enjoy the rest of your day. [captions copyright national cable satellite corp. 2014] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] journal" ashington authors series continues tomorrow. tomorrow, shane harris. thursday, martha bayles. on friday, author clarence page. "q&a" is 10 years old now.

are fit featuring an episode each day. 7 pm eastern on c-span. at tthe c-span, a look the justice y and system. the director of the equal with ce initiative ssince sister helen prejean. here's a preview. remember being shocked -- dead rned a lot through men walking, and people who had been executed. it shocked me profoundly. one of the things is -- when

you write a book, you do research. i learned about police brutality. also, when slavery was the 13th in amendment, it was except for are in prison -- they are indentured servants. it has not been abolished completely in this country. have been amazed. say it -- the to racism in the supreme court. study in georgia death sentences giving, and overwhelmingly corresponds to when the victim the death penalty makes news -- when the victim

makes ck, the news barely a blip. you are lucky if you can find five lines on page 30, in the case of someone from st. thomas. when a white person was killed, it was always on the front page of the paper. >> not long ago, we start representing children. when i talk about this guilt that poor people and people color are born with -- that is one of our biggest challenges in this country -- black and brown children born with guilt. in new york ring where we have stop and frisk. we are suffering in ferguson. it becomes an opportunity to victimize people. when i was in court, getting ready for hearing -- the first

i've been in the courtroom the suit -- i was was just waiting for to start. and prosecutor walked out, when he saw me sitting at the said, hey table, he get out i don't want any the courtroom -- go out and wait for your lawyer to get your. up, i told him my name, and i said, i am the lawyer. he started laughing. i laughed too -- people are supposed to be fair. they aren't supposed to act on

bias. for a lot of defense attorneys, courtrooms are not friendly places -- they are not comfortable places. all that rage gets directed at you. of course, for a client, it is the more hostile -- justice system to do better if you are rich. when you're poor, you feel the inequality. >> again, that conversation about the death penalty and the will can justice system air tonight at 8:00 pm eastern. >> here's a look at some of the programs you will find on christmas day on the c-span networks. start at 10:00 am.

that is this christmas day on the c-span networks. schedule, go to

c-span.org. >> a look now at cancer research. the aspen institute and the friends of cancer research posted is formed in october. >> good afternoon. it is a great privilege to be went to moderate a panel to remarkable pioneers in the field of cancer research. full o glad we have a house here, and c-span is here. introduce the panelists. dr. francis collins. he is renowned for his leadership at the international human genome project. many awards, use received

the presidential medal of freedom. and a doctor from the receipt of texas cancer center in houston. he was a founding director of the belfort institute for applied cancer science. he has received many awards and honors. thank you for being here. some oing to post questions myself, and later we will open the floor to questions from you all. keep that in mind. we will answer the question, how close are we to curing cancer. i thought we could start by a little back. dr. collins, you received a medical degree six years after president nixon declared a war

on cancer. talk about what with assumptions on cancer -- treating cancer -- did you think cancer could be cured by 2014, or what were your expectations? medical hen i was a student -- there wasn't a specialty in cancer at my i started -- it happen within four years that unit was developed. as a medical student, and then a scary place.was it seemed as if what we have to offer for most of the patients of the me in the part hospital were very toxic, poisonous substances. many people who had solid tumors responded quite poorly.

it didn't seem to me at that they had gotten things together very clearly. it may be hard to imagine, but the underlying model that we take for granted of the ncer is a disease genome, we had not appreciated. 20th nt back to the century, thinking it was something from the chromosomes. but in actual unifying approach the disease -- it is hard for anyone to imagine happening within my lifetime. i think when the war on cancer the early 70's, tools, the have the insight, we do not have the mechanisms to move up the pace that we now can. it was a good thing -- to draw

attention to a problem that needed a solution. the answers were going to have to come out of research. if research is expensive, try disease. in this case, cancer was taking far too many lives. many years it took to figure out what the approach should be, it was good to get that ball rolling. about 'm sure we'll talk this afternoon, we see the potential tackling many types a rational ith strategy that has great hope for curing the disease. now, if you said, are we going cure cancer -- cancer is not just one disease. we've already cured some of them, but their many we haven't.

they are all going to fall by a e wayside -- iit will be hard fought battle. >> we want to talk much more about what the steps will be. i wonder if you would talk about how attitudes have changed by patients and their diagnosis of he cancer. how different is it now from when you got your medical training back then. cancer ainly, back then, strikes fear in patients and their families. were subjected to treatment back then went destructors surgeries -- cchemotherapy was very harsh. even back then, as a result of those advances that have 40's, 30's,

and 50's, we had a significant reduction in cancer mortality, with about half of patients losing life. now does about two thirds of survive the encounter with cancer. not only that advances, but also the strategies. patients are more empowered with knowledge to prevent cancer in the first place. they are also being enlisted strategies, reening with a chance to cure is greatest. has led to vast reductions in colon cancer, among others. would say, over the past

of f a dozen years, because the insights illuminated by research over the last several decades, we now have a clear line of sight as to many cancers. patients feel a lot more hopeful as a result of enhanced diagnostics. the enhanced capabilities we have on the treatment fronts. as a result, we have increasing quality s with improved of life. we are nowhere near where we need to be yet. >> my first newspaper job was we didn't 0's where open dictionary on every person of kansas n the state -- i did many of those families with to they would die from cancer. it was seen as so terrible that at that point.

talk about the turning points. you talk about breathtaking ride over the last decade or the -- what has been turning point? is there one? >> i think the big turning getting an understanding why a good cell goes bad -- he goes the way it then pposed to, stops, when it rowing shouldn't. in certain mutated ways causes that happen. when you activate them cause cells to do this. others when u. s. posted brakes, the cell keeps growing.

and other variations on top of that. the epic genome. but having that understanding a cell mechanics of how growth was the essential step into more directive, rational approach, instead of an empirical approach. strategies until we had this understanding was to with toxic substances, and tried to dial is in where you're killing the cancer cells a little more than the normal cells. >> talk about -- >> the historical perspective here is incredibly important. wine incredible event -- the paradigm that dominate the thinking and cancer.

was a 1960's, there vigorous debate as to whether mutations and genes had anything to do cancer. most brilliant the s honestly thought that mutation of cells was not related to cancer. varmus and bishop were led to that there are genes us that lead them to -- ate cancer and viruses later, we identified mutations in the genes and cancer cells versus normal cells. it took us a while for us to selection of genes

that were real drivers of the disease. a breakthrough happened in the 1990's thanks to dr. collins and the human genome project. the , in 2007, we have human cancer genome initiative, again, under dr. collins leadership. that has given us the periodic table for cancer. lot, perhaps not all, but most of the genetic that are rogue they commandeered the cells. against the backdrop of the i just described, and 2010, it 009 mass of itical what caused it

but also game changing technological advances. to sequence genomes -- done for thousands of dollars and a time. when you can make critical decisions. that was game changing. advances in imaging. just decades ago, you had to go inside to see what was going on. now, we have noninvasive imaging. improvements in computing. to organize large amounts of data. what is exciting to me is that within a very narrow window, we a very -- we are at a

good position to make a more deliberate assault on the cancer problem. this is something that didn't exist because it took the research, fundamental research, for us to be able to move that knowledge to a position where he cannot act on it to help patients. >> so those are the breakthrough that rise to the are today -- e what you're looking for -- what is the breakthrough ahead that a big difference? >> as ron very articulately spoke about, we have now the tools for any individual who has developed cancer to read inside what is going on that tumor -- what is making those cells work. that allows you to move to a personalized approach it is a good thing that we can do that. every tumor is a little

different than others. have ake 10 people who lung cancer, and you asked what is driving the cancer in those will be at different collection of players. that means that if you are trying to decide a rational to know and you want that, see can choose your intervention accordingly. there's some complexity, of course. that means, maybe the old way a clinical trial may not work. if you have a targeted therapy, the people will have the best chance of responding. you an say, let me give example. lung cancer -- obviously, very scary disease

-- there are individuals who have lung cancer who have a rearrangement of a particular gene called alk. it drives itself to grow when not supposed to. is a drug which basically a specific way to stop the growth of those cells that have that alk rearrangement. for it doesn't do anything other patients who do not have that alk -- and is only about 5% or 6% of patients who have that. used to get all the same thing -- not anymore.

clinical trials -- soon, this should be standard care. have a have cancer, diagnosed right down to the -- find out what that 3 billion page instruction booklets like -- then, look at of targeted drugs that are being developed at a phenomenal pace. match p the one so be a to your tumor. the thing -- it at present time, we're still in a idea of ance where the rational treatment for cancer what is understood that tumor -- is monotherapy.

dramatic ive you responses, but not -- we should not be surprised by that. or two s. to one develop a mutation to be resistant to the drug, and grow back. the drug is given, everything looks fine, but a small amount cells are there. a ink about hiv -- it is similar situation. one drug d them with -- azt -- you got response, then it came back. the virus developed a resistance. how do we know treat hiv -- with three drugs. we need to reduce the chance of cancer cell to 0 --

that will be a combination therapy -- that is a hard problem to put together. from my perspective, it is our great hope to go beyond and remission to cures. >> francis spoke about -- and i need that is the way we to go. we talk of cancer, especially in developing countries, the of limited resources means that we really have to on other fronts. cancers can be prevented.

we can do things policy wise, education wise, to reduce the incidence of cancer. for k hpv vaccinations children -- over 45,000 deaths could be avoided around the world. of hepatitis -- excessive uv exposure -- these are during childhood. they are opportunities where we could then the art of cancer. chance of ning, the securing cancer is much better in earlier stages. if we can enhance our capabilities of detecting cancers earlier, that will be best ways to reduce cancer mortality. the treatment front, what is

particularly exciting now is dimension of immunotherapy -- it doesn't speak to what is going on in the lf, but it harnesses host: can tem, so the attack the cancer. giving herapies are enduring responses. i think what you will see over the next 5 to 10 years are significant reductions in cancer mortality. for re anything not melanoma, and we will see it in a variety of other cancers. >> that sounds extremely for doctors -- doing

targeted therapy based on specific genetic mutations. wonder if -- it is great to institution like m.d. anderson -- what if you at another place. our doctors able to keep up? day it becomes fda approved, it become standard practice at hospitals. the issue is really knowledge gap that you're referring to. very significant one. example, the or lung cancer -- n when there was a new therapy, it took on average seven years that community setting for

to become routinely used in the public domain. so, that knowledge gap is a critical issue. because of this where ne complexity physicians do not have a chance to keep up. anderson we publish up to 10 papers per day. to keep up. way to ught to be a a gest data instantly at community level. and how that taught by world expert, what would they do. that would give advice to the treating physician that this is what the world experts would do. you're failing standards of

care, these in the clinical and so you should try, on. once the strategies get broad front -- a i think in this age of this will n, i think on the most impactful reducing the burden of cancer. and o you worry about this, if so, what can you do about it? >> absolutely. do not have a good track how our f finding out results work their way into standards of care across the country. there are good news aspects to are going -- s rogers talked about some of them they relate to the field of cancer. of the the best part

story is that patients are no longer comfortable sitting back and waiting for someone else to make a decision. of the in the era empowered patient -- the much net has made that more possible. make pointed le to questions -- that alone motivate physicians to get up to speed. no physician was to be lack of sed by their understanding something that the patient has just sponsored attention. i think the advent of the electronic health record will be an opportunity, and should provide an opportunity for more patients have access to clinical trials. cancer, that is the case for most childhood cancers. hard on this.rk

is other part of this reimbursement -- if we're going kinds of advances find their way into the standard of care, have to be clear that we are paying for. that is a challenge for many these developments. they haven't gone through all the reimbursement discussions, and many drugs are expensive. >> there was a piece on 60 minutes one week ago about the high cost of cancer drugs. pretty random und -- what determines the cost of some of these drugs? >> i think the more fundamental question is what actually drives the cost. at the end of the day, for us to incentivize innovation to medical needs -- particularly rare cancers, etc. do much better

job in reducing the high rate in cancer drugs and developing. for every want the drugs that are entered into clinical trials today, only one will fda approved drug. patients sometimes benefit, but do not achieve significant results, so they are not approved. causes look at the root of why we fail, it is because we are not doing enough at the preclinical stage. the science to test the drug, a clear that, develop

hypothesis as to what patients he will give the drug to. if we did it that way, and put the front end, yyou would reduce the very high rate of failure, aand that would reduce the cost of developing these drugs. these drugs are significant in the expense, in part because we number ing for the high of failures that occur in the clinical setting. for that -- to pay government, , the the investors, patients with co-pays, etc. think the key issue for us to focus on is how can we reduce of developing drugs. secondly, which patients would truly benefit from getting a drug? when they would have a durable toxicity. though

i would like to see the dialogue be more balanced in causes g about the root and issues, as opposed to some of the dialogue that has been recently in the public domain. >> i totally agree with what ron is saying. i am also more invested in everett to find ways in the pre-clinical stage to be sure that you are chasing after a molecule that will succeed. that means our preclinical models need to be increasingly more reliable. we have cured cancer in mice can tell you an i -- but, i think sometimes we have been misled by the animal models. they gave us answers, but sometimes they want the answers we need.

increasingly, in that front end, we need to know a lot more the ll the way down to three-dimensional structure. the drug fate -- like lock target and key. from an take a skin biopsy anyone -- add the appropriate of four genes, and group of cells into hard muscle, put them on a chip, and bade them in a substance that you're thinking of giving to you, or someone

a cancer drug -- that way, fell early if you're going to fail. the old way we do this is slow and expensive -- we can do better now with tissue engineering capabilities. bottom line, what ron says is right. unless we come up with ways to the failure rate of drugs, drugs will cost a lot of money. when companies had to pay for all those failures, success is you want it to be. >> if the goal is curing all kinds of cancers -- what is the biggest hurdle -- what can make the biggest difference now?

-- each of you take this one. >> i can start. one of the greatest success stories in the nation has been our investment in fundamental and translational research has converted knowledge and insight into things that matter for patients. to us -- exciting when we went to school and then understand the genes and how the immune system works -- were flying blind. at thiss point, we very clear making impact in on the cancer problem worldwide through prevention, screening, and therapeutic advances that truly game changing. are dying -- s

families are being impacted. make a tion needs to decisive assault on the cancer problem. so, we need to act. we need to act decisively. as the u. s. goes, so goes the world. we need to invest in our make rch so we can really a difference in this decade and the cancer problem. >> is a fundamentally a matter of money? >> we are not limited by ideas, nor talent, i think we are limited by resources. at opportunities -- i could say the same thing autism, other , diseases -- we are at this remarkable moments i typically.

it is exciting to see how the landscape changes daily. is why might greatest director of the nih. >> are you tweeting? >> tweeting too. see the azing to coming up with technology that we do have before. to understand the details of clinical phenotypes. all these things coming together in a way that i would not have imagined what has happened in my lifetime. and yet, we are not nurturing that engine of discovering the way that we could be.

a statistic i think is particularly troubling -- often times, really discouraging to young scientists -- what is a chance, if you have a great idea about cancer research? where you going to go to get funded? the nih. and what is the chance to your grant will get funded? it is about one in six. traditionally, it has been one in three. in the cancer into two, it is in ten -- even lower. we were putting up high on this -- and the filter is rigorous peer reviews. and ctually went back looked -- back around the year we were funding up

-- we asked, is funded at the one percentile better than 20 t was funded at the percentile -- we can actually go and look and see what happened, did they make a difference? guess what, there is not a difference to anyone can tell two percentiles -- they are both great. that means we're leaving half of the great science on the table. that is what wakes me up at night. that is what causes a lot of community hunkered down, and deciding after a it isn't worth , and they go on and do something else -- maybe

to another country. but could see what has happened in europe or china, singapore, south korea, brazil. they're going the other way. there really are labeled in the 1980's in 1990's, and try to be what we once were. >> that is very chilling. it must be agonizing on making on these grants. >> it is. know we are turning away brilliant ideas. may have basically convinced young investigator -- who is now trying for the third time and not making the cut -- that is time to go law school. and there's nothing wrong with going to law school. >> talk about collaboration among researchers. is that something has changed?

you mentioned the lung cancer effort. is there more collaboration now than it used to be? >> there's no question that now more collaboration. multidisciplinary activities being brought together are very complex, large-scale projects. it takes a village of activity to move the needle. the need to bring together collection disciplines, technologies, and so on, to prosecute these ideas -- these complex clinical trials. folks seeing that because recognize that to achieve the in their want careers, they have to do that in collaboration with other team members. and science continues, individual ort

investigators -- that lone wolves out there that will make a seminal discovery that will change the world. an example that is jim allen at andy anderson. it was his discovery of a was a brake on the immune system that led to a class of therapeutics. that was individual investigators activity. >> you think that would be funded now if he came to us with a crazy idea? >> back then he even had a challenging time. a real maverick. >> we need mavericks. >> when you are out there, there's no conceptual president you have to have judgment to this may have an opportunity. obviously, those grants will

not fare well in this draconian setting of limiting resources. >> you have affected the nih by -- >> shutdowns. >> what makes this work better? does the whole government have to work better for things to work better for your agency? because, good luck with that. our e have lost 23% of purchasing power for medical research over the past few years. a big chunk of that happen in 2013. recovered from that. if anybody thinks the sequester is over, remember that deals 2014 and 2015 -- a two-year deal.

in 2016, sequester comes back, unless action is taken, that is what will be. the projection is that the nih with them lose $19 billion that would have gone to medical research. that is basically the default of what will happen next. am an optimist. i think winston churchill was when he said, you can always count on the americans to do the right thing when they all other sted options. laughter the case here is so compelling. many different diseases -- including cancer. everybody is interested in seeing the economy grow.

-- one e you once statistic -- the genome project. that were million spent on the genome project, $1 trillion with answer. health initiative -- a similar analysis was done a few years ago. 141 to 1 on the return investment. we are starting a looking at the brain initiative. i'm sure there will be all for the technology that span out that they create new businesses and economic growth. but we are struggling to get off the ground. to never i have a chance speak to members of congress

about this -- everybody says, you are right, this is something we should be doing. but, we all caught in this current gridlock -- inability to a long-range plan as to how resources in this country will be spent. we continue to be part of the discretionary budget -- part of the victims of his long drawn out project that has not reached a conclusion. to in, i'm an optimist believe that our case will be so irresistible, we will turn the corner. i hope it happens soon. turn the corner, we of 't see another doubling nih -- it was great, but it kind of slowed the speed of what followed. we're t ground, and now undoubled.

what we need is a stable trajectory, then you can plan. scientist can say, this funding won't get pulled from me, there won't be a roller coaster. if we could recover that. there's certainly members in congress were advocating for that. should that be a partisan effort? it is something that everyone has a stake in. everyone has a family member or friend looking for medical answers. going to ask one more question, and then turned to the audience. you have mentioned prevention something that could prevent 50% of cancers -- we all know cigarette smoking pretty familiar. >> 30% of all cancer deaths -- ttobacco-related.

>> i do this yesterday -- i googled this yesterday, what causes cancer? headlines i found -- a bra does not cause cancer. a lot of stories linking obesity to cancer. is this helpful to people? or do people feel whiplash by what they should and should not do. >> there are strategies that a solid bedrock of that do make a profound impact. going on websites to find out prevent can do to cancer -- these are very generic, broad-based recommendations. what you, or i, want to know is should be we

screened, wwhat are our risk factors. you will be seen with a lot of these technologies personalized wellness as well. you will be able to, based on family history, genetics, the environment they live in, levels have different of screening. you might eat s to change the trajectory of diseases that might afflict you. personalized wellness is an important aspect of what we do. big ones -- smoking is public health problem number one. second, we have obesity as a major problem in the united and other countries. that does big problem truly impact the incidence of certain cancers. have viruses -- i mentioned hpv, the hepatitis virus.

many other elements. those are what -- what is all those -- bout many of those are operative at childhood. about how we nk manage the trajectory of health and well-being -- i think we opportunity in k-12 to influence children and give them the knowledge they need. so, at the right time in their lives, they develop the habits they need. started dult smokers as kids. hpv vaccines need to be given at childhood. 80% of the human population is hpv positive -- it depends on subtype you get as to whether you get the disease.

in my view, cancer prevention is a childcare issue. have the responsibility to make sure children are empowered. a future that ave has lower incidence of cancer. >> dr. collins mentioned that an empowered patient is a good one. >> you see the patients are by knowledge -- i would save the challenge is really on both sides. -- re are an application to aren't enough patience that have that mentality. at m.d. anderson, we are very passionate about this.

we found that if you are professional program -- it is 37% success self quitting smoking. also, doctors to always remember that patients should sort of red to this clinic -- now, we do it automatically. as soon as he goes in, the patient automatically gets to the clinic. i think their technologies that we can exploit on the front end of the problem. >> so, this is a very smart group of people with intelligence questions to ask of your own. i think -- they would like you identify your self.

>> i think the underlying argument is a you do not have -- monetary rces resources. ever thought about working with other countries to do as a team? have probably should addresses already -- absolutely. the problems are so important, and the resources are so limited. for cancer genomics, there is cancer genome al consortium that has many countries working together to build the database. slightly ntry has a different epidemiology, so it is great he can tap into that. of the countries agreed to

have the same standards of data, and access. that was six countries, 20 labs. my job was to be the field general. the majority of people were even in the u. s., but they all agreed, it was so important to work together. of another e chair organization -- when we meet months, ceos of organizations meet together at the table -- we are constantly ways to be synergistic together, and not duplicate. sometimes we duplicate on purpose, we see something that worked in one setting and we see if they can work in another setting.

same can be said about the private sector. i probably spent more time talking with -- and we have made some pretty interesting models happen in that regard. likewise, with foundations. if you add up all the philanthropic contributions, it short of what nih lost in the sequester. it is all relative. -- and the i have anderson has been on the global fronts for many years now. this allows us to not only work with great institutions but other countries tell me the quality of care. we also work with governments well as countries, as media, so we can drive policy of the population.

is important -- it is not just resources that are important, but organizational opportunities the result from these collaborations. it is a big problem -- many are solving their disease problems are now being an aging population, -- it is concern collision course that they will decades from now -- alzheimer's, cancer, etc. >> 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 person's parents has any effect on your chances of having cancer. >> what a thoughtful question. yes 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. rather gradually, and it is a statistical change. as fathers get older, there are

more new mutations in the dna. we can actually be very precise about that. if your father was average age , 20's to early 30's, you probably have somewhere in the neighborhood 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

we know new mutations play a role, the risk goes up a bit. if you're looking for a rare new mutation genetic disease, you 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 very 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. i'm not aware of evidence that cancer risk goes up. >> that's correct. i mean, the overwhelming factor for the development of cancer is our age. statistic,very other

aside from tobacco, for example, which dramatically increases your risk. just simple changing demographics, aging of the united states is the single most important factor for the development of cancer. by we anticipate just because of 2030, changing demographics and the aging of our nation, a 45% increase in the incidence of cancer just because of age. >> you talked about how the odds of getting cancer increases with each decade increases. did you say after 60? >> for alzheimer's, diabetes, heart disease, and cancer, every five years, the incidences doubled. your 85, you have a 45% chance of having alzheimer's. by the time you are 80, you have a one and two chance if your -- you are male and one in three

chance if you are female. it is a question, can we afford not to support the solution? today we spend a quarter of a trillion dollars for 5.4 million americans inflicted with the disease. by 2050, just from changing demographics, we will be spending $1 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 through decisive research, application of that research development of drugs, and so on , that would make a difference. it would make an impact fundamentally. >> not to mention the human cost. i called on this person next, but she didn't have the mic. >> i am karen brooks.

first, i want to thank you both for a lifetime of service in science. can you speak to the state of research and treatment for brain cancer and other such forms of cancer? >> we have made tremendous progress across many different fronts. among the most challenging, to -- two 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 genes in those cancers, really outstanding genetic model systems that help us understand what those genes do, but we are still faced with converting that information into therapies that truly treat those diseases.

i am cautiously optimistic of some 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 legal, -- lethal virulent diseases, melanoma. in 2009 there were very few advances that had any impact on survival. with the advent of this new 23% ofherapy, we have patients that appear to be cure it. these are patients out 13 years. this is within six to nine months. 23% we have durable responses and now the addition of another immune modulating drug appears to be generating similar results

in the majority of patients. maybe be 80%. we cannot say yet because it hasn't been around long enough. it could be in the next five years with melanoma, we may have 80%, 90% cure of those with advanced disease. again the perspective is there , was nothing for these individuals, no hope, and that's the example of science being converted into new life-saving drugs. so i think with some of these other diseases, if we can get a armor, we can build with combinations, because we have this enormous technology to really figure out what is going on with these complex diseases. >> [inaudible] >> that's difficult. we have getting drugs in. there is a whole bunch. the same thing with pancreatic cancer, relating to drug penetration.

these are special problems for different diseases. we need a special effort in each 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. astrophysics, whatever. cancer immunotherapy was the most exciting thing to happen in the view of the editors. ron has already talked about the way people like allison figured out a way to unleash the system. the tumor has managed to basically convince it to go into its wound any figure out how do

you bring it 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 t cells to go after a target you identified in the tumor, and you basically give those cells instructions. you educate them about what their target should be. it's the chimeric antigen car,tor strategy, or developed by a number of groups. there is a paper describing dramatic results with the car approach in leukemias and lymphomas, but it has been tried in brain cancer. steve rosenberg at nih has a trial ongoing. a dear friend of mine is one of the participants in the trial, a woman who lives in michigan. she comes back every couple of months to see what happened.

she is now two years out without any evidence of regrowth, which is pretty good. that's an anecdote, but it is a fascinating strategy. in this instance, it is using the car approach, which she refers to as her ninja warriors going after those cells that need to be wiped out. it's hard-fought. it's really tough. nobody stuck with brain tumors or with pancreatic cancer would say this is anything but a tough problem. there are all kinds of personal consequences for those sick of the diagnoses. 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. you have such great success. what is going to be the kind of cancer that is the last one to solve?

would it be brain and pancreatic cancer? what do you think? >> i think there are challenges with diseases that show heterogeneity. i would that necessarily paid -- peg one specific cancer. those cancers such as lung cancer, colon cancer, it is as if there is a hand grenade in the nucleus, and there is massive re-wholesale 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 poster herbal -- durable responses unless used in that combination. it is the category of disease or which there has been wholesale change in the genome.

this is why if we can get the detection of cancer much earlier at a time in the history of an aspiring cancer to be able to intervene at a point where there are fewer cells, they have less levels of genetic alteration, i think the fight is one that could be won more readily. for some of those more earlier stage, look at last cancers. it's the combination, but brain cancer is a tough problem. pancreatic cancer is a tough problem, in part because we do not have a way to get adequate amount of drugs 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. but i have a great interest in the vaccine. do you feel someday it will be mandatory? >> as part of our initiative, we 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 proper use of vaccines or so on. 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. >> girls and boys. there is an epidemic amongst men. there is no pap smear like cervical cancer where we can

identify these cancers early, new present very late in the disease 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. it is an 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 of a patient with advanced head and neck cancer, advanced cervical cancer, and you tell me what the appropriate case of -- course 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 health and well-being of future generations. i have three children, ages 10, 12, and 13, all vaccinated. one boy and two girls. >> you saw what a political football that became in your home state of texas. >> i think the approach governor perry took was one where he did the right thing, but he did not engage in the appropriate instruction needed so there would be grass-roots consensus. we will approach the legislature

in texas and a variety of other states so we can educate our legislators of the opportunity. it's important to appreciate. this gets mixed up in sexual promiscuity. there is one 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.

>> maybe one last question. >> if you can address viruses to treat cancer. do you have hope in that area? >> i will just say a word. the way in which we have tried 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 -- but not to the point where we can fully see how that is going to provide a major new weapon we want to use against most cancers. >> there are many viruses being

utilized to try to take advantage of differences in cancer cells versus normal cells, that viruses may replicate in cancer cells versus not replicating. this provides opportunities to really disrupt those cancer cells and lead to death of the cancer cells, but as francis mentioned, this is not as effective as one would imagine on the basis of that particular approach and paradigm. however, those viruses that are new antigens, when combined with immune modulation may provide significant opportunities to train the immune system to recognize not only viral particles but bystander mutations that are occurring in the cancer cell, so it may really prime the immune system further. there is exciting work going on at m.d. anderson with a

particular engineered virus and brain cancer, which is showing impressive result, but in a subset of patients. we need to understand why some patients are responding versus not. those are exciting opportunities. i think that regimen is going to need to be combined with other modalities to bring out the full potential. >> we are out of time. i want to thank you for such an interesting discussion. [applause] .> q&a is 10 years old to mark a decade, we're featuring one interview from each year of the series over the holiday season. today, lonnie bunch. museum is currently being built on the national mall here in washington. q&a is today at 7:00 a.m. eastern on c-span. tonight at 8:00 on "book tv,"

"factory man." "money." boys." starting at 8:00 eastern on c-span2. grew at itsnomy fastest rate in more than a decade between months of july and october, surge in consumer spending according to government data released this morning. the commerce department said aggressive mr. product growth hit an annualized rate of 5% and other order and that is up from the previous estimate of 3.9%. not since 2003 has the economy expanded so quickly. the dow jones industrial average

topped 18,000 for the first time after markets opened this morning. coming up next, discussion on the need for additional resources and support for cancer research. commerce men bobby scott spoke about the work at the national patient advocate foundation located in his virginia congressional district. answer survivors and other members of the cancer innovation coalition who host this program also took part. >> on behalf of the cancer coalition members with executive board of directors of national patient advocate foundation, our ceo was not in attendance with us today, but certainly sends you his greetings and is gratitude for your attendance. thank you for being here with us today.

today, 1600ry people will die of cancer. every single day of this year, 1600 people will die of cancer. by year end, we will have had 585,720 people in the united states who will succumb to cancer. our nation will have spent $201.5 billion in health care costs to fight cancer and to provide treatment to the 1.6 million americans who will be diagnosed with cancer this year. these statistics are not numbers. they are families. they are futures not realized, and they are failures. that we all share as we have been waging this war on cancer that was declared 50 years ago. we have made progress.

between 1998 and 2000, life expectancy for cancer patients increased by approximately four years, which translated to 23 million additional years of life and roughly $1.9 trillion in value added to the economy. in an article entitled "an economic evaluation of the war on cancer." on behalf of every family in our nation who has mourned the loss of a loved one, thank you for being here today to listen and to learn about the work of the cancer innovation coalition through project innovation. cancer cures are born of innovation. you will be addressed by experts. they will include our first speaker, congressman robert

scott, and i must say our dear congressman, whom i will formally introduce in a moment. the panel that will address you includes dr. edith mitchell, john harrington, and heather. allow me to introduce each panelist to you briefly. dr. edith mitchell is an oncologist, board certified in internal medicine and oncology and a clinical professor at the department of medicine. a medical oncology program leader. gastrointestinal oncology at jefferson medical college of thomas jefferson university and associate director for diversity programs and director of the center to eliminate cancer disparities for the sidney kimmel cancer center at jefferson. dr. mitchell has spent her medical career helping individuals in medically underserved areas.

she has published more than 100 articles in this united states. she is known throughout this country as a retired brigadier general. the first brigadier general female african-american in the united states. her leadership in this country in the documented an numerous awards she has received, from the military, from the association of cancer centers, so it is a privilege to have her also as a member of the scientific committee of the national patient advocate foundation to address you. john harrington is recently retired. he spent his entire 36 your career with the legacy companies of santa fe. he distinguished himself by the late great teams and producing outstanding results.

he retired as a senior vice president and chief commercial officer for global oncology. he built a commercial team in cambridge, massachusetts and all -- also staffed the regions with commercial oncology. previous to this role, he led the u.s. oncology business unit. since his retirement, he now serves on multiple boards in the united states. including somerset regional health center, the ada industry advisory board, the concord cancer foundation. it is a privilege to have john with us today. there is a saying we have, and that is the patient never gets it wrong. the speaker you will certainly enjoy as well is heather falwell are. she is a graduate of american university and washington, d.c., and she now enjoys traveling to

exotic locations around the world with her husband, jeff. she lives in maryland with her husband, son, and two rescued cats. her hobbies include vegetable gardens, sewing, and home decorating. in the spring of 2012, she was diagnosed with stage four cancer following a craniotomy. her story is compelling. you will certainly enjoy all that she has to share with you. it is my privilege to also share , you will be addressed today by several biomedical researchers and clinicians who while not in this room, has sent their message to you via videotape. you will and today session with dr.message as well from janet woodcock of the food and drug administration another representatives from the research community.

it is a privilege not to be able to introduce to you formally commerce men robert c scott. he is currently serving his 11th term in congress. prior to that, he served in the house of representatives in virginia as a delegate from 70 -- 78 to 88. in the senate of virginia from 1983 until 1995. he has distinguished himself in his career with a passion for health care initiatives, but he also serves on the subcommittee for civil rights and civil liberties of all americans. as part of his commitment to the developing of universal health care for all and previous congresses, representative scott introduced the all healthy children act to ensure millions of uninsured children would be ensured. he likewise worked to get that same provision into the affordable care act.

he is a man of compassion. he is the son of a physician, and it is a privilege to introduce to you representative scott. [applause] >> thank you for your kind introduction, and thank you for all that you do. hampton roads is the proud home of the patient advocate foundation, and you have obviously used your experiences with your friends dealing with health care to help others. people are faced with many challenges of what choices in health care they will pursue and how to pay for those choices, and the patient advocate foundation has helped hundreds of thousands of people navigate the health care system. they are also a reliable resource when we went through the affordable care act, when we

went through that, and a lot of the provisions have your fingerprints on it. affordability so everybody can get health care. those with pre-existing conditions, those with no unfair cancellation of coverage, no cap on benefits, but a cap on total out of pockets of people so -- so people don't go bankrupt. your fingerprints have a lot -- you have a lot of fingerprints on the affordable care act, and i thank you for that. just as hentgen roads is the home to the advocacy foundation, we are also home to many other cancer related institutions, one of which the hampton university proton treatment institute is one of just a handful with the cutting-edge surgery that exists only in a handful of centers across the country. we have the cancer center, one of only 68 cancer centers

designated by the national cancer institute and is a vital resource for cancer research. both doing significant research in the area of cancer treatment. all of these entities will benefit greatly from groups like project innovation coalition and the positive impact they will have. under the leadership of the patient advocate foundation, the project innovation coalition represents a movement which will ensure access to life-saving treatment and medical care. launched just this year, project innovation was born out of the release of the report securing -- national patient advocate report securing innovation and help in cancer treatment, which identifies institutional and regulatory funding hurdles which are driving up costs and delaying new therapies, which will limit patient access to new treatment. i am sure as our speakers will

note today, these obstacles are not insurmountable. with dedication and investment, the federal government can and should be able to move in the right direction and increase access to life-saving treatments. the project innovation coalition will continue to show policymakers and other stakeholders why these improvements are so necessary. one of the problems we have in addressing this is some of our legislators will have to change priorities. in the past few years, congress has extended massive tax cuts. at the same time, they cut funding for the centers for disease control and other research areas. many states have decided not to expand medicaid to provide health care for hundreds of thousands of people. notwithstanding studies are showing those states that expand medicaid are actually spending

less -- less state money than those that did not. the states that expand medicaid are actually saving state money and providing coverage for hundreds of thousands of their citizens. we've done a lot with the affordable care act. but there is still a lot to do. i believe it is the work of the national patient advocate foundation and product -- project innovation will be key to changing priorities and informing how we can make improvements by facing patients desk supporting patients who are facing expensive ways to treat chronic or life-threatening conditions like cancer. once again, i want to thank you for all you have done and all that you are continuing to do to help patients face their critical health care choices. thank you very much. [applause] >> let me share that from this point forward, we will essentially have now an address

from cancer leaders who are going to speak out to you via video. and immediately, dr. mitchell will come to the microphone and address you. followed by john harrington and then heather will come to the microphone and address you. joel, thank you. ♪ [video clip] >> we are losing our edge. primarily because most of the innovation has taken place outside of this country. >> funds for conducting research and especially clinical trials is going down. as a result of that, many clinical trials are being conducted outside of the united states instead of inside the united states. >> what used to be the great engine of american innovation. it's now finding homes in europe and new business models emerging

in china and the far east. >> the urgency now is with more and more people being diagnosed. we need innovation in cancer prevention. we need innovation in more cancer treatments. >> the slowdown is largely related to funding of younger investigators. i think we are in danger of losing a generation of cancer researchers as we face this problem. >> not long ago, we had a woman present with an incapacitating headache. she had metastatic cancer to the brain, which was a life rat. at the time of surgery, we were able to take her tissue and send it for molecular profiling so we can take advantage of these -- new therapies. she had a mutation that allowed access to target therapy. she could take a very toxic pill

-- not toxic and her disease has gone into remission. >> a major step forward has been in using engineered measles virus to treat a disease. it is called multiple while oma -- multiple myeloma. we have seen a woman who had the disease become resistant to many cards of their pay, now going into remission for months going on years. innovation of cancer therapies is crucial at this point because we are reaching the limitations of some of the traditional therapies. as we gain knowledge into new therapies, horizons open that we haven't imagined before. in the way cancer can be treated. by increasing innovation, patients will have more access to treatment that can potentially cure their cancer. >> the tumors we treat continue

to change so that when we develop a new treatment, the tumor can actually adapt to that treatment and overcome it. we need innovative approaches that overcome that resistance when tumors develop to our treatment. >> cancer innovation is essential because that is how we have improved outcomes in the last 10 to 20 years. we have a lot further to go. and it's not just curing cancer. from a nursing perspective, it's returning patients to normal functionality. crooks and less innovation keeps up with the pace to changing demographics and changes in diseases we could fall behind. ,

>> it is now our privilege to welcome dr. edith mitchell. >> nancy, thank you very much. congressman scott. and ladies and gentlemen, thank you for being here this morning. it is a privilege for me to speak about cancer innovations. this year marked the 50th anniversary of the american society of oncology. which, in 1964, seven people got together to discuss cancer innovations and how it could move forward. move forward to 2014. it has more than 35,000 members

and is one of the largest organizations to demonstrate cancer innovations. so what we have now, not only is asco emphasizing its large membership, but it's emphasizing new cancer innovations. and the new and innovative technologies we are using and that show our patients can survive and live longer. certainly, the last 50 years have shown significant advancers and overall -- in overall cancer survivorship. the american cancer society just this year reported that there was a 20% decline in cancer deaths over the last two decades. this decline in cancer deaths means that 1,340,400 deaths were eliminated and therefore, these

people survived. 1964, there were fewer than 3 million cancer survivors. and now, in 2014, there are more than 14 million people in the united states living and having survived cancer. so this is an extraordinary time. it's very important that we continue the innovation in cancer research. certainly, at the meeting earlier this year, in celebration of 50 years of asco, there were demonstrations of what have some of the important advances been that we have made over the last 50 years. one of the was chemotherapy first cures for hodgkin's lymphoma. which was first found in 1965. and since that time, prior to

that, it was universally almost detrimental and caused death. the treatment was limited with radiation and surgery. now chemotherapy, today in 2014, more than 90% of patients with hodgkin's lymphoma are cured. the second advance was a vaccine approved to prevent cervical cancer. this vaccine against the hpv virus not only allows for treatment and cures for cervical cancer, but other cancers including head and neck cancers. and anal cancer. so the advance in presenting cervical cancer. number three, targeted drug transformations. targeted drug transformations with the fact of cure for rare

leukemia, in 2001. the fda approval of the drug means that patients who universally die from this leukemia are now cured of that disease. and within that drug, not only has it been useful in the treatment of chronic myelogenous leukemia, but other diseases now have much better prognosis. and the idea of targeted drugs which have fewer than the trans chemotherapy, these patients do not suffer as much. so very important. a number for was the advance for the cure of testicular cancer. prior to 1977, when dr. lawrence einhorn put forth his regiment

for treating testicular cancer, almost all patients with testicular cancer died in one year. move forward to 2014. almost every patient with testicular cancer not only survives five years, but they are cured of the disease. so innovation showed all of these therapies allowed for our patients to live longer. the number five advance was powerful antinausea drugs to alleviate the side effects of cancer treatments. the demonstration at the drug zofran made tremendous strides. not only have we conquered vomiting from chemotherapy and other treatments, but also drugs to treat anemia. and other side effects of cancer have been demonstrated.

and what we have, therefore, is a better quality of life for patients. as a result of our investment in clinical cancer research, more people are surviving cancer than ever before in this country. two out of three people live at least five years after a diagnosis of cancer. and many are cured. therefore, the cancer death rate has dropped more than 20% in this country over the last 20 years. so the last two decades. if we are to continue this advancement for treating patients and treating the side effects, we must continue the research. this month, october, is breast cancer awareness month. let me tell you about some of the advancements in the treatment of breast cancer.

no longer do we have the radical mastectomy, but breast conservation therapy is there and is the standard now, decreasing a lot of the side effects and consequences of massive surgery such as the mastectomy. the estrogen receptor and other hormonal and molecular receptors for breast cancer has allowed for drugs that address those specific receptors, allowing for personalized medicine with drugs such as tamoxifen. in early days when tamoxifen was first found, it was given to everybody. now we know which patients are more likely to benefit from the drug. consequently, personalized medicine, meaning, we can get the right drug for the right patient the first time. and that is very important.

not only have targeted therapies addressed breast cancer, but other cancers also. colorectal cancer melanoma, lung , cancer, and others. therefore, our innovative technologies develop new -- development of new treatment plans and regiment allows for more patients to survive. not only treatment, but innovative technologies for diagnosing cancer such as computerized tomography or ct scans. digital mammography, mris, gene sequencing, and finding the gene and mutations for cancer so that we can address specifically those mutations, those changes that cause cancer growth and proliferation in each individual patient. so in summary, i have provided you some of the innovative

technologies over the last 50 years that have allowed for patients in the united states. but not only in the united states, to live longer and survive cancer, and therefore, have a better quality of life. so whether we talk about chemotherapy treatment, targeted treatment, research, patient care, the nausea vomiting drugs, the chemotherapy, the technology for mri and diagnostic imaging so that we can more accurately diagnosed cancers, the molecular technology. how did this come about? it did not happen overnight. it happened through each of these milestones having resulted from careful, basic, laboratory research, rigorously conducted clinical trials, and these

clinical trials are made possible by the funding of research and the participation of patients in these clinical trials. you have heard from the video that many clinical trials are moved outside the united states. it's important we address clinical research and all the stakeholders involved collectively joined together to move forward in the research. -- stakeholders include collectively, we have to work together. legislative, scientific, clinical, policy and governmental, the administrative part, institutions of higher learning so that we are bringing newer and younger generations into the arena for treating patients. not only the institutions, but

patients and advocacy. all of us must work together to make the commitments to provide the resources that permit enhanced innovative research and clinical applications so that we can continue to say it is the legacy of asco and those early scientists and clinicians that got together to say, we must develop innovative technologies to take care of patients with cancer. so we must continue this legacy. the legacy of increasing survivorship for cancer patients, to improve the quality of life for cancer patients so we can say more individuals are survivors of cancer. i am urging everyone, let's get together. everybody has a role and we should all work together. so in summary, yes, we can

conquer cancer. thank you very much. [applause] >> thank you, dr. mitchell, representative scott, nancy. thank you for the opportunity to share my thoughts on some of the important health care issues facing the patients of the world and also facing the research capabilities of the united's -- united states. that issue is making sure that they have funded medications of access to prolong the quality and longevity of human life. while there is a very important and needed focus on health care coverage, expenditures, and financing that representative scott and congress have been working hard to accomplish, there is also a need that they are focused on as well.

it is to ensure that the innovation system in the united states that has delivered so many breakthroughs for so many patients in this country and around the world, continues to be funded and understood. i am very fortunate to have been able to develop these perspectives in terms of not only working in the united states for 32 years, but also a great opportunity to travel the world in a global oncology perspective. i have seen what has occurred most recently both in the united states and around the world. i've had the great fortune of working on several boards, whether it is the massachusetts biotechnology council, or the national patient advocate association. and also special care delivery systems. most people in this room, your lives have been touched by cancer. i lost both of my parents many , friends and family members and

i am a cancer survivor myself. it is that they gives you a razors edge in the need for innovation. it is my belief this country is becoming complacent. a nation that can become complacent with opposition as world leader and oncology care. research and development, and in -- advancement that have led to significant improvements to survival and patient care. four decades of unprecedented success have left many feeling, "what else is new?" and, " why haven't they cured cancer?" perhaps we no longer hear the national institutes of health, american cancer society, society of clinical oncology, which you have heard dr. mitchell speak about, we no longer hear the facts as relates to the clinical and economic benefit of

innovation. do these facts still resonate in washington, state capitals, and most importantly, with patients around the country? i would maintain in the patients , it's early does. there are the benefits, no beneficiaries of five-year survival is increasing for many types of cancer. and that includes breast, prostate, colon, and lung cancers, which many of these were thought of as a death sentence. and no patients have real, tangible hope. there's been a steady decline in cancer deaths. it was only 40 years ago when we were saying that cancer deaths were increasing by 4.7%. and now, in the most recent reporting time from 2007 22011, -- 2007-2011, there has been a 15.5% reduction. those are not just statistics. these represent pupils we know. birthday celebrated anniversaries achieved by those

, patients suffering from cancer. survival rates have increased 58% since the mid-70's for childhood cancers. childhood cancers. children that died most often, especially in leukemia. a 58% increase. and now there are almost 15 million cancer survivors. you will see many of them around the thanksgiving celebrations that you will enjoy next month. i hope that you give thanks to the innovation that helps to save these people's lives. the great news is, based upon investment encourage and commitment there are now more , than 1000 medicines in development for cancer. the promise offers new hope for cancer patients the unlocking of the human genome project. i would maintain the right product for the right patient for the right outcome saving money as well.

as nancy mentioned, you lose sight of the fact that since 1988 to 2000, 23 million years of life is granted back to cancer patients. $1.9 trillion from an economic perspective has been the improvement based upon cancer treatments. this is a global health success story funded by the united states government. also, the world-class cancer research and development centers, the biotechnical and pharmaceutical industries. with all of these positive outcomes, some facts are neither heard nor understood. the spending on cancer medicines represent less than 1% of overall health care spending. the spending on cancer medicines represent only 20% of cancer treatment. and also, if you look at the average price growth of cancer drugs and medicare part b, it's

actually less than medical inflation due in large part to the lowering of generic products. today's insurance covers a lower percentage. a cancer patient might face a 4% out-of-pocket, but 7% for outpatient. but now face up to 20% as it relates to pharmaceutical care. just before i retired, i attended an m.i.t. innovation forum where the former ceo stated the fact that the science promise of breakthroughs has never been more exciting, but funding of innovation has never been more challenging than ever. the council does phenomenal job representing the ecosystem of health care in massachusetts. they mentioned the funding which you heard representative scott talk about it certainly has gone

down. what is it as a parent, what that means for the project flows . venture firms. if the government is not reducing funding, where is the venture firm? they are an important part of financing the ecosystem and investing in fuel life science companies, particularly at the seat and series level of funding. it's down from the peak at 2007. it's hard to see how it's going to return. decisions by cms genetically cut reimbursement had a chilling effect on companies and investors. companies are working hard to show the cost benefit. and what the meeting means in long-term. while the affordable health care act brought many needed changes to health care coverage for teaching institutions operating , and facing many difficult trade-offs.

in my role, as nancy mentioned i , had the opportunity to work in other countries. and i would often meet our top investigators in china, the far east, portions of eastern europe. in many cases, 70% of patients, -- 70% of patients are enrolled are coming trials from other countries. while we should welcome the fact that there are more citizens in the globe being involved in cancer research and better understanding patient needs, i will tell you, that type of recruitment doesn't represent the diversity of the mecca population that these drugs need to serve. so i ask you to think about that as well. i personally observed the national single-payer systems so that delayed access, while negotiating price and access that were neither patient focused nor fair.

as a nation, we are facing a health improvement system that is threatened and fundamentally changed. tomorrow, if you go out to look at a new automobile, you would not ask for the technology of the 60's. few of you would ask for three .m. radio, an iron dashboard with no seat belts. you would not ask for a new computer based on cobalt and the system i remember being in college. is that what we are asking for now? what we are benefiting from right now are the innovations made in the 60's, 70's, and 80's. are we looking at a just good enough approach? just good enough. we have invested a lot. we have seen progress. isn't just good enough? are we looking at cost containment systems that were neither designed for the benefit of cancer patients? i encourage everyone to look at the total value of innovation,

putting the lives and well-being of patients first. in closing, i ask you to spend time with your constituents that are involved with cancer innovation as you enjoy the thanksgiving day holidays. many go back into their districts and whatnot. i would ask you, if you see cancer patients ask them what would ask you, when you them what they care for. cancer researchers, if you see them, asked them, if they have adequate funding for cancer research. "think about, but we do not fund research, what does this a nation ages, and the need