down on reimbursements for the providers, less providers are willing to take it increasing skin in the game in terms of co-payments and deductibles, some people make them uninsured, they can't afford it i have opinion working on ball ryan with outlining up and hope we will wind up as a country. >> this week, homeland security agency is going to run out of

money. >> on friday. >> what are you going to urge your colleagues in the senate to do and how are you going to vote? >> homeland security will continue to function. point out that border patrol agents and it. saing as and others will not get paid, which will not make flying a pleasant experience, if you know what i mean. obviously, bayed once it's reopened retroactively, it will function. the bigger problem we have is the democrats are filibustering the house bill. the house has passed a bill, they don't like something in the bill. they refuse to let us begin debate on it. my first initial ask is let's start debating this bill stop your filibuster let's get amount bill and have a debate. i believe we should stop the executive action. i believe we should stop the executive action for three reasons. number one 'cause it's unconstitutional. the president himself said 22 different times that he did not have the authority for this action. as far as i can tell constitution has not about amended in the last two years i don't know how suddenly he

acquired the power to do this. second is i think it has unintended consequences no one's thought through in terms of triggering another migratory crisis or even tax credit that it makes millions of people eligible for we haven't budgeted for. that comes out of the u.s. treasury. third, i think it makes it even more difficult to achieve the immigration reform our country needs. i think the real solution to immigration is a series of pieces of legislation, not executive actions that deal with this issue. in my mind, that begins with proving to people that we are going to enforce our immigration laws, people do not -- the hardest lesson of the last two years has been people are willing to be very reasonable about immigration but not until you proved to them that future illegal immigration will be controlled. they don't want to see 10 million people replaced with 10 million more ten years from now. second, we have to modernize our legal immigration system. no nation on earth is as generous on immigration as we are. 1 million people a year permanently emgreat to the united states. no other country even comes close. but it is done through a system that is primarily based on

family, whether you have a family member living here not whether you have a special skill or talent or economic contribution to make. and i think we need to refarm our legal immigration system more towards a merit-based system. after you have done those two things, after you have reformed and modernized our legal immigration system and proven to people that you are enforcing the immigration laws, i believe the american people are willing to be very reasonable about how we deal with someone who has been here for 15 years has not otherwise violated our laws and wants to be an american. i really do i think people will be very reasonable about it that is a problem we inherited, created as a result of decisions made when i was in high school. we should make sure it never happens again you deal with the fact we have it now. but people are not prepared to do anything about it until first they can -- proven to them that we are not gonna have another migratory crisis that puts us in the exact same place five to ten years from now. if we do that i think we can do a lot. >> thank you for coming by.

[ applause ] again, want to thank the senator for finding time out of his very, very, very, very busy schedule, stop by the politics and eggs. we have a feeling that after his remarks today we might see more of him here in the graham knit state but when he does make an announcement, we hope he makes it at st. a's here at politics and eggs. with that, we look forward to seeing you at our future politics and eggs convenient. thank all of the sponsors in particular, kendra morgan and bank of america who have just joined our list and we thank them. so, have a great day and stay warm. [ applause ]

coming up on c-span3 the director of the national institutes of health testifying before congress about how the nih spends its money. then a senate banking committee hearing looking at whether beenal regulations should be eased for smaller banks. and later, a conversation on violent extremists traveling from europe to syria to join isis. you would see what used to call when i was a kid, a mutt and xbref combination or a stick paul set. washington is -- was a large

man. six foot, very robust. terrific natural athlete and madison is a skinny little guy. >> this sunday on q & a, historian david o. stewart on founding father james madson and the partnerships he made that aided in the success of our pledge ling nation. >> his i write most about is his ability to form remarkable partnerships with really the great people of his era but also alludes to his gift to the country of his talents and what he was able to do to create the first self-establishing constitutional republic. >> sunday night at 8 eastern and pacific on c-span's q & a. le director of the bags inial institutes of health as well as the heads of the nih agencies for infectious diseases,mental health, drug abuse and the heart, lung and blood institute

testify before congress this week. they anticipated questions about ebola, the flu vaccine hiv addiction treatment and other medical issues. this house appropriations subcommittee hearing is two hours. >> good morning, we are discussing the fiscal year 2016 national institutes of health budget request. looking forward to hearing the testimony of dr. collins and some of his distinguished colleagues. i would like to publicly thank dr. collins and the staff at nih for hosting me and five other

subcommittee members for a briefing and tour of the nih campus a few weeks ago. i think it's safe to say we all left the nih with a deeper appreciation of the exciting work your staff do every day to find ways to save lives. the scope of biomedical research supported through and at the nih is wide and we are confident that thanks to the talented staff and scientists that work there, we will one day find cures for diseases like cancer and alzheimer's. ensuring a sufficient basic biomedical research base and supporting the next generation of researchers is critical to baf the way for these long-term advancements. your budget assumes many areas of enhanced spending on genomic activity, including a focus on ebola, universal flu vaccine, antibiotic resistance and alzheimer's research, to list only a few. of course we all support biomedical research. unfortunately right now, sequester is the law of the land and given the reality of funding

allocation, we might not be able to do everything that the administration is proposing, absent a larger, bipartisan budget agreement, one, quite blankly, i hope we achieve. i look forward to having a discussion with you this morning on your top priority for this year given our funding constraints. i would also be remiss if i did not point out how important it is to ensure that we continue to focus on the next generation of investigators. we know how long it takes for a new drug or treatment to make it from lab to the patient. so, without a pipeline of young researchers committed to following the scientific process of investigation and experimentation, we won't be able to find the cures we seek. today, we welcome dr. francis collin was the nih director to the subcommittee. dr. collins is accompanied by five of his distinguished institute directors who can assist in anticipating specific member questions. they are dr. on on thisny fall chill, the director of national institute of allergy and inbeck,

diseases, dr. thomas enle, the director of the national institute of mental health dr. john lorsh, the director of the national institute of general medical sciences dr. nora volko, the director of the national institute on drug abuse and dr. gary gibbons, the director of the national heart lung and blood institute. as a reminder to the subcommittee and our witnesses, we will abide by the five-minute rule and before we begin, i'd like to yield the floor to my chairman, the gentleman from kentucky. after that, we will above to our ranking members, the gentle lady from connecticut and then to the gentle lady from new york our ranking member on the subcommittee -- excuse me on the full committee. so, with that mr. chairman, you're reck fwhized. >> mr. chairman thank you very much. congratulations on being the new chairman of this great subcommittee and the responsibilities that you gladly have taken on. welcome to all of you, thank you for being here. dr. collin was, your leadership

role in the ground breaking international human genome project is just one example of your many talents. i'm told that another one of your talents is playing guitar apparently. apparently, very well. so, you know, you've got something to fall back on in case this don't work out. [ laughter ] unquestionably, you all are at the helm of research at nih during a time that demands our country's interest and investment in medical research. the recent ebola epidemic in west africa highlights the importance of nih's mission to gain and apply knowledge to enhance health lengthen life and reduce illness and disability. medical research is one of the most important parts of

preventing future enpidemics i and developing cures for diseases that are not preventable. the nih fiscal '16 budget request highlights priorities such as ebola, alzheimer's disease and anti-microbial resistance n addition to the public health benefits that accompany nih work, the economic impact of medical research should not be underestimated. nih research dollars not only impact research and facilities and researchers, but they also help get new drugs and devices to the marketplace. and i'm pleased that you've seen fit to invite dr. nora volkow to join us this morning. as the director of the national institute of drug abuse the doctor has been a true pioneer in the science of drug abuse and addiction. she was one of the first people

in history to use brain imaging to investigate the effects and addictive properties of abusable drugs and her research has undoubtedly made the world that we live in a much better place. she has opinion with us since day one since we have battled drug abuse in my area in southern and eastern ken keep. hard hit especially by early on by oxycontin and others. and i'm looking forward to seeing both of you, in fact, at the atlanta summit on prescription drug abuse this summer. and i thank you for coming last year and helping us battle this prescription drug abuse scourge that's killing more americans than car wrecks. and we appreciate your dedication to that's specially. we look forward to hearing also from you today about the two critical drug-related issues.

first, i'm pleased that nida under dr. volkow is pursuing an adolescent brain cognitive study, abcd to collect rigorous longitudinal data on the effects of marijuana, alcohol nicotine and other drugs on a young person's brain. it's up fathomable to me that states continue to pursue policies to decriminalize or legalize marijuana, in contravention of federal law, i might add. even here in the nation's capital. it's eye ronnic that in washington, d.c., the nation's capital capital, you can't smoke is cigarettes, but you can smoke pot. explain that to me. help me out. we don't have scientific data to tell us about the long-term

impacts of marijuana use on the brain, but hopefully this will open a lot of minds. this study will help close that gap, hopefully bring some much-needed sense to the conversation about marijuana use in this country. secondly, dr. volkow, i'm interested to hear about recent efforts regarding the apuss of prescription medications. as you well know, that's been characterized by your colleagues at cdc as a national epidemic. i understand that you're partnering with nine major pharmaceutical companies to evaluate the risks associated with long-term use of opioids for the management of chronic pain. if there are non-on yoid alternatives to the treatment of pain we need to know about them. and doctors need to be educated about them.

i'm also hoping that you can provide us with union updated out science of abuse deterrent rent medications. oxycontin, the dr.ing you that caused so much difficulty and still is but mostly back in the, five, six years ago, the pill -- the drug was changed to make the drug abuse deterrent, you can't crush it, you can't snort it, you can't inject it. it's a -- still retains though the good qualities of relieving pain over an extended period. that's what can be done to stem the use of opioids. and i commend you for it. in addition to our long-standing struggles with drug addiction and abuse, the research provided by nih is critical to understanding, preinvestment and developing cures for ailments

like die pete tease cancer and heart disease that continue to plague my region especially. we are very proud of the partnerships we have established with nih in kentucky. for example, the marquee cancer center national cancer institute designated cancer center at the university of kentucky and the uk center for clinical and translational science, which previously received your prest team joyce clinical and translational science award for its work to confront chronic health issues in keep keep and rural populations, especially in the appalachian region. currently, 22 of the world's 50 top-ranked universities for life sciences are in the u.s. and we must continue to foster the next generation of scientists. we look forward to continuing these important collaborative efforts as we work together to bring an toned these devastating

diseases. we thank you for being here and with your colleagues, dr. collin was, we expect to hear some good stuff. i yield. >> thank you mr. chairman. next, we will go to ranking member distinguished gentle lady from connecticut and frankly, a tireless champion of this particular agency..for many, many years. >> thank you very much mr. chairman, and good morning to everyone. it is a little earlier than we usually start these hearings but it's such an important topic that it was important to all of us to have the opportunity for the full two hours with the distinguished panel. i'm so thrilled to welcome you, dr. collins, the director of the nih, dr. fauci, dr. volkow, lorsh, begins to discuss the 2016 budget for nih. first and foremost, let me just say thank you for your work. every scientific discovery every medical breakthrough, the

research you support advances human knowledge and improves the quality of our lives and most of all, it saves lives. as an almost 30-year survive other of ovarian cancer, i am alive today because of the grace of god and biomedical research. when i was elected to the congress, i made supporting that research one of my top priorities. as well as improving health research also drives our economy, as the chairman said. every dollar invested in nih repays more than double that in local economic growth. nih is the cornerstone of our life sciences industry which employs more than 7 million americans, adds almost $70 billion to our gdp. so there is no reason not to fund nih as fully as possible. in january of this year, along with the chairman, i had the pleasure of touring the nih and along with other members of the subcommittee, it was, as always a fascinating visit. while there, we met with a

senior investigator, dr. nancy sullivan, who is largely responsible for one of the ebola vaccine candidates that's currently being tested in the clinical trial. that clinical trial is only possible because thanks to nih support, dr. sullivan and her colleagues have been able to pursue a vaccine over many, many years. since 1997 in fact. research can take a long time to bear fruit and if we do not invest now we will not be able to benefit from scientific discoveries five, ten, even 20 years from now. so, it is troubling to me deeply troubling to me, to note that since 'tis cal year 2010 after adjusting for inflation, nih has seen its budget erode by about $3.6 billion. that's an 11% cut. sequestration is terrible policy for any budget it is especially cruel where there are literally

lives at stake. in 2013 alone sequestration took more than $1.5 billion from the nih. even after modest increases over the past two years we still have not returned nih's budget to its presequestration level. a decade ago, nih was able to fund almost one out of every three applications for research grants. amid sequestration, that success rate has fallen to one in six. in 2015, nih will fund almost 1,000 fewer research projects than it did in 2010. we will never know how many scientific discoveries and medical break throughs the world may have missed out on because of these budget restraints. that is the disturbing context in which we consider the mih budget request for fiscal year 2016. overall, this request starts to set us back on the right track there are some exciting initiatives in this budget. the precision medicine initiative will help doctors

provide treatment finally tailored to the individual characteristic of each patient the combatting antibiotic resistant bacteria infwhishtive focuses on defending against deadly superbugs. the brain initiative holds the potential to revolutionize neuroscience and to make advances to treat alzheimer's, autism and many other brain disorder disorders. the budget includes funding for research to develop a universal flu vaccine and potentially, a cure for hiv/aids. it also supports basic science research that has long-term benefits across multiple fields. as i have said, i believe this is the right track, but give the severe neglect of nih the past years, i'm disappointed that we are not restoring funding more quickly. this request restores less that one-third of the cuts since business it cal year 2010. introduced a bill in the last congress and again in this congress that would fwhabl our committee to increase nih

funding by 10% this year and 50% over five years by providing a cap adjustment. that would ensure proper funding for research without robbing other vital programs to do so. we have invested strongly in nih before. in the 1990s, i was among a bipartisan group of members of both chambers on this committee who fought to double nih's budget over five years. to this day, it stands among my most proud achievements. instead of starving the nih of funds, we should be seeking to repeat that achievement and double its pummet again. but this investment cannot happen unless and until we undo that failed policy of sequestration summon the courage to ask those who can the wealthiest who have done so well in recent years to contribute more to support our national priority. biomedical research gives us the gift of life. it has done so for me and for

countless others. that is what the nih represents. we can and we must find the resources to support it and i thank you. i thank you, mr. chairman. >> thank you. next go to my good friend, distinguished gentle lady from new york for her opening statement. >> well, thank you, mr. chairman. it is a pleasure for me to be here today. and i'd really like to thank chairman cole and ranking member delauro for holding this hearing today. it is such an honor for me to have such a dissting bished group of public servants doctors comes, fauci, insell, lorsch, volkow and begin. i appreciate you being with us today and i thank you for the life-saving work that you do every day. throughout by time in congress, federal funding for the national institutes of health has been

among my very top priorities. the nih is the world's brie mere research institute. its researchers have mapped the human genome and i do remember, dr. collins, that empty shape that you had filled up, it's really amazing. you have created vaccines that are being tested to prevent the spread of ebola, developed advances in cardiovascular disease that have reduced death rates by more than 60% over the last half century and invested in hiv therapies that turn what used to be death sentences into longer, more productive lives. as a result, it is no surprise but it continues to amaze me that nih-support scientists have been awarded no less than $145 nobel prizes. not only does nih's work improve the quality of life for millions of americans, it is also a

spring board for economic growth generating 2.21 in economic activity for every dollar invested. and i remind my friends and neighbors all the time that not only are you moving ahead in saving lives but you are creating jobs. your 2016 budget request proposes an increase of $1 billion, resulting in 1,200 additional competitive research grants. it would make welcomed investments in advanced cancer treatments, with a new precision medicine initiative increase funding as my colleague, ms. delauro said for the brain initiative to r workings of the brain, develop treatments to combat alzheimer's disease, autism and other neurological and psychiatric conditions.

these are the very definitions of worthy federal investments. the president has also called for the end of the mindless austerity of sequestration. in fact, i've even heard some of my colleagues on the other side of the aisle refer to the mindless austerity of sequestration, urging congress to replace it with more targeted spending cuts program integritity measures closure of some outdated tax loopholes. i could not agree with them more. the effects of sequestration are immense and are still being felt. in 2013 alone, sequestration reduced the nih investments by more than $1.5 approximately in fy 2015 funding is still below the presequester level.

miami critically important research initiatives were abruptly halted. it really was a worse-case scenario for many agencies and we have to make sure it does not happen again. the united states must keep pace with the rest of the world. while mih funding is $3.6 billion or 11% below the fy 2010 level when adjusted for inflation, others are making substantial increases. between 2007, 2012, chain what ina increased their biomedical research spending by $9 billion. increased. while others are advancing, our investments in biomedical research are just not keeping up. as we begin the annual process of crafting a budget resolution, i know there will be many viewpoints, many of my colleagues may undoubtedly press for additional cuts and to leave

the outdated sequester level caps in place. you i think we all know how dangerous that is. discretionary funding, which includes biomedical research education, job training, transportation infrastructure and clean energy development is falling to its lowest level as a percentage of gdp since the eisenhower administration. we must act to ensure reasonable allocations for the important program and investments funded through the appropriations process, especially the national institutes of health and those under the jurisdiction of this subcommittee. i look forward to your testimony. thank you again for being here before us and i look forward to the nih's mapplans for the coming year. >> thank the gentle lady and dr. collin was whatever -- your

full statement will be entered into the record and recognized for whatever opening comments you care to make. >> thank you and good morning, chairman cole ranking member delauro, distinguished members of this subcommittee. it is an honor to appear before you today, as this panel has a long history of supporting nih's mission to seek fundamental knowledge and apply it in ways that enhance human health, lengthen life and reduce illness and disability. breakthroughs generated by nih-supported research are behind many of the gains you see here that our country has enjoyed in health and longevity. abortion, over the last 60 years, deaths from cardiovascular disease have fallen pie more than 70%. meanwhile, cancer death rates have been dropping about 1% each year for the last 20 years. and likewise, hiv/aids treatments have greatly extended lives and prevention strategies are enabling us to envision the first aids-free generation. the future of biomedical

research has never been brighter. allow me to tell you about just a few of the many exciting opportune that's nih is pursuing today. let's start with vaccines. thanks to nih research two different vaccines against the deadly ebola virus are being tested right now in lie peer ya. vaccine research is also making exciting progress against a virus that nearly all of us have tangled with influenza. currently, a new flu vaccine has to be produced every year based on our best guess of how the virus will evolve, but that approach suspect ideal as we have learned this past season. so nih-funded researchers are working to design a universal vaccine that will protect against virtually all flu strains. such a vaccine could eliminate the need for annual flu shots and reduce the risk of a global pandemic. so, i'm excited to tell that you universal flu vaccine candidates have now moved into early stage human clinical trials. nih also remains strongly

committed to supporting basic science, fundamental research that serves as the foundation for discoveries that have long made america the world leader in bioed me sin. one exciting example is the brain initiative. this bold, multiagency effort is enabling development of innovative technologies, you see one here to produce a clearer and more dynamic picture of how individual brain cells and neural circuits interact in time and in space. this initiative will give us the tools for major advances in brain diseases from alzheimer's and autism to schizophrenia and tram what theic brain injury. scientific vanses are also accelerating progress toward a new era of precision medicine. historically doctors have been forced to base their recommendations for treatment on the expected response of the average patient. but recent advances, including the plummeting costs of dna sequencing, now make possible a more precise approach to disease management and prevention that

takes into account individual differences in genes environment and lifestyle. with this in mind, we are thrilled that nih to take a lead role in the multiagency precision medicine initiative. in the near-term, this initiative will focus on cancer to accelerate efforts, this project will support research aimed at understanding why cancers develop drug resist taps using non-invasive methods to track therapeutic responses and exploring new treatments targeted to the genetic profiles of a wide range of adult and pediatric cancers. as a longer term goal of this initiative, nih will launch a national research cohort of 1 million or more volunteers who will play a active role in how their genetic and environmental information is used to prevent and manage a road array of diseases. a project of this magnitude will lay the ground work for new prevention strategies and novemberle therapeutics, no better time than now to embark on this enterprise to

revolutionize medicine and move this precise personal approach into every day clinical practice. in closing let me share a story that highlights the early promise of precision medicine. when mki -- maki was diagnosed with same 3 b carcinoma in 2008, it was unexpected 36 years old, never smoked a day in her life. her tumor was very large, as you see here, 7 centimeters, with a very low likelihood of survival beyond a year or two. as maki began standard chemotherapy, doctors suspected she might have a gene called egfr. genetic testing confirmed their hunch and maki was prescribed tarcepa, a drug that precisely blocks egfr's signal. after three months of treatment, maki's large tumor shrink

dramatically. this was followed pie surgery to remove caps rouse tissue plus retreatment with tarceba. today, seven years after her diagnosis, her doctors can detect no since of cancer. what's more, during the extra time provided by this approach, maki completed a triathlon, landed her dream job as a biology professor at ithaca college, and welcomed a healthy baby girl. clearly, we need many more stories like maki's. that is our dream, and i'm sure it's yours, too. with your support, we can realize our vision of invigorating discovery from basic scientific inquiry to more precise personalized approaches to treatments and cures. so, thank you, mr. chairman. my colleagues and i now welcome your questions. >> thank you very much, dr. collins. and just for the members of the committee, we're going to go first to our chairman and our ranking member and then we'll go through our normal order in terms of questions.

so, mr. chairman, you're recognized for whatever questions you care to pose. >> thank you, mr. chairman. dr. collins, dr. volkow, thank you both for your special interest in prescription drug abuse. as you know, every day, about 105 americans die from overdose, mostly prescription medicine. sadly, as we've taken strides to address that challenge, we've also seen a rise in heroin use, and as a consequence, people who are addicted to painkillers graduate to those drugs who are cheaper. i have long advocated for a multi-pronged approach to addressing this unique challenge, and, of course,

research is one of the main prongs of that approach. i'm particularly interested in the development of new technologies that will make these drugs more difficult to abuse. and we've seen some real progress in that field. effective abuse deterrent technologies that will ensure that patients truly in need of these therapies can receive treatment while also ensuring that these very powerful, addictive medications can't be tampered with or abused. let me ask you, what investments has nih or nida made to advance the science of abuse-deterrent technologies, and can you comment on the fruits of those labors? dr. collins? >> well, mr. chairman, thank you for your question and your leadership in this area, which is really quite remarkable the way you have shone a bright light on the importance of our addressing this, brought experts

together as you've done each year and will do again in april. i'm going to ask dr. volkow, who is an internationally recognized expert in this area, to address your question. nora? >> dr. collins, thank you very much. mr. chairman, thanks very much for asking the question and for your interest in the matter. and as you describe it, we do use some multi-pronged approach also in science to address the issue of the prescription abuse problem. one of them is to effectively develop medications that if they are opiate based, they have different formulations so they cannot be diverted and abused in ways that they can produce addiction and harm. many strategies have been developed, and some relate to drugs, and many relate to inserting the drug into a polymer so it cannot be diverted.

in this effort, we partner with seltica, so it's a public/private partnership to ensure the product will get onto the market, and here, innovation has very different ways of solving the problem. that's one. the other one is the development of medications and strategies to prevent deaths from overdoses because they are antidotes. in fact, naloxin is very, very effective in preventing overdoses, and we have again partnered with seltica because we have been able to provide naloxin effectively and anyone can take them. another one is treat anyone who becomes addicted to opiate medications because the proper treatment can prevent the overdoses. in parallel, we are also working on implementation research to

ensure that people will, and practitioners, will provide better screening and treatment of patients with pain, minimizing risks as well as substance abuse disorders. >> nida is working to make a abuse deterrent cominatoin of abuse deterrent comination of oxycontin using pro-drug technology. what is that? >> you administer an application that is not active until it gets a second application. it is a product that will not become active until it gets into the gastrointestinal system, and the enzyme drips in, then activates it. the advantage, therefore, is someone, if they want to inject

the drug, which is the way that these drugs are abused, they will not be any pharmacological effects because it will be an inactive drug. it requires the enzyme in the gastrointestinal tract to activate it. >> what do you think of that? >> i think very promising. there is already evidence in the past for drug stimulant medications that have shown they are much less likely to provide addiction. >> we have taken an interest in that particular approach and have worked closely with the company to make sure nih in a public/private partnership can fulfill that role, we hope, to fda approval. >> if this should be successful, is this -- this is a major breakthrough, is it not? >> it would be a very important breakthrough, and we hope that we will be hearing soon.

i mean, we're expecting hopefully some results in the very near future. >> about when? confidentiality agreement, so i cannot give details, but let's say that we hope we will be hearing soon. >> well, it's an exciting thing. oxycontin, like many of the other opioids are wonderful drugs for terminally ill cancer patients and the like, 12-hour release relief. but if it can be crushed and injected, all of a sudden, you get a 12-hour release in a split second. and, thus, the addictive power of this drug. so if you can find a way that we can use its great qualities while preventing it from being abused, that would be an extremely well-liked, lifesaving development.

105 people a day dying from drug overdose. how can we incentivize the private companies to invest in the development of these technologies? how can we make it so there's something in it for them? >> well, to start with, and again, it's an example of how science and policy need to work together. as these products are developed, there is research invested and dollars invested into it, so we want to ensure that once these products are developed, they will -- physicians will be able to prescribe it and the companies will pay for those prescriptions. so i think ensuring that the innovation, the resource in safer medications, that may be slightly more expensive, is supported by the resources that will make it possible for patients to get access to these medications. >> well, i thank you for your work and your dedication. thank you, mr. chairman. >> thank you, mr. chairman. the gentlelady from new york is

recognized for whatever questions she cares to pose. >> thank you. dr. collins, the example you gave us of this woman with a growth on the lung is really extraordinary, and what i thought of immediately is every person who goes to their doctor with a -- what i've heard in two cases, inoperable tumors in their lung, do they all get that test? >> that's a great question. and, in fact, one of the things we hope to achieve with the first stages of this precision medicine initiative is to make that kind of experience much more available. increasingly, individuals who develop cancer are having some kind of analysis done of the tumor to see what's driving it, 'cause we are developing a long list of reasons why good cells go bad and start growing when

they shouldn't, and the ability to be able, in the individual, to determine what's going on in that person and then connect that up with the appropriate choice of drugs, this targeted therapy approach is extremely exciting. in fact, the national cancer institute has, for lung cancer, started such a protocol called lung map, which aims to do that, in that case, for squamous cell lung cancer, and another for pediatric cancers and for adult cancers called match. but so far, the development of these approaches and the implementation across all of health care is not there yet, in part, because we don't know quite enough to know what is their best strategy. that precision medicine initiative, by expanding that effort in a very significant way, should make this kind of opportunity available to many more people with cancer. it should also teach us things about why it doesn't work when you think it should. i gave you a beautiful example of a remarkable cure, but we

don't always see that. and we don't know why when it doesn't work, something is responsible, or why, when it seems to have produced a remission and then the disease comes roaring back a year later, what's that about? if we could understand the causes of relapse, that would help us. and another thing which precision medicine initiative will focus on is the opportunity to find out, could we combine more than one targeted therapy or perhaps combine a drug therapy with immunotherapy, which is extremely exciting right now, and have a higher likelihood, not just of remission but of cure. all of those are ripe for investigation. this initiative aims to really turn up the heat in getting those kinds of answers. >> but it's still not widespread, is what you're saying. i just recently have two friends who had inoperable lung cancer. and i just wondered if those tests were available to them. but you're saying it's not that widespread. >> increasingly, they are, but i would certainly say to anybody

who develops cancer at this point who is interested, go to clinicaltrials.gov, find out what trials are currently being conducted all over the country, many of them supported by nih. find out if you qualify for one of these studies that would qualify with this dna analysis of the tumor and try to match that up with one of the therapies. >> i am particularly interested in how precision medicine, due to this initiative, could bolster treatments for breast cancer. we already know that white women are slightly more likely to develop breast cancer than african-american women, but the women under the age of 45, breast cancer is more common in african-american women than white women overall. these factors likely evident in our genetic code are why advances in precision medicine are so very vital. and i know there are many studies because i was part of initiating them years ago with

senator al damato on environmental factors. that never led to very much, frankly. so if you could share with us what breakthroughs for breast cancer have we seen as a result of nih-funded research and how will the precision medicine initiative improve the chances of finding a cure once and for all? >> thanks for the question. breast cancer, obviously, is an area of major priority for the national cancer institute. the ability to be able to look at thousands of breast cancers and see exactly what is happening at the molecular level has taught us that this is not just one disease. this is many different diseases with different kinds of molecular pathways activated, comparing one person to the other. and those have already led us to new insights about kinds of therapies that we didn't know about. obviously the discovery of genes brca 1 and brca 2 that play a role in hereditary

susceptibility plays a role in that, but we have a longer list of hereditary factors than i would have thought 20 years ago. what we need is ways of prevention. this is why i think the precision medicine initiative has a lot to offer. if, as we are claiming we can do, starting next year, we could put together a cohort of a million or more individuals who are participants in a study that collects all of the data you could imagine about their medical experiences, about their dna, about their environmental exposures, we might have sufficient power to really be able to get our hands on information that's been rather illusive about exactly what is the interaction between genes and environment that results in this disease or does not. electronic health records now becoming the norm in many people's medical records is going to help that hugely. that's why this is the right time to initiate a program of this sort. we couldn't have probably done it 10 years ago, but now we can.

between electronic health records, environmental sensors, dna analysis at an increasingly affordable cost and the willingness of the public and the enthusiasm of the public to be part of a national effort of this sort, we could do something really groundbreaking and historic. and that's what this initiative aims to do, for breast cancer and many other diseases as well. >> well, i see the red light is on, mr. chairman, but i just have to tell you, this is why our investments in the nih are so critical. i find the information we gather here so very exciting, and i'm ready to double it again, as john porter did. we could be groundbreaking here, mr. chairman. thank you. >> i'm very tough on the clock, except to my chairman and my ranking member of the full committee, so you take the time you need. let me quickly, if i may, ask one question for myself, dr. collins. one of the areas i know concerns you, and certainly concerns me,

is simply the pipeline of talented young scientists and researchers. i recognize, and i think my colleagues have pointed out, when we are not as generous as we would all like to be in terms of our appropriations in this particular institute, you have fewer grants to award to younger researchers, and our success rate of applicants goes down. i was really made aware of this recently by a good friend of mine, dr. scorton, who is the president of cornell, but the incoming president of the smithsonian. i asked him why he left a good job, a capstone job like cornell and he said exactly this. i've got some brilliantly talented young people, and obviously they enjoy teaching, but they want to research. they want to get things done, and we're not giving them the opportunities that they need to have, and that's going to cost us down the road. so i'd like to know, number one, your assessment, but number two, what are the things that we

ought to do, what are the things you're doing now to make sure that we engage the next generation of scientists that will hopefully match the accomplishments of this distinguished panel in their respective areas? the question. this is the issue that wakes me up at night when i try to contemplate the future of where biomedical research can go in the united states. we have such amazing scientific opportunities, some of which we will be able to discuss in this hearing. however, our most critical resource is not pieces of equipment or buildings, it's the people. and particularly, this next generation of researchers. they are full of ideas and vision, and yet they are finding themselves facing a situation that is the least supportive for that vision in 50 years. and they look ahead of them and see the more senior scientists struggling to keep their labs going and having rejection after rejection of grants that previously would have been supported, and they wonder, do we really want to sign up for that?

and many of them, regrettably, are making the decision to walk away and to do something else. meanwhile, the rest of the world, as already been mentioned, is picking up steam, trying to be what america was 20 years ago, even as it seems we have lost some of our momentum and that's going to have significant trickle effects downstream. so what are we doing? again, there is no real magic here to solving what is a very difficult equation of supply and demand, where the demand for resources to do research is not currently being matched by the supply. but we are trying to adjust many of the things we can adjust, and i've had many interesting conversations with people on this subcommittee about this. one thing we're doing is to try to be sure that that first application from a new investigator gets a special effort to get funded beyond what would happen if they simply competed with people of like -- larger experience. so new investigators,

early-stage investigators compete against each other, not against the experienced ones. that gives them a bump in terms of their likelihood of getting funded. and many of the institutes actually on top of that give them an additional bump in terms of the likelihood of making the cut. that has helped to some degree. but, of course, we don't want to set people up for that first award to be successful and then when they come back for renewal or the second award, we lose them because the edge is no longer there. we are doing a number of other things. we are funding a program that provides support for post-doctoral fellows who are ready to go on in a couple years to an independent position, to compete for that award and carry that award with them to an academic position, k-99 awards. we are increasing a number of those because that does seem to be a good mechanism. and a number of things are being done to try to free up more of the proportion of funds for more applicants. i'm going to quickly ask dr. lorsch, who is the director of

national institute general medical sciences and a major part of our training initiatives, to say something about some of the ideas they're pursuing. >> thank you, dr. collins, and thank you for the question chairman cole. this is an area we're very starting a new pilot program. which has at the fundamental goal to improve the efficiency of our funding mechanism which would increase our ability to distribute funds, especially to young investigators. it would also have several other targets, one would be to improve the stability of funding for the investigators, because if they're constantly at risk of losing their funding clearly that's not an ideal situation. it would improve the flexibility for investigators to follow new research questions as they arise, and we think it would improve their ability to take on ambitious research projects and follow them in a creative manner. but efficiency i think is the key. >> thank you very much. i want to move next to my friend, the ranking member from

connecticut. >> thank you, mr. chairman. and thank all of you. mrs. lowe and i just briefly talked to each other about the level of discussion at the hearings with the nih. they're inspiring. the intellectual pursuit, the science gives you -- and that the united states is on a cutting edge of these efforts. it gives us such a sense of pride, but more than that, again, it is what you are doing to push the edge of the envelope in so many directions in terms of saving lives. and that leads us to -- we were both on the committee mr. chairman, when we doubled the amount of money for the nih along with mr. porter. and it was so genuinely bipartisan. if there is an area in which we can come together and understand the value of what we have here

that i think it would serve us well to think through what we should do for the future. i'm going to address an issue that you know is of -- it's been of interest to me for a while. i know it is of my colleague mrs. lowe, as well. and that is the gender balance in pre-clinical research. we've worked to make sure that women were represented among the subjects of biomedical research, including in the clinical research studies. i don't have to tell you that men and women differ in their responses to medical treatments. and oftentimes using the models that rely exclusively on male animals can lead to serious harm. women experience higher rates of drug reactions than men, for example. dr. collins, in may of 2014, you co-authored a director with dr.

clayton. nih would require applicants to report their plans for the balance of male and female cells in animals in preclinical studies in all future applications. and that's a quote. you noted that the new policy would be rolled out in phases beginning in october of 2014. dr. clayton noted that quote the exception will truly be the exception, not the rule, end quote. let me just give you the two or three questions i have in this regard. if you can give us an update on nih's new policy to require that both sexes be represented in preclinical research, what kinds of responses have you received from the research community, are you seeing an immediate impact in applications for funding in fiscal year 2015? will you consider requiring the analysis of data by sex, and other subgroup demographics as part of grant progress reporting? what are you doing to encourage

journal editors to require an analysis of results by sex? how are you holding institute directors accountable for funding on studies on sex differences and the conditions that predominantly impact women? how are the institute directors accountable on women's health on studies? and can we expect all future nih funded research to include both sexes unless there is a specific reason to not include them such as the focus on ovarian cancer or prostate cancer? a lot of questions, i know, dr. collins. but i think it's imperative at this moment because you are moving and we need to make sure that we get all of this as we move forward. i know we've worked in the past, and some things have not moved forward, and now i think is an opportunity for us to address the issue again. >> i appreciate the question.

i appreciate your leadership in bringing this to the attention of the public. and certainly i can assure you of my strong personal commitment to addressing this issue as was documented in that article that you mentioned that i wrote with dr. clayton in nature. the update is, we have now had extensive conversations with the institute directors and including my advisory committee to the director which is my most senior advisory group about this issue. and i think there is generally broad embrace for the need in preclinical studies to include males and females unless there is a compelling reason. and that needs to be explained what it is, not just that it's not traditional or not convenient. the responses on the negative side have mostly reflected anxieties about whether this would mean now that every previous study of male mice now has to be doubled in size in order to study males and females. and that will cost more and

result in fewer studies being done. i think that's an unnecessarily negative response to this question. the idea that you should include males and females seems really compelling. the idea you should analyze the data separately is really compelling. you will have to decide in every study how subtle a difference between the sexes are you willing to miss, because that will determine how big your study has to be. but we know how to do that. that's called power analysis and it can be applied in this situation quite handyily. the institute directors are now in the process of finalizing their approval of the way in which we are going to implement this for nih grantees, with much community input. i can assure you this will be something that is not left neglected. we will have definitive guidelines for all grantees who are doing these kind of studies about what their expectations are, for reviewers who review these studies it will be made very clear that is part of how you are to review a grant that

comes to nih. journal editors have been in conversations with u and we've had great interactions with them about the reproduceability. that fits within that. if you have two studies that don't get the same answer, but one studied males and one females, that's not called lack of reproduceability, that's interesting data that you would want to follow up on. they're in this mix as well. i think it's fair to say that the nih is across the board, fully committed to making these things happen. and it's time. it's over time. >> thank you. and thank you for letting me go over the time. >> absolutely. thank you. i want to go next to my good friend from idaho. >> thank you, mr. chairman. dr. collins and all of the other directors, thank you for being here today. the bipartisan nature of this subject with this committee is pretty obvious and has been in the past. and that's good. it would be, i think, the desire of everyone on this committee to

substantially increase the research we're doing if we didn't have an $18 trillion deficit, or debt. and $500 billion deficit that we're having to deal with at the same time. which makes it more difficult. but still, it's something that we put priority on and try to do in a bipartisan manner. i would like to ask a whole bunch of different questions, but i'm going to come out and visit with you for a day and take a tour of some of the different institutes, what goes on there. so we can get down and have some real good discussions. but there is a couple of things. this personalized medicine you're talking about is fascinating to me. and i understand that it's the collective use of technology such as genomics, and protein medics, or something like that. that explore cells and organisms. nih, i understand in your testimony you're going to concentrate on cancer right now. obviously it's a lethal disease and so forth.

is there any plans to look at broader, maybe not as lethal diseases, or not as serious diseases and the effects that personalized medicine could have in the research in those arenas? >> absolutely. let me be more clear than i was. the precision medicine initiative has two components. an early focus on cancer, because this is so ready for this kind of really expanded effort to understand what causes cancer, what we can do about it. but the other component which is a long-term ambitious to be sure effort is this cohort of a million or more americans, which we could be studying for virtually all diseases and knowing that you are a dentist i would certainly include in that such things as periodontal disease. we know the environment and genetic risk are involved in those conditions. but we really haven't had a sufficiently large study with appropriate patient participation to be able to get those answers. this should be a way to go there. so that's true for diabetes, for heart disease, for alzheimer's

disease, for virtually every common condition with a million people, you're going to have enough events you should really be able to dissect, what were the biomarkers that warned this would happen what were the environmental factors that played a role. we never had that power before we aim to get it. >> that's fascinating stuff, and could really advance the advancement of diseases and cure diseases. i am going to submit some questions for the record. but one i did want to ask, in our conversations in the past you've indicated your strong support for the nkats. i heard from some advocacy groups several years ago that -- who expressed concern that putting more resources into nkats might come at the research. but you do request the $27 million increase for