couple ofming up, a programs on cancer research and technology. francis collins, the national institutes of health. and from capitol hill, lawmakers supporting cancer research and innovation. and later, violence in the black community. >> a look of some the programs you will find christmas day on the c-span network. all of the festivities start on c-span with the lighting of the national christmas tree, followed by the white house christmas decorations with first lady michelle obama and a lighting of the capitol christmas tree. p.m., celebrity activist. supreme court justice samuel alito and jeb bush on the bill of rights and the founding fathers. 2, venture into the

art of good writing. at 12:30 p.m., the film inside of a superhero, the secret history of wonder woman. as 7:00, reading habits. at 8:00can history tv a.m. eastern, the fall of the berlin wall with footage of president george bush and bob dole with his speeches from president john kennedy and ronald reagan. fashion experts on first lady fashion choice. and then at 10:00, former nbc anchor tom brokaw is in good years of reporting on world events. that is this christmas day. >> a discussion about cancer research with dr. francis collins, director of the national institute of health and .r. ronald depinho

they talk about the latest cancer breakthroughs and some of the research challenges. it was cohosted in october by the aspen institute and friends of cancer research. susan page is the moderator. and i am so glad when not only have a full house but c-span is here so we'll have an audience. let me very briefly introduced dr. francis collins. director of the national institutes of health, the larger biomedical research in the world. he is renowned for his leadership as the genome project. many awards, the national

medal of science and presidential medal of freedom. welcome. dr. ronald depinho, president of he university of texas where -- he was also the founding director of the belfry institute for applied cancer research. he has received many honors and awards and found this there will biopharmaceutical companies focused on cancer. thank you for being here today. i will post questions myself in the later open the floor to questions from you all. keep that in mind. we are going to answer the question, how close we are to curing cancer? start lookingl back. dr. collins, you received your medical degree six years after president nixon declared a war on cancer. tell us what the assumptions about curing cancer,

addressing cancer, treating cancer. would bessume cancer cheered by 2014? what were your expectations? >> i remember when i was a medical student at the university of north carolina and i was not a specialty at my school when i started in cancer. inhappened during my 4 years a special unit focus on oncology was developed and someone was hired to write it. what a scary place because it seemed as if what we have to offer for most of the patients who came into that part of the hospital were very toxic, poisonous substances. many of the individuals who had very types responded quite poorly. mecertainly did not seem to at that point if somebody was interested in having to bring together science and medicine that they had gotten together

very clearly in this space. maybe hard to imagine but at that point, the underlying model we take for granted that cancer is the disease of the genome had not really been appreciated. going back to the early part of the 20th entry suggesting that was something about the chromosomes. seeing that emerge as a actionable, unifying approach to this disease that will lead us in the direction of what we now embrace as a remarkable resolution of targeted therapy, that would've been really impossible for myself or others to imagine happening during her lifetime's. it has been a breathtaking ride. the worm cancer was initially declared in the early 1970's, we do not have the tools or insight or understanding mechanisms to be able to move at the pace we now can. it was a good evening to draw

attention to the problem that sods a solution and affected many people and the answers were going to have to climb out, research is expensive. case, research -- cancer was taking far too many lives. even though it took many years to try to figure out what should the approach me, it was a good thing to get the ball rolling in a significant way. about thisre we talk afternoon, we see the potential of really tackling the many types of cancer with a rational strategy with great hope of curing this disease. you say are we going to cure cancer? let's just say cancer is not one disease. disease.dreds of we have already cured some of them. there's a lot more. they are not all going to fall by the wayside at 1:00 on a thursday afternoon where someone

says i have the answer. it will be a hard-fought battle and every answer would have a different series of steps. critics we want to talk -- >> we want to talk much about these desperate you received your medical degree a few years later in 1981. by attitudes have changed patients and their families, the diagnosis? how different is if or when you saw when you were getting your medical training? cancer strike fear into the heart of cancers and bring does their two families. patients who were subjected to treatments that been underwent disfiguring surgeries was a little reconstructive capabilities at that point. the chemotherapy was really harsh. even back then as a result of those advances which really occurred in the 1930's, 1940's, in 1950's, we have significant

reduction in cancer mortality with about half of the patients losing their lives to cancer. now, it's about 2/3 that survive with cancer. nott of that has risen by just the treatment advances that we talking about but also the preventive strategies we understand a lot more about the indicators of cancer. patients are more empowered with knowledge to prevent cancer in the first place. and enlisted increasingly into more screening strategies where the chances for cure his greatest. that has led to profound prostate, in breast, cancerer diseases ,colon in particular. those are changes if you can do something about the disease to prevent or catch early and over half a dozen years in

particular because of the insights that have been illuminated by a great deal of have a clearnow line of sight for many cancers as to how it really bends the art. patients feel more hopeful as a result of the enhanced diagnostics, enhanced capabilities we have on the treatment friends and so on. as a result, we have increasing survivors with improved quality of life. we are nowhere near where we need to the. >> i remember my first newspaper job in the 1970's where we did an obituary on every person who died in the state of kansas. families would ask you not to say or acknowledge it or someone died of cancer and we had a practice of which we would say they died after a long illness which was a code word. it was seen as so terrible to have had cancer. talk about the turning point.

lastave talked about the decade or two, what has been the turning point that make so much difference? is there one? >> the biggest was getting an understanding of the fundamental -- behave the way it's supposed to and stops when is supposed to and starts growing despite all of the signals it should've shut it down. that really comes out of the recognition that there are genes in our book that is mutated in a certain way causes this to happen. them, they activate make themselves grow when they shouldn't. accelerator metaphor. others which are supposed to apply the brakes, is like losing your front and rear brakes and keep going when it should've stopped. and then other variations on top of that.

more recently, things we are learning by the genome. basically, to have that kind of understanding about the mechanics of what controls cell growth was the essential step to move us into a war directed, more rational approach instead of him. colin and les see what happens. most of our strategies until we had the understanding where to come up with toxins substances. -- let's wait and see what happens. and tried to dial in at the point where you were killing the cancer cell's environment more than the regular cells. about the history. >> it is extremely important and you talked about one critical event, the initial paradigm. the genetic paradigm. and the 1960's, there was a vigorous debate as to whether or

not mutations in genes had anything to do with cancer. some of the most significant minds of the last century honestly thought that the mutations of genes of cells are not relevant to the development of cancer. there was an especial irony because a discovery of a virus that contains a gene that caused bishop to their breakthrough and 17 7 -- 1976 that there are genes within us that look like the genes that cause cancer and viruses. int year i was graduating 1980 one, we began to identify mutations in those jeans. they were translocated or mutated and changed in cancer cell versus normal sells. it took a wild for us to begin to develop those collection of genes that were real drivers of the disease.

a real critical breakthrough occurred in the 1990's thanks to dr. collins and the human genome project which gave us the blueprint for the human genome. 2007, when he the human cancer genome initiated under dr. collins' leadership and that has given us the periodic table for cancer where we know a lot, perhaps not all, but most of the genetic elements that are wrote that actually commandeered the cell. to me, the most significant advance against the back drop of the foundation i just described occurred within a narrow window of 2009, 2010 work across a broad front, a critical mass of knowledge that was prosecutable where we understood what caused certain cancers and we could do something about it and reduce the knowledge for practice.

it also game changing technological advances. sequence genomes not in a decade in 1990's with billions of dollars but for house of dollars in a time period you can make clinical decisions. that was game changing. also advances in imaging. a couple of decades ago, the most common procedure in surgery was a laparotomy and you have to look inside to see what is going on and now we have noninvasive. the end -- and the advancing his profound. our ability and aggregate large volumes of data and use very powerful analytics that allow us not only to understand a disease but to actually inform clinical decision-making on that disease is before us. what is exciting to me is that within a very narrow window, we now have a very -- we are in a good position to make more

delivered his assault on the cancer problem. this is something that it not exist because it took decades of research fundamental for us to be able to really move that knowledge to a position where we can act on it to help patients. the breakthroughs that brought us to the point where we are now. what is the breakthrough ahead that will make a great difference? what are you looking for? very articulately spoke about, we have the tools for any individual has developed cancer to read exactly what is going on inside of the tumor and what is making the cells grow. you to move what has been a one-size-fits-all operation to a personalized approach. it is a good thing we can do that because every tumor, if you look closely, is a little different. you take 10 people who have lung

whatr and you actually ask is driving the cancer in those 10 people and will be a different collection of these genes and tumor suppressor's and other players. that means if you are trying to design a rational therapy, you ought to know that so you can choose your intervention accordingly. there is some complexities here, off course. that means making the old way of doing a clinical trial where you say anybody who has this particular cancer in this particular organ is an appropriate candidate. not so much. you have a targeted therapy. a particular genetic change of people were going to the best chances of respondent and where you want to run the trial. it sounds vague but let me give you an example. patients with lung cancer, which is a very scary disease and will

not done so great on over the , there areany years individuals who have lung cancer who have a rearrangement are -- of a particular gene and it dries her cells to grow when they are not supposed to. there is a you recently and rapidly fda approved drug thanks to the trials that have been works in abasically very specific way to stop the growth of those sells that have but it isearrangement not doing thing for the rest of the patients who do not have a rearrangement. it is only about 5%-6%. different.lly and the past, lung cancer, radiation and strong chemotherapy and everybody got the same ink. not anymore. that's why the long of that efforts, lung cancer getting this forward is a great example of where we need to go.

initially a clinical trial but so it out to the standard. ought to be standard when you have a chance. have a diagnosed to the base and figure out what that 3 billion instruction booklet looks like. look at the menu of targeted drugs which are being developed at a phenomenal pace, about 1000 of them now. and he out the ones that will be -- and pick out of the ones that will be a match and that is where you want to go. one more thing, at the present time, we are in a circumstance drug that idea of rational treatment for cancer based on understanding what is that tumor is a single drug. that can give you dramatic responses but unfortunately, they usually do not last. they are not cures. we should not be surprised by

that when you consider that by the time a cancer has been diagnosed, the number of cancer sells that person has is in the billions. two to takes one or develop a different mutation and make them resistant to the drug to grow back and the trust targeted with that small number are resilient cells. how should we deal with that? thing about hiv. wheny similar situation people were diagnosed with hiv and we treated them with one drug and we got a response and they came back. the virus developed in resistance. human selves have the same -- -- c sails have the same have theel same ability. you reduce the chancels. cells have the same

ability. -- you reduce the chance. but from my perspective, maybe that is our big, current challenge about our hope on the responses. >> i think when we think about reducing cancer mortality which is the bottom line and francis spoke to precision medicine and the promise of that. in fact, we have seen proof it is a way to go. when we end about cancer particularly in emerging countries, the challenges of limiting resources really means that we also have to approach the cancer problem on other fronts and be very aggressive. 50% of cancers can be prevented. the exciting thing is we understand a lot of the instigators of cancer and we can wise, education wise so we can really reduce the incidence in front of cancer and

that is a great opportunity. think hbv vaccinations for children -- hpv vaccinations for children. tobacco, number one. hepatitis and of excessive exposure. that is during childhood. these are all opportunities where we can then did the art and in the screening, the chances for hearing is much better especially solid tumors. we have proof that is the case. ability tonhance our detect these cancers earlier stand on a path to doing it thanks to the nih, that will be one of the lowest of the low hanging fruit to really reduce cancer mortality. treatment for it targeted therapy going after the genes that are at variance and a

cancer cell. what is exciting now as this new dimension of immunotherapy which does not really speak to what is going on inside of the cell but instead, harnesses the power of the immune system in the hopes, reawakens it so it recognizes that cancer and can attack the cancer. those therapies are giving responses in a large fraction of patients with advanced disease. combineif we begin to the targeted therapies going , harnesses the power of the immune system, i think what you will see over the next 5-10 years are significant reductions in cancer mortality. we are seeing cap for melanoma. and a variety of other cancers across the bar for. >> it sounds extremely complex to do targeted therapy based on specific genetic mutations.

doctors, it is one greatto be at a institution, what if you are at some other place? are doctors able to keep up and care that isind of made such a difference? institutions, george washington here in this area and so on and so forth, the issue is really the knowledge gap that you are referring to. it is a significant one. there was a report on the unevenness of cancer care throughout the united states. on average, for example, the cancer, whenung there was a new therapy it took on average in a community usedng for to be routinely

in the public domain. that is a critical issue and is widening the cause of this staggering complexity where physicians do not have the chance to keep up with m.d. anderson and we produce 10 papers a day. find at m.d. anderson on the oncology expert advice and be able to ingest data clinically in a community setting, not just in the walls of m.d. anderson. and how that system being taught by the world experts. what would they do essentially a second opinion? that would then give advice to the treating physician that is what the world experts would do and it would be the clinical trials you should consider and so on. will reduce -- once

they get implemented. informations age of and is in fact is going to be on a practical level as most impactful and reducing the burden of cancer in our country. critics do you worry about this, dr. collins? if so, what can you do? >> we do not have a good track record of taking research and finding how they integrate into the standard of care across the country. a few years ago, somebody look at that timetable and concluded 20 years and that is unacceptable. there aren't good news aspects of the way things are going. ron talked about some related to the cancer field. the best art of the story is the patient's are no longer comfortable sitting back and waiting for someone else to make

decisions about their care. we are in the era of the empowered patient and the internet has made that possible even for individuals who have no medical background to find information and ask pointed questions about how come you are doing this when you could be doing that. that alone motivates physicians to get up to speed. no physician wants to be embarrassed by their lack of understanding a patient brought to their attention. we are seeing improvement. ,he electronic health record michigan opportunity there and provide an opportunity for more patients to have access to clinical trials. in childhood cancer, it is the case for most hits with cancers. is a missedlts, it opportunity both for the research community and especially for patients who would benefit by enrolling and maybe giving them access to something that could've been much work targeted for their needs. we have to work hard on this.

the other point is reimbursement. if we are going to see these types of events is finding their way into the standard of care, who his handclear and as a challenge with many of the new developments being sufficiently new and have not gone through the discussions. some of the new drugs are expensive. >> there was a piece on "60 minutes" about the high cost of cancer drugs. it made a scene it was random how much a cancer drug cost, is it? what determines the cost? andhe fundamental question that is an important issue is to think about what drives the cost . at the end of the day, for us to incentivize innovation and address major needs especially in pediatric cancers or rare cancers, etc., we have to do a much better job in reducing the extraordinarily high rate of

failure in cancer drug development and testing. for every 20 drugs that enter into clinical trials today, only one will succeed into the common fda approved. and 56% of rate those failures incurred in sainsbury where the cost is very high and patience are sometimes benefiting but not achieve statistical significance. and vice versa. if you look at the root causes of why we fail, we are not doing enough that the plea -- preclinical stage due to the science needed to validate the target to develop the drug as the target, test and a very .ophisticated model system and develop a clear hypothesis to what patients you are going to be getting the drugs to in a setting and know if the

hypotheses is validated. if we get it that way and put more effort on befriended and, you would reduce the high rate of failure and that would reduce the cost of the -- of developing the drugs. they are significant and their expense in part because we are paying for the high number of failures that occur in the clinical setting. someone has to pay, the taxpayer, the government, the investors, the patients with co-pays, etc. a key issue for us to focus on is, how is it that we can reduce the cost of developing drugs? the point precision medicine before, which patients would truly benefit from getting that drug? would have a durable response, low toxicity so that you have impact on their disease. i would like to see the dialogue

be more balanced and thinking about the root causes of the issues as opposed to some of the dialogue that has been recently and in the public domain. >> i totally agree with what he is saying there. >> i am more invested in ever in the clinical space in being sure you are chasing after a model that is going to succeed and not one that is going to crash and burn after you have spent hundreds of millions of dollars on it. that means our models have to be increasingly reliable. we have cured cancer in mice more times than i can tell you. we will continue, but i think some of the time we have been misled. what we have.sing increasingly in the front end of

the development timeline, we need to develop a lot more, all the way down to the three-dimensional structure of that particular drug and how did it fit into it target -- its target and questions about toxicity, which we can do in the -- or at ways using ir chips .laborate ways using biochips we can do that. take a biopsy, add the appropriate number of genes, cellshat into pluripotent , and coke that into becoming heart or muscle or beta cells for your pancreas or brain cells. you can bathe them in the substance you're thinking about using and find out if there are

unexpected things you want to know about. basically fail early if you going to fail. way we do this is slow and expensive and involves small animals and large animals. we can do better. bottom line thomas -- bottom line, unless we come up with ways of reducing the failure rate, drugs are going to cost a lot of money, because companies have to remain solvent, and they have to pay for all these failures. the cost of success is much higher than you would want it to be. as au describe bankruptcy common side effect of cancer, which is very distressing for everyone. if the goal is curing all kinds of cancers, what's the biggest hurdle? what could make the biggest difference now in trying to ?rogress along this path

take this one. >> i can start. , don't know if he can say this but one of the greatest proven success stories in the history ourhe nation has been research that has converted knowledge, basic insight into shings that matter for patient and what is very exciting for us. we have a clear line of sight on canceran impact on worldwide through prevention, screening, and therapeutic advances that are game changing, and patients are dying. families are being impacted.

make ation needs to decisive assault on the cancer problem and other diseases for which we have a strong conceptual foundation at this point. we need to act. decisively.ct as the u.s. goes, so goes the world. invest in our research activities so we can make a difference in the cancer problem. >> is it fundamentally a matter of money? is that the number one thing? >> we are limited by ideas. we are not limited by talents. i think we are limited by resources. if you look at the opportunity scientifically in the field of cancer and many other disorders as well, i could say the same thing about alzheimer's or diabetes. we are at this remarkable moment scientifically. it's exhilarating to see how

this landscape changes almost daily. that's one of my great privileges to look across the landscape and see what is happening almost every day. you are reading my blog. >> are you tweeting it? >> i am tweeting it. it is amazing to see the insides. they are coming out of all sorts of technologies we didn't have before. the things they are doing are getting better. the revolution giving us insight into how things work and how things go wrong. the efforts to understand the and the advent of electronic health records. all of these things are coming together in a way i would not have imagined in my lifetime, yet we are not nurturing that the way weiscovery

could be. a statistic i think is particularly troubling, often discouraging to young scientists thinking of getting in the field is the following. what is your chance, if you have a great idea about cancer research and it is preclinical, but you have an idea about where you're going to get funded. what is the chance the grant is going to get funded? it's about one in six. traditionally it has been one in three. in the cancer institute it is one in 10. it's even lower. you might say we were funding too much stuff before, and we weren't putting a tight enough filter on this. the filter is rigorous peer review by experts in the field. went back and looked. this was in heart disease research, but i imagine it's true across the board. i can 2001 we were funding a third of the grants -- back in

2000 when we were funding a third of the grants. does a grant in the 10th percentile turnout more productive than a grant funded in the 25th percentile? it is. viewed, so is one better than the other? what happened? peer-reviewed, so is it better than the other? there is not a difference anyone can tell between the 10th percentile and the 25th percentile. they are both great. that shows we are living have to grade science on the table right now. just at this moment of great opportunity. that's the thing that wakes me up at night. that's the thing that causes a lot of the biomedical research .ommunity to really hunker down many individuals deciding after to go on to does something else or go on to another country where the

support happens to be better. we alone of the developed countries are the ones cutting back on biomedical research. look at what happens in europe or china or singapore or south korea. brazil. they are going the other way. trying to be what we once were. is that america's vision? is that where we want to go? >> and must be agonizing to make decisions on funding -- it must be agonizing to make decisions on funding some of these grants. onwe may have just turned the next nobel prize without realizing it could have happened. we may have convinced a young investigator who is trying for the third time in not quite making the cut it is time to go to law school. wrongat there is anything with going to law school, but i think we need science. >> talk about collaboration among researchers. is that something that changed?

you mentioned the lung cancer effort. there isis no question collaboration. for centuries academia celebrated the individual, but now we see multidisciplinary activities eating brought on very complex, large-scale projects, -- being brought on very large-scale projects, so you really need to bring together a collection of disciplines, use technologies to really be able to prosecute these ideas, these complex areical trials, so we seeing that because folks recognize in order to achieve the goal they want to have in their careers, which is to make an impact on the cancer problem, that they have to do that in collaboration with other team members. science continues and should support individual investigators , that lone wolf that will make some seminal discovery that will change the world.

an example of that is jim allison, who in the 1990's, was trying to figure out why the immune system was asleep at the wheel in cancer. it was his discovery of a molecule and the drug that led to a whole new class of therapeutics. that was individual investigator activity, that has brought in a multidisciplinary effort to bring up to full fruition. what do you think that would be funded now if he came forward with that idea? >> even now it would be a challenging time. he was a real maverick. there, there is no conceptual president. precedent.t -- you have to have the judgment to realize this will be an

opportunity. those grants will not fare well in district attorney in setting of limiting resources. >> you have been affected by the breakdown of the budget process in washington, by sequester, shut down. what makes this work better? does the whole government have to work better for things to work better for your agency? good luck with that. lost 23% of our purchasing power for medical research over the last 10 years. inig chunk of that happened 2013 with the sequester, which took away 1.6 billion dollars. it would have gone to medical research. we have not recovered from that. if anyone thinks the sequester is over, remember there was a deal made thanks to the hard work of congressman ryan. , and just a two-year deal

the sequester comes back unless action is taken, that's where we will be. they would then lose over the next 10 years $19 billion that would have gone to medical research. the trajectory, which is basically the default of what happens next. i am an optimist. i think winston churchill was right when he said you can always count on the americans to do the right thing after they have exhausted all the other options. compelling.e is so it's not just that this is the engine that has led us to --ances in month 70 longevity. it has also been probably the best driver of economic growth since world war ii, and everyone's interested in seeing the autonomy grow. i amenome project, which

privileged to be leading. of thed an analysis money spent on the genome project over the 13 years, and they came up with close to a trillion dollar answer. basically would hundred 78:1 -- 178:1 went into it. the women's health initiative. is the return in investment from that important project looking into what works and what doesn't work. we are starting down the path to look at the brain initiative, and i'm sure there is going to be all kinds of technology that is going to create new businesses and economic growth, but we are struggling to get this off the ground at the level it should be, so there are all these arguments. when i have a chance to speak to

members of congress and the administration, everybody says, you are right. this is something we should be doing, but we are caught in this current gridlock. this inability to come to a long-range plan about how resources are going to be spent. we continue to be as part of the discretionary budget victims of that long, drawnout process that has not reached a conclusion. just enough of an optimist to think ultimately the case will be so compelling as to be turnistible and we will the corner. corner, it washe great from 98 until 2003, but it sowed the seeds of what happened next. namely, we don't have to worry about you. we need is stable, predictable trajectories. then you can plan. scientists can say

it's a career for me, and it's not going to get pulled away by one of these terrible downpours. we are not going to have a roller coaster. we are going to have a pattern.le there are people in congress advocating for that. there is a bill pushing that. ?hy should that be part of it it's something everybody has a stake in. everybody who has a family member or friend with medical illnesses looking for answers. >> i am going to ask one more question and then turn to the audience, so you might ask the question that occurred to you. before you do that, you mentioned prevention that could cancer deaths. we know about cigarettes. you get the sense that every something doesys

or doesn't cause cancer. stories whats causes cancer. i found out wearing a bra does not cause cancer. local mom wonders about artificial turf's cancer risk. that's a new thing to worry about. we see stories about the link between obesity and cancer. is this the whole household, or t the people feel whiplash? >> there is evidence that rests on a bed rock of knowledge that does make a profound impact on health and well-being. i think this goes back to some of the things we talked about earlier. going on a website to find out what you can do to prevent cancer is a very generic, broad-based recommendation. what i want to know is how often we should be screened for what. what are our risk factors?

what can we do to modulate disease? what you are going to be seeing is personalized wellness, where you're going to be able to, based on family history, genetics, the kinds of food you eat, the environment you live in, you may have different levels of screening or different things you might eat in order to change the trajectory of diseases that might afflict you versus someone else. arsenal eyes wellness -- personalized wellness is going to be important, but for the big ones, smoking is public-health problem number one. second, we have obesity as a major problem in the united states and other countries. this is a big problem that really does impact certain cancers. we have viruses. as well as hpv

hepatitis, which are major causes of cancer deaths worldwide. -- what ishat interesting about all of those as many of those are operative during childhood. if we think about what we can do to change the trajectory about how we managed health and well-being in the united states and other countries, i think we have a mixed opportunity to teach children to influence them and give them the knowledge they need select the right time in their lives they develop the habits they need. 88% of adult smokers start as kids. hpv needs to be given during childhood to protect against infection later in life. 80% of the human population is hpv positive. it depends on which subset you get as to whether you are going to get disease.

cancer prevention is a childcare issue. i think we have a responsibility to make sure our children are empowered with knowledge and protected in a way they should be protected so they will have a future that is lower incidence of cancer. the power of ad positive thing. does every -- of thought as a positive thing. does every patient mentioned that? >> and patients are empowered by not -- the patients are empowered by knowledge. amount ofa specific patients that have that mentality, but physicians don't automatically recommend what they should be doing to prevent disease. a good example is we are front of mine with respect to tobacco cessation. found is if you get an listed in a tobacco cessation

program, it is 37% success versus 5% for self quit. it's a great opportunity. physicians who are busy don't always remember. now we did that automatically. the electronic health record, and as soon as it goes in, the patient automatically gets referred to the tobacco cessation clinic, and it increases fivefold the number of referrals. i think there are technologies we can exploit that can really impact the front end of the and screeningtion efforts. >> this is a smart group of people with intelligent questions to ask thomas to let me turn it over to you. ask, so let me turn it over to you. we're going to hand over the

microphone. identify yourself if you will. >> it seems the underlying argument is you do not have enough monetary resources. have you ever thought of working with other countries as a team as opposed to doing it alone? it seems to be the most intelligent way of dealing with the situation. quest that's a great question, and we should have addressed this already. absolutely. -- >> that's a great question, and we should have addressed this already. there is an international cancer genome consortium that has many countries working together to build this amazing database of what do you see if you have hundreds of lung cancers and hundreds of ovarian cancers and hundreds of gastric cancers. every country has a different epidemiology of which cancers appear. all the countries agreed they will follow the same standards about the quality of data and

data access so everyone can see the information. that was built upon the human .enome process a lot of people doing the work were not even in the u.s. soy basically agreed this is important we're going to work together. i am the chair of something called the heads of international research organizations, and around that table the ceos of the public funding agencies and some private philanthropy account for intof the dollars that go public funding of biomedical research. constantly looking for ways we can be synergistic and not duplicate. sometimes we duplicate on purpose. we see, it worked in this setting. does it in this setting? you are right. about theould be said

private sector. i have spent more time talking with the heads of big pharma than any of my predecessors trying to figure out ways we can knock down some barriers, and we have made some interesting models happen. likewise the foundation, trying to figure out ways philanthropy can fill in some of the gaps, although if you add all the philanthropic contributions, we still fall short of what they lost in the sequester. it's all relative. >> they have launched a global program. on the globaleen front for quite a few years. we have 30 sister institutions in 22 countries. this allows us to work not just with great institutions and those other countries to elevate quality of care and research, but also we work with governments in those countries as well as media so we can drive both alice he and education -- education of the

population. it's important it's not simply resources that is important, but there are organizational opportunities that relate to these sorts of collaborations between the private sector and and other countries and so on. it's a big problem. many nations that are now solving their communicable disease problems are being faced with an aging population, and they are concerned about this collision course they are going to be facing decades from now with alzheimer's, heart disease, cancer, and so on. is a big problem worldwide. we have estimated by 2025 1.2 billion people over the age of 60. -- we havelly essentially doubled life expectancy. a big problem. >> another question. wait for the microphone.

>> i was wondering -- >> go ahead. we will go to you next. >> i was wondering if they age of your parents when you were born would affect your chances of getting cancer, because i have read older parents, their children are more likely to be autistic. they are also more likely to have down syndrome, and i have also read if your mother was younger when you were born, you're more likely to live longer. i wonder if the age of a has any effects on your chances of having cancer. what a thoughtful question. we do know there are certain consequences that occur when parents are older than average, and you mentioned a couple of them. certainly as maternal age goes up, the risk of chromosome abnormalities, down syndrome but also others, increases. older, -- get

older, there are more mutations in the dna. veryn actually be precise about that. if your father was average age 20's to early 30's, you probably have somewhere in the area of 50 to 60 new mutations. that seems to be true across multiple different groups, but if your father was 50 years old, you might have 100 or 110. why is that? that's because the process means cell division is happening all the way along, and the older the father is, the more the sperm has gone through copying opportunities and more chances for a mutation to appear. it's a modest effect, but it's

clear if you are looking at the condition like autism where we know new dictations play a role, the risk goes up a bit. if you're looking for a rare new , youion genetic disease will find more often than average the father is a little older. when it comes to cancer susceptibility, theoretically i could imagine that might be the case. if you have one more mutation or two more mutations because your father is a little older and they happen to fall in a vulnerable place in the genome, but i don't know that is enough that you would ever see the actual impact, because it would be such a rare event to happen in that vulnerable spot. thatot aware of evidence cancer risk goes up. >> that's correct. the overwhelming factor for the development of cancer is our age. it works every other statistic

example,m tobacco, for which dramatically increases your risk. changingle demographics, aging of the united states is the single most important factor for the development of cancer. by 2030 we anticipate just because of changing demographics and the aging of our nation, a 45% increase in the incidence of camera just because of age. how the odds about of getting cancer increases with increases. >> for alzheimer's, diabetes, heart disease, and cancer, every sive years the incidence doubled. by the time you're 45 you have a 45% chance of having alzheimer's. by the time your a dui the one in two chance if you're a male, one in three chance -- by the 80, you have a one

and two chance if your mail and one in three chance of your fema. it is a question, can we afford ?ot to support the solution quarter of ad a trillion dollars for 5.4 million americans inflicted with the disease. spending $1ill be trillion in today's dollars if we don't impact on the disease. we have to make a concerted effort to get out ahead of these problems in a way we know we can research,cisive development of drugs, and so on that would make a difference. >> not to mention the human cost. she didn't have the might.

-- mic. >> i am karen brooks. i want to thank you both for a lifetime of science. can you speak to the state of brainch and treatment for cancer and other such forms of cancer? >> we have made tremendous progress across many different fronts. among the most challenging, to diseases i spent time studying in my laboratory is the brain cancer that took senator kennedy's life and also pancreas cancer. there has been a tremendous amount of basic science work that has given us the atlas of , really those cancers outstanding genetic model systems that help us understand what those genes do, but we are faced with converting into therapies

that truly treat those diseases. i am cautiously optimistic of early data beginning to emerge in the immunotherapy space, which may give us a foothold upon which we can build quite rapidly. a good example, another disease we studied because it is a very tent disease -- virulen diseases melanoma. in 2009 there were very few advances that had any impact on survival. with the advent of this new enemy in therapy, we have 23 percent of patients that appear to be cured. these are patients out 13 years. this is within six to nine months. 23% we have durable responses and now the addition of another appearsodulating drug

to be generating similar results in the majority of patients. maybe be 80%. because itay yet hasn't been around long enough. it could be in the next five cure we may have 80%, 90% of those with advanced disease. wasperspective is there nothing for these individuals, no hope, and that's the example of science being converted into new life-saving drugs. of these otherme diseases, if we can get a crack on the armor, we can build with combinations, because we have this enormous technology to really figure out what is going on with these complex diseases. that's difficult. we have getting drugs in. there is a whole bunch.

the same thing with pen creat a cancer, issues relating to drug penetration. cancer, relating to drug penetration. eached a special effort in of these areas. this is a great opportunity, but we need a stronger critical mass. >> i would say another word about the immunotherapy approach. this is so exciting. it has been built on efforts many thought was never going to pay off. science magazine calling cancer immunotherapy the breakthrough of the year, not just in medical research, in all science. was themmunotherapy most exciting thing to happen in the view of the editors. one already talked about the way people like allison figured out a way to unleash the system.

bring itout how do you back to life, that there is another, even more sophisticated approach where you not only activate the immune system in a general way, but you train those youlls to go after a target identified in the tumor, and you basically give those cells instructions. you educate them about what their target should be. antigen chimeric strategy developed by a number of groups. there is a paper describing dramatic results with the approach in leukemias and lymphomas, but it has been tried in brain cancer. there is a trial on going. i happen to be watching it closely, because a dear friend of mine is one of the participants. a woman who lives in michigan, and she comes back every couple months to see what happened.

she is now two years out without any evidence of regrowth, which is pretty good. anecdote, but it is a fascinating strategy. it's using the approach, which she refers to as her ninja warriors going after those cells that need to be wiped out. it's really tough. brain tumorswith were pancreatic cancer would say this is anything but a tough problem. there are all kinds of problems. i would say we have a better set of ideas and strategies than we have ever had. we ought to put every bit of energy into making this real. >> you talked about some kinds of cancer that are essentially cured now. what is going to be the kind of cancer that is the last one to solve?

pen create brain and a cancer? what do you think? cancer?eatic what do you think? but there are challenges with diseases that show heterogeneity. one cancer.pay those cancers such as lung cancer,: cancer -- colon cancer, it is as if there is a hand grenade in the nucleus, and there is massive regeneration of the genome. this is why it is so exciting because it is designed to go after complexity. it has many billions of combinations that can deploy to identify heterogeneity, and the targeted therapy does not elicit those responses unless used in that combination. it is the category of disease or which there has been wholesale change in the genome.

we can get the detection of cancer much earlier at a time in the history of an aspiring cancer to be able to thereene at a point where are fewer cells, they have less levels of genetic alteration, i think the fight is one that wond be one more readily -- more readily. it's the combination, but brain cancer is a tough problem. and greedy as cancer is a tough problem, in part because we not -- pen creat take -- pancreatic cancer is a tough problem, in part because we do not have a way to get adequate amount of to the system. but i would not expect melanoma would be one of the early successes, so i am totally unable to predict what will be the last one.

>> we are constantly humbled. >> we have about five more minutes. we have lots more questions. >> i am a head and neck cancer survivor, not caused by the hpv virus. i have a great interest in the vaccine. do you feel someday it will be mandatory? initiative, weur have embarked on a number of cancers where we are trying to push policy education on a variety of different fronts, be it tobacco or vaccines. i think it is an enormous missed opportunity for us not to vaccinate all of our children during the window of opportunity. girls and boys. there is an epidemic amongst men. like is no pap smear

cervical cancer where we can identify these cancers early, and it extracts a very significant toll on these individuals. we have hopefully later this year and early next year the fda may approve a vaccine. this is a unique opportunity we have where we can inspire our legislative bodies across the country to enact appropriate guidelines so we can really protect our children. incredibly safe, incredibly effective vaccine. this is what we have been dreaming for. a vaccine that can prevent cancer from happening in the first place. this is manna from heaven. we need to take advantage of this, because anybody who feels

this vaccine should not be given, i would ask them to come with me and do one examination headpatient with advanced and neck cancer, advanced cervical cancer, and you tell me what the appropriate case of action should have been for those individuals decades earlier. it is a childcare responsibility. we as adults have a solemn responsibility to protect the of future well-being generations. i have three children, ages 10, 12, and 13, all vaccinated. one boy and two girls. >> you saw what a political yourall that became in state of texas. >> i think the approach was one -- the approach governor perry took was one where he did the right thing but did not engage instructionpriate needed so there would be grass-roots consensus.

we will approach the legislation or -- legislature in texas and a variety of other states so we can educate our legislators of the opportunity. to appreciate. this gets mixed up in sexual promiscuity. time between ages nine and 13 where there is optimal immune responsiveness to the vaccine. that is the window of opportunity. it's not like you could wait later on and say, let's make a decision at a later time. 80% of the world's population is infected when they become adults. the vaccine does not work as effectively or at all later on. the time to give this life-saving vaccine that can prevent over 400,000 deaths worldwide is in those ages, and we must do it as a society. >> did you want to add anything?

>> i totally agree. >> one last question. using you can address viruses -- >> if you can address viruses to treat cancer. do you have hope in that area? >> i will just say a word. triedy in which we have to approach cancer has many different avenues. small molecules, biologic antibodies, and of course more traditional things like radiation, surgery. the virus approach often is you are trying to arm the virus to specifically go after the cancer cells. often it is a virus you engineered. i think there have been advances in that regard, some of them in brain cancer, what not to the point where we can fully see how that is going to provide a major new weapon