mostly not covered by insurance. the list of diagnoses is long for such a young child. her healthy appearance belies the death of her medical problems. based on her appearance, people expect her to be able to respond to them, speak to them, and share with them. robin has come a long way, but still has difficulties. i know of children who have fully recovered with the properties for their medical conditions. .

many families hesitate to use the word "bought his and." because "-- autism. we call it the "a" word. i have been involved with doctors for eight years discussing the treatment issues. because no action has been taken, thousands more children have suffered damage and their family's lives have been destroyed. the care will not only fall to their families, but appears in general. they cannot work and must collect disability checks. lifetime care for a child like robin will cost millions of dollars. i have accepted your invitation because i want to set the record straight. you cannot address autism without addressing some other a

words. we have the sickest generation of children with one in nine children suffering from asthma, one in six with some form of narrow development disorder, and a least 150 with some sort of what is and disorder -- autism disorder. agencies charged with protecting the health of our children suffer from serious financial conflicts of interest. these government agencies need to be held accountable. senators, it is difficult for me to sit at this table and tell you that you have been lied to. we have all been lied to. rovin's vacc -- -- robin's vaccines were administered red after her birth.

the data sheet identifies the chemical effects as follows. the mercury component has caused nervous system affects in experimental animals including mild retardation and motor impairment. he did not need to take my word for the scientific facts. the former founding editor of " environmental health perspectives," and former associate director of the toxicology program, considered the world's's largest toxicology research is with me today. the number of vaccines since i was a child has risen from around 10 to 49. those who create vaccines option -- often set the table and vote to approve vaccines, read the

dollars, and are immune from legal liability. where else do we see this scenario of no accountability and conflict of interest? who is on the table on behalf of the children? very few are doing it. we need transparency, honest communication, and once and for all, as you suggested earlier, a valid, unbiased study of the vaccinated verses on vaccinated -- unvaccinated populations. men voluntarily and inject themselves with steroids while thousands of children are injected with a neurotoxin under government mandate. some children are injured by vaccines. their access to legal compensation is barred by many legal obstacles. although i do not have time to

describe the necessary reform, please take a look at the on fairly restricted three-year statute of limitations among other legal problems facing these families. heavy metals like mercury and other toxic substances should not be injected into people, especially babies and young children, and others susceptible to a vaccine injury. vaccine safety certainly encompasses more than concerns -- mercury is so highly toxic, it is the 600 pound gorilla in the living room. it only takes a 0.6 micrograms to harm human tissue. according to scientific studies, it continues to be used in some vaccines including tetanus and flu shots. that is a fact. it is damaging at minimal levels -- nanomolar levels. it has been replicated and ignored.

we pretended not to see. those in power do not discern facts. they did not protect the health of the children of this generation. they protect industry and government. my hope is for action. can we really afford, with continued inaction, to risk losing another generation? thank you for listening and allowing me to share my concerns. as i return to our iowa farm, i will reflect on what we have lost. into the many other mothers and fathers whose hopes and dreams have been crushed with this chronic illness. we will continue to hope for action. our children and our future depend on you. >> thank you very much. i think we have heard the whole gamut of everything here now that we are confronted with. since your first on the left here, i will start with you.

you mentioned that no comparative effectiveness have been done to allow for treatment of autism. this is something we have the focus on. -- we have to focus on. we are in the here and now. families are struggling and facing this whole generation of growing up and what is going to happen to them as adults. this committee provided over $1 billion to hhs in the recent recovery act for comparative effectiveness studies. $1.1 billion to be exact. again, we do not say exactly where to put them. do you know of any of those dollars will be spent on autism?

they said it was one of the conditions that should be studied. you have any thoughts on that? have you been watching or have you been involved with trying to see that some of these comparative effectiveness studies are done on early intervention programs? >> yes, i am aware of the focus by the agency for health care quality on comparative effectiveness. we have submitted recommendations in terms of the kinds of questions we feel need to be asked. i think it is so critical that parents have a sense of whether one thing is effective more than another treatment. the other aspect of comparative effectiveness work has to do with method of service delivery. what we know now is that when children receive care, they often receive it by a set of

professionals that work with the child. the parents of himself has act as a case coordinator. there are other models for how to effectively work with a child with autism. it has a kind of financial aspect that goes to coordinating care. we feel this model is much more affected. it is an example that needs to be done to look at different models of service delivery it is ultimately -- and is ultimately more cost-effective. the other question has to do with personalized medicine. we know that autism is not going to be a one size fits all kind of treatment approach. we need to understand the effectiveness of understanding

-- the medical conditions that parents talked about, genetic conditions, and how to direct treatment approaches. we are at a very early stage. they seek out answers themselves and often are acting on decisions. >> that kind of brings me to mr. cobb's. i come from a rural state, and we don't have a lot of the access to facilities that people in urban areas do. finally, i became more interested -- more attuned to

the issue of autism a few years ago. families with young children are at their wits' end. they do not know what to do. there are some residential programs for traditional things you're talking about. correct me if i'm wrong, and i think there is evidence that the earlier you get to these kids and provide them with supportive services, interventions by trained people that know what they're doing, that they really do get over a lot of these things. they get over a lot of the problems -- the earlier you get to them, the more effective it is. how you do -- how you get to them if you're living in at no.

what, oxford, or someplace like that? this project of looking at telehealth, and you can get together with a group of professionals early on with high-speed internet, it is like your in the doctor's office, it is like you are right there. tell me a little bit about -- you have been in this experimental program to go since last time we have continued services to continue the study and test the longevity. >> have you talked with other people? you're the head of the iowa autism council. i do not know how many people are on this system right now. have you talked to them about this? what interest is there?

>> that is a great question. in fact, just this morning, we were talking. it is the light bulb that goes on. the mean i can get services where and when i need them? for instance, if he is having a great behavior day, we can replicate that. we can build on that with the foundation of applied behavior analysis and other proven methodologies. if he is having a bad day, it is not because we are in an abstract physician's office, it is because there is something that has triggered that behavior. it is that immediate response to track down what is causing behavior. we can get immediate results when the behavior is happening, both good and bad. >> the other thing that got me thinking about this is at other times, kids with autism do not act up when they are in a

doctor's office, and when you get home, they do. >> in our case, it might be the exact opposite. the environment may have to much stimulus in the area. you will get the reverse effect. maybe we went in for any rate, but all of a sudden we have a behavior taking place. and we may have believed that environment without properly giving them the care -- we may have to leave the environment without properly giving them the care. to dovetail on what ms. dawson said, it is also a great way to bring a comprehensive team together to treat the child in a natural environment. >> have we been doing anything to show comparative effectiveness? is this something that the million dollars will start taking a look at? does anybody know that?

have we looked at these early intervention, telehealth type programs? >> not with respect to the teller health -- telehealth study i am aware of. >> the recovery act has given us this opportunity to open up the doors for additional work. we do have exciting proposals on just this topic for autism specifically. i think this is the chance to see real progress in this arena. it is not only for the child, it is for the family. that is where some of the big implications will be. >> i am assuming you are not on this telehealth?

>> we have really hit all aspects. we found out to the medical side first and found out about aba, and used both. i feel both have been essential in robin's progress. i know a lot of other families agree with me that at least exploring if your child does have these biomedical issues, you're going to get better results when you're using the aba. >> how would you feel as a parent if you had access in your own home, 24/7, so that anything that happens in terms of behavioral problems, you would have ready access to train specialists. -- trained specialists? >> behavior's became not nearly as much as an issue. for me, the medical care that

she needs i can only obtain at our doctors' offices. if i am taking her in as an example, monthly right now, she has been undergoing a six hour infusion therapy in our doctor's office. that has to be done for us. it is a drive no matter what. >> i have taken 10 minutes of time, so i will yield. >> your very kind. i appreciate you calling the hearing. it brings back memories of other hearings we have had. we will just try to tailor programs of support that are needed that will help make positive contributions. i am wondering, is there something that any of you have

in mind to suggest -- and financial support and willingness for government to try to figure out ways to be more supportive, benefits of some kind? insurance programs that maybe the government can help support in terms of costs of premiums or disbursements for sharing responsibility? it seems to me that we have a lot of organic medical disabilities and frailties that come within the area of insurance that this challenge is just not being helped with. i wonder if you have any thoughts. >> i would like to comment on this notion of early intervention and actually tell you about the steady that the doctor was referring to. this was the study that i was the principal investigator of

this study, funded study where children began the intervention below 30 months of age. it is the first clinical trial that has been conducted with toddlers who are at risk for autism. it is the standard care in the community or intervention that focused not only on working directly with the child, but also taught the family how to use intervention strategy so that intervention occurred throughout the daily activities with the child. the intervention went over a two-year. -- a two-year period. all assessments were done blind with respect to the knowledge of whether or not the child received early intervention. they all had iq's in the mentally retarded range.

their iq -- the increased iq -- the average iq increased. their diagnosis was less severe. it was a less severe diagnosis, and remember, it was only two years. early intervention could continue for at least another one or two years. we know these are effective. the studies are impressive and will come out soon. what we don't have is two things that limit access. one is financial support for families. it is going to save us money. it is going to help families. it is going to help individuals take advantage of some of the

programs we have heard about at the community colleges and so forth. the second piece is training for professionals and parents. we're working now with infants and toddlers. they're teaching parents to deliver the interventions. in many of these interventions, we need programs such as telemedicine or web =based -- web-based programs around the world like africa and india, to train professionals. comprehensive coverage and professionals is going to be absolutely key. we will get kids on the right trajectory, and we will look step-by-step throughout the life span how we can continue to support people with autism to

become the most productive citizens they can. >> is a very interesting and helpful analysis of some of the options we should seriously consider. you were seeking recognition, and i wanted to call on the next. >> the task force looked at this in mississippi extensively because of our financial system -- financial situation. it is already a program that is out there federally. it needs to now include behavioral services, because many of these children are starting to be identified very early. i can speak to the success of that. as we were in san antonio this summer, i met a precious child named catalina. they began behavioral therapy after a year. the child is 4 years old now and

is absolutely amazing. senators, u.s. never recognized that she was a child on the spectrum. -- senators, you would never recognize that she was a child on the spectrum. states have an option whether they can give a not as an specific waiver -- and on to some -- an autism specific waiver. i ask that you not give that waiver. the other thing that dr. dawson mentioned is private insurance. there are virtually no policies in our states that cover autism therapies. in fact, not only does it not be covered behavioral therapy, but senators, it only covers 20 visits of any type of speech ot or pt. usually by the first six weeks

of the year, you have run through your insurance coverage for your child. that is. speech and -- that is combined speech and ot. the visits are kind of costly. those are the things that we looked at as to gaps that needed to be filled. >> we ought to introduce a bill to modernize our laws on medicaid and reimbursement. this ought to be included. >> how to people afford to do this? >> they can't. >> frankly, they can't. we have been working quite a bit to get insurance in virginia. it is a foxhole by fox whole thing. in virginia, the average income is about $40,000 or $50,000.

the average cost of service is about $85,000. the families have to do without. it is being done on a state-by- state basis. if you could do some sort of insurance preemption, that would be ideal. this is an educational issue, not a health issue. if you see my sons, it is clearly a combination of education, and health related problems. >> another thing that i would be remiss if i didn't quickly tell you is the financial stress that it relates to families -- the divorce rates. conservative estimates is that a minimum of around 80%. there are some estimates -- her divorce rates were among 90%.

these are absolutely incredible numbers. we lost to parents in mississippi this year who could no longer handle the stress of having the child on the spectrum. that is not unique to mississippi. those are things that we foresee all around the country. >> i would like to go ahead and piggyback off that statement. the government needs to move rapidly to go ahead and advance a great technologies such as telehealth technologies and insurance policies. in order to make a true change, we have the have the standards and reimbursement model for applied behavior analysis and other proven therapies as miss dawson said.

the private insurance companies typically did not reimburse that for families with autism. >> i wanted to say that we do have a unique opportunity with health care reform to address this issue. the house bill does include coverage for behavioral intervention for autism as well as ava. i think it is critical that with this opportunity, what we're looking at in terms of health care reform, we need to include this. in terms of the financial payoff down the road, it is going to be tremendous. it will help with the tsunami, and the impact on families will be tremendous. we must not miss the opportunity for federal mandate of insurance coverage for treatments that are

cost-effective and that work. >> [inaudible] >> we're going to introduce something together. we will find out the details a little later. >> from the iacc perspective, we have a service group made up of family members as well as somebody from cms who has been leading the charge -- the president of the autism society of america. they have been listening to families about these issues and trying to come up with recommendations. i am sure that group would love to have an audience and get some ideas that they have been grappling with.

>> you just wrote about standards. someone mentioned that you get all kinds of misinformation. you have been on this telehealth for three years now. when you mention standards, is that what you're talking about? >> absolutely. when we start our treatment program, it is a comprehensive treatment program. unfortunately, families can pop up in the internet search and tiepin -- type in telehealth treatment. i do not see how it is possible to form a true therapeutic bond and go ahead and treat the child. is very disconcerting.

you can quarry pretty much anything with autism and related disorders. whether it is some way to repair your car, somebody who can paint your house, it is so sporadic. parents do not have a consistent place to ensure that they're going to receive quality care. i am encouraged that you have folks meeting and talking about new treatments. until we get a set of parameters for standards so that when parents go to get treatment, especially over at innovative technologies like telehealth, they have the assurance that they will get a trained, quality professional. and they're actually standards that they can rely on. right now, those aren't there. >> i just wanted to mention a program that is a wonderful

example of a public-private partnership that is beginning to address this issue of standards. that is the odd to some treatment network. -- autism treatment network. cystic private -- to cystic fibrosis was in the same boat, not getting quality care with no standards on how a child should be treated. it is 15 hospitals that care for children with autism that have come together both to look at quality of care, models of care as well as develop standards that can be practiced standards, published in journals that physicians can use to guide things like assessments, behavioral interventions, and so forth. there is a mechanism where this is beginning to be addressed. it is indeed very early stages.

it is co-founded by of autism's speaks -- autism speaks. >> who does this? who is charged with responsibility for coming up with standards that have to be met so we don't have people out there that don't know what they're doing trying to treat people? >> you have stumbled onto a really important issue. it is not unique to autism. we have built standards that are overseen by the fda. in the broader psychosocial intervention arena, there is not an agency or a licensing body that oversees this in quite the same way. it is a gap as we look at this. even in this healthcare reform

consists -- discussion, when you talk about treatments that may not be a one of the 15 hospitals but involves training families to administer care 10 or 15 hours a week, how does that get reimbursed? how do we set standards for the degree of care and level of care that is needed to be reimbursed? >> did you ask me that, or as a rhetorical? [laughter] -- is that rhetorical? >> i am a psychiatrist. [laughter] >> how do i feel, doctor? [laughter] >> that's true. again, obviously we have a whole range of interests here.

everything from the research into the causes -- obviously, there is a lot of talk about vaccines. you covered that in your testimony. we had a couple of questions about the number of vaccines and how we set up that kind of a steady -- a study. ms. halverson talked about the kind of a steady. -- study. if you wanted to determine that, i did not know how you would do that. >> one of the reasons i wanted to bring that up, senator, is that there are some many families right now -- and this greatly concerns me. i believe in vaccines, i think

they're one of the greatest public health achievements that we have ever had. i am a huge proponent of it. what i am concerned about -- there are so many families that are not vaccinating their children. and we do vaccinate our children. there are some many that are not vaccinating because of what they perceive as a huge risk. i am concerned that the nih and the cdc, with their failure to look at this and give good, valid, scientific studies free of people that might have some interesting in this, that they are doing more harm to lower the immunization rates than anybody that is yelling out there to be concerned about vaccines.

there are so many people right now that are choosing not to vaccinate their children. i do not think that population is going to be as difficult as scientists perceive that it is. within the autism community, we see that going on right now. many of us feel that vaccines are very important. we hear families, to us and say, we are not going to vaccinate our kids. having a husband as a medical professional, i worked as an attorney in public health. that greatly concerns me. they do not have any of the possible health characteristics that some of us who did have children with vaccine reactions have that could have been red flags. now that we know that, it could have been studied. the scientific community can

find these people to do this. >> go ahead. ms. halverson. punch the button. >> i was going to mention, i do not know how many people would be needed to be included in a steady -- in a study, but in the chicago area, there is a practice of about 35,000 patients. many of them choose not to vaccinate, and their optimism rate is next to nothing. there are populations -- and there autism rate is next to nothing. the homage people can argue on that. -- the amish people can argue that. it is people from every walk of life.

>> i do not know about that. >> let me be very clear on this point. i am representing what we know about the scientific evidence so far. that is really an unequivocal. it is not that cdc and nih and multiple studies have not looked at this, this problem has been looked at over and over again. 16 large-scale studies that have plowed into this question that many different levels and many different populations. whether you read those studies or institute -- >> you mean the total number -- >> the possibility of a connection with particular formulations or without. and the prevalence of autism. whether this is a risk factor. studies have found no risk of a connection.

we have heard that from the institute of medicine. we have heard it from the -- >> when i mentioned getting a study done of the number of vaccines in the first two years of life, compared to 20 or 30 years ago, would be the incidence of optimism -- autism that received 29 vaccines compared to a cohort of kids that got five or six or seven or eight, what they did in 1980 compared to 1929. i do not know any studies. >> are you asking the question, as the prevalence of what is an increase over the time when the

number of vaccines of increase, is there a relationship? we know they have both gone up. >> but what we don't know is, is there any causal relationship between the number of vaccines that are given -- is 29 over two years now. in 1980, it was 8. is there any causal relationship between the number of vaccines, 29 in two years, and higher incidence of autism. we don't know that. >> the way to do such a study clearly would be asking -- we would have to do randomized control. we would want to look very carefully at those who are vaccinated and those who are unvaccinated or vaccinated in a

different way. that is when we get into ethical problems. >> she just mentioned somewhere in chicago -- i do not know where this is, but they do not vaccinate. are there places like that? and you mentioned people that there are -- you mentioned that their people not vaccinating their kids. >> the question one would ask is not only about does this have an impact on autism, but what is the impact on other diseases, a whole series of preventable illnesses for which we know the cause diarrhea we know the vaccines can prevent them. -- for which we know the cause of, and we know the vaccines can

prevent them. is there a potential relationship here? >> senators, this is where there are many people in the medical community -- and i mentioned the doctor that feels like this issue has not been appropriately evaluated, particularly also looking at sub populations to look at whether -- their mitochondrial issues involved with that. i think it is imperative that we look at those particular studies. i and the stand the ethical thing about asking parents to do this.

senators, we already have populations of families that are not doing this anyway. absolutely, we should look at whether their children developed measles. quite frankly, senator, measles and autism? >> if you had a choice? i had all those diseases when i was a kid. we had imams, measles, chicken pox, everything like that. >> is important to recognize that many of us were exposed to those illnesses and did quite well. they are also fatal. i grew up as a physician watching children died with meningitis -- children die with meningitis because we were not preventing those diseases at that point in time. i can tell you, to think that we

have been able to finally succeed in that sphere, and to go backwards --- we are better than that. the science tells us we are better than that. >> i know we're better off in that regard. i would like to see it -- i have had a lot of hearings and talked to a lot of professionals about whether or not we need all of those vaccinations in the first two years of life, or should they be stretched out longer. it is an open question. i do not know the answer. >> i have to point out also, vaccines do not always work overtime. my son is a walking example of that. the chicken pox vaccine was brand-new when he was 2 years old. the doctors said i should get it for him. i had chickenpox, it was not a

big problem, but i missed a couple of weeks of school. six months later, after being immunized, he developed a full- blown case anyway. that was my first clue that i was not necessarily going to choose immunizing my daughters for chickenpox, my future children at the time. i was pregnant at the time that my son developed chicken pox six months after his vaccine. had i not had it as a child and had a lifelong immunity, my baby could have been at risk for birth defects as i understand it. there is more to consider than just a blanket statement of the vaccine is automatically going to protect. it does not always work that way. >> miss dawson. >> in many ways, i agree with the doctor that we have

answered some questions definitively. it does not appear that thimeracol accounts for this large increase in the prevalence of autism. i do think that there are important questions that still remain to be addressed that have not been addressed by the large epidemiology studies that have been conducted so far. in particular, i think it is important to understand the role of underlying genetic in the medical susceptibilities and whether they may lead to an adverse response to an exit -- to a single vaccine or a set of vaccines that are given over a short period of time. the era of personalized medicine is beginning to and used our practice of treating infectious disease.

the underlying variation in genetics has not been studied in the context of responses to vaccinations. autism's speaks -- autism speaks looks at mitochondrial disorder, responses to vaccines, developing seizure disorders, and whether these may count for, again, some minority of cases of autism. another thing i might suggest is, i agree with the doctor that randomized study in which we ask parents to forgo getting vaccines is not ethical and not feasible. we could, however, study the potential role of vaccines in the context of two ongoing nih

studies. one is a study that we are finding, following a cohort of that risk infants. infants who have an older sibling with autism who have a higher chance of developing its. -- developing it. some parents are choosing to vaccinate, and some parents are choosing not to vaccinate. we must leverage those studies to see the effect that outcome. the other study is the national institute of health's national children study. this is 100,000 children that are being followed from conception through adulthood. keep in mind that 600 individuals will develop and autism disorder -- an autism

disorder. we oversee the expert advisory panel that is advising the national children's study on how to leverage this study. one of the weaknesses in the current design is that they are not collecting medical records. they are not collecting information that would inform how parents are vaccinating their children. again, with many parents choosing not to vaccinate their children, this is another opportunity with the collection of medical records that we could leverage an ongoing study to address this important question. and i want to say that our position is one of very evidence based -- we are very agnostic with respect to whether the vaccines play a role or not. by addressing parent's

questions -- we think is going to be critically important for public health. >> i have been a big supporter of that children's study. i have used my position to make sure that we continue the funding for it and keep it going. i think it is one of the most vital longitudinal studies we have ever done. you're telling me that of all the money we have put into that , this is a 20-year -- how many years is this? are they not keeping medical records? >> they do not have the funding to go back, obtain the medical records, and extract the

information we need. it also affects our ability to address really critically scientifically based questions like, what is the effective of a flu infectin during -- infection during pregnancy. these are all obtained through a questionnaire rather than medical records. our advice to the national children's study is that this is a key component. the reason for not doing it is strictly financial. they just don't have the funds to do it. >> i want to make sure that you do not go away with the idea that they do not have medical records. they are not able to obtain the original records with the current budget. they have looked at the possibility of getting supplementary funding that would allow them to obtain the raw records from the physician of

referral. that has not been done. dr. dawson is right about that. i know we're running out of time, but i just think it should be set by somebody here that there will be a time in the future where we will have a much better understanding of the environmental causes of autism. one concern that people have is that if we get stuck looking at one thing over and over again, we will miss the opportunity to look at another cause. we agree that the evidence now is very clear -- it does not explain very much about what we know about autism. we may be able to eliminate a rare event that is in place here that would connect the two. all the evidence says this is not the main story. the question for us is, where is the main story? where should we be looking?

i would hope that the focus on this topic, particularly in this conversation today does not obscure the fact that there is probably something out there that is truly important that we need to be focusing on very quickly and move into very quickly. the hope is that the kinds of studies that dr. dawson suggests that are agnostic also include some postnatal factors and we will begin to see a pattern emerge. so far, we do not have that. >> we're going to explore that for the idea -- i wrote that down. i will have to find out about that. again, i know we're out of time. we have three things -- let me see if i can capitalize this. the research and needs to be ongoing -- the research needs to be ongoing with what is causing

this. then there is the other elements of interventions and helping families right now. we know families in the next several years are still going to be having kids with autism. we have to think about what we do about early interventions and how we structure that better. the next thing is, we have a whole group of people out there that are going to be adults pretty soon with autism. how do you work with transition programs for independent living and things like that. it is a big task, but one that we can't shirk from trying to address in multiple ways. that is what this committee is going to try to do. i have picked up some good ideas this morning. is good to be refreshed of the information. i wish i had a simple answer.

the you have anything dad? -- do you have anything to add? >> thank you for interest. >> thank you for your leadership. >> i would just encourage you will to continue to talk with more of our independent researchers. i really take issue with dr. insel's statement. all of the evidence says this is not a connection -- it does say that thimeracol is very much a concern. i would encourage you to talk with other doctors, i could name a whole bunch of scientists that you would clean all lot of really great information from. >> i believe in open inquiry. i do not believe in closed

mines, closed doors, or open inquiry -- or closed inquiry. i want open inquiry. the vast majority of the scientific community, after looking at this, says there is no correlation, we have to move on to something else. again, i am always for open inquiry. any other last things before we go? >> chairman hock -- cochran, thank you for telling -- think you for letting us tell the story of the amazing technology that has helped our family. >> kids that just been diagnosed, they can't go to one office every day. you are an example of what happens when you have someone, when the child is acting up, a professional with the standards can come in and say, here is what you should do.

>> exactly. >> the problem is, you do not get reimbursed. >> you hit the nail on the head, sir. >> if you went to a hospital, there might be some reimbursement for that. >> somewhat. as the others pointed out, there is a complete public and private insurance breakdown. >> hopefully, we will look at that issue of reimbursement. i almost put that in preventative -- that prevented category of services. again, thank you all very much. to me, it has been very informative. we will continue our involvement in this issue. it bedevils us all on getting a good handle on it.

thank you for the interagency task force. thank all of you here. believe me, we will continue to pursue open inquiry and if there are questions out there, let's have some answers. thank you all very much. calle[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> two journalists held by north korea for almost five months returned to the united states today. this came after former president clinton met with north korean leaders. we will show their arrival next on c-span. coming up shortly, president

obama talks about the economy during a prison -- during a visit to indiana. after that, changes on the health care system. and later, president ahmadinejad is sworn in for a second term. on tomorrow morning's "washington journal." john solomon joins us for a discussion of the news. after that, andrew jakabovics. a european parliament member talks about europe's economy and their health care system. and we will get an update on the nomination of judge sotomayor and the government's cash for clunkers program. "washington journal" begins each morning at 7:00 eastern. and later, a senate panel examines the financial state of the united states postal

service. they announce they expect to lose $7 billion by the end of the fiscal year. it begins at 10:00 eastern. . le>> please tell me in welcoming home laura ling and euna lee.

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[inaudible] >> we were taken to a location, and when we walked through the doors, we saw standing before us president bill clinton. [applause] we were shocked, but we knew

instantly in our hearts that the nightmare of our lives was finally coming to an end, and now we stand here, home and free. euna and i would just like to express our deepest gratitude to president clinton and his wonderful, amazing, not to mention supercool team, including john podesta, justin cooper, david straub, and the united states secret service, who traveled halfway around the world and then some to secure our release. we would also like to thank president obama, secretary

clinton, vice president gore, who we also call al. [laughter] the swedish ambassador, and the people at the u.s. state department worked so hard to win the release of their fellow americans. steve bing and his crew, and the dow company, and i know that i am for getting a bunch of instrumental people right now, but forgive me if i am a little incoherent. to our loved ones, friends, colleagues, and to the complete strangers with the kindness of hearts -- kindest of hearts who showed us so much love and sent us so many positive thoughts and energy, we thank you.

we could feel your love all the way in north korea. it is what kept us going in the darkest of hours. it is what sustained our fate that we would come home. the past 140 days have been most difficult, heart wrenching time of our lives. we are very grateful that we were granted amnesty by the government of north korea, and we are so happy to be home. we are just so anxious right now to be able to spend some quiet, private time getting reacquainted with our families. thank you so much. [applause]

>> ladies and gentlemen, the families asked me to say a few words, and on their behalf, all of us, and on behalf of the staff and families of current tv and my co-founder, joel hyatt, we want to welcome laura and euna home. we want to thank president clinton for undertaking this mission and performing it so skillfully, and all the members of his team who played key roles in this. also, to president obama, laura mentioned this, but president obama and countless members of his administration have been deeply involved in this humanitarian effort, to secretary clinton and members of the state department, several of whom are here, they have really put their hearts in this. it speaks well of our country

that when two american citizens are in harm's way, that so many people would just put things aside and go to work to make sure that this has had a happy ending, and we are so grateful to all of them, to the thousands upon thousands of people who have held laura and euna in their careers, who have written letters and called and said emailed, we are very grateful. to steve bing and all those who made the flight possible, we say a word of deep thanks as well. this has been an ordeal for them, but i want you all to know, your families have been unbelievable, unbelievable. passionate, and bald, committed, innovative -- you will hear a lot of -- passionate, and in vaults.

-- passionate and involved. laura, your mom has been making your special soup for two days now. to everybody who has played a part in this, and again, a special thanks to president bill clinton, my partner and friend. ladies and gentlemen, thank you for coming out. we are going to let these families have a full and proper union now, but they give for coming out. [applause] -- thank you for coming out. >> once we knew that they were on the plane, the reunion that we have all seen on television i think is a source of happiness, not only for the families, but for the entire country.

i want to thank president bill clinton. i had a chance to talk to him for the extraordinary humanitarian effort that resulted in the release of the two journalists. i want to thank vice-president al gore, who worked tirelessly in order to achieve a positive outcome. i think that not only is this white house obviously extraordinarily happy, but all americans should be grateful to both former president clinton and vice president gore for their extraordinary work. my hope is that the families that have been reunited can enjoy the next several days and weeks, understanding that because of the efforts of president clinton and al gore

they are able to be with each other once again. we are very pleased with the outcome, and i am hopeful that the families will be able to get some good time together in the next few days. thank you very much. >> on his way to indiana today to make a speech on the economy, obama talked about the two u.s. journalist released from north korea. [applause] >> thank you. thank you very much. thank you so much. please, everybody have a seat. thank you so much. it is wonderful to be here.

thank you so much for their wonderful welcome and a great introduction. it is great to be back in indiana. [applause] i flew out here was someone i think the people of indiana have known for a long time. that is our great senator, and by. please give him a big round of applause. [applause] it is nice to get out of washington and spend some time with people who actually sent me to washington. [applause] too often, there are those in

washington who focus on the ups and downs of politics. my concern is the ups and downs in the lives of the american people, the families feeling the pain of this recession, the folks i have met across this country who have lost jobs and savings and health insurance, but have not lost hope. the men and women who still believe in the capacity, the ability of this nation to meet the challenges of our times. these are challenges you know all too well here in elkhart county. this area has been hit with a perfect form of economic troubles. over the last few decades, you have borne the brunt of a steadily weakening manufacturing. you have felt the impact of the struggles of the american auto industry and the repercussions that have hit the midwest, especially hard. your living every day with the

consequences of this recession and a financial meltdown. you have felt it in the form of lost jobs and lost savings. the elkhorn area has experienced the second greatest increase in the rate of unemployment in the country, up 10 points in a year. it is an astonishing statistic. there have been times when nearly one in five people in this area have been looking for work. you have seen factories closed and your sons and daughters move away in search of jobs and opportunity. this is more than an economic crisis. this goes to the heart and soul of the community and tests of the strength of families and the spirit of good people, hard- working folks who have given their all to a company and now cannot overturn. -- now do not know where to turn. some suggest it is all somehow

inevitable, and only way to get ahead is for places like el -- like elkhorn to be left behind. your that argument sometimes in washington. but you and i know that the truth is that lee opposite. i am here because i believe our ability to recover and prosper as a nation depends on what happenings it -- depends on what happens in communities just like this one. [applause] the battle for america's future will be fought and won in places like elkhart, detroit's, pittsburg, self been, youngstown, and cities and towns across indiana and across the country that have been the backbone of america. it will be won by making places like el card what they once were and can be again, centers of innovation and ingenuity and opportunity.

bunning engines of american prosperity. as the world grows more competitive, we cannot afford to run the race at half speed. if we hope to lead this century like we did last injured, we have to create conditions and opportunities for places like elkhart to could -- to succeed. we have to harness the potential, the spirit that is waiting to be awakened all across america. that is how we will rebuild this economy stronger than before, strong enough to compete in the global economy and avoid the cycles of boom and bust that wreaked such havoc on our economy. strong enough to support the jobs of the 21st century and some strong enough to unleash prosperity for everybody, not just some. before we can rebuild our economy for tomorrow, we have to rescue it today. that is why we passed and recovery act less than one month

after i took office, and we did so without any of the year marks or poor rural spending that is so common in washington d.c. let me just talk about the so- called stimulus package because there has been a lot of misinformation out there about the recovery act. let me tell you what it is and what is not. it was divided into three parts. one-third of the money has gone to tax relief for families and small businesses. one-third of the money is cutting people's taxes. for americans struggling to pay rising bills was shrinking wages, we kept the campaign promise to put a middle-class tax cut in the pockets of 95% of working families. [applause] it began showing up in indiana

households about three months ago. within 40025 small businesses in indiana have received sba loans are the recovery package. one-third of the money was tax cuts. another third of the money has been for emergency relief that is helping folks who have borne the brunt of this recession. for americans who were laid off, we expanded unemployment benefits, and that has already made a difference for 12 million americans, including 220,000 folks right here in indiana. we are making health insurance 600% cheaper for families relying on coper while looking for work. -- relying on cobra. we were able to reduce our costs

by 65% so they could keep their health care while they were looking for jobs. four states facing a historic budget shortfalls, we provided assistance that has saved the jobs of tens of thousands of teachers, police officers, and other public servants. that is the second have, support for individuals and small businesses and state that fall on hard times. the last third, is for investments that are not only putting people back to work in the short term, but laying a new foundation for growth and prosperity in the long run. these are the jobs bill in the future of america, upgrading our roads and bridges, renovating schools and hospitals. the elkhart area has seen the benefits. dozens were employed to

resurface the runway at elkhart airport. the heart city health center has received recovery dollars to expand services and hire additional staff. as part of the recovery plan, we are making a historic commitment to innovation. the recovery act creates jobs, dublin our capacity to generate renewable energy, billy new smart red -- building a new smart red to carry electricity from coast to coast. provide the largest boost in basic research in history to ensure that america leads in the breakthrough discoveries of the new century, just as we led in the last. that is what we do best in america. we turn ideas into inventions and inventions into industries. history should be our guide. the united states led the world's economies in the 20th-

century because we led the world and innovation. today the competition is keener, the challenge is tougher, and that is why innovation is more important than ever. that is the key to good, new jobs in the 21st century. that is how we will insure a high quality life for this and future generations. with these investments, we are planting the seeds of progress for our country and good paying jobs for the american people. that is why i am here today. to announce a $2.4 billion in competitive grants to develop the next generation of fuel- efficient cars and trucks, powered by that next generation of battery technologies, all made right here in the usa. [applause]

made in america. [applause] for too long, we fail to invest in this kind of innovative work, even as countries like china and japan were racing ahead. that is why this announcement is so important. this represents the largest investment in this kind of technology in american history. i am committed to a strategy that insures america leads in the design and deployment of the next generation of clean energy vehicles. this is not just an investment to produce vehicles today. this is an investment in our capacity to develop new technologies tomorrow. it is about creating the infrastructure of innovation. indiana is the second-largest recipient of grant funding.

it is a perfect example of what this will mean. you have perdue university, notre dame, indiana university, and they will all be receiving grant funding to develop degree and training programs for electric vehicles. [applause] that is number one. we have a small business in indiana that will develop batteries for hybrid and electric vehicles. you have allison transmission in indianapolis, delphi in kokomo, and magna located in muncie, and all will help develop electric drive components for commercial and passenger vehicles. right here in elkhart county, navistar will receive a $39 million grant to build 400

advanced battery electric trucks with the range of 100 miles. [applause] just a few months ago, folks thought that these factors might be closed for good. now they are coming back to life. thank the american people. the company estimates that this investment will help create or save hundreds of jobs in the area. already, folks like herman are being rehired. overall, the companies believe these investments in battery technology will save or create thousands of hoosier jobs. these jobs would not be possible if it were not for the leaders

in congress who supported the recovery act, leaders like evan bye and andrea carson. these grants will create tens of thousands of jobs all across america. today, vice president biden is announcing grant winners in michigan. members of my cabinet are fanning out across the country, announcing recipients elsewhere. we are providing incentives to businesses large and small that stand ready to help us lead a new, clean energy economy by developing new technologies. i do not want to just reduce our dependence on foreign oil and then in of being dependent on their foreign innovations b.g.e. end up being dependent. i want to be able to build a hybrid car here, not import it.

i do not want to have to import a windmill from someplace else. i want to build a windmill right here in indiana. [applause] i want the cars of the future and the technologies that power them to be developed and deployed right here. that is just the beginning. in no area will innovation be more important than in the development of new ways to produce, use, and save energy. we are not only delay our capacity to generate renewable energy, building a stronger and smarter electric grid. we have helped reach an agreement to raise fuel economy standards. for the first time in history, we passed a bill to create a system of clean energy incentives which will help make renewable energy a profitable kind of energy in america. while helping to end our dependence on foreign oil and protect our plan for future generations. the bill passed the house and we

are working to pass legislation through the senate. we know that real innovation depends not on government, but on the potential of the american people. if the american people get a clear set of rules and know what is needed, what challenges we have to meet, they will figure out how to do it. that is why our budget makes the research and experimentation tax credit permanent. this is a tax credit that helps companies afford what are sometimes very high costs in developing new ideas and new technologies and new products. that means new jobs. this tax credit returns to dollars to the economy for every $1 spent. for a long time, we are just trying to renew it once a year, and companies did not know whether they would be able to get it for the next year. that has changed. we have now made permanent. i also proposed reducing to zero the capital gains tax for

investments in small or start up businesses. small businesses are innovative businesses. they produce 13 times more patents per employee than large companies. in order to lead in the global economy and ensure that our businesses can grow and innovate, we also have to pass health insurance reform that brings down costs. [applause] reform that brings down costs and provide more security for folks who have insurance, and affordable options for those who do not. i promise you, we will pass reform by the end of this year, because the american people needed. the american people need some relief. [applause] we will have to make it happen.

in fact, the recovery plan began the process of reform by modernizing our health care infrastructure. we took so long overdue steps of computerizing america's health plans, that can reduce waste of protecting patients' privacy. it offers patients the opportunity to be more active participants. it will not have to felt the same form a dozen times or rely on remember when talking to your doctor about medical history. those things reduce your costs, lower premiums, and give you more security in your healthcare. in addition to energy and health care, we also know that the nation that out educates us today will now compete us tomorrow. we were making a historic commitment to strengthening and improving education from cradle for career.

right now, our schools continue to trail many of our competitors. that is why challenge states to dramatically improve achievement by raising standards and modernizing science labs, upgrading curriculum, for new partnerships to promote math and science, and improving the use of technology in the classroom. i have set this goal. in the next decade, by 2020, america will once again have the highest proportion of college graduates in the world. we used to be number one. we will be number one again when it comes to college graduates. [applause] to reach this goal, we have provided tax credits and grants to make college education more affordable. we have made a historic commitment to community colleges, which are the unsung heroes of american education system. america can and must have the best educated, highest skilled work force in the world, because if we are building new cars and

here in america, if we are building a new clean energy grid in america, we also need to build engineers and america and scientists and skilled technicians right here in america. of all these pieces in a fitting together. energy and innovation, health care and education. these are the pillars of the new foundation that we have to build. this is how we will not just rescue the economy, but we will rebuild it stronger than before. a lot of people are looking to defend the status quo. there are those who want to see political events, they want to oppose these efforts. some of them caused the problems we have in the first place, and suddenly they are blaming other folks for it. [applause]

they do not want to be constructive. they just want to get in the usual political fights, back and forth. sometimes that is fed by all the table chatter on the media. you and i know the truth. we know that even the hardest times, against the tough stalks, we have never surrendered. we do not give up. we do not surrender our face to chance. we have always endured. we have worked hard, and we have fought for our future. our parents had to fight for their future. our grandparents had to fight for their future. that is the tradition of america. this country was not built just like riding in complaining -- byte griping and complaining. it was built by hard work and taking risks. that is what we have to do today. i know these are tough times. if you have not lost a job, you

know somebody who has, maybe a family member, neighbor, or friend. you know that as difficult as the financial struggle can be, the sense of loss when you lose your job is about more than just a paycheck. we define ourselves by the work we do. it is a source of pride, the sense that you are contributing, supporting your family, and doing the right thing. the truth is, it can be easy to lose hope, especially when you see a lot of folks out there who fail to meet their responsibilities, from wall street to washington. it can be easy to grow cynical when you see politicians say one thing and then do another, or say one thing in and do nothing. when you have seen decades of broken promises and broken politics. this is a rare moment in which we are called upon to rise above

the failures of the past. this is a chance to restore the spirit of optimism an opportunity which has always been central to our success. we have to set our sights higher, not lower. we have to imagine a future in which new american cars were powered by innovation, a future in which cities that led the global economy before are leading it again, brighter future for elkhart, for indiana, and for the united states of america. that is what we are fighting for. that is what this plan is about. that is what you are about. that is what we are going to achieve in the weeks and months to come. thank you very much, everybody. god bless you, and god bless the united states of america. thank you. [applause] [captioning performed by national captioning institute] [captions copyright national

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>> we just heard president obama talk about health care and the economy. according to a new poll, americans are worried about health care legislation adding to the budget deficit, but they generally approve of major pieces of the bill, such as a government-run option. here's more about that survey with peter brown. this is about 20 minutes. what i am here to talk about the latest poll that deals primarily with health care. quinnipiac is the largest private university in the state of connecticut. what is interesting about this poll, in a political sense, is that we are seeing something that we rarely have seen in america in recent political

history. the budget deficit is becoming a big deal to average voters. over the last several decades, candidates and organizations have tried to use it to mobilize political support and win elections. frankly, it has not been very effective. ross perot tried in the 1990's. he finished third. you may remember 1984, when walter -- walter mondale campaign on the need for tax increase to eliminate the deficit. he carried one state. what we are seeing in this poll is substantial public concern about the deficit, so much so that majorities are willing to throw health care reform overboard if they think it will add to the deficit.

voters say they are more concerned that health care will add to the deficit then that congress will not enact health care reform. but a 57-37% margin, voters say they would rather have no health care reform and health care reform that added substantially to the deficit. also, one other interesting fact, when you ask voters if they would want a bill that was just a democratic bill, if it only had democratic support, 59% say no. it indicates the rising public concern about the deficit. president obama, who as we all know had very high job approval ratings during his first several months of office. in this poll, 52% give him a

thumbs down a job approval on health care. 39% approve of his performance, substantially different from july, the last time the question was asked on a national poll. one other ominous sign for the president on health care and public opinion, almost three in four voters, 72% said they do not believe that obama can produce a health care reform package or bill that will not add to the deficit. the president says he will be able to do that. obviously, voters are becoming skeptical. another interesting piece of data in this survey is that by and large, more voters think it

will not help the quality of their health care, roughly one in three, then think it will, one in five. this is not all bad news for the president. more than 60% of voters still support having what as been called a public auction, but the number has decreased about 5 points over the past month. the majority say they would prefer it to get their health insurance from a private insurer. much of the change in public opinion, and the reason why it the president's numbers are down and support for some new programs are down is independent voters. there are people who voted strongly for president obama last november, and in the early months of his administration, they have been supportive of him and his policies. but now, majorities are voting the other way, so does become or

indicating that they are less supportive of the president. i will be happy to take your questions. >> you point out in question 30 that the president has repeatedly said he will not sign a bill that is not paid for. the house and senate proposals supposedly are fully offset. why this reaction? it looks like people just do not believe in government anymore. >> i think that is a fair analysis. obviously, those of us in this room who cover politics or do policy or public opinion, by and large, may have a different frame of reference than the average voter. the average voter out there is skeptical and has always been skeptical about government.

some have interpreted obama's election as a mandate for larger government. that may not be true, but what is clearly showing here is a lot of skepticism about public officials that still remains. >> do you believe the republicans in congress are having this effect, or does everything to do with them? >> i am sure they are raising issues that make the public uncomfortable. they and the blue dog democrats have been very public about their worry about the increasing deficit and the health care reform bill might increase the deficit dramatically. they have obviously had an effect on the public. they have heard estimates of numbers that are very large, potentially trillions of dollars over decades of more debt.

again, it is worth pointing out that this concern about the deficit really is very unusual in recent american history. it is something that has been given lip service, but generally has not moved voters. this is not an election, this is a poll, so clearly there is a difference. what we are seeing is clearly that voters are concerned about the deficit. 57% say they would rather have no plan that won that substantially increases the deficit. that is a start finding in terms of what people want. -- a stark finding. republicans and democrats will spend a lot of money when they go home to see their constituents, and with television ads and interest groups that support them. they will tell the voters see the good part of the bad part of the plants, depending on which perspective you are coming from. we will know in a month or so whether they have been able to change public opinion one way or the other.

it is a fair analysis that the momentum that president obama enjoyed on health care reform, with the country being behind him, has slowed and perhaps stopped. that does not mean it will not start up again. let's be very clear about this. polls or snapshots in time, but these findings in which voters clearly say they are more concerned about not increasing the deficit than having health care plan is an indication that the momentum he came into office with has been slowed substantially. >> obviously the republican message is working, based on the pole. is there anything in there you it advised democrats in august? >> they need to be reversed the number. people not believe the president

and the congressional leadership that what they have finally come up with will not increase the red ink. that is really the key to it. there is a gigantic battle that will go on over the next month or so. it will not be inside the beltway. it will be in dayton, denver, detroit, and des moines, any place out where americans are, not in the beltway. lawmakers find when they go home -- what lawmakers find when they go home will determine what happens to this proposal, and therefore, what public opinion tells these lawmakers as they go home is critical.

>> [unintelligible] >> we asked who would do a better job on health care reform, president obama or the republicans in congress. the president has a 10 point lead. that is good for the president, but here is the bad news. when we did a similar poll a month ago and as the same question, he had a 20 point lead. it is in your packet. that is another reflection of the momentum slowing and perhaps turning. a number of the aspects of the plants have been tossed around a hill have strong support. voters think there should be a public auction. -- a public option. they like the idea of taxing business and the rich. they do not like the idea of

taxing themselves for taxes on health care benefits. they support subsidies for large groups of americans. the poll finds strong support for subsidies court individuals who make up to $43,000 a year, and families of four that make up to $88,000 a year. those obviously large groups of americans who will get subsidies and to these plans. the median family income is slightly more than $50,000. americans back the subsidies, so with one hand they think government is a good thing, and on the other hand they are skeptical of increasing the deficit. this kind of inconsistency is not surprising. that is what happens in politics. people always want to know, what is in it for me? what is interesting in this data is that voters are concerned,

many voters are concerned. roughly 85% of the electorate has health insurance. many voters are concerned that this will help other people, but not help them. >> you point out here that will enable businesses to pay for it. the rich do not want to pay for, so are they really worried about the deficit? >> as i said, public opinion is inconsistent. there is nothing new about that. you can go back over the years. voters want government to do certain things, but they do not want their taxes to go up. we gave them a choice between no health care plan and no larger deficit, or a health-care plan. -- health care plan that would substantially increase the deficit. they do not want that trade off.

it is hard to overemphasize how big a deal is that -- how big a deal is that the deficit matters. ron reagan got elected telling people he could balance the budget and increase federal spending by cutting waste, fraud, and abuse. he was the most successful politician in recent american history. >> the poll shows that people support the main prospects of the plan. do the results indicate war of a messaging success that an actual -- more of a messaging success? >> i am not sure that is messaging. my guess is that if we asked americans to finance anything, how they wanted finance, that would much more likely say let's tax business and the wealthy as opposed to the middle class.

we could be talking about widgets here, and the voters would have those priorities. that is just human nature. >> apparently, a lot of the messaging during the august rate, from what we heard from speaker pelosi and the president say, -- president himself, is going to be about the public plan. other polls have shown support in the public plan. given that they have pretty much come out and said that will be their focus, fighting for that over the break, you were saying based on what you are seeing here that the key to it is let's focus on the deficit and make people believe you when you say this is not going to add to the deficit. do you think that is a new issues of their time and energy to try to get support for the

public plan, attack the insurance industry. >> i am not a political strategist. these numbers show that voters are very concerned about the deficit. that is not to say that political hay cannot be made by a binding a villain and hitting the bill and hard -- finding a villain and hitting in the villain hard, but voters are very concerned about the deficit. again, the recent political history is one in which the deficit gets lit service but does not matter. these numbers show that seems to matter. that is really news, and that is really different. obviously people who -- clearly it, one would assume that making a villain out of the insurance industry is targeted towards the president's base. i think it is a fair assumption

that the president's base is on this. that group of independence that is drifting away from him -- perhaps. they have more experience doing this kind of stuff, so they must think it is going to work. perhaps it will. david axelrod is a very smart guy. these numbers indicate that the deficit matters and seems to matter more than anything else. at least to the people who have been drifting away from supporting the plan. >> you have any insights on what the sticking point was? >> this is a poll that was

taken -- >> in terms of people of a sudden being so worried about the deficit. >> trillions is a big number. it also comes with time, and the president's job approval over all in other polls have been coming down. it may be a melting of a number of things. it certainly doesn't help the president if unemployment keeps going up.up .

but, again, polls are snapshots in time. they do not tell you what will happen in the future. obviously, that trend is not one that makes those over at 1600 pennsylvania avenue happy. >> this is contrary to what we were seeing at the beginning of the day. >> clearly, we did not ask this question at the beginning of the

obama administration, but our polls clearly showed faith in the president, faith in the president to deliver the changes from the campaign, and what we are seeing here is the 70% that do not see him fixing health-care reform, there is the willingness to give him the.which is, among some voters, evaporating -- given the benefit of the doubt, which is, among some voters, evaporated -- give him the benefit. which is, among some voters, evaporated. thank you. -- in evaporating -- in evaporating -- evaporating. thank you. [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute]

>> your watching public affairs programming on c-span. up next, iranian president ahmadinejad is sworn in for a second term. after that, autism research and the united states. tomorrow morning, the head of president's council of economic advisers christina romer talks about the economic stimulus package. that begins at 8:0040 5:00 a.m. eastern. >> booktv sunday -- 8:45 a.m. eastern. that is this weekend on c-span2. >> iranian president mahmoud ahmadinejad was sworn in for a second term as protesters gathered outside parliament in tehran.

in his 25-minute inaugural address, he called for national unity and criticized foreign governments for criticizing the validity of the election. this event is courtesy of the iran english-language newschannel. >> the the president of and the holy koran and in the presence of the iranian nation. i hereby swear in the name of almighty god. the system of the islamic revolution and the constitution, and to use all my expertise, and

to the glory of the country and to the promotion of religion and morality and to support righteousness and to spread justice. and to protect the freedom of individuals and the rights that the constitution has recognized for the people. the political and economical and cultural freedoms of the country. i will spare no efforts in safeguarding these. and the imams -- i will guard the power that the people have entrusted me as a sacred trust.

i will guard it as a sacred trust the -- trusty -- trustee. >> now, we invite the president to address.

>> in the name of god, most compassionate and merciful, praise be to god almighty and blessings of god be upon the profits of the islam on common -- islam, mohammad. and his pure household. i praise god almighty for giving the iranian people the chance, who came to the scene and created an unprecedented epics on election day -- an

unprecedented epic. these are two great developments in iran, and major changes on an international level. all of those people who have helped the great aspirations of the nation and members of the parliament, i would like to thank them all. the people of iran have always been active and have had a major role, the great role, and today, too, they are fully present on the same, and they're actually giving rise to a humane government with a divine

characteristics. for 30 years, we have been bearing the flags of justice and dignity. in the recent years, with more fervor, with more experience, and ever more determined, the people have been present on this scene. the latest election, the presidential election, was a clear manifestation of experience and people's faith in following through the sublime operations of the islamic revolution. the epic of 40 million votes and casting the 25 million votes for their elected person is another source of pride for the iranian nation. the magnitude of this can be seen in the anchor and outrage of the enemies, a sworn enemy

is of human values. you can see these four yourself -- the enemies, the sworn enemies of human values. people are vigilant. they are aware, and they rely on god. they are present on the scene. they have shown their will and determination. they exercised their power. this and the islamic establishment. the vote is the continuation of the path, the activities of the last four years. all of these have been civilized and confirmed.

concessions, and dignity, and national dignity, and persisting and resisting against the demands -- the prevailing brotherhood and friendship are the major basis of this. people, through their presence, have one more time stressed the capabilities, self-reliance, and the great capacity is on a national level for moving toward their aspirations. they have stressed this through their presence. in the election, met for maintaining independence and dignity, as well as national unity, all of these were demanded.

the stress was laid on protected -- protecting the islamic culture, arts, and human resources. purity, serving the people without expectations, the moral and spiritual values. affection and love for other people. actually acting independently from world powers. this is what is insured by the people in the election. they want monotheism, and it was a model. this is what they voted for.

respected participants and brothers and sisters, i do not have any other interest other than serving the people and the country, and i do not think of anything but progress and development of the nation. i am committed to all of these commitments and aspirations. i have sworn in the presence of god and you people. i am committed to all these points, and i have no doubt that your respective representatives of the people, you also feel committed to the same principles. the outlines of my plans, i mentioned them. i informed the people during the presidential campaign, and people strongly endorsed them. in the endorsement ceremony by

the leader of the islamic revolution, i supported those. they were also confirmed. with the plans today, we are all responsible for that. we should join hands and try to fill these. who has voted for home? this is not the question. today, -- who is for whom? i am confident, respected brothers and sisters in the islam assembly and in the judiciary as well, they will be

supporting the government in line with the fulfillment of these plans. the recent presidential election indicated the great aspirations of the iranian nation. . great goals require great decisions and great measures, great actions.

stride's need to be taken. we're not given such chances all the time, so we should make the best of our chances. the past four years have shown that our capacities are abundant in the country. there have been some shortcomings and some problems did not allow us to make use of all of them. as a representative of the people, i hereby announce that in the new term and, the government is determined to use all of its forced to serve the nation and to use all of the potentialities and to activate the mall. this requires cooperation and support of the iranian parliament and other branches of the government.

i was once again like to mention some of the outlines of the plans. the first one is culture. maintaining the identity and our cultural values requires maintaining the elements -- our cultural elements -- seeking justice and dignity, acquiring knowledge, affection, sacrifice, love, pure it, and good deeds and moral values. the arts, literature, the culture, they all need to be dealt with in all educational and cultural spheres of the country. great thoughts, and men of letters and literature, where ever they are, thinkers any

leaks all kinds -- they are our main assets in this country and the model and dynamism for movement. we need to take more effective means for their presence in policy making across the country and planning and execution of the plans. i would like to invite everyone here to join forces to move with us. the cultural diversity is an unprecedented beauty of the iranian nation and is our asset. we need to protect this. it is incumbent upon all of us. the spread of tourism has some main factor of cultural exchanges between iran and other nations, this should be given

due attention. our teenagers are the main set -- assets of our country and they deserve to be actually active in different spheres like sports and scientific areas. the women and girls in this country, they are the purest, the kindest, the most noble women and girls in the world. they need have a more constructive role in all social, scientific, sports, arts, local, an executive fields. all of these need to be planned and they need to be more active as well. iranians are able to inspire hope in the region and in the

world. and this requires sparing no effort in giving chances to everyone to take part. social issues, and family is the main pillar for upbringing of mankind and peace in the country. the mothers of this land are the best. everyone should respect the boundaries of the family and protect it. everyone must feel, and tranquil. they should feel secure within families. honesty, firervor, and bravery in defending the oppressed -- all of the should prevail

everywhere in the country and in all our affairs. all individuals are first citizens and they do enjoy equal rights, and they are equal in the face of the law. no one has any special concession or privilege over anyone else. no one should feel their rights are trampled upon or they are not given a chance. no single individual should feel discriminated against. no one should feel that their dignity is being infringed. freedom is a divine blessing and get an achievement of the islamic revolution, and everyone should enjoy it and protect all of this. no one has the right, in different names and under different pretexts, to limit

social freedoms. the third point is the economic affairs. we need to do the distribution of wealth -- the production of wealth should be looked upon as a national service. this should be protected. there will be concessions for discrimination that would destroy incentives and a source of corruption. this should be supported. structures and mechanisms should be corrected quickly. the economic development plan as a prelude to the next plan and an exhibition of article 44 of the constitution, all of these must be implemented as soon as possible. targeted subsidies and

correcting the banking system, that taxing, and also a distribution and the strengthening of the iranian currency, these of the pillars of economic development that need to materialize as soon as possible. government for the scientific and expert work that has done, it has made relevant plans and they need to be correctly implemented. and that requires a brave decisions made by you parliamentarians. i do trust your open mindedness , and i think that we can solve the problem of unemployment and housing. my friends, during this term the

devising of the fifth planned and the points i mentioned before are on the agenda of the 10th government. you believe, everyone should believe that all the points i mentioned can be dealt with quickly. we need to get rid of the imposed mechanisms and formalities and bureaucracy that only kill talents and eliminate people and their human sources. especially our youths there were going to make that destiny of this country. they should be rid of all these restrictions so that they can take this country to the peak of progress. people can do great things. that is, you and me, we need to determine and take action.

we will continue with active foreign policy and to the blessing of god, with more power and with fresh plans and more effective plans, we will have an active role in all spheres. joint human values which are buying back use, we will emphasize them and invite everyone to peace, fraternity, and tranquillity. [unintelligible] we try to correct that discriminatory mechanisms prevalent in the world. the people of iran are still bearing the flag of monotheism and justice.

we can play an active role. some governments should feel responsible for their words and deeds. interferences, occupations, and cultural and environmental disturbances, they need to be corrected and a need to be accountable for this. the people of iran offer constructive dialogue and logic. but pillar of our foreign policy is interaction with all people and nations and other states based on justice, mutual respect, and friendship. however we will resist the violation of law and interference and the abuse of international mechanisms and discrimination. we will not remain silent.

we want equal and friendly relations but disrespect, if their parents, and in seoul's -- we will not tolerate these. you just heard that some of those countries announced that the election -- day to recognize the election but they will not extend their congratulations. what does this attitude mean? the message is that they just want democracy in at the service of their own interests. they do not respect the rights of other nations. they recognize them sell as the yardstick for democracy. other people oppose this

attitude and that is what our people are resisting. nobody in iran is waiting for anyone's congratulations. [applause] the people of iran do not care about their browning foreheads, nor about their smiles and congratulations. [applause] a bracket chanting -- [chanting] >> my friends come up with the blessing of god, and with

that firm resolution of the iranian nation, we are starting a new age of the islamic revolution and a new chapter of humanity. we need to realize our status and less historical juncture, and we need to fill our divine duties. this is our great mission, and we should come to believe that iran can stand on the peaks of progress, that iran is able to reach those summits, and we should have our eyes cast upon the heavenly aspirations. we should leave aside shortsightedness. we should believe that we can be the government of justice.

the pure son of the holy prophet of islam, we can feel his presence. and his reappearance is around the corner. let's believe in this, and the dawning of justice. we can. [unintelligible] we do belong to the historical heroes in literature.

i think you are all respected representatives of the people. my brother, and also the respected members of the iranian judiciary, the supreme council, and the ambassadors at the ceremony, representatives of people from different walks of life, and different minorities, i thank you all and god bless. >> the senate continues debate on the nomination of sonia sotomayor. paulette on our networks. you can see a tally of how senators say they will but. coming this fall, toward a on to america's highest court, "the supreme court." >> now a senate hearing on autism research. witnesses include the director of the national institutes of

health. tom harkin chairs the senate subcommittee on health and human services. this is about two hours and 15 minutes. >> today's hearing is on autism. the center for disease and control estimates that many will be diagnosed with autism. among boys, the rate is one out of every 94. we do not know what causes this disorder. most researchers agree that there is a genetic come upon it in some cases. -- component in some cases. autism has not won a genetic cause but many and we do not know what the triggering mechanisms are.

and our model factors may also be in play. we do not know what they are exactly or whether they take effect during the first few months or years are maybe during gestation period we know more about interventions. some behavioral interventions start help if they are early. we are nowhere near a cure. and still the number of people with autism continues to grow. the rate of incident is growing. the subcommittee has taken a strong interest in autism in the recent years. we held a hearing two years ago, and in fiscal year 2010, the appropriations bill includes a range of activities related to autism like outreach, surveillance, and the inner agency autism coordinating committee. this year's bill also includes $40 million for a new program that helps students with intellectual disabilities make the transition to college and

complete their post secondary education. we have an outstanding panel of witnesses today to help handle autism from many different perspectives. researchers, interventionist, and another problem that has not received enough attention to day -- how to address the growing population of adults with autism. let me just thank all the witnesses for coming here today. senator cochran is on his way. i will leave the record open for his introductory statement. we have two panels. the first panel is tom insel, director of the nih.

we have covered all the aspects that we want to cover on optimism with these two panels. first we will open up with dr. thomas insel, director of mental health directornih. he has been here many times. tom insel, welcome. with all the people testifying today, your statement will be made a part of the record in its entirety. proceed as is a desire. [inaudible] >> thank you, mr. chairman. it is a real pleasure and honor to be here with the other panelists. i know that this is a very busy time for you and your colleagues, and we greatly appreciate your taking time in the middle of the summer just

before recess to hear about the latest research and the latest challenges with autism. my brief is to give you a quick update on research since we last met, a little more than two years ago. this has been an extraordinary period with all lot of exciting progress. we will review that. the testimony, i hope, will be submitted for the record. instead of reading that, i would take you quickly through three questions. what do we know at this point, what do we need, and what are we doing? we will summarize them as quickly. tickets to one track here, let me make sure we are all on the same page in what we're talking about. autism by definition starts at age 3. there are three different types of systems -- symptoms. abnormal language, and

repetitive, restricted behavior's that often are called many other names. it is clear that these are the definitions that many job and with autism's come in with the additional complicating features. i have listed a few of them here. 30% will have a seizure disorder they can be part of the autism syndrome. intellectual disabilities of various sorts. we have many families concerned about gastrointestinal problems of many different kinds. about 10% of children who haven't autism label have ought faces or appearances. because that is more thick -- we call bacthat dismorphic. some children develop quite well and then lose language and

function. the results of understanding is complicated features and the fact that this is such a heterogeneous syndrome is that we talk about autism -- not about autism but about autism's s. the term that has been most widely accepted and you hear about it -- the autism spectrum, or autism spectrum disorder. we are talking about our range -- a range within the centrum, from children with limited functioning, no language whatsoever, may have sent your intellectual disability, show no interest in interaction, lots of motor abnormalities -- the most common called hand flapping -- and dismorphic facial features.

the other end our children that will be highly successful. they will have social all or does or d. key. they may be more interested in numbers than in people. but they may be tremendously useful and tremendously successful and make huge contributions as engineers, as computer scientist, and areas that probably will not tap into their social awkwardness but allow them to use what they do best, which is a -- being able to think about mechanical, numerical, and a less social aspects of the world. all those people, whether classic autism or ask berger centrum, that within the spectrum. -- s. peirce -- asberger's sent from, they are all within the spectrum.

will be important for us thinking about this as we go forward? there is wide recognition that this is a developmental brain disorder. we do not know yet where in the brain or what in the brain or even win in the brain things go off track. the most recent sec research suggests that we're not talking about a specific legion, but a synaptic disorder, a problem of brain connections. that may be very diffuse, and it is possible that the reason if you see problems and language and social interaction is that they require the greatest number of synapses. if you're not able to process information as quickly as you need to, or in a way that is too quick, you will see deficits. if your connections are not working, you'll see deficits in just those kinds of functions. the greatest degree of progress

is in genetics and that is not surprising. in every area of medicine, we're seeing an explosion of information from genomics. that has not necessarily deliver that cures that we're looking for yet, but it has helped us to understand much more about the heterogeneity of these disorders. when i talk to you about how we think genomics will be important, at that point we would have said that it is important because we know that couple percentage of the people with autism have recognized syndromes. single gene mutations in which perhaps 50% of the children and sometimes more have died as some -- had a diagnosis of autism as well. we have discovered her range of other prayer but apparently highly significant mutations that are in the form of structural lesions within the

genomes that also seemed to contribute. two years ago, i might as said by% of any population of children would have one of the sentence. now we can say that number will be considerably higher, perhaps more than 10% tariff we do not have names for all of the syndrome's but in the last couple of years, there are new reports about rear mutations that may explain another 1% or 2% of the children that have this disorder. there is a genetic factor that does not explain all of autism. we need to learn more about how genes and environment interact. there will be more research on this but that is clearly an area of progress. we spoke about this two years ago -- in your opening markets, you said that early intervention was helpful. it is especially helpful when started early.

i will not take a lot of time but we want the flag is. the issue here is making sure that the best behavioral interventions are available to the people who need them. and we're not talking just about children but children in transition to adulthood and adults themselves. they are not always available and they are not always paid through, at least through insurance. we need to have a conversation about how bad is going happen. i would recommend asking dr. dawson about the impact of behavioral intervention. some of her own work in this area is really setting a new bar far how far these behavioral interventions will go if they are done early. and the issue that you brought up in your opening remarks, great concern to you, this is increasing prevalence. the centers for disease control and prevention now report from 2007 our rate of one and 150

children 8-year-old given a diagnosis of something on the autism spectrum. i do not think that that number is a great variance with the numbers we have seen elsewhere. it is also true that that is a tenfold increase of the numbers coming from the cdc from the 1992-1993 period. the tenfold increase in prevalence is of great interest to many of us. i want to caution you that a change in prevalence is not unique to autism. we have seen a 40-fold increase in bipolar -- pediatric bipolar in the same period. tenfold or greater increase in hyperactivity disorder of the same decade. this change is not unique to autism but it is one that deserves our attention. the difference between

prevalence, which can be affected by diagnosis and a different of other new features, and the number of incidents, which we do not have good evidence that there is a true evidence there. our rate of new cases, that requires more research. if that is what we know, what do we need? we need to fill in gaps of what we do not know. i will take you to the kinds of things that we're thinking about. understanding more about risks. the risc architecture of the whole spectrum will be critical. genes are important, and our malefactors, and most importantly how they interact. that is not unique to autism. it is true for asthma and many other areas of development. new therapies are going to come from asbestos syndrome. and we want understand this heterogeneity better. the point of this is to be able

to develop ways of detecting the disorder much earlier. we know in general that for brain disorders, behavior's for the last features to change. that is true for alzheimer's, that is true for parkinsons, it is true for huntington's, and most important is to move upstream by having a by a marker -- biomarker to help detect these earlier. interventions are expensive and take a long time to work. it is not where we want to be at the end of the day. we want to offer much more than a behavioral interventions. we want to know what treatments will work best for which people. you will hear a lot in the next year about personalized medicine. we are hoping that the new nih director will be confirmed by the full senate this week, and said that the case, you will hear from him a high priority put on personalized medicine.

that is something that we need for autism as much as we need it for cancer and diabetes. i would point your attention to an issue that is not so much on the research agenda but needs to be on the social apology -- social policy agenda. we have a wave of children with autism that will be a adult -- and adults with autism. how it would take care of this transition to independence and coverage for the different kinds of care that they need? that deserves urgent committee attention and from others who make policy. let's say a little bit about what we're doing. that can be summed up very quickly through the work of the enter agency ought to some coordination committee. we have a new strategic plan which was released in january of this year. that provides a whole range of activities both short-term and long-term that we ought to be able to invest in so that we can

get some of the answers of what we need. we have an extraordinary opportunity now when we first came out with this plan -- a, we heard most often is that this is a great road map. art -- is there any gas in the car? what happens soon after their with the american recovery and investment at was a chance to make substantial new investments to jumpstart the strategic new plan. particularly this short-term objectives. we halt in the next six weeks to announce publicly to the large number of grants that have been funded through the american recovery and reinvestment act. these include not only the special raf's done through five institutes to support autism research to the tune of $60 million, but a large number of challenge grants and grant opportunity of words that will be made and will be announced before september 30 of this year.

finally i will mention that we also tried to jump start much of this progress by creating a national data base for autism research, which will be essentially a meeting ground electronically for scientists around the world to be able to share data and the tools that are necessary to accelerate progress in this area. as you'll see in the strategic plan, there are really six questions that guided the effort to steer research and to help us think about what the most important issues were to be. getting close but public members and federal members and is questions really came out of our rich discussion about what the families and people on optimism spectrum are most looking for. taking each of these tough part,

we have come up with a summary of what we know and what we need for each of the sixth question. we have short-term and long-term objectives that are now being addressed through the recovery act and other sources of funding at nih. i will finish with this vision statement which i thought would be worth of sharing with you from the strategic plan, which talks about what we're trying to do here as we move forward. we want to inspire research that will profoundly improved health and well-being of every person on that autism spectrum across the life span. i cannot emphasize enough the attention on adults and soon to become a hot dulse -- soon to become adults with autism. this will not only provide a road map for research but set the standard for public and private cooperation and for engaging the broad community, who will be so invested in trying to make sure that we expedite research progress. with that, i will make one final comment because i know -- we

thank you for so many things that you have done for autism and the other issues that you deal with. i like to send a personal thank- you for giving us allen murray, who will be joining hhs very soon. i understand that this was a lot to offer an a lot to give up. for those of us at hhs, it is a terrific gift. we're delighted that you saw to it to share her expertise with us. thank you, sir. >> thank you very much, dr. insel. dollars mr. chairman, i am pleased to join you at this hearing. i thank the witnesses that come to share their experience and what we can do to more effectively deal with the challenge of autism. we have had hearings before. it is important to continue our efforts to stay up-to-date and

join forces with the victims and their families to help make sure we triumph in don't let the victims and their families down. we want to support the cause. thank you for being here. >> thank you again very much for your leadership. i was just looking at the list of the people on the committee. our interest is in research and finding causes, which hopefully will lead to prevention. and yours. we're also interested in the early intervention programs. do you have enough expertise on this panel in terms of looking at that aspect also, what are the most effective early intervention programs that we can find and work on? >> on that panel and do we? we will bring in the expertise.

what each year we have to update the plan. we do that by bringing in the experts in all the areas that we're concerned about. we're hearing about both ends of the spectrum, early intervention and pre-emption, which bega -- when we can. and the other attention of the adults on the end of the spectrum that need more interventions. >> which treatments and interventions will help? this interagency group is actively out there looking at different interventions and trying to find out which ones work best? are you also promoting different types -- in other words, are you instigating different types of

early interventions to track and see which ones work the best? >> let me go to the progress very quickly. the first thing we did was to a portfolio analysis. i think this was unprecedented. we ask not only nih and cdc and the department of education, all the federal lawyers including the department of defense, that invest in this area, but also private groups which are substantial players in autism and then -- and are putting in significant amounts of research dollars. for the first time everybody has shared their affirmation about every amount. we can map on to these questions and see what is missing is. one of the places that we look like we are underfunded or under invested is this area of interventions. our we going to fill that in? the first thing we do is bring in the experts on an annual

basis to tell us, not only what the needs are, but where are the opportunities? what is really hot in terms of techniques and things going on in other areas of medicine? the meeting this year will be on september 30 and october 1. we did a previous one in january 2008, if i have got that right. and there we used four days to hear from a broad panel of experts. i might add that it is not only your typical academic brin t that we're hearing from. -- grantee that we're hearing from. they're bringing in people that they think we should hear about. we are also bringing in petitions -- condescends who might be doing things that we've not heard about. we're trying to get the best ideas on to the table before we decide what we want to recommend nih and others to look at for funding.

>> what do we know -- we talked about the applied behavior therapy. it seemed to be successful. how early in age can you start that? do we know what age you should start that at? >> i am going to duck that question because the world's expert on that is sitting right behind me. you will talk to her in a few minutes. dr. dawson -- and i do not want to put her on the spot but she has completed what will be dull landmark study on that question. i love to steal her thunder but because she is a friend and i do not want to alienate her, it would be better for -- for you to hear her -- from her directly on our data. >> i hear a lot about this issue of vaccines in autism's. can you summarize the status of

this science regarding that issue? >> i can tell you what we know scientifically. i think that there is no question from the community that our environmental factors at work. some aspect of the environment will be interacting with genetics to make children and maybe even unborn children vulnerable. maybe that these make prenatal and our model factors. the only factor that has been explored in great detail would be vaccines. part of that has to do with the increasing number of vaccines, which we talked about at the previous panel, has gone up over the last 30 years or so. i made a slicer you can see what that looks like. -- a slide so you can see what that looks like. there are more vaccines that are n -- that are now and the

recommended schedule. there are more injections and perhaps more per visit, and it is also where important for you to realize that while the number of vaccines have increased, the quality of vaccines has really changed in the same time. if you look at the number of antigens they go into these vaccines, although it does not show it there, in 2008, the amount of protein that goes into the apple group of vaccines that children are receiving is less than there were when you're getting a single shot in the 1900's. the vaccines are far more refined and targeted. they look very different than it would have even when your children what had been vaccinated in the 1970's and before. it is not quite comparing apples and apples when you look at this change over time. the research that has been

focused on vaccines as a potential association with autism had been largely epidemiologic gal research. there have been a total of 16 studies involving hundreds of thousands of children, literally, and there is no evidence at this point of any association between vaccines, the number of vaccines, but kind of vaccines, any of the things that we are showing here, and an increase or a particular, vulnerability to autism. >> i guess i want to understand that how you can have a a study involving hundreds of thousands of children, they are all getting the same number. you go back to the first chart, dr. insel. i have a different chart from the center of disease control and prevention that shows that in 1983