information over the internet. host: he used the phrase take over the internet guest: a lot of people use that phrase and the fs obviously disagree that's what it's doing. in terms of regulating the content, the fcc hasaid that's not what they want to do. they don't want to in any way control what it is that you're allowed to see. they just want to stop the broadband provider from controlling what it is you can see. or say also because in a lot of these circumstances people wing of as consumers are now what are called prosumer here. you're producing content and posting it up on the blog. host: the rules would give the fcc the ability on possibly going too far if some people are concerned like our viewer expressed? guest: it doesn't seem so. they say that the way the rules are written they describe

broadband service providers as the companies that are providing the connection from one end point on thentnet to all the other end points on the internet. which is not typically what someone who is putting content up on the internet is doing, which i think is what the caller was concerned about. host: next call is tulsa, oklahoma. thanks for waiting. robert, democrat's line. good morning. caller: good morning. this is my first time on air and good morning. caller: good moing. caller: i had a question. relates to the long-te issues of the internet brooned broadband and the internet web. this is more of a sense you have ms. stanten. as we expand the capacity and we understand the need for that, but the idea that the profitability or the entrepreneurship within that medium is, it's got to be prove b. it's not a free worldwide web

and we can understand that. but do you see any parallels between the securitization of for example we broke down mortgages more and more and more and more, and any possibility. and i know the rules are going to be a problem. but the possibility that the same techniques makes the internet in a sense almost so profitable that you finally see the point of content and access ibility get more and more restricted? i'll leave you with that sort of thought of is there a downside to this, or do rules take that into account? and i thank you for your time. guest: thank you. when the fcc is talking about this, the entrepreneurship, they're very concerned about what i referred to as the edge providers and the innovators. that might have problems being able to produce the kinds of services they want if they don't know how a broadband provider is going to treat their service. if you don't know whether it's going to be blocked or degraded or prioritized or not

prioritized. it'sind of hard to write the software and develop the product and get funding for it from vent tier capitalized and what not. host: from the vote on tuesday, the three democrats on the commission voted for it, the two republicans voted against it. would you say that that was expected as far as the vote is concerned? guest: the big question in the three weeks leading up to the vote was more whether the two other democrats on the commission in addition to the chairman who we saw earlier, and especially the senior democrat would be willing to vote for what has been viewed as sort of a weakened version of net neutrality by a lot of strong net neutrality advocates. and there was a lot of perception that in effect said that they were pushing for stronger protections in the area especially of the mobile providers. as i said, they don't have quite the strength.

in addition to not having the same blocking restrictions, they also are not at all subject to what's called the nondiscrimination provision. the fixed providers are not allowed to unreasonably . . viders aren't subject to that. host: we have a bit of the statement when it came down. and it kind of talked about what he wanted from this whole package of rules. >> there is more that i would have likedn this order. i would have pferred a general ban to discourage broadband providers from engaging in priority those of deep pockets who would confine the rest of us to a slower, second-class internet. also believe we should have done more to strip loopholes from the description of access service to prevent companies falsely claiming they are not broadband companies from slipping through. we made some improvements in

the definition but i still have some worries. i also argued for real parity between fixed and mobile. meaning wireline and wireless technologies. after all, the internet is the internet. no matter how you access it. and the millions of citizens going mobile nowadays for their internet and the entrepreneurs creating innovative wireless content, applications, and services should have the same freedoms and protections as those in the wire context. host: why did the final rules not reflect what mr. cops wanted to see? guest: i guess you have to see they confirmed that he was trying to put forth rules apparently that would have a reasonable amount of support from industry, an industry apparently was trying to prevent very strong rules that would include a reclassification, regulatory standpoint of broad band

internet service. the proposals that commissioner cox wanted to do would basically have subjected broadband internet services to an entirely different piece of federal statute that is much more expcit in terms of what the authorities would be. where as they're trying to act under a piece of statute that looks at this as what's called an information service, very lightly regulated. host: would the other classifyication treat it more like a phone company? guest: a lot of times the people that argue against it would say that what they wanted to do is to treat it like a phone company . host: a couple other things. he said he would have changed the definition of broadband internet to avoid loopholes. is that another thing? host: guest: some people are concerned that without a very good definition of a broadband internet service provider, what they will do is tweak their service just a little bit so it

doesn't quite go from your computer to every other computer on the internet, which would seem to bring outside slightly the definitn that the fcc has adopted. what the fcc did to a little bit alleviate the concerns was add a sentence saying they would consider anything that was functionly equivalent to a broadband internet service. i think the proof is going to be in adjudication and assuming the rules last that long it's going to take some adjudication, some people bringing cases to e fcc and so determination to see exactly how far outside you can stray and become something other than a broadband internet service provide host: he also used the term pay for priority. guest: there's concern that service providers, the larger ones that have deep pockets, would be able to pay the provider to prioritize their

traffic to get to you faster. so let's say net flicks request afford to pay whatever it might turn out to be, an extra penny per hour of broadband transmission to you to get theivideos to show up fully nice and crisp and everything on your computer or tv or game box stem, whatever you're watching it on. and there's some new startup that might have some great ideas or a better stock of videos to show, whatever they might have that might be an entrepreneurial or innovative improvement over net flicks but they don't have the pockets to be able to pay that -- and i'm just pulling a number out of the air. host: but it favors the larger for the smaller. guest: that's 2 idea. and what the fcc has said is that while they're not saying that paid forwardization is not allowed, it's banned, theare saying that they really doubt that it would ever pass the nondiscrimination provision

which again is only on the fixed services, not on the mobile services at this point. host: lincoln, nebraska. thank you for waiting for our guest. go ahead. caller: good morning. thank you for taking my call. now, as i unrstand it, this underlying the whole debate over net neutrality is the notion that the internet is a basic human right, or at least that's the way i heard it described at one point. i see the internet as being a wonderful tool and in ma cases an essential tool. but do you believehat the internet is a basic human right like water, food? guest: well, i'm not even sure that water and food are a basic human right in terms of how we run our sout. but it's a very important thing. and that was one of the fcc's arguments in terms of the being age to participate fully in the society. a lot of places, if you want to apply for a job now, you have to do it on line. if you want to really fully

participate in the political discussion these days, a lot of that is happening on line. if you want to fully participate in some educational opportunities, a lot of that is happening on line. there's a view to moving a lot of health provision and monitoring on line. so tre's a lot of things that people think of as essential activities of being a fully participating person, and that's what the fcc, although they haven't used the term i don't believe of calling it a basic human right, i think that's a large part of their concern when they look at it from the consumer side. they also have arguments from the economic side that they feel that the harm from economic standpoint of allowing the edge provider innovators to be harmed by possible discrimination and network management to be greater than the benefits that the network providers are going to get. host: what's the penalty to the network provider if they're found breaking these rules?

guest: the fcc has the power to say don't do that any more. and it also has the power to impose forfeit turs. i don't believe there was anything changing this -- they couldn't change the amount of foreif i turs. that would have to come from congress and -- my memory is it's about $10,000 a day but that would be per incident. and probably any time you're doing this you're doing it to more than one. so they probably would never impose a fine that would hit the maximum of what you theoretically could make it be based every incident for every day that somebody does it. because griven the number of customers a provider has, that would become an astronomical number. ho: could anybody in congress overturn what the fcc just did? . .

host: they were working on this effort this is what she had to say it. >> mr. ensign who is the ranking member of the subcommittee of commerce and i am the ranking member of the commerce committe to gather we are going to submit a resolution of disapproval under the congressional review act in an effort to overturn this troubling regulatory overreach by the s -- fcc. it is time for congress to say that we have not delegated this authority to the fcc. the communications act -- the fcc tried to do this in another part of the act. they were struck down by the board. they have now gone to a different interpretation in a different interpretation of the act to gain the capability to

obstruct but the freedom of access to the internet. it is a huge and serious issue that i hope congress will take of the reins and say to t fcc, if we need regulation in this area, congress will do it. host: what is the take away from all that? guest: there will probably resolutions introduced. whether th can get them through the house is questionable. they do need to get a majority. once that goes through, they will still have to not be vetoed or overcome a veto. it seems unlikely that that will be the way that this will be stopped. it is far more likely that it will come from the courts. the fcc to marshall's different arguments for adopting these rules they presented last

spring it was one scific effort on their part to stop comcast for managing its networks in a way and was overturned by the federal appeals court in washington. the commission that theadopted last week, argued that they have a different set of arguments, there is a legal argument that the court -- they think the court will accept and we will see if they are right. host: maryland, republican line, go ahead caller: i think your guest is on the right track that the cable companies are looking to bundle a bunch of tv programs and send 50 or 100 of them into your house as long as they pick and choose them. if you want to use the internet to get a tv channel of your own , that will infringe on their business and that is the real

reason they don't want to see this net flex-type technology mature. if they can send 100 channels to me for $50 per month, how much should they charge me to get one or two tv channels through the internet? will anybody study the price structure? guest: part of the differentiation is that we have a cable service for the channels already bundle. it is a point to multi-point architecture. you would choose from amongst the tv channels. with the internet, they have tens of thousands, millions of customers choosing different things.

even if pedro and i choose the same thing, they have to sense that separately to each of us in terms of the internet model of getting video. it is a little bit different. i am not sure about your question of whether anybody has done a study of the relative cost of providing you enough band with to review one or two channels versus the ct of sending you hundreds of channels that they had to buy the programming and build the network. there is many different kinds of economic things in there. i am afraid i don't know the answer to the question. host: democrats a line, go ahead. caller: i love cspan, it is nice to talk to you. when the oil spill occurred in the gulf, bp had an algorithm

put in on google said they would pop up first. an isp that does not abide by the rules, what reurse does this law give you internationally? will this affect citizens radio which is more controversial tax will that squash them as far as their ability to produce their shows? guest: on the google algorithm, the fcc said it does not want to have the language of these rules affect edge provider. the international question with if it is an isp

serving some went iceland, these rules would not affect them. the third question about the podcast, that seems to bean edge provider and these roles are not looking to restrict edge providers. caller: how're you doing today? i have a telephone number. my wife is disabled and ther are jobs she can do on the internet. our phone company would not run the line out here where we could

have entered -- fast internet. i rode our governor exploiting this. she responded back that they have a monopoly out here. all these jobs could be done at home. people could be put t work if they had fast internet. big business is taking over. i would like to hear your comment. guest: the fcc had an initiative last spring called the national broadband plan which congress instructed them to design which dealt with trying to set goals for getting broadbent out to the country. there was money and recovery act to pay for projects to bring broadband to places where it was not before.

that is intended to help. the fcc initially had that court decision and it said that they might be restrained from implementing the things they wanted to from the national broadband plan many of which are aimed at getting more broadband out there because of the court decision they did not have the authority over broadband services. they have gone back and forth on that issue. they said initially that they have to be read-classified as a telecommunications service rather than an electronics service. host: we have a twitter question -- please give a brief review of mr. mcdowell's point of view? guest: he is concerned that the

fcc does that have the authority to do what it is doing. the provisions in the act do not authorize it to do the things they said they are supposed to do. he is concerned that the fcc is prompting congress. we are at a point right now where congress needs to address this issue. until they do, the fcc should not go forward. he also had arguments about the wisdom of what the fcc was doing. he feels the fcc -- the majority's approach would interfere with markets and keep them from managing the networks in ways that might be wise. host: pennsylvania, republican

line, go ahead. caller: i understand there is another company involved with the discussion around netflix and compaq's -- and comcast for the other companies called level 3. can we connect directly to a company directly like netflix and not go through comcast? guest: level 3 provides connections across the internet. they are a backbone provider. they have gotten involved in thisy carrying more netflix traffic. comcast says the internet backbone providers have tier arrangements. they can provide the service for

free as long as the traffic has a particular ratio. this netflix contract that level three has thrown this out of balance with comcast that they have to treat it as content providers. that is how they got involved. i have forgotten t rest of the question. host: one more call -- of venice, fla.. caller: good morning. i am a c-span junkie and i am also a democrat. the reason i am calling you this morning is to let people know that you can get out to the internet without having a computer. i am using a comcast digital

phone. my e-mail address is on there. i am handicapped. i have a form of dyslexia. host: you will probably get mel from that response. guest: you can use other devices. as an individual, if you are not providing enough traffic to be a viable customer directly of internet backbone provider like netflix,

>> monday on washington journal, steven emerson, head of the -- talks about radical islam in the west. then in examination of u.s. immigration policy and part of our week-long series on food policy, attorney sarah client looks at new suit -- new food safety legislation passed by congress. we begin with the day's news and your calls and females and tweets. live at 7:00 a.m. eastern here on c-span. >> monday is day one of the american universities campaign management institute, training students to work on political campaigns. we will look at political strategist from both parties. topics include the general

political environment and the chicago mayor's race. we will have live coverage starting at 9:00 a.m. eastern on c-span2. you are watching c-span, bringing the politics and public affairs. every morning it is "washington journal." a live call-in program with policy makers and journalists. during the week, watched the u.s. house and our continuing coverage of the transition to the new congress. every week night, policy forums. also, supreme court oral arguments. on week nights, you can see our signature programs with newsmakers, q&a, the prime minister's questions from the house of commons. you can also watch our programming any time at c- span.org. it is also searchable in our c- span video library. c-span, washington, your way. a public service provided by america's cable companies. >> a closing speech has an

establishment. it is an extraordinary experience for me is coming to an end, but my dominant feeling is pride and great privilege to be a part of this very unique body. >> search for their wills .eecher's -- farewell speeches more than 160,000 hours. it is washington, your way. >> next come a senate hearing on the quality of care for alzheimer's patients. he would hear from the human health and services secretary this is one hour 30 minutes. >> the meeting is called to order.

himmer disease and its challenges. as many of us know alzheimer's disease is an irreversible brain disease that destroys memory and thinking skills and the ability to carry out simple tasks. damage first strike the areas that control memory and problems and memory are the first symptoms noticed in early stages of al himmer disease. as it progresses to other areas of the brain, other problems develop as well as it affects the brain and robs the victims of their lives and dignity. it is fatal and estimated to be the 6th leading cause of death in our country. nih estimates that as many as 5 # -- 5.1 million have it today, and this is expected to grow to 13.5 million by 2050.

these numbers give an incomplete snap snapshot. it is the advanced care taking with those requires places a heavy, financial and emotional burden on the family. the complications related to alzheimer's have to wo outside their home to earn a living while monitoring and treatment for family members living with the disease. for many adults known as the sandwich generation, they are dually responsible for caring for their aging parents and also caring for their children. alzheimer'has a devastating impact on the economy as well. it is estimatedhe cost for those caring for those with alzheimer's exceeds $72 billion a year. these costs remit the burden on medicare, medicaid, private

insurance care giving and out out-of-pocket expenses for families. until we cure alzheimer's it's imperave our health care system provide support for families caring for loved ones with the disease. the affordable care agent that we passed earlierhis year establishes the community assisted larry king living program. this legislation provide medicare beneficiaries with free annual wellness visits which may increase the detection of cognitive impairment enabling families to plan for better care needs. this ensures those living with preexisting conditions will not have to wry about insurance coverage discontinued or denied. in the future whether families are the summit of triumph or tragedy is dependent on the innovation and new drugs being

investigated in laboratories across our nation, and today we'll hear from the national institute they are doing to better understand, diagnose, and treat the disease. the objectives have focused on supporting early drug discovery and drug compounds for zheimer's therapy. we'll hear about major diseases in the crical path institute to apply regulatory science to strengthen our ability to treat diseases like alzheimer's, and time lee we'll hear from the al himmer's association about the key research they are supporting as well as their initiatives and resources that help to support day-to-day care taking of individuals with alzheimer's. many of the members of this committee has been touched by alzheimer's and examine the disease. i want to highlight our full

committee. i think he is going to be able to come today, but he informed, basically he is been touched of course by hisate mother's own struggle with the disease and for that and a lot of reasons, he's a leader in congress and chairs the congressional caucus on alzheimer's disease. he may join later, but i do want to mention him today. now i'll recognize our ranking member mr. gingrich. >> thank you, and thank you for your patients today. the witnesses will testify as we hear from them and this presents a looming threat to the health of our nation and the numbers is as many as 5 million have this dreaded disease, and the scientific community is in agreement these numbers increase significantly in the comi

years as our society ages. according to the united states census bureau, the number of seniors age 65 and older will actually double to about 72 million in the next 20 years as these baby boomers all reach retirement age however, as later others will testify, the generation behind them, generation x, the folks born between 1965 and 1980 is a significantly smaller generation than the baby boomers, so why is it comparison significant for the hearingtoday? as this disease requires monitor ing, the role of the care giver falls to our family members as we all know. an estimated 11 million

americans provide 12.5 billion hours of unpaid care annually for peopl usually their loved ones, with alzheimer's and other dementias. the disease also requiresarge amounts of medical care in addition to in-home and community based services. this hig use of medical services results in substantial cost to the federal government, states, employers, and indeed families. if the number of alzheimer's patients indeeds doubles over the next 20 years as many predict it will, we could be facing a health care crisis if the numbers of family care givers decline and have the costly care for the patients ultimately shifts to paid health care professionals. alzheimer's disease is a personal issue for me. my wife's mother was a very healthy and vibrant 88-year-old woman. she didn't hear very well.

i think she loved that, but she was active. she loved to watch sports. she spent time in her room every day watching baseball. her husband, bill, actually played baseball for the new york giants in the 1940s and laura picked up her love of the game from her husband. watching baseball was her favorite pass tim and spring training kept her warm all winter long. she was then diagnosed with alzheimer's and the woman we know and love was gone forever. gone was the active 88 and instead was a woman trapped in her body unable to enjoy the compass of these golden years. i can't begin to describe how emotionally druttive this diseasefuls not only f my mother-in-law, but my entire

family. ther are many stories like this one that help underscore the importance of finding a cure. today there's no known treatments to prevent, cure, or delay alzheimer's. the five drugs approved by the fd are shown successful in reducing the symptoms of the disease, but much more needs to be done to ultimately fiend a cure, and so with that thought in mind, i'd like to welcome our witnesses here today. specifically i'm interested in hearing from dr. marc cantillon, the executive director of medical diseases and as he'll touch on i his testimony, the goal of his organization is to promote a forum for scientists from the fda, academia, and industry to evaluate innovative testing methods for the drug and use development. as we've heard, pharmaceutical

drug development benefits from industry and t fda. to the fda's credit they recognize thisact in many areas including antibiotic and drug development something on which this subcommittee will be advancing little pieces of legislation in the 112th congress. as a representatives of the citizens ofgeorgia, i believe the government worked best when it processes are constantly scrutinized and reformed when necessary to ensure they work as efficitly as possible. that theory applies to congress in the wte house, but government agencies as realm. flfer, i hope to -- therefore, i hope to learn more about this phrase "applied regulatory science" during the question and answer portion of the hearing and how it might improve patient access to quality care. mr. chairman, thank you for scheduling this hearing today, and with that, my time is expired, and i will yield back. >> thank you. >> oh, mr. chairman, i did want

to ask for unanimous consent to submit for the record our actual subcommittee ranking member that comes out of john hopkins, evidence for neurorow plays tisty in older adults if there's no objection >> without objection, so ordered. >> thank you, mr. chairman. >> next for opening statement the gentlewoman from california, our vice chair. >> thank you for holding this, the final health committee of the 111th congress, and i want to thank you for your wonderful serves as chairman over the last four years. alzheimer's disease is a very topical subject for this hearing because the challenges faced by patients and loved ones are reflective of the challenges we face throughout our health care system. long term, these are some of the challenges which fit with alzheimer's so well.

long term care availability and its cost. respite care, inadequate work force, and research for better treatments and a cure. now, that's just touching the surface of the many challenges that we face with ts and so many other chronic conditions, but frankfully, the -- thankfully the new health care law provides much needed relief for many of these concerns. one of these is the new long term care insurance option. there's also medicare prescripon cost relief, and there's opportunities for training the next generation of health professionals in addition the cure's acceleration network along with what our chairman mentioned as the class act, and, of course, we have a lot more that we should undertake now within the framework of the new legislation. some of these other steps we can take such as passage of legislation that i'm prat to

sponsor in the national alzheimer's act you're addressing today in your testimony including the national alzheimer's project, and so with the goal being that we can provide and develop a comprehensive strategy for how to address alzheimer's disease, how to continue as if of you have been doing over the past many years, so i do look forward to hearing from our witnesses today about the latest in al himmer research and i understand there's break throughs that have gone through clinical trials and so forth and also what you see for us as guidance in the next congress as pressing needs that patients and so many of them in increasing numbers that their caregivers are going to experience. as also mentioned, there's probably not one person in the room who has not been touched personally by this devastating disease, and we need to know if crisis portion really in our

society now, how best to quip ourselves and communities to cope with it, so i yield back and look forward to today's hearing. >> thank you. i also wanted to thank you also as the vice chair. you've been tremendously helpful and so often giving insight on issues because of your practical experience also with a nurse in your [background background, so thank you. our next member for the opening statement is the gentleman from georgia. >> thank you, mr. chairman. thank you for your leadership also on the 111th cgress on this committee. the poet said that comparisons are odious and no one wants to have their trama compared to somebody else's. i think some exrairgses are useful. many impacts on folks but impacts in terms of the family. i think it's useful to point out

we didn't really begin to marshall the nation's resources until everybody knows somebody's who's been touched by cancer. i think it's fair to say everybody now knows somebody touched by alzheimer's and the impact it has on family and the communities of interest around family that is the hallmark of this dreaded disease. i think we can take inspiration by the fact that so many folks are impacted by this. i think it's important to point out also the cost of this disease. the uncompensated care and the out of pocket cost to the system is growing in ways that i think compare very unfavorably to the other diseases we deal with at the social level. right now we spend $170-plus billion a year in compensated and uncompensated care. take in to account those who are not getting compensated at all

for at all is out of our gross soci product. it's costing colts over a trillion dollars a year at current growth levels by the time we reach 2050. it's staggering on folks. the point is this is not only the right thing to do in terms of the quality of life affected by this, it's never been truer this is not the right thing to do, but the smar thing to do is use our resources in a managing way and preventing and treating this dreaded disease. with that, i look forward to hearing the testimony of our witnesses, and i thank you, mr. chairman, making this hearing a large issue that we've been dealing with for a long time. with that, yield back. >> thank you. next the wan from the virgin islands. >> thank you, and thank you for the hearing. welcome to e folks here to testify, and thank you for not only taking the time to be here, but for the work you are all doing. i really appreciate the approach

being taken to the devastating disease, a disease that's devastating not only to individuals communities and potentially our country because it's a holistic approach in looking at research, but also the caregivers who are often forten. first, the cost of care. due to the costf care, this bankrupts our health care system. it's estimated that $13.5 million americans will be suffering from alzheimer's and the cost will be as much as $1 trillion a year. second is the great discrepancy of the research and the funding where billions are spent compared to just over $400 million on alzheimer's. third, i want to call aention to the fact that racial and

ethnic minorities e disportioned. they are underdiagnosed compared to their white counterparts and also two other pieces of legislation to show that the national black caucus is really aware and engaged in the issue for several years. one is hr4123, the alzheimer's treatment and caregivers and supportact and hr1122 the stance act. both of these bills like the others that are being mentioned in the testimonies will help to take the fight against aleimer's several step forward and be a part of the solution. again, thank you mr. chairman, and thank you all for being here. >> i thank the gentlewoman, and next is the gentleman from pennsylvania, i mean from ohio,

mr. space. >> thank you, mr. chairman. today is my final hearing in committee, and i wanted to first express my gratitude to mr. chairman and to chairman waxman as well as members on both sides of the aisle for their work in those profound issues of the day and even a generation. on things like energy, health care, transformation effects that the whole broad band era has brought to this country and our culture, and while we didn't accomplish everything that i think we set out to accomplish, we got a lot done, and there's a lot to be done. my district back in ohio is a very rural district.

it's app ration ohio where people are good and work hard and a lot of good things going for us back there, but there's a lot of challenges we have, and we share those challenges with the rest of rural america, a one of the things that you think about the committee, i think, is the affect that it can have on bridging the divide that exists between urban and suburb america and rural america and certainly the divide does exist when it comes to accesses education certainly with regard to accessing health care, and i encourage the committee to be every bit as ambitious in tackling some of those challenges in the upcoming session of congress. with respect to the issue of today, alzheimes, the remarks of my colleague and friend from

georgia, 172 -- $172 billion a year, those are war-like numbers. in other words, those are the kind of numbers you spend when you go to war. if you couple the amount of money that we're spending as a society on bees like alzheimer's with what we're spending on diseases like diabetes, cancer, and the list goes on and on, it soon reaches a trillion dollar level. in fact, alzheimer's alone by 2050 will reach that lel, and we cann sustain that as an economy. when john says it's not only the humane thing to do, it's the right thing to do. what he's saying is if it's not important enough to deal with these issues simply because of the mitigation of human suffering that occurs as a

result of these diseases, then certainly we should be able to justify the cost, and like alzheimer's and diabetes and cancer, the answer from a congressional perspective is in medical research. we cannot simply rely upon the private sector to tackle these diseases. not simply because it's not the right thing to do, but we can't afford it. for every dime we invest in research, we will receive a return of dollars in the future, many dollars. i urge this committee and future efforts including these efforts with regards to alzheimer's to bear in mind the obligation we have as an instution, as a government, and the duty we have to our people to conquer these diseases through early diagnosis, advanced diagnosis, advanced treatment, and above

all, a cure. let's not forget cure. with that, again, thank you for your leadership, mr. chairman, and it has been a pleasure serving on your committee. >> mr. chairman? >> ye? >> can i have a brief point of personal privilege? let me first of all from my friend of ohio, mr. space, truly is my friend, we know that. indeed, we'll miss him. he's a great member with a great heart and the words he expressed to this committee indicate the type of person that he is, and in fact, we will miss you, and i really enjoyed serving with you and i hope toeep in touch, my friend. also, wanted to say to you, mr. chairman, and i say this on behalf of my colleagues who i guess are on airplanes right now trying to get home to their families, and not the least to which would be ranking member john schmkis, we enjoyed serving

under u on this committee, not alys agreeing on votes, but no one could be more agreeable when he disagrees, and mr. chairman, we respect you and hold you in high regard and look forward to serving with you in the 112th. >> well, thank y. i really appreciate that, and i want to say the same about you. i mean, you'r input not only as a physician, but just in general has been fantastic, and you know, i kind of wish that he was here today too because i wanted to say how easy it was to work with him in the last, i guess it's not two years, it's a little over a year or so, and it is true. i think that even though we often disagree on issues, we have been able to work together on many issues, and it kind of bothers me sometimes when the media pays attentioto the differences and doesn't

highligh what bills we passed and worked on together and got signed into law that were very portant for the american people, so thank you. let me say about mr. space, i again, i know that i'm really going to miss him. he's really contributed a lot and has been a friend on many different issues so thank you, thanks so much. okay. we'll get to the panel. let me, let me welcome you first of all. we only have one panel today, so i'll introduce the members starting on my life is dr. marcelle morrison-bogorad who is directer of the division of neuroscience at the national institute of aging with the national institutes of health. next is mr. harry johns who is president and chief executive officer of the alzheimer's association, and then we have mr. eric hall who is president and chief executive officer of the alzheimer's foundation of america, and finally dr. marc cantillon, did i pronounce it

right? it's french, okay. okay. who is executive director of the coalitioagainst major disease from the critical path institute and happens to be a constituent, so i should know how to pronounce his name, so thank you in particulafor being here today. we have 5 minute opening statements that become part of the record, and've of you can also submit other writings if you'd like. i will now recognize dr. marcelle morrison-bogorad. >> [inaudible] [inaudible] the national institute on aging of the nih. one of our responsibilities, so

in this regard i want to tell you of our 2009 congressional mandateed -- [inaudible] i am retiring at the end of this year. -- [inaudible] >> thank you. >> the momentum is there and i believe my successor will have this joy. federal reseahers, other scientific agencies, the private sector, and nonfor profit are collaborating as never before to solve the mysteries of this disease. for example, we have regular meetings with each of the entities that will testify at this hearing. we have partnered with the alzheimer's association on many occasions, and ongoing is a

joint venture on updating the definition of ad. the alzheimer's foundation of america and other organizations held briefings a couple of weeks ago where richard, director of nia was asked to testify, and we workith the coalition against major diseases for the institute on matters related to innovations and use on clinical trials. the nia plans and manages an extensive program to better treat and ultimately a way to prevent alzheimer's. how do we do this? well, from our alzheimer's summit in 2006, the 2010 state of the science conference from numerous specialized workshops, from programmer fields by our nia counsel every four years, we get input from all these sources

and from the deciding the best way toes advance alzheimer's research with our funding. for example, at the 2006 summit, it was recommended recognize families. we have since funded the international dominantly inherited alzheimer's network to study preclinical disease in these families. earlier this year, nih state of the science conference reported there was so farnsufficient evidence that any behavioral interventions for ad or cognitive decline were affective and that we ought to devote more resources to the questions. even before the report was finalized, we have stepped up our funding or clinical trials to get definitive evidence where

there are not various exercise and cognitive interventions that might impact age-related cognitive decline, impairment, and ad. now we are fuing around 20 such trls. the alzheimer's disease near imaging initiative is another example of our leadership. this is the very successful public private partnership to identify bilogical and imaging markers for better way of monitoring ad clinical trials and also identifying at risk people for the disease clinically. here we identified the process in a series of meetings bringing together all interested parties to discuss what initiative would be most useful for them for development in a precompetitive setting, and these discussions led to funding in 2004.

the substantial financial support from industry and from non -for profits. another aspect of our planning process is to ask our director for funds to specifically target new areas that need to be developed. an example is our translational initiative. partly through these targeted funds, this important and innovative portfolio has dwroan to over 60 projects each aimed squarely at bringing a new drug to the stage where it can get tda approve for performing clinical trials. this is a particularly important area for us to develop as pharmaceutical companies are often unwilling to put moneys into the beginnings of the drug

discovery process and translational research. one reason that drug trials have not worked so far may be that the drugs are given too late in the disease to have any effect, but prevention trials to test those possibilities take a lot of money and time under current protocols. we are developing new methodologies and in the meantime, we have been able to fund a number of prevention trials by th simple way of adding cognitive measures on to trials started for other clinical conditions offered by other institutes, so it's a cheap way to fund the trials. other therapies for alzheimer's

are directed against unique aspects of the diase, and so for these more specialized interventions, noia must continue to develop ad specific trials. we make difficult decisions all the time about where to put our resources. we do not have a crystal ball to tell us what approach will eventually payoff in relieving suffering from this frightening disease. we are committed to trying every proming avenue, and we will succeed. thank you. >> thank you very much. next is mr. harry johns. >> thank you very much, and good afternoon, chairman, distinguished members of the committee. i want to also thank ranking member and all of you for

holding this hearing this afternoon. i'm harry johns, t president and ceo of the alzheimer's association. it was created in 1980 and is the leading in care and support and in the funding of al himmer research as the largest nonprofit funder of alzheimer's research in the world. to do our job, we spend a lot of time listening. listening to people with alzheimer's, their caregivers, their families, to researchers, our many collaborators, and to hundreds of thousands of our advocates. we hear their stories and experiences, and they inspire us to go further faster, to provide better care, and ultimately the cure that we all seek. we listen to those families in your districts, and we listen to our own families. my mother had alzheimer's

sease herself. any of us w have seen the disease up close don't want to see it again for anyone, to have the disease or to be a caregiver. regrettably we know it will happen much more ahead of us. you know, the effects of alzheimer's as stated previously are truly devastating at the human level. in this country alone as previously referenced, we estimate actually there are about 5.3 million people with the disease. 200,000 them are younger on set, younger than 65, and by the middle of the century, it could be as high as 13.5 million. today, if you do develop alzheimer's, we can say with certainty, absolute certainty, you'll die with the disease or of it. of the ten leading causes of

death as previously mentioned, alzheimer's is now six, alzheimer's is growing the most rapidly, a 50% increase between 00 and 2007, the last year that statistics are available, and it's the only one of the top ten causes of death that have nothing to do to prevent, stop, and even slow it. alzheimer's is likely underreported, already today it's killing more people than diabetes, more people than breast cancer and prostate cancer combined. of the 11 milli caregivers i should say in the united states alzheimer's can literally take everything they have to give, thei time, their money, their jobs, and their own good health. it happens every day, oftentimes

never to be recovered. one study at least indicates that people who are caring r a spouse with alzheimer's can actually predecease the individual with the disease. the impacts are devastating. you mentioned the $172 billion in cost today going as high as 1 trillion by the middle of the century reported in the alzheimer's association trajectory report earlier this year, and those are in today's dollars, not inflated dollars. those are dollars rated in today's terms. a total of $20 trillion for the next 40 years just to pay for the care costs, not an acin additional cent for the research we so badly need, and our country is simply not ready for this on onsught of alzheimer's that's already upon us. let's take the case of research funding. we made significant progress in

other diseases in no small part because of the investments we made in those diseases. spending spent at the federal level for cancer is $6 billion, cardiovascular is $3 billion. those are good investments. they paid off and lives saved and they'll continue to pay in that way for our country, but in alzheimer's, we're only spending $469 million a year despite the other huge impacts we've already discussed. we know that more money invested in research saves lives, but too late money invested in research costs lives, and ultimately will drive those very huge care costs into the trillions. today, right now, we spend $250 in america on care costs for alzheimer's and dementia compared to $1 invested in

research. 250 to 1. to address this, the alzheimer's association strongly supports the break through act, a bill that authorizes $2 billion in alzheimer's research, but the alzheimer's association will not ask others to do what we won't do ourselves. we play an unparalleled ro in the research community in alzheimer's globally as well as in the united states, and that certainly includes direct investment in al himses and investing in science. our peer-reviewed program since inception funded $269 million making us the largest funder in the nonprofit world, and through partnerships and our own funding, we played a part in every major advance over the past 0 years as a result, but as i discuss these necessary investments in alzheimer's

research and more broadly, i mechanize our country is engaged in a necessary conversation about our fiscal situation. excuse me, our fiscal situation as a country. we have to address that, but alzheimers unaddressed is one of our most devastating issues both human and financial. so we must aim at what is the highest return potential we have for investment with al -- alalzheimer's being one of them. health care costs three times more for each individual. >> i've been trying not to cut anybody off because we only have one panel. >> let me wrap up quickly. >> all right. >> thanks, chairman.

certainly i want to mention the act and i want to thank this committee for its leadership, certainly again want to recognize congressman who you mentioned for his leadership as the author. certainly recognize dr. burgess who provided leadershi on this and senate passed the bill yesterday. we look forward to the real possibility of the house passing it. we urge you to pass it, and we look forward to working with this committee and the congress to realize the ambition of the alzheimer's association's vision, a world without alzheimer's disease. >> thank you. >> chairman, members of the committee, thank you for the hearing and providing the alzheimer's assoation to testify.

i eric hall, the chief executive officer and i'm honored to testify on behaver of our member organizations and families that we care for across the country. faa was formed in 2002 to provide care and services to individuals confronting dementia and to their caregivers and families through member organizations dedicated to improving quality of life. today, our membership consistents of more than 1400 organizations including grass roots nonfor profit organizations, government agencies, publicsivity departments, and long term care communities. our services include toll free hotlines stafferred by licensed social workers, educational material, care advantage which is a free quarterly magazine that reaches 1 million readers, afa teens, a web based port, and scholarship program and our national screening day. as a foundation, our money is

generate the by service organizations as well as respite grants to families who are in need. recognizing this severe fiscal challenge facing our nation, it is more important than ever to leverage available private sector resources in a cost effective manner to support public sector initiatives. we make investments to tackle the challenges associated with alzheimer's disease and related dementias for both individuals and their family caregivers, but the needs of the population are going to overwhelm our resources in the years to come. the national institute of aging report said as many as 1.5 million amerins over 65 are today dying with this disease, and those numbers are projected to increase dramatically in the coming years. the cost associated with the disease will put a heavy burden on families, businesses, and government economically. it is our opinion thatncreased

investment in preventing, treating, and our curing conic diseases of the aging such as alzheimer's disease is perhaps th most, single most effective strategy in reducing national spending on handgun. chronic diseases account for more than 75% of those on medicare and other health expenditures. unprecedented increases in these diseases as the population increases is why the budget projects total spending on health care will rise to 2 a% of the u.s. gdp by 20250. our nation doesn't not have the luxury of time to wait to address the health research needs of the population. recent report tighted global aging 2010, an irreversible truth stated no other force is likely to shape the future of national economic health, public

finances, or policymaking at the irreversible rate at which the world's popution is aging. the cost of caring for people will profoundly affect growth pros prospects and steer debates worldwide. as we learned from the experience we all had with polio, heart disease, and other diseases, medical research and breakthroughs can have a profound impact on reducing health care costs. as the extension of life expectancy from age 47 in 1900 to 80 in 2000 demonstrating medical advantages and prosperity, yet those benefits can only come about in nih makes the needed investments in research aimed at preventing, curing diseases and extending healthy life. afa recognizes the serious

fiscal challenges facing our nation which will require congress to carefully scriewt news future funding priorities. we believe it is critical to leverage available resources within the private sector including non-for-profit organizations including our own to have cost effective initiatives which is why we need congress to be our partner. this subcommittee and full ener commerce committee played a role in overseeing the mission of the nih, and we respectfully urge your support for continued amendment to this important research. afa is seeking $1.4 billion, an increase of $300 million in fiscal year 2012, national institute of health budget specifically for the national institute of aging. this funding is the minimum essential to sustain the research needed to make progress in attacking the chronic diseases that are driving mass increases in our national health

care costs. that level of funding would make the nia's baseline consistent with comparable initiatives made elsewhere. if nih funding is not significantly increased, we stand to lose a generation in aging in alzheimer's disease. this would be an enormous waste so they accelerate the discoveries that are translated into prevention and efficient health care to reduce the burden of this silver tsunami ofge associated chronic diseases. this can lead to treatments and public health interventions to slow the progression of costly conditions such as hea diseas stroke, diabetes, bone fractures, age-related blindness, parkinsons, and alzheimer's disease. from a budgetary perspective

alone, this could save trillions of dollars by the middle of this current century. at the alzheimer's foundation of america, our incredible strength and quick success has come from collaboration. afa looks forward to work wh members of the subcommittee to address important issues raised in today's hearing, and in the long term to end devastation caused by alzheimer's disease. thank you. >> thank you, mr. hall. the mic on? might have to bring it closer. >> mr. chairman, chairma and staff, thank you for the opportunity to present testimony on this important topic. i'm marc cantillon, a practicing physician and a neuroscientist with 15 years in research and ug development and within the

pharmaceutical industry. this is a nonprofit organization founded in 2005 by the fda and the arizona community in order to build collaborations that identify more reliable and efficient methods to test new medicines applied regulatory science. as you have heard, in spite of the exciting discoveries in research, we lack full translation. we lack new medicines that could significantly alter the course of the disease, and indeed, we've seen huge alzheimer's disease drug trials fail. nevertheless, there is reason for a renewed hope. across the hall in science is a proverb written that i'd like to quote. where there is no vision, the people perish. proverbs. thanks to the work of this subcommittee, the fda's amendment act of 2007 including a decision to create the public private partnerships.

we're extremely grateful to congressman blackburn for their leadership in the legislation. the coalition against mar diseases can be one of the first of the partnerships launched by the fda and it's already creating and identifying new tools to speed the safe development of new medicines for alzheimer's and other diseases. this recreates the sense of urgency and open collaboration that made the unprecedented rapid progress against aids possible. sharing this knowledge was a hallmark and generally accepted as the reason that the rapid success was secured against this epidemic. created by c-path, it is a consortium that currently includes scientists from 12 major pharmaceutical companies, nih scientists, as well as experts from patient organizations such as my

colleagues here today, the alzheimer's association and alzheimer's foundation. along withhe agency, the ema and indeed the mapa including 250 scientists that participate in sharing what they know about alzheimer's disease and how they better contest new territories. these accomplishments already changed the way we attack this devastating disease. firstly, researchers score dementia in a clean call trial, and it is corrected over a dozen inconsistencies. now it's possible for them to compare results directly from study to study. this is a great example of applied regulatory science because it improves the quality, the accuracy, and efficiency of decisions made by both the regulators and the regulated industry, the pharmaceutical

industry. first ever camd was able to pull this from 11 trials from different pharmaceutical companies creating the most reliable data base in the world and it describes the natural course of the disease in over 4,000 patients. over 200 teams of scientists are using this. for example, modeling. in the past, former scientists had to design trialing based on their experience or what they read in literature. this data base allows the patient level data to show progression over time. 24 is far more -- this is far more prosice than clinical experience or literature. this allows them to accurately predict the outcome for a particular trial or how long the time musbe or how many patients must be including. indeed how jen nettics might spond differently ect., camd

is working with others to pool data to fther enrich this is a leading edge tool. they are also using the qualification process described. in this work, camd submits data and has brain imaging tools or tests as qualified for identifying patients much earlie in their disease when there is still brain function to be saved. if there are reasons for hope that is. th critical past is applying science at the fda. however, we need your help. understaffing is a serious problem and it is especially critical for camd. we need your support to be able to have the number of scientists and staff to participate in this and other critical pat partnerships.

this is the science that is changing the way drugs are tested and evaluated today so that alzheimer's can be prevented, not just slowed. thank you for the opportunity to provide this testimony and everybody in the camd thanks y for your leadership and sight in authorizing the critical path, public private partnerships that are giving new hopes to patients and families at risk for this devastating disease. i'd be happy to answer any questions. >> thank you, doctor, and thank you all of you. we'll take questions from the members, and i'll start with myself and i'll start with dr. marcelle morrison-bogorad. scientists know alzheimer's hits the brain long before people exhibit decline, but the specifics are crucial because so far drug after drug failed to affectively treat alzheimer's in people who already show symptoms, and i know you mentioned or suggested that that was part of the problem that perhaps the answer is earlier treatment before you actually have the signs of the disorder.

what i wanted to ask is why are bilogical marker whether gene mutations or brain changes important to the development of affective treatment for alzheimer's and what research is nia conducting to better understand the markers? i'm going back to the same issue that you mentioned that perhaps we should be starting earlier, but we have to know whether people have the disorder. >> probably one of the items that we're pushing most of our efforts on to these da bause we do think that understanding the earlier stages of alzheimer's disease are very important, and we've thought that over since we reissued the request for applications for fundin our alzheimer's disease centers across the country because oh, about eight years ago now, we said to them, forget

about late stages of disease. we want you to really, really concentrate in the earlier stages so we've thought about this for quite a long time, and obviously, one of the things that held us up has not been able to be -- has not been able to identify preclinical stages. that's o of the things that really is being addressed by the alzheimer's disease and imaging initiatives because especially in people who are with symptoms are people who are developing mild cognitive impairments which is a precursor to alzheimer's. researchers working together with industry and people funded by us identifying markers and the spinal fluid and these

markers are lowered amyloid and higher levels of a proteins that signal a person is approaching the stage of mild cognitive inparent. the other technology which has been developed by us and others is actually being able to look at the brains of individuals see view brail plex that is the most amazing breakthrough in years because it's the largest area where a number of older folk older than 65 or 70, about 20% of these folk who otherwise wafer been thought of as normal,

who are quite normal cognitively have levels of amyloid plaques in their brain, but in some cases are equivalent to a person with al him -- alzheimer's disease who can't at the moment function for themselves. ..

>> i had a second question but imet would prefer if anybody else wanted to comment on this issue because i think it's pretty important, any of the others like to? >> i would simply add that what marcelle has said is certainly one of the most exciting areas obering. we worked together on this and the alzheimer's association over the summer there was significant -- there were significant findings at least on this very front. it is a potential to get to the point we can actually find alzheimer's and it's not yet ready for the clinic. that is for the lab at this point. that is a significant set of advances that are very important. what is of course very important

is we have a parallel in treatments. right now we're making fast advance on the diagnostic sciences been on the treatment site so what we need to do is catch that up and that is one of those important reasons. thank you. mr. gingrey? >> thank you. i think i will shift to the treatment aspect of i and maybe come back to the interesting thing is you just talked about regard to the early diagnosis dr. cantillon, i hope i did better. i know i sounded pretty bad the first time. i have a lot of respect for the work the fda, food and drug administration, performs. but that being said, i'm interested in exploring how the fda drug approval press might be improved in the hope it may help spur a development such as

alzheimer's i think i mentioned in my opening remarks that i have introduced legislation along with my colleagues here on the committee, energy and commerce committee, health subcommittee, bipartisan, mr. green and ms. degette on the democratic side and mr. rogers from michigan on this side, the game that isin regard to the srtage of xenobiotic, sodifferent disease, different category of drugs but equally as important. can you tell me, dr.cantillon, how applying scientific advances such as the use of the drug development ols might aid in drug development in this country? >> thank you. actually as a medical director of aheimer's and other

programs over the last couple of years i did sit on an industry group dr. speed will be speaking about and given the jurors the instruments and markers being developed i had my hat on in terms of both drug development and facing the fda with a package for an approval for treatment. the trouble is when you're coming from a drug develer point of view this is very cutting edge and as i said in my testimony the science by itself is truly not enough to half exciting markers that may predict somethi that is going on in the brain if it cannot be harnessed into a path and a defendant steps to use a new drug and prove that. i will give you an example. so we talked just now about the spinal fluid where we knew there were certain proteins that can indicate both disease and perhaps even the type of progression predicted. we would take that and we are

taking that in a collaborative way with coalfield so just one collaboration i had mentioned look at the evidencefor that in a critical way, in a scientific manner. the regulatory science part is having the scientific comics internationally view that in a context of u.s. does that alw you to choose a population for a trial not demented sought to call you demented you don't need a doctor. it's very clear the person doesn't of the brain functioning for memory and so forth. to find someone early in the disease or hasn't this show on the clinical symptoms you mean these markers. can we ask for the fda regulatory approval but these are standardized and such a way that they can become a tool for the standard tool publicly available to any company in this country or anywhere else to take off the shelves and put into a program such that by using this tool they don't have to defend

that when they go in front of the fda. the prcess has already been done in this qualification and instead they can focus on their own drug that it fits into this pattern and can use the patient population for a sample to show a progression over time. to those people who have low the beta or a particular brain picture, do they progress faster than others and can you show a difference in the people who are on drugs and off drugs? that is helpful development process can make use of this science and translate it into something the fda can then approve or not approved. the fda t out a document partially from working with us just two months ago and in that the steps are laid out very clearly pity essentially it is show us the evidence, very similar -- >> my time is rapidly grwing to a close but let me very quickly ask you to using it's

appropriate that such a drug developer tols or by zero markers that the first receive approval by the fda before being used by industry and the agency to make the safety and efficacy of the drug? do you think the fda would have to approve this off the shelf kind of testing ahead of time? >> if you have the pulse of the ability just to prove for commercial or other use of within the context of use we are talking about the context were told that tool to help define a particular population. so for example let me give you another consortium. we developed some markers for the kidney injury. they were brand new and they could allow a drug developer or anybody to show something inning were happening very early on before the kidney actually was destroyed. these markers on through the qualification process and are being very widely used by all including my former one to make decisions about drug development. when they go to the fda they

don't need to defend the markers for kidney as the of already been approved so it takes a lot of that work away and focus. >> that does answer my question and i will yield back, mr. chairman. >> thank you. as the gentleman from the virgin islands. >> thank you, mr. sherman. dr. morrison-bogorad, during the impact on minoties, is the national institute of minority health and research which is formerly the senator among the nih institutions that you're collaborating with? and also and how diverse or that since in the clinical trial? >> again it is something we pay particular attention t. especially in our flagship clinical trials, azheimer's disease, one of the consortium,

and there we have made it a rule that a certain number of people in each clinical trial that we run our minorities and it is an extremely helpful because we think it is a fifth fthe folks who participated in these trials are minoriti. is it is amazing what a local rule will do. we certainly have got quite a vibrant program epidemiology looking at azheimer's disease and minorities and comparing that with alzheimer's, and i would say at the moment the results are somewhat equivocal

because many of the ways in which you define alzheimer's disease are also very dependent on things like the education of the person who is taking the test and many older african-americans, of course for other reasons, haven't had the education that they shod have had and so they don't do as well in these tests as they should. it doesn't mean they have alzheimer's so this is a very, very thorny issue and we have good researchers working on that to actually try to tease out what part of the minority version of alzheimer's is real and i do believe some of it is because some of the possible things that cause alzheimer's as

you are aware are much more prevalent on the minority communities, things like heart disease, but i do believe that some of the numbers are a little bit older and larger than they should be because of this issue on how to determine alzheimer's disease and people with different backgrounds. >> this is interesting because my an impression that is that this under by a nose rather than over diagnosed and minorities, but i will let anybody comment on that but i wanted to ask, if i can get this question mistreat because this hearing is about getting more funding for alzheimer's, and i heard your argument through clearly for the need of increased investment in alzheimer's to reduce the cost of health care eventually and perhaps even save medicare.

we've been trying to get them to score prevention for a while, actually legislation to have them do that at the committee, so without having the prevention how do you foresee getting the funding needed especially in congress committed to ctting spending and how important do you think the present and is of this particular issue? >> certainly as you say, the fact is cbo will score what i would describe as the game changer. that is a problem for all of us when we have an interest in what would be effectively r&d for the country. we really have beyond the immediacy of alzheimer's what is the potential brain drain and now were country as a result of research being attracted and while the isn't specific all summer it is generic and then

related in alzheimer's and medical research, so we had as a country to face what is first of all significant problem in that regard with medical research and very specifically alzheimer's and of course we have the challenge of facing our economic realities and also in funding something that cannot be scored. we recognize fully the difficulties of this, but we can also see from the projections we've done, and we've gone to outside sources, the alzheimer's association, to develop what are the the debt. we actually use the cms aveda on expenditures, on medicare and medicaid. we have taken those to dartmouth and we said the group will get this the that and what we have identified is that the 20 trillion-dollar cost over the next 40 years, one of the problems we have in the country is addressing probls that are longitudinal, those of you

sitting across from me know that there is a mauney in terms of how hard it is to make those things work. but we certainly not come to my, the alzheimer's association and any of us here sitting on this side trying to change the course of alzheimer's disease. we have defined the national fortitude to address this already enormous problem. everyone who has the disease today will die with it or of it. we do not have a treatment that stops or even this close at. the devastation that a human level for all of us, all of us who've experienced it personally and for all of those who haven't, we recognize jut how bad that is. i don't have an easy answer for the question, but the scale of the problem, the enormity of the issue begs for us to find a way to answer the question so that we can address this now. we are running out of time.

one of the things the marcelle mentioned is that the science community believes ever more that we need to intervene sooner that the plaques and tangles of the disease are deposited earlier in life at least ten years fore the symptoms manifest. in fact we don't make these investments relatively soon, the baby boomers, 10 million of whom will have this disease will be a lost cause and the devastation at the human level and the economic toll will be solidified if we don't move relatively soon >> thank the gentleman, and next we have the alzheimer's hero who actually sponsored both of e bills that you mentioned, the one i guess is now in the house for action hopefully next week as well as the larger bill. >> thank you, mr. chairman and

thank the witnesses so much for your participation here today. robert browning fruit grow old with me the best is yet to see, but the truth is that for the millions and millions of americans, the golden years and now the worst years because of alzheimer's and the family caregiver who has to help, and so this is now at 4 million or 5 million americans already an epidemic so as we know not only does the alzheimer's patient have the disease but one family member has it was also about 10 million americans are living with it on a daily basis in their homes in some facilities. and when it goes up to 12 million times to come up 24 million, 25 million people, the care giver and the patient

is going to be an incredible moment in american history. so we have an incredible responsibility to make sure that we put in place a plan, and mr. chairman, you made reference to it, which is the national alzheimer's project act that i introduced on this side with the co-chair of the task force passed the senate fuss might and senator bayh and cementer collins did an excellent job and we will be able to pass that next week on the house floor and then we will have a plan, we will have something that makes it possible to put in place something that is a plan to attack this disease but it is a good beginning.

let me ask you this and maybe you could reflect upon it if you could. last year the federal government spent $122 billion on helpin people with alzheimer's. but really invested 469 million in finding the cure, and we know we are only at the beginning of the explosion of the bills that are going to come in this room across america or the federal government to help families with alzheimer's. can you reflect upon that and give your insight to how big it is comg to become? it is imperative that we act now. >> certainly and let me thank you for your authorship and the leadership of yours in the committee. certainly the alzheimer's is already costing the 172 billion you talked about for the federal

government. incidentally the medicare level alzheimer's is driving 17% of the medicare budget. >> see that again. >> 17% is driven by alzheimer's already today. the total cost for alzheimer's again to the country will be by the middle of the century in excess of 1 trillion per year and by far the bulk of that will be the federal government cost projected from today's levels with no changes so that is simply will not be affordable not only on the economic front, the again on the human front. we can't accept what will happen to the families. we do not have the ability to deal with of the end f life considerations of the long term care. families at some point, dedicated as theare with 70% of the people who have

alzheimer's living at home and care for at home at some point the other percentages a result of the fact that families, no matter how much time they spend, the 24 hours a day they often spend as caregivers, especially toward the end of life, it is no longer enough where they simply are not capable of handling of the difficulty of the care at ho so we are not equipped at this point as you have indicated to have a plan for any of the things at this point and now but will hopefully address that but we are not prepared as a country to handle any of hese problems at the scale that they are going to rise to. >> this is just something that isn't well understood as it will be. my mother had alzheimer's and she was the valedictorian. my father was a milkman and always said it was an honor that my mother married him and so he is to say as well it is the

strength of our brain determining who got alzheimer's he would have had it and my mother would have been taking care of him but we know this is an equal opportunity disease and at age 80, 82, 84, 86, 88, my father kept her in our living room in the arms of a milkman the size of my legs and he was able to do it but for many families it becomes exhausting, you can't do it. there's the point beyond which you need help and that comes increase slightly from the federal government in $122 billion a year right now. but i don't think actually we are gog to be able to solve the federal budget deficit if we don't dramatically increase the federal investment in research. it'll be $1 trillion a year just for alzheimer's care and another 15 years. it's just a number that is going to increase exponentially and despite the efforts of people like my father and of their families all across the country

these people are heroes. the need help and hope and only the national institutes of health really the institute of hope give people the courage to keep on going. so this whole effort is absolute i think it should be the number-one issue to be honest with you just as a budgetary secretary, from the humane perspective, yes -- it's, to me, coupled with the alzheimer's breakthrough backed, which it introduced, and the hope act, the health outcomes planning and education act we have to put in place the kind of ingredients of the plan that make it possible for us to solve this problem and i commit to all of you that i am going to work my heart how to make this

something that becomes real in peop's lives and i can't think you enough's. mr. chairman, i think you for conducting this hearing. i don't think there is a more important subject. >> thank you for all you do, mr. markey, on this and other issues. mr. engel? >> thank you, ank you free much, mr. chairman. right in the nick of time. first i want to thank eryone on the panel. this is certainly a very, very important and something that i have had a lot of concern about. i think that wt all of my colleagues have said, this is what we ought to be spending money on when we talk about some of the other issues and i think we should all agree on issues like this. mr. chairman, i want to ask

unanimous consent to insert my opening statement in the record, and let me ask dr. cantillon -- first thing you for your comments. i was told the comments he made before and i deeply appreciate you saying that. the critical path initiative is certainly something near and dear to my heart. i strongly support the public-private partnerships and am pleased to learn this program has been very effective in tackling diseases dislike alzheimer's, and you mentioned in your testimony that one way the congress can be helpful is to provide the resources to increasi the staffing lels of the fda and as i mentioned before i could not agree more. we need to increase resources to the fda to bring the new drugs to market but given the limited resources we are working with i was wondering if you could address other ways we might help break down the barriers to

translation research and help fill in the gap that opened up between biomedical researchers and the patient who need their discoveries which we unfortunately referred to as the value of death. >> thank you for your partnership. i think the public-private partnerships are certainly a major part of the answer in this fiscal environment, so we have all said several times this is about to bankrupt our country and may other countries around the world and there aren't unlimited funds to put into each disease and maybe we need to look at an innovative science and innovative we get answering the questions that have come up. so the fda is going to be faced with a lot of the new science are riding in different ways. part of what we had been working together with to translate this finance not just let's say from the test tube but all the way to the edication at the end, in other words to make the process

available to be able to gather the evidence yearly information. the fda doesn't have but a handful of staff we deal with on a very regular basis i mentioned as a part of our consortium and the europeans are in a similar situation so what i was referring to is basically stretching the dollar and the people we have and what we are seeking to do more of is in fact in a kind of work and there's a lot you an do with that, a lot of scientists like a lot of data that have been final be it in government or within companie once the trial is filled at the highest on the shelf somewhere. definitely with the kind of tools we are talking about the data can be reexamined and perhaps there will be some pearls but they also can be mindful of the learnings that are there. that is public that wants to all of us and we put together the various methods to do that. i would say it is an innovate

tool to get people to give up their thinking and will get a pretty competitive space for companies and even for academics that they don't own the the devotee generated but it belongs to the people and if we can set up that way the database i mentioned but also the other tools,hen that isthree for the best mind in the world to attack and it's very efficient way of doing that. >> thank you for pointing that out. it certainly is a shame if research is put on the shelf and none ee can get to it or look at it. this has to be a collaborative effort obviously, and you know, thank you for pointing that out. i would like to ask a question of mr. hall and mr. johns. as ensure you are aware the patient protection and affordable care act which is referred to as health care reform that we just passed, we were doing this as you know for almost two years. there was a provision that

improves access to home and communitbased care for patients. we know that the services eatly improve the quality-of-life for alzheimer's patients. health care reform as we know strength as long term care systems for chronic and other long-term neurological conditions posed by eliminating the cap on the treatment which we did, that was one of the crowning glories and by extending coverage to include preexisting conditions which is the second pillar that is so important in this bill. in an effort to improve the programs that positively impact the alzheimer's patients and help to provide services can you give some insight of the provisions will improve your ability to provide services for the alzheimer's patients and their families and can you also address with other federal programs exist to help to deliver service to more patient squawks

>> well, i personally think all of our constituents are in the position especially as i mentioned previously that 70% or more of people are cared for at home all of our constituents who are in a position to be at home need additional assistance as we see how all of this unfolds we will learn better how it can best serve the individuals who are in those situations so we may always have high hopes for what would be better care at home because we know as i mentioned a little bit earlier that we do not have the -- we do not the capability to accommodate all the folks who would ultimately need to go to long-term care so additional ways to find the ability to handle people at home is critical to the entirety ofthe alzheimer's constituency. >> additionally i think we all agree that the longer that we can prolong the institutional as

asian the better it is for the federal budget for sure, but families to thenormous amount of support. the conversation we have had has been there is no doubt we need to find a cure as quickly as possible and any amount of money that we can put towards this disease would be an enormous win at this point but the reality is it doesn't seem to becoming any time soon and so it does rely on care and the families, so any type of provision that supports individuals with fantasies and care for them and provide for them the greatest quality-of-life in a. of time is great but also to recognize the support that is needed for the caregivers across the country at this point at this juncture where we are in relationship to the cure is a critical step and is what we need to do. >> thank you. thank you, mr. chairman. >> mr. chairman, just very quickly, and i know that the

afternoon is getting along, and i appreciate the witnesses have done a very good job. i guess i wod direct this to mr. hall. can you talk about the benefits of early detection as it relates to both the financial realities of the patient is face and for making e of life decisions? >> the alzheimer's foundation of america is the initiator of the national memory screening day and the reason wdo that is just to sort of educate the public as a coal and then allow individuals to participate in a memory screenings across the country that isn't a diagnosis for alzheimer's but rather looking to see if there is an indication of the ideas the most common manifestation of alzheimes disease. that initiative to us is really important because of the fact that it points to a possible early diagnosis of this disease. it is really critical because our experience at the foundation

of america is that our phone calls, e-mails in the volumes we receive, every single one of those families is in crisis and chaos so they are scrambling now to figure out what dhaka as alzheimer's disease look like? what am i now responsible for as a family? what is required of me legally, financially, what is required of my time? so early diagnosis and our interpretation is really important because some of the treatments the are available right now that will offset th depression of the symptoms of disease and there by the person in joyce, the person with of the disease enjoys higher quality-of-life for longer period of time and i have to tell you, traveling the country -- and ensure they said the same thing -- we haven't heard one single family anywhere that house and said that all we wanted was one more good day with their loved one who is in the grips of alzheimer's disease, and so if we can prolong one more day i think that is what we have right now. but additionally, planning in

this situation is an enormous. educating, and how wearg the family unit so that they understand that it's generally one to 04 individuals caring for an individual alzheimer's disease but the not in a land of the organizations to surround those families, to hold their hand, to walk with them on their journey and support them and connect those families of the point of diagnosis with those necessary resources and instilling hope which is probably the greatest missing link in alzheimer's disease but if at least by surrounding a family with hope your doing just that, giving them a lifeline and letting them know they are not going to be alone trough the process that takes care of an emotional tuille for the family which is probably the bigest piece of the picture and then if you are able to bring in other resources of financial and legal planning and what all this looks like as far as care in the

future, those are enormous wings and the leading the burden, stress, depression for the caregivers. >> thank you. >> thank you. that concludes the questions to i want to thank all of you. it's obvious from listening o the questions and your testimony how important this is both now d in the future. we do plan to move the one bill that passed the senate on the house floor next week and push the larger bill will have to wait for another time, but this is -- i just want to stress how important and how we plan to prioritize this. thanks a lot. let me mention that you may get additional questions from the members to answer in writing. the members are said met defeat does it was to submit those in ten days or so but you may get those and of kaput work will notify you of that, but without objection this meeting of the justice sandra adjourned.

day o'connor talks about life on the court. "washington journal" continues. host: we are joined by the president and ceo of the alzheimer's research group. how much of the government contribute each year to funding for research? not nearly enough. a small portion of the money is used for research over all. there's a growing population of individuals with alzheimer's disease. it is estimated at 5.1 million

americans with alzheimer's disease. that's about one alison of aid over the age of 65. out of 8 over the age of 65. what we are looking at is an incredible group of individuals impacted by this disease. simply at this moment, not enough money being invested in research for the cure. above all of that is also to an investment in infrastructure that is required to support caregivers and to provide care for individuals with alzheimer's disease. host: according to the national institutes of health, alzheimer's research, government funding is estimated at $480 million for 2011. the figures have been dropping

since 2006. why is that? guest: i am really not sure. there is enormous amount of sensitivity in washington. every single elected official? i have spoken whisper -- wiht recognize --everyone i have spoken with amrecognizes this problem. this disease is front and center and we are focusing all of our federal agencies to look at how they could coordinate their service is better. additionally, start to take a serious look at what is required to be this disease, what is required as an infrastructure of care until we end up with a silver bullet. it comes down to finances and coordination. host: when have we learned in the last 20 years of research?

guest: i think we have learned a lot. there's an enormous amount of hope. the hope is in the hearts and hands of researchers all over the world. i've had the opportunity to meet many of them in my travels. they are incredibly compassionate and determined to make a difference. there is an enormous amount of expertise. probably the greatest minds on the plan is working on research for the cure for alzheimer's disease. the problem is we are not sure what the cause of the disease is. in the absence of knowing exactly what causes alzheimer's disease, we are really not able to come up with a cure. in the meantime what is left is the burden of caregiving for the population we have. mostly it is being picked up not by federal dollars to as much as family members providing the care day in and day out for love once. host: we have set aside the

fourth line for those affected by alzheimer's disease. if you are care giver or family member. we want to hear your point of view as well. according to the alzheimer's foundation of america, the national cost of caring for individuals with alzheimer's is estimated at $100 billion annually. alzheimer's disease costs u.s. businesses $60 billion a year. stemming from lost productivity and absenteeism by primary care givers and insurance costs. the annual cost of caring for one individual with alzheimer's ranges from nearly $18,500 --

again, how many people are estimated to have alzheimer's currently? guest: about 5.1 million americans right now. with the ratio being one in 8 over the age of 65, this disease has no place to go but to grow. simply because we are not in a position where at the moment we have a cure. but i think the other piece to the numbers that you just mentioned, peter, is what is not included is the evaluation of what the cost would be around caregivers' actually providing care. if we were to pay them a fair wage for their activities, what would that increase be? it is estimated there is about 11 million caregivers for this population of alzheimer's disease. if you were to do the aisle worst, i have heard members as great as $50 billion being added to that number.

-- if you were to do the hours. that is being a sore spot families. host: can you make the -- that is being absorbed by families, the cost. there was talk of aluminum been the cause of alzheimer's disease. there was a statement made three or four years ago. the problem is that at the foundation we ended up with a lot of phone calls from family members, mostly women, who believed they had given their husbands alzheimer's disease because they used to cook in aluminum pots and pans. there was enormous confusion about the statement that was being made. at the moment, aluminum has every other possible component

and element and is being looked at as a possible cause for the disease. but there's no definite research that is the cause of alzheimer's disease. host: where does it come from? guest: the name comes from the founder, who was able to determine its 50 years ago in one of his patients that was coming to them and he was able to capture what were some of the manifestations of the disease. it is attributed to the doctor in this regard. the whope is that as we are learning more -- and folks need to know there is an aggressive move to try to determine what the cause is -- there's no doubt that over 100 years

there's been an aggressive move to use every facet of our knowledge and experience to come to a determination. i believe what we are probably looking at in the next 15 or 20 years is a combination of treatments that will offset the progression of the symptoms so that we will die of some other natural cause. it is the situation the aids virus presently enjoys. individuals with hiv can live a long time given the treatments readily available. our hope is alzheimer's disease may have that. simply because i don't know if a silver bullet will be found. what our experience is, is doctors are saying it might be a combination of different activities, different situations and scenarios. a perfect storm that accursed in the human body that brings about alzheimer's disease. for the last 100 years to now,

we are in a situation of trying to find out exactly what is the cause. host: richard is calling from north carolina. go ahead. caller: hi, i want to find out if they are going to do more research on alzheimer's. i had two sisters that passed away with alzheimer's. guest: sure, absolutely. the federal government is looking at this now. i do know from testimony that i recently gave before congress that everyone is sensitive to it and realizes the irritants. the foundation has been asking for an increase in the fiscal year 2010 national institutes of health budget to increase its to 1.4 billion, and to be

allocated specifically to the national institutes of aging. the reality of chronic diseases, especially alzheimer's disease, really need to be head-on because it is an investment that will pay off in the long run. the alzheimer's foundation of america has a very bold attitude in this regard. the private sector is also engaged. a lot of major pharmaceutical companies all over the world are invested as well in trying to determine by research what exactly is the cause. not just with coming up with a cure, but more effective treatments as well. some of us know that there are some treatments available that seemed to slow or offset the progression of some of the symptoms of this disease. regrettably, as with everything,

the disease ultimately wins. we hoped that overtime and the more we learn and are able to implement our knowledge, that we will be in the position to hold off the disease and the progression of the symptoms of disease so they will die of some other natural causes or that their role be a cure. host: the next call is from denver. go ahead, john. caller: good morning. i witnessed my grandmother being the valedictorian and then went then nothenwh -- knowing who i wsa. was. is there a connection with mad cow disease? guest: i have also been impacted

with alzheimer's in my family. my mother, two years ago, a relaxed lunch, she had terminal cancer as well as dementia -- in her last month. the incident you mentioned about your loved one being the valedictorian, being someone of cognitive capacity and intelligence, it is the very traumatic experience. i feel your pain and i have experienced it personally. it is the one thing we have in common, as a nation, many of us have been impacted personally by this disease or we know someone impacted. this is really the time for all of us as a country to start a unifying our voices behind this disease and really pressing congress to do more. the national alzheimer's project act is a good for step. it talks about putting together a national plan and putting together funding and putting alzheimer's disease front and

center. it is really going to take our collective voice to get this done. as a nation we will have to make sure they understand how important this is to us and that we want the pain and suffering to stop. that is something that we, as a nation, uniting our voices, can do. your question about mad cow disease and the relation to alzheimer's disease has been looked at and continues to be looked at. regrettably, if it was that simplistic, i am sure we would have come up with an understanding of that by now. host: burleson, texas, andrew. caller: good morning. i have a question. you partially answered it. could you elaborate a little bit more on the dementia part of alzheimer's. how does that connect?

my mother is in the early stages and is living with my sister. her basic thing is she wants to live at home. she has been diagnosed with mild dementia. i was looking at a program the night when they passed a bill that was supposed to allocate more money for people to start living and palt home. guest: dementia is an umbrella term. it speaks more to a specific medical state of experiments in one's brain. that impediment we commonly recognized as forgetfulness and the like. dementia is an umbrella term. 60% of all diagnosed cases of dementia is alzheimer's disease.

there's also a huntington's disease and louis [unintelligible] all of those involved and deprivation in the brain. my recommendation is to try to determine by either the approve the position that you are presently seeing or maybe by way of of royal to someone more specialized in dementia, you want to find out exactly what type of dementia we are talking about. treatments will veary according to what type of dementia. you want to truly capture an accurate diagnosis because treatment will make the difference. it is based on the diagnosis. host: diagnosing alzheimer's thoroughly, is it possible that there are some treatments now

for early diagnosis, and is a hereditary? guest: diagnosis of alzheimer's disease right now is probably up percentile that they are able to diagnose. the most common thing is memory problems. it's the one thing that if you ask someone on the street what alzheimer's is, they say forgetfulness. the alzheimer's foundation of america fully believes there is the opportunity of capturing early diagnosis and that we as a nation needs to speak about that and get educated on what are some of the cognitive difficulties, what are some of the issues that we might be experiencing, so that we can hold an intelligent conversation with our doctors. many of us have not been talked

about how to discuss some of our cognitive issues. if we were having memory problems, how do we communicate that with our doctor? we all have ideas of what causes diabetes. we all understand hypertension. those types of common knowledge that we have as a nation is the cause of national campaigns. the alzheimer's foundation of america has established national memory screening day seven years ago. that was not talking about alzheimer's disease specifically, but rather stepping back far enough to look broadly at the most common manifestations, that being memory problems. the benefits of that is that we found tens of thousands of people participated on national memory screening day and went to see a health care professionals to have their screening done. and to determine whether they have memory problems. then the ability for that individual with education, then

they were able to go back and talk to their doctor and find out what was the cause of some of their memory problems. what folks need to know is not all memory problems mean you have alzheimer's disease. there are a lot of common causes of memory problems that are irreversible. vitamin d deficiency, stressed, combination of prescription drugs your doctor has prescribed for other health issues you have. a combination of some of these treatments can cause side effects of memory problems. it comes down to an enormous amount of education and stepping forward and talking to your doctor. the alzheimer's foundation website has lots of information did educate you on how to talk to your doctor. there are treatments right now available early and mid-stage alzheimer's disease that are able to offset the progression of the disease. are they as effective as we want them to be?

absolutely not. all of us watching right now, when we are sick, we go to the doctor and tell them what the issue is and they give us a pill and generally we get better. the commonality of this disease is it does not presently enjoy that mode of operation. what we have is what we have. the most precious thing around alzheimer's disease right now in absence of a cure comes down to quality of life. how long can we sustain the highest quality of life for the longest amount of time. that's the goal and objective. i have not met one person in my travels whose, to me and not said they did not want one more presses de with their mother or father or loved one. that is the goal. -- that they did not want one more precious day. host: amarillo, texas,

margaret's. caller: good morning. guest: good morning. caller: my husband had alzheimer's. he was 6 most of the time. he was 59 and died when he was 69. -- he was sick most of the time. i kept him at home seven years and finally had to put him in an alzheimer's unit. my husband had been an electrician. we had a business. when this happened, when i had to put him in the alzheimer's ward, we had to sell everything we had for the money. it was awful. i am 78 years old and now and i have nothing but my social security check. people areow how poor going to survive like this.

we worked so hard and my husband worked so hard all of his life. [crying] thank you. guest: i am very sensitive to your issue, margaret. you represent the many heroes in our country who have stepped up and provided care, not just financial. we could probably talk about the emotional and psychological and the physical toils that came with being a caregiver for your husband. i have no doubt about that. i know people are listening right now and watching and they feel where you are coming from and understand right now what you have, your social security checks, everything other than that had to be sold to provide

care. that's a common issued for loved ones. for people without long-term care insurance, it becomes a difficulty. and not all long-term care insurance covers alzheimer's disease scare. we need to be sensitive about that. the problem right now is medicare does not afford a benefit for the diagnosis of alzheimer's disease. unless there is some other co- issue that exists that allows you to get mental care and have that scare reimbursed, it comes out of pocket. so it is absolutely a difficulty. i know that you chose the facility that you chose and you spend what you spent because you knew that it was in absolute best interest of your husband and it was your love for your has been that made you do that. i know that passion is still there. i know that you would not change anything in that regard because you know that it was love for him that you did that.

that is being replicated all over the country. people going through an enormous fight because of the true love that they have for their loved ones. you are one of the heroes of our country. there's no doubt. i am glad you took the time treblinka up because i know there are the people listening and watching who have the same experience and feel they are isolated and alone. -- i am glad you took the time to call us up. we don't have the resources to care for this issue across the country, but we can make sure you are not alone and make sure you are appreciated and supported as much as we are able to support. host: i want to have you go back to the medicare and medicaid role when it comes to alzheimer's. guest: regrettably right now

medicaid is state-by-state. it allows the opportunity for different states to allocate what they will or will not cover in relation to alzheimer's disease. medicare right now, the one thing we were able to do in the new health care reform law is we were able to put into law the question of cognitive impairment in new annual medicare exam. it was a big step because medicare does not have a benefit for alzheimer's disease at the moment. by putting in cognitive impairment in to the annual wellness' example, that raised the bar. medicare will be able to focus on some of the cognitive issues as a result, which ultimately alzheimer's will be part of that. is it enough? no, more needs to be done. we are doing the best we can at the foundation to make sure that

we are pushing the argument, that we are trying to get as much done as possible. maybe one day there will be a benefit for alzheimer's disease. that would help so many caregiver is providing care out of their own pockets. host: the next call is from lancaster, pennsylvania. go ahead. caller: are you saying the diagnosis of alzheimer's is eliminated by any other cause? can it not to be seen on an mri or cat scans? my father is slipped into dementia couple years ago. buildup ofs show the plaque and tangles in the grain. that ise's a pet scabn

more specific in this regard and is helpful. there's a need to eliminate possible other causes to make sure what we are talking about is alzheimer's. years after my father was admitted to nursing care facility, the geriatrics physician attending him gives me the explanation still that your dad has a mixed bag dementia. to me this is not acceptable. in doing research, i have run across a complication called hydrocephalus. it spoke about the misdiagnoses of patience that actually have hydrocephalus which is treatable and reversible, but the family is being sold your loved one has alzheimer's and and there's a vested interest in the geriatric position who works

for the facility because it costs $5,000 a month to keep him there. i find the lack of fairness from a well-known -- host: all right, we got the point. eric hall. guest: i would follow your hunch, finding an opinion, talk to another doctor in the field, and have them come up with the diagnosis as well. the education you have bases some concerns and issues and you should follow them. host: a tweet -- guest: yes, regrettably, absolutely. that is an experience that more research is being focused on now. and brain trauma from war veterans, or multiple

concussions from, say, sports and sport activities, all of this is raising an enormous amount of research to determine exactly how prevalent that is in the onset of alzheimer's disease. yes, there seems to be a significant number of researchers who believe that there is a connection there to be had. host: a recall is the president and ceo of the alzheimer's foundation -- eric hall is the president and ceo of the alzheimer's foundation of america. caller: i just have a question on the prevalence of alzheimer's in the united states versus other parts of the world. guest: age is a prevalent risk factor, obviously. aged 65, one in eight over that age, and as the technology has grown, we're able to live much longer. it is recognizable that medical

developments have allowed that to happen. we have had an increase in alzheimer's disease related to that. in some countries, the life expectancy would not be 78 as ours is your and there would be a lesser incidents. i would caution people to recognize that this disease does not simply back to the old. there are cases -- does not simply impact the old. there are cases of people in their 50s and early 60's being diagnosed with alzheimer's as well. it does not in any way or shape or form choose one over the other, although it seems to be more prevalent in the older years. host: republican. caller: does obesity have anything to do with alzheimer's? guest: where we are out right

now is that a lot of the language and messaging surrounding, say, a cardiovascular health, really is applicable now as we're discussing preventative measures or risk-reducing measures about getting alzheimer's disease. a healthy diet, exercise, making sure we are watching our diet and cholesterol and hypertension and diabetes. all of these things we now know impact directly the brain being part of the physical body and, ubviously, being processed thr as everything we've taken and exercise and everything we do has benefit as well. a lot of the messaging about heart help is now we understand probably very applicable to bring health. host: via tweet --

guest: about 2% of all cases of alzheimer's disease that has a hereditary peace. if folks are concerned and have issues, it is great to hold a conversation with your doctor and get more information. if you like, you can come to the alzheimer's foundation of america. we have information on our website on issues surrounding hereditary disease, or you are free to talk to one of our licensed social workers who answers the phone. we can get you a lot of information in the mail so that you can educate yourself. host: eric hall, the alzheimer's foundation, when did it begin and how did you get involved? guest: it was established in february 2002. and the founding chief executive officer -- i am the founding chief executive officer. our goal -- first of all, for

both of us, we were impacted by alzheimer's disease in our family. secondly, it was seen that there was more that needed to be done in the area of care of alzheimer's disease. there was an enormous amount of emphasis and energy and financial resources going for a corporate don't get me wrong, we hope there is a two or -- going for a cure. it up to me wrong, we hope there is eight -- don't get me wrong, we hope there is a cure, but in the meantime, what we do for the millions of people who are caring for someone with alzheimer's disease? the other thing we are really sensitive about is making sure that people with alzheimer's disease enjoy equality of life, enjoy their integrity, that they were given the respect that was due them, and then, also, making sure that families providing care for them to receive all the necessary resources they codicil that they could do their job as effectively as possible.

in our mind, it does not fall on the federal government, but it falls on families, and it is in all of our best interest to make sure that they are well provided for and supported. host: the national tab for caring for individuals with alzheimer's disease is estimated at $100 billion annually. alzheimer's disease costs u.s. businesses about $60 billion a year stemming from lost productivity and absenteeism by primary care givers and insurance costs. the annual costs of caring for one individual with alzheimer's disease ranges from nearly $18,500 to more than $36,000, depending on the stage of the disease. the total cost of care is expected to rise from approximately $172 billion in 2010 to more than $1 trillion in 2015. this figure includes expenditures for medicare, medicaid, private insurance out of pocket costs, uncompensated

care. funding from the government, according to nih -- 2006, approximately six harbor $43 million for research. down to a $480 million today. massachusetts, jonathan, you are on with eric hall. caller: one thing that would make that research more effective is different autopsy protocols allowed information sharing between people, because it is the only way you can detect it was alzheimer's. the only conclusions that can be drawn is the autopsy data can be available to the researchers. also, there is a problem with a research dollars being too tightly targeted to specific avenues. as new promising avenues become available, they cannot jump into the new path because they will lose their funding, because the funding was slated for something slightly different.

finally, if you are not careful and you get an early diagnosis, it will just allow insurance companies to cut back on their coverage. thank you very much. guest: no, i mean, some of the points are well taken. there are concerns about all of those areas. privacy and outpatients -- privacy around patients, the ability to share the reports. looking inside the brain. you are absolutely right, there is a lot to be had from that type of information. if that could be used by researchers, that would be great. yes, regrettably, the early diagnosis in some regards help policies and entrances -- an insurance dropped individuals with i'd slamme -- with alzheimer's disease. it is a catch-22. left to itself, alzheimer's

disease is devastating. if there are treatments available, they need to be accessed as quickly as possible for the good of the individual. if the family is the one providing care, the more time they have to adequately provide a plan of action around the legal financials and the care plan, it really does come down to being the most beneficial. yes, we have to address those pitfalls that, but with early diagnosis. -- that come about with early diagnosis. host: where is the early alzheimer's research done? guest: it is done all over the world. i have been most impressed -- i am not a scientist, obviously, but i am most impressed by their determination, their desire to truly make a difference. they understand that this is the greatest challenge now facing

our country, facing the world. they understand that, as we are all aging, not just here, but every country, this is going to be the one disease that is going to have an incredible prevalence across our society an incredible costs as well, to provide care for all of these individuals with alzheimer's disease. the other difficulty is that individuals who are diagnosed, we can live up for very long time with this disease. it is not necessarily immediately breaking down our immune system. we can live, on average, seven to 10 years, as margaret was talking about with her husband, with this disease. i think researchers in the private sector, in government sector, are looking for the cure, i think they fully understand what is the challenge before us.

host: next call, houston, texas, michael, you are on the air. caller: how are you? host: good morning. caller: my wife passed away a year-and-a-half ago from ftd. are you familiar with that? host: the wellhead with your question. describe what it is and go ahead with your question. caller: dementia. she was diagnosed finely at age 59. front temporal lobe dementia. i was part of, and half of them had the same -- i was part of a terror group, and half of them had the same symptoms as my wife -- part of a care group, and half of them had the same symptoms as my wife. it is terminal, but they never mentioned to me that it was

terminal dementia. i had to go on line, the university of california-san francisco. there is a doctor at the that as these studies. -- dr. out there that does these studies. host: did your care regimen change after that? caller: absolutely. my wife cannot read or write the last three years. that lady explained it perfectly. it is the most devastating thing to a family. you cannot believe. this was a young, beautiful -- she graduated fourth in her high-school class, a graduate from college in three years, and believable musician, everything. to see the deterioration is unbelievable. guest: i think it highlights the need for the proper diagnosis. again, we utilize experts in the field to help us diagnose what

our cause of the dementia we are experiencing you make a great point. we never used the word " terminal" when it comes to demint, and yet that is what it is that makes the crisis more devastating -- when it comes to dementia, and yet that is what it makes the price is more devastating. host: last call. caller: good morning, c-span. eric, you are doing great work. he mentioned a few things about the nature of the disease itself. you mentioned vitamin d deficiency. personally, i've been studying clinical nutrition for years. there is an enormous amount of information about how thousands of the losses are directly and indirectly related -- thousands of illnesses are directly and indirectly related to nutritional deficiency, and how to possibly reverse and prevent

many diseases. when you said b of vitamins, i want listeners to go out and do their own research -- particularly b12 and alzheimer's disease. there is an enormous amount of information on that. and also, certain nutrients and antioxidants, like blueberries, raspberries, other fruits and vegetables, have shown promising results in treating many black belt -- many plaque buildup conditions in the body. and the work with linus pauling, a giant in the medical field -- guest: i would just say that there is an enormous amount of research being done in the area. we're looking at how nutrients impact the body, what are some of the early causes of this disease, and what might be

preventable by taking vitamins of whatever sort. the jury is still out. the clinical trials are not quite done. there is still an enormous amount of research being done. i am sure there is a threat in there that will be very important going forward.

schools have a tendency to teach to the test. if certain measures will be tied to the test on these subjects, then there is a natural human tendency that follows. no child left behind as the source of the problem. there was a series of conclusions drawn that teaching civic had a note if on what young and old people and of knowing.

that was the theory into that as i said it started getting drop. the problem with no child left behind is you have to find room to fit it in the school day. and overly pragmatic solution is suggested. the only good news in this particular attention is there is not an absolute tension between fulfilling no child left behind and teaching civics. a lot of the material that can be used for the reading segment

can be civics reading. there is a way to infiltrate no child left behind with civics. it is not an absolute position. how do you provide an incentive to the school districts to work this in a? one thing i have learned is trying to beef things up in new hampshire. the civics teachers are out there and are dying to teach. i met some at all levels. they are willing to go. we do not have a problem of conversion among teachers.

we will find a way to get this done. at the end of the line, people do not like to use the word testing anymore. we have to have a civics texts back in. >> you are involved in reform at -- reform efforts in new hampshire. tell us about that. it was a group formed by an organization it was somewhat a historical society. it had public relevance beyond the teaching of history.

it is a review of new hampshire curricular practice. is there something useful we can do? that sparked the examination. i had a fairly good sense of what was going on in new hampshire schools. i think what a group like mine can do and what does expect a group like mine can do in most states is not convince teachers that they should teach civics. that is fair. we do not have to sell them on not. we have to provide the teaching

apparatus and incentive to make room for this. and then we have to provide them with materials to teach from. there is not readily available standardize universally accepted textbooks of the sort. i think i remember. many states dropped testing from civics. we also have got to provide for a raise the money for a continuing education scheme to kit teachers together. we have to give them some more

education which they are dying to have. that is something useful. what is missing in new hampshire and what is accepted by the educational system fair will probably be true in many states. >> what about best practices? >> i have another idea. >> i am sure you do. >> i think young people today like to spend time in front of computer screens and a video. they spend 40 hours a week doing that. that is more time than they spend with parents. we have to capture some of that.

they have organized a program to do that and put the material for civics education in a series of games that kids can play on computers. they loved it. you should look at it. it is fabulous. [laughter] [applause] >> i have heard other people say that as well. >> it is very engaging.

you click on various arguments. i was really getting into it. >> it is a perfect fit. what is the worst bureaucracy in our country today? not one state where there is one person who can tell us what to do. we are organized with separate individualized school district. many hundreds in my state of arizona.

to get something like this conveyed, it is kind of a nightmare. how do you get everybody appointed. whether they will succeed remains to be seen. maybe some volunteers. >> what about this? >> we previewed some and may have made some suggestions. we have experts that are better at doing this. i have participated in some to figure out what we should do.

are there other particular deficits that you have noticed? >> they do not know their three branches of government. even if they do, the course work. who is in charge? in the case of congress, they do not know how things happen. not much does, i guess. we know what is supposed to happen. there is a lot to teach and a lot to learn. >> things have changed from the

time that we were kids. the resulting deficit. i tried to find the perspective on this. 50 years ago, people were not putting down the same kinds of survey. i have been impressed with one summary which went through several details and a survey findings. the conclusion to be drawn from meant was summarized by one of the educators in the field. the numbers seemed to show that

the degree of broader knowledge and civics on a high-school graduate was competitive to that of a high-school dropout -- drop out in the 1940's. comparable knowledge of a college grad was at the level of a high school graduate in 1940's. if anything needs improvement, during this timeframe the growth and availability of higher education was explosive. the level of collegiate knowledge affected to drop out.

something really bad has happened. >> in preparing for this, i've tried to find other resources out there to get a sense of how broad -- how broadly this was recognized. a lot is going on. one of arthur weighed in on this. he mentioned a curricular development program. the judicial system in maine, a coalition of the federal and state judges had started a program of the video interviews and injustice talking about their life and work. they had one judge who talked

about being a troublemaker in hawse -- high school and dropping out of college and it took him a while to get his act together. he did not want to make the judiciary seem remote. he gave citizens a sense that these are real people doing a job for the public who are approachable. it can be understood on a human level. there seem to be a number of justices that are out and about and making the court more accessible. you have been around long enough to see that as a trend.

is there anything to look at this as an institution or can you address this? . >> it was interesting, because i am not in washington d.c. all the time. i recently was there ever a set in the courtroom to watch the oral argument. nine positions on the bench. it was incredible. on the far right was a woman. in the middle was a woman. on the far left was a woman. it was incredible. it took years to get their i was pretty impressed.

same thing with the diversity. [laughter] things are happening. >> the court being able to model. >> i think the image that americans had over all of the court has to change when they look of there and see what i saw. i thought that was a pretty big change. not many people get a chance to see that. c-span has a dog in that fight. wanting to bring the court into the living room of america.

[laughter] [unintelligible] [laughter] >> looking at the election this fall, some of the judicial issues and what happened in iowa where sitting judges were thrown out the the in their retention elections. >> that is another subject on which i have been trying to be helpful. selecting the same court judges. this is an important topic. it seems that many of the state's need to consider some changes. when we started out, the framework of the constitution, when they came to the judicial branch it could be appointed by

the president with the advice and consent of the senate's. no election. the original 13 states had similar systems. no elections. a few years went by end of the sudden andrew jackson went to new orleans. he thought we should elect our state government. he said, we should change this. the first place to do it was torture. others followed suit. many states still have popular collections of their judges.

that means campaign contributions. they run for office. the lawyers appear before them. there was a case that said supreme court from west virginia. a big judgment and the chairman wanted to that judgment in trial court in west virginia. they have to two levels of that. and one wanted to appeal. there was going to be an election at the next general election. nancy gave the man about $3

million to help with the campaign. he won. big surprise. and then the case was heard and somebody on the other side said maybe you should recuse yourself from the campaign. they said, i can be fair. in a recent decision he voted to overturn the judgment with the participation of this newly elected judge. the other side filed a petition with the u.s. supreme court. they said we were denied due process. it was a hard claim to make. i am glad i was not sitting on

their for that. there was not due process. states will have to be more careful about how they organize their courts. they have to make sure they sent to the right signals. it was not a good idea. i would like to see more states to adopt a selection system where there is a bipartisan citizens' commission that will receive applications from people, review them, make recommendations and then served for six years.

and they can be ousted. that is what happened in ireland. -- iowa. the court had unanimously decided that the case involved a gay marriage law. they campaigned against these judges a majority of the voters voted them out. that was big. >> i wanted to ask you about that. the retention has been held up for years. what happened in iowa, some voters did not like the outcome of the same-sex marriage case.

outside groups came in to teach a lesson. the judges running for retention had never encountered anything like it. >> race is a question. and land still holds up as a civic improvement. >> it does. i have watched the progress in arizona. and it is so much better than the alternative. those that hope to be retained

better be active and do something. >> you are back in it? >> you go back to where it was. it is not going to happen every time. >> do you think that if the public has a better understanding of the role of the judiciary that this could be mitigated in some way? >> occasionally there will be a hot issue. abortion or gay marriage or something like that. voters can get excited about some of those issues.

>> i was appointed. it is the federal system. i agree with justice o'connor. try to have the missouri plan. and least you are better along the way. there is the fundamental understanding and the point is the system would be for long term appointment. when the heat is gone we tend to

do the wrong fein. we get excited. that is why we want a branch of government that has a reference to principles that will endure beyond the heat of the moment to say, wait a minute. you just violated your own will. if you do not have a branch of government with powers to do the and with the incentive to do it knowing that those that make the declaration will not be thrown on the streets the next morning that you in fact are compromising the very concept behind a rule of law that is the fundamental problem the development that has exacerbated

that problem is the development of that money in judicial elections which would be exacerbated by the recent development in the law. we had expressed opinions earlier. if that were not sufficient exacerbation. that combined with the legal avenues now the ford disguising the sources of political contribution, makes for a threat to this to the judiciary. how does one respond?

there is one of 40 that they have to start thinking of using. think back for a second to the reference to west virginia. the reason that case could be focused was it was a matter of public record as to where this money came from. the company was appealing this large verdicts. what do the litt against do now? when the limits are off as to

what corporations can do in federal law it seems to me that i know what i would do if i were litigating in that situation. i would require and demand in the name of due process a disclosure of all sources and contribution. and i would want an analysis of the sources. i think it is inevitable that this is going to come. i do not know if there is anything that litigants can do in the name of due process, unless they are willing to take the chance of a fish being shot out in a barrel in the they do

not know who is firing. >> there is the clash between first amendment in and due process. >> you are right. most are not questions of should we apply this principle but rather questions of should we apply this principle for that principle that might apply? the essence of principled decision making by a court like the supreme court of the united

states is in the reasoning that selects the principle that will dominate in a given case. the principal decision making is not just being watchful but also being reasonable in selecting among legitimately competing principles. we will see that as a the enduring view of due process. >> the question is if the current majority is willing to follow this. >> you will have to ask that. the process in the recent cases has not encountered the issue that we are talking about here.

the supreme court decided citizens united is also the supreme court. it is the same court that decided the west virginia contribution case. the case is robustly espoused by both principles. this is non due process. this is a court that has not shown itself shy of confronting either due process for first amendment issues.

i do not think it will be shy about resolving how to -- determining how to resolve the tensions. >> what is it like having been on the court for a chunk of time to watch them? you feel a mistake was made. what does that feel like? it must be a strange feeling to be on the outside looking in. >> people will be serving their four different time frames. you'll not be there forever. some may disagree with some of the areas you believe.

it is very possible that you will be concerned or disappointed. that is life. >> there is a joke about the young in the old. the older guy looks as fresh as he did at 9:00. the young doctor says how can you seem so fresh you were listening to these patients all day long. everything is wrong. and the older doctor says who isn't? [laughter] that may be one answer for retired supreme court justices. who wants it.

>> i think you are feeling a little liberated. >> liberated to not liberated from. i love my colleagues. unlike the work that i was doing. there were days that i had wished things had turned out differently. i feel liberated to do things. it is confining in time as well as in the discretion. there were other things that i wanted to do while i was still in a condition to do them. >> a better way to put it.

>> people in the audience have been writing down questions. this may be a good time to turn to some of this. we have a set of them. i am sure we will collect more. someone is trying to hand do something down there. do you think any of the decline results from the change in the rhetoric of the purpose of government?

the focus is much more on private cessation. we do not hear much talks about the higher purposes of government. >> i do not think the list but i am hearing out there. you have young people who are not learning anything about it. there is not much discussion or concern. >> a historical perspective helps here. the decline started several years ago. i do not think it was until the end of the 1990's where people were saying, there is something wrong going on here. and the state of public rhetoric in the united states did not reach like today as it

did in that time. i alluded a moment ago to the fact that i had seen many civic teachers in the last year and i had seen some of the kids that they teach. i will give you a couple of examples. i listened to a fourth grade class that was visiting the state house, and i happened to be around. the town was blessed with teachers in the fourth grade that had an enthusiasm for teaching and the kids were a bunch of winners. i found out how much they knew.

their farms where going out of the shoulder socket trying to answer questions. there were some combined high school class this in my own town. they were blessed with some really good teachers. and they were gung-ho. i do not have any reason to believe this is going to be a roadblock to educational reform. i agree. is the decline in the teaching of civics related to the decline in educational standards? >> i think there is a decline. i share some of that concern.

earlier, there was a time in our history where a lot was learned than what is today. and we have deleted it as we have gone along. >> i do not know enough to answer that question. >> in certain states be brought to teach this type of curriculum? >> i think it is possible. you may have a hard time on some of them. in massachusetts, you do not have the popular election of judges in the state. you have a pretty decent system. in texas, i was born there and

spent time there. the first thing you have to do is do research on the judge and try to find out how much money the judge has been given to get elected. that is what you have to do. you have to see if they will get a fair hearing in the judge's courtroom. that is pretty sick. why would you want a system like that? it is very discouraging. they would include in the

criticism in the curriculum. i do not think there system of judicial selection is ideal. one of the things that we will see is the evidence -- efforts to beef up teaching in the united states. the ferret is a contrast between teaching materials that would be used for the future. i remember the book in the ninth grade. it got a lot of basic factual material on the page. the notion of an acceptable

textbook on a national level is an antique. we will not see such a book. what we will see is a combination of what is going on in those schools teaching civics today. it is a lot of material is getting downloaded and then getting exchanged there is a decentralization of tax cuts going on. i would be very surprised if that trend is going to change. >> how can we get schools to include civics in their curriculum when they say they do not have enough resources to teach math and literacy well?

a financial question is posed. >> i am enthused about a program that can be used by kids on their own where they are having fun and will learn. that is one way to get around it. i am excited about that. the the >> there is a fundamental value cancer and another is more pragmatic on how to do it. one has been lost from the discourse or consciousness. people like us to take of the cost in other states, they have to keep pushing it.

in the aftermath, one person was at last what kind of government the constitution would give us. it would give you a republic if you could keep it. republics can be lost. eight people both free and ignorant never will be seen. there is a component of knowledge and understanding if democracy is going to survive. when two-thirds of the nation does not know the basic structure of their government and cannot answer questions that would have been appropriate for schoolchildren, then we are

getting to the place where we would worry. if ever we were in a position of worry, it is of greater worry today than any other time in our lives. there has been no time in my life where the degree of frustration with the government and dissatisfaction with government has been as great and volatile as it has been today. the response to that frustration, which everyone on this platform -- platform shares, the response have not been political responses. they have included suggestions

for structural change. they go so far as modifications of the 14th amendment. when that kind of possibility is around in public discourse, we have to be very worried about the inability of the majority of the population to understand the structure of what we have and follow the location of the responsibility against which has to be measured and the proposal has to be changed. this cannot intelligently be looked at as a simple question.

these are questions that is this proposal something that would be better than that for that which we have. the fundamental nature of these questions is compared to what if you do not know that the vast majority of the policy knows what we know now, it is impossible to expect that judgment can be brought and proposals can be changed. we have something to be worried about right now about the constitutional government as we know it in the united states.

those of us beating the drum like this have got to be very practical in helping people who would like to do the right thing to find a way to do it. get the non testing such tricks to work in the reading curriculum which is a tested the subject. most educators think that to compete with the testing if it persists, you will have to have testing in civics. . >> but we do not now. i have been trying to promote changes with no child left

behind. and congress will not intervene. >> i should say no. we have to make the argument clear on why this is not funny. we have something to worry about in the united states of america. then we have to say, if you want to do what we are pushing for get testing back in on the state level get to this reading material and no child left behind or even consider cutting back on other things that may not be as fundamental such as civil education. >> i want to understand the urgency that you're speaking from.

the population as a whole is vulnerable to manipulation. >> that is correct. we do not have a broad basis of critical judgment in united states today when two-thirds of the population does one know the fundamentals of the government. >> what are the important pieces of knowledge that american students should know about our government? >> you go ahead. [laughter] >> what are the three branches? what do they do? how do they work? how can they participate? these are the fundamentals that we would hope would be taught in

the classroom. >> i agreed. know the basic structure. creigh branches. have an idea of what those three branches do it is not an overly ambitious agenda. i would hope people would know about government is illustrated by a story that a friend told me. he was moving to a new hampshire school the subject of the exclusionary rule and the evidence is illegally seized and

it may not be used by the government. and some kids in the class said why should the public interest be where they could let this person go free when there was not a warrant? the response was you are next. if there is any one fundamental principle of good government, it is the principle behind the exclusionary rule and it is the golden rule. treat others the way you want to be treated.

look at the right constitution as opposed to the structural constitution. the one thing i would leave is the protection clause. we are in this together. we should be treated the same way. if that were understood, i would take my chances on the outcome. that is the fundamental lesson behind it government's of power that are limited structurally and about the individual liberty. that would be my lesson. you are next. >> thanks for being willing to

do this. [applause] >> thanks. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> the original documentary on the supreme court has been

updated in paris on sunday. you will see fit available all -- of the stated on c-span on sunday. learn about some of the recent developments in the court. it is home to america's highest court, iran for the first time in high-definition sunday on c- span. today is the first day at the american university campaign management institute, training students to work on political campaigns. we'll hear from people from both parties. the topics includes the chicago mayoral race. this begins at 9:00 eastern on c-span2.

>> this week, a look at the american in british forms of government. this product compares and contrasts the forms of government with our own. >> is there any way to describe the differences between americans govern and the way britain's govern? >> i am always struck with the quality of intellectual discussion in the media is higher in the u.s.. the discussion of political issues is somewhat more dominated by policy ban the crazy minutia of washington life. here we have tiny westminster stories.

in terms of the politicians, they do have issues more than those in the u.s. in january, we will have a republican house of representatives and a democratic senate. explain how the difference is in the u.k. >> a mistake lot of british people who follow british politics make is to think they are broadly comparable, the american and the british system. your president is like our prime minister and that you have two houses of your parliament and