employers go out of business. especially in times like now. for our economy to be as productive as possible, for us to be globally competitive, we really need the work force development system to be a mechanism that will really assist people when the it is a big challenge, but it is a critical challenge for our u.s. competitiveness. host: if you want to read the report, "multiple employment and training programs" you can find that on gao.gov. thank you to andrew sherrill. we want to thank everyone who

participated. we will see you again tomorrow morning at 7:00 a.m. eastern. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> coming up in about half an hour, we will go live to the pentagon with lieutenant general william caldwell. last week, during a senate armed services committee, leon panetta said afghan soldiers are progressing toward handling their own security.

that briefing will get under way at 10:30 eastern and we will have it live on c-span. this afternoon, we will also be live with president obama at a town hall meeting in california hosted by linkedin. over in the capital today, lawmakers are still working on a federal spending package to fund the federal government for the first seven weeks of the new fiscal year, which begins this coming weekend. the senate rejected a house- passed measure that included measures for disaster relief to be cut. the senate will take up a version that does not include those spending cuts this afternoon. you can watch live coverage on c-span2. keating is the oshte editor over at "foreign policy" magazi and is here to talk about the 2012 republican presidential candidates and their views on foreign policy. welcome to the program. guest: thanks for having me. host: during one of last week's

republican presidential debates, it featured an increased discussion on foreign policy. which candidates benefited most -- which candidate benefits most from a shift to foreign policy issues? guest: i'd say that's probably jon huntsman, who's not really a major figure in the race right now. he's kind of in fourth or fifth place, but he can really run on his record as ambassador to china and as somebody with a large amount of foreign policy experience, which, frankly, the other candidates don't have. host: is there any particular aspect of foreign policy, for example, the mideast, the far east with jon huntsman, southwest border issues, or our relationship with europe, that one cdidate can use to separate him or herself from the rest of the group? guest: well, rick perry has been talk ago lot about immigration, and as a border governor, oiously that's sort of his core area. he has a very different take on it from other candidates.

he's thought of as this conservative, but he's the only one in the debates who's saying it's simply not practical to build a fence on every inch of the border as some other candidates are saying. he's supported several programs , sort of head start type programs, to help immigrants have access to the texas educational system, and so he was kind of getting hammered on that in the last debate, but it's one area where he kind of -- there is some daylight between him and the other candates. host: is there a coherent obama foreign policy that the candidates as a group seem to be focusing on running against? guest: well, i think the words you're going to hear a lot are leading from behind, which was a comment that an obama advisor made in a story in the new yorker earlier this year to describe how the administration is responding to the revolutions in the middle east, and obviously leading from hind doesn't sound very presidential. it's the kind of thing he's going to get consistently hammered on. what's important to remember is at whether you're listening

to president obama or these candidates, that the foreign policies they run on don't necessarily tell you much about how they're going to govern. president bush ran on being humble abroad. he spoke out against nation-building and embarked the u.s. on one of the largest nation-building projects since the end of world war ii. presidenobama, if you had to define him early in his campaign, it was on his opposition to the iraq war and on his stated willingness to talk to autocratic governments and perhaps sometimes anti-american governments, and we've seen him both scale up the war in afghanistan, you know, participate in an intervention to remove muammar gaddafi, and call for bashar al-assad to be forced out of power in syria. it's important to remember that often foreign policy, they're responding to crises to these so-called 3:00 a.m. phone calls and their stated positions in these debates don't necessarily

tell you that mu. host: wee talking about t 2012 republican presidential candidates, their thoughts on foreign policy. here to discuss that with us is josh keating, "foreign policy" magazine associate editor. if you'd like to get involved with the conversation, 202-737-0001 for democrats. republicans, 202-737-0002. independents, 202-628-0205. you can also send us messages via email, twitter, and on our facebook page. throughout the discussion, we're going to be showing some clips of various republican presidential candidates and what they've had to say regarding their views on foreign policy or how they perceive foreign policys has been exhibited by the obama administration. first like to take a look from last week's debate with former governor romney talking about president obama being euro-centric and how he gets

his inspiration from europe. we'll take a look and then get a rponse from joshua keating. >> what president obama is a big-spending liberal. he takes his political inspiration from europe and from the seerblist democrats in europe -- and from the socialist democrats in europe. guess what, it's not going to h line of attack. he used the phrase european a number of times describing obama. that's kind of convenient shorthand, because it has a domestic and intnational component. it's both big government, liberal, pseudosocialist, and a certain timidity in foreign policy. it will be interesting to see how long he can really keep up this line of attack, because interestingly, european governments are, of course, most of them are embarking on austerity programs and cutting

quite a bit of spending. and we've seen the french government take the lead in intervening in libya. so this kind of shortha of european as passivist and liberal, i'm not sure how well it holds up anymore. host: when candidates talk about trade inerms of foreign policy, is it more of a domestic issue for them or a view of foreign policy or a little bit of both when you'r talking about trade? guest: i think it's mostly domestic issues. we had several callers talking about the outsourcing of u.s. jobs overseas, and, you know, that's always going to come up. but it's also, you know, especially with a rise in china, mitt romney in particular has hamred on this point that he's not going to allow chinese currency manipulation to create a trade imbalance, and so there is that kind of great power competition aspect to it. it was interting, not the

last debate, but the one prior to that, to see jon huntsman kind of counter that and say that the least productive thick we could do would be to have a trade war with china. host: our first call comes from pennsylvania, bill on our line for republicans. you're on the "shington journal." gues good morning, gentlemen. josh, i have a question for you. you said that obama and bush were unable to keep to the foreign policy that they campaigned on. do you think that ron paul, if he were elected, would be able to keep to the foreign policies that he's presented? and also, why is it that these other two guys and so many of them can't keep to their foreign policies that they campaign on? guest: well, i think it's -- you know, the general rule in u.s. elections is that candidates are elected on their domestic policy, but get remembered for their foreign policy.

and i think that's generally been true. the lastlection was a bit of an exception to that rule. president obama was first distinguished by his opposition to the iraq war, so john mccain is very experience on foreign policy, so that election did turn quite a bit on foreign policy. but generally speaking, in these races, candidates are trying to appeal to a domestic audience and sort of sell themselves on domestic concerns, whereas when they get into office, they're responding to crises and situations that upt, and often the sound bites that they used on the campaign trail simply don't work anymore. and you mentioned ron paul. ron paul is a real outlier in this republican field as somebody who favors large-scale defense cuts and st of pulling back u.s. bases overseas and quickly eing the wars in iraq and afghanistan, which none of the other candidates have really

committed to. you know, i don't know if he'd be able to stick with that if he were elected, but, you know, it's been very interesting having him in this race and to see the other candidates respond for him in these debates. host: ron paul, also during his time on the date last week, talked about linng the currency reform and also a tougher line on immigration all together. i'm going to take a look at what he had to say and then move on. >> this leads to capital controls and they lead to people control. so i think it is a real concern. and also, once you have these data banks, the data banks means that everybody's going to be in the databank. you say, oh, no, the data banks are there for the illegals, but everybody is in data bank. that's a national i.d. card. if you care about your personal liberty, you'll be cautious when you feel comfortable, blame all the illegal immigrants for everything. what you need to do is to attack their benefits. no free education, no free

subsidies, no citizenship, no birthright citizenship. that would get to the bottom of this a lot sooner. but economically, you should not ignore the fact that in tough economic times, mone and people want to leave the country. that's unfortunate. host: josh keating of "foreign policy" magazin sort of a mix of foreignnd domestic policy from ron paul? guest: he was following u on an earlier statement where he said a fence won't just keep immigrants out, it could also keep americans in, which is kind of a surprising statement and widely marked upon. you know, i think he's sort of staked out a very clear position on immigration. a lot of the candidates are trying to sort of outdo each other in how tough they can seem about immigration in these debates. you know, it's interesting to see that the candidates with the sort of most experience on border issues, rick perry, is very different from the other candidates in this regard and also governor huntsman as well.

you know, i wonder to what extent they're sort of going back to george bush's immigration picy, which was not quite as exclusionary, and he was sort of looking a little more long term at demographic trends, the degree to which latino voters are going to be a major factor to elections in the future, and potentially republican voters, and, you know, it's interesting because none of these candidates are looking at that and saying that . host: let's move oto new hampshire. keith is on our line for republicans. go ahead, keith. caller: good morning, thanks for c-span. just got some facts here. i'm kind of fed one everybody saying how the republicans' vision is going to cripple the country. january 3, 2007 was the day the democrats took over the senate and the congress. at that time the dow closed at 12,621. gpped for the previous quarter

was 3.5%. unemployment rate was 4.6%. the annl budget deficit was $161 billion. host: keith, we'veoved on from that discussion and we're talking about foreign policy and the presidential candidates. this is what we're talking about. caller: ok, then you don't want to hear what i got to say, i guess that speaks volumes too, huh? host: let's move on to baton rouge, louisiana. tyrone on our line for independents. caller: gorge. how are you doing today? host: what are your thoughts regarding the republican presidential candidates? caller: several things very quickly to mr. keating. first, ron paul didn't want a fenc he was the one who said that if you put a fence up, it only not keeps people out, but it also keeps those who are in from leaving. second point i want to make is about the israeli foreign

policy in the middle east. i think ron paul is the only candidates that just don't want to give israel an open key to the candy shop, and we're just not going on with anything that they do. i'm more israel. i recognize israel, and i recognize them as a country. but he is the only one, when he mentioned the rights of the palestinians, he got booed by his own republican counterparts. my thing is, if you just -- if you don't address this and have a broader mind set about,ou know, a more fair and balanced approach, that's never, ever going to get solved. i'd like his comments on that. thank you for c-span. host: joshua keating? guest: that's true, and ron paul does have a different policy, especially on aid to israel. we've seen the other candidates trying to position themselves very pro-israel, particularly after last week, you know, mitt

romney said that there should be no daylight between the u.s. and its alli. now, of course, all countries have, you know, somewhat differing interests, as there's no daylight between them. but we're going to continue to see israel as a major factor in this campaign. you know, it's interesting to see president obama at the u.n. last week addressing palestinian statehood and taking a very -- mh more pro-israeli line in the speech than he has in the past, and, of course, the u.s. is planning to probably veto the palestinian statehood bid it's interesting to consider how much of what's driving his considerations campaign issues and to what extent that dreams the u.n. was partly a campaign speech as well. host: telegraphing officially or unofficially from officials in israel as to who they'd like to see as the republican candidates, or would they refer just continue dealing with president obama? guest: well, i think prime

minister netanyahu has definitely been closer to the republican party in the past. in his visits to washington, he's had very sort of warm meetings with republican leaders. it's obviously not been quite as close with president obama. as for which candidates, i don't know to what extent they're really taking a position. but, you know, several of the candidates have visited israel and are definitely all trying to position themselves as the most pro-israel of candidates. host: back to the phones and our discussion with joshua keating of "foreign policy" magazine. new york, eleanor, caller: i wanted to comment on the candidate who spoke about immigration. this country is built on great immigrants and on the backs of great immigrants. it to say we will close our doors sounds like foolishness.

we need to create better policies to except those who have stayed in america and made an honest living and tried to be productive. children have graduated high school and our college students. many of them are good members in their community, never did anything wrong. our stores have never been closed -- our doors have never been closed. we need to control the things that go beyond our borders. there needs to be laws to protect tm, too. they should not live in america and be afraid. host: that is eleanor in new york. the current governor perry and

rick santorum talk about something similar in a discussion about mexico. we will take a look of that. >> one question. have you ever been to the border with mexo? >> the answer is yes. >> you are going to build a wall or fence and then go to tijuana does not make sense we know how to make this work. aviation assets on the ground. the federal government has not encased in this at all -- has .ot engage in this at alled we'll stop illegal immigration.

we will make america secure. host: joshua keating, what did you tnk? guest: the candidates are trying to make a name for themselves in these debates. rick santorum has been the defender of conservatism in a lot of these debates whenever ron paul talks about cutting the military budget, rick santorum has been engaging them and again in these long ck in force on foreign policy. host: this morning in "the washington post," they talk about the tightening border in one their editorials. talking rious about immigration.

"is it worth spending billions of dollars?" host: the overall thought is thatepublicans should claim a victory and move onto something else. guest: it hard to build and defey fence. no matter how we build up the border, it will not stop the flow of immigration into this country. i think there's a need for a

more nuanced discussion in this country. host: joanne in san diego. caller: my concern has been ever since president obama opened cairo, that he has wanted to weaken the role of the united states in the world. we saw that inibya. initially he try to find a way to get gaddafi outp. i am concerned the republicans are becoming more isolationist. i think we should be supporting democracy in the middle east. this war on terror, i view this like the cold war. the american will was so strong. we need a republican leader who

will stand up and say the problems and yemen, we will help fight terrorism in yemen. we have to be in it for the long haul. we need a powerful republican leader. host: joanne in san diego. guest: the influence that the tea party movemt is having on the republican party. the tea party is mostly focused on economic issues. the question becomes, is defense funding going to be on the table? traditionally the republican line has been a strong military any strong u.s. presence abroad is a priority. those parts of the budget should be off the table in terms of these discussions.

you see rand paul talking abt putting military spending on e table -- you see ron paul talking about putting military spending on the table. host: you wrote that ron paul said there is a difference between military spending and dense spending. guest: i think there is a distinction. not just weapons systems. i think he refused -- i think he views this as a way to create jobs and as much as a domestic program as anything else. he wants to separate building high-tech weapons systems from addressing the u.s. national security. i think that's the distinction he is trying to draw.

host: joshua keating has been an associate editor at oreign policy." he also blogs. you can follow him on twitter. you can also follow us on twitter twitter.com/cspanwj. caller: good morning. host: thank you for waiting. caer: what happened to all the good informants america had in thesforeign countries. we have be losing troops. candidates like obama and george bush, they have no idea that those foreign countries are run by a tribe of people.

will we get a presidential candidate -- getting americans killed. guest: it is striking to see the degree to which the war in afghanistan has not been a major issue in this election. august has been the deadliest months so far. we saw the assassination of a former president and a major figure in the negotiations with the taliban. the economy is going to be the major issue. it will be jobs who determines who will be the next president. i think it has been striking the degree to which -- the question of what these candidates plan to do to bring the war to an end has not been a major topic of debate. host: there was a class on the

u.s. role in afghanistan in the debate last week. >> after 10 years of fighting the war on terror, people are ready to bring our troops home from afghanistan. this country has given its all. what remains behind, some element to collect intelligence. we will have to do that in every corner of the world. >> very quickly. our country is not six - that doesn't mean our country is sick. the bottom line is that we should be fighting wars to win, not fighting wars for politics. [cheers]

not giving the troops what they need. unless we change those rulesnd make sure our folks can win, then we will play politics with our military. host: joshua keating. guest: i think huntsman is put himself as the thinking candidate. if you listen to these candidates, they all say to bring the war in afghanistan into a close. we will bring troops home when it is prudent. i would not put that much stock in what we're hearing in terms of withdrawal plans. it will be determined by

political factors and conditions on the ground. there isn't that much room between them on this issue. host: ken from new york. caller: good morning. could we ever have peace in the middle east if, like rick perry advocates, given support to israel. i would like to see peace on both sides of israel. this seems to be something that israel does when we get close to peace. ariel sharon launched into jerusalem to vanilli the palestinians -- lawns into jerusalem to humiliate the

palestinians. the israelis seemed to put settlements into the palestinian territory. guest: i think that israel is a potent political issue in the u.s. and subbing the candidates can continue to stake out the strongest position in order to criticize the president. how much daylit theres between democrats and republicans have a process is real, i'm not sure there's much difference -- between democrats and republicans with israel. host: david in new york. caller: i do n see anybody from the democratic party

running against barack obama or with barack obama or against the republican party, which tells me that barack obama or those republicans -- i do not believe barack obama can defend the border with mexico. i did not think he can't defend the border in israel. he is not capable of doing it. it is israel's issue. >> we are going live now to the pentagon for update on training and security forces in afghanistan. lt. gen william caldwell is leading the training of afghan forces. forces. >> now, nearly 22 months later, he joins us from headquarters in kabul. s

the general will make some opening comments and then take your questions. with that, i will turn it over to him. general. >> ok. let me just talk. i appreciate this opportunity, having the ability to come back and talk to you. has been well over a year. there has been some significant progress and changes that have occurred in the last two years when i look back. two years ago, when we made the decision, nato did, the key thing they did was a major we have the right resources, the right strategy, and the right type of people necessary, and the right organization in place. it really enables us to get after this mission that was so critical. the return on the investment we are starting to see is pretty significant from these efforts

made over the last few years by the men and women of the international community. it is a clear sign that the afghans are moving forward and will have the ability here in december 2014 to assume the lead for their security in their country. tremendous progress has been made. to put it in perspective, september 2009, only 800 young men decided they wanted to join the afghan national army. in september this month, we had over 8,000. that is not something that just happened this month. it has been going on since december of 2009, when we had more than ample recruits every month, all becoming a member of the afghan national army and police. over the last 23 months almost, over 114,000 new personnel in each of those forces. that is really helping the afghans move forward. very often you hear "the surge."

we call it the afghan surge. it is starting to make a difference and is putting in place the conditions that will enable a drawdown of forces. we have also seen the geographic transition start to take place. seven areas already at this point with more coming in the fall. the one thing i will tell you that nato training mission has been able to do is to get things standardized. there's a lot of individual disparate efforts, great profits in many different areas, but one thing the nato training mission was able to do was to get a standardized program instruction set, not only for the army, but also for the police forces for afghanistan. everyone in afghanistan today is receiving the same, identical type of police training. we reduced the untrained police

we found in 2009 from about 50,000 who had never gone through formal police training down to about 20,000 today. still, some more to go, obviously. there's a plan in place and we are deliberately, methodically getting at that am bringing them back into a formal training system, putting them through the eight weeks of training, and returning them back. we have -- when we stood up the command in november of 2009, we had one civilian police trainer in this entire organization of about 1200 people. today, we have over 525 civilian police trainers. these are the royal canadian mounties. these are the bodies from the united kingdom. united kingdom. they are from throughout europe. it has made a significant upl forift. silly, the australian federal

police have -- recently, the australian police have joined. we went from an all contractor- based training program to a coalition led program now to an afghan led training program. we have over 3100 afghans assigned to training and structure training -- instructor positions. today, over half of those, about 1500, have been certified. the others are still going through that. this is leading to december of 2012 when the afghans will be in the lead or training at the very basic level at all of our training institutions in afghanistan, which will be another significant step forward, and giving them the capacity and capability to make this thing long term and enduring. developing the trainers have

been key, but developing the institutions have been the hallmark of what we've done. since day one, we said our number one priority is leader development. we have trained just over 50,000 new police and army officers and noncommissioned officers and added them to the force, where there was a significant deficit that existed in 2009. while we were growing the force, of this 114,000 additional people, almost half of them have been leaders, which has now made a big difference in the way they are performing and how they are starting to professionalize as we move forward. the institutions we have put into place -- we have now expanded and brought in 600 students this past march. we will now remain in effect for the out years. we started a school for the police and army. sufficient numbers now today

were able to produce the required officers for those organizations. we have other things going on, from non commissioner officer forces to the national police academy of afghanistan. in 2013, we will stand up people to replace the one-year officer program of school that will continue feeding leaders into this army. if we want this investment to endure, it will be critical that we stand up those institutions that will enable that to happen. that's what you're doing -- that what we are doing in this program is free we have started a deliberate effort to professionalize this force. important special the skills that are really essential. we have started to involve combat forces first. we're now getting to the more challenging and difficult area of developing specialty skills. this past may, we opened up the

last of our 12 specialty vocational schools doing everything from engineering, human resources, communications, those type of skill sets that are essential for police and army forces to become more professionalized and the more self sustaining. we have been able to do this by putting in a very robust literacy program. when you looked at the fact that every recruit we bring in, only about 18% are illiterate. and of the words, maybe 1.8 out of every 10 can read and write. that means at least eight of them have no idea what a number or letter is. they cannot leave the serial number on their weapons. they cannot read a manual to do maintenance. they cannot count the money they're getting paid. they do not understand the inventory. the literacy program we put in effect in march of 2010 is

really starting to reap the rewards. we have over 3000 afghan teachers we have hired and work for us full time. again, that number is increasing over time. the literacy rate has been dramatically increasing over the last six months to eight months. we have now trained over 120,000 afghans into some form of literacy training that are currently serving in this force of about 305,000. by december, we estimate that half of the afghan army and police will have received some form of literacy training that they did not have before they came into the military or the police force. again, this sets the foundation, enabling us to get at the professionalism that is important long-term. we realize that we have also been spending time getting advances in areas like growth objectives.

in 2011, the army and police will both meet the objectives that have been established for them. we will, in fact, what was stated to be a goal of 305,000 moving towards 352,000 by october 31 of next year. we have the systems in place that we need to do the professionals nation, the leader-developer programs, the things we're still working on right now that will still be challenging, but is what we deliberately put into the development plan. it is now getting down to logistics', maintenance, and medical. again, with the foundation of literacy to unable us to -- to enable to stand at those programs. specialty skills is a program that we will continue to focus on. stewardship will be another one. there's been an enormous investment by the international

community over the last couple years of giving them infrastructure, equipment, and material. we now need to make sure we become good stewards of this and maintain good care and continue to keep good control of that. we are also going to start working on sustainable systems. the parts about maintenance and logistics and medical that will be so important. i would tell you that after two years, as we look at what we have really learned from this, it has become very apparent that the number one thing in a mission like this is leader development. if you have able, capable leaders, it does not matter what kind of material you have or what kind of institutions or foundations you have. you can build anything if you have capable leaders. leader development has been and continues to be our top priority. the second thing is the importance of literacy. i have told this story many

times. when i arrived here, it became very apparent, very much thanks to the late ambassador richard holbrooke, and he was exactly right. if you have the foundation, then you have the ability to move forward and start to professionalize the force. third would be the role of nato. i was probably a skeptic as to what the future of nato would hold. had it not been for this nato organization, we would have been unable to achieve and accomplish the mission we set out to do. we started with two nations. we now have 37 different nations contributing traders on the ground as a part of our overall efforts. about 1/6 of the country world's are involved in this training effort in afghanistan. we went from literally one police professional to now just about 525. enormous uplift in our ability

to get at and accomplish the police mission. that kind of gives you a quick recap of where we have been over these last two years. some of the challenges we see ahead that we will take on and work as we continue moving forward. if i could, i will turn it back over to you at this time, george. >> general, thank you very much for that excellent recap. we'll start with questions. i will call on a questioners from the pentagon briefing room. >> general, can you give us an idea of how you assess the program progress of the afghan security forces in these recent attacks in kabul, including the one on the u.s. embassy and nato headquarters? second question is, can you also tell us how the ethnic balance has evolved in the force? do you think you have addressed the shortage that was always a concern? >> what i would tell you is, on

the ground after two years, as i have watched the response by the security forces, i will tell you they are learning from each incident and they are adapting. they are adapting each and every time. the most recent attack was probably the most vivid example i saw in terms of how they handled that with a very deliberate, methodical approach. as the investor calls it, the harassment that occurred on the american embassy. how they took down the building to minimize civilian casualties and to ensure that minimal damage to private property -- they took down the facility. i was very impressed. did we learn lessons from that? we sure did. the interviews we conducted, of which we were able to be a part of, once again, showed us areas to continue to refine and work

on. it was interesting to watch. what struck me about the september 13 attack, for the first time, you really did see the police force out there learning to serve and protect the people. they were willing to lay their lives down for the people of afghanistan. what you do not hear very much in the press is the stories about the police who gave their lives that day. there were suicide bombers around the city, mostly around a 30-minute period. there was one at a local high school. a suicide bomber was moving into the crowd where the students were. he went in and literally gave -- took a bear hug by the suicide bomber. in the process, he was willing to give his life. that was a police officer by the name of johb ali that did that.

when suicide bombers approach the headquarters, they were able to shoot and kill one of them. the other was able to get close. there was a senior officer who did the exact same thing. he ran up and he hugged the suicide bomber. when he did detonate himself, only he and the suicide bomber were killed. the other policemen received minor injuries. at another facility, police officials approached what they thought was a suspect out there. in the process, one police officer was killed. the other was wounded. they were able to kill the suicide bomber before he was able to set off his bomb. on that very day, in multiple places in kabul, policemen were doing heroic deeds that received very little attention.

for us, they learn, they adapt, and they continue to get better. on ethnic balance, we continue to watch that very closely. sparely bounced and the forces. we watch it obviously between -- is barely balanced in the forces. the southern pashtuns is what we have a very intense focus on and are trying to raise the level of what we're able to recruit. we have a good proportion, about 34% of the afghan national army is composed of pashtuns, but they're not all from the south. this past month was the best recruiting month they've ever had bringing in southern pashtuns into the afghan national army. again, last fall, the ministry of defense made a conscious effort and put a brigadier-

general in the two corners and the south. each one, who is a southern pashtun himself, can engage with the local elders and encourage the young men to serve with the army and to be part of the recruiting effort in the south. an upward climb. not where it needs to be dead. is it in fact improving? it is improving slowly but steadily. over time, if it keeps moving like that, we will start to see a much better representation of southern pashtuns. >> i wanted to ask you about the sustainment issue. admiral mullen said there is now an effort to reduce the cost from $12 billion -- by 70% to 80%. how long can you go without jeopardize the ability to

sustain themselves? secondly, what do you give up fight going with such dramatic reductions? over time, there's a natural reduction. it seems like going that low cuts and to some core lowhere -- core capabilities here. >> two years ago, i would not know as much about programs and costs. we spent a lot of time going through a modeling effort here that we run and changing the variables all the time. in the zero years, what you normally hear is the long-term sustainable cost for 352,000 afghan national security force is about $6 billion. that has been generally said and agreed upon as the long-term cost. what i will tell you is from the efforts that have been ongoing,

it will be significantly lower than that. over the last two years, a tremendous effort at making things -- how do you make it more capable for the afghans, affordable -- again, not for us -- how do you make it affordable for the afghans? more sustained -- most importantly, do they have the human capital and the ability to sustain it? through that effort, we have been able to reduce the overall type of equipment, quantities, and organizations that we built using this system. i got it from the president afghanistan through one of the briefings. he talked to me and said, general, i want to make sure whatever you do is affordable in the long term. i will tell you, the efforts we are doing, the two things that have been clear from michelle for noise -- flournoy -- in no

circumstances can we cut corners and the training programs that we have put in place. what ever we do, it has got to maintain the same level of quality we have today and we cannot afford to give up any capability that's required for them to handle the level of insurgency out there. if you believe, and i do, that this level of insurgency will go down -- i do not think it will quite ever go away because of the border region and everything else, but it will go down. that will also be a reduction in the overall size of the afghan security force. that will generate much smaller sustainment costs. we constantly review this. it is an effort we continually work. we will be looking at sources from the international community to help pay for it in the long term, from the government of afghanistan itself, and the contributions the united states

are making to this effort, too. we continually ask ourselves, are we being goods stores of what we have? are we putting in place systems that are capable, affordable, and sustainable, so we get this return on investment? >> how well below $6 billion do you think it is practical to go without giving up significant capability? >> you do not give up any capability at all going down to $6 billion. 352,000 maintain a dolla force. coming from multiple sources, not just the united states. i'm not sure it will even be that expensive. here is a great example. we have instituted something called afghan first.

we asked ourselves, why are we by dean foods -- are we buying boots, about $170 per pair. why don't we asked some factory in afghanistan to make boots to some quality control standard? we did that. we get them at about 1/3 of the cost. enormous savings. we did the same thing with uniforms. we reached out and found people who were willing to stand up a business. we signed contracts saying we would buy so much if they were able to meet a certain quality. we brought in outside experts that we have on our payroll -- we paid to do nothing but quality control checks at these afghan-run factories in

afghanistan that are doing everything from our boots, clothing, sheets, pillowcases. on an annual basis, we are now saving $168 million per year, each year, by using the equipment made in afghanistan to the same quality statements. i wear a pair of afghan boots. i have been for seven months. it really is good. we now have three boot factories. they're starting to diversify. they're doing everything now from commercial commerce, which will be a long-term, sustainable thing, by producing sandals and tennis shoes and other things like that for commercial use, but our estimate is we have saved over $650 million that we have programmed to spend, but because of the afghan first

initiatives, we are no longer required to spend. we are still fighting the same quality and the same quantity that we have always wanted to get and use for the afghan security force. >> can you talk about how many afghan battalions you have now and how many can operate independently? >> let me think. right now, today, i want to say -- independently, -- there are varying degrees of how they can operate. some require a tremendous amount of coalition assistance. others require coalition assistance, but minimally. there are others, as you are asking about, operate independently all by themselves. i will go back and verify the exact numbers. i want to say, today, the

battalion's currently operating by themselves is about two. 124 thatbout another are operating very effectively with minimal coalition of support -- coalition support. we bring the units initialed operating capability. it is the field experience, the partnering in the field, that continues to help them evolved and developed. those that are out there today that are operating in that manner will, with time, reached a level where they are able to operate independently. we've been watching this on a monthly basis for two years. there's a nice upward flying. by december of 2014, they will have the ability to take the lead for security in afghanistan. it will still take some

coalition support. there will still be coalition enablers. they will still rely on us for intelligence support, air support, and those types of activities that we are not building in a very robust, deliver a manner, because we do not see that as a long-term necessity for their security force. >> out of the total number, what is the total number [inaudible] >> i would have to double check. i want to say it is about 180 today that we have out there in the force. >> you expressed concern this spring at the brookings institution that the attrition rate was 1.4% per month. last week, secretary panetta testified it was reaching as high as 3% per month. what accounts for the increase?

human rights watch has been documenting abuses documentingrape, murder, -- has been documenting abuses like rape, murder, and land grab. >> first of all, when we talk about attrition -- we will talk about attrition first. is attrition to hide that we cannot continue growing this force and making our growth objectives? the answer is no, it is not. with the current levels, we are 11ing to make the october 200 growth objectives of 305,000. i am very comfortable that will happen. the attrition of 1.4% is the goal that we set. that has been agreed upon. we want to bring the police and

army down to that rate to make it sustainable in the out years. police have an attrition today of 1.4%. they are there. there are elements in the police force that are lower. the one that has the most remarkable progress -- when we stood up this command, they were about 120% attrition. so significant going from one under 20% -- 120% down to 30%. so that it is sustainable in the out years. we have trainers that are coming we have trainers that are coming in, 120 by this fall. we will partner with the afghan

units to continue helping them and professionalize. a tremendous downward trend already. it is in the army or everyone is watching the attrition of very carefully. we have not seen the decline. the thing -- it is about leadership, having the right leaders, that they are living in conditions that are appropriate, that their food is right. that is the key. we have a brigade in kandahar whose patrician is 1.2% -- whose whose patrician is 1.2% -- whose attrition is 1.2% . then the soldiers continue to

serve. these are 100% volunteers coming in. we turn away 1000-plus every month that we do not allow into the training base. we can be selective because our training base only requires so many permanent to make these growth objectives. this is something we watch very carefully. we took an army of about 95,000 two years ago. today is about 170,000. it will grow another 25,000. expansion can't lead to challenges -- expansion can lead to challenges. the leaders and the growth is

occurring. the human rights watch report. i have not sat and read the report. report. because of this report, a new effort on its human-rights training. look at what we did in the afghan national police. you are talking about the local police. we went to an eight-week program of construction -- instruction. we added 18 more hours of human- rights training. this is something you want to reinforce. the local police -- the element has the responsibility to do that training and oversight

understands that this is something that needs to be further reinforced. we do take these allegations very seriously as alleged in this report that is out there. they do know and we have been helping them as other elements developed. key to a lot of this is the partnering out there. you really find that type of thing happen because we are instilling into our own actions and daily contacts the appropriate kind of behavior. >> so you're not going to take on that training? >> well, we have not been asked to at this point.

as we move forward, if there is a request for us to help and become more ingates, then we would. i think the special forces understands what the report says. we all take this seriously. there have been modifications to how weak due to the training as they move forward. getting with the minister of interior. they have the oversight. we have been retraining. there are teams in these districts data from the ministry of interior and we of the oversight for. we have been doing retraining with them so they know better what to be looking for in the districts.of those

>> hi. thank you for doing this briefing. if you could assess the intelligence gathering capabilities, in light of these incidents in kabul. what kinds of things which you consider to improve the intelligence gathering? >> [no audio] >> repeat the national director -- whether it be the national directorate or other intel elements that are out there. collectioning intel

that is pretty robust and operating outside through the country and down in the south ind in the east and in campbeka trying to develop a network of information that would enable them to deter some of these things. part has been successful. there are four more attacks that the been disrupted and people picked up because of those efforts. you don't normally hear about those things but they are going on. we are now starting to develop intelligence units that are going out into the army formations. that is in the last six months that we've been putting those out into the formations. we have been cross sharing

between the different ministries, the national director of nds and the m.o.d., which is not been there in the past. that is starting to help. biometrics. the afghans now have a national biometrics database and they can cross reference when they are bringing people freight vetting process or to work their way into the army or the police. or they pick someone up and take their biometrics and take a back to the database and compared to whatever may be in the afghan national database, of which we do cross scarinharing. there is an intel effort going

on. we stay within the defense and the interior and do not get involved in the national intel system itself. some other elements work with them. >> time for two more questions. > a clarification on tom's question. that means they are operating without any logistical or medical support from the coalition. is that correct? telescope part of the country their operating -- tell us what part of the country they are operating. >> i will be glad to come back to george. i monitor all the training aspects. i collect that kind of data so we get feedback to just our

programs. i will have to come back and make sure george gets that. i do not want to mislead anybody. that does not mean they didn't have any coalition support. we keep saying in december of 2014, there still will be coalition enablers here. we have not yet developed their logistics system, their maintenance system, or their medical system. those are areas that we're still working on. this is the year where we start taking that on. we have an additional 800 trainers better still coming to us. we will do an uplift of about 800 people by next march that

will help starting getting at some of these specialty skills that are important. we have two or three years to get that in place so that they are much more able to operate without our support as we near 24 team. today we have not developed their systems to enable them to do that yet. >> i would like to go back to the question of long-term financial support. you have long-term projections that suggest you will need about $6 billion a year to support them? how much lower could you go before you think that would jeopardize some of the capability that is needed? >> $6 billion would be the max

in the out years. once it is fully operational, the need for long-term sustainment cost collectively from the united states and the afghans themselves. there are a lot of variables. we are assuming that that is with nothing changing from what it is today. we do expect the level of insurgency to go down. we expect us to find more efficiencies in how we do things. that could further cut the long- term cost. we run lots of variables to look at the high and low. we've been told not sacrificed their capabilities and to make sure they have the same capacity that they have today as we do

this. it will work closely with the afghans on this and looking at the long term cost. if we do not need 352, then it starts to reduce the overall cost. some of the things we're doing will show savings later. we're putting air-conditioner is in most of the places we are building two years ago. today we do not do that at all. we put in fans. we have recognize what is best for afghanistan. each time you put in another air-conditioning unit, you require human capital. it goes on and on.

we do keep looking at an asking ourselves, how do we get the best return on the investment so that it is the most sustainable while still giving them the same capability they need to handle this law loved insurgency. -- this level of insurgency. that is a big part. it will be less than that amount. >> we will wrap these things up here. any final comments before it let you get back to your evening duties? >> let me say thanks for this opportunity. we do most everything in an unclassified manner. if you have any follow-up

questions or information you would like to know, we would be glad to provide answers to those. 95% of what we do is unclassified over here. we will get those other answers back in terms of the effectiveness. we have that data available. i don't have that and by fingertips. we'll get that back surely to you, george. -- we will get that back to you shortly, george. after being on the ground almost to its ears, i am optimistic about the future of what this place can haul for the afghan poeople. i see this out there, whether

it's a senior afghan official with ideas to better do something, whether it is the attack we saw on the 13th, attack we saw on the 13th, heroic deeds by afghan police, giving their lives to save other afghans. it is things two years ago that i did not saee. they got better at what they do. all this underpinned by leadership. leadership is the key to making a difference in this country. they are starting to bring a district police chiefs and provincial police chiefs back for refresher courses of three to five weeks being taught by us and everybody working

together. we're starting to see a difference in their performance. it gives you hope for the future, what this country have to have itself. >> once again, thank you. have a good day. >> coming up this afternoon, we'll be live with president obama in a town hall meeting in california posted by linkedin. we'll have it for you here on c- span at 2:00 p.m. eastern . we have a live event right now on c-span2.

they are looking at programs for returning injured service members to society. a panel discussion now are under way looking at ways to help service members. live coverage right now on c- span2 will go to about 3:00 p.m. today. >> most all of google's problems are self-inflicted because they don't play by the rules of the game, and they don't obey the law. >> if you're wondering whether or not you're getting an honest result from google, all you got to do is move that mouse and go to bing or go to yahoo! or go to facebook and you can figure out whether or not you're getting the fair results. >> a look at competition and google's business practices with googlemonitor.com's scott cleland, and former federal trade commmission bureau of competition policy director david balto, tonight at 8:00 eastern on "the communicators," on c-span2.

>> which part of the studio constitution is important to you? be sure to include more than one point of view and video from c- span programming. there is $50,000 in total prizes. >> many cancer patients are not getting the care they need. those officials told the house energy subcommittee on health that drug scarcity -- a bill was introduced requiring drug members to notify the fda of possible shortages.

>> the subcommittee will come to >> were reported to the fda. by 2010, there were 178 reported drug shortages. 132 of which involved sterile injectable drugs. so far, this year fda has continued to see an increasing number of shortages, especially those involving older sterile injected drugs. these shortages have involved cancer drugs, anesthetics used for patients undergoing surgery as well as drugs need for emerncy medicine and e electrolytes need for patience on of ev feeding. it appears that there are many potential causes for the drug shortages.

in some cases shortages have been caused by quality and manufacturing issues. additionally production delays at the manufactured level including limited production lines for certain older drugs and difficulty in receiving of rall materials and components from suppliers to cause drug shortages. many raw material suppliers also experienceapacity problems at their facilities causing delays that ripple through the drug production process. shortages n also result from a company discontinuing a particular drug. cerin drugs are susceptible shortages particularly those of our complex to manufacture, such as an injectable drugs or require longer lead times. fda cannot compel a company to manufacture a particular drug and if there is a shortage of that drug it cannot compel others to increase their capacity. further, companies are not required to notify the fda in advance of a potential drug

shortage unless the company is discontinuing a sole source. medically necessary drug. in that case a company must inform the fda six months in advance. drug shortages have real effects on a real patient is due to shortages patients have nt received the appropriate drugs for their conditions often gettng a less effective drug or more costly substitutes as a result. according to a sdy done by the premier health care alliance of 228 hospitals, retail pharmacies and other health care facilities nearly 90% of hospitals reported a drug shortage in the last half of last year that may have caused a patient safety issue resulted in a procedural delay or cancellation required a more expensive substitute or resulted in a pharmacist compounding drug. i look forward to hearing from our witnesses today abot their experiences with drug shortages and learning what remedies they

believe are necessary. i would like to say a special hello to richard, vice president operations pharmacy laboratory and radiology at the lancaster general hospital in my district. it the largest employer in the 16th congressional district and for ten of the past 13 years it has been named among the top 100 hostals in america by the leading source of of your business intelligence. the hospital is also helping to revitalize the northwestern part of lancaster city for the partnership with franklin marshall college. again think you to the witnesses and i will yield the balance of my time to congressman shimkus from illinois. >> we want to welcome our folks in the two panels. obviously this is a concern. whenever there is a lag in a commodity good or product, you have to really wonder about the

demand and the supply and the available cost because when there is a limited supply and high demand cost should go up so that begs the question of what is constraining the market signals from producing the product to consumers need is that insurance companies, is that government reimbursement rates is that the state medicaid provision? that's what i will be looking at because the bigger the government is the more manipulative it gets in the market services and the less to provide goods and services to consumers. we appreciate that, look forward to it and i yield back my time, a researcher man. >> we recognize the ranking member of the subcommittee for five minutes. >> thank you, mr. shean i want to thank you for holding today's hearing on this important issue. i am encouraged by the bipartisan nature and i think the witnesses for joining us. today we will discuss the ecent

increase in the drug shortages that have been the subject of numerous reports. the girard shortages appear to be on the rise and an alarming rate and threatening the supply of some of our most important medications from life-saving life saving on ecology drugs to antibiotics to and aesthetics to go through even the most minor surgical procedures. these drugs have become an important part of our health care system. no patient want to be told their chemotherapy most be postponed because the only drug used to treat their cancer is unavailable. likewise, no anesthesiologist to begin their work with the realization they have to use sub-par drugs on a patient because the one they normally rely on is out of stock in definitely so we can't letthis become the new norm. we've depended upon the medications on the fda drug shortage list for years and continue to look for them for the health and well-being. it alarminthe drugs that have been around for so long would suddenly be the most

difficult to keep hospitals from pharmacies and doctors' offices supplied with. furthermore they tend to be a low-cost generic which are an essential component of health care for most americans as they seek to keep their health care costs low. in this fiscal climate, having a readily accessible supply of generic medicaons is a profound importance. and to that end, it has been disheartening to learn that the so-called market would to get the vantage of such a dire situation to engage in price going at the expse of those desperate enough to pay. so i'm hoping we can begin today to identify thcause of the shortages and to discuss solutions for replenishing the drug supply. we must address this increase so that americans can continue to receive high-quality treatments at low costs and remain confident to both the pharmaceutical industry and health care providers. unfortunately companies are not currently required to report to the fda when a shortage wl be occurring whether because of

changes in the investment strategy or manufacturing difficulties. there is currently no policy for notification unless the company is the sole manufacturer. my colleague representative diana degette has introduced bipartisan legislation h.r. 2245, the prserving access to life-saving medications act of 2011, as a first step in addressing this issue. this legislation would require manufacturers to notify the fda of any actual or perspective drug shortages, and i want to commend representative degette on pioneering this effort and hope that as a result of hearing from the witnesses today, we can identify additional solutions to this growing problem. this hearing will allow us to learn more about why drug shortages are occurring, with the administration and industry are doing to address the problem and what new authorities the fda might need to do to prevent shortages from happening in he future. and i am encouraged that we are exploring this issue in the subcommittee today and look forward to working with you,

chairman, as we get to the bottom of this issue and again, thank you for having me here and i yield back. >> the chair recognizes the ranking member of the full committee,r. waxman for five minutes. >> thank you, chairman pets for recognizing me and for having this hearing. the recent media and others indicate the drug shortages are now at an unprecedented level. indeed, according to fda the number of drugs and short supply of 2010 was almost triple that of 2005. the shortages affect a broad spectrum of critically important drugs including oncology drugs to treat lynn chollet, leukemia, breast and other cancers and drugs without which surgery's have to be postponed and antibiotics to remedy life-threatening bacterial infections. without these drugs, patients'

lives are at risk. drug scarcities generally affect sterile injectable drugs. these drugs are technically difficult to make and each drug is usually manufactured by only one or a handful of producers. if only one company develops manufacturing problems, which is not uncommon, other companies may have little access capacity to help fill the need t read with the aging of the population and field sourcing of drug manufacturing, the increasing consolidation of drug companies, and the general adoption of a just-in-time approach to the drug production and distribution this problem may be significantly worse unless the media measures including congressional action not taken to address this mltiple causes. representative degette has introduced legislation that would be an important first of in ths process. h.r. 2245, the preserving access to life-saving medications act

of 2011 would require manufacturers to notify the fda of any actual or prospective drug shortages, such events notice would enable the fda to help the volume of mitigate the shortage by those working with the manufacturer and the hospitals and physicians of the problem. weigel this is an important piece of legislation that has broad bipartisan support i don't think anyone believes it alone can solve the drug shortage problem so i look forward to hearing from the witnesses to lead to better understand the causes of what is already a crisis for many patients, and to find out what we in congress can do to help even the shortages in the future. we already have been working in a bipartisan manner to learn about this very disturng issue, and i trust it will continue to work together to develop and to enact legislation to help address it and address it quickly. >> thank you mr. sherman. i yield back the time. it's been in the chair thinks the gentleman and that concludes opening statements.

.. >> i am pleased to be here. the growing problem with drug shortages is a troubling situation. this is one that is taken very seriously. this could impact the entire health-care system. we should always remember that our goal is to protect the health of people. i say that as a physician who is care for patients for over 30

years. according to drug evaluation and research, the number of shortages 1 rising over the last fiv years as you already heard, and shortages occur with any drug, generic, sterile, and injectles make a large share. in fact, in 2010, 27% of the shortages involved the older these include critical products and many drugs used in emergency rooms. whye is no single reason a drug shortage occurs. many factors are involved. alone or together to cause a shortage. these factors include, but no r not limited to industry consolidation, major issues of quality and manufacturing

challenges, changes to inventory and distribution practices, difficulty in producing a drug. are finding solutions to protect patients. in 1999, the the drug shortage program to monitor and mitigating potential drug shortages. when the fda becomes aware of the shortages, it works collaboratively with the affected firm to return to the usual market availability without affecting harm to the patient. although the fda does not

require it, it does encourage other firms to do so. fda expedites reviews of submissions from manufacturers that include expiration products, increased capacity, use of new raw material source, license new manufacturers, and allow changes in product specifications. the fda committed to working with drug manufacturers to prevent shortages whenever possible, and, in fact, as a direct result of this report, staff and experts across the agency, last year in 2010, 38 shortages were prevented, and so far for 201, this year, i'm pleased to report for the first time that 99 shortages have been prevented. also, at the same time, t fda goes to great lengths to mitigate shortages let r

lessening the impact when they occur. one notable recent example involves the well described shortage of the drugs used to treat certain types of acute leukemia. kris call formation in the viles of the drug represent a quality problem that led to a disruption in production and a shortage that received tremendous publicity across the nation within recent months. in this case, the fda worked with the manufacturers found the viles were warm, the crystals dissolved and the drug couldbe safely administered to the paent. as a result of this collaboration, the manufacturer was able to ship the viles to health care professionals along with a letter from the fda notifying them to inspect for crystal formation, and if present, warm the viles to dissolve crystals, and this led to ensuring and upholding patient safety. we can report today that this

drug -- this well reported drug shortage has been recently resolved. in limited circumstances, the fda can allow the temporary importation of critical drugs when l shortage is not resolved immediately, however, there's several factors limiting this option. the product may already be in short supply abroad, so importation could exacerbate the shortage. fda has to ensure drugs from abroad meet fda quality standards. to discuss these and other possible solutions, the fda will be hosting a public meeting next month, september 26th, and this is held t gain additional insight of the causes and impacts of this challenge and possible strategies for solutions. then on friday, september 30th, the fda is conducting a webinar for the public, and this is an opportunity for people to learn more about what the fda is doing to address this challenge, and it wil be a venue for citizens

to ask queions 20 experts working on this topic every day. although i focused my comments until now on the fda, i should stress that the entire department of health department and human services has been fully engaged on this topic for quite some time. we view this as a pressing public health challenge, and we want to resove this on behalf of the department and indeed the entire country. this past summer, i convened a series of meetings with representatives from fda, national cancer institute, the cvv, center fer disease control and prevention, office of assistant secretary, the secretary of planning an evaluation, office of medicaid serves, and others. we have joined together as one department to explore more deeplyhe root causes of this problem and the possible steps to be taken to address them. these have been productive meetings and we pledge to continue them until the problem is solved.

we are committed to protecting the public health. earlier this month with senior leaders in the department hosted a meeting with over a dozen representatives from pharmaceutical manufacturers, organizations, hospitals, insurance companies, group participating entities and add vo cosigh oanizations, an this meeting gave us firsthand insight into the challenges, gerated a good discussion, and also served as a foundation for our future colboration. shortly, later on this fall, the fda releases a report with a detailednalysis of the problem with recommendations for the future and potential solutions are being examined. one suggestion is manufacturers to report impending supply disruptions with discontinuation

of drugs to improve shortages and improve the drug supply. the sooner the fda learns of a shortage, the more effective they can be and notify the blic and uphold patients' safety. we are committed 20 working with all parties, manufacturers, patients, and other stake holders to minimize and solve this problem. in conclusion, the depament is committed to addressing and solving this critical public health challenge. it is our goal to advance this dialogue with all interested parties both internal and external, and we also recognize and depply respect the roles of the members of congress, and we welcome the opportunity to discuss this important topic with you today. thank you very much, and we will be very happy now to take any questions you may have. >> chair thanks the gentleman doctor, why have drug shortages

increased so much in the last few years? >> well, again, there's no one single reason, but there are changes here that we are seeing in the backdrop of an economic and business climate that's leading to market consolidation, a complicated manufacturing process that's bng conducted increasingly in aging facilities, leading to quality in manufacturing issues as we have heard now. sometimes products are discontinued for business reasons. it's a complicated process, so all the factors converge to create the issues we are macing right now. >> have other countries experienced shortages such as we have? >> unfortunately, the united states is not unique this this situation, and, yes, we are indeed seeing similar situations in other countries around the world. >> and when a shortage occurs in another developg country, how

is that situation resolved there? >> well, we want to learn more from our colleagues there. i don't know if you want to say more about that particular issue? >> we are often contacted by our regulatory colleagues from other countries looking for -- looking to collaborate on finding solutions to particularly worldwide problems. different countries have different ways of producing drugs -- assuring production of product, but we work as much as panel with others to ma sure that shortages are limited and mitigated. >> does europe have a particular method of resolving the situation? >> i believe the method in europe is pretty much similar to ours, particularly since they have multiple countries. they look, seek other sources of supply from other countries. >> and do you know what is causing the drug shortages in

these countries in europe? >> many of them are the same sorts of things. they are, you know, many of the products are marketed globally. they are not just in the u.s.. the sources of the drug substance itself are -- most of them are foreign sources, so if there's an interruption of a source in the u.s. at a u.s. plant, they -- if a source in another country -- a manufacturer in another country has the same source, they will be in the same situation, and everyone will be out looking for alternatives at the same time. >> okay. dr. kweder what steps were taken to prevent or alleviate drug shortages? >> first, we tend to learn in terms of preventing drug shortages. we, when companies let us know that they have -- that they are

experiencing a problem, it is usually a problem in prurks. sometimes it's a business decision to discontinue a product. when they inform us in advance, that's the case. we work very closely with them to understand the problem, and assess whether the shortage would be something that would be critical for patients, so, for example, if a company -- if a company is making a product that 20 other companies make, that's not likely to be critical health situation or anything, but for the injectables, that's not the case, so we'll work with the company to help them develop solutions to fix the problem and avoid an interruption in production. that is not always possible. when it's not possible and looks like the company may have to interrupt production, we go to other manufacturers, and we talk

to them about their capacity to crease their production. they usually can't turn that around on a dime, but we work with them to facilitate ramping up in order to supply the market with usual sources. if it requires -- we'll work with the original company that's having a proem, we have a number of tools in our kit that we can use to help them address the problem. you were given an example of the kinds of things we can do in some cases to look at the end prodt itself. if there's a problem with the end product itself, in this case, it's crystallization of the active drug, and we work with the company. they got right on the case to figure out why those kris crystals were forming, what can be done to mitigate that, inform providers, and since then, the

crystalrobl has been fixed. >> do you feel you need earlier warning than you currently have? >> we can always use elier notification. there's circstances where things happen and they are very, very unexpectedly, but the vast -- the majority of cases of shortages -- we could have been nofied, and in the majority of cases we are not notified in advance. it's getting better. i'll say it's getting better, but we still have a large percentage of actual shortages where we were not aware that it was coming. >> thank you. my time expired. chair recognizes the ranking member for five minutes for questions. >> thank you, mr. foreman. i'd like to ask unanimous consent to enter into the record the testimony of the national coalition for cancer research. i think you have a copy of it. >> without objection, so ordered. >> thank you, mr. chairman.

we all agree tat drug shortages are the rl problem, you know, are a real problem facing the country, and, you know, from what i understand, it's getting worse, but i guess it's hard to figure out, at least for me, what the cause is, and i'd like to ask, you know, some questions bouts the root causes of the problem. the fda has said in 2010 last year, over half the shortages were due to manufacturing and quality issues, and i understand, i think you mentioned many or a majority of those are sterile injectable drugs. why would these drugs be prone to manufacturing and product quality issues in particular? >> well, many of these products are the result of a long production proces and those production processes are now occurring in fewer manufacturing sites because of industry

consolidation. there's also aging of the facilities where this work is ongoing. there are business and economic factors in the background that are lowering the profit margin, so oftentimes businesses make a decision to perhaps discontinue a particular product for business reasons, and as a result, we are seeing the quality of manufacturing issues, congress maren, that you are -- congressman, that you are referring to. some of the issues are quite disturbing where we literally are tracking products that have particlat matter like pieces of glass and metal in what should be sterile products that are injected into patients, so this is the reason why the fda upholds this mission of safe and effective drugs and also high quality drugs in the middle of this challenges environment. >> now,he next panel, the written testimony, they state it

takes two or three years to get approval from a new supplier for ingredients or an alternate manufacturing site. is that true? does it take two to three years 20get the fda approval? why is that if that is true? >> i'll start. one of the advances of the fda in this situation is to prioritize generic drugs, expedite, and accelerate approval in every way possible particularly if the public health is threatened, so there are efforts to try to advance that time frame. that's also the goal of the generic drug user fee act under review right now, so these are issues that are very important to the fda, and they take it seriously. >> but i mean is that time period that was mentioned -- i mean, would that generay be

true, and is there any kind of flexibility that you have to expedite review and inspections of new facilities t -- so they could address the shortage when it exists? >> there absolutely is flexibility, and we do that routinely when we are aware that say a new facility is needed or a new supplier is needed, and when there is a circumstance that might lead to a potential shortage of an important medical product. we do it routinely. we can often turn things around in a matter of weeks. >> but i mean you have not answered that two or three year time span. >> sure. i'd be happy to do that. the two or three year time span is what is being referred to under usual conditions when a company -- when there is not a sharnlg situation. >> but if there is, then you deal with it quicker? >> absolutely. even the two to three year time

frame, we are working and happy to see there's been an agreement on generic user fees to change that into a matter of months and not years. >> my concern is we face the extraordinary fiscal pressures and the house passed budget for fda with a 20% cut with appropriated funds. i mean, are these -- is this cut -- will that affect your ability to work with companies to avoid or mitigate shortages? i know you mentioned generics. are you negotiating with the generic industry to develop the user fee and can that alleviate drug shortages? this is about the funding now. >> we are negotiating and have reached agreements with the generic industry about user fees, and that will be coming up for discussion by yourself, you know, within the next year. >> what about this house buet cut? >> as far as -- there's no question that resources matter, and there's -- it takes -- these

are not automated processes. they take people with judgment and knowledge and having enough people makes a big difference. >> all right. thank you very much. thank you, mr. chairman. >> chair thanks the gentleman, and i want to request the following statements to be entered into the record. i think you have copies. the statement of the national community pharmacist association, the letter from the american society for hematology, and the statement of the generic farm suital association. >> without objection, so ordered. i recognize the gentleman from illinois for five minutes. >> thank you, i think we all agree resources matter in this tough fiscal period. i think also part of the issue is priorization,nd especially in life saving issues and what

are agencies doing to put first things first, and what can they do to obviously redirect funds in a different direction? for -- how have cost and payment factors impacted these drug shortages 234 >> again, this is an industry that's producing products in an environment where they are facing increasing economic pressures. the profit margin for any particular agent is declining for them, so they have to make business decisions, but also keep their products moving until the decision is made, perhaps to discontinue a product or another. throwing in the quality and manufacturing issues and delay issue contributes to the

situation that we're seeing now. >> who are the big payers? >> well, there's a process where purchasers hospitals, and fashions and pviders buy these products, but they are purchasing organizations and managers involved who want to drive down the price for understandable business reasons. these are all the stake holders involved in the chain. >> i do appreciate the opening testimony because we had a series of questions, and really you answered them in the open statement which i'm just going to highlight. one of the things was, a question we were going to ask was closely collaborating, and you gave the example of the drug with the crystallization, and i thought that was very, very helpful. the other issue was alternative sponsors and using import

restrictions or -- i can't read my writing -- temporarily doing something else, but you said that's constrained based upon if there was a shortage overseas of the same product which, and something that we've talked about over the past years, and with ranking members is the ability to make sure that the dryings we're importing were inspected by our inspectors so we know the safety of that. >> right. >> i've always been a risk-based person saying on the focus point that those who are more questionable facilities ought to get a lot of looks. if they have been operating safely and they have been inspected like a #*us facility every year -- u.s. facility every year, then it might make for every two

years or 18 months, and that's the issue of shifting sources too from the critical elements in safety versus known products and industries that you all have real competence in. we don't expect you to do that to industries that have a poor record, but those who are, you know, you have really good confidence in, that's the funding issue. you also mentioned, you know, business reasons and aging facilities, and i think you mentioned increased regulations. is that part of your testimony? >> well, the quality of standards the fda puts forward in areas like this are unchanged. in fact, the fda really has gone the extra mile in my view to

show tremendous regulatory flexibility re. again, since we can't require any manufacturer to do much of anything, all we can ask isor information, communication, collaborate and they show flexibility, the rewarming of the drug i mentioned, filtering out matter so again these medications can be used and not put aside is another example. >> i have 12 seconds. >> sure. >> i'll go back to the statement of the testimony because i scribbled a comment, and i'll look at that. why doesn't a shortage of a product in this sector then send an increased price signal to manufacturers for them to then produce the good? >> well, we have come to learn that the standard economic

principles of supply and dema -- >> and the question is why is that distorted? i think that's the basic fundamental question of the problem. what has distorted the fundamental principles of supply and demand and my time's expired, but i think that's the heart of the issue. i yield back my time. >> would you like to respond? >> sure, and first of all, the agreements are made often through long term contracts, and so alaska this whole process involves multiple stake holders including the pharmacy managers and purchasing organizations, so it complicates this environment, and sort of does not make relevant the standard supply and dend economic principles we see in other businesses. >> i would say you said what i would say. thank you. >> chair thanks the gentleman and recognizes the gentlelady

from illinois for five minutes. >> thank you, i'm sponsor of the degette legislation for early notification. we have a chicago based injectable drug company that h endorsed the bill, and they already do many of the things including proactively reporting the fda about potential drug shortages. you've explained the advantage of that early notification. let me just raise a question that some hve raised about early warnings that could increase the problem and lead to hording of critical drugs. ..

have you heard of that? >> i will respond to that. we don't turn around and put that on our website and notify the public of a potential shortage that might have the exact opposite effect of what we wanted. we judge very carefully, when is the right time to make a public announcement about a potential shortage. first we assess we are talking about. is this an imbalance in distribution? sometimes you if see things that are insured is but there are plenty in another part. we take that potential for making things worse very seriously. very seriously. meanwhile we are working on it to access it and what we might do to mitigate if