religious right again. the religious right, top-10 organizations, have expanded $350 million to $400 million on their legislative activities in the last year of reporting, back in 2009. that is an extraordinary amount of money to promote a single interpretation of the bible and turn that into the policies of the united states, particularly on hot topics like abortion, a subject that is not even addressed in the christian bible. host: as a theologian, this tweet. "asked this guy what happens after death." guest: i have to admit that i'm not sure what happens after death, and of course there are various interpretations in the bible itself. jesus at one point suggests that his father's mansion has many rooms, you will get into that room as soon as you die.

at other times, he seems to be promoting the idea of a long pause and literally bodily resurrection. theologians from the first to theologians like myself have different opinions and cannot answer all these questions. host: carroll joins us from rockaway, new jersey, on the independent line. caller: mr. lynn, as far as i'm aware, the constitution guarantees us freedom of religion, not from religion. thank you. guest: carol, i have heard that many times, and i do not think we have a guarantee against religion. that is to say if somebody is religious or sets up a church in your neighborhood and you do not like it, and there is not much you can do about it, nor should you be able to do anything about it. but when the government gets into the business of embracing one church over another,

someone's interpretation of the bible to make policy for your life and everyone, and 20 to 25 million nonbelievers, then we have a problem because the constitution also says that the congress and, because we passed the 14th amendment, the states cannot make rules respecting an establishment of religion, touching upon this religious issue. religious neutrality is what the constitution demands, and i think we are a stronger country when we appreciate that fact. host: joe asks this question. "should christmas be a federal holiday?" guest: i think the horse, the cow, and the pigs are out of the bar on that one. frankly, courts have looked at this idea and said so few people would be at work if it were not a federal holiday, it has gotten this secular veneer and no one

is thinking about changing it. i think that of course has left. host: democrats line from texas, good morning. caller: thank you for c-span. mr. lynn, every word you have uttered is what i want to say. i have one thing i would like to point out and maybe you can affect it on polls. do you think the country is going the wrong way? i am a liberal democrat, and my answer is yes. that is because we have lost all compassion and humanity, and i do blame it on the rise of the religious right. i would like to see that question changed. it is not the policies of the president for me, it is the lack of humanity and walking your own shoes. if the question were offered, maybe more people would think

about it. right now if i say yes, people think i do not like the president, and that is not true at all. do you understand what i'm saying? please articulate it for me. guest: i think it is a very good idea because polling questions do not often get to the nuance of what they really mean, allowing people to make decisions about who is wrong, talking about the direction of the country, and making people, including the pollsters, have them assume what those answers mean. i think in polling, the closer we are to explaining very specifically what people want, the more likely we are to get good answers. for example, on that faith-based initiative we talked about recently, 2/3 of the american people in poll after poll, if you ask them specifically, if the government gives money to a religious group, should it be allowed to discriminate in hiring, giving special deference

to people who think like they do, 2/3 of americans say no. 2/3 of americans also say pastor's should not endorse candidates from the pulpit. -- also say pastors should not endorse candidates from the pulpit. the more specific questions you ask, the more you learn about what is really on people's minds. host: do not normally talk about other networks, but there has been a lot of attention in the blogosphere about fox news. "fox & friends" in the morning taking aim at governor lincoln chafee, and in oklahoma where they change to the christmas parade of flights to the holiday parade of lights, fox very critical of that change. what are your thoughts?

guest: as an occasional visitor to the fox news channel, this is total nonsense. there is no war against christmas. i would like to find someone who does not believe in the fundamental equivalent of the bat cave that there is a holiday going up, it is called christmas, and if they drive past the local church, they somehow know that on december 24 and december 25 there is some very important kind of religious activity going on there. i frequently say to people if you're a christian and you want to communicate your face, do not ask the government to declare some kind -- to communicate your faith, do not ask the government to declare some kind of special holiday, go across the neighborhood to your neighbors and say would you like to hear some good music, would you like to come along?

that evangelicalism is -- that is good evangelicalism. host: "are there any out of the closet agnostics in the senate or in the house?" guest: the starts in california. beyond that, it is hard to find anybody taking that position. host: "asked barry lynn if there's any candidate that he believes -- if there's any republican candidate that he believes would respect the concept of the separation of church and state." guest: i do not endorse candidates, and i have not heard anyone suggest that separation of church and state are high on his agenda. governor romney did say once that he thought it was silly to worry about sharia law taking over the united states. there's an article about this whole movement in "the new york

times" this morning. that is not what is putting this nation at risk of losing its secular morning. what is putting that at risk frankly is the fact that so many of these religious right activists -- 20% of the american electorate defines itself as a member of the religious right -- they want to take certain christian beliefs they have and turn those into the rule of law in america. it's not like the muslim tiny minority is going to interject sure real lot into the constitution of oklahoma. host: you have sparked quite a debate on line where the emails are coming in. fort worth, texas, republican line, the morning. guest: if there is a christian right, there must be a pagan left. host: a lot of people would say

that with jesus, with emphasis of helping the poor, jesus would be a person from the left. i do not want jim wallace's interpretation of the bible, or richard land, the two guests on at the same time yesterday. i do not want them turning their theological beliefs into public policy. we need to look at freedom of the press, equal treatment under the law. these are principles, values, and they do not derive from any one theological position. they are held by the great bulk of americans, and that is what politicians should turn to to make decisions. host: from andrew, omaha, nebraska. "what is mr. lynn's position on the pair indications that take place before each session of congress?"

guest: i think the senate chaplain has an assistant, a big office. so many people here locally around capitol hill would be happy to volunteer for that job, and in fact then they would not have to have a paid chaplain in the first place. in fact, long ago when newt gingrich took over as house speaker, bob livingston was the second or third in charge of the republicans, and he briefly considered doing away with the paid chaplaincy. mr. gingrich said that time said that would make us look nonreligious, and of course quashed the deal even though it would have saved some money. host: "what does mr. lynn think about islam?" guest: i think it is a major faith, a faith practiced in peace by most muslims certainly in the united states and indeed around the world. unfortunately, the few radicals who are engaged in activity,

criminal activity, terrorist activity, seem to paint this entire religion, and that is a most unfortunate thing and leads to these silly arguments like sharia law is about to take over america. host: our next call is sally from pittsburgh, independent line. good morning. caller: good morning. i had the pleasure of attending ynn sevenwith mr. whel years ago. about veryo ask complex problems regarding jewish people. when mr. land talked about a jewish representatives in congress, he said -- he referred to them as a religion. now, jewish people have a dual identity. many call themselves secular

jews because israel calls itself a jewish state. there is also a marginal was and, therefore. that is one of the complexities in thinking about jew and and being anti-semitic if you criticize political activity. and the religious component, sentimental cover and robust critical analysis of what is taking place politically. host: thank you for the call. we will get a response. guest: certainly there are secular jews, and they like to read -- and christians who have

bought out of the theological ideas. i think we can have a robust debate without trying to take positions on the truth, the falsity, the veracity of anybody's religion. one of the things i find so i, i remember once active in the late dr. jerry falwell in one of my hundreds of appearances with him over the decade. he was not just promoting a christian agenda, he said, at a press conference that day he had had a rabbi there. i asked dr. falwell, "will that rabbi be going to have an?" and he literally would not address the question put -- "will that rabbi be going to heaven?" and he literally would not address that question. if you ask them, waiting minute, will jews go to heaven? they will say of course not,

unless they accept jesus as their savior. host: our guest is the author and co-author of a number of books, including "piety in politics: the religious right's assault on politics." and a tweeter who is somewhat critical of your sense of humor. "great guest. this is informative." republican line. savannah, georgia, good morning. guest: good morning -- caller: good morning, thank you for taking my call and thank you for c-span. earlier i heard you say you're a lawyer as well. i did happen to attend court hearings and testify as a witness. my question is, i have to place my hand on a bible.

is that -- if i were an atheist and i put my hand on a bible and i was ordered to put my hand -- to tell the truth, would you believe me? guest: a name like lynn i would be forced to believe you. most courts have tried to do away with that because of the diversity in this country. if you are a believer but a believer in a different religious system than the judeo- christian face, you might also object to affirming -- the judeo-christian faith, you also might object to a firming truth on a bible. in many state constitutions, you could not run for office unless you were a christian. that has been done away with most recently in states like south carolina and tennessee. we're making progress, but

unfortunately when it comes to politicians, they are regressing deeply and very far from the principles of john kennedy, an absolute separation of church and state at the cornerstone of his administration and of his system of how american needs to be governed. host: we will conclude on that point. barry lynn is the executive director of americans united for the separation of church & >> returning iraq and afghanistan war veterans took part in the discussion about the challenges they face when reintegrate into society. the u.s. naval institute and military officers association hosted this discussion in washington, d.c., part of the fifth annual forum on services for severely injured service members.

>> we will get started. it is now time for our first panel discussion, community reintegration and challenges back home. directing the panel is our moderator. mrs. mcfarland appears frequently on fox news, fox business news, and numerous radio programs. she is also the host of one of the internet's most popular national security shows. she has served on national security post for several presidential administrations, to include president nixon's -- presidents nixon, ford, and reagan, and received the highest civilian award for her work in the reagan administration. she is a graduate of george washington university, oxford university, and the massachusetts institute of technology, concentrating on nuclear weapons, china, and the soviet union.

of equal significance, she is the mother of five, proud of all of them, but i understand one of her graduate is a recent graduate of the naval academy. it is my distinct honor and pleasure to introduce ms. kt macfarland. [applause] >> thank you all for being here. you may not recognize me, but i am the brunette at fox news. [laughter] this year's defense forum focuses on the journey back and helping the wounded warriors and their families transition. the panel this morning is going to look at the issues of community integration, the challenges our veterans and their families face, and especially our wounded warriors and their particular needs. the vietnam war

generation. is anybody here as old as i am? more than you would think. after the vietnam war, we treated our veterans shamefully. it was an unpopular war, and it did not end well. instead of blaming ourselves, we blamed the military. when they came home in the 1970's, we did not honor them for their service. we did not adequately care for their families, and we did not give them the support and medical attention they needed. it was a war we wanted to forget, so we forgot about them as well. in the 1970's, our programs for community reintegration were few and far between. our veterans and their families suffered from it. it was a stain on the soul of america. when i went into the pentagon with the reagan administration in the 1980's, not only had we hollowed out our military force, we have ships that could not sail, planes that could not fly.

we're cannibalizing parts. we have pilots that were not certified because they had not been trained, but the most shameful part of all was when we went out -- and around the country and that our veterans, we saw people who could not get to veterans hospitals because they were too far away, veterans with prosthetics that did not fit, people who had injuries which we pretender were not there and it was a sign of weakness, and the most junior thing was when cap weinberger met some of our junior enlisted, and they were paid so little that they qualified for food stamps. we promised ourselves as a nation we would never let that happen again. here we are today, and we have returning veterans from afghanistan and iraq, many of whom have seen three, four, five tours of duty. we have been at war for 10 years, and many of our returning warriors have serious disabilities. they will need help not only reintegrate into society, but they will need significant medical care for the rest of their lives.

the good this is that if we do wind down these wars, national leaders of both parties have pledged to care for our returning warriors. there is a new and general recognition in the country that some of our bets are coming back with injuries on the outside as well as on the inside that will be with them for the rest of their lives. our military culture, which is often, as i do not have to tell you, suffer in silence, is more upfront about the psychological injuries our troops suffer an offer treatment that was never available after previous wars. there's a focus on medical attention, and there are programs to help the transition reintegration of civilian employment for our veterans when there were none before. we're going to talk about some of these today. this morning's panel and this afternoon's panel focusing on employment. in lot of ways, the integration task we face will be more difficult. our active forces as well as our

reserves have done more combat tours more frequently than they were designed to do. our guard and reserves have not been used as militia, but they have been used as rotational forces. many of our military families, husband and wife, are both in the service, and that families double burden. our women, particularly -- half of our women are mothers who have left their children behind to fight. that is an integration issue. our all-volunteer force means that the servicemen and women we have on duty -- they want to be there. they have signed up. but it means they are isolated from the rest of society. only 1% of our citizens served in the military. less than 10% of our citizens even know anyone who is in the military. that is a small minority. in politics, the worry is out of sight, out of mind. with the pressures we are all facing with government spending and cutting, many of our

servicemen and women worry, probably rightfully, that this time, the budget ax is going to fall on them as it did in the 1970's, but with greater intensity and immediacy. this morning's session is one of those rare events where everybody -- that means you, me, them -- we learn from each other. our panelists have been carefully chosen to cover the range of challenges and opportunities our returning vets and wounded warriors and their families face and the programs available to them. we have our wounded warrior family, sergeant tom markham and his wife sitting in the middle of the panel, and will talk about the unique journey they have had from the perspective of the inside, what a family goes through. you all will have an opportunity to ask questions, but the way this will work is i will introduce the panel. they will talk about the programs that they represent, that their communities offer.

i will build them fox news style, and then we will let you grilled them. i think that by the end of this, what we want to do is go over a couple of things. what are the roles and responsibilities of the government? not just the defense department and veterans department, but the other agencies. what is the demobilization process and the disability evaluation system? where did the programs that we have fall short? what are the gaps in the care and services? whether they are from bureaucratic red tape, budget shortfalls, or they are poorly designed programs. we want to talk about the yellow ribbon program, the new gi bill of education programs. finally, how do our wounded warriors and their communities react to each other? they come back -- it is not world war ii. they are not coming back to the parades, but they are coming back into their communities. what are the expectations that they and their communities have, and what is the reality?

what i would like to do now is introduced the panelists. you know who i am -- the only burn at fox news. -- the only brunette at fox news. we have all switched around. let me first introduced major- general james atkins, the guy with the ribbons and the brass. he is the 28 admen general of maryland. .

>> lost 80% of the hearing in his left arm. he was formally with the iraq veteran's association, the largest from that war, with over 200,000 members, and now working in new york for jpmorgan for their community outreach and philanthropic programs, although he's left 80%, he's got enough to hear what those bankers have to say. david brown -- used to be a brunette. so -- he tells me that he thinks that's a good enough reason that he should ultimately end up at fox news. but he's with the office of the secretary of defense, a clinical psychologist and expert on recovery and integration.

and a former member to work with survivors with ethnic cleansing and genocide, and he was a lead for the recovery care and support excellence. lieutenant rod lewis, the guy on the end not wearing his uniform. he works at the white house, and a current air force ca-17 pilot and a former squadron that handles the most sensitive cargo. and has joined the staff of the east wing and the national program for all sectors of members and their family. and we have nicole keesee and she's a colonel and served as an

army comrade medic, and now working at veteran's center dealing with posttraumatic center. and finally we have the marcums, they are a wounded family. we thought it was important to meet someone who dealt with these issues. they have had a long journey, and sergeant marcum was injured in iraq and suffered memory loss, and his wife, and caregiver will speak for the family and how that was snarled and the red tape. and how this has impacted their entire family and children. i would like to get started going first to rank. and we will ask general adkins

if he would like to talk about what the programs he's in charge of and what they are offering. and then go to everything, as i said, we will go to everyone, they will talk and i will ask questions and then you can ask questions. >> the rank doesn't work well at my home, so i am not sure that's how we start here. first let me thank moa and the naval institute for hosting this great event. i happen to be life members of both organizations. and you may say what is an army guy doing part of the navval institute and in maryland and has been in a position there. i come to a position as adjunct general out of retirement, and to serve from 2003 to 2009, and

it brings a great perspective of dealing with the veterans of our nation's greatest generation, korea, vietnam and desert storm. and to see the young men and women and some not so young that serve today. i was in iraq and we have 1600 in maryland, and the generation that stands tall than any before them. they should be proud. we have been at the war for a decade. we are seeing the level not seen since world war ii. there are a lot of lesones -- lessons learned from the past and we need to look at those as we build for the future. the greatest generation comes

home, this book they read, as the secretary veteran affairs by issues of returning veterans. some may know that general omar bradley of the first veteran of the v.a., and he was quoted of saying that issues were wrapped in red tape. and we need to evaluate our nation and how far we have come since world war ii. and another interesting quote of general bradley, after world war ii, it was a world war ii load on a world war i chassis. in other words that the system was not sufficient to support those veterans coming home. as late as last week, i heard an

army four star make the comment. we are operating now on that world war ii system. and we have been kind of over the last 10 years trying to build a system, like working on a car, building it and repairing it and maintaining it as goes down the road at 65 miles per hour. there are a lot of lessons learned. and one last quote from general bradley as we look at our nation. that the problems of our veterans cannot be solved by washington alone. those problems are solved as they rub shoulders with their neighbors and where the friction occurs in the community as they return home there is a military cost to war, and it's not just fuel and bullets and those who make the ultimate sacrifice. it's those who continue on for decades to bear the wounds of

war. i think that these wars we are in now for the next five to six decades, our nation will be dealing with issues related to these wars. i tell you that because when the war came out, the ken burns film. i was in the room with a bunch of world war ii veterans at the premier of that firm. and post traumatic stress tacame out of the veterans after decades of not having issues. i saw it out of individuals i served with, came out of vietnam and as they get older, that post-traumatic stress comes to be. our focus is that the war is not over as it was in world war i, where they were discharged and $30 and a train ticket to go home. the war is not home, until those

individuals are not fully integrated back at home, at work and the college campuses. we need to prepare for the next war. we need to look at our systems now to identify those lessons learned. and work on building that system that the support the needs of the nation and our veterans in the future. thank you. [applause] >> thank you, general adkins. i would like to turn now to todd bowers of the wounded marines who is now in new york. listening to those bankers. todd. >> thank you, can you guys hear me okay, now i will like to point out that the general is reading an ipad and now to the marine that is reading on a note pad with crayon. clearly there will be differences that we discuss.

on a good note, i have been in the marine corp reserves. and i something i am proud of and i will always be a marine. and i had a year to decide whether to come back, and on day 364, they will get a phone call from me. and i served three tours, and i spent time in south america. and then most recently returned from afghanistan. it was during these times and in between the tours i was serving as an advocate. what better job as one from the military, you see the issues and understand what the issues are at hand to focus on yourself. but i did not. it was something they didn't handle correctly. and i am trying to pinpoint on the reason why. if i knew that all of these

resources are available, and why did it take until last month to take care of todd. it took a time to learn that the military trained me to take care of others, but not taking care of myself. it's something that is notable in the military but it's at a detriment of themselves. as a went through the four different levels of t.a. p., a saw the system change over the years, and sometimes for the better and worse, hey, you got home from war, and it's time to take care of yourself. what did we do? we took the death by pamphlets and put it in a bag, and stepped away. and the general is right, it takes years to see these

manifest and why you are not sleeping and not connecting with friends. all of issues piled on me, and wasn't until i made the call. and called the vet center, and i am excited to hear from someone from the vet center today. and i said, i need help and the v.a. was there in a heart beat. and they took me under their wing. and i convey this publicly, because that simple step, that small communication, on the battl battlefield we know that is key, you have to accomplish that mission. that's hard for folks to step up and do, myself included. and having made those changes, i

found that life turned around and i got a fancy banker job. >> and have to wear these things, they are called ties, and i thought they were fabric belts. and when i look at these and the capacity of philanthropic and jpmorgan is a big company of sorts. and focus on fill an th-- philanthropic giving and we have to look in the future what are the tools that we can use to get to the folks to say, hey, it's time to take care of yourself. it's the community level organizations that reach out to the folks as they reintegrate and become civilians. they will be say are you

stepping into the v.a. and into the housing, they have programs for that. and that communication is critical. i have to applaud the v.a. because they have made amazing steps to do their out reach for service members. they are on facebook and twitter and reaching out to the vets and where they are, they are online. i was joking about the crayons and the ipads, and have a communication tool and knowing it's just a button away. and going forward we have to focus on that every service member is different. everyone reacts differently when they come home. i a young, single, somewhat stupid combat marine. i am very different from my

other friends. and understanding how to communicate with these folks will be critical. and i look forward seeing how it goes forward. thank you very much. [applause] >> thank you todd and now turn to nicole keesee, who someone who is familiar with those programs at the local level. nicole is in reserves and head of the v.a. center in little rock, arkansas. >> good morning, i want to thank the regional director at the v.a. for letting me being here today. and my boss, mrs. ingles that is retired from the army. it's something to come prepared to talk about one thing and you find you will talk about another. but all the ladies in the audience who heard single, that are single, he's your right. [laughter]

>> and i want to interject, i am married to a banker they have good jobs, and not only cute and eligible but probably a good catch. >> my number is on the back of the pamphlet. >> he said that he uses crayons and i use pen and a pad. that's army. in order to understand the context of the situation we are dealing with regarding our transitioning service members. we have to remember the differences between the military and the civilian culture. and i want to point those out. in the military is a faster pace, although anyone in the military would dispute that if you stand in line. but in the civilian life it's a slower pace day-to-day. there is hyper vigilance. in the military there is a fostering of aggression and

paranoidpar paran paranoia, and you have to be both to survive on a battle field. now hyper vigilance is not good in the private sector, it will get you fired. and in the military you can have a hostile environment. in the military you give and receive orders, it's an environment of obedience, and it's an environment that is more inclusive. and in civilian you have to engage in critical working. and military you foster teamwork and interdependence. those who haven't been in the

military will have a hard time understanding this, but there is a simbeosis from going from a "we" to "i" has ramifications. and we have interdependence and self-sufficiency. we answer to a chain of command. there is no chain of command on the civilian side, unless you include your spouse, that may be your chain of command. in the military it's a closed system, and that's evident if you have tried to access an army reservice unit. where are they and how the hell do you get to them. and lastly in the military they foster emotional stoicism.

you have been to be tough and put your best face forward. whereas in the civilian sector it requires emotional investment and emotional relationships. what are the challenges we face? it's difficult for the military to provide community support. especially if you are outside of an installation. again we are more of a closed system. there are fewer clearer pathways to a system of information. when a person goes from the military to the civilian world, there may be an increase or decrease in respect one is given. think of being a 21-year-old squad leader who gets out of the military and does not have a job. that's a real shift, it's a real shift in the mind-set that is really hard to get your head around. there is a lack of knowledge of benefits to the reserve

component. a lot of people here -- i don't know what the reserve has, only what the active component has. and there is a big difference between reserve benefits and active military benefits. and there is constant changing of military benefits. i know that every veteran i see that walks through the veteran doors, i have to know them individually and so much i have to know about them on an individual basis, to understand what their benefits are. not everyone has the same transition challenges or at same time as it was pointed out. there are changes in significant relationships. i mean how many people do you know in the civilian side undergo the tremendous relationship stresses that our military members go through. there is feelings of being left

behind. when you transition out of the military. and also we forget in the civilian sector people have a limited capacity to listen. it's hard for others to listen to another person's story. because they are all caught up in their own life. reserve components they have family-readiness groups but they are geographically dispersed and many don't have the same military command structure. you have to understand before this war started, you can have reserve folks in the military for 20 years, and retire. and they would tell their spouses they didn't get a paycheck for going to reserve duty. it was one of those guy things, you know. websites are hard to navigate. and they give the impression they don't care.

there is difficulty getting benefits because you don't know where to go, and don't know what to do. this death by power point, and death by brochure, no one listens. their minds are elsewhere, and it's hard to reach out. we can have a discussion about that, but there is probably a lot of factors that lend to that. there is a variance of policies and procedures, of active duty and reserve and veterans. one big example is reserve component in the army reserve, you have to have a line of duty to get your military health care needs taken care of. if they are related to the military. if you don't have that line of duty, you have to pay for it out of pocket. whereas the active component doesn't need a line of duty. and believe me not everyone know

how to fill one out. what works for the r.c. in peacetime does not in wartime. this feelings of isolation and of anger. isolation is a killer. fort hood is a good example of how the installation rallied around a traumatic event that occurred. but ask the reserve components stationed there and how much rallying was around them. health care skipping. when you go from reserve or civilian to reserve, to active duty, i mean it gets really confusing on who i go to for what and who is going to cover what. the v.a. has a wonderful five-year health care program. but not everyone wants to go to

the v.a. and there is the challenge of being dual status, i am reserve member or veteran, actually you are both. and outreach, it's a big issue. more later about that i guess. in order to successfully transition, service members have to have a strong sense of community. they have to have meaningful employment. they have to have a strong sense of support. and they have to have support. i say it again, isolation is a killer. solutions. everybody needs a readjustment plan. why aren't we providing transition service members readjustment planning. we have t.a.p.s and other things but sits down and asks people

face-to-face, where are you going. do you know about your benefits. all too often service members are told to go to the v.a. where is the v.a. in my community? when you get to the v.a., where do i go? as good as it is, we still need to do better regarding navigation of these systems. it's best to help those of us who are veterans, i think we are the ones that are best to help other veterans. one thing about the vet center staff, over 72% of the vet staff are veterans. 47% of combat veterans, and 31% are g.-wat combat veterans. 42% are women. big brother type programs might help out too. i know canada has a wonderful

veteran program kind of peer-to-peer where they train their older veterans. give them two week training to mentor to young surveillanveter. and we need to foster veteran-owned businesses. mental health services for service members and veterans and not family members, is not effective. we have to strive more to provide services to family members. we need to make our systems and processes easier. most of all we need to make sure that every service member, are welcomed and respected and given respected privacy and gratitude

for their sacrifices. vet center programs are unknown, we get a lot of calls to care for dogs and cats. and at least several times during the day. but i am one of a staff of six at the little rock vet center. we provide counseling services to arkansas and anyone from arkansas know it's a rural state. we have underservice areas with veterans in those areas. vet centers were established in 1979, thanked to max clingman, and we were established for counseling thanks to the vietnam veterans. they spearheaded the program because they stopped going to the v.a. because of the treatment they were getting. we are community based and we

have 50 mobile vet centers out there that will go where they are needed. and i have to wrap it up. anyways i would be happy it talk more about vet center services. thank you. [applause] >> thank you, nicole. and now turn to dr. david brown, with the office of the secretary defense. an expert on suicide prevention and recovery and reintegration, and before that he was a lead in recovery care. dr. brown. >> thank you, k.t. i am former army and i will lean into the general, i feel comfortable doing it, sir. we offered up the seats and didn't think about the mics. i would like take a minute or two about speaking about health seeking behavior. prior coming to d.c., i was overseas for 15 years, i was the lead psychologist in bavaria,

treating people, the slew of what you have from being in the military. part of that grass is green on the other side. issues come in, all of my career was very active duty centric, and we hear from the garden reserve things work better. once they deploy they go home and back with the family and support. whereas when you are overseas you don't have those support settings. since shifting over, and in a nonclinical role, i learned that's not the case. i am highlight areas of care for caregiver and well being and employment. before doing that, i want to speak on a program that we created in europe called soldier 360. what this is about is help-seeking behavior. and trying to bring treatment to individuals let's say resistant

to seeking that out. when i was active duty and in a tent sleeping next to the next individual. and you knew who got letters from home and who didn't and who was sleeping and eating. when you pull back from deployment, many times they seek behavior health in a back corner. and no one can find us. and we said create this program, invite only, the best and brightest. and you are hand selected from your company commander or battalion commander. so we had individuals who were screened and didn't meet criteria for treatment. and we learned this was a trojan horse, and talked about the importance of sleep, that four hours is not sufficient. contrary to what others told them. we had soldiers that eat

skittles and mountain dew because it was a funny things to do. and realized they were impulsive and irritable. and the college course received three credits and we had success with this, is we did reach out and in the army care they embed providers in the units and school system tol system thyste. and we see great benefit to that. and there was a time i went over to the wtu, and we used humor and learned the benefit of having a one-hour instruction in humor. and i went to the wtu and tried to use humor. and there was a gentleman that

lost a portion of his foot. and after we got going, this guy was cracking us up. and he said it was nine months and he forgot how to laugh and what he did most. you have been to the dean martin roast -- i am trying to relate. you remember the dean martin roast, this guy had us going. and he said, you know, doc, may have lost a portion of my foot. but i still have my hair. and you can seek help for that. and he had us going, taking some insights and opportunities i had to learn from others here in the nonclinical position. it's interesting. i was presenting at polytrauma and focusing on care for the caregiver. and what we hear here, many times we focus on the other, not

on ourselves. and this was a focus on poly traumia and we need to look at ourselves, and it's a challenge to go counter with our culture. well being. we have focused a lot on well being, and those familiar with gallop studies, and the difference of active duty and garden reserves, and active may have a job. and the employment of well being, the gallop studies focused on employment, and notice that your well being focuses more on the death of a loved one than deployment. and that's something to think

about, and they do it throughout the year. and they bring employers and the businesses, and all of those other components in. that is rather important. and lastly i want to shift to one more lesson learned. if you not familiar with the work of thomas joiner, the psychologist, he speaks about suicide and about two components in particular. a sense of belonging and a sense of burdensome. and i a soldier with intent and means to die. and i sat down with the release papers and when you release from the hospital we screen you before to your unit. and i said can i give me heads up on what brings you here. and he said, i killed a soldier. and i think oh, my goodness, this is going to be a sanity board. i wasn't prepared for this and

perhaps a mishap of the paperwork. and i said can you tell me more, he said that everyone had a chance to take a break in deployment. and when they came to me, they pulled me with a substitute and that substitute died from an ied. and carrying this guilt and now in third deployment and this is still eating at him. and he had a new spouse and before he left the concern was family planning. and she said, when you come back we will work on a family. well, that wasn't working, not to change the topic but i have shared this story before. she could see in the morning it looked like it was working and when engaged it wasn't working. he was still down range. i brought this information to the soldier 360 program, and said, you guys experiencing

this. and these guys in their 30s and 20s, and 70% said yeah, and thought it was normal. one gentleman shared at the suicide attempt, i failed my team and now i am failing my wife, i am burden and i don't belong. and that's when he attempted suicide. not to leave you a somber tone here. there is a positive side to the sto story, after treatment and they have three children. so he's going well. and the wife looked at me like, i am going to kill you. so -- yeah, with regards to health seeking behavior, it's important that we focus on that. and what we do when we reintegrate back to society. thank you for your time.

[applause] >> thank you, doctor, i would like now to turn to the white house, and lieutenant colonel rodney lewis, what this administration seems to come in and has a particular interest in not forgetting the military families. you would like it talk about the adjoining families at the white house. >> absolutely, k.t. first thank you for having me here today. it's a privilege and honor to be on this panel. and to speak to you and have a conversation. i would be remiss if i didn't say that the executive director of joint forces, captain cooper would love to be here but his schedule didn't allow. i am an active duty air force officer, lieutenant commander

and graduated, and in the spirit of services, i have my crayon and pad of paper and ipad. we are prepared. i have been in this job and have seen amazing things in terms of watching not only our government. but the private industry, all galvanized to come behind. and the first lady recognizes that as well. k.t. mentioned that 1% of the individuals are out serving our country. only 10% know of a service member. well the first lady is trying to reach the other 90%. that's what joining services is, it's an awareness campaign. the east wing is not the policy side of the white house. that falls within the west wing

and within all the agencies that the president owns. and it's a privilege to be on the east wing to watch the first lady trying to bring a nation up to speed in terms off afa afar awareness. that's what joining forces is. and the first lady went to visit military services and spouses. and recurring theme, these are areas that we need help and places you can help us as the first lady. and the pennacle point of that rested on three pillars. the employment piece as transitioning members needed jobs. that was something that the first lady and dr. bynum heard a

tremendous amount. that was one pillar. and the second pillar, education. and to the employment piece she heard that military members were changing locations so much that the spouses were left out. now a personal story, i have had five different assignments in seven years. so my spouse who is a college graduate has a master's degree, and the last place we left she had a wonderful job. but when he transitioned to the next location she couldn't take that job. and those are issues that the first lady heard and dr. bynum heard. and that employment piece came in for spouses and veterans transitioning out of the military. and it's nice to watch this come

together with agencies focused on a specific task. education, there are issues that can be there when military families, pcs. i don't have high school children but imagine if you will, five different locations in seven years. the transportability of records and transportability of having a consistent education basis. my parents when i grew up, my dad had a job, and he was really proud to have his 35-year pin working for the state of oklahoma. i lived in one house. i had the same friends. i had the same teachers. i knew the school i was going to before i went to them. so it's a different environment. education in terms of military families that's an important piece that we are working towards trying to improve with great agencies like the national math and science initiatives with an initiative for military families. that do placement courses for

military schools or military members. and the third piece was wellness. that was an area where the first lady and dr. bynum saw a need to talk to the military members. i the way i -- the way i like to think of it is like a tripod, and if one leg is broken, it won't stand. so joining forces is a program, and you can go to it at joiningforces.gov. it's a program that is started by the first lady and dr. bynum, to go out and hit the areas where key pieces of government cannot work well within. for example, within the community, and faith-based and more importantly in the private industry. to be able to bring resources to

bear on an issue that all americans should be aware of. so the first lady has been doing that through her program. joining forces. and k.t., i think that's it. >> thank you very much. [applause] >> now we heard at the national level, at the state level and at the local level the programs that are offered and a lot of the challenges that our military and their families face. but there is one family that i think we should spend time listening to, and that's the marcums, sergeant tom marcum and april marcum. april will speak on behalf of the family. and i have spoken to her many times. i was particularly moved by what an amazing courageous lady and

her husband, who is not atypical of a military man and reluctant that they had a problem. and finally the difficulty that the marcums had to navigate the system. >> thank you, as i look around i have ipads, and have mine double-spaced because i am the teacher. tom and i came today to share our story with you, not particularly to bring attention to us. but to help the men and women that are in the road where we were two or three years ago, this is our story. when my husband deployed to iraq in january, 2008. i had the usual worries of any spouse, how long will he be gone

and the challenges of running the household. but this was not our first deployment and i dug in and did what i had to do. when i received a call from my husband and he was on a mobile armory and there was an explosion and i thought, oh, my god, you are ago. he down played the injuries, said he was fine and he had a bad headache and his ears were ringing but the medics said he would be fine. when he came home a few weeks later after nine months in iraq. it was easy to see he was not fine. he had headaches and short-term memory loss. the last straw was when he called me on his way home from work, six miles from home, and said he couldn't remember how to

get home. i made sure we called the doctor. the local medical community and including the air force doctor seemed to be reluctant to help. tom's primary care doctor implied tom was trying to get out of work. this was like a slap in the face after 15 years of active duty after no complaining. and the doctor said i will write you a script but you need to suck it up and go back to work. and we made a group with the medical group and his primary care after that appointment and that tom should go through a medical advisory board. this was long and then my husband ended up in tampa,

florida where he received outstanding medical treatment. the team found that tom had a brain injury called by a blow-out fracture behind his right eye. and he had visual loss and they suggested that he be further evaluated for ptsd. as my husband went to this hospital, poly-trauma unit, it was over a year since he had returned from iraq. the air force placed tom on tempary disability retirement status, and told us that he would be reevaluated every six months to find out what they would do with him. over a year later, tom and i had to travel to san antonio, texas from our home in south georgia. we paid for the entire trip

minus the flight and waited for the air force to reimburse us. and the total trip was $750, more than our mortgage payment. we had yet to hear what they would do with tom. as of now we travel over two hours one way, to get to the v.a. center that has the right personnel to treat tom's injuries. we have an amazing team of professional that is we work at the v.a. i would love to name them all by names but i will tell you that his primary care doctor is amazing, and he has a psychologist that understands him and does not take his crap. we have a nurse case manager that is helpful in giving us the appointments we need and not making us travel more than the two hours we need to travel.

we are blessed. the challenges have been many. not only have we had to get used to a new normal in our home because of tom's cognitive deficits. but our family has worked in other way, while tom was put in waiting status, not only did i have to quit my job to care for tom. but he had a significant pay cut and we were forced to dip into our life savings. and by may, 2011 it was gone. our youngest son began to act out at school and home and had terrible nightmares. i myself was having nightmares and felt i had no help.

and i had to figure out how to pay for the mortgage. not everything that has happened to us is negative. we have grown closer as a family, and my children are matured under stress and growing into amazing people. and tom and i have met people we never would have met. it may be strange but i am glad for the trials in life. am i saying that i wouldn't rather have my old tom back? but we have sevaccepted it and want to say he's served his country well, and god bless america and the soldiers who serve.

[applause] >> i think everybody in this room, everybody in this country feel that none of our veterans should have to go through that again. so i am opening this up to anyone on the panel. you all represent various aspects of the care community, why did this happen? and what can we do to make sure it never happens again. i will open that up to anybody. and if no one volunteers i will call on people. general, how about you, you have seen this through the administration and as a general

of maryland. >> i wish that was the only story like it. but it is not. and i think it gets back to that system under the burden of dealing with a nation at war for 10 years. not prepared to handle the t.b.i. or the posttraumatic stress. and it's crittal aical out of conflict that we build a system to be prepared to handle future cases like this. and to ensure that it doesn't happen again. there say -- is a lot of work to be done and identify what is important in those resources environment. and making sure that whatever we do works to prevent this type of situation happening again. >> anyone else? doctor, i want to ask you.

one of the things that i think is so upsetting. the first place they went to their primary care physician fell on deaf ears. is this something unusual and how do we prevent that from happening again? >> to reiterate what the general said, and unfortunately not to say it's common but you hear of it occurring. when i showed up in germany they had transitioned striker unit out there and on my first day there were seven walks and this is 2007 and within the year we hired 42 new provider. and of those 42, five of us were veterans. dr. gise from health affairs

shared that the v.a. put together a wonderful dvd on the military culture. because many provider s that come in don't understand military culture. and for someone treating an alcoholic and never had a drink, because it's a different culture and to learn those nuances important. i had the misfortune/benefit to go through eight accreditations of inspections in hospital. and i have seen all work that comes through to prepare a hospital for the joint commission inspection. and many of these people transfer out, and the next joint commission inspection, and what are those documents and you get hit not passing an inspection. my concern is that we don't forget these lessons learned.

as these conflicts disashgs psid that we keep our infrastructure in place and we never forget. >> i ran for the senate in new york, and i would campaign where fort drum is. and i found that women came up to me, mothers and sometimes younger women. they would say, who do i talk to, my son-in-law just came back from deployment and he never drank and now drinks. and others said that my son came back and with anger issues. and i had no idea where to tell them, and todd you said when you came back, and what the first

step someone does where they come back. and how does their family take that first step? >> i would like to answer that question, one thing they can do is find the nearest vet center. and the reason i say that because it's free. it's free to combat veterans and free to families of service members that are killed on active duty. and free to veterans that are sexually traumatized on active duty. we are faith based and if a counselor can't see you immediately we will make sure you have an appointment in three days. we are there on the front line and we are separate from the v.a. hospital and we have more ability to be private. but we have, it's peer-to-peer. you know we have a lot of veterans on staff that can relate to folks coming through the doors. we welcome veterans as they come

through the doors. we give them a cup of coffee or something to drink. and we make them feel at home. and it's a good first stochlt -- stop. then we can refer them to other resources not only in the v.a. but in the community. >> doctor, one thing that comes up time and time again, if you are in the military, you are the kind of person that sucks it up and doesn't complain. and particularly if there is psychological issues. is there any way to convince families what should they look for when someone comes home. and how do you change that mentality of someone who fights and has these characteristics and come back to the united states and needs to have different characteristics. >> as a clinician i got a lot of

mileage to have their spouses bring them in. we are not good keepers of records. i can't tell you how many times i have asked a spouse and asking the service member have you experienced that and this and they are saying it's fine. and wife says you can't recall your mother's phone number and you are having nightmares. i spoke in a county and i mentioned about people coming back and wanting to reretuturn e they changed. our society is much different, even though the world war ii vets were treated parades, but not with the opportunity for treatment. and one lady said that my husband doesn't engage on the fourth of july and he used to

drink and would mumble in german, and we are from des moines. and there are cultures that met the criteria for these diagnoses, and they didn't have the opportunity. so i think community outreach and peer-to-peer programs. we have tremendous programs out there, i heard at the peak over 500 resilience programs, depending on how you define resiliance. and we are doing better. >> todd, why don't you add to that as a former marine. >> creativity is the key for a lot of spouses. i will give an example of a friend of mine who work at the vet center and came up with an idea because of signs and didn't know who to contact of the a simple concept of the piece of paper, on the frig, is he not

sleeping well or drinking too much, or having a hard time. call us. plain and simple, and just one single line. one number to call, and that was the vet center he was employed at. it's genius, and to think communication how to layout for the folks. it's all right, this is normal behavior. .

on the policy side in the east wing, in january president signed a psd meeting america's commitment. being an active duty air force number is a watershed event. every single cabinet member signed that document. every cabinet member said i am going to look into his or her department and agencies and determine how we are doing this to go straight into what the general said. are we utilizing our resources effectively? that was assigned in january. if you have not read that, it is a document that is well worth

the read of the policy side. it is a part of government and private industry as well. it is definitely in education peace. >> since you have two starts on your shoulder, you obviously know what it takes to have a successful career in the military. is somebody who comes as active duty or former -- if they admit to having any kind of the psychological problems that you can't see like a broken arm, is that something that would be detrimental to their career as they enter into the civilian war -- world war of the state in the military? >> know. i think you have to understand we have been part of a journey over the past decade. from experience with in my own family, i had an uncle who committed suicide after world war ii. it did not come to me to

understand the issue until i visited the mental health ward at walter reed. they say the big challenges to get them to sleep. we all probably have those of clothes and our families after world war ii who went to the american legion and a self medicated with fellow veterans. if that did not work, they got to the point of suicide. that is the challenge we see now. i think we have changed the culture. we have had senior officers in our army come out and admit they have issues. that is where we need to go in the future. i think in maryland, our lieutenant governor was anthony brown. he came back and made sure we had focus on having a safety net for our returning veterans and for our research.

-- reserve. to make sure that they understand that there is a place they can call -- that we are there to help. we all have to understand that there is tremendous cost to war as i said earlier. these are natural responses to the unnatural environment of combat. >> i think at this point is time to open up to the audience any questions you might have. we have microphones set up here and here. if you would like to ask a question, we first asked that you identify yourself. if you have a specific member of the panel you would like to address, please do that as well. i want to warn you, i am from the world of television. we believe in sound bites and not speeches. if anybody's question is for too

long, it will not be for two long. >> i have a question for colonel giese. how long do perspective employers come to your vet center. city are interested in hiring a veteran. -- and say they are interested in hiring a better read. >> by my silence, i guess you can say that very often. that does not mean we are not working within the state. they have the veteran representatives to work with veterans. as far as employers coming to the vet center, they do not. >> i see it as a challenge to hire disabled veterans. i am one of 16 veterans on my father's side and my wife's side of the family.

i work for the department of defense. i reached out to hire some veterans. i wish more people would. i know we have a veterans that used the g.i. bill and go to colleges and universities. i wonder if that would be a gateway. we need to have a gateway to help these veterans -- their unemployment rate is 15% and the rest of the country as 9%. >> it is even higher when they go back to rural areas. >> using the gi bill, we can give veterans to go to the college and university career center and say i am looking to hire a vat. there are all these things out here. i hear a lot of "what" and not "how." i am frustrated because i do not like veterans being unemployed. >> i think the afternoon panel will speak with you are talking about. >> that is great. thank you.

>> ask it again this afternoon. >> let me say in maryland with something as simple as identifying and our job bank when a company puts a need in their, to put a little minuteman saying i am interested in hiring a veteran. for reza maze of -- for resumes of veterans, they can say i would like to have their skills working in my organization. >> the lady in the center of the mike. >> can anybody hear me? far end andto the we will sort that mike out in a bit. >> i would like to thank you for serving our country. my name is jennifer hunt. i have a two deployment under my belt so far. i also work for an organization

called the national resource directories. we help to connect to veterans, their families, service members to 14,000 resources nationally and at community-based to help connect veterans with the help that they need and making the reintegration and healing. that is out there as well if anybody wants to look into that. my specific question is, you protect service members when they come home to get their jobs back. it seems like it would need an update to protect student veterans who might get caught up in the middle of a semester or even family members who have to move several times what their service member and make jobs more affordable for the family members. i know my caa is out there but that is not always available for the spouses. can any of you speak to that?

>> let me just address a couple of those things. in maryland we had to establish and employment office in the national guard to focus on getting individuals from coming back from their tours of duty. as many of you know, i have to sign off on the readiness of the unit before it decoys. i get a briefing on that unit. we also have started getting briefings on returning units had a listing of individuals who need employment when they get back. we are looking 90 days out and working. and bringing them home is just as important. i think you have a good point. there is lots -- there are lots of different resources. in maryland, many of you served in the military. your spouse has to quit their

job to move. maryland it changed the lot few years ago to allow the spouse to get unemployment insurance. up until that point they could not get unemployment charentes because they said it was not related to losing their job. maryland recognizes that change. we are also looking at changing licensing in the state of maryland to make sure those licenses are reflected -- accepted as they go from state to state. this is a few examples of how we are working on this process. >> if i could just add an here. i have no agenda for hunt for years. she is a purple heart recipient and a new mother of probably the cutis babies in the entire country. she is one of the strongest female advocates for soldiers serving in iraq and afghanistan. if we could -- [applause] you can yell me -- you can yell at me later for embarrassing

you. >> i will add a little context to that as well. these are all things being talked about right now. that is key. i know we will talk employment in the afternoon. with the joining forces campaign, the first lady has been ever -- able to leverage your position with many private companies to provide job opportunities. we have teamed up with the u.s. chamber of commerce. they decided to put on over 100 job fairs. that is moving quite well. there are some opportunities out there. i would encourage you to go to joiningforces.gov. >> i am going to tag team this question with my friend that france is because i have a feeling that we are going to be asking about the same thing.

april, you talked about your son having secondary posttraumatic stress syndrome. one of the biggest concerns i have as a military wife and an advocate is we are just not addressing a effectively the mental health challenges facing military families themselves. right now we have no standard operating procedures on what happens if a family member attempts or commit suicide. we have a working model that we use for the military member. that does not apply to the family member. i know there are a lot of challenges around this with hippa and that thing. but it is a huge issue i do not think we understand at this point. with all due respect to the general, i do think there is a step before a recent. it is not just a perception based diplomat in regards to if it will affect your career. we have seen it affect our husbands' careers and us going to get services have had some negative blowback.

i also think until that never happens, people will air on the side of caution. >> mine was also to april. i was talking to a young lady the other day. her husband is also 100% disabled. she went to a care giver group at the v.a. hospital in jacksonville and said, i need help. i need to talk to somebody. she was told it, we are full up. we cannot take you. we cannot help you. i have never been so bad in my life except with jessica and with a couple of other instances of active duty spouses who have committed suicide and are completely ignored.

what can we do and how do we make sure that there is enough help for the care givers? if you are told, we do not have room, you are the sole caregiver for your husband and three kids, there is something severely wrong. i am wondering if you find that as well, or argue still sucking it up and putting up your big girl panties and all the rest of it? >> what do you not address that? >> it was really difficult to find the health care for my family at first in the mental health care. one, my base we are assigned to is very small. the mental health in that there allocated mostly for active duty people who have problems and needed to be seen right away. it did not leave a whole lot of appointments for the rest of us. i have been following with an off based provider of my own.

the difficulty that came with that is because we do live in a rural area, there is not anybody that is specialized and trained in dealing with family members who have gone through -- not only did my husband have an injury, even if they come home with no injury, the things that they see and do and hear and smell stay with them forever. withre not trained to deal what i deal with on a daily basis with outbursts were refusing to take his medication is because the demands he is a man and he does not have to take medication if he does not want to. the biggest problem i have in a rural area is not having adequate care with a specialized providers. i was telling dr. brown, when they came to my son's problems,

there were significant. i will not sure the minister because there were private. he was behaving in a way that no little boy should behave. there are only two mental health providers in the town where we live that are capable of dealing with children. when i called and told me it was a four month waiting list to be seen. i beg and i cried on the phone and i called back the next day and the next day and beg and told them this is what is going on in my house every single day. they were able to put us on the cancellation list. thankfully, we only had to wait about three weeks. it was a long three weeks. we definitely need more mental- health people who are trained in dealing with p t s t and the people who deal with the people who have peaty st. -- ptsd.

>> i think also everything in dod and the va were working perfectly, and we know it is not, i get all that. even if it were working perfectly we do not have the resources and the culture and lot of times to deal with what comes after 10 years of war. like you said, they never come home the same. that means no family is ever the same. what regulations do we need to change internally to let those organizations like some of these nonprofits that can step in and fill the gaps. i did not know about that organization until after i was sitting in the white house. that was the first time i heard about it. what do we need to do to integrate safely these organizations, we need to figure out a way to connect to those

stocks. >> is this just we do not have enough resources or is it an attitude and culture? >> it is complicated. with that said, there are a great many resources. a great many resources have not been vetted. trying to coordinate this is daunting. with that said, we are working quite a bit. christie, i appreciate you bring us up. i have had many conversations with the general, we will have the privilege of hearing him speak. he really gets it. we are reaching out to all of the respective services and also the ngos and the civilian organizations. with that said, i really do not have a clear answer for you on

that. we are doing it. i have taken your drum and i am beating it in the pentagon the same way that you are. the wonderful thing is there are people out there who really understand it and it really care. their heart is in and their mind is an end. their intellect matches their passion. it is just a lot of work. i am not saying people wash their hands and give up. stay tuned. >> you two have been waiting very patiently. >> i am going to concede to my colonel. >> i have -- first of all, i want to concur that i have experienced the same thing. my plight is no where near yours of the va saying, the problem you have is beyond our capability to take care of with the number of his its you are going to have to have and the time you're going to take. you ought to go out and the

civilian world. he will have to go out and the civilian world and pay for it yourself if you do not have to have this thing going on for eight or 10 years. the big reason i came up here was to suggest one of the problems i think the va hospitals all have, at least the three that i have attended and gone to, is that i see people like my two brothers, one has served in the navy and one has served in the air force. a very good friend of mine who had two years in the marine corps, none of them ever had an injury or a scratch or anything else. all of them served over 40 years ago. all of them get right in front of anybody else. they get an appointment to the fee a listing for service just

as though they were 100% or 90% disabled. i know the va has regulations and a prioritization scheme of one through six or seven as i recall. it is not being enforced anywhere in the country. people walk again -- at least it is not being enforced in salt lake city, and washington, d.c., and is not being enforced and indianapolis. those are the three that i have attended. there has got to be -- we say on active duty, your sickness cannot be any greater than mine. your health is no more important than mine. as an officer, we always -- i anyway always would stand at the end of the line and wait were to come back after sick day was almost over because i went back in. he did not have that

opportunity in the v.a. hospitals. your clinician sees you. he says i need to see you and another two weeks. you go out to get another appointment. they are filled up in the next four months because there are all these people who are in there that have had probably little too -- there are probably classified six or seven and their taking the same spaces -- they're taking the same space is up in chronological order. >> we only have a few minutes left. is there anyone else wishing to ask a question who has a related question to that? >> no, but i would like -- >> go ahead. >> thank you. i am from san diego. from 2006 until 2009, we had a program for the wounded warriors. it is a form of hands on key link that research shows improves healing 30% to 60%.

is very effective with post- traumatic stress. we did that for almost three years. what i saw was that before they even got out of the military, once they got out of their bed in the hospital we could see. i am not a psychologist, but we could see all of the problems. the problem was that many of them would not go see a therapist because they did not want it in their records. >> we just addressed that. >> as much as we try to encourage this therapist to work with us, there was absolutely no interest on the part of the medical group. after walter reed hospital, the close down the program and a fixed up the places. we have not been able to get back in. >> maybe that is something you can address. >> but we are talking about the

problem. the problem is before they get out of the military. we understand the problems with the va. as a community support, how can we do it? we are constantly told know. we do have a solution in place. >> let's hear a solution. >> we do have a solution in place. it is in fact the law of the land. it was created by all of the military services and about two years ago. if it is implemented with leadership oversight and accountability and data to back it up, the recover recorded nations plans and the federal recovery coordination plants and the screening to identify every serious and severely injured service member, and a plan that addresses the needs of the family members also, and integrates the community assets of for the people live, it would

prevent that kind of thing that a pro or andrea or panama or other things that the if spouses go through. we know how to do this. there is a stigma that is still out there. it is unacceptable but it takes leadership. it takes accountability. the legislation is in place. the instructions are in place. the tools are in place and it should not be happening anymore. >> does anybody want to address? >> i know you guys are probably saying, well, the brain dead guy out there is not talking. i will talk for a little bit. i am not completely brain dead. [applause] i think one of the big issues that i hear -- you are exactly

right, ma'am. everything is put in place. i have heard from people in the navy and from people in the army, from the marines, from the air force -- every branch of the unit has something put in place. the problem is, they are not talking with each other. that is the problem. [applause] if the air force would talk to the army and the army would talk to the marines, if the marines would talk to the navy and the navy would talk to the air force -- if everybody would talk to each other and say this is what everybody has and make one big huge coal operation, this is the perfect plan. we would not have this. that is what i think. [applause] >> he probably said about the smartest thing anybody said all

day. thank you. i think we have time for what mark question. >> my name is danny camp. i served at two stores and vietnam. i have ptsd. one thing i would like to see the fee a do is called the one department. you can't google it and pick it up it will show every -- the people with ptsd -- they have no idea what it is. if it would show them that video, i think that would be a big help to help them understand what the guy is dealing with to come and see them. pbs stayed with these guys for about one year and filled them all. it shows what happens to people who have this and come home andptsd home without care. >> i think unfortunately we have probably gone to the end of our program.

i know there are other people who probably want to ask questions. can i ask the people on the panel, would you be available for a few minutes after words if any of you want to come and talk to these people? this is the a team here. i would say, right up afterwards, but we do have to break. if i could summarize, i think there are a number of things that people have said. mental health as a bigger problem. we have never really recognized that in previous conflicts. we are at least identifying it but we have a really long way to go. secondly, it is the stigma attached to it. third, it would be the whole issue of family. is there support for family? as a person, the care givers that are giving the care often have a lot of problems as well as a result of their wounded warriors coming home. tom, you probably said it best. we do have the programs out

there but we all need to talk to each other. thank you for participating in this panel. i have learned a lot. i want to thank everybody here. mr. bowers, james adkins, the cute single guy, david brown, thank you for educating us. [applause] [captions copyright national cable satellite corp. 2011] [captioning performed by national captioning institute] >> he was recently interviewed by wall street journal editor murray in new york. before that he was in charge of the legal defense during litigation concerning the drug.

frazier is a trustee as well as the penn state alum. this event is just over one hour. >> thank you for being with us this morning. is great to have you here. you have been in this job for about one year. >> about one year. it has been a long one year. >> how is it going? >> i think it was going relatively well. it has been a challenging time for our entire industry. there are a number of important challenges that we face including a fundamental challenge around research productivity. on the whole, i think things are going well. we have had a strong year. we have had a strong performance with about 5% growth on our top line. we have introduced new products into the market. we have 19 products in late stage development, eight that will be found in the next couple

of years. >> i want to talk about research and innovation. there is an interesting book written by a business school professor, marshall goldsmith. >> i have read it. >> you are an interesting case. what got you here at least from reading the press was or defense of the company from the fox claims. what will get you there is overseeing innovation. a new generation of innovation and directs. it seemed like a different skill set. >> i think you are completely right on that. i guess i would set a couple of things on that. first of all, the defense was at -- ultimately the defense of innovation at the end of the day. many people saw it as a tactical war erotica rooms and the lawyers and that nature.

would you are inside a company companymerc that is committed to scientific research and integrity depending how we handle biopsy. it is critical as to what we say as a company. the charge that we are in some way trying to cover up what the true safety profile of the drug was, i think we are fortunate that when the cases were tried and they could hear both sides, the most often cited with us. back to your question, i have been very fortunate in my career. i have worked for three see those now going back to the early 1990's. he hired me and insisted that i not be in the legal department. for my first six years in the company, i was responsible for public policy and communications.

i learned a lot about the need to communicate. what we were communicating was the value of pharmaceuticals and the importance of innovation. i then had a step in the legal department when we talk about vioxx. but our current c e zero allowed me to run the business of merck for three and a half years. i did have some experience outside the legal department, i think that was helpful to me. >> is legal training itself helpful in being a ceo? >> that is a hard question for me to answer. i think some aspects of it can be helpful. the ability to cut through the clutter of discussions and it tried to do what is fundamentally important, i think that is helpful. i do not think by and large, business and a lot are very close to one another. i think the way business people think is very different. i think the way lawyers think

about protecting businesses is a different thing. in some ways i do not think it is perfect preparation, but i think i was fortunate that the majority of my time was spent outside of the legal department. >> started at about one year ago. he made a strong statement shortly after starting that research and development was the core of the company and you intended to focus on that. you had a new ceo around the same time and a different statements at the time talking about slashing costs and slashing the r&d budget. in the months cents, phiezer has stayed about the same. >> i am very pleased that we stayed about the same period for a long period of time we were very much down in terms of our stock price. >> because of vioxx?

>> no, i mean this year. i think the issue had to do more with an issue that came up an hour late stage platform. i will just say this about are indeed. i think at merck, science and translating cutting edge signed into important products has always been a core of what merck has defined as its purpose in the world. without commenting on anyone else's strategy, i think that the position i took was consistent with merck's core values and consistent with what their strengths are. i think one -- i think when me one runs a when mrck, i think it is important to keep in mind that you are not running the company for the immediate reaction of the stock market. obviously, i can tell you it is

better to have your stock go up than down. what we are really trying to do is create sustainable long-term value for our shareholders. from my perspective and i think my management team agrees, the most sustainable strategy is really around innovation. over time the marketplace will try hard to come monetize goods and services. the on the way you can escape that. the only way you can provide sustainable high returns for your shareholders, much less for customers and the patients, is to do the innovation. >> there are clearly people out there who think the big farmout are in the model is broken. -- pharma r &d model is broken. they cannot invest that much money in a way that can get a decent return. is that a message to hear from the market? "i think i do hear that from

some investors. i would back up and say that if we were sitting here four years ago in 2007, merck would have been introducing eight new important products including the are cervical cancer or her -- cervical cancer vaccine. at that time nobody was saying you should not invest in r&d. the problem is it is not always consistent. it is not like engineering where you can incrementally innovate and make another version of the iphone purity iphone for and to the iphone 5. -- we are trying to do something and come up with a completely new molecule that will work with a different molecular targets and it provides some benefits in terms of medical needs. that does not happen regularly.

it happens up and down. if you look in the past, there have been other periods for our north dakota. in the long term, --other periods for r &d. science has always made progress. there is always a lag time to apply what we learn from the basic science and come up with new drugs. when i am saying is having looked at the past, having seen the stages and changes in the past, i am confident that if we focus on cutting edge of science and if we put into place the kind of environment inside merck where world class scientist when the come and make a career, i think we will turn it around and come back. >> what can you do and what have you done to maximize the return? >> first of all, i would say my colleague who runs our research lab is focused on this question

as much as anybody else is for roi. we have looked at the disease areas we were and and we have made some decisions to narrow the areas we want to focus on. research dollars going forward. we continue to hire the best talent. we continue to work and heartily so that we can make better decisions -- to work internally so we can make better decisions. 98% of your projects are going to fail. the question is can you make in 98% and not 99%? >> one of the things that has probably sour people is the fact that 10 years ago we had the

decoding of a human genome and the excitement that that would revolutionize medicine. 10 years out it really has not. nothing seems to have changed that much. what do you say to those people who tell you that? >> i will say a couple of things. they have to be patient. if you look back, and the late 1970's, the predominant way to discover jobs was in vitro testing. you take so will elements and a plant extracts and he put them in a petrie dish. then we learned how to synthesize molecules. the change between in vitro approach and the chemistry approach was not overnight. it took a while for people to begin to take these new approaches and figure out how to apply them in the context of the industrialization of pharmaceutical discovery and

development. i think the same thing is happening right now with the human genome. i am not a scientist as we have already established. i talked to my scientific colleagues all the time. they were in areas like oncology, what used to be a black box they are understanding the disease processes. they understand multiple targets are involved in cancer or asthma or other conditions. it will take some time before people can master that and it really pick the right target and find the right intervention's whether they are small molecules or biologic. i am convinced that what happened. >> in the next decade? >> absolutely. >> he mentioned cancer, it has been 40 years since the war on cancer has been declared. it sometimes feels like the war in afghanistan. progress is very hard to measure. are we going to see that change in the next decade? >> we have seen a couple of drugs this year that has made a

real impact on certain tumor types. i think that gives us reason to believe that if we continue to apply the sites in that context, we will be able to conquer specific types of cancer. cancer is an interesting word that describes a lot of diseases that actually involved tumors. i think one of the issues we are dealing with is, it is not something like a hypertension or high blood pressure where a medication can treat a very broad population of people. what we are learning is how to find drugs that affect specific tumor types. i see progress again. >> can you quantify that at all, 10 years from now how many types of cancer will have the effective treatments? how much of a reduction? >> i cannot quantify it as i sit here today. i would be making a wild guess.

>> are fine with wild guesses. >> let me say this -- a whole bunch. i am convinced again will we look at the process we have made in the last 10 years that you see an acceleration of our understanding in oncology. i think as we begin to understand the molecular targets, we will be able to target compounds that actually affects those in specific patient types and tumor types moving forward. >> we have made it this far in the conversation without you making any reference to public policy. you wrote a pretty tough peace and "the wall street journal" attacking some of the aspects of the health-care bill saying they would prevent innovation. >> i would send one of the big challenges the industry faces, i have to spend the past week

minutes telling you how excited we are about the science. we are excited about where it can go. one of the challenges we have is what kind of marketplace will there be what we come up with new drugs? that is where public policy comes in. globally, governments tend to be our customers outside of the united states. we are dealing with public policy challenges, would you deal with the economies around the world, it is important there be a pop -- public policy and are meant that is conducive to the kind of innovation we are talking about. our business requires significant investment over a long period of time. we faced regulatory uncertainty. it is tough on top of that to have a marketplace where public policy does not really support new drugs that actually have a profound impact. >> are you saying by and large the government to procure trucks in most other countries

do not give you the incentives for innovation? >> i think over time the incentives have been lessened. in europe right now, those countries are facing major problems that we all know about in terms of the deficits that the have and the lack of economic growth that goes along with the deficits, many countries are struggling in their social welfare systems to afford health care at the level and which would benefit the population. one of the impact is that they tend to focus on one part of the health-care bill, which is what i would call the ingredient cost. >> partly because it is a big cost? >> 10% of health-care costs are actually the direct costs. the other 90% has to do with other ways of providing health care. hospitals, physicians, diagnostic procedures. a lot of inefficiency and how those services are provided.

we are 10% of the health-care bill. when you look at the proper use of drugs, it tends to be cost- effective. it is an easy target if it is one segregated part of the health budget. is growing because there are new drugs. people will say let's keep that static. that is an authentic "with innovation. i will give you an example. we introduced and hepatitis c drug. with previous therapies, only one-third of patients were able to cleared the virus. now the cure rate is up to around 70% or 80%. i was just with the german health minister, a young man who looked like he was about 30 years old. we were talking about the fact that in germany, the health technology assessment agency has determined that this change from one-third to about 80% does not represent a real innovation that

has to be paid for. if that is the case, it is pretty hard to have an industry like ours. i think what is happening is people are putting their finger on the scale because they know there is an economic problem. the reason i put wrote that piece in the economic journal, i think it is important for others to be very loud about the importance of paying for real innovation when it occurs. >> one of the things that frustrates the americans who have looked at this question is that we seem to be paying for innovation for the world. we are delighted to have the most innovative pharmaceutical companies in this country. the cost seems to be baked into the cost that we pay for drugs and everyone else is getting it at a discount. >> let me start by saying before we get to the cost of the drug, recognize that the u.s. does have the benefit of a strong pharmaceutical industry. european countries locate their pharmaceutical companies in the united states because it is

conducive to that. it is one of the few net exporting industries we have left in the united states. let's not forget the benefits it provides the country in terms of a very strong industry. that is along with the computer industry in silicon valley. we do not have that many really strong american nation -- industries. getting to the cost side, that is a challenge. there is a great deal of transparency worldwide with the cost of drugs. countries like the united states or germany -- germany wants to pay the same price that croatia pace. if that is the world in which we live, two things happen. first of all, you take away the incentives for innovation as we talk about in the past couple of minutes. he returned the incentive for differential pricing. if people who cannot afford to pay more are forced to pay the same amount as wealthy people, you will discourage the use of

drugs and those poor countries. to me that is not a borrow position to take. i understand the frustration of looking at other price control environment and saying we wish we had those prices. one more thing i think people should recognize is let's go back to this story. the other problem with price control regimes is the newest drug take long this to get to patients in a lot of those countries. also want to have a situation where you have a free market where physicians can make individual judgments about whether this new drug will provide a benefit to a particular patient. i will say you cannot have everything. you cannot have cheap prices and the most innovative industry in the world. one of the problems we have to think about is how many vital industries do we have that are located in the united states? >> your fear is the united states is with the latest lot moving in the direction of germany or other company -- countries? "i would not say it is near

germany but i say that you can see a process by which he u.s. government becomes more of an important customer to us. if the u.s. has its own financial challenges, we have to find a sensible way to reduce health-care costs. i completely support the idea that we have to reduce health- care costs. generic drugs ought to be used for patients that they work for. if you say, i am going to put a cap on what innovation can provide. as we started off in the beginning, the investors are already restive. >> to you think that is what is holding down your stock prices? >> i know that it is. i talk to our largest and busters. most of our largest investors -- the good news is most of them and said we think that is the right thing to do.

they said two things. you have to work on the roi. you have to promise us that you are going to engage the public policy and hard to ensure that if you do get a drug across the finish line they can get reasonable reimbursement pierre >> how are you doing on that score? have you talked to the president about that? at what levels do you engage? >> i have the honor of being received in the oval office earlier this year. i did have an opportunity to express my views on specific things with the health care law and the fda. he was gracious to provide me half of an hour of his time. had the same time -- >> did you get a good response? >> i did get a good response. i do not know if it has been translated into action so far. it was a good conversation. i think the president understands the need to maintain a strong and viable industry here.

the other issue is, how much time can be set with the congress? that is where the reaction is. we spend a lot of time on capitol hill trying to persuade people by putting additional rebates -- a benefit that has two virtues. one is very well received by seniors around the country. i say seniors with some hesitation because i am now possibly being viewed by one. it is also one of the few government programs that have come in under budget. it has used the private market. i think it is a mistake to tamper with a benefit that provides such satisfaction to people and comes in under budget. if we start putting price controls in the united states that are like the ones in germany and other countries, i think we are taking away a huge amount of incentive for innovation. >> we had last year on the stage from ibm, he was talking

about visiting with the president. he had a whole list of ideas for how the government could save money with the deficit problem. i said we will give this an example. he said, if the government would negotiate for its drugs directly from the pharmaceutical companies rather than going through intermediaries, they could get a much better price and save millions of dollars. but you think of that? >> i think it is a terrible idea. the concept -- having the experience of negotiating with european governments, that is not what the word means. they set the price and that is it. i go back to what i just said. it is one of the few benefits that have come in when under the way it was scored by the cbo. there are a lot of people who are employers to go to health plans that provide the right balance between cost

effectiveness and the benefits to their employees. for most -- the congress has a private benefit. it the fact of the matter is, i think the private market has worked pretty well when it comes to drug prices. we provide very significant competitive rebates on our product in order to get them -- i do not see that there is a problem that needs to be fixed as it relates -- the problem as price. >> when you say that, what you are really saying is that you do not need a new drugs. i cannot be in a business when i take this much risk. i spend $8 billion. i am going at new targets that have huge uncertainty around them. i can get it through a regulator and it costs $1 billion to bring a new drug to market. the problem is price. the reality of the world is that

every drug that was on the market in the year 1995, a pretty high standard of care, is already a generic. in their people want to live with today's standard of care or they want a drug for alzheimer's. i will not get into the details because that you have my extent of my knowledge on neuroscience. it is a program that we are spending a significant amount of time and effort on. if that program is successful, we will have a job in 10 years -- we will have a drug in 10 years. we can not charge enough in price to not make that drug a net benefit to society. if you say the drug's cost too much, you have to be intellectually honest enough to say that i think the drug today are good enough and i do not need the once the your "to come up with tomorrow. >> you were talking about the

importance of merck engaging in public policy. we had a little bit of them engaging in public policy in texas. >> i heard about that. >> or the governor mandated card is still in the state and there was a lot written about his former chief of staff who became a lobbyist for your company. it was a case and how involvement in public policy can get you into a hornet's nest of trouble. >> i agree. the story is many years old. >> it was not under your watch. >> the. i am making is that the recycled in a political campaign. we were told this drug that prevents a cervical cancer, almost all of it call it -- causes mental retardation in girls. the level of political recourse and it is low.

governor. did sign an executive order. the texas legislature is an interesting innovation in that it meets only every other year. maybe that is a good thing. i am not sure. there might be some texans here. in the interim, he decided that given what he had learned -- not just from the lobbyists but from his own public health people about the importance of this vaccine, he would sign an executive order. it created a huge fire storm in texas because, the difficulty of this drug against cervical cancer is caused by a virus that is transmitted sexually. in the discourse of becomes an issue about whether you are promoting promiscuity do -- or prevent -- protecting girls against cancer. he immediately retracted that. the discussion this year was really what happens when people are running for president.

people revisit those issues. i do think at the end of the day the concept that the governor of texas would sign an executive order providing for the vaccination of every girl and the state simply because somebody was later going to become a lobbyist for merck is a little in direct pierre >> it does not trouble you much? "it does not trouble me. although the appearances, i do get why with respect to the eight american people, people are concerned that various elements of society have too much access through the political system by political contributions and lobbying efforts. . merck has always tried to do, we try to do what we believe our sound policy principles. our policy is what is good for the patients is good for us in the long haul. >> but you do make significant

contributions? >> absolutely. there are no two was about it. the reality of the world is the political system is a difficult one and this country. if you run for congress or the house of representatives or the senate, your challenge is to stay elected. the cost keeps going up. we think it is highly appropriate for our political action committee for our employers to contribute so we can support those people that support innovation. >> we had the spectacle of seemingly endless republican debates. i have lost, but we are over one doesn't. the standard line of health care is to repeal the obama health care plan. is that the right approach? >> i do not think so. there are a lot of things about the old, health care plan that i think are really positive. the focus on prevention for example. that is something i would point out. there is no reason we should not give people first dollar

coverage for vaccines. i think it was inappropriate for our country to get into a position where we could take the uninsured and provide some basic level of coverage for them. there are aspects of obama-care. i do not want to call it the. the affordable care act. we have some concerns about ipac, a body of people that is not accountable to congress whose job it would be to sit around and decide which drugs would be reimbursed. >> do you think that will be like the chairman health ministry? >> i am worried about that, effective. one of the geniuses of the american health system is that we believe decisions made by a broader groups of people are better than decisions made by concentrated groups of people.

physicians are able to look at data and decide whether a new drug makes sense for a particular patient. >> but we know there is lots and lots of evidence, there are a lot of physicians and they are not up with the state of the our best practices, they do not have all the best information on what drugs are most affected. few really believe that disturbing those decisions over all of the decisions. >> yes, i do. better job of informing them? >> i think we should provide medical education. >> a lot of their information write no -- the drug companies spend a fair amount of time on them. >> it is interesting you should say that. what is happening in the outside world and social media is that there is more access to information today than there has ever been in the history of mankind. if you like it data are on what people seek when they go to the

internet, held is one of the primary things that people seeking information for. the critique that they are dependent on our sales representatives for information actually is sort of 50 years too late to make that critique because everyone has access. >> what would you do to raise the level of knowledge about new treatments that physicians have? >> cme, continuing medical education, is really important. we just talked about the pace of science changing faster and faster. i think it is important for people to have access to unbiased medical education. unbiased, independent, continuing medical education. >> turn the focus for a minute to china and then i want to open

it up to questions. you recently announced a major investment in china for research and development. why take that to china? >> first of all, i think we have to recognize we're living in a global society. merck is a global company. the emerging markets are a big part of our business from the standpoint of sales. we anticipate 25% of our sales to be in those markets and china is the leading market by 2013. at the same time, you look at the low cost of the human genome sequencing in china. it is revolutionizing medicine. i think if we are going to be an important player in global health, we have to seek the best medical and scientific talent wherever it is. in merck in the united states,

in terms of our bio statisticians, 60% of our by statisticians are native born chinese. there we brought in to united states with visas to work in our body statistical department. there is tremendous talent there. we have to access that talent where it is. >> last november, we brought together or ceo council of 100 ceo's from different parts of the world, and and a survey prior to that event we talk to them about their concerns about china. the number one concern was intellectual property protection. number one concern about china. does it bother you to be doing research in china when there are concerns about the protection of intellectual property, which is obviously critical to the survival of your company? >> it is a very valid question.

i would say that we chose specifically which parts of the research value chain we want to do in china. we made decisions about what we are not going to do there. i think we have done that with ip protection for most in mind. >> in certain industries, has been explicit about quid pro. quo. was there anything like that in your case? >> there it is something like that in china. but it didn't relate to this installation. the issue in china, as it relates to market access, really has to do with "the colbert report for example, if we want to sell vaccines -- to do with china, for example, if we want to sell vaccines to the chinese children. they had a huge hepatitis b problem. merck donated vaccines.

we saved tens of millions of lives. we have a long history there. as we deal with the chinese government, in terms of access to their children, there are some demands that have been made around manufacturing those vaccines in china. and we are negotiating with them and with their chinese owned vaccine company to see if we can come to an agreement about technology transfer that makes sense. >> a final question i want to ask before i open it up, as if reviving merck or not a big enough challenge, you have taken on the challenge of investigating the jerry sandusky situation at penn state and what it says about the culture. why in the world would you do that? >> question that my wife asks all the time. she has the list of things she

would prefer that i do and i do not get around to them. i think the bottom line here is that i was already on the board of trustees. this is my. it is as quote -- i grew up in the inner city of philadelphia. i got four years of education at penn state that changed my life occurre. when this thing happen, people looked around and said, has anybody have experience that is have this kind of experience with this kind of widespread situation before? and i didn't raise my hand. then there was a question of is there anyone here that is handled vioxx before? i had been outed. and so, it is really hard to step away from an institution that you have placed your support for in a valid need. so i did take that on. we were able to get a former fbi director to take over the

investigation. no i have someone who i think the public would agree is an able investigator to take over, it should take less time. >> some people have been critical of the choice for precisely that reason. they say that what you did at vioxx was protect a company from excess liability and what should have been at penn state is not a focus on liability but a focus on what went wrong. >> i said earlier on, when you said we defended the company, people on the outside tend to look a fact that there were saying that liability could be as high as $50 billion and it was less than that. >> around $6 billion. >> it was 4.8 billion. and others will tell you, inside the company, it was the defense of the institution. i am a big believer in institutions. they allow us to have continuity

in our civilization. and merck is an important institution because of what it can do 20, 30, 40 years from now in terms of alzheimer's, cancer and things of that nature. so, too, is penn state, an important institution. so i took on that responsibility because i believe in the institution and i believe it is important to maintain institutions. this is a horrible situation, but it does not define that university. i do not know what the facts will ultimately be, but i think it is important in times like this that people step up and remind people of the value of an institution to the country. that is how i see my responsibility. >> questions? yes, please. >> betsy mccoy. you mentioned the independent payment advisory board as part of the obama held a law that troubles you.

the courts may strike down the individual -- the individual mandate or the medicaid expansion. if not, the nation may elect a republican president and push for repeal. tell us what part, aside from first dollar coverage from vaccines, you'd like to keep in the obama help law, and also, what other parts trouble you? for example, controls on doctors who treat privately insured patients. well that interfere with clinical decisions and access to medications? >> she's spent some time on this. >> i thought that was 1312. i think the things that concern us most -- i talked about the independent payment adviser board. the advent of these additional rebates is another big thing that concerns us. i think the benefits of a lot -- big ones.

providing medical access for a broader section of our population is important. >> is the mandate essential? >> i do not think it is geared >> so you think you can achieve that goal? >> i believe you could. >> would you be in favor of that? >> i would be. it could strike down the mandate in keep the rest of the law and say that the law is sufficiently whole to keep it. we could get repeal legislation. but it is clear that republicans in the house and senate have made repeal of the law a major priority. i think the law has some goals that are laudable. my biggest disappointment in a lot coming back to the earlier discussion is that i think it did not do enough to remove some of the disincentives to efficiencies we have. you see these studies that compare to hospitals in a particular city with respect to back surgery, if one has a lot of specialists and another one

does not, you get very different amounts of back surgery is. ies. the over-utilization and inefficiency in the system. if i had one critique it was that it did not aim at where the costs are going out of control. again, i comeback -- the ipad focuses only on new technology. i'll go to that point. tooou think drugs, are expensive, you should try disease. as 10% of the budget. if you will focus on the 10% and not focus on the efficiency of the downstream health care delivery system, then you are missing a big opportunity. from my standpoint, to answer the woman's question, the most important thing i think they missed was focusing on some of the incentives that create the inefficiencies in the system. >> yes, sir?

right here. >> so, i would like ascok about your arr &d. a bunch of things are happening with the genomics. when you do clinical trials, you can now look at different populations, not just race or age or sex, but also genotypes. in many cases, you are likely to discover that a certain drug is a very effective for a subset, but useless for another subset and toxic for a third. it is great for you to discover that. it means, in theory, you can target the drugs to a smaller population, may be charged more. the fda needb and to recognize that. i am curious, where do think

they are? second, you talked about the doctors ensorcell media. the doctors as well will need to understand and know more about your own patients -- talked about doctors and social media. the whole amount of knowledge that will be required will be much greater. how does that happen? the third than -- >> how many are there? >> the last thing. i believe it was a merck that long before the war and baldpate $225 million for a drug tested in russia that proved to be useless. >> i do not think it was. we did not get that one, but we had our own atrocities. >> the question is, in a polite way, how reliable do think that kind of research will be in china? >> let me start with your first question. i think that is one of the

exciting things that is happening. as we get more information about the human genome and personalize gene expressions, it gives us the opportunity you talked about to focus not only on broaden populations but on narrow populations who might respond better to a medicine. and i think the fda is very much focused on those kinds of issues. i would say that one of the things we can do as an industry and as society is to spend more money on the fda so they have the resources to stay current insides. we want regulatory size to keep up with basic science so that these changes can be made. i think that is an exciting thing about our industry. as the cost of drugs increases and the economic pressure gets greater, it will help us to be able to demonstrate the utility of that drug, the benefit in a specific patient population. i think that is an exciting thing. it is a way for us to provide

value going forward. i think that will only help innovation, not hurt innovation. on the type of thing, i think i would not take one example -- on the china thing, i would not take one example of a clinical trial in russia and not have the replicative to say there was a problem in china versus the u.s. our industry is where most drug candidates fail. often in the smaller trials, we cannot replicate them, but we learn about a side effect that did not appear in the smaller trout. i would say that what we do when we come to a licensing drugs is we try very hard and are due diligence to ask all of the right questions to make sure we are not wasting our shareholders' money, to give ourselves the right opportunity to make those judgments. but coming back to the main thing, the fact that we have diagnostics and by workers and genetic insight into these drugs, opens of all whole new

avenue for a valuable drug innovation. >> there is a question back here. reuters news. i have a couple of questions on penn state. you mentioned the investigation. can you let us know how the investigation is going? and your brother of the role of louis freeh. the you have a sense of when the investigation might be over? >> i did not have a timetable. we told the judge she has complete free rein to do the right kind of investigation. he's very much early in the stages of investigation. i would hope there would be done by the end of this academic year so we could come back in the new academic year and have that behind us. i cannot put a timetable on it. i think judge freeh and has the skills and background.

all i've heard so far is that he is getting good cooperation from people. that is a good sign. i am not in a position, and i do want -- and not want to ask for interim reports. he needs to carry out his investigation just as a law- enforcement agency board. >> question right here. >> the speed of the market and unnecessary delays for drugs of the fda is a theme of the editorial page. can you comment on that? >> i think for companies like merck, our goal should be to work constructively with the fda. i think the fda works under very difficult circumstances. i just alluded to the funding may have. there are a fair amount of challenges from congress and others as we saw the other day,

the administration overruling the fda with respect to the determination on plan b. something that i think they felt they had good evidence that could be used safely. i am not a person who knocks the fda. i think it is full of very talented people. my interactions with them, they are first-rate people who work for our government. i think people in public service though they could leave and make a lot more money in the private sector. i think we have terrific people. the challenge we have is to find ways of meeting their needs in a more expeditious way. from their standpoint, a little more transparency about what the standards are going to be is what i think would help us. because we have to design these clinical trials in advance. if the evidentiary standards shift in the middle of it, it is hard to adjust. the big thing for me is the openness, back and forth in terms of dialogue and

transparency, in terms of what quantum of proof or benefit of risk will be necessary to get a drug approved heard cou. >> i appreciate it your comments on the need for innovation in our industry. when you look at the changes taking place in the health care marketplace, physicians coming together, consolidation, 50% of doctors are part corporations. there are more employees with corporate goals. all of this. do you field this landscape is more conducive to innovative medicines or is this another way to squeeze costs, take new drugs out? >> so i think every industry has to figure out how to compete in the marketplace it actually has. you do not get to choose your customers. your customers' shoes you. it is very clear that health care is viewed as an inefficient

market place with a lot of discontinuities. i think the challenge we have the inside work is to adopt to that -- adapt to that environment. i think people still value innovation. i think the challenge for us is to recognize that the customers out there -- let's be clear, our government customers in europe are mostly bankrupt. so we are going to have to think about innovation, but low-cost innovation will be a big part of our business model going forward. so we are stepping up to the challenge at merck. pfizer is doing the same thing. these companies have to think about running themselves in a way that is sustainable to provide not just to benefit from a therapeutic standpoint, but benefit from a held-economic standpoint. the biggest change that has occurred since i've been in the industry is the rise of health economics.

before was just physicians making an individualized medical judgment. now physicians are not the decisionmakers anymore, because there are people looking at drugs, managed-care providers or a nice in the uk, these are the health of technology assessment corporations. the people that are trying to insure that there are evidence based ways of deciding which drugs should be used for people, including not just a benefit and risk but also cost. i think we can lament that all we want, but everybody else gets measured in the world and everyone is challenge to provide a better service. if you have a new cell phone, each subsequent one has to be better and cheaper. so, in many ways, our industry has had the luxury of not having to compete on the basis of cost. going back to the question that allen asked, i am not saying we should not compete on the basis

of cost. the problem is if your only customer is the government and the government is to decide the value without regard to input from others, that is what worries me. >> other questions f? >> some right here. >> thank you. you mentioned plan b. and i realize this is an issue, per se. but do you feel it would have a chilling effect on industry as w a whole? >> the link between that and the discussion we started off with respect to the texas governor's executive order, every time you are talking about children and six relatives, you are in the space -- and sexuality, you are in a space where that the political dynamics will dominate the science. scientists tend to look at it from the perspective of we need

to provide young women with options when they have an unintended pregnancy. we need to protect young women from the risk of cervical cancer. that is a medical problem. when you move from that public health arena into the political arena, then we know that we have different kinds of considerations. as the president said himself, he thinks that "common sense and needs to be applied." that implies science and common sense are not compatible. i'm not sure about that. it is highly politicized. i do not think it will have a chilling effect. because of drugs are not used in that context. >> here is another question from that table. >> i have a question with regard to cost and innovation. there is a a significant amount of drug development financed by

venture capital markets. and by individuals who are on drug discovery. i am curious as to whether that is important in terms of merck. >> it's very important. one of the challenges we have in terms of ensuring we have the right kind of return on investment is to get the balance right between work we do internally and basic research and don and externally. a lot of fantastic work being done by startup companies. many people would argue that big drug companies ought to spend less internally and more outside. it is not to minimus' -- de minimus. merck wants to be a good partner. the fact the biotechnology industry is suffering a little bit know, their struggles is the mirror image of our struggles off. we have the resources to take some of these medicines into

broad populations. so that is the benefit that we can provide, if you will, the resources and the ability to do big clinical trials. he was seat of drug tested in a and our population because they cannot afford large populations. the partnership will create value for the biotechnology industry and our industry and value for patients. >> we had one of these conversations with marc andreesen and he said, and we were talking about biosciene and the argumentde when you can put the human genome in open databases and 12 and 13-year-old can start playing around and innovating the way they do with computer software, that that is what it will explode. do you buy that argument?

>> i think that is the world we are going into. and it has been shown before that the more access to have, the more people trying to solve a problem, the better you are in terms of getting a good outcome. i think that will be beneficial. i think there is a role for our industry because it takes concentrated amount of capital to take something from the very beginning stage of discovery all the way through large-scale clinical trials, fda approval, and brought commercialization. i think that, frankly, i am excited by what you just said because the more discoveries we actually can validate, the better off the industry will be in terms of the poulter on the other end. >> i think we have time for one or two more questions. >> hi, diane brady, bloomberg business week. i wanted to go back to penn state for one second.

i know. >> this is so predictable. >> i have two elements. one is, i know there is an investigation into the actual case. how you feel the trustee is handled the crisis, since you have a lot of experience with crisis? i with love to get your thoughts on this new center for exploited children being set up by penn state/ . there is some question about whether that is the best use of money. anything you might have done differently? >> i think the board of trustees acted rather quickly after the information became public. so i will not go back and critique. i just remember how shocked we were to hear that information when it became public. i think it became public on a saturday evening, and believe we took action with respect to the president and head football coach on wednesday evening.

i think, and given the fact that we are a large board, and geographically dispersed, i think we reacted in a fairly quick period of time. i think we did the best that we could with the information we had and the circumstances under which we acted. i leave it to others to decide whether or not we did a good job on that point. on the center for exploited children, i think that is a positive thing. i think one of the things that is being missed in this tendency, which is an unfortunate aspect of our public life and media and the american people, is that among the strongest form of rhetoric in our society is what i call the rhetoric of blame. we spend more time trying to parcel out blame then we'd do looking at the broader societal issue. so the issue here is that too often, children are being exploited in our society. this case arose at