his medicine. 50% don't take he could have learned a lot from that. when they finally let matthew out against our wishes and he agreed to go to outpatient, they will agree to anything to get out. they are smart enough to learn after six days, let me out. the releasing psychiatrist from the psychiatric hospital never contacted the outpatient service. i asked why. i was told off the record is the function of money. we do not get paid to contact those guys. the other thing to me is that hippa is a major problem. i have contacted many people about the questions. my son signed in medical release.

-- my son signed a medical release so the doctors could talk to us. we did not know this because the doctors were not talking to us. we found out after he was deceived. read the medical records. we found out he signed a release. the doctors still would not talk to us. the way the law is written, it is still up to the doctor whether he chooses to talk to you or not. the other question i have announced that no one can seem to answer is, if a patient signs a release, cancels it, and reinstates it, and cancels it, does there have to be a paper trail on that? i cannot seem to find that. there does not seem to be a rule on how that works. how do we know if doctors can talk to a patient? if they signed to a release and verbally cancel it, who would know? none of that is documented in the medical records. >> i wanted to let members know

something interesting. four states and the district of columbia have claimed the privacy rule is preventing them from putting records into a national criminal database. rhode island has submitted zero. montana, three. mississippi, three. washington, d.c., 477. new mexico, 5000. i think virginia is 180,000. the committee did send a letter to the secretary of state asking her to clarify when you have someone filing mentally ill -- violently known who violently mentally ill or through commitment, there would not be able to purchase guns. a lot of times, the state will not release them. i think it is a judicial issue. >> mr. chairman, as someone who was here when we wrote it, i do not think hippa.

is those records from being divulged. i think people are misinterpreting -- i do not think it presents those records from the doubles. i think people are misinterpreting it. >> thank you for inviting us for this important look at severe mental illness as a factor in the tragedies we're looking at. we have heard a lot about the uncontrolled. guns are a major part of the problem. untreated mental illness is probably a bigger part of the problem. i want to focus on the single biggest impediment is the fact that people with severe mental illnesses are different from people with severe physical illnesses in one important aspect. about half of them have an impairment of their understanding of the fact that they are sick. the breeze and they have that is because they have damage to the parts of the brave -- the reason they have that is because they had damage to the part of the

brain to understand that. someone with a severe depression or psychotic features is not like someone with cancer. the laws do not reflect this. about half the people with schizophrenia have been. awareness of the illness. we are not talking about a mile. -- will not talking about denial. we're talking about a part of the brain we used to think about ourselves. we see this in alzheimer's. in. your ability -- it impairs your ability to understand your sick and need treatment. we now have studies that show the brains of people with schizophrenia who and some with bipolar disorder, when you look at them, there are changes in the green -- brains of people who have the impairment compared to those who do not. 15 of the 18 studies show significant differences in the

parts of the green we used to think about ourselves. two other studies have come out in the last year. 17 of 20 studies show the brain is different. yet the laws do not reflect that. unless we have treatments that reflect the fact we're dealing with people who do not understand their sick -- they are sick, the treatments will not be effected. my sister have schizophrenia for 53 years before she died. she never understood she had schizophrenia. i would ask. she thought she has it's a pretty. she would say, and i know you think i have schizophrenia. i would say, why did they keep him in the hospital for 25 years? she would say i had a cold. i do not know why they kept me all that time. unless you deal with a problem in the laws and treatments, we're not going to go anywhere. thank you. >> i want to make three points

and get some reaction. we have been talking about potential solutions. i want to say there are a couple of bills. one has to do with mental health on campus, the improvement act. it is 15 years this month that one of my best friend's son committed suicide on the harvard campus. he was popular, doing well in school. no one could figure it out. obviously, mentally ill. she had asked me at that time if there was something we could do to provide more help to college campuses to identify and treat the problem. i wanted to get some reaction to that. the other is what you talked about about expanding the availability of mental health professionals. i have legislation that would allow clinical psychologists not

to have to expand their scope of practice, to not have to be under the supervision of a physician to offer that service. i wondered what you thought about that. i wanted to say something to dr. welner. i looked at what you can do as parents. it says to teach your children to take personal responsibility. a child who takes responsibility is not inclined to blame others and will never come close to the patterns of land that generalized to those he has never met. it feels to me with that kind of statement, it adds to the feeling the plane and -- blame

and responsibility and stigma without recognizing we're talking about mental illness, not just how parents teach our children how these situations go beyond that. it does not feel good to me. it seems to add the stigma idea. >> i think there is an important piece here. let's remember the suicide rate in this country for people between the ages of 14 and 24 is going to be 5000 people that lose their lives this year. 600,000 will make a serious attempt and go to an emergency room to be treated for that attempt. we know that there are brain changes that occur in individuals at 13 and 14. for people who have serious psychiatric illness, it

overprunes. there is a reason why rental companies do not let you rent a car until you are 25. it is because they have figured out the accidents between 18 and 24 are more significant. if they wait, the brain will calm down and suicide rates drop. it is important college mental health be an important component. it is the stress of being separated from your parents. it is the genetic disease coming out. it shows its appearance at this crucial age. the real problem is the fact we do not let colleges share information with parents so that when a kid starts showing symptoms, you can reach out to a family and say, her son is in trouble -- your son or daughter is in trouble. with virginia tech, it is the

attitude of the professors. if someone sat in the room bleeding, someone would say there is something wrong. you cannot come back to class because you might contaminate someone. you would have to be checked for tb because you might infect someone. there was this menacing individual in class where people sat beside the door to be able to run out. it has to be corrected so colleges can share the information with parents. imagine if your child is on scholarship and the first notification you get is he lost his scholarship and is doing bizarre things. that is the first time you get called. the other idea is of letting psychologists, are you talking about prescribing medication or not being under the supervision of psychiatrist? in the states, psychologists are independent.

the more important part to think about is there is something we can do if we think about the schools of psychology and social work. only 20% of them are educating people on evidence-based treatments. you go and get your social work degree or doctorate in psychology. you might learn about analytic theory. you are not learning about the most cutting edge cognitive behavioral therapy, the stuff we note has evidence that can make a difference. there is no certification program. there is no licensing that says this is what required. in medical school, there are certain things you must teach people to get a medical degree. >> of want to keep this moving. -- i want to keep this moving. comment and hone in on how we can prevent the next step of

violence. >> i appreciate your question. we have not heard anything about the newtown type of individual today. you asked the question that introduced it. from my experience and the literature, a great number of people who carry out mass killings cannot have a psychiatric illness. they have a personality disorder. what is common to all is they have resentment and externalizing responsibility to others. if you attack on a paranoid condition, you have an individual bloated by how he relates to the world -- loaded by how he relates to the world who then has a psychiatric condition on top of that. they get into a way of relating to others where it is always their fault. every parent in america asks how

to prevent the unthinkable from happening. the idea of how the child relates to the world, one can make a difference beyond nature. the last quick point i would add is in my professional experience in dealing with these cases, the muscular at risk population is harder to treat and manage than individuals with psychiatric conditions who have denial or are struggling in other ways. this is a unique population. what we need is better training. we have to incentivize better trained people to deal with the most difficult populations rather than make qualifications available to people who might not otherwise have an opportunity to be nominally in charge. we have to have mental health

fields. that is the population of treaters that need to be refocused on these individuals. a lot of them are in treatment with people that care. they crawl into the cracks so they can act on a homicidal fantasies. >> thank you for holding the hearing. let me ask a housekeeping question. since this is not a hearing, there are a lot of questions. will we be able to submit questions for response? >> i would be glad to forward those on. >> i think that is an important part of continuing this dialogue into the future. mr. earley, thank you for sharing your story. dr. welner prefaced one of his comments. you told us a compelling story.

i think it had a positive ending. i do not really know how you got there. can you share with us how you got to the positive ending? >> absolutely. thank you very much. my son finally got the meaningful service he needed. he got a case worker. that took a tremendous load off of me. i could be the parent. every conversation before th at, i would wonder if he was off his medications. i could be the. again. i had to become his partner. i had to learn to team work with him. it is not rocket science. people with mental illness want a purpose in life. they want someone to love and they want to be somewhere it is safe. the worker said we will get you into housing. living with your father and your age is not a smart thing.

they got into a house in with people with schizophrenia. my son has had seven psychiatrists. the only figure out his name and medications. they let the social workers do the work. treating the mind requires treating the heart. they said let's try this. all of a sudden, he became compliant. she said, what do you want to do with your life? my son has never been on disability. my son became a peer support specialist. he is paid by fairfax county to go into jails and prisons as part of a diversion team and help people with mental illness to get their lives together. he is an amazing success story. he has been stable for six years because people took the time and

effort and gave him the services he needed to move forward. >> he has become one of those mental health seals dr. welner referred to. >> most people with mental illness can get better. you have to give them hope and the tools to do it. those with severe illness will require more. most can get better. >> what prevented the intervention at one of his earlier e.r. visits? >> even if you realize you have a mental illness, who wants to admit that your brain is impaired? he fought it until he was arrested four times. the reality set in.

a doctor told him every time you are having a significant break, you are killing parts of your brain. that finally did it. how each person reaches that, i would be a rich man if i knew how to do that. he has finally realized it. when he did, we have the services in place to give him the help he needed. that is where services are so crucial. >> i do not disagree with that. i feel obligated to point out there is a cautionary tale as well. i grew up in the 1950's and 1960's. i remember the state schools and hospitals in texas. those were criticized because of warehousing individuals and providing no medical treatment. i have an article indicating the abuses of the psychiatric institutes of america that hospitalized adolescents for the one month insurance would cover. it was a very lucrative

business for that entity. they did not really help anyone. i do not know if some of the difficulty you had was because of the reaction someone took legislatively to that abuse and fraud. i remember those facilities in my home state of texas. they were quite rampant at that time. the justice department requires them to come up with fines and people got in trouble. i practiced gynecology. it was difficult to get someone into a treatment facility. nobody wanted anything to do with it unless people got in trouble. they were doing things wrong. there is no question about that. i will submit this 1991 article. >> nobody wants to go back to the old days.

you have to realize those kinds of facilities should have been closed down. in virginia today, if you go through the involuntary commitment process and make your son going to treatment, the average length of stay is five days. the treatment is five weeks. i would urge you to remember this. which closed down horrible facilities. we have moved people back into the community where they should be. if you read my book, you will see we're putting people in substandard nursing homes and they are homeless. they are in our jails and prisons. the harriman report studied the economics of this and how much money you are state was wasting because of people in jails and prisons who could have gotten help. i think for every $7 spent on incarceration, community services would have cost $1.

>> we should be about solutions. we also need to remember the pitfalls of the past. >> absolutely. >> dr. cassidy? >> mr. chairman, there is an insurance company called usaa that sells its products to members of the military and their families. they have a marketing campaign where they identified a specific battle or moment in history where the family started using the product. my understanding of mental health was burned when my dad came home from iwo jima after seeing a friend of his vaporized a shell burst. in high school, i had two severe bouts of depression. i learned about how people do and do not respond when someone is suffering from severe mental illness.

one thing you learn is in addition to the compassion family members bring, there is always resentment because you cannot find solutions to problems other people do not understand. , itpreciate my colleagues' about the past abuses that have created the current legal system creating these obstacles. it used to be putting someone in an institution in voluntarily could be used for punitive measures by husbands and families tired of dealing with problems they cannot solve. we have to remember these issues are dealt with on a state-by- state basis. we have 51 different solutions. that is why this is such a difficult challenge to solve. we know individual states have legal proceedings like

conservatorship that gives parents and concerned family members the opportunity for greater access to involvement in the care of a loved one. but those are cumbersome proceedings. we do not know how we can expedite that under the circumstances we have heard from these families today to protect the rights of the patients and give parents more involved. when i talk to mental health professionals and law- enforcement officials in my district, we come back to the same problem we dealt with in the aftermath of 9/11. that is the issue of interoperability. organizations concerned about solving these problems cannot communicate with each other. it seems if we're going to get to the root cause of how to solve the problems we're talking about today, we have to bring in state officials involved in making these decisions on a day- to-day basis and come up with

constructive solutions that are going to get people more engaged and involved in a more timely fashion. it is in much deeper problem than saying we can have a solution by clarifying the intent of hippa when it is being interpreted by different jurisdictions. i want to thank all of our panelists. it has been illuminating. you have put a fine point on why this is such an enormous challenge. >> maybe some of the parents could comment on the experience in terms of the barriers and was. >> my personal thing is the doctors used hippa as a weapon. they do not want to talk to you. i tried one-way communication. i must have sent 300 e-mails and

everything else with the final realization that the doctor was not going to return calls. the last three days of matthew's life i sent a fax to the c.e.o. begging for help. help me save his life. no response. i am told hipaa, we cannot talk to you. >> can you comment on that? can you comment on that in terms of confidentiality laws preventing people from communicating? >> i am very fortunate he has explained exactly why am concerned about what happens when my son turns 18. he is 13 so it is not an issue for me. it is on my mind for all of the reasons he articulated so well. >> in pennsylvania, 14 is the

age of maturity. i would not let a 14-year-old do much of anything else. i want to let someone else speak. >> a couple of things. there seems to be consensus. there are two issues. one is commitment. the other is the ability to understand the commitment of an adult can remember. the other is the ability to get information about the adult family member. mr. earley, i am about to reference you. one issue is to change the commitment laws and the hipaa laws. it is almost a consensus that these need to be addressed. in your book, you do a fantastic job. there is not consensus on this. there are activists who would

absolutely opposed changing current commitment laws and potentially oppose changing current hipaa laws. understand there is not consensus. i wonder how we address that. dr. torrey, you have been a sharp critic and have proposed federalization or block granting federal dollars to the states to not federalize control. i want you to comment on that after mr. earley speaks. >> no one wants to have their rights taken away from them. it is a slippery slope we have to watch. if you look at the history of where this all came from, you will see it came from what he

was talking about. people were arrested for having mental illness and their brains were scrambled. the civil rights movement said he should not get arrested because you have mental illness. he should not be forced into treatment. he should have a voice. the targeted involuntary commitment because they believe putting someone in an institution was worse than putting them on the streets. we have to have safeguards. i want to protect my son. i know how people with mental illness have been treated. i am saying the imminent danger criteria is a false criteria. >> [indiscernible] >> we can modify the laws to enable [indiscernible] >> absolutely.

>> we looked it having now you committed, conservatorship in louisiana. my father-in-law is an attorney that prepare documents. we realized in the condition he was in, the rage he had, it would take us two months and probably $20,000, which was not a problem. in two months, he would have had a court hearing. he would have been scheduled with doctors. then there would have been another court hearing. that cannot work with a person potentially violent. >> impede your ability. >> i thought my son would take his life when i told him we applied to have been committed. >> it turns you into the enemy. you take them before the judge. if the judge or psychiatrist says he is not a danger to

himself at this minute, they say we're not going to commit him. believe me, they are not happy. the dangerous criteria is a false criteria. what mike set about changing the wording, then you build in more safeguards. if there are parents trying to dump their kids or people do not need thatnow we have the barriei think we should have after when you need the treatment here. >> louisiana has something like that. mr. milam you went to the process and it was not adequate. >> i was just in back and rouge, and you guys are short on hospital beds. >> the doctor responded to that,

too. >> these are state commitments laws, we should not be under an illusion that any group in the federal government can change all of the state commitment law s. saar state laws -- there are state laws. we can provide models to understand what proper treatment can be. yes, you are correct, i have been a severe critic. they are not doing the job they should be doing with their budget, but that includes several hundred million dollars in a block grant. that could be used well to provide a model on how treatment can -- which can that account for people who did not have an awareness of their illness, and decreases hospitalization, and

violets, and saves money. it is a proven way to treat people such as we are describing, especially those who are not aware they are sick. this would be a good use of money. on a basis where you actually follow these and measured the outcome, ascertaining what decrease you have in hospitalization, jailing, there should be -- this should be the way we're going. that is not what they are doing. the one treatment they're proposing specifically does not include half of the people not aware of their illness. recovery by definition insists he must make the decision herself, so the only treatment they propose is a treatment where the purpose has to agree, which is fine for half the people who are aware, but for half who are not aware, it is irrelevant. >> i wanted to throw it down

something because i appreciated your framing. there is more we should be throwing down here as long as we're talking about newtown. professional experience has taught me the three most important said thematic elements of them mass killer our paranoia, hopelessness, and masculine identification with destruction. there is a reason why heterosexual males are not the overwhelming majority of people who are carrying out mass killings. if we completely limit our consideration as it is with guns, the idea of psychiatric illness, we are recognizing the first qualities. i would also add that while medications are very effective for paranoia, which are dealing with a population that, beyond those who have fallen to the

cracks, many, and perhaps most mass killers, because it is not an impulsive decision, it is a decision which one deliberates and becomes determined, and once they become determined they will do it, they crawl into the cracks. they keep themselves from being appreciated for the risk that they represent the others. the people we have heard about today did not have brought resentment of society to lash out. they killed themselves, and research denigrates that the psychiatric illness link is to the home. when a person lashes out at the general committee came not that is a different illness. we can never ever with all good intentions, all applications an example, federal law and well- meeting states to pick it up. we will never resolve the issue of mass killing in the united

states in particular, good mental health care until we deal with the cultural forces of entertainment violence and a video game detachment that at the other end -- and are influencing vulnerable people to identify this week -- with the assertion when they are finding themselves as man. >> can treatment prevent some of these mass killings? >> the key thing and i think the doctor brought up an important point, if you appreciate mass killers involved in such a high concentration of folks who crawl into the cracks, you could build the best facility, have the best staff, they will not come. you have to engage them at a level and in a dialogue that they are willing to have with you whether you are in for more, whether they did not appreciate you as a psychiatrist, and this is why the assertive committed the model has such promise for

folks who are either in the nile because they have a lack of insight or are invested in destruction and have to be defused by those mental health seals who are especially capable as a hostage negotiator would be. >> i think the one thing i would add goes back to your question, these are treatable in the sense that we know that the risk of violence in someone with serious mental illness goes down 15-fold with treatment. it does not solve all the problems, but that part of the problem is entirely triple. it is getting them into treatment about which you are suggesting them is where the struggle else. this is not a new conversation. we have been talking about how do you find the right balance between individual rights and public safety. after big events like this, we went to the sinking with virginia tech, we want to

rebalance we will want to be creek is a state-by-8 decision, but i hope we can bring better and better sides to that question. there are real opportunities to the cdc to try to understand what has worked best and what has not worked well. we need to be careful about making policy decisions in the wake of a rare event like this, that as weak rebalance this we do not want to go too far in one direction or the attic. it has to be a very careful conversation. >> are you the counterpoint to mr. earley, that the folks who would say this incompetent at all, not speaking pejoratively, but technically, does this in competent adult by nature of their alicia not have the right to make a decision say no to appropriate therapy? i think mr. earley bridles

against that. i relate to that. somebody of the incompetent say no. are you saying they should have that right? >> i do not think it will be a black or white call. you want to look at the unintended consequences. >> i accept that, but at some point public law is a little blunt. >> it is. um as i understand, and there is a "wall street journal" article, where the man released kills his mother, and a family was never informed. it is a hipa issue. a question for you, it is would you say that is the appropriate level of the law, or i did not know where you're coming down on. >> this is the exact conversation had. i will not give you a direct answer because i cannot think there is one, but in every

state this is the conversation we are trying to encourage. >> but if we cannot answer in -- public policy makers, then we got to despair. >> this plays out in every state. your first question, not all the groups to weigh in on this are here today. there is a robust dialogue that is going on. my concern is we focus on virginia tech, we focus on the newtown tragedy. smaller versions of this happen every day in this country, which people who are on treated, have no insight into their illness, and their families cannot get access to the system. we need to have this dialogue, and after every one of these tragedies we have these dialogues, but this is the opportunity to rethink how we do this and how we get people into treatment before they die under

a bridge in the winter, before something happens within a family that is tragic. >> i wanted to bring her into the discussions about too. >> thank you, and i want to thank you for your outstanding leadership in convening these hearings. that is a good segue, as i would like to focus on what is working up there and what you can highlight that we need to do more of, because we have got to be as the efficient and effected as possible with the scarce resources that we have. first, i would like to thank the parents of the panel have shown great bravery in coming forward and telling their personal stories, because you represent thousands, maybe millions of other family members who have struggled with similar challenges.

i am curious, before we get to highlighting what is working and what we can do better, when it did you notice the mental illness manifesting itself, and was its identified by others, a teacher in a classroom, or someone on the little league team or the scout troop? if ms. long still available, i could ask her first, did you notice it or was it someone else like a teacher? >> yes, it is a complicated process. my son is not my only child. i have three other children. i did notice the little things, especially in hindsight, that were maybe a little different with this child compared to by other children, that we knew by kindergarten. we had a clear the room safety order in kindergarten for my son, which was that was what we

went with a variety of psychiatrists, died disease, across the board, and now we are looking at an autism spectrum, possibly bipolar, so we struggled for a long time. things became exacerbated when he went into middle school and he is now actually in a program with children who suffer from emotional issues. he is not able to be mainstream to the other children at this time in school. they noticed early, and it has progressed. >> thank you. >> i will get this wrong. my wife will correct me grit that he was diagnosed as addhd, and we started having problems with that, but it gradually got worse, and he was treated by one of the top psychiatrists in new

orleans for many years in a different medications. i go back to the main issue with matthew, if he took the medication, ok? when he was in trouble, and he took the medication, he was fine. there needs to be a mechanism that if patients are not taking the medication, what does the parent do? you cannot make a 21-year-old man take his medication. you cannot go to the doctor, he will not talk to you. you have no mechanism to try to fix the problem when you know the medication helps. >> the obvious medication is assisted outpatient treatment. 44 of the 50 states have a. what is, and i used this in st. elizabeths hospital for eight years and the district of columbia has said, i would go to the court and say this individual has been in hospital 19 times, has no awareness of his illness, i brought his mother and sister to take to

explain what happens when we let him go each time. he never takes his medicine. we have seen him throw his medicine away. the judge says you have to come back every three weeks, get your injection, and if you do not, we have the right to bring you back to the hospital. we know there are six studies showing it decreases hospitalization, studies showing it decreases homelessness, victimization, arrests, violent behavior. studies in new york and new carolina showed that the decreases of violent behavior by individuals and it saves money. a study in california said it saved $1.81 for every dollar invested in aot. north carolina found that the savings were 40%. we know this works. we know it is not used except in new york state, a fairly widely,

but not as widely as it should be, but otherwise because of problems we're talking about, there has been great resistance to using any kind of treatment that involves in voluntary medication, which this does, but you are dealing with people who have a brain injury that impairs the ability to make those kinds of decisions. in answer to the question, yes, some of these people need to be treated in voluntarily. >> can i ask you, to identify the early stages? >> son was 22. he was a college student, and all of a sudden he complained that my food to some tastes good. i saw him several months after this, and he could not eat. we took him to a psychiatrist. the psychiatrist said if you are lucky your son is using drugs. if you're unlucky, he has a mental illness. i dismissed -- who says that kind of silly stuff? he gave my son medication, my

son could staking -- mike son quit taking it after a few weeks. a year later, he was psychotic like i explained. we looked back and you have to be careful because it is easy to look back and say that is why he did that. there were no signs. >> the chairman wants to move on and then come back to what works well, but i have to say, what i am hearing from families at home and educators and from doctors at our last briefing, was that the pruning of the brain early the identification of changes in behavior in activity, we have got to figure out how to give educators and mental health professionals and families the tools as early as possible to identify and then to treat. samsa does very well. i think they really put some

outstanding tools and hands of professionals at home. i am worried about a disconnect with the resources that are not available through schools at home, especially. and then for you who have health care coverage, using to be able to access greater treatment, and there is a large segment that is uninsured that will change, how can we best combat the growing number of insured to make it meaningful. >> would you like to comment? , thank you. i wanted to speak to the problem of lack of insurance or coverage for mental health. had the most extensive library fines he threatened to kill me overnight. i had to get the police

involved. i had to transfer him to the emergency room. then he calmed down. we did not have insurance that covered metal held at the time. he was declared stable and we were sent home. >> did you want to comment on that, too? but this is in reference to what works, and i would go back to dr. torrye's stated. the sides said that more reduces violence about but both of us and the other psychiatrist at the table would say that is a really low bar, not where we want to end up pick important to do, but the real question is, what do we have in place and what can be deployed to make sure that people finish their education, get jobs, have families, contribute in some important way, and there is an entire package of interventions

that help in that respect. they really do help people to work, and they need people to get back involved. you heard some of the things that made such a difference for their son. they are not available in many places, and they are not integrated in a package of care that you would expect. we do this pretty well for diabetes. we know there can be good diet supervision. you need to take your insulin. there is a rebel people who can make that happen. in this spirit, not so much. >> i wanted to make a couple of quick comments. first of all, the issue we are hearing about is now comply 31 aspect is getting to comply, and the other is to get him to stay on pit with the involuntary treatment, you can get someone to take medicine for a certain amount of time, but sooner or

later you are going to have to meet jesus. you're going to have to get to a place where the person -- you are going to have to bring somebody to take him that medicine that they did not want to take pick what i have found as a clinician, much more difficult for younger people than for an older dependent, is you must find your leverage within the relationship. for some people, that leverage is i know you did not believe your l, you do not believe you need these, but if he did not take your medicine, you're going to lose your child because of certain issues that have come up. for others, i know you think it is ever been else at the workplace, but if you want to keep your job, you may want to consider taking his medicine that may make you more relaxed. then going back to the example, many years later, the person says i know you think i am schizophrenic, but to some degree there is some

acknowledged compliance that goes along with it. for others, the criminal justice system does work. a judge can say, you know, but, you do not have to be locked up. but if you are not compliant, that is what is going to happen, and that is what manifest in the insanity system, that if people violate an order of conditions, they go back into a custodial environment. finally, for those who are of age and who are adults of there is a prospect of homelessness. they say you are in your 30's. i am supporting you. i do not have to support you. yet to consider if this lifestyle you have where you are comfortable is something that is entitled to you if you do not take your medicines. you'd have a responsibility in this just as i love you. that is something that each family finds on their own. i can tell you if from not only professional experience, but i have had chronic mental illness

in my family, also buried a sibling with psychiatric illness, and i know not only the futility, but the lessons learned thereof. i can tell you if you learn your leverage and use it right, and a sensitive loving, relations. you get interim compliance, and that is the holy grail. >> quickly, thank you. early identification, intervention in schools and primary care offices where families and children are i think is something we need to explore. the norm is there are a package of services and treatments available out there that if you could make them available in all communities, it would make a difference, and they include treatment teams and a crisis stabilization programs and supported housing, supported employment programs, for children, cognitive behavioral therapy.

behavior therapy and other inventions that absolutely make a difference. the challenge we have, and we saw this in the 2009 state report, hit or miss. it can go from one county to the next, one county those services exists, the next update the do that. the recession comes, it wipes out services, long waiting lists. it takes families years and years to find the services they need. we know what works now. we know what the road to recovery is for most of the people with serious battle ellis. we also know there are people who lack inside. that is a different path. >> there is a some projects that are impressive. there's one called the massachusetts child psychiatry access project. you have pediatricians across the state who get stuck with a patient who has a psychiatric

problem in their pediatric practice. they are able to get a telephonic consultation within that date as to how to help. it becomes a safety net not only for the patient, but for the pediatricians. they have proven in this part of the pediatricians feel better, able to take care of these kids come understand what kind of interventions they should do, and know when they should reach for something more comprehensive like a hospitalization or a psychiatric consultation. models like that, that was developed during governor romney's term and buy a child psychiatrist who is now a colleague, is effective, and they take resources and say we can make the people they're better book than before because we give them more knowledge and they are the first line of attack. if pediatricians because -- become better at identifying those warning signs and that is

to parents turn to first. >> i would like to thank the panel, and this is a very powerful discussion that we're having here. i do want to go back to the issue of hipa, because that is something at the federal level we can intervene. i think one of the points or clarification that i want to make, mr. chairman, is you had mentioned even hhs in some instances uses hipa and i will say as an excuse or relies on misinformation that is related. is that correct? was that one of the things we were talking about when we were talking about in relation to mental-health, is that -- because i know we have talked about doctors who unfortunately many times rely back on hipa and

say it is because of hipa cannot do this. i would like to say there that's i think a lot of the times it is the fear of legal action against a physician, and physicianhipa is difficult to understand, and it is something that may be an easy out, so to speak, and i know that does not seem reasonable, especially in the seriousness of these issues, but i think that sometimes that is what happens. in north carolina, we need more mental health bed. there's no doubt about it. i have this is -- i have visited brazil rooms where they are treating mental illness patients who are dangerous to themselves and others in the emergency rooms where they have had to make accommodation, and these are not individuals -- the

health care professionals there are not qualified to take care of them as little help patients. do not have psychiatric backgrounds, but they are doing the best jobs they possibly can in the circumstance. i also want to be very helpful in that area. i do want to go back to one point, because you had talked about having private health care insurance, and one of the main points was medication maybe being treated in five days, but it takes a while for the dedication to the taking effect. in your experience, in the experience you have had with your son, what could you have seen done better or as far as insurance coverage? was there a cut off of days of treatment? was there something that could have been done better?

that is another place where we might be able to help. >> yes, these are wrong to be strong words, but one of my problems i consider the medical community and health care community to almost be in collusion or conspiracy at the adverse for the patient. in my son must situation, it was always, the insurance company is going to prove five days. my son was always well in five days. my son was still seeing invisible policeman wearing mink coats. they said let him go. there's no doubt in my mind that there is and it may be what we have to live with, ok, but certainly the doctors -- and it is in the medical record, it says we're charging him for discharge rate that is from day one. he was not ready. one of the things i mentioned is

the joint accreditation. it only tracks suicide tracks for two days after they are released. i do not see we're tracking what we are doing. my son was not going to take his medication. he told them it is in the i am notatecords going to be taking my medication. as i mentioned, my father-in- law, said visible, most of these men are in trouble with the law. it could be a part of the bonds trade in would be part of your bond. you got to take a drug test to make sure you're not doing illegal drugs, and you are taking medicines. i believe california has a lot like that, where you have to check in every today's trade we have to be something proactive to make sure that even if he does not want to take his medicine, he takes his medicine.

>> thank you. i appreciate having this particular discussion, very, very powerful. >> i want to ask a question here of the panel in some ways, continuing to follow up on the comments and some of our families'. a couple of weeks ago, the question of biomarks. last week there was an article that said they found a connection between the five different severe mental illnesses, they found these on chromosomes' 3 and other parts on chromosome 10. as we're going through this, and back to the purpose of why we're here, try to help identify people early on, to prevent at nimh?, doctors

>> i need you to make sure the that is at the very beginning of trying to provide the genetic architecture for any of these disorders. in some ways, the glass is really half empty because the other part of that was it did not provide a bio marker for any specific disorder. the same genetic markers crossed over all of the disorders that people were looking for. your general point is right on the mark, that in the rest of medicine, where we have had the most progress, is with early detection, intervention. which do not wait for the heart attack before we treat people with heart disease. we make sure the people did not have a heart attack. in the case of brain disorders, behavioral changes is a late event, always a late event. by the time to have a psychotic event, you have had your brain changing for years, for a long time, and we do not know if.

how do we identify that, and one of a typewriter is -- one of the highest priorities is to develop the markers to this at this years before the behavior becomes the issue you have to contend with. what we have learned from cancer and collie ig -- and cardiology is that is what gets the best outcome street he did not wait for a heart attack to try to intervene. >> this is very possible into de's times. there is in an editorial about a baby who might have been cured by a trick 10 years ago we said that was impossible, and with that kind of funding, the kind of scientific rigor that we apply to the aids epidemic and now to the treatment of aids, we can start to think cautious about the fact we could cure aids. while the class maybe half empty, the fact is that between the genetics and between the resting brain state and imaging and the ways we can look at the

brain, we can get to the point where we can start to identify kids, but it will be kids and adults before the first episode. >> i will ask each person here to give a closing one-minute statements as to go through this. i will start with dr. burgess as we're wrapping up. >> i want to ask a follow-up question. i appreciate everyone has put a lot of time in this today, and this has been great. you outline three things for you said these are the cardinal signs of somebody who is going to be in real trouble or cause real trouble to society. i have a list here, and it leaves off the three most notorious mass killings recently, but going back 15 years, there are 25, and they all seem to have a common thread, and the comments that -- threat is treatment with some type of into the present. i cannot raise this to say there

is a nexus, what it strikes me is that every one of these individuals had accessed our mental health system and received a therapy, whether or not it was the right therapy or whether it was enough ordered whether they were taking it, those are questions we are on tap to struggle with, but it does not look like there is a lack of identification of these individuals. in fact, they have all been in front of a psychologist or psychiatrist or school nurse and received prescriptive medicine for their condition. since we know your all indicators, and they are coming to someone in the system, how do we improve that track record? >> i will answer this fast. i would be interested to know what the doctor has to say about what i am about to say, and i think for a time, the psycho

pharmacologic approach to an adolescent who was struggling is a lot harder to untangle the struggle of what is going on and an adolescent. illnesses are just darling. they're going through changes. are we seeing depression, psychosis, and so i lot of describing practices for people who are struggling, for a long time relied presumptively on anti-depressant because they were say, because they would diminish anxiety, diminished agitation. of course, if you give someone a medicine that can cause agitation at a time when they are turbulent and of to have violent urges, that is a pretty lethal cocktail. are you speaking of -- is that history reflective of prescribing practices or the diagnosis itself?

is that reflective of the fact or side effects of medication in someone who has behavioral problems and that the mental health professional is obliged not to say he is personality disorder? you have eight mental health professional who says, that we presume there's something terrible. you have a number of forces to prescribing practices, as long as what happens if you get someone who can agitate and agitates the wrong person at the wrong time? >> the broader point is these are all individuals who have come for the system. >> you have made my point, that people are crawling into the cracks, not all of them, and these are people i met and interviewed and they had people concerned about them. in many cases that loving

families. a person even came by your office. these are people who did not necessarily fall through the cracks, and this gets back to the act discussion we had before. it does not mean that some of encounter anycc system. >> the diagnosis of -- in psychiatric is a clinical -- in psychiatrist is a clinical diagnosis. we did not have that in south africa. it cannot be done in seven minutes. it takes a while but it takes most people to do and about alois and several hours for it you need multiple informants. you have to hear from the school as to what report is, and you want to see a change in behavior. get a big issue we have found as many times you can prescribe the medication and the medication is not taken. in fact, we hear from parents

today who they may have gotten the right diagnosis, the right pill, and yet the patient just is not going to take the pills. as far as ssri's go, came out to the country and the overwhelming people giving them were not psychiatrists, because we had an anti-depressant that did not kill people. the the toddler's took these -- little toddlers took these medications and they had cardiac arrest. there is evidence that once prozac came out the suicide rate in white males went down by 18%. once we put the warning label on and primary care physicians got nervous about it, the suicide rate went up by 18% in that dangerous curve, and white

males are most successful in killing themselves diagnosis is complicated, it takes time, training, and the fact that almost all kids, do not want to take pills. it is an ongoing conversation. >> in terms of -- i do not think your statement should go unchallenged. i'm not sure anybody has good evidence that all of the mass shootings are many of the violent events we are talking about are meant to better chris are linked together. it is like what we were talking about before with respect to the commitments laws. there are people on both sides of this, and there are many people in this community who are against any medication use at all. it is a polarized argument, you're probably safest to try to find yourself in the middle.

>> our people who they have been in front of your profession. >> you talk about this last time, most of the people you found who were most dangerous where people who were taking medicine who stopped come in people who stop their treatment, that there was this group of people who had psychosis, they were very ill, and they stop taking their medicine. am i quoting you correctly? >> that is fair, and your basic point, i would not disagree with. there is an issue that many of these people come because of what you will hear is the real problem is stigma. reality is many of these people have been assessed, and many of them have been prescribed or been evaluated and referred for additional cuts of treatments. that is true for both suicide and homicide. we have an issue with respect to the effectiveness of what we're doing. about the massg

killing street the day that suggests 50% of them are associated with untreated mental illnesses. a broader group also does not necessarily have a severe mental illness. those with a severe mental illness, it is clear in retrospect that they were identified. the question i think is most important is why were they not refer for treatment, and i refer to virginia tech, tucson. loughner was identified with schizophrenia. i would say the same thing with james holmes in all right. that not carried forward? if we did not address that, we will be back in six weeks, because the will could do to happen because we get people not getting into treatment. getting treatment

.an >> i would like to thank you for organizing this hearing. in addition to the early diagnosis and treatment, i do think that all of the evidence suggests we have got to continue to invest in brain research and the example dr. koplewicz gave of the recent tavis news of curing aids in an infant, that as only come about because of a sustained commitment through ryan white and our communities and researchers and the congress in providing the resources to get to that point. and i think it is obvious now we need to do more on brain research, whether alzheimer's because of the growing bigger

boom population and the outrageous says his six of suicide in mental illness. it is a call to action. am glad the obama administration appears to be considering this, but i think the congress can do a great deal working together in a bipartisan way pushing that for parry ward. >> the closing minutes of statements. >> thank you for having this. i have learned so much from these panelists, and i am grateful for you for opening up this dialogue because it is dialogue like this that will reduce stigma and increase access to treatment for millions of american children and their families. i was struck by the repeated comparisons to die be this kid i feel if we can learn to diagnose nettle elm as early and then manage it like it, we will have a lot more stories like mr.

earley's, that they can live happily lives and live as had a productive members of society. >> thank you very much crape and i would like to continue. thank you. you are my hero. we should have more psychologists and psychiatrists in the congress. you are the example for us of bringing something that is essential. it is an essential national conversation. it is not just one hearing or two hearings trading is the fact that every family, some way in america, has been touched, and it is time to speak up for kid'' trip 75% of most of the psychiatric illness occurs before 24, we have to consider annual little health checkups. the only way you can do that is pediatricians have to do better. we have to do a better job in educating new teachers and teachers who are currently

teaching said they do not avoid the weird, the quiet, the socially isolated can and just hope they go away, that they feel there are tools to identify them and to go to the guidance counselor or psychologist to get help before there is some kind of violence. the message should be that these are as real, as common, and treatable as physical ellis, and they deserve the same kind of scientific rigor which means more investment in pediatric neuro science and brain sides and they deserve the same kind of compassion we give when we see someone in a wheelchair and as treatable as difficult ... like aids and like cancer. >> thank you. these are very important hearings. i look forward to the future hearings this committee will conduct. we need to have more research, brain research. we are on the verge of a very exciting discovery and we're not

where we need to be quit this is stigma stops people from getting treatment. these need to the community conversations. a change happens in local committees, and we need to engage it as we have on other ellises' and problems as and have these to be larger community conversations. this hearing is all about access, giving access to treatment, to diagnosed treatment, the support for people with serious battle ellises and their families, and there are a number of issues we need to look at in terms of the law, is particularly state law, that block access. better, or diligence systems. that is attentions to where people did not get lost. only 40% of the people in this country with mental illness have access to treatment. that is stunning, appalling. we do not have a single chord in the system. the fertile care act gives us the opportunity street when the final regulations are leased by

hhs it will give us a signal on the impact of the affordable care act on serious middle of this, because the parity language is written all through the aca. effective treatment does exist, but it is in pockets around the country, and we need to spread that treatment and what is effective to communities across the country. back to my notion of community dialogue pick it is really about early intervention. early engagement trade getting in there early, not having families for years and years bouncing around the system that sometimes is not very welcoming, and we need to take a look at that. thank you. >> closing comments. >> thank you very much for having these hearings trade because hearingsnewtown are reaching a to the point. we have to do something. i would urge you to be very thoughtful and careful about

what actions we take in virginia after the virginia tech shooting there were a flurry of bills. virginia is now one of the leading states in reporting mental illnesses. even people who have shown no danger, people who have shown up and said i need help, i need help, and a hospital. we talked about stigma. when you make lists like this, you are creating says matt. you're saying these people are different, they're dangerous. we have to have less of that. you have to be careful about that. i read 40% of first responders after 9/11 suffered from some form of pt e.s.t.. what about officer who is getting a divorce because he is having eight trouble dealing with that? do we need to start banning him? we are your brothers and sisters, we are patrick kennedy,

we are terry bradshaw, we're not the enemy. >> thank you. >> thank you for having these meetings. my wife and i appreciate opportunity to speak for you. a final thought, my son was a great kid come--loving young man. he looked fabulous. through his demise, and i lay awake at night, every night, thinking about what more could a parent do? i appreciate this committee trying to work toward what more can we do, because the horrors that my son had to go through to worry about people coming to get him from outer space and the site that, that has got to be a painful way to live, and i thank you for this opportunity. i would pick up on the model

of heart disease to say that culture matters. we now have a national imperative against obesity because eating habits have an impact on physical illness. our fascination and indoctrination of a culture of young people with violence to entertainment media that are polluting the culture of this united states has to be dealt with the same way we have dealt with the tobacco industry or the convergence of this poison -- and is a poison -- on the developing minds is the last thing a paranoid individual needs. culture matters. just as it matters in fiscal bonus, and i believe that culture has to be part of the solution here. >> we're obligated to you for this and appreciate it very much. the future belongs to dr. insel and nimh.

he has been the first one to focus on the issue of severe mental ellis. that is where the future is, but we have a large number of severely mentally ill individuals out there who are asking for help. we're not doing a good job of helping them into treatment, and as long as we are failing, we will continue to see auroras, tucsons, newtowns, until something changes, it will absolutely continue. >> that me finish again by thinking that parents for joining us and sharing. i know how difficult this is. it is difficult to listen to, and is incredibly important for us to hear the message you have to send. i think if i were going to summarize, we have heard a lot about about the need of access,

changing access, changing policy, about the need for better science, which would support. bibby most of all, i think the unspoken message here is the need for leadership in this area. he started off by saying we have blinders on, and i cannot help but think of the message that president kennedy gave to congress 50 years ago last month in which he said this neglect has gone on too long. here we are 50 years later, still with blinders on. so let me thank you for beginning this process. let's hope this is a journey. we would like to continue with you as you show your leadership in this area. it certainly is greatly needed. and everything we can do to help you as you make us take our blinders off will be there to serve. >> thank you. i want to thank all the panelists. your stories were very movie,

compassionate, and sadly, they were true. and i think the members and my colleagues who were here also at this very valuable discussion, and we wanted this to be in a different direction. we will do some other hearings targeted to what we could be doing as congress moves forward in this. i think it helped members understand, put a face on metal, and families, understanding the fears, or is, of, frustration. is our obligation to continue pursuing this. it is a public health and public safety issue, and it is within the realm i think of looking at promoting the general welfare of our country. it is also important to know from those who are here, and watching over the years we have developed effective treatments. mental health treatment is not where it was 100 or 50 years ago.

even a lot of changes have taken place in 50 years. we have had major changes in the value of prescriptive medication, but still have a long way to go. we will have to go further with reviewing federal law, state law, which in pair actions we can take, and we will have to look at those. we have a long way to go with research, and we hope we can continue those areas. i want to say and i want to thank the several staff behind- the-scenes working on this. we will continue to work them on this, but it is because we are committed to this and we know it has to be continuous, unwavering, and thoughtful in our approach. i want to make sure we are not doing a knee-jerk reaction to say that we're doing the right thing. the worst we could do is low ourselves back to some state of sleep so we're done for the next decade, and i did not think either side will be satisfied

with that at all. to the parents, thank you. have hope. do not give up. we hear you. thank you very much. [applause] [captions copyright national cable satellite corp. 2013] [captions copyright national cable satellite corp. 2013] >> if you missed any of this hearing, watch it tonight at endicott 30 p.m. eastern on c- span2. >> one of the things that an early american wife was taught to do, she supported her husband's career, usually to entertain. dolley was both socially adept and politically savvy, so she could structure her

entertainments and such a way that she could lobby for her husband under the guise of entertaining. she also thought it was a very important to create a setting in the white house, almost like a stage, for the performance of her husband and the conduct of politics and diplomacy. >> dolly madison, we will follow her journey into the woman that history remembers, the wife of james madison. we will include your phone calls, tonight on c-span and c- span3. >> afterward, a discussion on transportation funding in the united states. here is a prequel. -- sensibletate's

steps will have to be taken. in modern dress rotation system is not a luxury, but an absolutely necessary. we're looking at the challenge of how to move 100 million more people over the next three decades. all while our highways are stretched close to their limits and the overreliance continues to grow. according to last month cost texas report, the annual cost of highway congestion alone across our economy -- will cost our economy over $100 billion a year. close to $3 billion -- 3 billion gallons of fuel, enough fuel to fill the new orleans superdome four times is wasted annually. for the first time the institute measured travel reliability. underscoring the need to provide more transportation alternatives, the study found

that increasing amounts of time have to be set aside to ensure on-time arrival for a high priority freeway trips. in our airports, they're struggling to keep up with moderate demand. about 20% of all flights are delayed. it is a way of confronting high fuel prices and she did to my, they are making significant cutbacks to flights to small and medium-sized cities. in the face of these challenges, rails if disease cannot be ignored, which services targeted pit real can be the most effective and most environmentally friendly mode to move both people and freight. two tracks can carry as many travelers and an hour as 16 lanes of highway hit while the cost of building rail favors --

compares favorably with roads, the right way consumes only 1/3 of the land. >> much more of the federal transit administration administrators talking about finding with public transportation systems tonight after first ladies at 10:30 p.m. eastern on c-span. now a look at prescription drug -- a drug scams, with speakers from the justice department, nih, and the food and drug administration. this is about 50 minutes. >> good morning, everyone. i am an assistant director of the consumer protection branch, and the panel this morning of speakers will address the subject of the risks of dietary

supplements. we would be remiss if not acknowledging the passing of a lenl end in the food, drug and dietary supplement industry, rick blumberg served as deputy chief council for litigation. no one will be as passionate a bout protecting consumers from the dangers of pharmaceuticals, medical devices, rick blumberg protected the country for four decades. on the subject he cared most about, and that is the marketing of health to the public. now, before marketing health to the public, generally speaking, firms and individuals have to get approval from the government before marketing

health insurance to the public, you've got to get licensed. before marketing yourself as a pharmacist or a nurse, or a dentist. you have to get approval. you have to take tests and show that you know what you're talking about before you become a doctor. you have to pass a couple tests to show that you know what you're talking about. before marketing medical devices, before marketing pharmaceuticals to the public, you have to demonstrate that your products are safe and effective. now, why is that? why do you have to get approval before you market these sorts of products and services? maybe it's because health is the most important thing we've got. before you take something or use a service, you want to know that that product or service is tried and true. we don't like to think of ourselves as guinea pigs. unlike other health related

products and services, dietary supplements require no similar approval process. if you don't research the dietary subbles you're taking, then you may be signing up to be a guinea pig. there are plenty of safe dietary supplements out there. but there may be one that presents unnecessary risks to consumers that consumers need to be aware of now, the esteemed group of speakers we have here today will talk about dietary supplements and the potential risks that they pose. our first speaker is dr. paul coates, the director of the office of dietary supplements at the national institutes of health. dr. coates' office evaluates, supports, and conducts research on dietary supplements. i'll introduce the other speakers in turn. but first dr. coates will speak

on the issue of efficacy. that is whether dietary supplements due what -- do what they claim to do. >> thank you very much. it's awfully nice of you to have invited me. i'm not like the other children. i'm not a lawyer. i'm not a regulator. my office has indicated is very much involved in the science of dietary supplements. we work closely with our partner agencies in the government notably the federal trade organization and we're also a major scientific source for the consumers as well and that's where we feel as though we have our best opportunity to inform people about the issues related to supplements. i meetings -- you mentioned

efficacy and what we're concerned about and what we support at the office, efficacy, safety and quality are the three major issues in most everything we do and is consumed under those rubrics. in terms of efficacy, there are many documents in which efficacy is hard to prove. there are some for which it's not difficult because for many of the ingredients in dietary supplements, they're already getting them as part of the food supply. it's part of the reason in a commodity class they are regulated as foods and not as drugs. that doesn't necessarily help the consumer who doesn't care a whole lot whether something is a food, device, a supplement but do want to know whether something works. sometimes to prove the

ingredients in supplements which are then usually given in a level over and above it is not always easy for people to sort out the differences here. but like others, we like to think we provide a good clearing-house before the consumers should be consulting when they're preparing to think about taking dietary supplements. you don't have to. you can walk into a vitamin shop or the local supermarket or the local 7-11 and pick up dietary supplements of many different kinds and you don't need somebody's advice or counsel to do that. i think you should be prepared to have the conversation with

your doctor. will it be effective. is it safe under the conditions of use. those are questions you should always have in mind when thinking about the question to take dietary supplements. and the app is called my dietary supplement and it's available if you go to our website, you can download it easily. and it's really a way we encourage people to use to track their use of dietary supplements. kind of like if you're tracking your physical activity with one of these little things or if you're monitoring your food intake using a food diary is a similar tool to monitor your dietary supplement use or your dietary supplement use for

people whom you're caring for. the other use i think it has is it helps to conduct the conversation with your physician. why do i keep saying that? because we're concerned about not only issues related to efficacy but safety and one of the components of safety is the interaction that might exist between ingredients in dietary supplements and prescription drugs you might be taking under a doctor's care. if you think about it, then probably a good idea to let your doctor know what dietary supplements you're taking. in order to avert potential harms associated with the interactions between some dietary supplement ingredients and some prescription drugs, there are several examples. it's not widespread. this is not the sky is falling. but there are enough examples that we should be alert to the fact that interactions with prescription drugs might be an issue for you to consider.

the third, i mentioned to you is quality and this is an area where other speakers will have something to say about it because it speaks to what's in the bottle. sometimes what's on the label is not in the bottle. and because of f.d.a. actions the last several years, increasingly manufacturers of dietary supplements are being expected to toe the line about quality of products meeting good manufacturing standards and so on and being much more conscious of the need to have on the label what's in the bottle. don't overestimate or underestimate. the point is when those regulations are fully implemented and fully implemented by the industry, that consumers stand a better chance of being confident at

what's on the label is in the bottle. in the meantime, he and others in the government are trying to provide data and useful information to health care providers, to researchers, to consumers. it may help them in gathering that kind of information. i'll stop there and see if you had something you wanted to ask. >> if i'm a consumer, dr. coates, how should i make a decision? how should i know whether i need a dietary supplement or should take a dietary supplement to help my condition if it's an illness or if i'm a perfectly healthy individual, what kinds of considerations should i have and what should i look to to provide guidance? >> these are very important and sort of very practical questions to ask. we can offer some advice to consumers, and the one i've already mentioned is i encourage you to seek advice from professionals. we have information on our website. i emphasize we're not the only

ones who do but our websites provide links to other valuable sources of information, health related information, for example. one of my colleagues, paul thomas in the office, and other colleagues are involved in the development in updating fact sheets which we provide largely for consumers and for health care providers to give them the details as well as the overview information that we might need in trying to understand whether vitamin e in a particular set of circumstances might or might not be valuable. the fact sheets provide references to relevant literature or other information that either consumers or health care providers might find useful. so i really do think that you treat this as a health care intervention. if you pause for a second and realize what i'm telling you, it's an intervention. dietary supplements are biologically active.

they may have consequences. they may have benefits. they may not have benefits for everybody. you might not know, since you're just a simple consumer, as am i, and would probably benefit from gathering a little more information. in the age of the internet, there's a wonderful dichotomy that the blessing is that there's a huge amount of information available on the internet. the curse is, there's a huge amount of information on the internet. and it sometimes is quite difficult to sort out which is which. a good place to start is a trustworthy site to get information like that. i think you should be asking yourself, if you're planning to take supplements why. if you're reasonably healthy, diet conscious, you're getting enough of the nutrients you need from other sources. there seems little reason to be enthusiastic about getting

additional ingredients like these from dietary summent -- supplements. there are factors it will benefit you. but for the most part, are you seeking your nutritional insurance or seeking coverage for's down jalls in a slightly otherwise unhealthy diet? it may not be a value to you to take dietary supplements. i mentioned a little bit about possible safety concerns. they are not widespread when it comes to dietary supplements but are there lurking in the background for some people who may be taking some ingredients at levels that are not recommended by the manufacturer. so at very, very high levels of intake of things like vitamin a, there can be serious toxicity. it might not be difficult to get to high levels of vitamin a, for example, if you're taking it from supplements in -- and you're eating a diet

complete in that ingreed yent. -- ingredient. the level is not huge in vitamin a. but in vitamin b-12, there is a very wide range between what is recommended and what is -- we don't even know what is a toxic level of vitamin b-12. it's hard to identify one. nevertheless, taking very high levels of anything, you should think about why you're doing that. and so that gets to the notion of dose. sometimes it is very valuable to talk with your physician about what might be a recommended intake. he can't give you a prescription for it. she can't tell you that this is the perfect dose for you because we don't really know those pieces of information. but you should be alert to the fact that dose can make a difference. very high doses of some things

can be of a concern. and then the dosing schedule is another thing that you might want to be thinking about. the other piece of advice that i would give you if you're thinking about supplements, don't do it because you think you have a health condition you think you've diagnosed yourself. not a good -- what is that phrase, the doctor who helps himself as a patient has a pretty lousy doctor. the point being that you shouldn't be making these decisions for yourself totally in a vacuum. think about why you're doing this. and i do urge you again not to consider taking dietary subbles with prescribed medications unless you're doing that with the knowledge and possibly the approval of your health care provider. i think the last thing i would comment on here is that safe is not equivalent to natural. so it's clear almost every

dietary supplement ingredient you can find comes have some natural source or another or has been synthesized about what we know about its biology and chemistry. but that doesn't mean it's safe under all conditions. so you need to be aware of all those things. >> dr. coates, one more quick question. you mentioned briefly following dosage labels on the bottles following recommendations of the manufacturers. is it always the case that these recommendations and labels of a manufacturers of dietary supplements are based on science and well-founded research? >> generally speaking, that's the case. the science that underpins some of those recommendations is very stable. and consistent with public health recommendations. sometimes the science that supports dietary supplements

and some of the more exotic ones would fall into this category are ones where we don't have a huge amount of science upon which we can base good recommendations. and often, not always, often that is reflected on the label, that there are plenty of reliable, honest broker manufacturers of dietary supplements. the trouble is you might not know who they are or who they aren't. when buying products. they look like drugs, they come in bottles that are placed not next to but not far away from the drugs that they might be intended to replace. consumers are at a bit of -- can be confused by that. but i would say for the most part, recommended intakes follow dietary reference intakes that are made as recommendations by the

government, canada, u.s. make very much the same kinds of recommendations. >> on the subject of darker side of the industry, let's turn to our second speaker, jeff ebersol. jeff is a special agent and senior operations manager of drugs at the u.s. food and drug administration's office of criminal investigations. jeff began his career with o.c.i. in 2004, serving in the new york field office. investigating a variety of criminal schemes involving f.d.a. regulated products. for the past five years -- 5 1/2 years, jeff has served at o.c.i. headquarters, managing and coordinating various investive areas involving drugs, medical devices, biologics, veterinary medicine and tampering. so, jeff, would you address the issue of the claims made on dietary supplements and fraud that you've seen and your agents have seen? >> sure, absolutely.

good morning, everyone. it's a privilege to be here and i appreciate the invitation from attorney goldberg. just a little bit more about myself. i come from a health care background. i'm a registered pharmacist. and i've been involved in the drug arena in some sort or fashion for over 25 years. my first professional career was as a registered pharmacist working in the retail drugs sector, both as the independent drugstores and the chain drugstores. the biggest thrill that i had as a retail pharmacist was to consult consumers on their medication usage, both prescription or over the counter. also, dietary supplements happen to fall on my lap in consulting with patients on their particular needs. after a stint as a retail pharmacist, i began my career with the f.d.a. on the regulatory side as a consumer safety officer.

my primary role as a consumer safety officer was to inspect f.d.a. regulated facilities, primarily in the area of drugs. it was then i was bit by the law enforcement bug, coming from a law enforcement family, i began my criminal investigative career with the u.s. department of health and human services office of inspector general, office of investigations. there my primary rule was to investigate medical care fraud and then to f.d.a.'s law enforcement arm. as attorney goldberg mentioned, i investigated a variety of cases of criminal activity primarily in the drug arena. for those of you that don't know much about o.c.i., we're a small organization, located underneath the office of regulatory affairs within f.d.a. we are f.d.a.'s law enforcement arm. we conduct a variety of investigations involving all

f.d.i. regulated commodities, including but not limited to dietary supplements. for those of you that don't really know the structure or the framework of f.d.a., basically speaking, there are six backbones to f.d.a. located here in maryland. they're known as centers. each center is responsible for overseeing and regulating particular commodities. those six centers are the center for biologics evaluation and research, the center for veterinary medicine, the center for devices and radiological health, the center for tobacco products, the center for food safety and applied nutrition, and the center for drug evaluation and research. dietary supplements primarily are regulated by the center for food safety and applied nutrition. however, in my line of work in the drug arena, at certain times, which we'll talk about in just a few moments here,

those dietary supplements are under the purview of the center for drugs. the types of criminal investigations that i see involving dietary supplements are twofold. we have tainted dietary supplements and supplements associated with health, fraud scams. these particular investigations that we do in these areas can have potential hazards, both direct hazards meaning the product itself can cause serious injury or harm, including death. or there can be an indirect hazard where the product itself poses no health hazard but consuming it likely will delay treatment or cause a consumer to discontinue appropriate medical treatment. that being said, tainted supplements. unfortunately this is a growing area. and when i checked earlier in the week on f.d.a.'s website where f.d.a. lists every

tainted supplement it has identified, there were 332 different dietary supplements that were identified to contain active pharmaceutical ingredients, also known as a.p.i.'s. i really would like to hammer home the seriousness of this issue because it's very important to f.d.a., and it's a public health issue. i'm going to provide you with a couple examples of these a.p.i.'s that we are finding day in and day out. the first example would be an active pharmaceutical agent called cybutromine which was an active ingredient in an approved f.d.a. predictive drug product for weight loss. a few years back, f.d.a., through information gathered in clinic cal trial data that suggested an increase in risk of cardiovascular system.

f.d.a. noted an increased risk in strokes and heart attacks, for example. f.d.a. requested the manufacturer withdraw this from the u.s. marketplace and it did. however, due to unscrubeluss individuals, criminals, this particular creme cal is making it into dietary supplements you can buy on the internet or in your corner gas station. cybutromine itself in certain individuals can cause a substantial increase in blood pressure and/or pulse. as dr. coates mentioned earlier, there can be interactions with consumers who have particular disease states, in this case, you can only imagine if the individual consumer looking to use weight has a cardiovascular ailment such as congestive heart failure or arrhythmias or

coronary artery disease, active pharmaceutical ingredient that increases blood pressure or pulse rate is not for that consumer and could cause serious injury or even death. another example would be in the male enhancement area. countless numbers of times the f.d.a. has identified active pharmaceutical ingredients already found in prescription drugs approved here in the u.s. in dietary supplements for erectile dysfunction. these a.p.i.'s, also known as sadenofil and sadalofil come with their own precautions and are contra indicated for use in individuals consuming organic nitrates. organic nitrates commonly used by heart patients to treat angina or chest pain. say, for example, you can imagine a consumer visiting

with his physician and requesting an erectile dysfunction prescription medication, but based upon the current medication that that patient is taking, for example, nitrates, the doctor decided against it. that consumer then goes to what they believe is the natural dietary supplement arena and decides to purchase a suspected product or a product that may contain one of these a.p.i.'s. you can see where the danger can occur. these two products, along with organic nitrates, can significantly lower blood pressure to the point of a dangerous situation. and if containing active pharmaceutical ingredients which are found in prescription drugs is dangerous enough, the criminals have found other ways of getting other vitamins into dietary supplements. and the f.d.a. has found analogs are sadinofil and

sadinofil in the supplements, an analog is a chemical or drug that is chemical in structure as these approved drugs, however, slightly different. and the criminals suspecting the product will give the same therapeutic effect as the approved prescription drugs. however, as you can tell, some of these analogs may not have actually been studied in clinical trials, therefore we're actually playing in the wild west. another example of drugs found in dietary supplements is another prescription -- or actually contained three different active pharmaceutical ingredients, those were a cortico steroid known as

dethametrozon and dothenic and a muscle relaxant called methocarbonal and we have three ingredients in oneover the counter products and depending on the disease states the consumer has and what types of medications whether they are prescription or over the counter they're taking, this is a threesome problem now because you have three active pharmaceutical ingredients. not to belabor the point, but some of the other drugs, a.p.i.'s that f.d.a. has found in dietary supplements include blood pressure lowering medication such as terasosin, luke diuretics such as bumetanides, designer steroids, and i just found out and again, learning every day, phenaton,

used in seizures, all found in dietary supplements to date. and another type of crime that i get involved to in the drug arena is health fraud scams, the snake oilsman scams. let me read to you the definition of health fraud. it is the deceptive promotion advertisement or sale of products as being effective to diagnose, prevent, cure, treat, or mitigate disease, or to provide a beneficial effect on health but which have not been scientifically proven safe and effective for such purposes. and i think that's particularly where we get into the drug arena when a dietary supplement, regulated as a food product, tends to make statements that diagnose, prevent, cure, treat, or mitigate disease. examples that we see in this arena are treatment statements

involving chronic, serious diseases such as cancer, arthritis, diabetes, and sexually transmitted diseases, including but not limited to h.i.v. you can only imagine what individuals -- what can happen to both the consumer as well as other individuals associated with the consumer when taking products that give false hope. unfortunately, these criminals that are out there providing these type of dietary supplements with treatments and cures that never have been discussedied, they feet on the vulnerable public, especially in times of panic. for example, during the bird flu panics. what type of enforcement

fda has both regulatory options and criminal options. from regulatory standpoint, fda can issue warning letters, they have administrative authorities where they can institute the unemployed or refusal -- can institute a refusal. a product can be stopped at the border. some regulatory civil judicial actions, seizures and injunctions. fda can investigate criminally and a lot of times our criminal investigations move parallel

with civil action. what kind of education can i provide to you today? look for the red flags. look for statements that say treat serious incurable diseases. look for other catch phrases. scientific breakthroughs, secret formulas and my favorite, they do not want you to know about it. check with your physician or your pharmacist prior to taking dietary supplements and be sure to tell your physician or your pharmacist if you are already taking a dietary supplement. visit the fda website, there is a lot of information regarding dietary supplements, especially

when it comes to the scams out there. it also lists a lot of the product names that are associated with the scams and are tainted. consumers need to do their due diligence in this area. also, be aware of where you are purchasing products. the internet is like the wild west. be careful and do your searching wisely. >> we have heard a lot this morning about the various challenges of law enforcement to combat scams. what are some of the difficulties and obstacles that you have seen in combating the types of scams in the identified? >> it has been mentioned this morning, it is a global problem. any time we're trying to conduct a criminal investigation were the criminals are located overseas, it makes us that much more difficult to run the

investigation. we rely on collaborating with other law-enforcement agencies and we rely on collaborating with other law-enforcement and regulatory components of foreign governments. in addition, the fda is a public health and safety organization. to conduct a criminal investigation involving a public health and safety matter where the public needs to be warned, it makes it difficult at times to conduct a criminal investigation because once an alert goes out, notifying the public of another tainted supplement the hatch is -- hat is tipped. there may be consumers who are saying to themselves, i have a disease, and i need something that is going to cure me. they've gone to their physician, gone to different sources and they are lacking something that is going to cure

their ailment and want to say, i will not listen to some government bureaucrat to is telling me i should not take this product because it might cure might otherwise incurable disease. why shouldn't i go on the internet? why shouldn't i go someplace else and look for this cure? >> that is a difficult question because i have been the bureaucrats. the only thing i can say to that is consumers need to do their research. at the end of the day, you need to trust your physician and a pharmacist. >> i want to turn to our third speaker.

patrick is a trial attorney at the department of justice. he has been in that position since september 2009. prior to that, he was a clerk on the u.s. court of appeals for the second circuit. his is going to address a specific subject, the subject of manufacturing practices. he will talk about it globally. >> i'm a trial attorney in the consumer protection branch in the department of justice. we handle cases on behalf of the fda. i would like to talk about the rules under applicable to dietary supplement manufacturing practices. up until around a few years ago, the only rules that are applicable were the same rules that were applicable to the production facilities. those for the general -- in the latter part of the 2000's, the

fda committed to regulations because they identified the need and the dietary supplement industry. those new rules are beneficial in 2007 and went into effect in 2008 and 2009 and 2010. compliance with those new rules has been very difficult challenge for many manufacturers. an fda audit in 2012, the inspections that have been conducted, fda found that in about half of the inspections, they had identified manufacturing practices. fda cannot inspect even half of the facilities that are out there. it has to inspect cosmetic manufacturers. it is impossible for the fda to inspect all the dietary

supplement manufacturers out there. half of the supplement manufacturers are not even getting to the baseline of being able to ensure that their products are what they say they are. we've been talking -- i want to give a specific example of when things can go wrong. i will talk about the case i litigated. i brought a little show and tell today. i want to talk about a firm in new jersey that i litigated against. quality formulation laboratories was not a fly by night company. it was a large dietary supplement manufacturer. it had been around for over 20 years at the time of the lawsuits. it made a lot of products, but the bulk of the products were worked out supplements. -- work-out supplements.

these are protein powders. qfl made milk protein and egg protein powders that were sold the about the country. most of the products for sold as third-party brands. there were labeled as other company brands. he would have no idea where they were manufactured. they also sell products under their own brand name which was american sports nutrition. at the time, qfl had a distribution deal worked out

with costco or its product was going to almost every costco warehouse in the united states. that deal was lucrative. it was worth about $10 million upfront. there are plenty of companies out there trying to do the right thing. in came on to fda's radar 2007. there was a consumer in the pacific northwest. he was a college student and he had a lifelong severe milk allergy. his parents bought him a top of protein powder that was supposed to be fed protein powder. it was labeled with a different companies' brand.

he took half a scoop of fat and protein powder and then a very short time, his heart stopped, his throat had swollen shut. his roommate got him to the hospital. his parents complained to fda and told them about the situation. fda found that this product had been manufactured at the facility. in early 2007, the investigators found a number of issues that were of some concern. qfl did not have controls over cross contamination. what that means is they would produce and halogen containing product followed by a product that was supposed to -- without making sure that none of the

prior allergen admitted to the second product. one would be inadequate cleaning of the production equipment, another would be because it is a powder substance. there was another problem that fda observed, inadequate formulation records so that it was not clear exactly what ingredients and how much had gone into what product. there also labeling issues. fda took a bunch of samples and noticed that some of the labels did not reflect what was in the product. fda try to work with the company to bring the company into compliance. the agency pursued through

letters and other submissions. fda went back any issues of cross contamination -- fda surmised that the issues were by the consumer had been issued in the pacific northwest. fda continued to try to work with the company. when they went back to the company in 2008, the inspector saw something that was truly extraordinary. they found an active rodent infestation. there were rats running for the facility. there were bags of raw ingredients that had been gnawed through by rodents. in addition to that, the investigators, the residue was all over the place of the protein powder.

this time, there were hundreds of mouse footprints in the residue. most troubling, the investigators found half of a rat that had been cut in half and was sitting next to this group that was used to scoop the powder into the blenders. that was a -- there was a bright red blood coming out of it. attorneys from -- the other thing that happened was there were some indications that the products had been intentionally -- milk protein is cheaper than egg protein. attorneys from my office filed lawsuits against qfl on july 1, 2009, seeking to shut the

company down. costco dropped the products and returned all to the firm. that was about a million dollars for the product. qfl chose to litigate the case for about nine months, even with the evidence that we had. eventually, the firm agreed. it requires the firm to do an upfront shut down. the firm is supposed to stop all operations and then provide a path forward is which the firm can hire experts and it's a new fda inspection and a half to get written authorization. that is the kind -- now we're up to march 2010. in march 2010, the district of new jersey court entered a consent agreement and in most cases, that would end the case. that did not and the case. the consent decree, and shut them down and forbid them from receiving manufacturing, caring, packing, distributing food at their plant located in

paterson, new jersey, or any other location, or any new location. this case was just getting started. shortly after that, the fda got a tip that they had simply just moved its operation somewhere else. they work every day instructing their employees to arrive at their present facility and

putting those employees into vans and driving them a certain distance to an undisclosed location and from there, they were putting powder into tubs and sending it out to consumers. fda's office of criminal investigation conducted a criminal search warrant of that new location on may 13 of 2010. that new location was a 30 miles north of northern new jersey. when they got there, they found employees sitting around tables. they saw a large operation that was hand packing. at the exact same time the search warrant was being executed, inspectors from new jersey field office went to the qfl facility to conduct an inspection. they asked the owner for

records relating to qfl. the owner of the firm and his son -- the investigators say we know about the other place. and then there were records offered 100 pages of records. the inspector found some other products that have been shipped to that facility during the time it was supposed to be doing nothing at all. in july of 2010, we petition the court in new jersey told them in criminal contempt. the court accepted our petition and started criminal proceedings against the companies and individuals. great number of extraordinary

other things that happens. in january of 2011, which was a month before we were supposed to go to trial, we recalling around for various witnesses to see if you could find some other companies who had gotten products. we call the company, performance food centers, we asked them if they'd gotten product from qfl. and they said, we're supposed to pick up a shipment from then tomorrow. that was interesting. the oci agents conducted an undercover operation where we put an agent on performance food centers track and videotaped them distributing product of the paterson, new jersey, where house. this was a government exhibit 805. ultimately, the defendants went to trial in may of 2011 in

trenton, new jersey. there were convicted on all of the charges. the companies were fined a total of a million dollars. the honor got a 40-month prison sentence. when they were sentenced in november of 2011, the judge said the criminal contempt -- i do have to say they appealed their convictions and in january of 2013, the court of appeals in philadelphia confirmed their convictions. we're still litigating this case right now. it is likely that they will ask the supreme court to review their convictions.

>> patrick, for those in the audience and those who may be watching on television, they should be horrified by some of the things that he said. when consumers are researching their dietary supplements and figuring out whether they are safe or have been manufactured according to best practices, what can i do -- what other steps can and do to find out whether the dietary supplements their taking have been manufactured as they should be? >> one of the most important things that a person can do it is a research online. possible other complaints against the company's better making these dietary supplements. the fda website is very important resource in terms of companies that fda has taken regulatory action against. we had a large database of warning letters. it is rare that for a case to

get to our office, fda issues many more warning letters to advise companies that they are engaged in practices that unsafe for consumers. >> i want to thank the panelists very much. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] >> of our coverage tomorrow, at a hearing on world wide security threat. witnesses include director of national intelligence. this is live at 10:00 a.m. eastern on our companion network c-span3. all five commissioners testified in an oversight hearing by the senate commerce committee. you have that live it to 40 5:00 p.m. eastern.

>> tomorrow paul ryan will releases 10-year federal budget proposal. we will bring you live coverage at 10:30 a.m. eastern here on c- span. >> we cannot look back years from now and wonder why we do nothing in the face of real threats to our security and economy. that is why are there today i sign an executive order that will strengthen this by information sharing in developing standards to protect our national security, our jobs, and privacy. >> there are things that need to be done with an executive order. some things can only be dealt with legislation. i wish the president has put as much effort into getting some legislation passed and then come out with the executive order rather than the other way around. >> it has been around for a long

time. we finished talking about it. we finished wondering what is going to happen because things are happening every single day. they are destroying our intellectual property. people are very casual about it. we are not. we cannot afford to be. >> a look at the executive order was senator jay rockefeller and maxtor very tonight at 8:00 eastern on c-span2. >> some of the things that an early american life was taught to do, she supported her husband's career usually entertaining. she was one of those socially adept and politically savvy people. she is structure this in a way that she could lobby under the

guise of entertaining. she also thought it was very important to create a setting in the white house, almost like a stage for the performance of her husband. >> we will folly dolly madison from a widow to first one in. >> not a discussion about women running for elected office. this is part of a woman in politics symposium hosted by southern methodist university. it is just over 1.9 hours. and 1.5 hours. -- it is just over 1.5 hours.

>> the weather in d.c., i thought i was kidding a break. i had to wear my coat this morning. this weekend i was looking on the internet. i got a much better title. ask not what you can do for women but what women can do for you. eight years ago i found myself sitting next to the mayor of salt lake city. he was a nice guy. we started to talk about what to do for living. i told him i lit a -- i were to encourage young women and girls to run for political office. why? in my world the question of why we need more women is not a question. they just ask how do we get more women there. he said i have two daughters. i have a wife. i have a mother. i know what women need.

what can women do in office that i cannot do? it was an interesting question. he had no idea what it can of worms he was opening. i really believe that no matter how well intentioned a man in office is his decisions will never be as strong as if he had men and women legislating together. i am happy to say in the years since i started doing this work the world has really come around to this idea. the idea that we need to add women to leadership not because it is there are the right thing to do but because adding more women to leadership is going to make stronger decisions in a better world for all of us. when i talk to groups, the best news comes from the business world. there are two studies that came out a few years ago. i think there are really

relevant and exciting. i'm going to read this you do not miss the new ones. what they thought was that fortune 500 companies with three or more women on the board gain a significant performance advantage over those with the fewest. there were 73% return on sales, 83 serve on equity and 112% of invested capital. at women, and make more money. -- add women, make more money. the companies with the highs a lot of women showed the best performance. >> this research has been taken so seriously that when i was in belgium speaking to the people on the european parliament i learned about how they are talking about having 400 women

on every corporate board. it is huge. this is something that could change the way business was done. would this also hold true for politics? of course it would hold true for politics. adding women to corporate boards, it is that that women have some magic money-making ability. it is that they add diversity in diversity is the key. i want to reduce and think again. there was a recurrence that said research is demonstrated groups with greater diversity to and to perform better than homogeneous went even if the homogeneous groups are more capable. think about that. that is fascinating. when people say we cannot have coaches because you do not get the best women, at this report says if you have a diversity that well outperform even people

who are smarter and more capable on paper. diversity absolutely matters if you want to get the best results. i speak to a lot of groups of very young women. i ask what do you think, do you have diversity of politics. i am telling you. they all say yes. of course we do. we have hillary clinton. she ran for president. she is secretary of state. we see her every day. the have sarah palin that was all over the place. michele bachmann. these are big names. we have nancy pelosi running the house. we have record gains in the senate this year. everyone is talking about how this is such an exciting collection. now we have 20 senators. we have an entire state with an all female obligation.

women are everywhere in politics. i think that is what most people think. everybody in this room knows it is not even the slightest bit true. women hold 18% of the seats in congress. we have been stuck at 23% forever. there is no movement. we still have nine government -- 9 governors. all of this place is the u.s. at about 95th in the world in terms of our female political representation. that is another one that i will ask the students. were you think we rank in the world? and as this to domestic groups and abroad. where do you think the u.s. ranked? in forming the restaurants will say we're no. 1.

many of international students think the same even when their countries are much much higher. secretary clinton has said frequently the unfinished business of the 21st century is the empowerment of women and girls. it is really cute she is saying that. this drawing attention to the fact that we're using half of our brain power. we are using half of our talent pool right now appear adding more women is about what is best ever body. the springing back to my organization. i want to tell you a little bit about the work i do to get more women into leadership. we have a very unique approach

to this age-old problem. 12 years ago i was working in a law firm. i was running a political action committee on the side. the name of it is the women under 40 political action committee. professor palmer was on the board. we tried to change this name. whenever got anywhere. the mission is to elect women under 40 to congress. in that demographic women under 40 running for congress, that is an incredibly a typical candidate. did these women or not old. there were not mail. many times they were not white. if you look at our congress, that is what you see. because the or not are typical candidates they had trouble getting traditional donor support. they loved wolf pack because you're the first people to give them a check. we're the first people to say i

believe in me as a candidates. i think you can do this. they were incredibly great candidates to back. while other people saw the woman with long hair and high heels who looks like a granddaughter, we saw a political candidate. we were often really write about how great these women are going to be. in the 12 years that will pack is been around we have collected some of the people who are the big names in congress. debbie watson and scholls started out at age 33. -- devi wasserman scholls started out at age 33. she is backing the rounds trying to get money and establish herself as a viable candidates. the meeting she went to she had our newborn baby with her. i just loved. she was breast-feeding. she lived in florida. she had to bring this baby with her.

cathy rodgers is a republican young woman from washington state. we helped elect her a while ago. she was 33. she was chosen as one of the top picks for gop leadership. she is going places. center perce in july brand is one of ours. -- senator kirsten gillibrand is one of our. and gabrielle giffords to everyone knows. she brings so much that to congress. she is very young. she's been in politics and she was 21. we have all of these non- traditional candidates that not only bring diversity of gender

but also diversity of experience. they bring different things to congress. i will tell you what this problem is. the problem is that if we have all the money in the world, and au pair were to come in and say i love you -- loveoprah were to come in and say i'm going to be a million dollars, we literally would not have that candidates to give the money to. that is a crazy problem. it is because the number of women under 40 who run for congress is teeny tiny. some have 50 great candidates. and really good years you have five candidates. -- on a really good years we would have five candidates appeared as but the board and have. half of them continue to run a wolf pack. the rest of us came to running

start. want to grow this pipeline of women who would become candidates. nobody was really talking to young women about running for office. we decided to not work with candidates which most bridger trying to get women into politics. we decided to not even work with women. we started with girls. people thought we were absolutely crazy. we started with high school girls. some of them were 14. that is a lot of years until you can run for congress. running start is a very long game. do reason we didn it has to with dr. richard fox. they did research that he will tell you about. i dare not barely even mention it. you have the real expert right here. his research basically says that

women do not feel qualified to run for office as men do. we took that and thought that is just horrible. we were surrounded by all of these bright wonderful women. women have the same qualifications as men do not feel as qualified to run for office. we need to change that. they work with women when they're still thinking about what they were and what they were capable of. work at them at a point or you could convince them that they do have what it takes. they are qualified. he can give them the skills they need in order to really feel confident about their leadership ability. he talked to a high school girl and you tell her if you see hillary clinton how could i ever the hillary clinton? how could i get up to the top ranks? it is not rocket science. there is not one magic formula.

it is all about hard work and learning the skills. we get these young girls to think of themselves as candidates. we have been around since 2007. it is still a baby organization. we started with 20 girls from could 2007. as a 2013 we have trained 7000 young women around the country. that is another story about how you're able to do so much. -- how we read able to do so much. the most exciting thing is we started i knew it was a good idea to train girls. and you it made sense and that it really could make a real difference for -- i knew it made sense and that it could really make a difference. i have no idea i could convince the girls. the program is rigorous. and makes these girls do things they do not want to do. public speaking is just excruciating for all of us.

been put on camera. we bring in reporters and interview them on camera. they hate it. that is worst in public speaking. the meat into fund-raising. the great news is we started out with 20. the next year they told their friends. we have to re-enter girls applied to our program. -- we had 300 girls apply to our program. after the 2008 election will when we had all of these amazing people running for office or politics is call for the first time and so long, we started to accept applications for our 2009 summer program after the election. at this point we were working out in my attic. we did not have much money. the first week we got 1000 applications in the mail. we made a stupid mistake of opening them in november and posting them until february.

by february will be closed if we had received 30,000 applications. the great thing is that we really do see results. the girls that come to our program right is e-mails all the time. i have to redo a quick one. before attending running start would never occur to me to run for office. to my surprise i enjoyed politics and the opportunity it gives me to make a difference. a plan to run for office in the near future. that is what we hear. i was in israel speaking to this group of young women. i will asking women raise your hand, let me know how many of you think it is a good idea if there were more women in politics.

they all raised their hands. and never had a group that does not. then i followed it up with the question, not tell me who is going to run. which you are going to run? one girl raised her hands. why are you not going to run i asked? they said i am a behind-the- scenes person. shelley would do a fabulous job. she is really good at all of this stuff but i will help her campaign. initially is like not mean. let's talk to barbara. -- initially, shelley is like, not me. let's talk to barbara. they feel like they have real spa responsibility to step up -- real responsibility to step up. what i want to do is to take the

girls to apply to our program. they are such amazing girls. they're going to bring some is to politics when they get there. the reason they want to be in politics is not because they want to be powerful people. the want to because they are coming for regina from communities or schools where they see real problems and they do not see anything -- because they're coming from communities or schools where they see real problems and nobody doing anything to fix it. i am incredibly encouraged every day when i work with these young women that they are stepping out of the sidelines. they're refusing a rising -- realizing that they have a responsibility to get up there and run.

>> good morning. i am more the dark beater -- vader of politics. thank you so much for inviting me. my title is why women are not running for office. i am a typical social scientist. i'm going to give you a world wind of statistics. i will go over a lot of them quickly. ask me more about these later if you have questions. if you look at the major elected positions in the united states and out mayors occupy between 75% and 95% -- minute occupied between 75% and 95%.

the percentage of women in our legislature, we are 90 fit. maybe we have gone up. we are 95th in the world. there's a big difference between the parties here, democrats and republicans. if you look at the u.s. house, 31% of democrats in the senate are women but only 9% a republican. in the house the numbers are similar. if you draft this out, at the democrats have slow and steady gains among women. the republicans have been flat lining. what is going on? researchers have looked at a bunch of explanations to try to explain why women are so slow to

move into office. there must be widespread discrimination, right/ ? although individual women will say they felt discriminated by a voter or a media source, there is no evidence of broad discrimination. when they run for office they raise as much money as their male counterparts. they're just as likely to win and get vote shares. another explanation is electoral structures. it is hard to run for office. we have very candidates entered politics. if you want to run for congress to have to build your own campaign organization. he might be a democrat or republican. you have to be very entrepreneurial and raise your own money. there's something to that

explanation. these of it that the people run for office. some of the key professions are those of not been in at the highest level. what we have done is we have spent the last few years serving men and women will in the professions that proceed a career in politicians. the jobs are law, business, education, or political at activists. we see if men and women are equally ambitious and running for office. in 2001 we interviewed a sample survey of almost 3700. we went back and contacted over 2007 years later. 200 seven years later.

we just surveyed a national sample of high school and college students to see if they have future potential interest in running for office. we literally got those a month ago. we spent the last 12 years examining men and women levels of ambitions of running for office. what have we found? in 2001 when as some of their ever considered running for office, people in their mid- 40's, a generally successful. there's a 16. gap between women and men. these big league qualified women and men. -- equally qualified women and men. then went back to 2011. no change in woman saying they

are running for office. this will present the from our high school and college students. the gap seems to be fairly static. it is not changing dramatically. the republicans cannot want to run and democratic women do. not really. there is a 20. gap among republican women with republican men. it is not about party. if you get to the pool of candidates, party is not the

explanation. what are the explanations? p.s. 7 explanations. and when to go through them quickly. -- i have seven explanations. i will go through them quickly. women are more likely to percy'proceed by is and as highy competitive. there is a perception that is very competitive. there is a perception there will be biased against them. none of those much a particular true. -- may be particularly true. that perception of competition is one reason women are less likely to say they will run for office. the as women about the key

activities, how you feel about soliciting campaign contributions are going door-to- door with the constituents? women are more likely to appeafa willingness to engage. maybe these things lead to breaking down the doors. there were some very high- profile instances. instead of these things breaking

down barriers, we will discourage them. if you're sitting there watching this you are a 35 year-old law partner of things it looks less appealing. we found this in 2011. these highly qualified women perceive themselves as less qualified than their male counterparts. they are twice as likely to say they are not at all qualified to run for office. the good to very qualified there is a huge gap between men and women. you did not run for office unless you think you are good.

these are it self assessments. we ask people whether they thought they were confident or competitive. hillary clinton is a you have to have a thick skin. that is what we've done repeatedly that women say you do not have. been recruited by real political people makes running for political of israel.

women are less likely to have those suggestions made to them. it is even sure about your colleagues at work. someone from your church. it is across the board. they are doing a vast majority of household responsibilities. there are six times more likely than their male counterpart to say they are responsible. they are 10 times more likely to say i am responsible for the majority or all of the child care. it makes it far more complicated to run for office for women.

women of all professions are less likely than their male counterparts, and the gender gaps in every category. the two biggest reasons are that are not recruited and they do not feel qualified. women remain the primary caretakers of the home and children. those are more complicated considerations. where to go from here? the one thing is recruitment matters. that is one thing that equalizes things. recruiting closes that gap if you get to enough women and suggest them. spread awareness about women's electoral success.

there is broad scale relief that there harder to run. it is not harder to get a vote or wind. so women redid many women perceive it is more difficult to do that. in may feel that way. i think i'm going to cut it off right there. thank you very much. >> i am going to start to tell you why it matters once women get elected to office. what i'm going to talk about is a connection between electing women to office and the representation of women issues

in the state legislatures which is where i specialize. the thing that has led me to this question was i started doing research on this area. i came across a big puzzle which we have done all of this research on women in politics and whether women "make a difference." there's a fundamental connection between electing women to office and seeing the policies in the state legislature. it is really variable. it depends somewhat kind of legislature you are in. we cannot get this consisting connection between the presence of women and these outcomes without having xyz variables in between. parties or often ignored at the highest of proving women made a difference. that was the important part of the research. we know and docilely -- we no

antidote to lead the parties matter -- antidoteally that parties matter. what i'm going to talk about is what partisanship can mean, particularly to different ways we see partisanship affect how women represent women. by have turned in the short-term and long-term ways. and going to show you some evidence from the state legislature. short-term forces are those forces inside of the legislative body. particularly to things. whatever party is in charge really controls the agenda process. if anybody has been in the legislature, this is not a shock. it is something that we do not

necessarily think of as having so much control. especially when they are polarized. they are very different. there are very consistent it that they really can have a show cold. that means if you're in the minority party and you want to introduce your women's issues bill is going nowhere. why is this short-term tax begin change very quickly. the loudoun -- long-term forces are harder to put our fingers on. we know the party has changed a lot since the 1960's. people have turned them realignment depending on how you see it. it boils down to something very basic. parties have picked of different types of women issues in different types of women have identified the party's over time.

the era have legislation that many considered in the late '70s became a partisan issue over time. it asked congress with flying colors. but 1982 it was extremely partisan. more women started running for office. these forces are little longer over time. they're harder to put our fingers on. i am going to show you some evidence from a couple of studies that i have done. some of this research work done for quite a