t evidence to indicate they are putting new improvements into those bases and new equipment. we can get you a classified briefing if you'd like. mr. poe: so the sanctions have not stopped russians building military installations and crimea. are any of those nuclear installations? ambassador nuland: i think we would like to speak to you about dubious capability in a different setting. mr. poe: anyway, they are building up their military presence in crimea? ambassador nuland: yes, sir mr. poe: that would seem to me that they are there to stay. what do you think? ambassador nuland: i think we need to maintain the pressure and we have to maintain the cost and we have to keep safe with ukraine so it can continue to try to get its territory back. mr. poe: when i talked to the president of ukraine last year asking what we could do, he replied that they would prefer that we send something other than canned food to them, which is what we were doing. are we still talking about

helping them fight for their own freedom in the sense that we are giving the military aid? are we still talking about that or actually doing that? >> in the last 14 months we have provided over $108 million in security assistance. i can you do a rundown of what would be included in that, but it would -- it would be things like medications equipment emergency medical, those kind of things. we will look at what more we can do. >> that is all nonlethal aid. are we sending any guns, bullets? >> no, sir. >> why not? they want to defend themselves. >> as i said we have continued to look at other request from the ukrainians on the lethal side, but note decisions have been made -- no decisions have been made. >> so the russians aren't each in ukraine, besides being in

crimea, which i don't think they will ever try to leave crimea and other nations are very concerned they are next in the russian aggression. i meeting with some ambassadors today. -- i meeting with some ambassadors today. what is our policy on russian aggression? what is our policy to torque that, if we do have one. -- to thwart that, if we do have one. >> i did not go through that in testimony, but we are, with regard to nato allies, starting with the decisions taken in december -- in september, which you now see implemented, we are now providing concrete visual reassurance to our nato allies all along the eastern edge. on land, sea, and air, we have some 300 young americans in the baltics and in poland, and we have redeployment bulgaria and romania. they are exercising, etc. and we are working to establish headquarter elements that will

allow nato forces to move quickly in a contingency. we are standing up a very high readiness of force. >> are we helping non-nato countries as well? >> this is all designed to make it clear to the kremlin that we will defend every inch of nato territory. we are also providing security assistance to georgia and moldova, the two countries most under threat, and continuing relationships with other countries in the region. >> thank you, mr. chairman. >> the gentleman's time expired. we are greatly concerned about the situation, and specifically the dismemberment of ukraine. we cannot wait for ever. we look over to following up on these critical issues. and with that, the hearing is adjourned. [captions copyright national cable satellite corp. 2015] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]

a live picture once again -- quite a live picture once again come and consider the capital in the background as snow continues to fall on the nation's capital and elsewhere in the region. forecasts predict for-eight inches with an overnight freeze that could affect government and schools again tomorrow. residents came out in defiance of flooding on capitol grounds. bridget bowman tweeted out a lot

more greek d.c. residents have showed up to sled on capitol hill. and members of congress have tweeted out what they are doing as snow continues to fall. are present of chris stewart says he is running in the snow. and the government made it close, but the snow didn't stop penciling of farmers and didn't stop our meeting this morning. his picture is of a capitol hill office building. tonight, former astronaut, including buzz aldrin, testifying on the teacher of the space program. -- testifying on the future of the space program. hearing also from a panel of

executives, witnesses testified on space. it is chaired by congressman ted cruz. can see that at 8 p.m. eastern on c-span. also, justices will be meeting tomorrow to go over the challenge of the health care law subsidies. it will impact the 34 states that declined to begin their own health exchanges. the court plans to release the oral audio of the argument in the case tomorrow. you will be able to listen to it tomorrow night here on c-span starting at 8:00 p.m. eastern. the house appropriations subcommittee on labor, health, and human services, education and related agencies heard from the national institutes of health director, dr. francis collins, and other institute heads this week about president obama's fiscal year 2016 budget request. this is about two hours.

>> good morning. it's my pleasure to welcome you to the subcommittee on labor health, human services, and education to discuss the this winter 2016 national institutes of health budget request. looking forward to hearing the testimony of dr. collins and some of his distinguished colleagues. i would like to publicly thank dr. collins and staff at nih for hosting me and five other subcommittee members for a briefing and tour of the campus at nih a few weeks ago. i think it is safe to say we all left the nih with a deeper appreciation of the exciting work your staff do every day to save lives. the scope of biomedical research supported through and at the nih is why, and we are confident that thanks to the talented

staff and sciences network there we will one day find diseases -- cures for diseases like cancer and alzheimer's. supporting the next generation of researchers is critical to pave the way for these long-term advancements. your budget assumes many areas of enhanced spending on genomic activity including a focus on ebola, universal flu vaccine and antibiotic resistance, and alzheimer's research, to list only if you. of course, we all support biomedical research. unfortunately, right now sequester it the law of the land and given the reality of funding allocations, we might not be able to do everything the administration is proposing asked a larger bipartisan agreement, one quite frankly, i hope we achieved. i look forward to the panel discussion with you this morning on your top priorities this year, given our funding constraints. i would also be remiss if i did not point out how important it is that we ensure that we

continue to invoke -- to focus on the next generation of investigators. we know how long it takes for a new drug treatment to make it from the lab to the patient. without a pipeline of young researchers committed to following the scientific process of investigation and experimentation, we will not be able to find the cures we speak -- seek. we welcome the and i jh -- the nih director, dr. collins, to the subcommittee. dr. collins and his colleagues can answer specific questions. they are the director of the national institute of allergy and infectious diseases. the director of the national institutes of mental health. the director of the national institute of general medical sciences. the director of the national institute on drug abuse. and dr. gary gibbons, the director of the national heart lung, and blood institute. we will abide by the five-minute rule.

and before we begin, i would like to use the floor to my chairman, the gentleman from kentucky. after that, we will move to our ranking members, the gentlelady from connecticut and then the gentlelady from new york, member of the full committee. after that -- and with that, mr. chairman, you are recognized. >> thank you very much. congratulations on being new chairman of this great subcommittee and the responsibility's that you have gladly taken on. welcome to all of you. thank you for being here. dr. collins, your leadership role and the groundbreaking international human genome project is just one example of your many talents. i'm told that another one of your talents is playing guitar. [laughter] apparently, very well. you got something to fall back on in case this don't work out.

[laughter] unquestionably you all are at the helm of research at nih during a time that demands our country's interest and investment in medical research. the recent ebola epidemic in west africa highlights the importance of nih's mission to gain and apply knowledge, to enhance health and life, and reduce illness and disability. medical research is one of the most important part of preventing future epidemics, and producing cures for diseases that are not preventable. the nih fiscal 16 request highlights priorities, such as ebola, alzheimer's disease, and microbial resistance. in addition to the public health and if it's that -- benefits that a company like nih works

on research dollars not only impact research facilities and researchers, but they also help give new drugs and devices to the marketplace. and i'm pleased that you've seen fit to invite dr. nora volkov to join us this morning as the director of the national institute of drug abuse. dr. volkov has been a true pioneer. she was one of the first people to use brain imaging to predict the effects and properties of drugs. and her research has undoubtedly made the world we live in a much better place. she has been with us since day one as we have battled drug abuse in my area in eastern

kentucky hard-hit especially early on by oxycontin and others. i'm looking forward to seeing both of you, in fact, at the atlanta summit on prescription drug abuse this summer. and i thank you for coming. -- thank you for coming last year and helping us battle this prescription drug abuse scourge that is killing more americans than car accident. we appreciate your dedication to that especially. we look forward to hearing also from you today about the two critical drug related issues. first, i am pleased that under dr. voclkov that you are seeking the effects of

marijuana, alcohol, and other drugs on a young person's brain. it is unfathomable to me that states continue to pursue policies to decriminalize or legalize marijuana. in cartridge into federal law, i might add. even here in the nation's capital. -- in contradiction to the federal law, i might add. even here in the nation's capital. it's ironic that here in the nation's capital you cannot smoke cigarettes, but you can smoke pot. explain to me. help me out. we don't have scientific it to tell us about the long-term impacts of marijuana use on the brain, but hopefully this will open a lot of minds. this study will close that gap and hopefully bring some much-needed sense to the conversation about marijuana use in this country. secondly, i'm interested to hear about recent efforts regarding

the abuse of prescription medications. as you well know, that has been characterized by your colleagues at cdc as a national epidemic. i understand that you are partnering with nine major pharmaceutical companies to evaluate the risks associated with the long-term use of open your rates -- of opioids for the management of pain. if there are non-opioid treatments for pain, we need to know about it and doctors need to be educated about them. i'm hoping you will update us about the science for abuse deterrent medications. it is remarkable that oxycontin, the drug that caused so much difficulty, and still is, but mostly back five or six years ago -- the drug was changed to

make it abuse deterrent. you cannot crush it. you cannot sort it. you cannot inject it. it still retains all the good qualities of relieving pain over an extended time. that is what can be done to stem the use of opioids, and i commend you for it. in addition to our land -- our long-standing struggles with drug addiction and abuse the research provided by nih is critical to understanding preventing, and developing cures for ailments like diabetes cancer, and heart disease that continue to plague my region especially. we are very proud of the partnerships we have established with the nih in kentucky. for example, the marquis cancer center, the national cancer institute designated cancer

center at the university of kentucky, and the u.k. center for clinical and translational science, which previously received your procedures clinical and translational science award for its work to confront chronic health issues in kentucky and rural populations, especially in the appalachian region. currently, 22 of the world's 50 top ranking universities for life sciences are in the u.s. and we must continue to foster the next generation of scientists. we look forward to continuing these important and collaborative effort as we work together to bring an end to these devastating diseases. we thank you for being here, and with your colleagues, dr. collins, we expect to hear some good stuff. thank you. >> thank you, mr. chairman. and next to go to ranking member, listing was gentlelady from connecticut and ryanair at this particular agency for many, many years.

-- pioneer at this particular agency for many, many years. >> thank you, mr. chairman. this is a little earlier than we usually start topics, but it is important for us to have the opportunity for the full two hours with this distinct scandal. i'm thrilled to welcome dr. collins, the director of the nih , and colleagues to discuss the 2016 budget request for nih. first and foremost, let me just say thank you for your work. every scientific discovery every medical breakthrough, the research you support advances human knowledge and improve the quality of our lives. and most of all, it saves lives. and as a 30 year survivor of ovarian cancer, i'm alive today because of the grace of god and biomedical research. when i was elected to the congress, i made supporting that research one of my top priorities. as well as improving health

research also drives our economy. as the chairman said, every dollar invested in a -- in nih repays more than double that in economic growth. nih is the cornerstone of our life sciences industry, which employs or than 7 million americans, as almost $70 billion to our gdp. there is no reason not to fund nih as fully as possible. in january of this year, along with the chairman, i had the pleasure of touring the age along with other members of the subcommittee. it was as always fascinating. while there, we met with a senior investigator, dr. nancy sullivan was responsible for one of the vaccine candidates for ebola currently being in a clinical trial. that clinical trial is only possible because of nih support. dr. sullivan and her colleagues have been able to pursue a vaccine over many, many years

since 1997 in fact. research can take a long time to bear fruit. and if we do not invest now, we will not be able to benefit from scientific discoveries 5, 10 even 20 years from now. it is troubling to me, deeply troubling to me, to note that since fiscal year 2010 after adjusting for inflation, nih has a just a road --erode by about $3.6 billion. that is an 11% cut. sequestration is terrible for any budget and is especially cruel when there are literally lives at stake. in 2015, sequestration -- in 2013, sequestration took more than $1.5 billion from the nih even after modest increases over the past two years. we have still not returned nih's budget to its pre-sequestration level. amid sequestration, the success

rate previously seen has fallen to one in six. in 2015, nih will fund almost 1000 fewer research projects than it did in 2010. we will never know how many scientific discoveries and medical breakthroughs the world may have missed out on because of these budget restraints. that is the disturbing context in which we consider the nih budget for fiscal year 2016. overall, this request starts to set us back on the right track. there are some exciting initiative in this budget. the medicine initiative will help doctors provide finely tailored care to the individual characteristics of each patient the combating antibiotic bacteria initiative against superbug. the brain initiative. potential to revolutionize neuroscience and make advances in treating alzheimer's, autism, and other brain disorders.

it includes research to fund a universal flu vaccine, and potentially a cure for hiv/aids. it also supports basic science research that has long-term benefits across multiple fields. as i said, i believe this is the right track. given the severe neglect of the nih over the past two years, i'm disappointed we are not restoring funding more quickly. this request resource more than one third of the cuts since fiscal year 2010. i just a bill in the last congress and again in this congress that would enable our committee to increase nih funding by 10% this year, and 50% over five years by providing a cap adjustment. that would ensure proper funding for research without robbing other vital programs to do so. we have invested strongly in nih before. in the 1990's, i was among a bipartisan group of members of both chambers on this committee who fought to double' nih budget

overs five years. -- thought to double nih's budget over five years. we should be seeking to repeat that achievement and double its budget again. but this cannot happen unless we undo that failed policy of sequestration. and some in the courage --summon the courage to ask the wealthiest who have done so well in recent years to contribute more for national priorities. biomedical research give us -- gives us the gift of life. it has done so for me and countless others. that is what the nih represents. we can and must find the resources to support it. i thank you, and i thank you mr. chairman. >> thank you. let's go to the gentlelady from new york for opening statement. >> thank you, mr. chairman. it's a pleasure for me to be

here today. i would really like to thank chairman coral -- chairman cole and ranking member delauro for holding this hearing today. it's such an honor for me to have such a distinguished group of public servants. i really appreciate you being with us today and i thank you for the life-saving work you do every day. throughout my time in congress federal funding for the national institute of health has been among my very top priorities. the nih is the world's premier research institute. its researchers have mapped the human genome. and i do remember, dr. collins that empty shape you had filled up. it is really amazing. you have created vaccines that are being tested to prevent the spread of ebola, developed

advances in cardiovascular disease that have reduced death rates by more than 60% over the last half-century, and invested in hiv therapies that turn what used to be get sentences into longer, more productive lives. -- death sentences into longer, more productive lives. it is no surprise that it continues to amaze me that nih supported scientists have an awarded no less than 145 nobel prizes. not only does nih's work improve the lives of millions of americans, but it's also an economic springboard for growth generating two to one in economic activity for every dollar invested. and i remind my friends and neighbors all the time that not only are you moving ahead and saving lives, but you are creating jobs.

your 2016 budget requests an increase of $1 billion resulting in 1200 additional competitive research grants. it would make welcomed investments in advanced cancer treatments with the new precision medicine initiative. increased funding, as my colleague said, to research the workings of the brain. develop treatments to combat autism and alzheimer's disease and other neurological and psychiatric conditions. these are the very definitions of were the federal investments. the president has also called for the end of the mindless austerity of sequestration. in fact, i've even heard some of my colleague on the other side of the aisle refer to the mindless austerity of

sequestration, urging congress to replace it with more targeted spending cuts, program integrity measures, closure of some outdated tax loopholes. i could not agree with them more. the effects of sequestration are immense, and still being felt. in 2013 alone, sequestration reduced the nih investments by more than $1.5 billion in fiscal year 2015 funding -- and fiscal year 2015 funding is still below pre-segregation levels. many important initiatives were abruptly halted. it really was a worst-case narrow for many agencies, and we have to make sure it doesn't happen again. the united states must keep case with the rest of the world. while nih funding is $3.6 billion, or 11% below the fiscal

year 2010 level when adjusted for inflation, others are making substantial increases. between 2007-2012, china increased their biomedical research spending by $9 billion. increased. while others are in balancing -- are advancing in biomedical research, we are just not keeping up. i know there will be many viewpoints in crafting a resolution. many of my colleagues may undoubtedly press for additional cuts and to leave the outdated sequester level caps in place. but i think we all know how dangerous that is. discretionary funding, which includes biomedical research education, job training, transportation infrastructure, and clean energy development is falling to its lowest level as a

percentage of gdp since the eisenhower administration. we must act to ensure reasonable allocation for the important programs and investments funded through the appropriations process, especially the national institutes of health and those under the jurisdiction of this subcommittee. i look forward to your testimony. thank you again for being here before us. i look forward to the nih's plan for the coming year. thank you. >> thank the gentlelady. dr. collins, your full statement will be entered into the record. you will be recognized for what over -- whatever opening comments you care to make. i thank you and good morning, chairman cole, ranking member delauro, and he wished members of this subcommittee. it is an honor to appear before you today. panel has a long history of supporting the nih mission, to seek funding for knowledge and

apply it in ways that will enhance human health, lengthen life, and reduce illness and disability. breakthroughs generated by nih research are behind many of the gains that our country has enjoyed in health and longevity. for example, over the last 60 years, death from cardiovascular disease has fallen. meanwhile, cancer death rates have been dropping about 1% each year for the last 20 years. and likewise hiv/aids treatments have greatly extended lives. the future of biomedical research has never been brighter. allow me to tell you about just a few of the exciting opportunities nih's pursuing today. let's start with vaccines. thanks to research, two different vaccines against the deadly ebola virus are being tested right now in liberia. research is also making progress

against a virus nearly all of us have tangled with, influenza. currently, a new flu vaccine has to be produced every year based on our best guest -- best guess as to have the virus will evolve, but that approach has not always worked, as we saw this season. we are working on a vaccine that would protect against all flu strains. this would reduce the risk of a global pandemic. i am excited to tell you that vaccine candidates have moved into early-stage human clinical trials. nih also supports basic science and fundamental research that serves as the foundation of discoveries that have long made america the leader in biomedicine. one example is the brain initiative. this bold, multi agency effort is enabling technology to

produce a more dynamic and clear picture of how brain cells interact in time and space. this initiative will give us the tools for major advances in brain initiatives, -- in brain diseases, from alzheimer's to schizophrenia. historically, doctors have been forced to base their recommendations for treatments on the expected response on the average patient. recent advances, including the plummeting cost of dna sequences, now make possible a more precise approach to disease management that takes into account individual differences in genes, environment, and lifestyle. with this in mind, we are thrilled to take a lead role in the multi-agency lead medicine prevention initiative.

we are trying to understand why cancers resist drug treatments and exploring new treatments targeted to the genetic or files of a wide range of adult and pediatric cancers. -- genetic profiles of a wide range of adult and pediatric cancers areas that cancers. -- cancers. a project of this magnitude will a the groundwork for new prevention strategies and novel therapeutics. there is no better time than now to embark on this enterprise to revolutionize medicine and move this approach into everyday practice. in closing, let me share a story that highlights the promise of precision medicine. when michael was tie -- when

maki was diagnosed with cancer, it was completely unexpected. she had never smoked a day in her life. she had little survival beyond -- little chance of survival beyond a year or two. doctors assist acted she might have -- suspected she might have a genetic mutation. testing confirmed their hunch and she was prescribed a drug that blocked a specific signal. after three months of treatment her large tumor shrunk dramatically. this was followed by surgery to remove cancerous tissue. today, seven years after her diagnosis, her doctors can detect no sign of cancer. what more, during the extra time provided by this approach, she completed a triathlon, became a

biology professor at ithaca college, come to healthy baby girl. clearly, we need many more stories like hers. that is our dream and i am sure it is yours as well. with your support, we can realize our goal of developing more scientific inquiry to precise are several approaches for treatments and cures. and you, mr. chairman. my colleagues and i welcome your questions. mr. cole: thank you, dr. collins. mr. chairman, you are recognized for what ever since you care to pose. mr. rogers: thank you. thank you both for your special interest in prescription drug abuse. as you know, every day, about 105 americans die from overdose

mostly prescription medicine. sadly, as we have taken strides to address the challenge, we have also seen a wise -- rise in heroin use. those people addicted to pain pills are graduating to drugs that are cheaper. i have long advocated a multipronged approach to addressing this unique challenge. of course, research is one of the main prongs of that approach. i am particularly interested in the development of new technologies that will make these drugs more difficult to abuse. we have seen some real progress in the field. effective abuse deterrent technologies that will ensure that patients clearly in need of these therapies can receive

treatment, while also ensuring that very powerful addictive medications can be tempered with that cannot be tampered with or abused. what effort -- medications cannot be tampered with or abused. what efforts has nih made in this arena and can you comment on the fruits of those labors? dr. collins: thank you, mr. chairman, and your leadership in this issue has been remarkable. i am going to ask dr. volk l who is an internationally wreckage ninth -- recognized expert in this areas to answer your question. dr. v: thank you for your

question and your approach. as you said, we use a multipronged approach. one effort is to develop medications that, if they are opiate-based cannot we diverted and abused in a way that can cause addictive harm. some of this relates to a combination of drugs. others relate to inserting the drug in a poly mersereau it cannot be diverted. -- polymer so it cannot be diverted. we are forming partnerships to enhance the likelihood that products will not get into the market. innovation has led to different ways of solving the problem that is one. the other is strategies to prevent deaths from overdoses

because they are anecdotes. -- antidotes. we have partnered to provide the locks them in ways that are user-friendly and cannot be tampered with. third is a way of developing medications to treat those who become addicted to opiates. proper treatment can prevent overdoses. parallel, we are working on research to ensure that people and their practitioners will provide better treatment and screening of people with pain and other disorders.

mr. rodgers: you are working to develop an abuse deterrent for oxycontin using what is called a prodrug technology. what is that? dr. v: you administer a medication that is not active until it suffers a second conversion. in this case, a drug will not become active until it gets into the gastrointestinal system and then another drug activates it. the advantage is if someone wants to inject the drug, which is the way these drugs are abused, there will not be any pharmacological effects because it will be an active -- and in active drug. it requires the enzyme in the gastrointestinal tract to activate it. mr. rodgers: what do you think

of that? dr. v: i think it is very promising. dr. collins: the dr. has taken a very personal interest in this issue and is playing a role in that effort going forward. ultimately, we hope to have fda approval. mr. rodgers: if this should prove successful, this is a major breakthrough, is it not? dr. v: it would be a very important breakthrough. and we hope we will be hearing soon. we are expecting, hopefully, some results in the very near future. esther rodgers: when? [laughter] -- mr. rodgers: when? [laughter] dr. v: i am under a

confidentiality agreement, but i hope we will be hearing soon. mr. rodgers: well, that is very exciting. if it can be crushed and injected, all of a sudden you get a 12 hour release in us that second, and the addictive power -- thus the addictive power of this drug. if you can find a way to retain the qualities while preventing of years, that would be a life-saving development. 105 people a day drying from a drug overdose -- dying from a drug overdose. how can we incentivize the companies to invest in these technologies? how can we make it so there is something in it for them?

dr. volkow: there have been research dollars invested. we want to ensure that prescription -- physicians will be able to prescribe it and the companies will pay for those descriptions. ensuring the innovation that results in safer medication that might be slightly more of is supported -- more expensive is supported so that it is possible for patients to have access to these medications. mr. rodgers: i thank you for your work. mr. cole: the gentlelady from new york is recognized for whatever western she would like to pose. ms. lily -- ms. lowey: what i thought of it

immediately was that every person who goes to their doctor with inoperable tumors in their lungs -- could they all get that test? dr. collins: that is a great question. one of the things we hope to achieve is to make that kind of fixed.'s much more available -- kind of experience much more available. increasingly people with that type of cancer are having more tests done on the tumor. we want to enable the individual to determine what is going on in that person and then connect them with the appropriate choice of drugs. this targeted therapy approach is extremely exciting. the national cancer institute has started a protocol called

"lung map." they have started another one for pediatric cancers and one for adult cancers. so far, the development of these approaches and the implementation across all of health care is not there yet in part because you don't know quite enough -- we don't have quite enough to know what is the best strategy. the precision effort should make this opportunity available to many more people with cancer. it should also teaches things about why it doesn't work when we think it should. i gave you a beautiful example of a remarkable cure, but we don't always the that, and we don't always know why, when it doesn't work, what is responsible. or if you seem to be in remission and then the disease comes roaring back a year later. causes of relapse. that would help us.

another thing is the opportunity to find out if we could combine more than one targeted therapy or a drug therapy with the which is extremely exciting right now, and have a higher -- with immunotherapy, which is extremely exciting right now, and have a higher opportunity to find a cure. ms.. lowey: i just recently had two friends who had inoperable lung cancer and i wondered if those test were available to them. dr. collins: i would recommend to anyone who gets diagnosed with cancer, go to clinical trials.gov and see if there is an opportunity to be matched with available therapies.

ms. lowey: i am particularly interested in how this could also treatment for breast cancer. for women under the age of 45 breast cancer is more common in african american women than white women. these factors, evidently in our genetic code, are why advances in precision medicine are so vital. i participated in a study with senator al d'amato on environmental actors that never led to very much, frankly. if you could share with us what rate through's we have seen as a result of nih funded research and -- what breakthroughs we have seen as a result of nih funded research and how that

might help us find a cure once and for all. dr. collins thank you for the question. breast cancer is a major priority for the national health institutes. to see what is happening at the molecular level has taught us that this is not just one disease, but many diseases with many pathways activated, comparing one person to another. that has already led us to new insights regarding therapies. genes that play a major role in hereditary susceptibility play a major part in that, but we now have a long list of other factors. of course, what we really need is better means of prevention and early diagnosis and treatment. put all of that together. here is why i think the prevention initiative has a lot to offer. if we are claiming we can put

together a cohort of a million or more individuals who are participants in us that even collects all of cash in a study that collects all of the data you can -- in a study that collects all of the data you can imagine about their dna and environmental exposures, we might finally have the power to get our hands on information that has then fairly elusive -- has in -- has been fairly elusive. medical records are going to help that immensely. that is why this is the right time to initiate a program of that sort. between electronic health records and dna analysis, and a willingness of the public, and enthusiasm on the public's heart to be -- by the public to be part of a national effort of this sort, we could really be groundbreaking for breast cancer

and other diseases as well. ms. lowey: i see the red light is on, but i have to tell you that this is why our invest and in the in the nih is critical. i am ready to double it. we could be groundbreaking here as well. mr. cole: i am very stern about the clock except for you. one of the areas that concerns me is the pipeline of talented young scientists and researchers. when we are not as generous as we would all like to be in terms of our appropriations, you have fewer grants to reward to younger researchers and our success rate of applicants goes down. i was in aware of this

recently by a good friend of mine who is the president of cornell and the incoming president of the smithsonian. i asked him why are you leaving a wonderful place like cornell and he said the thing that concerned him in the future of science was exactly this. he said i have some brilliantly talented young people who enjoy reading -- enjoy teaching, but they want to research. they want to get things done, and we are not giving the opportunities they want to have, and that is going to cost us down the road. i would like to know your assessment as well as what are the things we ought to do as well as what are you doing now to make sure reengage the next generation of ryan test -- of scientists that will hopefully match the distinction of the panelists in their respective areas.

dr. collins: this is what keeps me up at night. we have so many amazing opportunities in science, but our most critical resource is not pieces of equipment or buildings. it is people. particularly this next generation of researchers. they are full of ideas and vision, but they are finding themselves facing a situation that is the least supportive of that vision in 50 years. they look ahead of them and see senior scientists struggling to keep going, having rejection and rejection of grants that previously would have been awarded, and they wonder, do i want to sign up for that? meanwhile, the rest of the world is picking up steam, trying to be what america was 20 years ago, even as we seem to have lost some of our momentum. that is going to have really significant trickle effects

downstream. so what are we doing? again, there is no real magic to solving the is a very difficult equation of supply and demand, where the demand for resources to do research is not currently being matched by the supply. we are adjusting many of the things we can adjust, and i have had many interest in conversations with people on the subcommittee about this. one thing we are doing is trying to be sure that the application gets a special effort to be funded, so new investigators early-stage investigators compete against each other. that gives them a bump in terms of their likelihood of eating funded. many institutes on top of that give them an additional bum -- in terms of getting funded. many institutes on top of that give them an additional bum. -- bump.

many of them, when they come back for the second award, we lose them because the edge is no longer there. the other thing we want to do is provide for postdoctoral fellows to compete for their award and then carry it with them to an academic position. we are increasing the number of those because that does seem to be a good mechanism. a number of things are being done to try to free up a larger proportion of funds for applicants. i am going to ask the director of science is to say something about some of the ideas they are pursuing. mr. cole: -- >> thank you, mr. cole. we have a fundamental goal to appreciate -- to improve the

efficiency of our funding mechanism, which would increase our ability to distribute funds especially to young investigators. it would have several targets, one of which would be to improve stability. if they are constantly at risk of losing funding, clearly that is not an ideal situation. it would improve the flexibility for investigators to follow the research questions as they arise, and i think it would improve their ability to take on ambitious research projects and follow them in a creative manner. efficiency is the key. mr. cole: thank you. i want to move onto the ranking member from connecticut. mr. laro: thank you. -- ms. delaro: the intellectual

pursuit, the science and that the united states is on the cutting edge of these efforts gives us such a sense of pride. what you are doing to push the envelope and so many directions in terms of saving lives. we were both on the committee, mr. chairman, when we doubled the amount of money for the nih and it was so genuinely pipe artisan. -- bipartisan. if there is an aria we can come together and understand the value of what we have here, i think it would serve us well to think through what we can do for the future. i am going to address an issue that has an of interest -- being -- been of interest to me for a

while, and that is the gender balance in preclinical research. we have worked to ensure that women are represented in the preclinical studies. i don't have to tell you that men and women are different in their wrist wants is to medical treatments -- in their responses to medical treatments. women experience higher rates of adverse drug reaction, for example. you co-authored an article in "nature" with the director of the office of research on women's health. he required applicants to report their plans for the balance of male and female cells in pre-studies of all future applications. you noticed -- noted that the policy would be rolled out in phases beginning in 2014. dr. clayton noted that the exception would he the

exception, not the rule. i me give you two or three questions i have in this regard. -- let me give you two or three questions i have regard. what kind of responses have you received from the research community? are you seeing an immediate impact on applications for funding in fiscal year 2015? will you consider requiring the analysis of data by sex and other subgroup demographics as part of grant progress reporting? what are you doing to encourage journal editors to require an analysis of results by sex? how are you holding institute directors accountable for funding on sex differences and conditions that predominantly impact women? how are the

institutes accountable for partnering with research entities for women's health? is there any specific reason not to include women, such as a focus on prostate cancer? we need to make sure we get all of this, as we move forward. i know we have worked in the past and some things have not moved forward and now i think is an opportunity for us to address the issue again. dr. collins: i appreciate the question and your leadership in bringing this to the attention of the public. certainly, i can assure you of my strong arsenal commitment -- personal commitment to addressing this. the update is we have now had

extensive conversations with institute directors and the scientific community as well as senior advisory group about this issue. i think there is generally brought embrace for the need in clinical studies to include males and females unless there is a compelling reason and that needs to be explained what it is. the responses on the negative side have mostly reflected anxieties about what this would mean. that will cost more and result in fewer studies being done. that is an unnecessarily negative response to this question. the idea that you should include males and females seems really compelling. that you should analyze the data separately is compelling. how subtle a difference are you willing to miss because that

will determine how big your study has to be. that's called power analysis and it can be applied in this situation quite handily. the directors are in the process of finalizing their approval something that is not left neglected. that we will have definitive guidelines. with what your expectations are it will be made very clear that that's how you are to review a grant. we have had great interactions with them about reproducibility. if you have two studies that doesn't get the same answer, it's called interesting new data that you want to follow up on.

it's fair to say it is, across the board, fully committed to making these things happen. >> i want to go next to my good friend from idaho, distinguished member. dr. collins and all the other directors, thank you for being here today. the bipartisan nature is pretty obvious and has been in the past. that's good. i think it would be the desire of everyone on this committee to substantially increase the research if we didn't have a debt and deficit that we are having to do. something that we put priority on and try to do in a bipartisan manner. i will come out and visit with

you for a day and take a tour of some of the different institutes so we can have some real good discussions. the personalized medicine or precision medicine is fascinating to me. i understand that the collective use of technology such as genomics and protein medics, or something like that, that explore how cells and organisms work. concentrating on cancer right now. it's a lethal disease. are there plans to look at broader, not as lethal diseases or serious diseases that affect the personalized medicine? >> absolutely. let me may be more clear that i was. the precision medicine initiative has two components.

this is ready for this kind of expanded effort to understand what causes cancer and what we can do about it. the other component is a long-term and ambitious effort of this cohort of more and more americans. i would certainly include such things as. on told disease. we know there is an environment and genetic risk involved in those conditions but we haven't really had a sufficiently large study with appropriate patient participation. that is true for diabetes, heart disease, alzheimer's disease virtually every common condition with one million people. you will have enough events that you can begin to distract what the biomarkers were to mourn that this might happen. >> fascinating stuff, and could really advance the treatment of

diseases. i am going to submit some questions for the record and the one that i want to ask is that you have indicated your strong support for the national center for advanced translational sciences. i have heard from some advocacy groups several years ago who expressed concern that putting more resources might come at the expense of research. i don't believe that to be the case but you do request a $27 million increase for mcat in fiscal year 16. can you tell us some of the benefits we have seen? >> it was focused to identify one of the bottlenecks that nih

could address with our partners in the private sector. i think there were concerns that nih is becoming a drug company. instead, we are identifying areas of technology development that no single company could undertake. we could give you the effort to try to figure out if it is going to be safe in humans or not, it has been a real difficult one. we use animal studies. it it's not accurate. it is slow and expensive. we might lose some drugs on the way because a mouse got a slight liver issue. and we lose the drug. it would be able to test toxicity against human cells but not put humans at risk. now with the ability to create a skin biopsy, those that seller -- that our brain or kidney or muscle are on a three dimensional biochip and we can

begin to do those experiments without putting people at risk. we are doing this with fda and darpa. it's a very important thing. if it works, it could greatly improve the likelihood of knowing whether something is safe. they are all quite innovative. they probably wouldn't happen without nih stepping into this space. i think it will be high risk but high reward. the clinical translational science centers. 62 academically-based centers which is worth an awful lot of clinical research. >> as i said many years nih is,

for good and bad, the best-kept secret in washington d c. >> our good friend, the gentlelady from california has been dealing with a difficult personal situation with the loss of her mother and has been in our thoughts and prayers. it is wonderful to have you back with us today. >> let me thank all of you and the chairman for your condolences and your support and real expressions of sympathy during this very difficult time. i'm glad to see everyone here today. i want to thank all of you for your work for your effort to save lives and ensure the quality of life for everybody in our country. my mother was 90 years old and died of copd which is the third-largest disease by death

ride disease in this country. i spent many nights in emergency room's. but she lived to be 90 and lived with copd. my sister had multiple sclerosis and again, because of you, she is 67 years old and leading a very healthy life as a result of nih and the research and the treatment. i want to personally thank you all of the work you do and i want to see your budgets doubled so that everybody can be free of these diseases. i wanted to ask you a couple questions with regards to copd research, prevention, and treatment. also with regard to multiple sclerosis and the brain initiative, and how that will impact people with ms.

sickle cell. i have been looking at the a-1 c test as it relates to diabetes and the correlation between sickle cell traits and diabetes and the a1 c test to see how the doctors and labs are fully aware that it could be positive. in terms of your budget as it relates to hiv and aids, i am pleased to see the entries. want to see if you are coming up or if we are close to a vaccine. what types of new treatment with the disease. and as it relates to the national institute on minority health and disparity. we want to look at how your focusing on health care.

we know many of the health disparities in minority communities directly relate to the social determinants and how this is being framed and researched. personally, i have to thank all of you. >> those are great questions. ask him going back to medical school now. as a result of my family. >> we will try to work through his many of these as we can. >> the leading cause of death in this country, they provided clinical trials that provided a better course of life to the nocturnal oxygen trial. the challenges we often diagnose and treat the disease toward the latter stages, a lot of the

damage has been done. this is really an opportunity or they can diagnose and develop interventions to prevent a lot of that deterioration that occurs. we are excited about the opportunities that come of genomic medicine. we understand the pathways that promote the progression towards death. we have exciting opportunities to develop therapeutics in that regard. >> maybe i will ask the doctor to say something about a new trial in multiple sclerosis. >> thank you for this question. just a few weeks ago, there was published a very exciting study in which 25 subjects were involved in a phase to open label study of stem cell

transplantation in individuals that had rapidly aggressive progressive multiple sclerosis. the historical control is so compelling because when you get those patients, they almost invariably progress in these patients did not. we are very excited but we have been doing over the last several years, this is the most exciting.

there are so many aspects of hiv and we are seeing several countries taking that tipping point with a number of new infections less than the number of people going on the therapy to the point were we are starting to see a deflection in the curve. the thing that would nail it down, what you are very familiar with and decreased by 96% transmissibility by treating them, there have been several studies that came out at the meeting in seattle last week that showed that preexposure of individuals at high risk, particularly men who have sex with men, it has provided a substantial decrease in infection rate with certain areas.

there are two major parallel pathways being pursued. one is the follow-up of the very exciting though modestly successful trial from several years ago that i reported to this committee, 31% effective. not enough for prime time but enough to give us some insight in the next stage of what we are going to do. the response is quite similar to those which means it is a glimmer of potential success in the african trial. and there is a whole bunch of research that is led by our vaccine research center at the nih as well as the number of centers throughout the world looking at the ability to reduce neutralizing anybody. we are making headway being able to reduce them.

>> dr. collins, you can see that your colleagues are very brilliant but mine are crafty at loading up questions with their great questions. the chair will be as generous as he can with the clock. i will move to my good friend the distinguished member from arkansas. >> i know i have two or three questions. i was one of the people that went up on the tour. i am in on just as i was the day we toured the institute of health. i am grateful that the guys and gals are doing great work. i will follow-up up on a question from earlier. when you said you need to make sure patients can access new medications and treatments coming out of the nih, i completely agree with that.

right now, regulations for medication therapy for opioid addiction prevent this and only push to medications. can you follow-up on what the nih is doing to make sure patients can access these medications? are you working with other agencies to make sure they are not detracting from but complementing the efforts of the nih? >> for us to succeed, we have to work in partnership with our sister agency. we have mechanisms by which we bring together the researchers and clinicians to ensure that development in this case, it is implemented in the treatment setting. there are always problems

ensuring that patients have access to these medications. that is why i have made the point before, including the need to ensure that insurance will provide access to them. there is a third medication also available. and as of now, we know that not only is this medication effective, they are effective preventing overdoses and hiv. >> you expect i will have a question about idea funding. arkansas is one of those states that benefits. we have an underserved population and i know a lot of our applications go wanting. we would like to approve -- improve that. dr. giddens -- gibbons, you

asked for a 3% increase over fy 15 but the budget request level wondering for the idea program, i would like to know why the program that helps states like mine the other states are not prioritized. will you walk with you that process? -- me through that process? >> programs in states like arkansas are truly exciting and a great opportunity for research. there was a $50 million increment that the idea program received in 2011 which means it has only grown more rapidly than the rest. this particular year, it did not change in its total dollars but the idea has been doing pretty

well. idea is managed to say something about this program which i know he is quite enthusiastic about. >> the idea program, we are very proud to have it there. we are completely committed to the goals of the program. the key is that whatever the budget we will do what we can to ensure that those goals are increasing the geographic distribution and ensuring all 50 states have cutting-edge biomedical research going on. i recently traveled to arkansas and little rock and saw some of the amazing research going on there in the southeast region. we have a center for biomedical research and excellent that is focusing on determining the three-dimensional structures of proteins from viruses and bacteria, using that information to develop drugs.

it will continue to push the goals of this program forward as best we can. >> as i said in my opening we are grateful for the work being done by this agency. it gives me a great deal of pleasure to be associated with a panel. >> next, we go to my good friend. >> let me ask first about the joint program of the neurodegenerative disease program. i know there have been some discussions about american participation. can you tell the committee whether we plan on engaging in terms of broader political trials?

>> we appreciate your strong leadership in the area of neuroscience. the co-lead on our brain initiative and a major figure in their science will respond to your question. >> thanks very much and thanks for all you're doing in this area. this is the joint program that we talked about. it will be under the g-7 authority around dementia. that is the piece we have become most involved with. i suspect it will be some joint initiatives. >> i know prime minister cameron

initiated that. i would like to get a particular review, something that we are or are not going to join. let me ask the question right in your alley why i have -- while i have you. the mental health block grants the institute to help states implement programs that have proven effective in terms of preventing the first episode of psychosis. i understand in this way researchers from your institute is recovery after initial schizophrenic episode. and that patients are benefiting quickly. tell us where we are right now and what the future holds? >> the rise program is -- the

race program -- raise program study was completed in terms of its feasibility in december of 2013. and soon thereafter, asking sams a to implement the findings of that study. the story of science to service or science to practice, it takes longer than six weeks. it happened in 2014. we are watching that now as it continues to grow in 2015. what we would like to do now is build on that. in a very specific way. we want to create a learning health care system out of these kinds of programs. that would really be not so much

research to practice but practice to research. it learning from the experience and how to improve outcomes for people that have a first episode and how to prevent that first episode. we are trying to move earlier in the cycle to reduce the numbers. >> to prevent the tragedies we have seen across the country the committee will have a continuing interest going forward. let me go 30,000 feet up in the air. i know that you have cochaired a group that i establish the language in the commerce justice science bill where i am the ranking member. the fact that i can be in the same room with tom cole, i'm happy. you cheer the working group and the brain initiative is a major inspiration. there are a number of other things in terms of the

pharmaceutical industry. there are a lot of things germinating. the budget requests, how those will be meaningful as your moving forward. >> i will take that on. i should say at the beginning that anytime i go anywhere, the congressman has just been there. stamford, m.i.t., and every neuroscience lab. the brain initiative, when it was first set up, we asked a group of experts to sit down with us and give us the best idea how to develop this 10 year plan.

the budget will grow by 2019. it's pretty much like the human genome project. we are at 2015, we will be around $80 million with the president's request next year. the question that gets asked seeing how spectacular the scientific opportunities are, we have a great roadmap as long as you have gas in the car. we are hoping with the funds that we've got now that we'll be able to do 10 this year. we did 58 last year. we would like to have another 50 or so come out this year.

it's going to depend a lot on your support. >> i begged the chairman -- the gentleman's gracious compliment it may not get him extra money. we will see about that. let's go to my good friend, the gentleman from tennessee. >> thank you, mr. chairman. dr. collins and all the directors, i want to say thank you. the melodies that face so many millions of americans, it is incredible. as you all know, i have been a very vocal, outspoken advocate. i thank you for all your endeavors.

cancer, children with cancer. my question today, i hope you can help me. a little boy came to see me. he was blind and had a brain tumor. he and his dad came to see me and sat with me. i was not even his congressman. i hope you can help me with this. pediatric low-grade astrocytoma is a slow going -- growing cancer that impacts 22,000 children every year. there are over 1000 new cases diagnosed every year. existing treatments for plga are invasive, highly toxic, and relatively ineffective. the treatments can cause serious

permanent damage and are often life-threatening. what research is being conducted on plga? what alternatives are on the horizon for patients? are there clinical trials currently being conducted for >> thank you for the question. >> the director of the nci is currently out of the country. if you were here, he would certainly answer your question. i agree plga is a cancer we need desperate answers for. it does not respond it particularly well to the kinds of approaches of the cancers that are rapidly growing and have made advances possible. clearly there is a connection tween what we were discusses and why we go in terms of cancer focus in the prevention

initiative, and the cancer institute aims to enroll almost 1000 pediatric patients in this release your stage. -- early year strage. they want to find what drives malignancy. they want to try and understand more about the disease. one of the difficult problems is access to tissue. it is not an easy thing to imagine doing a biopsy of a tumor growing in such a vulnerable place. there are potential ways that one can begin to look at that. by looking at dna that is loading around freely in the blood circulation. because cancers could do turnover release their dna. one can discover it by looking in the circulation for free dna not inside a cell that can tell you what is going on without having to do a needle biopsy. a so-called liquid biopsy. in terms of clinical trials for

plga i do not know off the top of my head. i would go to clinicaltrials.gov to see what is listed. i can give you a list of what might be planned for this terribly difficult condition. we share your concern about needing better answers for that boy who came to see you. >> thank you doctor. i would like to ask a follow-up question. our country prides itself on being at the front of research. biomedical research is no exception. you have expressed concern about the money going towards international research. can you please share with us why with the budget of the size of nih, you have these concerns, and in an effort to maintain competitiveness, while working to make the largest strides possible to finding cures for the diseases that have the raised impact on our population, what are you doing to take it of the research done in other countries?

>> that is a good question. science is an international effort. many programs, including the human genome prodject, was international. it is very clear that the country that leads in biomedical research enjoys other benefit directly especially in terms of commercial spinoffs. those are wonderful ways to create jobs. america's leadership has led to the fact that we are not only great in iowa medical academic research -- biomedical academic research, we would not want to lose the benefit of medical companies as well. if you look at the project rate our funding is on compared to other countries, there are deep concerns. we have lost about 22% of our purchasing power at the nih sinc e 2003. a very substantial downturn in terms of what we can support.

other countries are going the other way, china in particular increasing their support of biomedical research by 20% per year over multiple years. the consequences of that -- i would refer you to an article by economist hamilton moses. it was about a month ago. it had a lot of data in it about pointing out a number of things that are quite alarming if you really care about the u.s. maintaining that leadership. it includes the fact that china is now filing more patent in biomedical research than the u.s.. not as a proportion of the gdp but absolutely more patents. the repercussions will be significant. their final conclusion of this article is that given the national trends, the u.s. will relinquish its historical international lead in biomedical research in the next decade unless certain majors are undertaken. they see the pathway and they don't like what is happening. we can turn this around. what nih test really needs and what would be such an

inspirational moment for our community is eight cents of stable trajectory -- a sense of stable trajector, that we can take risks to do research without uncertainty of what will happen the next year. a doubling would be nice, but will be better is to see a path forward that keeps up with inflation plus a little bit. something we can count on where people can flex their innovative muscles and take advantage of this amazing talent that we have in this country. >> thank you dr. collins and everybody. i yield back the remainder. >> i would like to yield to the gentlelady from california. >> let me first associate myself with the comments made by my colleagues about the tremendous work that you all do, and what a positive impact it has

had on the life of so many people not in this country, but throughout the world. i do have some concerns i would like to address. dr. collins in 2000, this congress authorized a national children's study to investigate how the environment influences a child's development and health. over the last 15 years, congress has appropriated over 1.5 billion dollars to plan and pilot the study. given the huge investment congress fully expected that the study would be carried to to its completion. in fact, in every fiscal appropriations report from the year 2000-2014 there have been specific instructions from both the heououse and senate directing the continuation of the study.

the iom concluded that there were conceptual -- i am having trouble with that word. you know what i'm trying to say. [laughter] and administrative challenges that must be addressed. but the ncs offered "enormous potential." they also concluded that the study was completed "imm easurably added to what we know about children's health in the united states." after reading the iom summary report and giving the billion and a half dollars at have been sent, i was surprised by your announcement canceling the national children's study. i am sure i am not alone in believing a better outcome for the $1.5 billion investment should be a completed study.

my question is -- by what authority did you use to suspend the study whose authorization is still in current law, after which congress has spent $1.5 billion after the last 15 years and for which this committee and fy 15 put in language that said "the nih director is expected to use this framework" meaning the framework coming out of the iom report " to ensure the mission and goals of the ncs are realized to anticipate the joker generated returns -- the de generated returns from taxpayers." >> i appreciate the question. this has been one of the more difficult decisions after being nih for more than 6 years. the national children's study was designed over quite a long period of time.

as that time passed, some of the design issues in retrospect were not serving the need of getting the information, which we all agreed was crucial -- that is to understand environmental impact. factors that occur at the and beyond that influenced child's health. we all agree those answers need to be found. the problem that increasingly seemed clear that the design of the children's study, which carried a historical legacy, was not sitting with the weight which technology was -- the way in which technology was developing over the last 20 years. the iom study as you mentioned was quite critical about the issues and administrative issues. because of that, i asked a working group of my advisory committee to look closely at aspects of the children's study and to make recommendations about whether it was feasible. they came back and said frankly

they did not believe that it was. and that it was more responsible at this point to try and make sure that what the data had been collected through the vanguard studies, which were a pilot for the children's study, which were made available and kept in place. but that we ought to think about coming up with a new strategy to get answers for these same questions. the congress in the minas will -- in the omnibus bill give us the ability to take money in the budget and come up with new ways to obtain answers to these questions about environment in pediatric health. we have been vigorously engaged in that effort over the course of the last two months. we will in the very new future announce what the programs will be in fy 15, which i think you will find quite innovative. this gives us a chance to step back from the legacy of the last 14 years and say in 2015, with

all the technology that has advanced in the interim, what can we do that would get her answers, perhaps for less cost than what was anticipated for the original study? we are quite excited about it. the institutes have gotten engaged with this opportunity to rethink this. ultimately we will get to where we need to be, but in a different way than what was imagined. >> it was my understanding according to a bloomberg business report that baker, who was a researcher at the university of california irvine who ran a pilot and was the lead investigators of the study said that the iom "did not concluded that the enterprise was beyond saving. and that that was a decision by nih. we know that this study is feasible and even identify a pathway."

that was a decision that was made by nih, not based on the outcome of the iom report. just very quickly -- i know my time is up. what is the period of time and amount of funding that would be needed for nih to address the recommendations made in june? >>if you could do that for me. >> if you care to make a quick comment. >> just in terms of the process if you read chapter five and six of the iom report, not always well reflected in the executive summary, it is actually very critical of some aspects of the study. my advisory group led by the former dean at stanford and former pretty attrition, andcame to a unanimous conclusion that the children's study was to longer feasible. i had to accept their

conclusions because they were so well-founded. in terms of where we go, please look at the next proposals coming very shortly about how we will address these issues. we have a lot of things to talk about in terms of going forward. where should this kind of research go in the coming years. we need to have that kind of conversation. >> thank you mr. chairman. >> you're welcome. i want to go on the one number to our team who may have the intellectual power to stay with your team down there dr. collins. i recognized dr. harris. >> thank you very much mr cha irman. let me start with a rhetorical question. since the last time you appeared before this committee, you may know my wife passed away with heart disease before her that the birthday. we have really underfunded research into heart disease for women over the years. i looked at the chart of what

the nih spent on. hundred 58 million americans have heart disease. and yet the amount we spend per death is 100 times less on heart disease than it is on hiv and aids. that kind of discrepancy needs to be justified. this is a rhetorical question. it is stunning what that discrepancy is and how the fact that we dedicate as little as we do to heart disease, most trouble and disease in the country, how that will affect the population. anyway, rhetorical question on that one. i will ask you a question about drug use. there is obviously an ongoing discussion about legalizing a dangerous drug called marijuana. some people may not think it is dangerous or addictive, it is. it affects the human brain including memory, motivation, a

lot of things probably not good for people, especially our youth. do you know what the economic impact is of marijuana use is, including its use on workforce preparedness, on educations, do we have these answers? are these important things to study, and do you have the resources to study these things for we go willyn-nilly in legalizing it a dangerous drug? >> there have been many stories that illustrate the consequent as of the use of marijuana among teenagers. they have consistently shown that it actually decreases the use of smoking in adolescence it decreases the likelihood that you'll finish school and a degree. with respect to the impact in the workforce, the data there is much less clear. studies have not been done as extensively as for education. we know in general that the use of drugs in the workforce is

responsible for 30% on an individual. that has not been distinguished with respect to whether it is marijuana or contain work methamphetamine. -- or cocaine or methamphetamine. we do not have a precise number. >> you say marijuana saps motivation, something important when you go to work. are you implying it might have a quite and it was on work -- quite and influence on work? >> the decreases on productivity are absentees and -- ab senteeism. and the lack of motivation may cause lack of outcomes and education. >> we should expect scientific answers i imagine. dr. collins, let me follow up with you about some things being said about internationally what is going on in our biomedical

workforce. in january you said something in your article suggesting that heine -- that china will have to overcome the u.s. in 2022. but what is interesting is that the growth in china is actually in the private investment, the industry investment. there is a little bit of growth in the public investment. but the real growth is private industry. one worrisome trend in the u.s. is that the industry investments in biomedical has gone down. that is not where you have the ability to directly impact. may be, or maybe you don't. that is an important key that we

are not talking about. there are certain policies that do impact that. we are undergoing a tpp negotiation where patent protection of biologics actually hinder. that doesn't help our biomedical industry. when we are negotiating a trade agreement, it actually hurts our biomedical industry because the nature of biologics. what is the strategy, we can go on ad infinitum, the ministration in spending 35 billion additional dollars we don't have on a discretionary spending decided to spend only one billion on the nih, a 3% increase. that is a drop in the bucket if we don't get it eager picture of the entire biomedical research effort in the u.s. what can we do, or what can you do at the nih to implement a strategy where we can promote industry investment. so that we have workers in industries, so that we are leveraging nih dollars as it appears china is doing. >> to be fair, be brief.

i remind the question is not to jam the against the time and leave them hanging. [laughter] that is a tough position to put our guest in. >> i agree we have a responsibility and an opportunity to bring together the public and the private sector investments in biomedical research like never before. one example is accelerated medicines partnership that i spent three years working with number of heads in r&d of numerous pharmaceutical companies. now with shared expenses 50-50 by the private and public sectors, doing something never attempted before for alzheimer's disease, or diabetes for rheumatoid arthritis, lupus. putting scientists around the table, holding them accountable and making the data accessible to others who might have good ideas. this is unprecedented. we are one year into this, i had of schedule. i am looking for the

opportunities i can find where those traditional firewalls back out in the way of making progress towards making sense. we have to make clear about conflict of interest. that should not be a reason to not think of creative endeavors that flying the face of creative opportunities. >> thank you very much. i will go to my very patient friend from virginia who was here early and has waited a long time. >> i appreciate dr. collins and your colleagues being here today. i am learning a tremendous amount.. i respect the work that you are doing. i will bring us not as a question but i didn't take note of your comment about how helpful it would be to have confidence and continuity of funding. i have transitioned from house armed services to this committee. i was struck on my service on that committee where senior uniformed and civilian officials would say the same thing about just how beneficial it would be

for us to be on regular order. chairman rogers and german coal and really all of us on the committee have been strong advocates for this. i will continue to fight for that and i know my colleagues will as well. i take note of what you said. i have an incredible concentration of men and women in the country in virginia. i want to talk for a moment about ptsd. i know there is some funding for it including in your budget $79 billion i believe to go to -- excuse me, million. i better get that right. my point is this. how me to understand. from the resident to the first

lady, this is a shared american value. i do not question for a moment anyone's commitment to this. that said, i did not see it mentioned in your budget justification. i know the department of defense and va is working on this as well. help us understand where this falls in the priority level. is it getting attention, even in your internal documents, that it merits? >> i appreciate your question. let me defer to the doctor who leads ptsd research. >> our institute was founded in 1946 to deal with the problems of veterans. is part of the dna of the institute to try and figure out what causes ptsd and the best way to treat it and prevent it. we have been working closely

with dod. one of the areas talking about the relationship with industry, this one we have taken on in a very joint way. especially with the army. the army and the nih have worked together on the stars of initiative, 100,000 soldiers pairing with us to understand over time what causes not only key tsd, but depression, high risk behavior, and suicide which is the worst outcome. i must say having worked as closely with dod as we have over the last three-or years, that is a great inspiration. that study has completed its first phase, moving into the second phase. we are already getting insights about the best interventions to make sure that people who develop mental health problems don't go on to suicide. >> the question of allocation generally, how much is allocated to one disease or particular challenge that we face.

dr. collins, can you help me understand when things need to be reallocated? whatever your experience has been like most american families, we have lost some to alzheimer's and cancers and things like that, but how has all of that structured? i would like to see a higher allocation for the topic just mentioned. what our servicemen are facing. how is that process unfolding? >> is a question many people ask, and they should. it is an ongoing, organic process of looking at what the public health needs. what are the scientific opportunities? what is the current portfolio look like, and do we have gaps that we need to fill? we are constantly doing that kind of analysis. we have more tools than we used to. a whole series of ways to look at the portfolio and figure out whether we have the island out of whack in terms of where our

-- the balance out of whack in terms of where our funding is. we can learn about diseases about common illnesses or which sadly affect a few people who desperately need help. if we did everything on the basis of public health needs, we would neglect the rare diseases. alzheimer's comes to mind where the birth of individuals of their families and the cost to society is so daunting that we feel we have to push even harder as long as the scientific opportunities are there. it is a constant recalculation. all of this would be easier if we were not in a circumstance where frankly, we are underfunding virtually everything we do versus what we could be able to do, given the talent that is out there. >> thank you for your comments and i yield back. >> just for informational purposes, as my colleagues and witnesses know, we do have time constraints this morning. i will go to mr. and so he has a opportunity to ask his question.

i will go to close out the committee that is all right with everybody. >> thank you mr. chairman and thank you all. thank you for receiving us a few weeks ago at the nih. dr. collins, i want to mention an analysis of the national cancer data from 1975-2005, found that liver cancer incidence rates increased over 300%. 1.621.9 cases per 100,000 persons per year -- 1.6 - 1.9 cases per 100,00 persons per year. historically, the survival rates in liver cancer has been. dismal the five-year survival rates is only about 16%. these survival rates are second-worst among all cancers only slightly better than those for pancreatic cancer. and yet the nci has no dedicated

specialist program for research excellence on the liver or liver cancer project. can you tell me why, and will this accelerate the pace of liver cancer discovery? >> i appreciate the question. certainly liver cancer is a question that many components of nci are involved in working on, whether there is a specific division vocus to it ==-- focused to it. liver cancer is typically occurring in those with hepatitis c which is one of the good success stories in terms of touring people. it reaps rewards in terms of reduction. i will not take for the record the opportunity to respond to the organizational part of nci and liver cancer.

i can for you in on where that work is going on and how it is being coordinated if that would be helpful. >> that would be very helpful. also a question for you. i recently met with cdc director and one of the issues we discussed were the recent failed out breaks of antibiotic resistant bacteria across the country, including my home state of pennsylvania. the threat post by antibiotic threat back, also causes superbugs, was so dangerous that last year resident obama declared combating superbugs as a national security priority. they are highly contagious and spreads quickly and a hospital setting. can you tell me if nih is collaborating with the cdc to study and contain a treatment or cure to these antibiotic resistant accurate -- antibiotic resistant bacteria?

>> let the other doctors a word. >> with the president strategic plan and the effect of order and the cost program is a multiagency u.s. government involving the cdc, the fpa, the department of agriculture, and nih. our fundamental mission into that multiagency approach is fundamental basic research to understand the pathogenesis, particularly with high sequencing capabilities that we have to examine a wide array of cause i species of microbes that are resistant -- quasi-species of microbes. it allows us to do things we could not do years ago in terms of pinpointing mechanisms. we have now amplified in terms of the president's request for

more dollars in the anti-microbial study, what we call an anti-resistant your group -- leaerder group. doing studies that you can't do and it individual institute because of the fact that the incidence aren't -- and finally we're doing work on developing vaccines for some of these difficult microorganisms that are highly susceptible when you think in terms of people for example, who have transplants or are immunosus preed. -- are immuneosupressed. the