recommending those. >> thank you, dr. hodes. our former surgeon general brought up an important issue in this past sunday's washington post. he noted that african-americans are two to three times more likely to develop alzheimer's disease than non-hispanic whites, but they participate in clinical trials at far lower rates than other ethnic groups. we all know the shameful history of the tuskegee experiments. so the community's level of distrust is natural. is there anything nih can do to inspire more participation by minorities in these research endeavors? >> yes. i read that editorial. it was indeed compelling, moving, a reminder of how important it is to focus on health disparities. that's certainly an issue for alzheimer's disease. i'll say one thing and ask dr. hodes to say a bit more about what we're doing now. one of the greatest opportunities in terms of

encouraging minority participation in clinical trials is if the researchers themselves represent the diversity of our country. you can see that over and over again. this is a strong reason why we need to focus on improving and expanding our own work force. we have a number of new programs that are quite bold. this is a high personal priority for me, to try to see if we could do a better job of recruiting and retaining and mentoring it and supporting individuals from underrepresented groups in order to populate those clinical trial work forces with people who represent our country and would therefore be perhaps more welcoming to the groups that tentatively now are unsure if they want to join up or not. dr. hodes can tell you what we're already doing in terms of alzheimer's trials. all of our centers are engaged in that. >> we are indeed making great efforts to correct what you point out, an underrepresentation of minorities in clinical studies. all the alzheimer's disease

research centers have outreach cores. some of them, for example one in the city of chicago, happens to serve an area where some 90% of individuals are african-american. but in all cases, these outreaches are intended to maximize recruitment. we're working actively with cdc and former aoa, acl, the partners in an exercise that's called roar, which overall is attempting to increase the recruitment of older adults into clinical studies and trials with a very concrete emphasis on minorities. we have a program of centers that are particularly focused on minority ageing research and developing methods for enhancing the right liaison in communication with minority communities to increase their level of comfort, confidence, and stability as a means to recruiting them to clinical research. >> i appreciate that. i hope you'll do it very aggressively. the chair of our distinguished appropriations committee and a distinguished member of this

subcommittee was the first person to bring to this subcommittee's attention a long time ago the disparity in women in terms of research trials at nih. so i hope that we've taken a lesson from that and really become much more aggressive in including these minorities in these clinical trials. so i thank you very much. i'll turn to senator moran. >> mr. chairman, thank you. dr. collins, thank you for your testimony. we're honored to have you here. you indicated in your testimony several developments promising opportunities in this area of research in alzheimer's. let me ask you to put this in my view and again kind of a chart. where are we five years ago compared to today? are the increases in knowledge -- are they growing at a faster rate all the time? how does this look in the progress that's being made or not being made?

>> well, i love the question. thank you, senator. i think if you go back ten years, people working in alzheimer's disease were pretty darn frustrated. the ability to understand what are the molecular pathways that have gone awry in the brain to cause this condition was limited. our tools, our technologies were not very good at making that kind of comprehensive assessment. our clinical trials largely based upon hunches were turning out badly. we had a limited number of ideas about where to go next. in my view, and i've been at nih for 20 years, the last five years have been really quite a dramatic change in that environment. we have learned through a variety of approaches things that we probably didn't expect would be now in front of us this soon. for instance, what are the hereditary factors involved in this disease? it clearly runs in families. we have gone from knowing sort of one risk factor for the late

onset type of alzheimer's disease to now depending on who you ask 19 or 20 that we have. that number is growing. in fact, it will be growing rapidly this coming year in part because of the fy-'14 appropriation because we're expanding our ability to do that kind of genetic analysis. we have gone from understanding that amyloid was a player to understanding a lot more about tau and to be able to look at pathways in the brain that are really quite complex and point to other sort of nodes in those pathways that are really important and might be drugable. we have gone from having a few clinical trials focused largely on advanced cases of alzheimer's to what you heard about today, where we now, because we can make the prediction about high risk, start the treatment earlier. just like people have often said, and i'll say it now, if you try to test stattens by waiting until somebody had far advanced congestive heart failure, you would assume they don't work because you're too

late. well, likewise, if we want to have a successful treatment for alzheimer's, start while there's still lots of brain cells and see if you can protect them. so there's a sense in this community of momentum, and it's coming from imaging and genomics and clinical studies and biochemistry and behavior studies. everything sort of coalescing here. so it is the right moment to really try to provide that extra push. that's why what's happened in fy-'14 could not come at a better time. it's momentum we hope can be sustain sustained. as you know, this kind of science is not a 100-yard dash. we're engaged in a marathon. the other thing about that trajectory you're asking about, it's on an upward course. i guarantee it won't be a smooth and steady one. we'll have big moments of realization that we've learned something we didn't expect. then we'll have big disappointments where a clinical trial that looked really good somehow didn't work. it's going to be jumping around a bit, but it's headed upward. and it is my hope and my

commitment that with your help and with the amazing talent that we have in our u.s. and worldwide scientific work force we are going to tackle and win this disease battle. >> i appreciate that answer. again, you use the word hope. i always use the word hope when it comes to medical research. what you're suggesting is that there are reasons to be hopeful. >> yes, i totally support that statement 100%. >> let me ask about a particular set of people that we care greatly about. scientists have discovered that people with downs syndrome are at increased risk for developing alzheimer's disease by the age of 40. as i understand, almost everyone with down syndrome has beta amyloid deposits in their brain. yet, only about half of those people ever develop dementia. even if do they do, they develop plaque. so my question is, is nih

exploring the question of why 50% have a different outcome, a different result than the other 50%? >> a wonderful question, senator. i just spoke this morning to the director of the child health institute about this very issue. this is another opportunity, perhaps, to try to understand this disease in a group that has such a high risk, both in terms of understanding why some development and some do not. what are the other modifiers? but also, this could be a great opportunity to try new therapeutics at the earliest stage, before the dementia has begun to actually take its toll on function. there was a workshop which was held specifically on this topic about alzheimer's and other dementias in down syndrome kids. there's a challenge here in terms of things like the informed consent. we would want to do whatever we were doing in a way that's absolutely recognizing the difference in carrying out research in individuals who may themselves not be in the best

position to give consent. we will depend on their parents. but there is intense interest on this. i would predict in the course of the next year or two there will be new initiatives focused on that very special population to see what we can learn and how we can help. >> thank you. i have senator mikulski. >> thank you very much, mr. chairman. thank you and also ranking member moran for organizing this hearing on this topic of alzheimer's. it is very special to me because my own very dear father died of the consequences of alzheimer's now 25 years ago. so i've been at this a long time. and for many of us, we've had it either in our own families or people near and dear to us, and of course there are marquee names that talk about this.

this is reagan, justice sandra day o'connor and others. really, it's -- this is an equal opportunity epidemic. it hits people at all income levels and whether you are the president of the united states like president reagan or a small grocer businessman like my father or like the men and women out here in the audience who wear the purple sash. they know this tremendous impact on family life, the family budget, and ultimately on our budget. so i think we all do need a sense of urgency about how we can come to grips with this and accelerate what we want to do. i want to welcome the witnesses here. dr. collins, dr. landus, dr. hodes. i was just at nih on monday. i'm so proud of the fact it's in maryland. i call it the national institutes of hope. the national institutes of hope.

and i think that's what brings all the men and women and family members here. my question, because we've been able to do something in this year's appropriations, and i might add every single senator up here is also a member of the appropriations committee. we can feel proud of the fact that we put close to $30 billion into nih, $1 billion more than last year. we increased the national institutes of ageing by $100 million. we've included money for the brain initiative. so we think we're making that progress. that comes to me, dr. collins, and other esteemed witnesses. we would like to be able to accelerate these breakthroughs. what you just testified seems so promising, but i feel we also need a sense of urgency because we are facing an epidemic in this country. and the impact again on family

budget and on our medicaid budget because ultimately the impact of people being in long-term care. what, dr. collins -- i remember what senator harkin and senator spector did when they doubled it. do we need more money? do we need more people going into science? what do we need to put this on the fast track so these promising breakthroughs following all the rubrics of the scientific method, how can we? because the clock is ticking. the numbers are growing. the poignancy is there. could you share how we can help move this along? >> i appreciate the question, senator. it was great hosting you at nih on monday. i think we are not at the moment limited by ideas. we're not limited by scientific opportunities. we're not limited by talent. we are unfortunately limited by resources to be able to move this enterprise forward at the

pace that it could take. and it would be, of course, great to see that achieved, and it would actually, even setting aside the pressing need for the benefits to health, would also be a nice investment in our economy since as many of you know, the way in which we put dollars into medical research pays back more than twofold in just a single year. at the moment, people who have great ideas about alzheimer's disease who come to nih with those -- and again, we have some ideas about areas that we think are exciting, but we also count on our community to come up with ideas that we, the three of us, couldn't necessarily have thought about. and to send us those. we put them through the most rigorous peer-review process. but their chance of getting funded right now is about one in six. >> one in six? >> so five out of six are going away with nothing. the community is incredibly struggling and demoralized about that. you and i looked at this survey from the chronicle of higher

education on monday that just came out indicating what's happening. investigators in laboratories all over the country -- remember, nih is not just in bethesda. most of our money goes out to all 50 state where is this research is going on. more than half of those investigators saying they basically had to let somebody go or they can't take on a student they wanted to or they're not going to start a project they're excited about but don't think they have the resources to do it. we're constraining the energy, the innovation, the creativity of the most amazing engine for discovery the world has seen, which is america's science. >> dr. collins, what you're saying is that young people are discouraged from coming forth because they don't think that there's going to be the money there to fund their project? i see dr. hodes and landus shaking their head. so we have promising ideas. people in our own country, in our own country with these ideas ready to roll. well, let me ask you this. the whole idea of doubling, i don't know if it's in our fiscal

cards. but i understand we shared an idea here that if we had stayed on the 3% growth initiated by harkin-spector, where would we be now, about $40 billion? >> if you look at that curve of what the trajectory was prior to the 1998 doubling, it was about a 3% growth rate, and that's accounting for inflation. so real growth in terms of purchasing power. if we had stayed on that curve, we would now be just at about $40 billion. rvelgs so it's $10 billion less than where we are. we're both not only at the national institutes of ageing, but as you pointed out, this could be in a variety of other institutes from dr. landsus' on neurological behavior. everything. so here's my question. i understand you have an idea that if we took inflation plus 5% for about four years, we could get to where we ought to be. >> that would, if you do the math, carry nih back up to that

$40 billion number, if it were possible to do that. again, that's a decision that is up to the congress, the administration, the american people. but i must say from my perspective, the best thing we could do for science would be to get on that kind of a stable, predictable trajectory so we can plan more than three months at a time, so we can actually tell young people who are coming into the field there's a career for you. america is going to invest in this. you can count on if you have a great idea you're going to be able to be part of an adventure that is going to be exciting and world changing. right now people aren't quite sure. this up and down and uncertainty has really done quite a lot of damage to the momentum. >> well, thank you, dr. collins, and also the wonderful people there. my time is up. i look forward to really -- this seems to be an achievable goal if we put our minds to it. >> thank you, senator. >> thank you, senator mikulski. and senator shelby. >> thank you. dr. collins, i just want to share some statistics i have and see if you agree with them.

i bet you would, but i don't know. that alzheimer's is the only cause of death among the top ten causes in america without a way to prevent it, cure it, or even slow its progressions and so forth. is that true -- basically true here in america? what about some of our european countries like germany and england, france, switzerland, more industrialized countries. are some of these statistics, if you have some prevalent there too? >> yes, sir, they would be. the alzheimer's epidemic is not just the u.s. it's worldwide. it's a function of the ageing of our population, which is by the way a good problem that medical research has contributed to. 100 years ago, alzheimer's was barely known because people didn't live long enough to get it. now we've created a wonderful possibility of longer life, but with it has come this new responsibility to do something

about alzheimer's. >> so some of us that hope to be in the 90s some day, the good chance we might have symptoms of it or even have some of it or have acute cases, is that correct? >> dr. herd, who's in the second panel in the study, he published in the new england journal, kind of went through those. as i recall, people in their 90s, the incidence of alzheimer's or some form of dementia is up there in about 30%. >> tell us again about how some of the translational research that's going on at nih hopefully will affect maybe a slowdown or a cure for this. >> well, translation is the process of going from basic science diskorys, translating those into clinical benefit. that is a major focus of all of the parts of nih, all 27 institutes have an investment in that. i think i'll ask dr. hodes to give a quick snapshot of some of the most exciting areas of

translation we're pursuing right now. >> thank you. i can really organize thoughts along the the lines of dr. coll response to the areas of hope and progress over the past five or ten years because they really do range from basic discovery through their translation. the level of basic discovery noted, for example, the number of new genetic risk factors and protective factors we're finding. with funding that was made available this year we can expand new analysis, contrasting what goes on in a normal brain and diseased brain and these are identifying critical points that seem to be central to disease, we can test that hypothesis by tracking an intervention of a drug or specific molecule, find out in a single cell or animal model if that's correct. for translation to emphasis what dr. collins has noted we now

have the capability of beginning interventions at a stage which we can track disease long before extensive cell death. we can track the effect justifiness of treatment through biomarkers. biomarkers are what we know now and as we learn about the progress of disease. everything is about translation and in fact in the planning process now and years beyond with the benefit of this increased funding by appropriation we'll be looking at precisely the right balance of initiatives across this whole spectrum from discovery, to translation, to clinical trials. this is an ongoing effort. we'll meet periodically with the best minds in the nation and internationally to revise those plans, but translation is what is primarily in mind for this whole effort and i think progress at each of tlefls from basic science through clinical trials will support acceleration with full utilization of the

resources made available to us. >> let me add one other translational thing that's exciting and that's stem cell. to take a skin biopsy or skin sample and by adding four genes convince those cells to go back in time. then having achieved that, add a certain number of growth factors and convince those cells to become neurons. you can take somebody with alzheimer'sand study their neurons. it's a disease in a dish. you can tell there's a difference in those neurons if it came from somebody with alzheimer's versus somebody who doesn't. to understand the disease in a system where you can work closely with it and use it as a drug screen because you could then take 1,000, 100,000 drugs which of these make the alzheimer's cells make them look

like normal neurons. >> one last question, my time super. in your research, do you do research into animals that live longer than others and see if there's some corresponding problems with their ageing process? if so, which could you speak to that. >> this is the central role of the institute of ageing, a question of longevity. >> go ahead, doctor. can you? >> looking at varied species with different life spans and expectancies is an important part of the research that's ongoing and is still a mystery which is unraveling. for example, we know that examples have been given for different kinds of clams that live in the same environment. some species of clams will have a life expectancy of nor than a year two. others 500 years. the longest life expectancy of

any animals. try to unz that. comparativ comparative. those with single or multiple genetic changes we can extend their life span several fold. maybe three, four, six or ten fold. now, that, obviously, reveals something about the basic pathways that determine health and life expectancy and now the real promise and excitement currently is translating that to the equivalent pathways in humans to understand whether manipulating those pathways will improve health and life span. very informati very informative area of research. >> mr. chairman, thank you. thank you all for joining us today to discuss this situation.

i am reminded that at the university of mississippi dr. arthur embarked upon a study of the heart and flowing from the research that he managed and was in charge of at the university, a textbook was written and great strides were made in understanding and prescribing changes in life styles and medications that could have this effect or that effect on the human heart. is it time now for us to encourage and identify someone or some place where a crash course in research and emphasis on one element, this horrendous disease called alzheimer's can be undertaken maybe with the hope of marshalling the best minds we have and techniques we

have for research and take one step in the future where your name might be on a textbook? what's your reaction to that? do we have the capacity to do that? what amount of funding should we urge the senate to consider appropriating for such a crash course endeavor? >> interesting question. think back about the incredible impact that the doctor had and reverberates down through the decades what we understand about the heart. over the course of those decades we have moved more and more into a realization that for the current challenges it's bringing discipli disciplines together. certainly in alzheimer's disease the idea you can bring together people who know something about neuroscience, people who know something about clinical

medicine, people who know about imaging technologies, people who are engineers, robotics experts, big data is a big part of this now. that's where a lot of the excitement is. increasingly what we need to do, the modern version is to come up with teams that are made of many brains sort of working together and that is very much the way science has now proceeding. the brain initiative which dr. landis co-leads for us is a great example of how to achieve that. maybe you can say a word about how that is coming together that reflects a change in the dynamics. >> it's very clear that we made excellent advances in understanding brain structure. we know we have crude wiring diagrams for the brain but we don't know how information is processed along those wires, how the vision of a rose actually

gets translated through many, many different way stations in the brain to recognition that this is a rose and the expectation it will smell sweet. what we really need to do to understand how the circuits work, the organization of brain, brain cells is to bring together neuroscientists, computational people, physicists, chemists, engineers to work together develop tools that we can then apply to answer those questions about how brain circuits really function and that obviously starts with normal brain circuits but what we learn from understanding normal brain function will have significant implications for diseases like alzheimer's, other kinds of dementia, park joininson's dise and epilepsy. >> yes. first i have to agree the appreciation for the remarkable

family. but in line with your suggestion of a new kind of center that will allow a translation from basic observation through pre-clinical observations the very existence of the additional appropriation this year has led us to begin -- set aside funds for translation centers, the concept approved this morning by our advisory council, concept developed and now implemented in the context of funds available. it's intended for the sort of thing you mentioned, bring together as dr. collins mentioned individuals from multiple disciplines to look at new ways to integrate and accelerate in this area. >> thank you very much. thank you, mr. chairman, for calling this hearing. >> thank you. senator kirk. >> mr. chairman, i just wanted to highlight and praise dr. collins for the a.m.p. effort

that brings together ten pharmaceutical companies. one headquartered in illinois. biogen. smith kline, johnson & johnson. institutionally these are all shareholder sponsored entities who all are going to be very interested in bringing something to market eventually which actually means actual patients will be helped. and not 25 year -- with all these institutions coming in to play they are only interested in the clinical application of what they find. and for a lot of the people, i'm sure that's where they are most focused on. >> senator, i appreciate your raising a.m.p. because i'm personally very excited about this and put close to three

years in trying to build the momentum and was thrilled that it was possible to announce this just a couple of weeks ago. it is unprecedented to have nih and academic researchers getting together around the same table with equal financial contribution, with these ten pharmaceutical companies to say this is a hard problem let's work on it together. and with agreement that all the data is going to be publicly accessible. so we're calling this no longer a competitive part profit sees, this is pre-competitive. but the opportunities now because of the proliferation of discoveries to move those to the clinic has never been greater but overwheming to see how to do that and those ten companies came to the conclusion no one single of them could do this in the kind of time frame that's necessary. let's get together and do it as a team. and recognize that once we've

done this pre-competitive part the coerce going to jump in and going to race each other to try to get to the end point of having an fda you a proved drug and we want them too. that part of competition is how we get to ultimately the treatments people are waiting for. it's an exciting model. never been tried like this. watch this closely. we put ourselves in a position to deliver on some ambitious milestones. i think we'll get there. it will be great to mix these cultures together. the culture of the academic scientist and private-sector scientist with different kinds of ideas but agreeing as deep as their dna that what they are really at here is to try to solve problems and help patients. >> thank you. >> and i just want to make clear, this information is shared across all the companies? >> absolutely. >> the public and everybody? >> some of the companies initially like why should we join because if we sit on the outside and watch we'll still see the data, right?

>> yeah. they will sit on the outside. if you're on the outside you're not actually able to steer the project, you're not able to say why don't we try that. being part of the team is going to be significant and useful and i think very exciting for the participants. i should have said alzheimer's is one of the projects that was chosen. we had to figure out which of these various disease opportunities where the companies excited enough to put money on table and alzheimer's was one of those. alzheimer's the goal is to see what we can do about biomarkers to identify whether a therapy is working or not and study these brain networks that the doctor was talking about to identify new targets for drug treatment that we don't know about already. >> again, thank you and congratulations for pulling this group together. quite a feat. senator alexander. >> thanks, mr. chairman, thanks dr. collins and to all of you.

of course we greatly admire what you've done. i think we all asked you about the same question so let me ask you again, make sure i understand it. a moonshot had a very specific goal, all the incredible human activity was organized around that specific goal. i suppose mapping the human genome was a specific goal and all the activity was organized around that goal. you knew when you got to the moon and you knew when you finished mapping the sequence that you worked on. what is the a.m.p., the equivalent of those big crash courses as senator cochran called them or goals or is there a better goal? i think what i'm asking, i think every one of us may have asked what's the equivalent here in terms of brain research or in

terms of alzheimer's, what should the goal be and then how much money should a great country put behind that to reach the goal? in my work in public life it always seemed to me the money was not the problem, the goal, defining the goal usually was the problem. the goal was compelling enough, usually the resources would follow the goal. so, tell me, again, what the equivalent of the moonshot or the human genome project is here so i understand it clearly and then remind me again, if you know, what it would cost to do it. >> that's the hardest part because we don't know what trajectory will be. let me see if i can address your very thoughtful question. you're right the moonshot, the human genome project were unique situations where you could

define a precise end point and everybody would know if you got there or not. you got a man on noon. you read out 3 million letters of the human notebook. what's the goal. there's lots of goals. getting diagnosis so it's accurate and can be done early before symptom. we're coming along pretty well on that one. i wouldn't say we're there. of course the big goal is prevention, treatment so no one gets this disease any more. that's far enough out in the future that i think it's hard for us with the uncertainties about how we will get there table to put a timetable on that but people are trying. i'm going to ask dr. hodes to say -- >> before do you that. is the goal to prevent anyone from getting alzheimer's just like we say today polio is gone? >> that would be my goal. that's very bold. very ambitious but that's got be the place to try for. now i'm going to ask hodes to

say something about the alzheimer's plan. we also have this brain project. like genome project that will stretch out over a decade or so but it needs have clear indications of whether it's succeeding or north milestones. that's the difference. wean the moonshot you had to have milestones whether you can get there. can you go around the moon and come back. can you put somebody on the moon? maybe dr. landis can say something about brain how we're setting those milestones so we can say if we're getting there. >> so, as i said we have maps of the connections in the human brain, but what we don't have is a way to record from the 86 billion neurons and the thousand connections that each of them has in order to understand how the brain actually functions. so what we need to do is to be

able to record not just from one neuron or tenure rons or 100 neurons but hundreds, tens of thousands of neurons as a person or animal to start with ising b reconstruct how those brain cells directed that behavior. if we can do that it would give us a much better understanding of this amazing computational machine that accomplishes actions and thoughts that no computer could ever replicate. >> there are milestones. >> there are milestones. in fact those milestones are being developed and will be presented to the advisory committee, to the director. we have request for applications out on the street now that have discreet pieces of that problem that we will fund projects to answer. different steps in that process. >> maybe you can say a quick

word about the national plan because it's all about milestones. >> yes. the national plan establishes and has zab lished long term goals including the very ambitious goal of 2025 generating an effective means of prevention. what we did was what would be necessary to reach that success by that date and from there set a series of specific research objectives and milestones so that in 2013 and 2014 there are investments in certain areas of research which as projected if successful will lead in 2025 to ultimate success. we don't know which of the. approaches we take will succeed or which will fail but the design to set out and approach that has potential for that success and as ambitious it is we have no choice but the urgency to move towards that accurated course. >> thank you, mr. chairman. >> thank you dr. collins, dr.

landis for being here today. congratulations on bringing together the drug companies on this a.m.p. project. i think it's a milestone. and, again, hopefully we'll be able to continue our funding and next fiscal year and this fiscal year. thank you all very much. we'll now turn to our second panel. >> mr. chairman, if i could, others have raised kind of like a manhattan-like project, genome, landing on the moon, the manhattan project itself. wasn't one of the biggest concerns the fact that there would be a discouragement or impediment is two things. the shut down of our government and the other sequester so that there's the lack of certainty as

you have to not only sequence the human genome but you got the sequence what you're going to do when in terms of research, recruitment, retention and so on. don't you need certainty as well as resources? >> absolutely. people say that the worst thing you can do to the business community is uncertainty. well that's true for science even more so. our cycle time for projects runs about four years in order to come up with an idea, put it into practice and work really hard and see if it works. when your cycle time for support sometimes is three months, and we've been there for some of these continuing resolutions and certainly when you lose a billion and a half dollars halfway through the fiscal year as we did with sequester it's very damaging for people to pursue momentum and to be able to take risks. not worrying whether they will miss the pay line because it's so tight. if we could find our path forward, madam chair woman to that kind of stable support for

medical research in the united states it would make a huge difference. >> i can't help them but add here that years ago, mark hatfield, senator hatfield came up with an idea i joined with him on it and others did. he pointed out every time you buy a drug in a drugstore, every time you go buy an off the shelf drug or even a prescription drug some of that money goes for research. when you buy health insurance policy none much it goes for research. think of the amount of money we spend every year on health insurance policies to treat and to take care of illnesses, but none of it goes for research. so senator hatfield came up with the idea, it was a long time ago, about having, i think it was two or three cents out of every health care dollar that would come to the appropriations committee to go to nih and, of

course, the argument was made well that would just supplant the money we were doing. no. as long as this committee funded nih or the congress funded nih at a minimum of inflation, then that money would flow on top of it and be a supplement to it. i've been preaching this for 25 years. that some of this health insurance money that we spend ought to go for research and i'm sorry the health insurance industry has always opposed it. but it seemed to me that -- i just say this, this is one way of getting some amount of money that you know every year is going to be there. with that, thank you very much dr. collins. we'll town our second panel. >> thank you. >> dr. michael herd, congressman

dennis moore and mr. seth rogan. while they dome the table i'll go ahead and introduce them. first, dr. michael herd, a senior principal researcher at the rand corporation. where he directs the rand center for the study of ageing. also a professor at the party rand graduate school in santa monica, california. his research focuses on economics of retirement, social security and social welfare systems and other topics related to the ageing. congressman moore who has served in the house of representatives for 12 years. first elected in 1998 congressman moore served on the budget and financial services committees. in 2010 he announced he would not seek re-election. prior to his time in office congressman moore served in the u.s. army, u.s. army reserve, was an assistant attorney general for the state of kansas,

johnson county district attorney as well as private practice lawyer. in february of 2012 he and his wife announced that congressman moore had been diagnosed with alzheimer's disease. mr. seth rogan a stand up comedian, actor, producer, screen writer, voice actor, originally from vancouver, british columbia. moved to los angeles to pursue acting in the late 1990s. since that time he's acted in and co-written movies and done voice over work for animated films. he raises awareness for alzheimer's disease as a celebrity champion for the national alzheimer's association and that alzheimer's has affected his wife's family and he'll, i'm sure talk about that. we welcome you all here. i read your testimonies last night. they are great. all your testimonies will be made a part of the record in

their entirety and i would ask if you would give a short five minute summation of that so we can engage you in questions and answers and conversation. first, well recognize our former colleague from the house side, congressman dennis moore. good to see an old friend back again from the midwest. dennis, thanks for being here and please proceed. >> thank you. good afternoon, chairman harkin, ranking member moran. as an individual living with alzheimer's disease i thank you for the opportunity to testify before this subcommittee. alzheimer's is a devastating progressively and ultimately fatal disease. it currently impacts more than 5 million americans. these men and women are husbands and wives, mothers and fathers, sisters and brothers, republicans and democrats. i should know i'm a former member of the united states house of representatives and i'm one of them. i was diagnosed with alzheimer's

disease almost three years ago on june 1, 2011. i had become concerned when i noticed i was having some difficulty remembering random events and difficulty managing our household finances. since then i've learned coping skills but still recognize the issue i have with my short term memory loss. i now an alzheimer's advocate for the alzheimer's association because i know personally how this disease affects an individual and family. there is a great need for educating the general public and funding research for a cure. not only is it alzheimer's stealing our memories and independence and our ability to function but demands increasing amounts of care. beyond the exhaustion and stress there's the financial burden. the direct cost of alzheimer's and related dementia is greater than any other condition in the united states including heart disease and cancer according to a recent study in the "new england journal of medicine." over the next 40 years caring

for people with alzheimer's will cost $20 trillion. however, even with this, information for every $27,000 medicare and medicaid spend on caring for individuals with alzheimer's the national institute of health spends only $100 on alzheimer's research. fortunately alzheimer's is a bipartisan issue. in 2010 congress unanimously passed the national alzheimer's project act. the act mandated the creation of the first-ever national alzheimer's plan, which was released in may 2012 with a goal of preventing and effectively treating alzheimer's disease by 2025. recently updated the plan now includes important milestones and a timeline to facilitate achieving that goal. however goals of this magnitude, goals aimed at changing the trajectory of a national health crisis requires significant investments if we hope to realize success.

recognizing this we commend congress through their leadership of you chairman harkin and moran for increase for alzheimer's and appropriations act in 2014. this is an important down payment and step into implementing the national alzheimer's plan so we can reach the goal of treating and preventing alzheimer's by 2025. this will allow scientists to pursue innovative research that will thread new treatment, interventions and diagnos diein diagnostic. in order to take full advantage of the potential of the national alzheimer's plan, congress must

see to it the necessary resources are prioritize to accurate the government's investment in alzheimer's. it's now incumbents upon our nation's leaders to ensure the promise of the national alzheimer's plan. my fellow alzheimer's advocates i thank you for your support in fiscal year 2014 and urge you to stay committed to alzheimer's as you start discussions for fiscal year 2015. an epidemic is upon us and too many families are in situations like mine facing a fatal disease that currently has no way to prevent, cure or slow its progression. as a nation we cannot afford to wait until alzheimer's bankrupts us. we must make the smart investment now realize a better, healthier future for our families and our country. thank you very much.

>> appreciate you being here. next we'll turn to dr. hurd, the author of this famous study that came out last year that i think shook us all up. >> thank you for the kind words about that study, as challenging as i'll outline now. chairman harkin, ranking member moran thank you for the opportunity to testify about the monetary costs of dementia in the united states. my testimony will be based upon research that co-authors and i did at the rand corporation and university of michigan and it was published last year in the "new england journal of medicine." the costs of dementia are immeasurable. our more modest goal was to measure the monetary cost of dementia but even so there were a number of challenges. first most people with dementia have co-existing health problems such as a history of stroke or heart condition, which by

themselves would lead to higher costs. we wanted to find the costs attributable to dementia itself, not the health care costs of people with dementia. a second difficulty concerns informal care that is unpaid care most often performed by a family member. we had to develop a method of placing a monetary value on that care, knowing it could have large effect on our estimates. these and other challenges made it difficult to find valid and reliable data that were adequate for the needs of this research. fortunately the national institute on ageing, nia under the lloyd of dr. hodes and others had the foresight many years ago to invest in a data infrastructure, the health and retirement study without which this research could not have been accomplished. the hrs has become the pre-eminent data source for general population representative studies of

ageing. it provides a wide range of data including cognition, costs and health care caregiving. it lacked the dementia status. in 1998 a multiple disciplinary team including myself proposed and then fielded a small substudy for dementia status. in our study we used these diagnoses to estimate the dementia status of a much larger sample of 6,000 persons. according to our results in 2010 the prevalence of dementia in the population aged 71 or older was 14.7%. the annual health care spending attributable to dementia was about $29,000 person. the great majority of these excess costs were for nursing home stays and paid in home care, adding in the cost of

unpaid or informal care increased the total annual cost per person to between $42,000 and $56,000 where the range depends on the method of valuing informal care. we were not able to allocate costs between alzheimer'sand other dementias but we know the great majority would be due to alzheimer's. we use census estimates of the population to estimate the annual cost of dementia in the united states. we found that actual spending attributable to desmaen was $109 billion in 2010. this cost places dementia as the most costly disease in the united states in terms of actual spending. adding in costs for informal care increased this estimate to a range of $160 billion to $250 billion per year. because the prevalence of dementia sharply increases with age the ageing of the population itself particularly when the baby boom generation reaches an

advanced age will increase future costs. the costs for care purchased in the marketplace will increase in real terms from the 2010 value of $109 billion to $260 billion in 2040. that's in real terms. adding in the costs of informal care increases the cost estimate to the range of $380 billion to $510 billion per year in 2040. we are kpernding this research in two directions. dementia is very costly on average but these costs are unequally distributed. some households spend nothing while others might spend more than $100,000 per year. in new research we find that the costs are even more ask youed when accumulated over many years because some people with dementia can be in a nursing home for five years or even longer. can you my lated costs can be financially devastating to some families. in a second extension because of

the great importance of long term care and total cost dementia rand is developing a report to be release this year that aims to help providers, payers and policymakers efficiently improve long term care for dementia. in summary dementia is already very costly and will grow even more costly. clearly, medical break throughs that would prevent or delay on set are urgently need. but even in the absence of such break through, innovations and policies that can reduce costs should be pursued. thank you, mr. chairman and ranking member. thank you for your attention and i look forward to your questions. >> thank you very much, dr. hurd. now we'll town mr. seth rogen. >> thank you for having me. thank you for the opportunity to testify today and for the opportunity for me to be called an expert at something because

that's cool. i don't know if you know who i am at all. you told me you never saw "knocked up" chairman. it's a little insulting. >> i want the record to note -- >> very important, guys. >> want the record to note this is the first time i will wagger, this is the first time in any congressional hearing in history that the words "knocked up" have been used. >> you're not going to like the rest of this then. [ laughter ] first i should answer the question i assume many of you are asking yes i'm aware this has nothing to do with the legalization of marijuana. in fact, if you can believe it this concerns something that i find even more important. i started dating my wife lauren nine years ago when her mother was almost 54 years old. the first time i met her parents being the mench i am i was excited to spend time with them and make lauren to think i was the type of guy she should continue to date.

lauren first admitted to herself and to me something was off with her mother. clues were unfortunately easy to spot since both of her parents had alzheimer's disease. soon after this trip at 55 years old lauren's mother was diagnosed with early on set alzheimer's. now at this point my impression of alzheimer's was probably what i assume most people's imexpression. i thought it was something only really, really old people got and i thought the way the disease showed itself was in the form of forgotten keys, wearing mismatched shoes and being asked the same question over and over. this period which was the only way i saw alzheimer's displayed in movies and television last ad few years for lauren's mom. after that is when i saw the real ugly truth of the disease. after forgetting who she and her loved ones were my mother-in-law a teacher for 35 years then forgot 0 how to speak, feed herself, dress herself and go

the bathroom herself by teenage of 60. lauren's father and a team of caregivers dedicated their lives to make my mother-in-law be comfortable. they would love to do more but can't. there's no way to prevent, cure or even slow the progression of alzheimer's. another thing i didn't realize until i was personally affected is the shame and stigma associated with the disease. it was before i was born but i'm told of a time cancer had a stigma. celebrities and other public figures that were stricken would hide rather than be voices of hope. although it's turning this is currently where we are largely at with alzheimer's disease. it's because of this lack of hope and shameful stigma my wife, some friends and myself decided to actually do something to change the situation. we start hilarity for charity.

it helps families struggling with alzheimer's. the situation is so dire that it caused me a lazy self-involved generally self-medicated man child to start an entire charity organization. it was through this that we felt we weren't just complaining there was nothing to be done but actively taking steps to do something instead of being disappointed so many young people were misinformed we started to educate them. we recently started a college program that allows university students to hold their own hilarity for charity events and in the months it started 18 schools nationwide have signed up to hold events. we have college students to stop playing video games and volunteer their time is a had huge accomplishment. i came here today for a few reasons. one, i'm a"house of cards"

fan. had to be here. march thond whole thing. two, is to say people need more help. i personally have seen the massive amount of financial strain this disease causes and if the american people ever decide to respect geni the afternoon lia comedy we can't afford it. i can't imagine how people with more limited incomes deal with this. alzheimer's and related dementia is the most costly condition in the united states. it's more costly than heart disease in a country wherefore $1.29 you can get a taco made out of doritos. they are delicious but not healthy. while death from other major diseases like heart disease, hiv and strokes continue to decline, deaths from alzheimer's have increased almost 70% in the last 15 years. over 5 million americans have alzheimer's and at this rate in 35 years as many as 16 million

will have the disease. third reason i'm here simply is to show people they are not alone. so few people share their personal story, so few people have something to rethe light. i know that if me and my wife saw somebody like me talking about this it would make us feel a little less alone. americans whisper the word alzheimer's because their government whispers the word alzheimer's. although a whisper is better than silence that the alzheimer's kmuptd has been facing for decades it's not enough. it needs to be yelled and screamed to the point that it gets the attention and funding it needs. i dream of the day my charity is no longer naens i can go back to being the lazy man child i hope to be. i ask you to continue to take more steps from vied more funding. i want to thank the committee to share my story and voice my whole hearted support for the continuing work that purr sauce

cure for alzheimer's disease. thank you very much. >> thank you, mr. rogen. that was great. thank you. although i'm sorry you had to unmask me, i'm really kevin spacey. not too many people knew that. thank you all very much. i'll start with dr. hurd. i'm pleased to see your research was funded by the national institute of ageing. you may be aware, maybe all of you, maybe you're not aware, that some of my colleagues in the house of representatives hold a different view of the role of nih in health economics research. the house draft of last year's appropriations bill, our counter part which they released but did not pass included language that would have precluded nih from supporting any health economics research such as what dr. hurd

did. so dr. hurd as an economist researcher, how important is nih's support to your work? are there other federal grants you could have applied for to get this study off the ground? >> it's extremely important, i would say say all-important to my work. i'm the holder of several grants and a center grant. the importance of nih funding comes from its, i would say primarily from its long term reach and also from its multidisciplinary aspect. our study involved cognitive scientist, economists, gerontologists. that kind of assembling a team is not easy outside of the nih umbrella.

the long term reach is extremely. hrs was the foundation for this study. it wouldn't have been possible without them. the study began in 1992. i was part of the original team. that sustained funding over many years doesn't happen outside of nih for this type of research. i mentioned the 1998 study, similar example where we are laid the foundations for the study that we published in the new england journal really in 1998 and pursued over many years. i just don't think the kind of study we did would be feasible outside of the nih. i don't know of an agency that would support that kind of long term study as well as the multidisciplinary aspects. >> we didn't do this on this side, bipartisan. i just want to get that out just so people understand that and that hopefully the house won't repeat that again this year. representative moore, as a

former policymaker and a patient, is there anything you personally experienced that would change? do we need -- is there anything we need to better educate primary care physicians on number one. i'll ask two questions. that's number one, dennis. secondly, you've spent a lot of time on this side of the dais. is there -- if you were here what questions would you ask of nih. is there anything that we didn't ask or something we didn't cover? >> i really think you have asked the appropriate questions of nih. i just think it's important that people in this country understand that this is a disease that's affecting more and more people. i had it in my family with my dad. so i wasn't terribly surprised when i was diagnosed. i understand there's some genetics involved. something you wouldn't wish on anybody but it happens. i hope some day they will find a cure. right now i just think as a nation we need to deal with this

disease as best we can and i really, really appreciate the fact that you're holding this hearing and trying to get more information so you can do the right thing. >> thank you very much, dennis. mr. rogen, i got to be honest -- [ laughter ] -- i was reading this last night very quickly. hilary for charity? >> i forgot the t. >> i had to stop and go back. >> it's a progressive program. >> so tell us more abohilarity charity. >> there's zero acknowledgement in the world of these young people. it seems to be something not of a high priority. something that people, again,

think only happens kind of naturally when people enter their 90s and i don't think people understand that it's not their grandparents being affected, it's their parents being affected and soon enough it's them being affected. i really just saw that firsthand and really felt that there was a massive hole missing when it came, to you know, informing young people about the reality of this disease and it didn't seem like a high priority anywhere globally to inform young people about the disease, so we decided we should do it because no one else seemed like they were going to. >> good for you. senator moran. >> mr. chairman thank you very much. i don't know i'll ask mr. rogen any questions. i'm a dull, boring person and i would certainly be reticent to have a conversation with you as a comedian. i was fully prepared to be shown up by you, but it really bothers me that senator harkin is even

more funny -- >> that kevin spacey line was great. >> so, i don't know whether i'll ask a question or not. i'll start with dr. hurd. and this really probably is a question -- let me put this into the record and it's a question for dr. collins and his crew at nih. as i was listening to dr. hurd's testimony it occurred to me it would be useful for me to understand whether the prevalence of alzheimer's is increasing or is that just a factor of us living longer? and i don't know the answer to that but assume that has significant cost significances. so are you expecting greater costs in the future as a result of longevity and then just scientifically on a research basis, has alzheimer's been with us to the degree that it is today, into the past, it's just that now we live longer and,

therefore, it's not that we're changing we just live longer and therefore the evidence exists. i don't know if that's a question for you dr. hurd or not but before i foregenentech my question i wanted to make certain i got it in front of dr. collins. >> i can say something about that in two ways. we looked in our data to see if we saw any trend and prevalence adjusted for age. you're exactly right. one needs to be quite careful about increased dementia due to increases in ageing of the population. from changes in dementia prevalence holding age constant. and the latter would be very important finding because then that would suggest that as the population ages we may see less prevalence than had been forecast. our forecasts are based upon constant prevalence holding age constant. so the question came up earlier about over the age of 90.

we mated 39.5% those over age ever 90 are suffering from dementia. we assume that rate remained constant to 240. as the ageing of the population more people reaching those ages increased overall population in prevalence and increases in cost. we studied in our data quite carefully whether we could see any change in age specific rates of dementia over time. we saw slight suggestion of that but we're not ready to write a paper on that until we really are quite certain about that. there was a recent study in england suing geftd a decline in age specific prevalence of dementia, quite a large decline in prevalence i think before we would want to take that and put that into a forecast we would want to have more examples of that from a wider range of

populations. right now from our perspective we don't see a change in a specific prevalence. >> doctor, we generally have been using the word alzheimer's and you have been using the word dementia. is there a distinction to be drawn here? >> yes. we used, our study was about dementia because that's what our data would support. we had subdiagnoses of alzheimer's but the data, we didn't have enough observations really to distinguish ose. this is somewhat outside my area of expertise but my understanding is that there's somewhat of a blurring line between many forms of dementia and alzheimer's. the majority of dementia is alzheimer's. great majority. but typically there will be vascular dementia in addition to alzheimer's at the same time. >> should we expect an announcement, another study, the

results of another study from you related to these topics? >> we're working right now, we have an ro 1 from nia to look at long term care. the costs of long term care and the role of health insurance for long term care, long term care insurance, why do we not have a functioning long term insurance care market. it's very clear the costs are highly ask youed and this should be an insurable situation but we don't yet have well functioning market for that. and we've produced one paper on that we'll produce further papers. >> thank you very much. mr. rogen, i appreciate your work hilar the iy for charity so my comments are dull and boring but it's an expression of gratitude. i appreciate your efforts to educate and to communicate with young people. that's something that i have no doubt that is missing. one of the things that i might

suggest in that regard in talking to young people is we need to instill in american young men and women the desire to pursue careers, degrees, education in science, research, medicine. we need the next generation of the doctors that were on the preceding panel and i would encourage you and maybe you have comments in that regard to do everything you can to instill in people desire that this is a noble calling, worthy of a career. >> yeah. i would love to do that but actually i think one of the most distressing things honestly i learned today was talking to dr. hodes before the panel justin little waiting room area and he was explaining to me something that he touched on here as he was talking was how the funding for the research in this area is so sporadic and inconsistent that people and i relate to it as just a young person who is

pursuing a career, people are discouraged from entering this pursuit because it's not as financially stable as many of the other diseases that are having great strides taken in, you know, conquering them. in a will do my best to encourage it but, again, ski the government to create a situation financially where there's the means for people with ideas to do swoigt. he told me again back stage was there's people that come to us with ideas that could literally be the thing that cures this disease and what we have to tell them is there's one in six chance of that getting funded and they take from that man if i go focus on heart disease i'll make money and save lives but a more glamorous situation financially. alzheimer's isn't a cool disease, unfortunately and it's something that i think, you know, that was obviously one of

the most distressing things i heard today even people whose natural instinct is to pursue curing this disease are discouraged from the financial landscape of this profession. >> while you earn living as a comedian, you are very effective lobbyist turning my request around. >> i'll do it. >> you give me the means i'll give the people. >> i certainly noticed it although you will find that it's -- this request, this plea for constant increasing of funding is one that we've made for a number of reasons but including in those reasons is the understanding that people who are making decisions about what to do in their careers need to know whether it's alzheimer's or any other disease that nih funding will be there and there's an opportunity for them. the uncertainty that congress and the administration can create in budgets and spending create a real challenge as we try to recruit young people.

>> i think that mentality trickles down to people my age and shows it's not that high of a priority on a national level and that's what we're trying to change. >> thank you very much. let me now visit with my colleague, my former colleague from kansas, dennis thank you very much for being here. i appreciate you reminding me -- i was at your father's funeral. i remember his condition and the reminder of heredity. my question to you is this. what is the state of knowledge, what is it that we know when you've been diagnosed with alzheimer's, what is it that they can tell you to do to make the quality of your life better, to slow the process. in other words, what does -- my impression would be, you would be a typical patient who learns of a diagnosis and you've pursued, i assume all the

opportunity to try to find things that make life better over the course of your rear manger life. and what is it that's out there that people can tell you that are health care professionals and others that can tell you what you can do? what is the alzheimer's association tell you to do to accomplish that in your life? >> basically to take the medication that they diagnosed for me and others, i think. and also to get some exercise, which i try to do on a daily basis. my wife very much encourages me. as a smart husband i say yes, dear. >> some things we won't forget. it's a good thing. dennis, again, i appreciate you, your public service. >> thank you. >> the chairman had a long list of things that you've done in our state, and i wish you and stephanie all the absolutely all the very best and it's very pleasing to me to see you here not on your behalf but on behalf of all the people who sit in

this audience and the thousands of americans and people around the world who have encountered the same circumstance that you encounter, and the way that you're living your life i believe gives others courage and hope and i commend you and stephanie for that tremendous addition to your life. another role to play and you're playing it very well. >> i thank you very, very much for those colts and i also thank you for conducting this hearing and learning more about this and what we as a nation can do to better deal with this situation of alzheimer's because millions and millions of americans as you well know are being affected by this. thank you very much. >> you're very welcome. mr. chairman, thank you. >> dr. hurd, and maybe i need to get dr. hodes in on this too. i'm a little confused a little bit. listening to your response on this. in other words, is dementia

getting more aggressive, affecting more percent of the population or is there just aff population or is there an increase in the number of people living to the age of 65? is there data in someone who is 50 or 55 compared with what it is now. so, do we have a higher percentage of our population affected? >> maybe this is for you. i don't know. we have no evidence. >> there is no evidence of the increase of the risk of dementia. as you were eluding to there was so few people reaching it in age

that we don't have accurate figures for that point. but there is at present no evidence that there is an increase at a given age. >> so 55 or 60 that were diagnosed with dementia 50 years ago is about the same? >> i think i can say there is no evidence of a change. 50 years ago we didn't have the statistics to answer your question. >> i thought you told me that it was about the same? >> i'm trying to be careful. we have no evidence that there has been a change. if you are asking us to speculate, we don't know of reasons for change. there are for example, vascular

components that are affected by hyper tension. but the straight forward answer to we have statistics 50 careers a years ago and now the answer is we don't know. the studies that have been referred to, the population based studies in health and retirement studies that began now and years ago will tell us in the future. we'll be able to answer your question 20 years from now. >> i'm retiring next year. >> doctor hodis. >> i saw the doctor in front of hurd and started asking medical questions. if you took the 50 years away and said five or ten is there

evidence that the disease is more prevalent the incident is changing either increases or decreasing in a shorter period of time or we just don't have the evidence we have to wait 20 more years? >> you want to comment? >> in the hrs, again, we looked at that, this is the time period of 2000 up to 2008. and maybe saw a slight suggestion in improvement in the rate of dementia. we want to pursue that further because of technical reasons. there was a study that suggested an improvement. but i would say that right now we don't know. you have to have consist ept methods in the hrs. >> i think why this is important

is part of it is the cost. when you analyze what the costs are going to be. but from the cause, i hadn't thought about high blood pressure, but what is the consequence and again, does that have a consequence on the disease we are trying ining to eradicate. as part of the priorities is having in place means to do the surveillance. preventing and delays alzheimer's disease means to have surveillance and those studies are now in place. we see whether it is on blood pressure or on more specific approaches, we can monitor the impact on the prevalence on the

risk of the disease and prevention. dr. hodis thank you for attempting to answer the question. >> i have a follow up question with dr. hurt. let me find your testimony here. under study, something leaped out at me. it was this. those who did not graduate from high school were more than twice as likely as those who graduated from college to have dementia. and those with household incomes with less than $15,000 were more than four times likely to have dementia as those with household income with more than $75,000. what does that tell us? >> four times? >> so these are raw statistics in the population over the age

of 70. >> but why would income have any bearing on whether someone gets dementia or not? >> it has to do with the correlation with age and income. very old people have lower incomes than younger people. so within the age of 70 and above. the poorest people are the oldest people and age is so high they correlated with dementia status. >> rich people live to be old too. >> probably live longer because they are better able -- >> yes, that is certainly the case. >> more wealthy people live longer than wealthy people. >> people who live through the age of 90 so when the 90 year olds were 70 they were poorer

than today's 70 year olds. there is a relationship between income and age that brings the relationship between income and dementia into the kwan ti taytive aspect that you mentioned. but when i read that, when you say household income more than $75,000. i would assume that is at every stage. >> $72,000, $75,000, $80,000, $90,000? >> no, that is not in that table. it is not corrected more anything. it is not corrected for. in our research we do correct for that. but in that table there is not that correction. so. >> i'm having trouble with this. um, ask mr. rogen. >> i actually get it, i think. >> you get it? >> i think i do, right? >> and kevin spacey does.

>> tell me what you think. >> i think what he is saying is older people have less of an income and therefore if you are older by default you will have less of an income if you have dementia odds are you are old which means you have less of an income which supports those statistics. >> thank you dr. rogen. >> i see in education the older population is much less educat educated. they have education less than high school. education is highly reralated t education status. >> my mistake was thinking that this was true at every level, at every age.

i wondered why there would be that difference and there is not. thank you for clearing that up. >> anytime. >> you have a future at nih or the rand corporation i don't know which. did you have anything else? >> only this mr. chairman. thank you very much to these witnesses and to the earlier panel. grateful for you allowing for us to have this hearing today. i appreciate the folks across the country who are observing this hearing. we understand how important this issue is and we want to continue our efforts who want to find the cure and provide hope to the american people. on a more pedestrian matter senator collins ask that she have a statement made part of

our record and without objection it is ordered. i would join with my friend and colleague senator rand thanking you all. thank you for your great leadership and all of you who are here today. i know you came a great distance. i want you to know. this is an issue that we are serious about. and we've got to find the funding for it. we have to make sure we have a steady stream of funding. this up and down can't continue. i was happy that i was able to join years ago the funding for nih but since then it has gone down hill. we have it up in that plateau and it didn't work out that way. so we need your presence here but we need your presence back

in your home states. talking to your members of congress on both sides of the i'll to let them know the importance of this. i hope that our funding level this year will reflect the increases last year. we'll do everything in our power to make that happen. again, i thank you for your advocacy and i encourage you to keep strong in that. this place, this senate, this congress, however much you read, responds to what people want us to do. and so, if you want this to happen.

if you want us to make sure we get this good funding stream you have to keep the pressure up. you will see the way clear for great strides in getting to the point where we can prevent, treat and cure alzheimer's. that is our goal. and we are going to get there. [ applause ] . >> house keeping, the record will remain open until march 5 >> coming up over the next several hours, the latest on the situation in ukraine, beginning with president obama. in about 15 minutes, republican senator john mccain's comments. then union united nations --

united nations security council discusses intervention in ukraine. later the comments of secretary of state john kerry. >> on the next washington journal, we will be joined by national political reporter robert cost to discuss the administration's proposed budget for fiscal 2015 and republican alternative. you can call in with your questions about the political unrest in ukraine for stephen from who is ambassador 1998-2000. washington journal is live every day at 7 a.m. eastern. join the conversation on facebook or twitter. >> president says russia has violated ukraine's sovereignty and that the u.s. is considering economic and diplomatic measures to isolate russia. the comments came during a photo israeli prime

minister benjamin netanyahu. this is 15 minutes. >> well, it is a pleasure, once again, to well, president netanyahu to the oval office there is no one i have met moore or consulted with more. it is a testament to the incredible bond between our two nations. i have said it before, and i will repeat, we do not have a closer friend or ally than israel, and the bond between our two countries or people that is unbreakable, and that is the reason why on the whole spectrum issues, we consult close with and have the kind of military, intelligence, and security cooperation that is unprecedented, and there is a strong bipartisan commitment in this country to make sure that israel's security is preserved. in any contingency.

we have a lot to talk about, so we will spend time discussing the situation in syria and the need to not only find a political solution to the tragic situation there but also to address growing extremism inside syria, the spillover effect on lebanon and jordan, in particular. we will have the opportunity to discuss the work that we do in counterterrorism and the work that we are going to be continuing to do to try to stabilize an environment that has been made dangerous in many respects. this is of critical importance,

and where we have an opportunity, i think, to move beyond recent events over the last several years to a point in which, once again, there is a legitimate pass towards political transition inside of egypt, and that is for israel's security as well as the u.s. security. we're going to be talking about my absolute commitment to make sure iran does not have a nuclear weapon, something i know the prime minister feels deeply about, and we will discuss how the joint plan in action that is currently in place could potentially lead to a solution that ensures that they are not developing a nuclear weapons, and we will spend time talking about the prospects of peace between israelis and palestinians. i want to commend publicly the efforts that prime minister netanyahu has made in very

lengthy and painstaking negotiations with my secretary of state, john kerry, and others. they are tough negotiations. the issues are profound. obviously, we wish they would have been resolved years ago, but i think prime minister netanyahu had approached these conversations with a level of seriousness and commitment that reflects his leadership and the desire for the israeli people to have peace. it is my belief that ultimately it is still possible to create two states, a jewish state of israel, a state of palestine, in which people are living side-by-side in peace and security, but it is difficult, and it requires compromise on all sides. i just want to again publicly commend the prime minister for the seriousness with which he has taken these discussions.

the timeframe that is set up for completing these negotiations is coming near, and some tough decisions are going to have to be made, but i know regardless of the outcome, the prime minister will make those decisions based on his absolute commitment to israel's security and his recognition that ultimately israel's security will be enhanced by peace with its neighbors, so, mr. prime minister, i want to welcome you again, and thank you again for your leadership. and your friendship with the american people. thank you. >> mr. president, i appreciate the opportunity to meet with you today, especially since i know you have got a few other pressing matters on your plate. during the five years of your

presidency, you and i and israel and the united dates have worked very closely on important issues, security, missile defense, and we are deeply grateful for that. i look forward to working closely with you in the years ahead to address the main challenges that confront both our countries, and the greatest challenge, undoubtedly, is to prevent iran from the capacity to make nuclear weapons. i think that goal can be achieved if iran is prevented from enriching uranium and deals with its nuclear and military organizations. that goal can be achieved peacefully and through diplomacy. no country has a greater stake

in this, because, as you know, and i am sure you appreciate, iran calls openly for our destruction, so i am sure you appreciate that israel cannot permit such a state to have the ability to make atomic bombs to achieve their goal. we just cannot be fought back to destruction, and as the prime minister of israel, i will do whatever i must do to defend it. we will also discuss the peace process, as you said. i want to thank you and secretary kerry for when i say tireless efforts. i mean the tireless efforts that you are putting into this. it is an opportunity to

congratulate secretary kerry on the birth of his new granddaughter. the new granddaughter came to secretary kerry while we were discussing bp stocks, so we have had many productive meetings, so i thank you both and your teams. the 20 years that have passed since israel entered the peace process have been marked by unprecedented steps that israel has taken to advance peace. we have a gated -- vacated cities. we have not only frozen settlements, we have uprooted entire settlements. we have released hundreds of terrorist prisoners, including dozens in recent months. and we look at what we got in return, it has been scores of suicide bombers, thousands of

rockets on our cities, fired from the areas we vacated, and just incessant palestinian incitement against israel, so israel has been doing its part, and we regret to say that the palestinians have not. no, i know this flies in the face of conventional wisdom, but it is true, and the people of israel know it is true because they are living it. what they all want, fervently, on the streets is not a piece of paper, although that also, but a real piece -- peace, two nationstate to recognize and respect one another and sovereignty on the ground. mr. president, you rightly said that israel, the jewish state, is the realization of the jewish people's self determination in our ancestral homeland.

so the palestinians expect us to recognize a palestinian state for the palestinian people, a nation state for the palestinian people. i think it is about time for them to recognize a nationstate for the israeli people. we have only been there for 4000 years, and i hope, president obama, that you will look at the genuine is really security needs, because as you know, and i think everybody does, in the middle east, which is definitely one of immersed -- one of the most turbulent and violent parts of europe, what we need is a peace we can defend, and what we know from jewish history, but i think from general history, the best way to guarantee peace is to be strong, and that is what i think the people of israel want us to do, to stand strong to secure the future of the one and only jewish state, and it is a

partnership, a partnership between israel and america, which i think is important. i want to thank you again for your friendship and your hospitality and the work you show me on this snow we washington day. thank you. it is good to see you again. >> threatening against russia for their efforts in ukraine, does not seem to be having much of an effect. is the u.s. concerned primarily about getting russian forces out of crimea, or is it about eastern ukraine? >> all of the above. i spent the weekend talking to leaders across europe, and i think the world is largely united in recognizing that the

steps russia has taken are in violation of ukraine's sovereignty, ukraine's territorial integrity, that they are in violation of international law, that they are in violation of previous agreements that russia has made with respect to how it treats and respects its neighbors, and as a consequence, we got strong statements from nato, from the g7, condemning the actions that russia has taken, and we are going to continue these diplomatic efforts during the course of this week. my interest is seeing the ukrainian people being able to determine their own destiny. russia has strong historic ties to the ukraine. there are a lot of russian nationals inside ukraine, as well as native russians, as there are a lot of ukrainians inside russia.

they have strong commercial ties between those two countries, and so all of those interest can be recognized, but what cannot be done is for russia with impunity to threaten its soldiers on the ground and to violate basic principles that are recognized around the world, and i think the strong condemnation in has received from countries around the world integrate -- indicate that history feels russia is on the wrong side of this. we support the ukrainian government. john kerry is going to be traveling to kiev to indicate our support for the ukrainian people, some very specific and concrete packages about economic aid, because one of the things we are concerned about is stabilizing the economy, even in

the midst of this crisis, and what we are also indicating to the russians is that if, in fact, they continue on the current trajectory that they are on that we are examining serious steps, economic, and telematics to isolate russia, and it will have a negative impact on russia's economy and its status in the world. we have suspended preparations for the g-8 summit. i think you can expect there will be fallout from that. there is a whole range of issues that john kerry mentioned yesterday. and there is a question for mr. putin, who i spoke to directly, and the question for the russian government generally is if, in fact, their concern is that the

rights of all ukrainians are respected, given the fact that their primary concern is, as they have stated, that russian speakers, russian nationals are in no way harmed or abused or discriminated against, then we should be able to set up international monitors and international efforts that mediate between those parties, that is able to broker a deal that is satisfactory to the ukrainian people, not to the united states, not to russia, but to the ukrainian people, and so we need to be very specific with the russian people about how that might be done, maybe with some other international organization, and john kerry will pursue that further when he arrives, so there are relatively

few paths that russia can take at this point. obviously, the facts on the ground in crimea are deeply troubling, and russia has a large army that borders ukraine, but what is also true is that over time, this will be a costly proposition for russia, and now is the time for them to consider what would serve their interests in a way that resorts to diplomacy as opposed to force. one last point i will make on this. i have heard a lot of talk from congress about what should be done, what they want to do. one thing we need to do right away is to work with the administration to help provide a package of assistance to the ukrainians, to the people and their government, and when they

get back in, assuming the weather clears, i hope that that will be the first order of business, because at this stage, there should be unanimity among democrats and republicans that when it comes to preserving the principal that the country has -- no country has a right to send in troops to another country unprovoked, we should be able to come up with a unified position that stands outside of partisan politics, and my expectation is that i will be able to get congress to work with us in order to achieve that goal. >> senator john mccain says that russian leader vladimir putin does not believe the cold war is over. the arizona republican spoke monday morning at the meeting of the american israel public affairs committee.

this is 15 minutes. ♪ >> thank you very much. thank you for that warm welcome. thank you for those kind words. thank you for not mentioning that i lost running for president of the united states. i thank you. [laughter] after i lost, i slept like a baby. [laughter] sleep two hours, wake up and cry. sleep two hours. [laughter] i'm very happy to be with you. [applause] and did i mention i asked your sympathy for the families of the state of arizona as barry

goldwater ran from arizona for president of the united states, morris udall from arizona ran for the president of the united states. arizona may be the only state in america where mothers don't tell their children that someday they can grow up and be president of the united states. [laughter] so i ask your sympathy. i noticed that the conference was introduced by my dear and beloved friend, joe lieberman, the finest man i have ever known in my life. [applause] and joe and i travel together extensively for many, many years, literally every corner of the world. just prior to joe's leaving the senate, there was a wonderful dinner at the israeli embassy for joe, and all of the important people in washington were there. and there was speaker after speaker after speaker extolling his virtues and records and the wonderment and beauty of joe

lieberman, and all of it was true. when i was the last speaker. i said, look, i'm not going to tell you about joe lieberman. you've already heard it. but i have an announcement to make. i have spent all of these years with joe lieberman, eating salmon, writing the shabbat elevator, not being able to ride in a car on saturday. [laughter] i've had to go through all of this all of these years and i've gotten none of the benefits, so i'm announcing my conversion to judaism. [applause] and joe said, that was great. only, i had to have a brisk. so i change my mind. [laughter] i thank all of you for being here trying to do the lords work in the city of satan. [laughter]

and the snow may have shut down the government, i'm -- but obviously, it can't shut down aipac. [cheers and applause] as a by the way, in case you missed it, only 12% of american will approval for congress. we are down to paid staff and blood relatives. [laughter] in my mother is 102 years old -- [applause] she called me the other day. we are now down to paid staff. [laughter] so you shall i really do come to you this morning with a heavy heart, with a heavy heart and great sadness because of events taking place in ukraine. and what happens in ukraine is directly related to what happens in the middle east, and obviously we know that what

happens in the middle east is vital to the existence of the state of israel. i'm not going to go through the history of ukraine with you. but the fact is, crimea is a sovereign part of a sovereign nation of ukraine. and the people of ukraine, by the hundreds of thousands, went to a square in subzero inc. -- subfreezing weather saying they did not want to be part of putin's russia. and that is what it was all about. now that the olympics are over, immediately afterwards, we now see the occupation of crimea. and by the way, in case you missed it, one of the reasons why there is a majority population of russians in crimea is because stalin exported all of the tartars, and the fact is that over half of them were killed as he drove them from crimea. the fact is, this is a blatant act of aggression on the part of vladimir putin and one that must be unacceptable to the world community. it cannot stand.

[applause] and i have to be very honest with you. there is not a military option that could be exercised now. but the most powerful and biggest and strongest nation in the world should have lengthy of options, and those options are many, ranging from identifying these kleptocratic, these corruption people, and the people who ordered the magnets --magniski act. it could be their last trip to las vegas. there is a broad array of options. why do we care? because this is the result of an infections -- infectious foreign policy where nobody believes in america's strength anymore. [applause] [whistles and applause]

in 2009, many of you may remember that we saw on youtube, young woman bleed to death in the streets of toronto. -- tehran. people were saying, obama, obama, are you with us, or argue with them? and you know what? the president of the united states did not say a thing. the president of the united states believes the cold where -- cold war is over. that is fine. it is over. but putin does not believe it is over. he does not believe this is a zero-sum game. look at month-old, the occupation of georgia, the pressure on the baltic -- look at multiple the, the occupation of georgia, the pressure on the baltic nations.

look at what is happening in cities and towns and the countryside all over syria. it is an outrage. and vladimir putin -- vladimir putin, while he is cooperating with us in the removal of chemical weapons, plain after playing of artillery and tanks and rocket are landing at the airport in damascus, slaughtering innocent people. i will tell you, it's hard for a mother to differentiate whether their child has been killed by a chemical weapon or one of these horrible barrel bombs that are basically cluster bombs that are being dropped on innocent civilians all over syria. and we have sat by and watched it happen. and if bashar assad prevails, it will directly endanger the security of the state of israel. it has now turned into a regional conflict. lebanon is destabilized. what do you think 5000 hezbollah fighters will be like when they return from the fighting in syria to southern lebanon?

what do you think is going to happen if bashar assad used to prevail, as far as the other nations in the region are concerned? jordan, probably our best friend, is destabilized. the whole situation cries out for american leadership, and i'm sorry to tell you it is mia. let me also -- [applause] by the way, a couple of my favorites. tell vladimir that i'll be more flexible when i'm reelected. tell vladimir i will be more flexible when i'm reelected? there is difference of opinion even amongst our dear friends as to whether sanctions should be passed by the congress of the united states is the talks fail.

and my argument to you is, do you believe in light of recent events of last five years that the iranian mullahs think we are serious? i do not think so. i don't think so. i don't think so. i believe the iranian people can have access to peaceful civilian nuclear energy, but that does not require an industrial uranium enrichment program. it does not require a heavy water reactor. it doesn't require advanced centrifuges, and it certainly does not require nuclear facilities dug deep into mountains. [applause] i hope as you do that we can find a peaceful resolution to this crisis, and the only reason there may be a modest chance for

that now is because of your tireless efforts and support. thank you and god bless you for your tireless effort and support. [applause] i believe we have to keep the i believe we have to keep the pressure on. iran's rulers must know the only alternative to compromising on our terms is even more crippling sanctions or worse. that is why i believe the senate should pass a new bipartisan sanctions legislation that would take effect if the current negotiations do not succeed. [applause] we must stop iran from developing a nuclear weapons capability, and we must do so because the nature of the threat posed by this iranian regime. it is not an arms control challenge. the iranian revolutionary guard is in syria slaughtering people today. they are training these