someone the system failed this is long overdue. and also this comment from david munoz. take away the medical side and contract it out to a proven health system. the government hasthe governmens not capable of delivering quality care in the least amount of time. list for long waiting treatment. you can offer your comments and react to today's veterans affairs committee hearing. a final call will be bill. villas in tucson, arizona. military family. we had excellent service from the v.a. in new york. faced duringt i accuracy was they decided not to allow veterans of rejoin theeight to v.a. system. >> what is a category eight?

>> you were not actually wounded during a war. during aa veteran period of time, but you were not in a war it self. >> i am a veteran era that. i was disqualified for three years. president obama came in and congress changed and allowed us to get in again. >> the thing that was not brought up this morning is that most people -- on medicare. medicare pays up to 80% of your bills. , if they want to go private with this, they should allow you to go to medicare and have the v.a. cover the 20% that is not covered by medicare. i think that would solve a lot of the delays. >> how about the tri-care system? >> my mother was on that. it was excellent.

the two,u combine >> youe and medicare can. i am not sure they pay for each. i believe the v.a. system takes out of medicare if you are on medicare and not be other way around. >> thank you for your calls. yourk you to continue with comments, suggestions, and reaction to today's hearing. viacan send us your tweet c-span chat. another senate hearing coming up. it is over e-cigarettes and other new tobacco products. prohibiting the sale of e-cigarettes to minors. that hearing is set to begin in

about 15 minutes. we plan to have live coverage of that for you here. right now, a discussion on the challenges facing iraq facing the most recent elections from this morning's washington journal. >> joining us now, the iraqi correspondent. how did elections go? >> they went well. we have to remember they are pretty low expectations, so going well means a substantial number of people voted. voted. there weren't a lot of attacks, which is what everybody was looking at. it was quieter than a normal day. national elections, the first in four years -- a controversy real that controversial prime minister looking for a return.

the kurds wanting independence, increasing violence, and incredible poverty. problems and not a lot of hope that elections can fix them. host: where does the work go on from here you go guest: they are still telling -- still counting the ballots. they make a critical bid to put together a coalition. no party has won enough seats to win a majority. a lot of tough bargaining. last time it took him eight months to come up with the government. the primet four years minister has made a lot of political enemies.

how much can you contribute to security forces and things in iraq that are there for security? i would say you can attribute some of the security to security forces and some of it you can attribute to lock. to be painfully honest, the security forces are not in great shape. they're using devices that have proved not to work. really have the ability to launch investigations. obtained --ions are many concessions are obtained through the use of torture rather than investigations. frameworkot a strong of security in the country, particularly in baghdad. host: over you try to tackle with this story? all thessentially strains and divisions that were

there since saddam hussein was toppled in 2003. there was a belief that we get rid of a dictator and we have a brand-new country. we found out that is not that easy. later, all decade those divisions are really widening and not in a way we would have thought. it is not just the kurds versus central government. it is sunni and shiite, it is sunni parties. it is really fraying the fabric of the country. host: here is a map. a point is out the points we should pay attention to. they are now a semi-economist country. againstthey rose up saddam hussein and did not

manage to break away. they did manage to carve out a semi-autonomous region. they're still dependent on iraq he government money. he killed his army in a campaign against the kurds. massive destruction, demonstrations. that is the region that is thought to have been most likely to break away. down and goes north as iraq, that is the sunni area that has had a substantial portion of she is -- of shiites. religious andt of ethnic minorities.

ae governor is advocating separate region of sunnis allied with the kurds. it is not the sunni shia thing. they are saying we don't have clean water, we don't have power a lot of time, why should we main -- why should we remain part of iraq? we will remember the name from the war when american troops were there. marines fought one of the most bitter battles of the war. ift city is at war with iraq government forces. they say it is a war against terrorism with the islamic state of iraq. a lot of people say it is not a war against terrorism. those are the big flashpoints but not the only ones.

what is the worst-case scenario? guest: the worst-case scenario is to have multiple weekend state in the region. you have the gulf which is sunni arab and has been dramatically opposed to shia led government. still there is that attention. syria is imploding. that border where suicide bombers came, that border is open again. battle hardened iraq is coming to launch attacks. going to fights with syrian regime forces. it is a very delicate balance and a complicated region,

especially when you throw in iran and turkey. host: you can ask her questions on one of three lines for democrats. that's on one of three lines. for democrats -- if you want to send your thoughts via twitter, that is @cspanwj. potentialthe fracturing of iraq, what does it mean for u.s. policy echo are there still policy concerns? guest: this is a country that could contribute to destabilizing the region in the same way the united states thought toppling saddam hussein would help stabilize it. it has got huge oil reserves. it has a huge army. destabilized or

devolved into weekend states with fighting along the edges, that could actually spill over even more into the rest of the region. scramblingtration is to figure out what to do. for a long time they wanted to believe that it had gone away, that at -- that americans could stop thinking about iraq. it is still a huge potential problem. the leverage has declined. there is the diplomatic leverage, which is questionable. a there is certainly the leverage you have when iraq wants to buy billions of dollars of your weapons. that is a powerful incentive. a lot of those weapons are being .sed in falluja

derek he government is showing -- the iraqi government is showing the outskirts. from our first call comes bernie in columbus, ohio. caller: good morning. i'm a vietnam veteran but i work a lot with iraq he veterans. i am deeply concerned that this iraqme of division within is falling along the same lines , in thated in vietnam indochina was terribly disrupted after the united states troops left that area in 1973. now we have a similar situation. i am curious, do you think it will be another 10 or so years bordersption within the that will finally been resolved and have some reconciliation with united states so that could

trade and good options can possibly come out of it? guest: that is a great vantage point. it will take a long time. possibly not even 10 years. maybe generational. what is left in iraq is a country without a lot of functioning institutions. pretty much everything there has been broken. backdrop ofnst the , ofence in the region incredible corruption, of a lot of sectarian sentiment. a lot of people still leaving the country. iraq ease are still arriving because they do not have hope in their country. it will take a long time.

host: and -- a question from twitter. guest: it depends on where you as an individual are coming from. whether your individuals -- whether your family was killed or imprisoned by saddam hussein, whether they were killed by american forces or whether you lost people last week or last month in an explosion. i think the only thing you can safely say is iraq has the possibility to be a better place for most of the citizens. that possibility hasn't translated yet into reality. host: sally is up next from fort lauderdale, florida. i think it was one of the biggest mistakes we have made in our lives, jumping into that war with no real reason to do so. aside from that, do you feel

-- do you think iraq, compared to when saddam hussein was their, keeping the peace at least, do you think there really better off now? we need something from this catastrophe that we have caused. guest: the good that has come out of it is the possibility that the country can be put back

together again. it will never again be what many iraqis believe it was, which was despite saddam hussein, a country where people do not have to worry about walking out the door and being blown up on the way to work. it was a country where it didn't matter quite so much on a day to day this is whether you are sunni or shia or christian. must iraq is would not trade for a second having saddam hussein back. host: we heard about the ability of electricity and water. hasn't it changed since then? iraq ease are getting electricity almost all the time, which is very good news. it's those other things combined the lack of security that

are leading to a very fragile nation. there's almost no job creation. half of the people work for the government. amounts of oil revenue. it just doesn't trickle down. streets, trash in the there are kids working in the street because they can't afford to go to school. there is little access to clean water. has the leasthat amount of clean oil reserves in the world, that it has the most amount of clean oil reserves in the world, the kids are not

getting enough to eat. the u.s. is one of the buyers of iraq he oil. it helps stabilize to some extent. it benefits a lot a certain segment of the iraq he state. that keeps programs those bloated bureaucracies. it also benefit the ability to buy billions of dollars of united not just for the states but russia and other places. it bodes well for the future of iraq that oil money is not enough. oilhave to come find that money with a government that is not corrupt. on theere is rick independent line. caller: good morning. know -- [indiscernible]

it was created without any regard for sectarian nature of the country as several countries in the middle east were. you can tell that by the straight lines of their borders. democracy.had a they were ruled by kings and military dictators. what, in your opinion, is the future for a country that is so divided in its loyalties to tribes and to religion? is there a possibility the country will revert back to being a dictatorship with a strong central government able to hold the country together in peace because the people simply disaster theyhe have right now? guest: one of the problems was

essentially throughout the years it has been created on the basis of a sunni leadership. sunni arabs did have major positions of power. that is why the shia led government sees this as a struggle for survival. really to create a foundation for a state that is at all democratic, that has freedoms, a youmum number of freedoms, really need to instill a sense, you need politicians that have the since they are iraq he first. things are so threatened that you don't get that. politicians identify themselves as being sunni or shia or kurdish, there are policies that spanned all of those. now with security so bad, when people went to the polls they were voting on security. they were voting for shia candidates if they were shia.

the kind of fallback on that and i think that will be the case for a while. host: jolt from washington, maryland. you're on the line. caller:. on whatant your opinion are the benefits of america such notwhen it did on stable evidence. we went in and district some of we alwaysorking considered any country outside of europe as being dictators. guest: i guess one of those is the definition of a dictator really is are there checks and

balances that will keep a person from assuming absolute power? it is not so easy to become dictatorial. in the middle east it is much more easier. we have seen in the past couple of turns is people believe a weakening of the powers of parliament. for instance if parliament wants to hear from a defense minister they would have a hard time. first because there is no defense minister. it the prime minister is acting defense minister. cannot get a military official to brief them. he has created a system where a lot of the military, top military institutions and intelligence institutions answered directly to him.

that would be much harder to do in europe. it is a case of you have the system, does it actually work? in iraq it is not working. host: what they say themselves it is not working? guest: i think it is one of the few things that everyone agrees on. even in a system that is not of peopleou get a lot who benefit from the fact it is not working. if you consolidated power and you have that power in your hands you probably will not give it up quite that easily. that is why this postelection time is so important and why it will be so messy. >> what is the perception of the united states in iraq these days? guest: it is interesting. warvet iraq from before the and during the war. when there was no electricity and no clean water, when there desk ins in the three's the streets they blamed

everything on the united states. the united states is all-powerful and they can fix things if they wanted to. they can bring electricity if they wanted to. what they do blame the united states for is coming in and -- and saddam hussein toppling saddam hussein without a plan, or at least a plan that fit the reality of what iraq was. they want to be friends with the united states. they want to be friends with pretty much everybody. you will see a lot of people try to get the united states still. one of the places they're coming to is the u.s.. host: our next calls come in from texas. caller: there were a group of iranians that helped with -- helped americans. i am wondering what their status is.

it is such a complicated story. it was a group fostered by saddam hussein. their role was to topple the iranian government. they were invited in by saddam hussein, given a camp and heavy weapons. when saddam was toppled they were temporarily put under u.s. protection. sad and troubled and complicated story since then. their major campaign's been shut down. there have been attempts with directly government forces to shut them at camp. in doing so dozens of people appeared to have been killed in the incidence by iraqi security forces. the problem is other countries won't take them. people who belonged to an organization that does have a lot of cultlike ax specs --

cultlike aspects. it has been problematic trying to figure out what to do with them for the international community, for the united states, for the united nations. they want to be able to resettle them but it is proving very hard. host: al qaeda, is still a presence or issue in iraq? guest: it has moved into the islamic state of iraq and syria. it is still fundamentally the same ideology. the thing about al qaeda and iraq is they have taken control of some of those cities. i was with the u.s. marines when they were fighting al qaeda in falluja. the entire city had been taken over. there were houses rigged to

explode. the u.s. put in more troops during the military surge and they managed to drive al qaeda out. near the syrian border. then they came back. there is a security vacuum. there is not an effective security force. there isn't a counterinsurgency campaign in the sense that you would need. some of the tribes have begun reverting back to working with al qaeda because they feel it is the only option. they claim responsibility for most of the suicide bombings and most of the bombings that are detonated. host: birmingham, alabama, this is sean. go ahead. caller: my question is about the economy of iraq. in the u.s. dos

business with the middle east. i know espn is opening a business in yemen. guest: the iraq he currency has been pretty consistently trading in the same range. there is no indication that it will dramatically train -- dramatically change. there is a lot of opportunity but it is very difficult to do business. huge influx of companies doing business. a lot of big american companies are coming in but it is really quite cold, still. host: what is the reporting like ?here

guest: it is fascinating if you are willing to tolerate a bit of risk. you have to be even more careful than you did in the past. elections ip to the was covering one of the major rallies of the shia party that was a breakaway party. three suicide car bombs went off, three suicide bombings went off in the parking lot as we were covering it. it becomes the kind of thing where you really have to make the decision if this is so important that you should be there. it was the party's first foray into politics. in retrospect you really have to think hard about where you are going and what you are doing. it is still so hugely important. we need reporters there. we need reports coming out of there. on every level they are fascinating and compelling that are important to the united states.

a source ofraq have independent media? guess, there are incredibly -- guest: there are incredibly brave and porters. you run the risk of being ,rrested, put in jail disappearing. that still happens. journalistsill many who try to report credibly. there are hundreds of television stations and media type to businesses and political parties. caller: good morning, what is the approximate number of meant -- number of -- since we invaded? guest: it depends on how you

defined fatalities. other organizations are tracking civilian deaths. they seem to be 1000 per month. it is not as bad as it was during the sectarian violence when there were bombings in the streets every day and there were upwards of 3000 civilians being killed every month then. if you look at the total is up for debate. it depends on how you find violence. that's how you define violence. one thing that has stood out is the reluctance of the united states took knowledge the extent of the people being killed. the we were covering military in iraq, when the military was essentially in charge, u.s. military said we would not track civilian deaths. how could they not to? it is a huge indicator of how well they are doing. they changed that line later on and they began to acknowledge that large numbers of people were being killed. exact numbers are up for debate.

certainly tens of thousands is a conservative estimate. i just wanted to ask you if you see any hope in any of the transnational collaborations that are going on? they seem to be doing some pretty effective state building there. given the arbitrary nature of some of these national lines, i just wanted to see if you see any hope there. guest: do you mean bringing in syrian kurds? was under the assumption there was collaboration between the kurdish government and the kurds in syria. guest: there is some collaboration. it is a complication -- it is a public and picture because there are factions fighting in that region of iraq.

president things the as the most do powerful unifying kurdish figure -- as you know there are kurds in iran, kurds in syria, kurds in iraq. but it is only in iraq that they have managed to run their own province. in many syrian refugees but it remains to be seen what happens on the other side of the border. >> life figures from a senate hearing room this afternoon or a senate health committee is about to be to hear testimony on the .egulation of e-cigarettes the fda is proposing new legislation on them another products. state legislatures and advocates

according to politico. hearing was scheduled to start about 15 minutes ago at about 2:45. the senate is holding a series of votes on a number of judicial nominations and a package of tax credits. you can see the senate live on c-span two. we will have live coverage of the hearing when he gets underway. some news from earlier today out of the senate -- republican senator lindsey graham released a letter signed by 37 senators pressing for harry reid to establish a senate select committee to investing the -- to investigate benghazi. we ask you to reconsider the decision not to create a similar committee in the senate, wrote the senators. start ofiting for the this senate hearing on --ctronic figure at

electronic cigarette legislation. as we wait, discussion on the 300 girls abducted in nigeria. ambassador, thank you for joining us. >> thank you for having me. >> can we start off with what the u.s. has contributed so far for this search and what do you think about not only what we have contributed, but couldn't go further? we have, along with the british, the french, and israelis, offered to provide the nigerian government with assistance. the nigerian government has responded favorably. present, there is some intelligence sharing going on according to the media.

the u.s. surveillance equipment is being used in northern what's more important is there is an interagency team now on the ground consulting with the nigerian government about what it needs and what we can provide. it has to be borne in mind that though this has now become an , leadershipl event rests firmly with the nigerian government. nigeria is a sovereign state. outsiders can operate their only at the request of the nigerian government. as far as diplomatic efforts are concerned, what goes on now from someone currently in the position you formerly served in? is the would be going on

members of this team to which i referred would be talking to their opposite numbers within the nigerian government to work out a kind of strategy, to work with we -- which we would attempt to honor. >> susan rice talking here yesterday in d.c. about the resources committed i the united states, here's what she had to say. obviously, job one is to try to find them. they are missing in a search area roughly the size of the state of west virginia. that's a large territory. the united states is very active and we have a team of up to 30 people on the ground cooperating very closely with the nigerian government. our team consists of diplomats,

andtary advisers, experts law enforcement and development experts coordinating with the nigerian government and representatives from the reddish french government and israeli government, all of whom were there in search of the girls. fighting -- also applying aerial assets to do what we call intelligence surveillance and reconnaissance over a large area so we can maximize the resources devoted to trying to locate the girls. >> you heard the national security advisor talk about the current resources, what about actual roots on the ground? should it go that far? >> to even contemplate that would require an invitation from the nigerian government.

whether such a request would be forthcoming. the national security adviser has it right when she points out the territory involved is comparable to the state of west virginia. it is a huge area and i think she's also right that the first thing that must be done is to locate the girls. , locating the girls is only a first step. rescuing kidnapped victims in the area is difficult. often, the kidnappers murdered their big the him when there is an effort to secure their release through force. what made mitigate that threat somewhat is the kidnapped

victims who have been murdered up till now have all been males. the groups generally appear to be reluctant to murder females. about theked invitation from the government to do more. we have folks like senator john mccain here in the united states saying if it were him calling the shots, special forces would be part of the strategy to rescue the girls. >> that is extremely tricky. ofs extremely tricky because a widespread narrative in nigeria that the united states is at war with islam. in fact, a military presence in northern nigeria will be seen by many through that particular deck.

that of course would be counterproductive to rescuing the girls will stop -- rescuing the girls. >> does that complicate wings as far as africana -- as far as africom. >> the african command is not physically present in africa. it sends assets to africa as required and almost certainly they have contributed to the personnel, the american personnel now in nigeria. yes, they are viewed with suspicion by many in west africa . they are seen as part of the network.m

>> our guest is with us to talk about the u.s. effort in nigeria and take your questions on it. you can tweet us your thoughts or send us a thought on e-mail. first call is from craig on our independent line. you are on with ambassador john campbell. >> good morning. i want to appreciate the effort to help the people in nigeria but this situation you are not going to solve overnight stop the reason why is because boko haram it not just come from

nowhere. they are a sponsorship in that country. talking about how they are going to free the girls, but nobody is addressing the issue. everybody know that. out toeral just came criticize boko haram. i'm telling you come you could stop this nonsense overnight. >> is ahead will stop widely believed in the southern part of nigeria, particularly amongst nigerians who are christian that there is kind of a relationship or sponsorship

between boko haram and certain northern political figures. would point out in northern nigeria, it's frequently said there's a relationship tween the jonathan government and boko essentially the jonathan government wants to make the north ungovernable before the 2015 elections. validity to either of these narratives. inc. that boko haram is the conduct of northern political figures and i certainly don't think the nigerian government is in cahoots with boko haram. the existence of these two narratives however, tells us something about the widespread this trust that has only exists

reason -- amongst the amongst the regions that make up amongst the two major religions, islam and christianity, and the distrust many nigerians feel for both the federal government and the state government. deadly from mississippi on the democrats line. >> good morning. been reported in the media numerous times that these girls are for sale for $12 american. think we should make some formpts to purchase them $2400 and return them back to i'me they belong and wondering what would be the possibilities in the real world of this.

>> i'm afraid not much. viz. rhetoric has been somewhat contradictory. initially, the warlord who essentially holds center stage in this particular episode first talked about selling the girls as it essentially brides to his own operatives. subsequently, he's talked about using them essentially as a tool to extract boko haram prisoners being held by the nigerian government. the girls have become an extremely important political pawn in the struggle between

boko haram in the united -- and the nigerian government. toon't think it's feasible talk about outsiders going in and essentially ransoming them, though i wish it were possible. headline this morning saying nigeria has ruled out an idea of a prisoner swap. is that standard practice? guest: yes, it is. -- prisonerops swaps have gone on the past and may have been covert. the united states on most always opposes this kind of thing and you can sort of see why. a prisoner swap would increase the capacity of local rom to make war on the nigerian state because the number of operatives it would have would increase.

swap would prisoner certainly be followed by another round of kidnapping because kidnapping is shown to of work. usefulway, it might be to note in passing that there are more girls being held than kidnapped. the kidnapping of girls is ongoing. small buts are quite if you add them all up, it's a significant number. host: here is gary from st. charles missouri on the republican line. caller: good morning. your heart goes out for these girls, but this is not something new. it's been going on all over the

globe. we've had people being killed and murdered in so many third is just partes and of life. there's nothing you are going to do that. you can't waste lives trying to stamp out these old fires all over the world. that's not our job. these countries had to come in to lay on their own. let them do what they want to do in the country and forget about it will stop -- forget about it. thank you for that comment. i think resolution for the kidnapped girls in nigeria is very much something the nigerian government has to take the lead on. assist, but the assistance is likely to be at the margins.

it literally has to be undertaken by the nigerian yes, therewill stop have been numerous previous example. this magnitude. of adolescent boys were murdered by boko haram. while the magnitude of this episode was greater than what we had seen before, the caller is perfectly correct when he said it did not just jump out of the sky. >> we have a viewer off of twitter who asks you directly what the national interest is in using military advisers to search for these girls. guest: the national interest is

twofold. there's the humanitarian one. carenk americans passionately about the fate of the kidnapped girls and in a democracy, that metals a lot -- that matters a lot. secondly, we have had a long and fruitful relationship with the nigerian state. we have cooperated closely on security matters in the past. this means an attack on the nigerian state certainly impacts on our interests, but not particularly on our security. >> earlier this week in washington, there is an event in

ecma had a forum featuring a nigerian national and told her stories about the father being killed by the local rom in 2011. here is a bit of that. at 7:30, three men knocked on the door and my brother opened the door for them. they asked where her dad and i said he's in the bathroom taking a shower. so they waited about three minutes and then they dug him out of the bathroom and he said he's wasting their time. so when they take him out of the bathroom. he told him they're going to kill him if they did not deny his faith. die thane would rather go to hell fire.

so my dad was here and they shoot him three times in his just will stop >> that was part of the story but it goes to the religious tensions in the state itself. >> it does indeed. tragedy there is so beh killing that seems to based on religious allegiances. it should also be borne in mind that sometimes religious allegiance -- religious allegiances correspond to ethnic or tribal identification. corresponds toso how land is used. country,nter of the areflat toes state, there farmers. fight

is the murder taking place because of religious, as is the, or land-use or is it taking place because of all three? >> if you are interested in more on this issue, there's a hearing on africa live today on c-span3 at 10:00. go to our website for more information. joining us is ambassador don campbell. samuel from texas, go ahead. morning ambassador and good morning c-span for taking my call. nigeriathe problem in in regards to the american role in the kidnapping is corruption. nigerian troops seem to have been fighting in different peacekeeping interventions, yet they cannot deal with boko haram. to stopld america do

the politicians meant for security. >> certainly corruption is a huge issue. nigerians resent the amount of corruption to be found in official circles. something like a quarter of the nigerian budget is supposed to to the military and security services to respond to boko haram in the north. and yet, there are repeated reports that boko haram is able to out gunned them, that that they have superior weaponry.

oft leads to the question the money being appropriated. the issue of what the united states or any outsider can do about such a profoundly internal and domestic issue as corruption is difficult to say. we have actively supported such as those by transparency international and have actively supported nigerian toups that have been working counter corruption. and again, corruption is primarily an internal nigerian matter. next holler from baltimore maryland identify as a a jury in american.

i would like to talk about the issue of boko haram. politicians doing it because these guys don't have money. somebody is the one giving them all the money for the weapons. i look at the governors of the state and they can never be trusted. [indiscernible] host: let's get a response from the ambassador. guest: as to where boko haram thisits money and weapons, is shrouded in mystery as are

all aspects of boko haram. but nevertheless, it is possible boko haram largely finances itself through bank robberies, largely arms itself by stealing armories, the thing about terrorism, particularly the kind of terrorism boko haram is involved with this it doesn't cost much money. car, you load up with explosives, you attach a atonator and park it outside building or target. not a whole lot of money is required to do this. why i tend to find allegations that boko haram is fromving funding either

politicians or other personalities or from groups outside of nigeria. it is less than credible. >> you were asked the question off twitter this morning, why isn't nato handling this? is --guest: this is outside nato's normal area of operation but i have to go back to the final point -- nigeria is a sovereign state. nigeria to request assistance from nato, that would produce another set of circumstances in how nato would respond, i have absolutely no idea. has nigeria not done that, i would not anticipate it would do so.

general plead a for assistance in which the u.s., the french, the british and israelis have responded. efforts are underway to determine what the nigerians need and want and what can be provided. as the national security adviser has pointed out, some of that process is already under way with aerial surveillance, but these are still early days yet. james from bronx, new york, democrats line, go ahead. caller: good morning, ambassador. i think the main supporters of these extremist ghouls like -- -- mys like boko haram solution for such action is to

change our policies towards saudi arabia and those others who are supporting such criminals. thank you. --t: i would point out guest: i would point out that religious leaders in saudi arabia had denounced boko haram violence and kidnapping. ambassador, a couple of things. thoughts on the first lady holding up the sign reading #bringbackourgirls. i think the first lady was expressing through social media a feeling that is widespread amongst americans. that, after all, is a rule of a first family -- to express publicly the deep-seated

american people, and that's what she was doing. she was doing it through a relatively new medium, but one which is of increasing importance. there are that ongoing demonstrations by nigerian women calling on the nigerian government to do more. these demonstrations appear to means of social media. this is an increasingly important dimension to everyday lives around the world. thought on foreign policy, the sugars to critics of former secretary of state hillary clinton, why she did not label boko haram a terrorist group.

was one of those amongst perhaps 20 who signed a letter to secretary clinton urging her not to designate boko haram as a foreign terrorist organization. the arguments that we made then, . think, are still valid if you look at the legislation, it basically does two things -- it restricts the ability -- in fact, denies the ability of boko visas toerence to get go to the united states, and it also blocks the transfer of funds from the united states to a designated terrorist organization. , it iscase of boko haram hardly imaginable that boko going toratives are

show up at the american embassy and request a visa to the united states. as for assets, i have seen no evidence that there are any boko haram assets in the united states to be transferred to nigeria. essentially, designation is irrelevant under the terms of the law, but it goes further than that. what designation also does is it essentially bans contact between private americans, to say nothing of a book once, and the designated organization. and yet, it is easy to foresee at some point in the future where it might be useful for a private american to enter into

some kind of dialogue with boko haram as part of a larger settlement. what designation does is it of thatlly deprives us possibility or that opportunity. therefore, in effect, it reduces the tools that we have to address the particular problem. that's why i oppose designation. and it is why i think secretary clinton was correct. i would add that at that at the time, designation was also opposed by the nigerian government. >> our guest has been ambassador john campbell, former ambassador to nigeria -- hearingve convened this to examine the state of tobacco use and regulation in the united states, both the extraordinary public health efforts that have driven down tobacco use and the enormous challenges that remain.

our nation has made remarkable progress in the 50 years since the first surgeon general's report on smoking and health. in that time, the smoking rate has been cut by more than half, from 42% to 18%. we have learned what works from smoke-free workplace is to access to free cessation services, from meaningful tobacco taxes to robust regulation, from 80 a campaigns like the wildly successful tips from a former smoker to common sense marketing restrictions -- from media campaigns like the wildly successful tips from a former smoker to common sense marketing was churches. despite that, tobacco or means the number one preventable cause of death in the u.s. 5.6 million kids alive today will ultimately die from smoking. one in four high school seniors smoke. most young smokers become adult smokers. the problem is not just

cigarettes. last fall, the center for disease control and prevention reported that the use of electronic cigarettes or e- cigarettes -- i will have more to say about those after a bit because i have an array of them -- the cdcp here reported the use of these electronic cigarettes among middle and high school students .ore than doubled in one year it is because of statistics like these that public health efforts to combat tobacco have been among my top priority since i came up here. in responding to the hundreds of thousands who die every year due to tobacco use, in 1990 it, i introduction 1998, i introduced the first, hence a bipartisan bill to give fda authority to regulate tobacco -- in 1998, i introduced the first comprehensive bipartisan bill to give fda the authority to

regulate tobacco. more recently, in light of the fact that some 35 hundred children try smoking for the first time each day, i have authored revisions in the affordable care act that ensure every american has access to tobacco cessation service without co-pays or deductibles. also in the provisions i put in on the provision of public health fund, he have invested more than $3 million in community-based public health efforts to curb tobacco use. last month, in front of a big prospect of a generation becoming addicted to nicotine by joinede-cigarettes, i 210 of my colleagues to release a report showing that manufacturers are devoting massive resources to the marketing of e-cigarettes, and their marketing strategies are expressly designed to appeal to kids, so i urge everyone to read that report. i just share one a couple of the many graphics it contains, that is this chart you see up here. it is an animated cartoon videogame through which players

earn e-cigarette coupons to redeem on facebook. kids play these games and get on facebook and can redeem coupons. cartoons, video games, social media, candy flavors. the ones i've got here -- i've got -- let's see -- dummy bear, that's one. that appeals to adults, right? gummy bear. here's one, rocket pop, that has a popsicle on the front of it. .otton candy concentrated nicotine. i've got another one here -- cranapple. strawberry, too. i did not want to leave out strawberry, for crying out loud. it is the same thing we used to see with candy cigarettes. name thing. again, they are pulling out all

the stops to target children. absolutely shameful. a disgusting throwback to big tobaccos label to promote traditional cigarettes to kids before restrictions were in place. i know some believe e-cigarettes are a promising alternative to cigarettes, but hopefully, we can agree these products not belong in the hands of kids. keep in mind, this is a drug deliveringvice, nicotine. nicotine is an addictive drug. that is why i look forward to hearing today from fda about their new proposals to regulate these e-cigarettes and other tobacco products. what is this one called? .herry crush i did not mean to leave that one out, either. that is for the refillables. you can refill them. at any rate, the e-cigarette phenomenon has created a black

hole that has gone on too long. today marks our first examination of that proposal, which has extraordinary consequences for public health. we are pleased to have someone from the cdc office of smoking a public health, a representative from the office of tobacco products to talk about the ongoing public health challenge posed by both. we will also report on the important community-based and regulatory work of those agencies that are engaged in this. i will turn to senator alexander for his opening statement. >> thanks, mr. chairman. welcome to the witnesses. congress passed the law to which senator harkin referred, the family smoking control and prevention act, almost 20 years ago, and it clearly attempts to discourage the use of tobacco products. what has happened since then -- around 80% of adults still smoke cigarettes, but that is down from 20% in 2010. smoking among youth continues to decline. electronic cigarettes has grown

rapidly. the number of adult smokers who tried e-cigarettes doubled between 2010 and 2011. thell hope this mostly on regulation proposed by fda two weeks ago, but i want to first read some statistics about the center for tobacco products. fda spend nearly 80% of the one $.8 billion in user fees collected, more than half of the spending occurred during fiscal year 2013 -- fda spent nearly 80% of the $1.8 billion in user fees collected. there are over 4000 substantial equivalence applications pending for tobacco products. fda has decided on 34 of the the agency has received. i believe these statistics reflect the poor performance, and i think it is important to

call that to your attention. i appreciated being informed .bout the proposed regulation i want to articulate my strong support for the alternative exempting premium cigars from fda regulation. i have some concerns about that, but i will follow up with questions on how that works. the fda regulation should fit the product and the risk .roposed by that product throughout the proposed regulations, fda talks about a somewhat controversial idea of harm reduction. for the 42 million americans who currently smoke, fda should enable companies to find creative ways to reduce the negative health effects of nicotine addiction, not regulate that innovation out of existence. most of the discussion around the gaming regulation and tobacco seems to be about understands, and i there are competing points of

view. , suchublic health experts as the largest nonprofit public-health charity in the nation, to tobacco control, has said, "this could be the single biggest opportunity that has come along in a century to make the cigarette obsolete." that's one view. on the other hand, the director of the cdc has been quoted as stating that "many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes." i would like to understand what research we have done to answer those questions. there are reports from countries overseas that some of these new products do not seem to be a gateway to traditional cigarette use, but we do not know that. we do not know that yet. the purpose of a hearing such as this -- and i thank the chairman for calling it -- is not to presuppose an answer, but to find from experts in our

government what their opinion is and what i would like to know is which of those points of view you subscribe to. here is what i think we all have agreement on -- the regulation should be based in data and on sound science. second, no sales to anyone under 18. any child beginning to use a tobacco or nicotine product is bad for public health. third, manufacturers should register and list the products they make an ingredients they use for the fda. after that, what we need to focus on is the research and what it tells us. i look forward to the testimony. thank you. >> thank you, senator alexander. i know senator white house has to leave shortly, but you wanted to make a quick statement. >> i appreciate the chairman recognizing me for a short minute. we have a couple of representatives here, but i wanted to make the point as a senator from rhode island that there has been some very

important corporate leadership in this area of reducing access to the number one cause of preventable death, which is tobacco, and that comes from cvs company, a headquartered in rhode island. they are a significant pharmacy chain across the country, and the ceo and his management team have made the decision to phase out the sales of tobacco october 1 of this year, and i think that is an important and commendable step, and i just wanted to have that be part of the record of this hearing. >> thank you very much, senator whitehouse. never miss ann, i opportunity to say something when given the opportunity, and since i feel like i have lived with this issue as long as anybody in congress now, mr. zeller, thank you for the job you are doing there.

mr. chairman, i remember when opportunities for harm reduction goal andal -- were the could not be achieved because technology did not allow us to get there. i remember when r.j. reynolds spent several decades and came that i guessoduct was a precursor to some degree of the electronic cigarette even though it operated differently, ,nd esther zeller -- mr. zeller .ou might remember that there became a real opportunity for individuals to use a product that got what they were looking for without a combustible. how quickly we have moved to a point where now harm reduction is no longer a goal. technology allows us to get there. trust me, mr. chairman, we can

work out these things about flavors and all of this. but for god sakes, let's not say we are not going to let technology play part of the process of taking more americans off of using combustible tobacco .roducts i look at the pool that was cameable to us when gum out. we were ecstatic because this gave the ability for some people to break the cycle of combustible tobacco products. then the patch came out. not everybody could do the gum. not everybody can do the patch. now we have electronic cigarettes. rather than kill this before we know what we've got -- let's do the science. i think mr. zeller is attempting to do that. i know the job in front of you. i know the statutory requirements. let's not condemn the -- where

the technology has gone before we have ever had an opportunity to see what effect this can have on pulling people off of combustible tobacco products. i hope the fda puts as much stock in harm reduction and how we get people off of something that is not as safe to a product that is safer. this is, for some people, it is not eliminating -- in some cases, it is illuminating a product category. it has been for 20 years, and nothing has changed today. that's fine. as long as i am a member of the committee, i will fight for the american people to have a right to make a choice. , it is determined -- to determine what those choices will be within reason. i encourage you to continue the job you are doing. policies reflect an opportunity for the american people to make a decision based

on what technology is available, to choose a reduced harm product , which, i think, many of the categories we see today are beginning to move towards. i thank the chairman. >> thank you, senator. >> dr. mcafee is a family physician who practiced for more than a decade and served as a clinical faculty member at the university of washington family medicine and school of public health -- dr. mcaffee. he also authored the world health organization tobacco quit line manual for low and middle income countries. thank you for being here. after dr. mcaffee, we will recognize mr. zeller, the director of the center for tobacco products, where he leads

the fda efforts to reduce tobacco use and to develop regulations for a variety of tobacco products. mr. zeller has been working on fda issues for more than 30 years. he served as associate commissioner director for fda's first office of tobacco programs. prior to rejoining the fda in 2013, he worked on tobacco control as executive vice president vice president of the american legacy foundation and as senior vice president at penney associates, and we thank you for being here. both of your statements will remain part of the record in its entirety, and we will ask if you could just summon up in just five minutes or so. we would appreciate it, and then we can get into a discussion. welcome.ee, please proceed. >> thank you very much. it is an honor to provide this statement to you. i want to thank the chairman for his leadership and also

recognize this committee's bipartisan history of support on tobacco control. the director of the office on smoking and health at the centers for disease control, ad prevention, and i am also physician. today, i will discuss briefly the past, present, and future of tobacco control, drawing on findings and recommendations thearily rubbed -- from 50th anniversary surgeon general's report on tobacco use and public health. couldo companies advertise everywhere including tv, and schoolchildren carried lunchboxes with cigarette company logos. smoking was common in public places. today, the landscape is already dramatically different. adult cigarette smoking has fallen from 42% in 1965 down to 18% today, and tobacco prevention and control measures saved 8 million lives over the last 50 years. today, half of our states

prohibit smoking in workplaces john's and bars, and on tv, we now see the real consequences of smoking through cdc's tips from former smokers campaigns. these ads show real people fighting serious disease and disability. despite enormous progress, everyday, children under the age of 18 smoke their first cigarette. smoking-related deaths approach half a million a year in the united states and another 16 million americans smoking -- suffer from smoking-related disease. the surgeon general's report concluded that tobacco was initiated and has been sustained by the tobacco industry, which deliberately misled the public on the risks of smoking. in addition to make their product powerfully addictive, the tobacco industry spends nearly $1 million an hour on promotions. they are developing products such as fruit and candy flavored

little cigars and electronic cigarettes. little cigars, which are similar in size and shape to cigarettes appeal even more to use than adults because of their flavors and lower prices. showedes to our surveys the sponsors among non-hispanic black didn't in 2012 was nearly double the rate of 2009 and cigarette use among 12 graders surged in recent years to levels we have not seen in over a decade. e-cigarettes are heavily marketed on tv and radio, and some marketing includes unproven health claims and things proven to appeal to youth. as a result, nearly one point 8 million students in grades six through 12 reported trying e-cigarettes in 2012. there are hundreds of products ranging from disposable e-cigarettes to refillable output e-cigarettes. regulation alone is

insufficient, and the process will take time. that is why many states and cities across the country are folding the policies that enacting bans on e-cigarette sales to minors. s existt that e-cigarette and are being marketed by some companies assess the same cigarettes but safer is a dramatic shift. according to the surgeon general's report, e-cigarettes could be beneficial if they are completely substituted for burning tobacco and could assist in a rapid transition to a society with little or no use of or in tobacco products. as we consider these issues, we must not forget that burned tobacco products are overwhelmingly responsible for tobacco-related death and disease. if current rates of smoking continue, 5.6 million american children under the age of 18 will die early because of smoking. the good news is we know a great deal about what works, and we

also have a regulatory framework to accelerate our progress. the bad news is we are not doing enough of what works, like 100% smoke-free policies, access to cessation treatments, hard-hitting media, and state tobacco control programs. progress we've made includes as noted companies like cbs, which stops selling tobacco products in october. also thousands of businesses that are helping employees quit smoking. working together, we can help americans live longer, healthier lives. we can prevent one in three cancer deaths, save our economy $1.3 million annually and prevent half a million premature deaths a year. thank you for the committee's attention to this important matter, and i'm happy to answer questions you have. >> thank you. mr. zeller, please proceed. >> thank you for the opportunity to testify today. i am director of fda's center for tobacco products, and i am

honored to be here today to discuss fda's activities in implementing the family smoking prevention and tobacco control act since it was signed into law in 2009. marks the five-year anniversary of the tobacco control act -- next month marks the five-year anniversary of the tobacco control act. since the act became law in 2009, we have made significant progress toward establishing a effective, and sustainable framework for tobacco product regulation. our first priority was the creation of the center for tobacco products, the first new center at fda in 20 years. ctp has grown from a handful of employees in 2009 to nearly 500 employees today. during our startup days, even as the center was establishing itself, creating infrastructure, hiring appropriate personnel, we were required by law to make

more than 20 mandatory statutory deadlines. we were also required to access user fees, established the tobacco product scientific advisory committee, and refer tpsac, and we to met fairly all of these responsibilities. ctp the sponsor bill it is include developing the science base for product regulation, enforcing the law, issuing regulations and guidance for industry, and educating the public about the risks associated with tobacco product use, and i would like to briefly touch on each of these. ctp is committed to carefully and thoroughly reviewing all tobacco product submissions in a consistent, transparent, predictable, and timely way, and we recently established performance measures that include time frames for review of many of the submissions we received. as a regulatory agency, we can only go as far as the regulatory

science will take us. ctp funds and uses scientific research to better understand tobacco products, how the differences in product change the behavior of users and nonusers, and how to best reduce the harm from these product. the nationalth institutes of health and the center for disease control and prevention as well as with fda's on national center for toxicological research to the regulatory science base. vigorous enforcement of the tobacco control act and implementing regulations is carried out through tobacco retail compliance check inspections, inspections of domestic manufacturers and imported tobacco products, and review of tobacco promotions, advertising, and labeling. ctp also provides compliance education and training to regulated industry. in february, we launched a national public education campaign called "the real cost," to prevent youth tobacco use and reduce the number of teens who

become regular smokers. the campaign uses compelling facts and vivid imagery designed to change beliefs and behaviors over time to educate youth about the dangers of tobacco use and to encourage them to be tobacco-free. we have faced some challenges in the five years since ctp was created, including the growing pains inherent in building a regulatory body rum the ground up. -- from the ground up. we have worked through the logistical challenges of creating a brand-new organizational structure, hiring qualified staff, developing processes, procedures, and dedicated i.t. resources to carry out 's regulatory functions. a responsibility is an president. no other country has passed a regulatory agency for marketing based on public health criteria. we have had to create a retail

compliance program within fda. intendforward we to sustain momentum to make known the risks associated with tobacco use. i return to public service in march of last year to direct the center for tobacco products. the main reason i returned was the public health opportunity to help used to robert greg -- product regulation tools that were granted. roughly one in five adults still smoke and we will explore all available regulatory options reduce the harm caused by tobacco products. perhaps our greatest opportunity to overcome this pressing up with health problem is to dramatically increase the access and appeal of tobacco products to use. we intend to use the many tools at our disposal to make the next

generation tobacco free. i thank the committee for its efforts and am pleased to answer any questions. iq. >> thank you very much. now we will have rounds of five-minute questions. , we mentioned the hard-hitting and critical -- and incredible effects from a campaign using resources from the aca. the outcomes of this campaign from what i have seen have been extraordinary. you mentioned more call lines. more longterm quitters. can you elaborate on the work on this campaign, how did he decide to message it, and what evidence do you think your as it is effective? lastly, is there a difference

between the cdc media campaign tips from a former smoker and fda's media campaign? much, andou very please feel free -- if i do not remember each one of the ones you asked about, please refresh my memory. chairman harken, the campaign has been remarkably successful. the 1.6 million figure was the number of people who made a quick attempt because of the campaign just in the first year of the campaign. we also stock and currently -- we are now in our third year now and we have also seen doubling calls to the national telephone and as much as fivefold increases in visits to the website of the campaign. so we are excited by this. we are particularly excited about the specific information

about quit attempts. we also saw increases in non-smokers, millions of whom said they had actually talked to a loved one who smoked and encouraged them to get help quitting. i think one of the reasons that we were not surprised by these results is that we put a lot of work in upfront first reviewing all the information from other countries and other states' experiences that have done campaigns, and then working with it early thousands of smokers, asking them, what would be most helpful to you to make a quit attempt, and we designed a campaign through several cycles of trying out our ideas and checking back with smokers. they were very firm, that this was the type of campaign that they wanted. smokersen 80% to 90% of who say they have seen the ads. we're feeling very strong about the response i have had.

i would also mention that jerry hall from north carolina, who died in september, was our poster child of the 30 americans who stepped up, very difficult step, to show, to put a face on what the harms smoking will cause. in terms of the question about fda and cdc -- >> two different approaches. >> yes. we are really in different swim lines, because the cdc program is focusing on adult smokers and encouraging them to quit. that is its laser focus. and the fda's campaign, which mr. seller can't talk about, but we are excited about the work that they have been doing is also laser focused on youth and trying to keep experimenters from consolidating.

we are doing very good things. the other thing to keep in mind is both campaigns combined represent in terms of the amount of promotional effort that we are able to make about five days out of the year compared to what the tobacco companies are spending. >> you're talking about both combined? >> both the fda and cdc campaigns. the 365 that would be funded by the tobacco companies? >> right. >> just elaborate on the real cost. >> sure. unfortunately, too many kids experiment with cigarettes. over 700 -- each day. over each day they make the progression to becoming real smokers. compared to 20 years ago, those numbers are done. the bad news is those numbers are still unconscionably high from a public health perspective.

their 25 million 12- to 1 in theolds country, and what we came to understand is there's about 10 million of those 25 million teens who are at risk. we call them being one party away from taking that first puff, or they have already started to smoke a few cigarettes and are on the trajectory to becoming a regular smokers. we develop insight into how to communicate to these kids in ways that will break through the initial launch of the campaign has focused on the health consequences of smoking and addiction. we do not talk to them like an adult lecturing a child about do not smoke. it turns out if you talk to at risk kids about immature skin wrinkling or gum disease and tooth loss, instead of talking to them about ticketing and

addiction, you talk to them about loss of control if they become addicted to cigarettes, that enables them to hit the pause button. that enables them to rethink their relationship with the cigarette. major also making a investment in the evaluation so we will see how we are doing overtime. it starts with building awareness that will lead in changes to attitude that belief, and alternately changes in behavior and we have made the investment and evaluation to follow 8000 of our target over the next couple of years to see how we are doing. >> thank you both very much. senator? mr. zeller, on one point, i think you are correct that premium cigars should be treated if relying. treated differently. i introduced legislation like that. i believe people who are adult

ought to be made able to make their choices. i have a couple of questions. how would this price of $10 at retail work? if one retailer sold a cigar at $9.99, what would that do? >> we have proposed options on cigars, and one of the options is to exempt premium cigars. the other is to include them. we are in a rulemaking period now, awaiting for all the comments come in, and then we will consider the options by the information -- >> can you comment on how it would work? >> i do not want to prejudge what the outcome of the rulemaking would be. >> [indiscernible] [laughter] >> what you are free and i'm not. your question about the price point. out, wherewe laid premium cigars would be exempted, there would have to be a definition, so we would know what is in it. at that price point, it seems

like that might not work very well. we have asked for comment on the price point, and if people have a better way than what we have proposed, we welcome that. absolutely. >> are you open to considering extending the comment period? >> we have received multiple requests for extension which we are reviewing as we speak. >> i would encourage you to do that. it is more important to get this right in as you know very well, because of your background. this is an extensive complex area. let the asking a rotter question. where'd you come down on this difference of opinion on these cigarettes? david adams of the american legacy foundation, the single is opportunity comes along to make this a great obsolete. that is one point of view. many kids are starting out with the secrets and then going on to smoke conventional cigarettes.

do we know enough to know yet what the impact of e -cigarettes is? >> we have proposed to extend our jurisdiction over electronic cigarettes that meet the statutory definition of a tobacco product. we are also funding literally dozens of studies to answer all the questions that we have about e-cigarettes. right now we have more questions about the safety of the product, what is in the product, what is in the vapor. we have questions about who is using the products and how they are being used. it is a very complicated -- >> so you do not come on either side yet as to whether it is a important as a tool to help those who are already smoke cigarettes to stop reoking or more dangerous? >> the only position for fda to

take if they have the potential to do good and may have the potential to do harm, and we need answers to questions which we are funding through research. --don't you have to have when will you have enough answers to be able to make the kinds of decisions that you are expected to make here? >> first up is having regulatory authority over them. we do not need the answers to those questions to complete the role making we launched several weeks ago. going forward, in terms of figuring out what regulatory policies and approaches should ttes, weed to e-cigare need answer to those questions. let me give you an example of one of the studies where funding. we're spending a lot of money on what is called the longitudinal study, following the same people over time. it is called population assessment of tobacco and health. ofis following tens thousands of adolescents and adults. over time, studies like that will begin to give us information that answer some of

the behavioral questions. who is using the products, how they are being used. we need additional cyber -- studies on the product safety. there are a series of questions raised about these liquid exposureproducts and to the nicotine in these liquid nicotine products. when we have answers to those kinds of questions we can't figure out how to use the many tools that congress has given the agency to figure out an appropriate regulatory craig mark to relate -- predatory framework. it starts with the authority. >> my time is up. thank you, mr. chairman. >> senator? >> thank you, mr. chairman. to you believe, that some tobacco products present greater risks to individuals than other products? >> yes.

>> ok. of risk, do you believe that noncombustible tobacco products are more likely to reduce harm than a smoke form of tobacco for individuals who would otherwise be using a conventional cigarette? the answer is that it depends on who is using the product and how they are being used. you can take any non-combusting product, whether it is a smokeless tobacco product, onte,ret to it depends who is using them and how they are being used. we look at a subset of smokers who are unwilling to give, they will continue to smoke that type of cigarettes. half of them will die prematurely later in that from that decision. if we could get all of those people to completely switch all of their cigarettes from one of these noncombustible products, that would be good for public help, but our job is to figure out what is going on at a

population level, and it includes the larger group of not like a first group, who are concerned about their health and who are interested in quitting, and what happens instead is people completely substituting with a noncombustible rock left, they start using both. along the way they went up being less interested in quitting. that might not be good for public health, and our job is to figure out what the net of this possible behaviors, including any initiation, which would not be good, and then try to make regulatory policy on that. >> so much for the adult that shows nicorette five years ago. the gum and then they went out back and have a cigarette. and he could not smoke it, so they chewed gum, and they went out and had a cigarette. does that mean that nicorette is for thatful tool individual?

it is only a useful tool if that individual uses it to quit? >> i would absolutely concede that any of these products at an individual level can do good. what is challenging for all of us dealing with the law that you gave us the responsibility to implement and enforce is the decisions we have to make are not going to be made about what i'd be good for the theoretical individual. we have to have regulatory signs to support decisions that inform what is happening at a population level. we have to look at all possible behaviors. >> if you're trim line is this healthan the public effect is better. you have got less people using combustible products. you have got or of those individuals that have either quit or have gone to her reduced harm product that is good for public health. vst me say for the record, c eliminated their cigarettes. patches, sells nicorette gum, all of the

pharmaceutical products that aid in eliminating or reducing the rate of smoking. it is not likely throughout the whole category. the retailers that sacrificed some large amount of sales, they still believe that risk reduction is an important thing for them to endorse. would you agree? >> i would answer in this way, senator -- the products you are referring to have been approved by fda as he and effective medications, and they have been on the market for over three years. there is a robust evidence-based to know that that product works to help smokers stop smoking. they are not approved for reduction, actually. they are only approved for abrupt cessation. there is a robust evidence base that shows when marketed to help smokers quit and use properly, people can succeed. by contrast, to go to the

questions from cellular hogs enter about -- senator alexander, when it comes to de-cigarettes, there's a lot more we need to know about the impact on reduction on -- >> i agree with you totally, but can you point to any new innovation where we know right at the beginning everything about it, and that we could come to an assessment -- i'm hopeful that through your studies you find this product is safe. we do not want an unsafe product out there that contributes to a different problem. safe, you find that it is are we going to see the same thing about e-cigarettes 10 years from now. the body of evidence says that this thing moved a lot of people off combustible tobacco products? >> we have to find that the claims, the new products are

appropriate for the protection of the public health. it is not the safe standard. congress gave as a different standard to use when using the tobacco authorities. under the standard of appropriate for the protection of the public health, it is that makes of behaviors i was describing that we have to assess and make regulatory policy based upon -- >> i certainly look forward to the science that is produced on this. i just cautioned you and our friends at cdc that if we kill technology and innovation, which is in essence what some are tempting to do with electronic cigarettes, to just stop it, no more, should not be sold, then innovation is not going to play a role in reducing the amount of americans that smoke. it is just not. i think it is safe to say that when i look at that -- today, i look at other things we would

consider a public health epidemic. give uson is going to the ability to do it. i do not think it is going to be by limiting whether they can go to mcdonald's and by a double cheeseburger. and the cdc is not proposing that. it is going to be innovation. it will be driving technology, coming up with products that allow us to turn around the problem we have got. that is what we're talking about here, and i look forward to the work you are doing. thank you. thanks. thank you, senator burr. last month's proposal to expand the authority to include more products marked an essential step forward. while i was heartened by the release of this proposal, i was disappointed that the rule did not address some of the most egregious practices of manufacturers. i mentioned in my opening statement that last month i released the findings of our

investigation into the marketing practices of nine commonly sold tte brands. to see those funds were disheartening is an understatement. youg his findings i know will not be surprised to hear that six of the companies reported that a market e-cigare ttes in flavors that appeal to children and teens. like cherry crush much outreach, mint. keen, i would say anyone who claims these products are explicitly targeting kids is clearly blowing smoke. , not are targeted to kids adults. i've got some examples here. there's one year i pointed out earlier, rocket pop. i got a charge, had it blown up. you can take a look at it. rocket pop. got a popsicle on the front. does anybody say they're trying to market that two adults?

the other one i have is gummy bear. i do not think i have gummy bear, but it is there. there's another one, cotton candy. cotton candy. here is for the refillable's cherry crush. was applehad earlier cranberry. again, these are targeted to kids. again, congress knew what it was the evidencepon that we had that they were using flavors in cigarettes to go after kids. forget about the -- if these cigarettes are good or

bad, we do not know that yes, and that has got to be learned. is it safe to say that when you are talking about kids that may be or ought to kids? or mr. zeller, why did the fda take it was important to hold off on assertions in marketing when they're clearly targeting kids? why did fda hold off on that? >> i appreciate the question and the perspective, mr. chairman. and we share the concerns about any marketing of any of the currently unregulated product have anould appeal to kids. we need after stitching over them to do something about it. proposedeamble to the deeming rule that would give us a party to take regulatory action, we summed up all the evidence we had of the flavors,

and we asked a series of profound and far-reaching questions about -- that we want comment from all points of view, on what role the presence of flavors like this should play as an influence on the regulatory policies that the agency will be in the position to make when the meeting is final and we have the ability to use all manner of. . players,ly, to ban requires the issuance of a products under, under a different section of the statute, separate rulemaking, but we need answers to the questions that we post about what role should the flavors play and how these products are related. >> does fda have the authority to regulate drug delivery devices? >> fda first tried to regulate delivery devices and we were struck down by the courts. in the absence of a secession claim, the very first action

that fda try to take 2001,garettes in 2008, before the act passed, was an enforcement action to prevent the importation of these as unapproved devices. we were sued, and the importer won in court. i guess i do not understand. is nicotine generally recognized as a drug? >> yes. >> and addictive drug, is it not? garettesn't an e-ci deliver nicotine to the body? >> we can make an assumption that is. >> what else does it does? you do not turn on the ground. you put it in there and inhale it. >> i can only tell you what the courts ruled. these in regulate

exactly that with, and were overruled by the courts. in the absence of a medicinal claim, the therapeutic claim, the courts told fda that the only way we could regulate these was under to back authorities, and that is because of the statutory definition of a tobacco product. it has two parts, something that is either made were derived from tobacco, and the nicotine of these cigarettes is derived from tobacco, and the court said absence of the drug claim, the only way we could relate part nicotine in this price was under the back authorities. >> the reason i had all these fears was to show the proliferation of the devices that are going to get. one that is 800 puffs, deliver something. a cran apple -- they say on the back in fine electronicsays, " hookah is not approved by the fda.

you must be legal tobacco purchase age to purchase these products. this product has not been tested or proven to aid in smoking cessation. and the product contains nicotine, which is an addictive and toxic substance and must not be used by pregnant women and non-smokers. keep this product out of reach of children." we know kids are getting them. they are buying them. they're proliferating among high school students. they are buying these fancy things here. they got a love that goes into the wall. looks like a computer club. it's got a little computer device it goes in there and recharge it, rechargeable. i do not know what that costs. i'm told this costs about 10 bucks. you get 800 puffs on 10 bucks. these are all geared toward

young people. i handed it out to show -- i heard we need a longer comment period. i do not know about that. something has got to be done about this. other partsll of the proposal that would address the issue of use of these products. we propose extending the minimum age of sail that exists are e-cigarettes, so retailers who sold these cigarettes to minors would be violating federal law. we would propose to ban the sale of annuities product inventing machines. on the issue of nicotine and addiction, we are proposed a warning labor on all these -- label that explain to the public ticking. caontain the common time is the opportunity for the public to make comments.

>> none of the stuff does. nothing on it. >> that is because they are not currently related by fda. >> concentrated nicotine, and addictive drug. i'm way over my time. i thank you, mr. chairman. i have no more questions, and i have an appointment that i have to go to, but i have no objection to your continuing. >> thank you very much. i am going to change things a little bit. dr. mcafee, one of the most early findings was that cigarettes are more dangerous today than they were in the first surgeon general's report was issued 50 years ago. that a startling. they have a higher risk for lung cancers and smokers in 1964 despite smoking fewer cigarettes and that some if not all of his increased risk is caused by

changes in the composition and design of cigarettes. can you explain ways in which these secrets -- these cigarettes are more dangerous? >> sure. the other thing we have found disturbing around this in some ways unexpected finding is that it does raise concerns about the ability of innovation to automatically lead to improvements in public health without regulation. . .