the appropriations subcommittee on labor health and human services education and related agencies will come to order. i'm certainly pleased we could have this opportunity this morning, dr. collins, to talk to you and the other institute directors about the work you're doing and the work you'd like to do. certainly every family faces

health concerns during their lifetime and there are so many things that can be done by nih that i think can't be done as well anywhere else. a new drug, a new device, new treatment can take anywhere from a decade to longer to develop, can cost billions of dollars on occasion with a pretty high failure rate, even when you think you're on the right path. certainly it's necessary for the federal government to invest in biomedical research. it represents the hopes of lots of people and lots of families and particularly now as we see conditions growing as people survive heart problems and stroke problems, we see more people with alzheimer's and cancer challenges. we see the potential for designer medicine, largely because of the great work that was done to figure out how to

define and understand the human genome system in a better way. this year, this committee, the subcommittee and full committee, have placed a high priority on this research. we have planned for and have a bill that includes $2 billion of extra money for that research of increase of about 7% over current years spending. over the past decade, with not much new money going in to nih, the purchasing power at nih has decreased by about 22%. we hope to see that reverse if we're successful with what we're trying to do to provide the increase that we're looking at here. these are clearly difficult budgetary times and i'm sure we could spend a lot of this hearing talking about how there should be more money for other things in this budget and there's a disagreement on that and an agreement in some cases,

if we had all of the money in the world, the priorities might be a whole lot easier to achieve. but i look forward to hearing from you, dr. collins, from your team that you bought and i specifically said this morning, can you bring some of the people that we haven't seen lately that are focused on the individual areas of research so we can get a greater sense of understanding of what the potential is, what the needs are, what is out there that you are seeing and begin to see and also the challenge of young researchers having a research grant approved are dramatically less than they were a decade ago and i'm sure that that's a topic we'll want to discuss as well. how long do young researchers stay in research if they continue to have their ideas not allow them to move forward. so those are all things we want to talk about today. we're glad you're here. i want to turn to senator murray, a big supporter of your work as well for her opening

statement. >> well, thank you very much, mr. chairman, and especially for your focus on this. i think we all appreciate it. dr. collins, thank you for being here. i'm grateful, as we all are, for all you've done to champion the critical work that nih does. you have been a great partner and it's great to see you here and thank you to all of your team that is with us today. we look forward to hearing from all of you. all of us here today agree there's a lot more we need to do to keep our families and communities healthy and continue investing in priorities that strengthen our economy from the middle out. and the work of the national institutes of health is vitally important to that effort. the nih supports basic research that makes medical advancements possible and helps drive economic growth and competitiveness. in my own home state of washington, we have researchers working on ways to repair heart tissue that's been damaged by

disease and injury. we have people decoding on difficult to treat forms of breast cancer. we use precision medicine to tackle eye disease and alzheimer's. the list goes on. those are just a few examples of the incredible work done to improve health and well-being for families across the country and really around the globe and at the same time, the life sciences are helping to drive economic growth and job creation. in my state, the director directly employs 34,000 people. the investments that we make in nih and in education and other programs under this subcommittee's jurisdiction that supports the life sciences indirectly will help our economy create the jobs of the 21st century and help ensure a workforce that can take them on. that's why like chairman blunt i see maintaining our country's central role in the life sciences as a top priority and federal investments in medical

research could not be more important to this effort. supporting medical research starts with making sure short-sided budgeting doesn't get in the way. for far too long, we've seen inflation erode federal investments and r & d making it hard for researchers to get the support that they need. in fact, i know that you, dr. collins, have said that increasing the nih is having to turn promising projects away. for patients and families who are waiting and hoping for medical breakthroughs, that is unacceptable. i'm very proud that in late 2013 democrats and republicans were able to reach a budget agreement, to roll back sequestration for fiscal years 2014 and 2015. and as we all know, that deal expired last week, which means congress is going to, once again, have to come together and find a solution. as i've made clear, i believe we need an agreement that builds on the bipartisan foundation set in the budget deal from last congress, rolls back the cuts to

defense and nondefense investments equally and protects priorities that are essential to promoting a strong and growing middle class, like research and education and infrastructure. i've been encouraging my colleagues on the other side of the aisle to come to the table and work with us so we can reach another bipartisan budget deal and avoid those automatic cuts that impact these and other important investments in our country's future. i'm also currently working with chairman alexander who is here today on the help committee on the bipartisan initiative to advance medical innovation that is an effort that is very much related to the conversation today. i see that initiative as an opportunity to help patients get the best, most effective cures in treatments as quickly as possible while upholding the highest standards of patient and consumer safety. and to me, a central part of accomplishing this goal and tackling the tough medical challenges our country faces is making sure that research and development can thrive.

i'm pleased that so far we've seen bipartisan interest in ramping up investments in the nih and fda and i've made clear that i'll only support a bill that does just that. i'm going to be very focused on finding a path forward on this goal in the coming weeks because, put simply, stronger investments in medical research means a stronger, healthier country. i'm hopeful that republicans and democrats can come together to build on the bipartisan foundation we set in the budget deal last congress and make the investments we need to help our economy and country work better for our families. thank you, mr. chairman. >> thank you. dr. collins, do you want to make an opening statement and a brief review of the team you brought with you? we won't count that against your opening time. >> thank you, mr. chairman. yes, i'd be glad to introduce the folks with me. we're happy at nih that we have a deep bench of science and leaders, 22 institutes and centers. you'll see in front of you five

of those folks. to my left, your right, dr. john lorsh, an institute which is having a pretty big day today because the nobel prizes in chemistry were given to -- a nice moment for nih. and then next to him, the director of neurological diseases and stroke, distinguished neurologist and basic scientist as well as a clinician. the acting director of the national cancer institute to my right. much recognized for his work in the development of a vaccine against hpv which is saving many lives from cervical cancer. next to him, dr. rodgers. and also one of those folks who is being honored this evening at the sammy's awards because he's one of the nominees for this year's awards for public

service. and over on the far end, dr. volkow, highly educated in addiction science and highly recognized by the press because she's often in front of them talking about addiction, the national institute of drug abuse. that's my team. i would like you to start the clock and i'd like to tell you a few things by way of an opening statement. it's a great day for my colleagues and i to be before you to discuss how nih is investing in a healthier future for all americans. longevity, you can see what has happened, breakthroughs by nih-supported research. for example, cardiovascular diseases, death rates have fallen by more than 70% in the last 60 years. cancer death rates are now dropping by 1 or 2% annually. likewise, hiv/aids, when first

being written about as a death sentence, greatly extends lives and an increasing potential of a vaccine are enabling us to envision in real terms the first aids-free generation. the patient community and employees, i want to thank all of you for your support and for holding this hearing today. we see in front of us a remarkable landscape powered by exceptional advances in scientific knowledge and technological innovation. this morning's announcement of the nobel prizes in chemistry for dna repair is an example of how these investments have been paying off, building upon work that's gone on over decades. i'd like to share with you an inspiring story, another one emerged from decades worth of n nih-funded basic research. it's harnessing the own immune

system to fight this dreaded disease. i'd like you to meet emily. emily whitehead, back in 2010, when this photo was taken, she was struggling with acute ly mph osat particular disease. she was in the other 10%. her prognosis after failed chemotherapy was grim. but doctors approached her parents about trying something radically different. a clinical trial of an experimental approach called immune know therapy. i'd like to make this point about the long arc of medical research involving many years of work ultimately leading to emily. let's take a brief journey back in time. the history of cancer immunotherapy can be dated back to the 1890s. a new york surgeon, william

coley, stimulated patients' immune systems with bacterial toxins. but his results were highly variable, the treatments were very toxic and this treatment fell by the wayside until the mid-1980s. then, at the national cancer institute, steve rosenberg explored the ability of site toe toxic t-cells to destroy cancer cells. he wondered whether the immune system could be helped to do this by taking these t-cells out of the body, stimulating them with an activateling factor and reinfusing them to the cancer patient. it did not always work but there were dramatic responses. steve is a true pioneer. steve was made this morning the federal employee of the year by the partnership for public service and will be recognized in the sammy's awards ceremony

this evening. meanwhile, basic research spearheaded again in large part by nih led to the discovery of methods to supplies fragments of dna together, giving birth to the whole field of biotechnology. armed with this set of tools and technologies, nih supported researcher james alison, you see here, pioneered one form of immunotherapy and discovered a protein on those t-cs t-cells by designing an anti body, he showed that the breaks could be released and advances to untreatable cancers began to appear. another award. alison just received america's

nobel prize for this last month. building on this building momentum, scientist carl june, one of emily's doctors and whose lab i know chairman blunt has recently visited have been designing more precise ichlt mmunotherapies. t-cells are collected from cancer patients and engineered in the lab so they could produce special proteins on their surfaces calls c.a.r.s. they multiply and with guidance they seek and destroy the tumor cells. let me just show you how these killer t-cells seek and destroy cancer cells with a quick video. this is pretty dynamic and the results can be dramatic. that's a t-cell that you see there lit up in red and it's busy migrating around on this petri dish looking for foreign invaders. you will see, when it finds a

cancer cell, it's going to get really excited. there you, see, the cancer cell in blue, the t-cell is really going after it. i'm going to change the colors on you in this next little clip. they are now in green. the cancer cells are red and watch for the red flash. that's where the t-cell just ruptured the membrane of the cancer cell and sent it off to the cancer cell graveyard. you can see it happening with them being attacked by t-cells to figure out how to do away with them. one of the recent patients refers to those little t-cells as ninja warriors. and they do their job. this isn't just of the future of cancer treatment. it's the present. note, this was built on decades of work. in fact, going back to jim alison, a recent analysis shows that the pathway that led to his award included the contributions

of 7,000 scientists for more than a century with many pursing questions that had no apparent connection to cancer. so i tell you this story to emphasize the critical need for federal investment in this whole spectrum from translation to clinical research. if we do that, we can accelerate discovery across this vast landscape of biomedicine and ultimately save many lives. remember little emily? here she is today. a junior bridesmaid, this picture of health. her parents' decision to go ahead and enroll her in that trial. 28 days after that treatment, emily was cancer-free. and more than five years later, she remains cancer-free. emily is just one success story. i could tell you many more, including all of these folks across the entire nih portfolio about how basic scientific inquiry is leading to a

healthier future for all americans, from the development of brain initiative to the co-hurt person and am i would say our future has never been brighter. and my colleagues and i welcome your questions. >> i'm certainly glad you're here. i did -- senator toomey went to see what dr. carl june was doing and that effort was very much -- you can correct me where i'm wrong here, very much focused on the patients' needs and at all age groups have been seeing success in that particular effort but two thoughts about that. one is, what is -- how does

this -- is this likely in cases like this to go beyond treatment to the level of where, in this particular case, this particular fighting agent is always there so you've got -- you're talking about cure instead of treatment and i'd be interested what discussion is going on, how we look at a world where cure is one of the options as opposed to a health care world that's largely been defined by treatment up until now. and i'll just go ahead and ask my second question at the same time, which is, on these individual cases, i would assume at some point, one of the challenges are, what do we do that makes that most likely to be scaleable so that every patient doesn't have all of the expense of a unique treatment but a scaleable effort made that will -- i think will become naturally but talk to me about

those two things and then whoever you'd like to answer those questions. >> those are great questions, mr. chairman. i think i'll turn to dr. lowy as the acting director of the cancer institute who's investing in big ways to address both of those. >> thank you, senator blunt. this is really a critical juncture right now because we have opportunities for long-term responses and what you're asking is are a subset of those responses going to lead to cure and we certainly are optimistic and hopeful that this will happen, at least in some cases. but we need to understand better, as you point out, what the mechanisms are that drive the important clinical responses to immunotherapy and if we can understand them better, we may

be able to devise effective immu immunotherapy because we hope eventually we can get to the area of precision and predictive oncology where patients -- we know what treatment to give to them and what kind of therapy to give to them in addition to targeted treatments. thank you. >> in terms of a scaleability, which is a tough question for some of the very personalized immune know therapy that you saw in carl june's lab, there are strong interest from companies figuring out how to do this where you can make it available to thousands of patients instead of small trials and we would think that's a very appropriate kind of place for private/public partnerships to spring up so this idea of engineering your own t-cells to go after your

cancer could be done for more individuals. >> i would just say, before i turned to senator murray, i think this is a topic that i'm having some discussions which people representing health insurance companies are thinking about a future where traditional treatment may be less expensive initially but a long-term potential cure, the more expensive initially but less expensive over time. what are your standards going to be? are you thinking what we can do now, which really the whole concept, i'm sure we'll get to, of designer medicine, what can happen with the efforts, doctor, on the brain and that impacts. i think we'll have time for more than one round of questions. we have a couple of people on a time frame. we'll try to get to them quickly and do this by order of both appearance and first person to go to is senator murray.

>> well, thank you very much. dr. collins, we're working on a continuing resolution. what affect would a year long cr, at the current rate, have on the nih research? >> believe me, we're thinking and worrying a lot about that. here we are in a circumstance where perhaps emboldened enthusiasm we've seen in both the budget and the house, initiatives to launch a fy 2016. and under way for two years but it's at a critical point to ramp up and to build on what's already been done. the ability to be able to push our vaccine strategies for influenza, for hiv/aids. it's at a critical point and

we've been heartened by the action of this committee that we might have a chance to do those things. a year-long cr would be simply devastating. the precision medicine initiative, for instance, would basically have to go into the freezer or on moth balls. we would just be at the point of starting this effort to enroll a million americans in this unprecedented study and carry out and that would have to go on hold and that would be enormously disappointing. similarly, imagine the brain initiative, it would basically have to take a pause for a year just at the point when the momentum is building. so i can't emphasize enough how much we are worried about this. we can struggle along with a cr until december 11th but if it's a year-long cr without an anomaly, it's going to be a dark

year indeed. >> thank you. doctor, more than 20 million people in the united states have a substance abuse problem and only a small percentage will get help and those looking for treatment often can't find it because of long waiting times for care or because of limited insurance coverage. the work that you do to address addiction is critical but i really worry cutting funding for treatment and recovery as this 2016 bill would do would make it very hard for addicts to get the help they need, especially at a time when 10,000 more americans now diane actually from overdoses than they do in car crashes. >> the substance abuse block grant that represented 42% of state spending on substance abuse as recently as 2007, that share would likely drop to below 32% under this subcommittee's bill. i wanted to ask you and take advantage of you being here today. are you seeing shortages in

treatment services around the country for addicts who want help and, if so, does that concern you? >> unfortunately, the answer is yes and of course it concerns us. because the problem of drug addiction has been increasing in our country and we've known all along that only 15% of those addicted have access to treatment. >> 15%? >> 15%. >> 15% ask for help? >> 15% who have an addiction have access to help. they all search for treatment but one of the reasons they don't search for treatment is they are discouraged by their lack of -- the lack of infrastructure to support their needs as well as a stigma. so those are two aspects that have made it very, very difficult to provide treatment. what we are doing is trying to take advantage of the infrastructure that we have in

our country to maximize the involvement in substance abuse disorders and that includes the health care system, the criminal justice system. those two are structures that we are engaging to provide with evidence-based treatment that can improve outcomes. >> and doctor, i wanted to ask you, i know the brain initiative recently received its second round of awards bringing nih investments to 85 million for 2015. can you tell us about the progress you've already made under the brain initiative? >> yes, i'd be happy to do so. it's incredibly exciting and off to a great start, as francis mentioned. the center of the brain developed new technologies to allow us to monitor and interrogate and modulate brain circuit ability. that's really what patients are suffering from, disorders in brain circuit. we don't have the technologies

to modulate those except in a very unsophisticated matter. so some things have already come out that are really, really exciting. a couple of examples, there's a new technology which you can put artificial gene into particular neurons in the brain and with a drug that has no other effects, you can turn on or turn off precisely certain neuron types in the brain. and this is really an amazing feat to be able to do that. so just to contrast that with treatment for parkinson's disease where a wire is put into the brain and an electric current is sent in, no one knows exactly what it is doing, it turned out to be quite effective. you can just imagine how this kind of technology can completely change how we basically normalize or cause compensation in brain circuits for patients' neurologic

deficits. it's really quite exciting. >> thank you. unfortunately, time is up so i'll wait for the second round. >> fortunate to have the chairman of the full committee and ranking member of the full committee with us. senator cochran? >> mr. chairman, thank you. in my state of mississippi, we have one of the highest rates of type 2 diabetes in the nation. we're told that over 12.5% of our state's adults have the disease and the problem is growing rampantly. are there any new approaches you have in mind in dealing with hot spots or outbreaks, whatever you want to call it, in areas like our state? >> that's a great question for dr. rodgers. >> thank you, senator, for the question. type 2 diabetes is increasing at an alarming level there,

currently 29 million people in the u.s. with diabetes and 86 million who have pre-diabetes. there are two things that we're doing about that. number one, for people who have established diabetes, there's a common drug that is started on patients called metphormin but in a great majority of patients, that drug will no longer be and fe effective. we're looking to see what would be the next effective drug given for individuals, a trial that involves 5,000 individuals in 45 centers around the country to determine the effectiveness. this really will eventually get to the area of precision medicine. the second thing is, for those people sort of underneath the iceberg, the 86 million americans who have a possibility of going on to develop diabetes,

we have tried to translate a very effective diabetes prevention program to scale this up in a way to offer this lifestyle, which was quite effective in these patients, to prevent them or delay them from beginning a diabetic. these will have an important financial role in the future in terms of cutting costs. >> thank you, chairman. senator m mccaulski. >> when you look at us, we have a chairman that is very much dedicated to nih, certainly a vice chairman that is, all of us

going around here have a history of support for this. you have people here that want to be nonpartisan. you want you to know that. >> thank you. >> we are stymied by our own processes. when i first arrived in the senate, we had a triad that worked. authorizing, they would often create great policy when a bipartisan basis. kennedy hatch, kennedy cassabell, et cetera. we had appropriations that could really move the ball forward and we had a budget process that gave us an orally methodology process. so we've got problems here. so we've got big problems here. and i know that you live them out every single day. colleagues, when i visited the national institute, which has been my great joy to represent for 28 years, i call it the national institutes of hope. this is what we just heard here. the national institutes of hope. what they do on the campus in

bethesda but also what think do for the extra neuroresearch like in the university of homp kins. they are going to dedicate a room at the hopkins club, the faculty club, two weeks from now. 38 people associated with hob kins have won the noble prize. because of the role that our government plays in doing that. we're an economic engine. when you think about the jobs that are created because of you, in pharmaceuticals, biomedicals, medical devices, you are a turbo engine. so rather than seeing you a cost factor, we should see you as an economic generator and i hope that we can be able to do that. i'm deeply concerned about the caps. i don't like budget caps but, most of all, i don't like the

caps on innovation. we cannot continue to cap innovation. we cannot cap break clzthroughs. we cannot cap the opportunity for young people to dream for these careers by dr. rosenberg and all of you here. when we look at the research to be done and the workforce to do it, i worry about the young investigator and the debt that they carry that's a deterrent to pursing this. could you tell me, if we could go down the table, if we lifted the caps and went to president obama's budget, nothing more, president obama's budget, what would be the three things each and every one of you could do and how would it also impact young investigators. >> okay, folks, there's the challenge. maybe we should just quickly go down the table. nora, do you want to quick this

one off? >> if you just have one -- >> no, no, no. >> one would be enough. >> but number one is we would accelerate that development of medications for addiction. there are many variable potential interesting targets and pharmaceutical industries is not investing the responsibility through our federal government, money through the nih. that would be one. the second one would be to have a -- to expand a study and understand how drugs affect the development of the human brain. we now have the technologies. we should have that information. and i will -- and the third one relates to making research more accessible to the investigators so we don't lose talent. >> i would just expand upon that. i would say that there's three areas i would focus on. the young investigators, we know that there are two critical point that they will likely stay in research or exit. one is on their first

application to get a grant. the second is getting that renewed and they get that through the second hurdle and it's likely they will be with us for a second time. we'd like to encourage them for making the first application as well as the second renewal. the other point that i would make is with expanded funds we'd be able to allow for expansion of some of our existing clinical studies because of the curtail that we have to do and one way to amplify the infrastructures in these clinical trials is having ancillary studies of these trials. i would expand existing trials as well as ancillary trials. >> thank you. the question of young people we at nci are in the process of trying to develop new approaches to enhance their ability to move

from being graduate students to starting their own laboratories and the areas where we would invest would be in cancer prevention, cancer screening and cancer treatment using molecular, precision medicine approaches which have enormous potential in those areas and i would highlight the potential of immunotherapy as discussed earlier because of the issue of its potential for improved responses, decreased side effects and scaleability, as senator blunt mentioned. >> we talked about the brain initiative and also the action plan for alzheimer's disease research and all of those have milestones. it's all planned out. if we had funding, we could really accelerate both of those major projects. in terms of the young people, i

think it's incredibly important. the average age of become being independent with an nih grant is going towards the mid-40s. we've got to move that down. i think we have a couple of things that we're playing with at nids to take a shot at somebody who is really young, looks bright and give them a chance much, much earlier in their career. >> so my institute funds basic research to the discoveries that mr. collins told you about don't come from me and much as i esteem my colleagues don't come from them. they come from the great, brilliant minds from the universities in your districts across the country. we'd focus on promoting these brilliant scientists to do their work. and as a measure of that and the success of that, my institute, as dr. collins alluded to, has funded a number of nobel prizes

and i would have said 81 yesterday but as of now it's 83. that's an indication of the power of investigator initiative research. we'd have a focus on promoting the careers of the young sciences who win the nobel prizes of the future. >> i would point out only senator mikulski gets 50% of the time that she's allocated today. i wanted to get on the record the kins kinds of things that would you do now, the president asks for half of the increase that the committee has proposed you get. so i'm going to look very carefully at all of the things you said you would do if you had the president's number and assume i can multiply that by two and those would be the things that you would do if you had the number that the committee's proposing at nih. mr. shelby? >> thank you. dr. collins, picking up on what

senator blunt says, talking about money, funding is important, if you had several -- say you had $3 million more above, what could do you with it as far as investigating and hoping to turn a lot of what you just investigating results into better health and better treatment? what would $3 billion -- use that as -- i made it up -- but i hope we could do something for you. what would it do for you? what would it do for us, everybody? >> what would it do for america, for the world? i appreciate the question. it's a lovely thing to contemplate because, as you've heard, we've lost over the last 12 years about 22% of our purchasing power. this would be a 10% increase and not get us quite back to where we were in 2003 but it would be an enormous shot in the arm to a community that has such talent and energy and is basically being squeezed to the point where a lot of innovation that

we could be doing is just not happening. you heard from my colleagues the areas that they picked from their own domains and i'm talking about the directors that are not here and a couple others i'd want to put on that short list that if they were here they'd speak to. vaccines. we are on the brink of being able to develop a vaccine that would work against all influenza strains. we have a path towards something that would be both able to then result in not needing your yearly flu shot that needs to be reengineered every year but more importantly the pandemic which is overdue and we're not pushing that as hard as we should be because the resources are not there. vaccine for hiv/aids, we really do see a path to making that happen, 30 years of frustration. the precision medicine

initiative which we hope to start in fy '16, i which i think has a lot of bipartisan support and a group that debated about this is very jazzed. we can't start that if we have a year-long cr. but we could start it and we could ramp it up much faster if we had this kind of a curve to work with as far as research. and then there's this whole area that we all high-risk, high-reward research. we just announced a couple days ago the funding about 78 of these new awards. these are pioneer awards and new innovators and early indepent dent awards and ones that you can't even apply unless it's out of the box and don't have to have a lot of innovative idea, but if it's exciting, we want to see what you can do. many institutes are taking that tact but we can go faster and inspire people to be more risk taking if we had that kind of

opportunity. put all of that together and with $3 billion, well, let's try it. let's try the experiment and see how it turns out. i promise you, it would be amazing. >> also, not only health, it would be a good economic investment. >> thank you. you repeated economic analysis demonstrate the return on investment for dollars that go to nih is about two-point two-fold. >> where are we today, as far as the cutting-edge research on cyst cystic fibrosis and autoimmune diseases such as lupus? >> i have a personal and long-standing interest in cystic fibrosis. this is a very exciting time for that disorder because after all those years of figuring out how

that small glitch was capable of causing this disease. we now know a great deal about the protein that is made and why it doesn't do what it is supposed to do in assisting s cystic fibrosis. very exciting times, indeed. autoimmune diseases, lupus, rheumatoid arthritis, one exciting public slach slach private partnership, several of us have been working to bring together ten drug companies within nih to work together and one of the targets is lupus and rheumatoid arthritis. what is going on with t-cells and lupus? are they overactive and going after normal tissues when they

shouldn't? how do we understand how single cells are behaving in order to bring up tragedies? all of these areas are full of potential right now. >> thank you, sir. senator durbin? >> thanks, mr. chairman. thank you all for being here. let me say at the outset to address this side of the room for a moment, gathered in this room at this moment in the united states senate are the 11 or 12 people who could literally make a difference for generations in medical research, as was noted by senator milkulski. if we said come hell or high water we are not going to tolerate a shutdown, a sequestration, a cr, we are going to increase the funding for nih and related medical research agencies, we can make a difference. we can just make it clear. don't try to get true the senate if you're going to touch it.

i want to commend the chairman because i bothered him, begged him and challenged him for a long, long time based on dr. collins' admonition to me, give me 5% real growth for ten years and i'll light up the scoreboard. and we've done it in this bill. i might add par ren thir ren th thats are equally important as well but i want to commend for making this commitment of 7% growth at nih which equals 5% growth. one time infusion is a good thing but constant, predictability is what leads to research commitment in long-term success of what we can achieve. i'd like to throw out a possibility that we rally around one particular person who's up here. for 28 years, barbara has been the strongest voice for national

institutes of health on capitol hill and she's leaving soon, unfortunatelily for all of us, but i hope we can make her a promise that we're not going to forget the commitment of this budget and the commitment in years to come and i will tell you this, in the time i've been in the senate, you don't want to break a promise to barbara mikulski. something you'll hear about. >> well said. >> i hope we can be inspired by that. let me try to bring this down to ground level, if i can. i have two questions if i can get to them. the first is, when we talk about $2 billion in growth, $2 billion in growth in this coming year, i need to ask you, when it comes to areas like alzheimer's, we know that we spent $226 billion on alzheimer's treatment, just medicare and medicaid. we estimate that the private contribution of families is almost equal to that in value.

so we're talking about one-half of 1% of what we are spending as a nation on alzheimer's as the delta, the 2 billion that we're looking at here. when it comes to brain research, we have now reached a point -- and please confirm if i'm right, where we can start to visualize the development of alzheimer's in the brain and know many years before the obvious onset that a person is moving in that direction. what do you see, dr. collins, or those who are with you, in terms of what we could do if we knew 15 years in advance that alzheimer's was likely to occur. what could we do to look forward to soon or to delay it and find a cure? >> i'm just showing you a picture that outlines the statistics. you can see what the relative

numbers are here in terms of what is currently being spent on alzheimer's disease. this is 2013 numbers and we need it to go up and it is but compared to what the estimated, $1.2 trillion in 2015 if nothing gets done. this is a matter of great urgency not just because of the economics but because of the enormous human tragedies. the director of the neurology institute can tell you where we are on this and why we are optimistic that we can get to a place. >> for the first time, we can actually see what is going on in the brain in people with the alzheimer's disease. in the past, we knew what happened when people died but couldn't see that happening in the living people. but now we have markers, scanning markers for the major culprits in alzheimer's disease and we can see that in the brain

now of living people and, as you said, we can see it developing years before the taz sets in. alzheimer's is like the gun, tao is like the bullet. so if we can -- the vision is that we develop a screening tool for people who are developing the analoid know that they are going to develop alzheimer's and come up with a drug to block that process. in actual fact, those drugs are currently being tested in clinical trials. we could get lucky. this could be very, very promising. >> let me interrupt because senator moniz would help that i would add, the department of energy and office of science had a lot to do with this. when you talk about medical research, the technology side of this equation relies on other

agencies. do i have ten seconds? darn it. >> we have a joint meeting about the brain between the department of energy and nih coming up in two weeks in chicago. >> senator alexander? >> tlanghanks. i'm sorry that barbara left because i'd like her to know that dr. collins played the guitar and sang at a place that senator durbin has been and where she wants to go. it was quite a show. knockout disease? >> that was it. i'm surprised you remember. i thought you might have suppressed the whole thing. >> no. it's a great hit. and i want to thank -- i mean, we all admire your work but also of your team. we know that they could be making more money some other place but the fact that they are here and working to help other people is something we all respect and appreciate. i'd ask you, dr. collins,

earlier for this -- the bill that senator murray mentioned. we're trying to create environments, where we can get inventions and discoveries through the process more rampantly. one of the problems we have is the national academies groups have identified the investigators spent 42% of their time on administrative tasks. now, if we're talking about billions more for investigators, shouldn't we be spending an equal amount of time trying to get that 42% down so we create more money there? there's a new report headed by the chancellor of university of texas which includes a research board that would coordinate an approach toward the spending of the 42 billion we put out, not all of that through nih, to colleges and universities to try

to eliminate replication. will you review that report and over the next year set up a way to consider making the changes that it makes? and if you have impediments, either within the administration or the law that would keep you from doing that, we might be able to include them in the legislation senator murray and i are working on. specifically, the research po policy board. >> sir, i appreciate the role you've played in bringing this important issue to the attention of constituents and including the government. >> thank you. i'm going to ask you to leave me two minutes because i have another question to ask. >> we'll take with great seriousness this report. we've looked at in a preliminary way. i'll look at it much more deeply. i have ideas and responses to

that. i'd be glad to share that with you how to reduce the 42%. >> thank you. i want to ask you questions about funding but i don't need the answers today but i think we all need the answers in the next few weeks. the house included something called mandatory funding as well as discredtionary funding. that part of the budget has gone up like this and the discretionary side is like this and you're on the discretionary side. so our visceral reaction is against new mandatory funding but i'm convinced this is a critical time in science and opportunity so i'm willing to think about that and i have these questions as i think about that. and these are the questions i'd like to talk with you about some time. what happens at the end of the five years that the house propose? there's a cliff and you lose $2 billion, what happens then? what's the purpose of the

mandatory funding? if there's a difference between discretionary and mandatory funding, do you mix it all up or is there a steadier stream of money towards mandatory funding and what would that be? should there be a focus on preventive medicine, for example, or on precision medicine, for example, or on investigators, for example? and what about oversight? we had an embarrassing thing happen in the nih about its manufacturing of sterile drugs recently. and if you're not accountable to us for what happens there, then you're not accountable to anybody, really, and that's our job as appropriates. so it takes education, capital

formation, infrastructure and research and technology, i understand with that. i'm all for more research. i think we should be doubling energy research rather than subsidizing windmills and putting money into the pockets of rich investors after 22 or 23 years. i think we should be setting priorities and my priorities very well do include your work and dr. moniz's work. i'd like to ask you about that type of funding and maybe one of these days we'll have a chance to talk about it. >> i will certainly do so, sir. >> thank you. senator merckley? >> thank you for your video of the t-cells destroying the cancer cells is inspiring. i think we're all hoping that over the years ahead every possible type of receptor on every possible type of cancer cell, the ability to program

t-cells to attack them will continue to develop and i think that's the vision that we're anticipating. one of the concerns i've heard often and oregon health sciences university is a major research partner within nih. is the stranding of young researchers and i believe it was dr. rodgers, you mentioned the young investigators, folks who were partway into their career, they've gone through their post graduate work, they are in a laboratory and then the grants don't come through and they have this incredible specialty about some form of nerve communication or chemistry deep within a cell that may be the key but who knows but suddenly they are going, well, what do i do now? does this continue to be a problem and to what degree should we be deeply concerned about the loss of this? we expend a huge amount of

resources to develop that talent and then suddenly its ability to be applied is cut short. >> well, i think we should be deeply concerned. we do put a great deal of resources into the training of this generation of young scientists, the talents and skills that they possess are incredibly impressive and yet if you, as i often do, go and visit universities across this country and meet with graduate students, post doctoral fellows, it used to be when i made those visits they wanted to tell me about the science they are doing. now they want to tell me about their anxiety of whether there's a career path for them or not or whetn fact, the support for biomedical research is continuing to grow.

maybe i'll ask the doctor to say something about the ideas that we're pursing, although, i will tell you, there's no magic here without seeing some relief from the budget squeeze in terms of what we can do to make every dollar count.