ce. they used to tell story of how justice marshall could relate his life and so on. the question is, what do you think about the urgency of trying to encourage more diversity in the court? >> i must correct you on one thing. we just had this mistake in the washington post. i have been hearing about it for the last two days. there are only five graduates of harvard. justice ginsburg's degree came from columbia after she spent two years in harvard. justice thomas, at an event at yale, that is the one he picked out as a problem for diversity.

there are a lot of great law schools not represented on the court. i cannot explain to you why it is this way right now. except perhaps, you have very ambitious people who go to harvard and yale. people who are thinking this is a goal for them. i think, when presidents pick nominees, it helps to say, this person went to one of those law schools. >> i don't think it matters much that they are from those schools. you do have a point in terms of different life experiences. justice o'connor, put a great deal of her political experience in the court.

that is true people in private practice. people from civil rights backgrounds. those are relevant questions. i'm not sure the fact they all went to elite schools. one was a sharecropper's son. others were immigrant children. it is not just the elite backgrounds. >> you may remember that president nixon tried to put someone on the court. when the man was defeated because he was demonstrably unqualified to sit on any court's, a senator from nebraska commented, everybody is entitled to representation on court, even

mediocre people. mediocre people don't get into harvard and yale. i think when politicians go looking for people to nominate they have some stars in their eyes about the elite schools. they seldom get beyond that. >> i am wondering if you guys see any cases coming down the pipeline where there could be a conflict between religion and secularism. >> i don't know.

there has been one case so far which has been about religious accommodation. the length of a prisoner's beard. whether arkansas has to accommodate a muslim prisoner who wants to grow a beard because his religion dictates that. it was an interesting case. partly because, unlike some of the ones we had last term, theo obama administration was on the same side as conservative groups supporting the prisoner. this one did not seem it was going to be as tough as other cases had been. >> later in the term, we are going to have the sequels to hobby lobby which do not involve private business corporations but involve nonprofits. if hobby lobby was in some ways

a test of sect carrion organization, we could see that recur in those cases -- were the organizations are more distinct the religious and character. >> another question? i think we will get everyone. >> i am a patent attorney. my question is about -- i was thinking about how he wrote an article 23 some years ago about having jews on the supreme court. i would love to see muslim justices sometime. muslim american justices that could help with national security issues.

i wanted to get your insights about how far out you see that happening. >> we could make a very bad joke and say if present obama became a supreme court justice -- [laughter] >> i was hoping to ask the panel that question myself. i'm glad it came up. >> let me put in my view. there is a tragic amount of bigotry about people of the muslim faith. it all probably originated on september 11. it runs throughout public policy. the way we treat the people at guantanamo bay, cuba, is nothing less than despicable.

maintaining guantanamo is no different than what we did in world war ii in maintaining the concentration camps for japanese-americans. that is all driven by a suspicion of the muslim faith. when you see legislatures like those in texas passing laws that say, courts are forbidden to make any judgments based on sharia law, the chance that any muslim, however devout and peaceful in his or her view of public life, there is no way the senate of the u.s. as presently composed and composed anyway we can anticipate for the next generation, that a muslim would get appointed to the supreme court and confirmed. >> let's start with the lower courts and try to work up.

>> we have muslims in the house. that is an important breakthrough. there was a time, and perhaps i should not be saying this because i am a guy. there was a time when there were not many women in congress. increasingly, the country has discovered the virtue of the feminine perspective. we are getting more women appropriately and we now have three women on the supreme court, which is the high point for that sector of our society. i don't think in my lifetime which is not that much longer, who will not see a muslim on the court -- we will not see a muslim on the court. >> one must question. -- last question.

>> it seems like we have a people of -- a fear of people putting religion into the opinion. can we talk about religious -- what is the beauty of the religious diversity of the supreme court? >> positive aspects of this religious diversity? we have covered some of them. anybody want to add anything? >> diversey itself, however you define it, is virtuous. there are different ways to apply and defying the law. we are a long way away from what used to be called mechanistic jurisprudence where you say the law is on most like a mathematical proposition. there are so many intellectual cultural, social logical, even economic inputs in making a sound legal judgment. the more input you have from a

variety of experiences, a variety of backgrounds -- including a variety of religious faiths -- the better the law in substance is going to be. if any president has the option of enlarging the diversity of the court, as wilson did in premade you on the court, -- putting a jew on the court and reagan did by putting a woman on the court, i hope they take that opportunity. >> if no one else has anything -- [applause] nadine and i want to thank everybody. >> thank you so much, everyone for coming.

for being on the wonderful panel. we now have a reception. please join us in the other room. >> tonight on q&a, glenn kessler on his biggest pinocchios of 2014 awards, given to politicians and political groups he believes made the biggest false claims this past year. >> democrats tend to get more upset at them because i think they have bought into the myth of the liberal media and a kind of think the media is on their side. republicans firmly believe in a myth of the liberal media. they kind of expect the reporter from the "washington post" -- they are not going to be fair to me. i hope over the last four years i have done enough back and

forth. treated both parties with equal fervor that people have come to grudgingly say ok, you're someone we can do business with. the senate majority pac which is affiliated with harry reid they stopped answering my questions midway through the campaign season because they felt they were not getting a fair shake from me. >> tonight at 8:00 eastern and pacific on c-span's q&a. >> monday night on c-span, a funeral service for the late "washington post" editor ben bradley -- bradlee. speakers include bob woodward and carl bernstein, who under his guidance, work the watergate story. >> september 23, 1972 about 9:00

p.m., i reached john mitchell by phone about a story we were running. it said he had controlled the secret fund for undercover operations such as watergate trade -- watergate. mitchell was quite upset responding "jesus" several times as i read him the story. he then proceeded to threaten an important private part of katharine graham's anatomy which he said would get caught in a big fat ringer if the "post" printed the story. he said we are going to do a story on all of you. he hung up the phone. i called ben at home. woodward and i did much -- did not much observe the chain of command. ben interrogated me.

had mitchell been drinking? i could not tell. did i properly identify myself? yes. did i have good notes? yes. ok ben said, put all of mitchell's comments in the paper but leave out ms. graham's -- tell the desk it's ok he said. a top official of the knicks on -- nixon campaign called me a few minutes later to make an appeal that mitchell had been caught in an unguarded moment. he has been a cabinet member and so forth. he doesn't want to show up in the paper like that. the official then called bradlee at home to repeat the appeal. bradlee recalled saying which just boils down to this question , whether mr. mitchell said it or not. whether the "washington post" reporter identified himself as a reporter, and if he did that,

all my requisites have been satisfied. mitchell's comments state in the paper. >> ben bradlee served as editor of the "washington post" for more than 30 years. he died at the age of 93 in october. we will have his funeral service monday night on c-span at 8:00 eastern. now an update on cancer research. dr. francis collins, director of the national institutes of health. the latest brick through his and challenges in developing cancer drug therapies. this forum was assisted by the aspen institute and friends of cancer research. >> good afternoon to everyone. i'm so glad we have not only a full house at the aspen institute, but that 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. among many awards, the national medal of science and presidential medal of freedom. welcome. dr. ronald depinho, president of the university of texas where he leads groundbreaking research. 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? i think we will start looking back. dr. collins, you received your medical degree six years after president nixon declared a war on cancer. tell us what the assumptions were then about curing cancer, addressing cancer, treating cancer. did you assume cancer would be cured by 2014? what were your expectations? >> i remember when i was a medical student at the university of north carolina and it was not a specialty at my school when i started in cancer. it happened during my 4 years in a special unit focus on oncology was developed and someone was hired to run it. and 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 various types of tumors responded quite poorly. it certainly did not seem to me 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. when the war on 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 thing to draw attention to the problem that needs a solution and affected so many people and the answers were going to have to climb out research is expensive. and this 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. now, i'm sure we talk about this 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. it is hundreds of disease. 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. >> you received your medical degree a few years later in 1981. how attitudes have changed by patients and their families, the diagnosis? how different is if or when you saw when you were getting your medical training? >> back then, cancer strikesfear

into the heart of cancers and bring despair 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. a lot of that has risen by not 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 reductions in breast, prostate and other diseases ,colon cancer in particular. those are changes if you can do something about the disease to prevent or catch early and over the last half a dozen years in particular because of the insights that have been illuminated by a great deal of research, we now have a clear 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. you have talked about the last 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 reasons why good cells go bad -- 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.

so when you activate them, they 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 more directed more rational approach instead of him. -- try and see what happens. most of our strategies until we had the understanding where to come up with toxins substances. and tried to dial in at the point where you were killing the cancer cell's environment more than the regular cells.

>> talk 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 cancer that led bishop to their breakthrough and 17 7 -- 1976 that there are genes within us that look like the genes that cause cancer and viruses.

that year i was graduating in 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. and then and 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. the ability to 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 deliberate assault on the cancer problem. this is something that it not exist because it took decades of research, fundamental research for us to be able to really move that knowledge to a position where we can act on it to help patients. >> those are 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? >> as ronald 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. that allows 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 cancer and you actually ask what 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 course of many years, there are 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 done which basically works in a very specific way to stop the growth of those sells that have that alk rearrangement but it is not doing thing for the rest of the patients who do not have a rearrangement. it is only about 5%-6%.

that is really different. and the past, lung cancer, radiation and strong chemotherapy and everybody got the same ink. not anymore. that's why the long of that effort -- lung cancer efforts, getting this forward is a great example of where we need to go. initially a clinical trial but so it out to the standard. -- but it 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 a match -- 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 where that idea of rational drug 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 cells that person has is in the billions. it only takes one or two to 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. a very similar situation when 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 -- human sails have the same -- c have theel same ability. you reduce the chancels. -- human 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 do is policy 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. the challenges of hepatitis and 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.

if we can enhance our ability to 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. lastly on the 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. and so, if we begin to combine the targeted therapies going after the genes, 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. i wonder if doctors, it is one thing to be at a great institution, what if you are at some other place? are doctors able to keep up and provide the kind of care that is made such a difference? >> other great 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 mutation in lung cancer, when there was a new therapy it took on average in a community setting for to be routinely used 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. what i 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. and this will reduce -- once they get implemented. being in this age of information and is in fact is going to be on a practical level as most impactful and reducing the burden of cancer in our country. >> 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. the 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. but with adults, it is a missed 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, it has to be clear who his hand 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? >> the fundamental question and that is an important issue is to 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. 95% failure rate and 56% of 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 sophisticated model system. and develop a clear hypothesis to what patients you are going to be getting the drugs to in a clinical 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?

and to 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. we have been using what we have. 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 lab or at ways using ir chips -- elaborate ways using biochips. we can do that. you can take a biopsy, add the appropriate number of genes, turn that into pluripotent cells

, 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. the old 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. >> you describe bankruptcy as a

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 progress along this path? take this one. >> i can start. i don't know if he can say this, but one of the greatest proven success stories in the history of the nation has been our research that has converted knowledge, basic insight into things that matter for patients and what is very exciting for us. we have a clear line of sight on

making an impact on cancer worldwide through prevention cancer -- screening, and therapeutic advances that are game changing, and patients are dying. families are being impacted. this nation needs to make a decisive assault on the cancer problem and other diseases for which we have a strong conceptual foundation at this point. we need to act. we need to act decisively. as the u.s. goes, so goes the world. we need to 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. i'm sure 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 details 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 engine of discovery the way we 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. we actually went back and looked. this was in heart disease research, but i imagine it's true across the board. back around 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? -- it is 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

community to really hunker down. many individuals deciding after a couple failures to go on to do 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. >> we may have just turned on 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. not that there is anything wrong 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 is no question there is 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 clinical trials, so we are 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. when you're out there, there is no conceptual president. -- president -- precedent. 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. >> we have lost 23% of our purchasing power for medical research over the last 10 years. a big chunk of that happened in 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. it is just a two-year deal, and 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. it follows 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. the case here is so compelling. it's not just that this is the

engine that has led us to advances 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. the genome project, which i am privileged to be leading. they did an analysis of the 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. 141:1 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. i am just enough of an optimist to think ultimately the case will be so compelling as to be irresistible and we will turn the corner.

if we do turn the corner, it was great from 98 until 2003, but it sowed the seeds of what happened next. namely, we don't have to worry about you. what we need is stable predictable trajectories. then you can plan. then young 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 predictable pattern. there are people in congress advocating for that. there is a bill pushing that. why 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

prevent 50% of cancer deaths. we know about cigarettes. you get the sense that every week someone says something does or doesn't cause cancer. i googled news stories what 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 to 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.

i mentioned hpv as well as hepatitis, which are major causes of cancer deaths worldwide. those are what -- what is 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. >> you mentioned the power of a 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. there are a specific amount of 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. what we 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. it's in 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 problem prevention and screening efforts. >> this is a smart group of people with intelligent

questions to ask thomas to let me turn it over to you. -- questions to 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 genome process. a lot of people doing the work were not even in the u.s. they basically agreed this is so 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 95% of the dollars that go into public funding of biomedical

research. we are 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. the same could be said about the 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. anderson has been on the global 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 -- policy and 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 public 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. this is a big problem worldwide. we have estimated by 2025 1.2

billion people over the age of 60. it essentially -- we have 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 person's parents has any effect 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. as fathers did older, -- get older, there are more 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 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 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 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. the overwhelming factor for the development of cancer is our age. it works every other statistic 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 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. >> you talked about how the odds

of getting cancer increases with each decade increases. >> for alzheimer's, diabetes, heart disease, and cancer, every five years the incidences 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 time you are 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 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 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, development of drugs, and so on that would make a difference. >> not to mention the human cost. she didn't have the might. -- mic.