and imprisonment by the erotic government -- by the he romney -- irani government. here is some of that. when i was in prison and being interrogated, my -- became my muse. when i got to prison, i saw -- d guards in 10 days and i decided to write a book and every time it was saying something stupid or he was making a presumption about my life or life in the west, i would say -- [laughter] basically, he did not have any other human contact besides

myself because he spent all his time being in the interrogation room. he was tired of talking to revolutionary guys so sometimes he was confiding in me, telling me about his personal life. i can hear his conversations with his wife. sometimes even while he was beating me, he was talking to his wife. wasmember one day, he holding my year in his hand that he was twisting my here and it was really painful and then he -- his phone rang and he kept on twisting my year while he was talking on the phone. then he hit my head and he said, i'm talking on the phone, be quiet. his experiences in an iranian jail, all of that tonight at 8:00 eastern on c-span.

homeland security secretary jeh johnson next, outlining his department's efforts to counter homegrown terrorism, foreign fighters and cyberattacks. he also talks about a new national security alert system. he spoke this week at the association of the united states army. [applause] good morning everybody. that was pretty good, good morning everybody. here.good to be as generals one pointed out, this is my second address to the ausa. summit he might get the impression i actually like the might get thedy impression i actually like the army. i've taken my prepared address given to me by my speechwriter. i read it, said it looks pretty interesting, then i prepared my own remarks which means i will

tell you what i really think, within limits. , whatd my staff last week should i say to the ausa? very simples are, just tell them how great the army is -- very simple server, just tell them how the great -- how great the army is. i am here to tell you that the army is great, i love the army. why did i say that? a real -- for real? i love the department of defense -- i left the2012 department of defense at the end of 2012. the thing i miss the most about public service is the character and the quality of the people that i worked with in the

department of defense, in the pentagon, in the united states military. the character and the quality of the people with whom i worked. o10, an 04,was an or an o6. i have come to respect and admire a number of people. retired general carter ham, for example. just to name a few, general tony thomas. these are people i worked with on an almost daily basis. , for two a daily basis years. someone from the joint staff down in the basement of the pentagon, a young army major. i won't name him because he would be embarrassed if i did. he would come and brief me when i was general counsel about

intelligence matters, about counterterrorism matters. he did his job. he was modest. he did it well. after he was reassigned, someone told me about this army major. -- wouldg man, who had never say these things himself, had been on 16 deployments. he had broken his back when his parachute failed to open. lost part of his leg to an rpg. was shot in the back and had been the victim of three ied attacks in afghanistan. after servicing the pentagon, went on to run triathlons and 50 mile races. that is the quality and the character of people in today's

united states army which i find remarkable. it's the thing i miss most about public service, which is why part of me is pleased to be back in public service. i have the job of secretary of homeland security. perhaps the army general officer i got to know best was brigadier general mark martins. many people here probably know him. chief prosecutor act guantanamo they in the military commission system. i got to know him as in the pfizer. -- as an advisor. i spent time with him in afghanistan. 2011,ted the airbase in martins.y mark

he showed me around the base. nighttime fell. we were about to hit the sack after a long day. he finished first in his class at west point, scholar, harvard law review. better grades than the president of the united states. thought was aat i very profound and deep question coming from a rhodes scholar. sir, look up toward the night sky, what occurs to you? above,d up at the stars it was a clear night. i wondered what general martins was thinking of, so i

searched for a deeper meaning to his question. i thought about the men and women of the united states army surrounding us. i thought about the inspirational words of winston churchill. i answered general margins with a quote from winston churchill -- "we shall fight on the beaches, we shall i on the landing grounds, we shall fight in the fields and the streets, we shall fight in the hills, we shall never surrender." general martin replied look up at the sky again and what really occurs to you. i gave it a second try and i thought of fdr's inspirational words on d-day. of the united states army, the

so-called pride of our nation remarks. they fight not for the lust of conquest, they fight to end conquest. they fight to liberate and let justice arise and tolerance and goodwill among all people. they urine but for the end of yearn but for the end of battle they returned to , the haven of home. i said to general martins, how about that? he said look up again -- what are you thinking and what really occurs to you? i thought of john f. kennedy's inspirational words at american university about the inherent nature of armed conflict and international tension. kennedy, in june 1963 -- these words i gave in the hope that is going to answer his profound

question -- our most basic of linkbasic comic -- common is that we all inhabit planet and breathe the same air and cherish our children's future, and we are are all mortal. general martins says what really occurs to you when you look at the afghan sky. i said i give up, what are you thinking? someone stole our tent. [laughter] the army is great. the army's family to me. some of you may be interested to know that my grandfather was a sergeant major and combat veteran in world war i. my father was an army sergeant during the korean war two uncles in the army air corps who were egee ehrman.uske

-- air men. when i say the army is great, i love the army. my words are matched by these -- i'm stealing people from the united states army. my assistant secretary, my acting assistant secretary for public affairs, combat veterans from afghanistan, dr. jennifer mcdonnell, i'm sure many of you know pete. one of my cyber security experts. it is the case that the army and department of homeland security work together closely on a number of matters. the army corps of engineers, the army guard when it comes to disaster response. i saw this in person in south carolina last week.

when it comes to the department of homeland security, i am in a -- i am a native new yorker. i was present on 9/11, in manhattan on that day, before my service for the department of defense. i witnessed the tragedy of 9/11, that devastating terrorist attack. it was out of 9/11 that the department of homeland security was born and my commitment to lead homeland security was born. as many of you know, the department of homeland security is the third largest department of our government. we have about 240,000 people, 22 components we are responsible for among other things, counterterrorism, border security, port security,

aviation security, maritime security, enforcement and administration of our immigration laws, detection of biological and chemical threats to the homeland, response to disasters, natural and man-made. and the protection of our national leaders. we include customs and border protection, which is the largest law enforcement agency. citizenship and immigration services, tsa, secret service, the coast guard and fema. i want to take a moment to highlight the extraordinary work of the secret service and other elements of the department of homeland security just a few weeks ago. just a few weeks ago, we had what many would consider the perfect storm in terms of the

protection of visiting heads of government. we had in late september, 170 world leaders and their spouses in this country, in new york city all at the same time. and the lead responsibility for protecting them all was the united states secret service. we had the president of china, we had leaders from afghanistan, iraq, israel, the united kingdom, russia, and the pope, all in this country at the same time. no other agency of our government except the secret service, no other protection service in the world could have. -- could have pulled off what the secret service did -- probably the largest the mystic security operation in the history of this country.

flawlessly and perfectly with other components of the department of homeland security. hsi, fema, the coast guard. i'm awfully proud of what our folks have done. i am told the topic here is to win in a complex world. i could not agree more that that is what we in the department of homeland security find is our challenge -- winning in a complex world. i have spoken many times about the new reality of the evolving global terrorist threat now. there is a new reality to the threats, to the homeland, which you and i are responsible for guarding.

there is a new reality -- the global terrorist threat has evolved from terrorist directed to terrorist inspired attacks. when i say terrorist directed attacks, i mean attacks or attempted attacks conducted by people who were recruited, equipped overseas and directed by a terrorist organization and exported to our homeland. the most prominent example of a terrorist directed attack is operatives were trained and directed overseas and exported to our homeland. then the attempted underwear bombing over detroit, the attempted times square bombing

in may of 2010, the attempted package bomb plot, these are examples of what were likely terrorist directed attacks by those overseas. today, we see in addition to that threat, the threat of terrorist inspired attacks. from those who are homegrown or even home born, al qaeda in the arabian peninsula no longer builds bombs in secret. an instruction manual and urges the public to do the same thing. we see the potential lone wolf act or and the foreign fighter. the foreign fighter who leaves their own country and goes to syria and returns home with an extremist purpose that we have

to be vigilant about. in this new wave of attacks and attempted attacks, conducted by those who may be home grown, the boston marathon bombing in april of 2013, the attack in ottawa on the parliament holding -- parliament building. the attack on the charlie hebdo headquarters, the garland, texas attack in 2014 and of course, -- in 2015, and of course, chattanooga in july of 2015. this is the new reality of what we face. terrorist inspired, more complex and has led to a more complex world and, in many respects, harder to detect. our government has become pretty good at detecting overseas plots

at the earliest stages. the homegrown actor could strike at any moment and is inspired by something he sees. this threat is in many respects more complicated and harder to detect. it involves a whole of government response. so what are we doing? first, we continue to, as we have in the past, taken the fight militarily to terrorist organizations overseas and, through our efforts and through the efforts of the united states army and others, we have taken out of the fight by killing or capturing many of the leaders of terrorist organizations and those who have been plotting directly to attack the homeland.

osama bin laden is dead, killed on may 1, 2011. if 9/11 was my worst day as an american being president in new york, perhaps my best day -- being present in new york, perhaps my best day was the day we got osama bin laden. other terrorist leaders had been taken off the battlefield. khalid shaikh mohammed awaits trial in a military commission. others have been killed or captured. we have, to a very large degree, been successful in degrading the terrorist threat to our homeland from overseas. but there is much more we need to do given how this terrorist threat has evolved. law enforcement, the fbi has a key role in this. the fbi almost on a daily basis has become very good at detecting, investigating, and

interdicting terrorist plots to our homeland here at home. it has become all the more important that the department of homeland security, and the fbi, given how this threat has evolved work closely with and share intelligence with state and local law enforcement, which we do on a daily basis through joint intelligence bulletins and the like in response to the attack last year in ottawa, i directed that we enhance our protection of federal government buildings in major cities around the country and that enhanced protection continues to exist today. much of the terrorist threat as it has evolved continues to center around aviation security. we are building what i refer to as preclearance capability where, on the front end of a

flight from overseas to the united states, you will see our customs personnel, screening passengers before a flight to the homeland. any opportunity i have to push out our homeland security, i want to take it. we are establishing preclearance capability. we have done this in 15 airports overseas. as a result of preclearance, including some who have been in our databases. we want to build more, so we have engaged in discussions with a number of authorities around the country and this is something we will continue to build. under the leadership of the new tsa administrator, we are implementing reforms to our

aviation security, both in response to the inspector general's report the summer and other things. when it comes to aviation security, there is a new emphasis on security that the administrator and i have directed in the field, frankly less managed inclusion. what does that mean? less instances when you go to the airport and you are not a member of tsa pre-check, you get put in line anyway. we want to renew an emphasis on security, so we're stepping up the effort and hopefully it will not sacrifice wait times. there's a renewed effort on security. in response to the concern about foreign fighters, we have done a

number of things. a number of foreign fighters come from countries from which we do not require a visa, european countries are in our visa waiver program. there are 38 countries that -- through which we do not require a visa. out of concern for security, we have added information request. never anyone travels to this -- whenever anyone travels to this country, they are required to fill out additional information. last summer, i announced security measures to our waiver program to require countries in our program to make or use of passenger name recognition data and advanced passenger information. we are requiring countries in the visa waiver program make or -- make better use of interpol

to make better use of our federal air marshals on flights from overseas to the united states. as the new reality has emerged and the global terrorist threat has evolved, we are asking the public for help. if you see something, say something has to be more than a slogan. we are asking the public for help, public awareness, and public vigilance. you -- i will tell you that we are considering revising our systems, the national threat advisory system, which we have never used. we left the color-coded bars to a system which we have never used. i have asked our folks to consider whether we should revise that system to accommodate how the terrorist threat has evolved.

that review is underway now. importantly, given how the terrorist threat has evolved, we have embarked on aggressive efforts at what we refer to as counter environment extremism. that means members of my department, the fbi and other departments literally go out into communities, muslim communities in this country to talk to them about countering violent extremism. i personally traveled to boston, new york city, suburban maryland, l.a., houston, columbus, ohio and elsewhere to meet with leaders of the muslim community. our conversations are almost always three-pronged. first, to listen to them about issues they face at airports,

with our immigration system, and to build trust with this community. i hear repeatedly from muslim leaders in this country the hatred that they feel for the islamic state. they say over and over to me, mr. secretary, they are trying to hijack my religion. my message to them is help us help you when it comes to public safety. help us protect the homeland and your communities. if you see someone heading toward violence, let us know. help us to help you. in my view, with we must enhance effort given where we are now even how the threat to our homeland security has involved.

-- has evolved. two weeks ago, i announced the creation of an office for community partnerships to spearhead and lead our efforts within the department of homeland security. we want to take efforts to a new level and encourage the artistic -- the participation of the tech sector. we want to help muslim leaders to counter the isis message and develop our own grantmaking programs to provide resources and support to communities engaged. just a few more words on cyber security. i have directed an aggressive plan to enhance our federal civilian cyber security. it is not where it needs to be. i directed an aggressive timetable for the civilian system in terms of monitoring,

detecting, and blocking suspicious and unwanted intrusions our system. this system is deployed across half of our civilian and has blocked hundreds of thousands of efforts to infiltrate and exfiltrate data. we are urging the passage of cyber security legislation in this congress. the house has passed a good bill and the senate is considering a good bill. my hope is that the senate bill comes to the floor for debate and passage this month. there is an urgent need for help from congress when it comes to our cyber security efforts. we want to encourage the private sector to share cyber threat indicators with the department

of homeland security. even for the most sophisticated of private cyber security actors among you in the defense and industrial base, benefits from information sharing. we want to encourage that. the pending legislation is a good way to do that. we hope for the passage of that legislation so that it becomes law. when the president of china was here, we reached an agreement with the chinese government on some cyber security norms and an agreement to combating cybercrime. an agreement that the theft of commercial property for commercial purposes by a state actor is in proper. time will tell whether the

chinese will in up to these agreements. we have created a ministerial level dialogue on my side and our side, represented by the secretary of homeland security. we want greater partnership and our cyber security efforts. in terms of border security, chief fisher and his fisher saw only about 332,000 apprehensions on our southern border this past fiscal year. apprehensions are an indicator of total illegal attempts to cross the border. the misperception in this country is that illegal crossings on our southern border, on our southern border is that they are going up. the reality is they have been going down dramatically. the high was fiscal year 2000,

where there were 1.6 million apprehensions on our southern order. border.ern in recent years, it has gone down to about 450,000 stop this past fiscal year, the apprehension number on the southern order was 479,000. this past year, 15, the number will come in at a proximately 331,000. which, 1972, is the lowest number of apprehensions we have seen with the exception of one year for this is the result of a number of our border security efforts, including the investment our government has made, more personnel, more surveillance, more technology. that must also be the future, to strengthen even more our border security efforts.

i have directed our immigration enforcement arsenal goa are the personel gont after the criminals, invest the time in the interior to go after threats to public safety so there are fewer undocumented criminals on our streets. we are engaged in our efforts for the department of homeland security which has involved more centralized decision-making, fewer stove pipes, fewer components don't pipes, more stovepipes,ponent more centralized decision-making when it comes to budget and acquisition decisions. i have directed our new under secretary, a former johnson & johnson executive to warm our act decision process.

we are building a homeland security industrial base, reforming our acquisition process for our 12-year-old department. most of all, we are just about helping people, like the united states army. a reminder of that for me was last friday in south carolina, inspecting the cleanup efforts from the floods. every time i do this, i'm reminded of the basic mission of the department of homeland security to help the people all of this country. so in south carolina and other places where disaster has hit, the governor, senators, congressmen and myself, the president of red cross, to basically help people devastated i floods. the loss of their homes.

that is what we are all about, helping people. more than political ideology, we are public servants. three thoughts i want to be with in my prepared remarks. first, the eking for the department of homeland security, we need the congress to repeal sequestration. i cannot do my job as the person responsible with a decapitated budget. i cannot do all the things congress and the american old need us to do for border security, response to national disasters, cyber security, maritime security with a sequestered budget.

we are urging congress to repeal seek restoration. -- repeal sequestration. homeland security is the front line to national security. homeland security is the frontline to our national defense. homeland security is the department of government that interacts with the american public more than any other. 1.8 million people will a day interact with tsa. but he cannot do our job with a set western budget. sequestered budget. it is time to repeal sequestration. next, i want to repeat something i said last month in missouri at westminster college as part of the green foundation lecture series. the most famous lecture there was given by winston churchill himself in 1946 where he gave his iron curtain speech. in 1954, former president harry

truman gave a green lecture entitled what hysteria does to us. i decided to go those remarks. i said all of us in public office, those who aspire to public office and command a microphone oh the public calm and responsible decision-making, not overheated proposal of superficial appeal. in a democracy, the former leads to smart and sustainable policy and the latter can lead to fear, hate, mission, precious, and government overreach. this is especially true in matters of national security and homeland security. my final point is something that is consistent with the soldiers creed.

there is a quote that is consistent with my mission -- "i am a guardian of freedom and the american way of life." that matches almost word for word what i tell audiences at almost the end of every speech i give. the army is not just the guardian of our safety, but the guardian of freedom and the american way of life. in homeland security, we must achieve a balance between basic visible security on the one hand and preserving our laws and values in a free society. homeland security means striking that alan's.

-- that balance. i am a guardian of one as the other. i can hold you with all of our homeland security resources a fairly safe city, but it would resemble a prison. i can build you a perfectly safe commercial air flight, but nobody would be wearing any clothes, no one would the allowed to get up, no one would have anything eat, and no one would have carry-on luggage i can build you a perfectly safe e-mail system, but you would be limited to a conversation with 10 people without access to the internet. so, we can build more walls, we can interrogate more people, we can make everybody suspicious of each other, but, if we did, we would risk things that are most voluble to this nation. -- most valuable to this nation.

we are a nation where we cherish the freedom to associate, the freedom to travel, we cherish privacy, we cherish our laws, we cherish diversity. we cherish these basic freedoms and in the final analysis, those are the things that constitute our greatest strengths. thanks a lot. [applause] i think i am available to take a few questions. if anybody here is not shy. yes ma'am? >> i'm with cms news. could you address the syrian refugee crisis and how bringing

them into this country affects homeland security? sec. johnson: yes. we have committed to resettling 10,000 syrian refugees in fiscal year 16. we are looking at more for fiscal year 17. by the end of 15, we will have resettled approximately 2000, so we want to do more. i am committed to doing that and ensuring those who are resettled are vetted properly and receive the appropriate security review. that means dedicating the resources to the increased number of refugees and making sure they are vetted against the right databases we have. we've gotten better over the last couple of years, but it is a time-consuming process and one of the challenges we will have is that we are not going to know a whole lot about the individual refugees who come forward from

the u.n. high commission for resettlement and vetting, so it will be a challenge, but we are committed to doing it. it's meeting our international commitment for the sake of our homeland security, ensuring they get the right security review and i am committed to both. >> i'm bob baron, national defense reserve. as you may know, at one time, we had an active executive reserve comprised of senior members of military and industry. for approximately the last 10

years, none of us have been able to get any answers from our parent organization, who is in charge, where do we go and what do we do? we carry all the expenses. the only thing we utilize the military for was open seating at certain military training sessions. would you please tell me what happened to the national executive reserve? sec. johnson: the short answer is i don't know. but we'll look into it. i can tell you that outreach to the private sector to her to industry is a minority of mine for the sake of improving the manner in which we conduct business. part of our acquisition and

reform efforts is to establish a council of experts to advise us on the acquisition process. i don't know the answer to your question, but i will certainly look into that. >> thank you for your remarks today. i want to what is being done at the enterprise level to solve the cross agency challenges we have faced for decades? sec. johnson: the communications challenges and meeting them is part of a unity of effort and initiative. the ability to communicate across components is pretty basic. as part of our unity of effort, less stove typing, more stovepiping, more

centralized decision-making, improving our ability to communicate is a priority. thank you. i have time for one more. >> good morning. i'm staff sergeant campbell. i'm curious where you are based right now? sec. johnson: i'm at the pentagon. >> the pentagon? i'm sorry. [laughter] sec. johnson: that was a great joke -- i'm sure that does not reflect upon you. a cab driver driving with a fair and the cab driver says that the awfully big holding. -- big building. how many people work in that building? he said about half. [laughter] >> no comment. i'm curious if there is an estimated cost bringing allotted number of syrian refugees over?

sec. johnson: that's an interesting question. i don't know the estimated cost, but within dhs, the principal responsibility of vetting belongs to uscis, citizenship and immigration services which is a fee-based agency. with the exception of e-verify, cif does not get an appropriation for conducting its is this. it depends on fees for its services. as no applicant to be a refugee. so they must pay for the vetting through the fee collections, so it is not an appropriate amount for congress. it is an agency of government that pays for itself through fees. imagine that. thank you all very much and have a successful conference. i see a number of friends out

here. they've gotten a little grayer, but i recognize them for thank you for all of your efforts, your continued efforts to help secure our nation and work with the army, to work with the department of homeland security. appreciate it. [applause] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2015] announcer: "the hill" writes that the justice department created a new office to investigate domestic terrorism. the new domestic terrorism council, and our main point of

contact for use attorneys working on domestic terrorism matters. that was from cemetery john carlin. -- that was from secretary john carlin. he says it will help identify build our help strategy. there is more road to the white house coverage this afternoon on the c-span networks. jeb bush had a campaign event in concord, new hampshire. the democratic debate, hillary clinton in las vegas for a campaign rally at 8:30 eastern here on c-span. on c-span 2, road to the white house coverage with donald trump at the speedway in richmond, virginia for a campaign rally at 6:30 p.m. eastern. monday, onthis "landmark cases," i-83, the mississippi river around new

orleans had become a breeding ground for colorado and yellow fever. cholera and yellow fever. follow the slaughterhouse cases of 1873. be sure to join the conversation as we take your calls, tweets, and facebook comments during the --gram using "landmarkcases #landmarkcases. order your copy of the companion book available for a dollars $.95 less shipping at www.c-span.org/landmarkcases.

announcer: dr. francis collins and other nih institute directors testify about the need for more nih funding in the areas of ongoing medical research. appropriations committee heard from the nih officials last week.

>> the appropriations subcommittee on labor health and human services and related agencies will come to order. i am certainly pleased we could have this opportunity this morning, dr. collins, to talk to you and the other institute directors about the work you're doing and the work you'd like to do. certainly every family faces health concerns during their lifetime and there are so many things that can be done by nih that i think can't be done anywhere else.

a new drug, a new device, new treatment can take anywhere from a decade to longer to develop, can cost billions of dollars on occasion with a pretty high failure rate even when you think you're on the right path. certainly it's necessary for the federal government to invest in biomedical research. it represents the hopes of lots of people and lots of families and particularly now as we see conditions growing as people survive heart problems and strock problems, we see more people with alzheimer's and cancer challenges. we see the potential for designer medicine largely because of the great work that was done to figure out how to define and understand the human genome system in a better way. this year this committee -- subcommittee and full committee have placed a high priority on this research. we have planned for and have a bill that includes $2 billion of

extra money for that research, increase of about 7% over current years spending. over the past decade, with not much new money going into nih, the purchasing power at nih is decreased by about 22%. we hope to see that reversed if we're successful with what we are trying to do to provide the increase that we are looking at here. these are clearly difficult budgetary times and i am sure we could spend a lot of this hearing talking about how there should be more money for other things in this budget, and there's a disagreement in some cases and an agreement in some cases that if we had all the money in the world priorities might be a whole lot easier to achief. butic look forward to hearing from your team that you brought

as we talked about this morning. i specifically said can you bring some of the people that we haven't seen lately who are focused on the individual areas of research so we can get a greater sense of understanding what the potential is, what the needs are, what is out there that you're seeing and begin to see. and also the challenge of young researchers having research grant approved are dramatically less than we were a decade ago. and i'm sure that's a topic we want to discuss as well. how long do young researchers stay in research if they continue to have their ideas not allow them to move forward. so those are all things we are going to talk about here. i will turn to senator murray who is a big supporter of your work as well. senator murray: thank you very much, mr. chairman, i think we all really

appreciate it. thank you for being here. i am grateful as we all are to champion the critical work that nih does. it's great to see you here. and thank you to all of your team with us today. we look forward to hearing from all of you. all of us agree there's a lot more we need to do to keep our families healthy and continue investing in strengthening our economy from the middle out. the work of the national institutes of health is vitly important to that effort. the nih supports basic research that makes medical advances possible, gives those living with diseases hope and competitive. in my own state of washington we have researchers who are working on ways to repair heart tissue that's been damaged. we have people working on decoding difficult to treat forms of breast cancer. we use precision medicine to tackle eye disease and alzheimer's' and the list goes on. these are just a few examples of

the incredible work to improve health and well being across the country and around the globe. at the same time, the life sciences are helping to drive economic growth and job creation in my state the life sciences sector directly employs 34,000 people making it the fifth largest employment sector in my state. the investments that we make in nih in education and others that support the life sciences indirectly help create the jobs of the 21st century and ensure a workforce that can take them on. that is why like chairman blunt i see maintaining our country's central role as the top priority. and federal inswrestments could not be more important to the effort. supporting and making sure short-sighted budgeting doesn't get in the way. make in fact, i know that you, dr. collins, have said that increasingly the nih is having

to turn promising projects away. for patients and families who are waiting and hoping for medical breakthroughs, that is unacceptable. i am very proud that in late 2013 democrats and republicans were able to reach a budget agreement to roll back sequestration for fiscal years 2014 and 2015 and as we all know that deal expired last week which means congress is going to once again have to come together and find a solution. as i have made clear, i believe that we need an agreement that bills on the bipartisan foundation set from the budget deal last congress rolls back the cuts to defense and nondefense investments equally and protects priorities that are essential to promoting a strong and growing middle class like research and education and infrastructure. i have been encouraging my

colleagues on the other side of the aisle to work with us so we can reach another bipartisan budget deal and avoid those automatic cuts that impact these and other important investments in our country's future. i'm also currently working with chairman alexander, who is here today on the help committee on a bipartisan initiative to advance medical innovation that is an effort that is very much related to the conversation today. i see that initiative as an opportunity to help patients get the best. most effective cures and treatments, as quickly as possible while upholding the highest standards. and to me a central part of accomplishing this goal and tackling the tough medical challenges our country faces is making sure that research and development can thrive. i am pleased that so far we have seen bipartisan interests in camping up investments in the nih and the f.d.a. and i am clear i will only support a bill that does just that. i am going to be focused on finding a path forward in the

coming weeks because put simply stronger investments in medical research means a stronger healthier country. so i am hopeful that republicans and democrats can come together to build on the bipartisan foundation we set in the budget deal last congress and make the investment wes need to seize these and other opportunities in a way that helps our economy and our country work better for our families. we have a deep bench of remarkable scientists leaders, 27 institutes and centers. you will see five of those folks. starting to my left dr. john lor. a nice next to him dr. walter korshez. a distinguished neurologist and scientists.

over here on my right dr. doug lowy. next to him dr. griff rogers, director of the diabetes digestive diseases and kidney diseases institute. and also one of those folks whose being honored this evening because he is one of the nominees for this year's awards for public service. on the far end dr. nora volkal who serves as our able and highly recognized by the press because she is often in front of them talking about addiction.

the national institute of drug abuse. that is my team. now, i will maybe let you start the clock and i would like to tell you a few things by way of an opening statement. it is a great honor to be here before you to discuss how nih is investing in a healthier future for all americans. longevity, you can see here what has happened. breakthroughs generated by research are behind many of the gains our country has enjoyed. for example, cardiovascular diseases, death rates have fallen by more than 70% in the last 60 years. cancer death rates are now dropping by one to two percent annually. likewise hiv aids originally when first being written about as a death sentence now treatments greatly extend lives and prevention strategies and the increasing potential of an effective vaccine are enabling us to envision for the first time an aids-free generation.

i want to thank all of you for your continuing support. we see in front of us a remarkable landscape of biomedical opportunities powered by exceptional advances in scientific knowledge and technological innovation. this morninging's announcement of those noble prizes is a compelling example of how these investments have been paying off building upon work that has been going on for decades. but i would like to share with you this morning an inspiring story, another one that has emerged from decades of research. this is the story of cancer immunotherapy, a treatment that involves harnessing the body's own immune system to fight this disease. i would like you to meet emily. back in 2010 when this photo was taken she was struggling with acute lymphoblastic leukemia, a disease that, thanks to advances made possible by nih, chemotherapy can cure it 90% of

the time. unfortunately, emily was in the other 10%. her prognosis, after failed chemotherapy, was grim. but doctors at children's hospital philadelphia approached her parents about trying something radically different. a clinical trial of an experimental approach called immunotherapy. so i would really like to use this story to make a point about the long arch of medical research involving many investigators and work leading to emily. let's take a brief journey back in time. the history of cancer immuno therapy can be dated bact to the 1890s. a new york surgeon reported success in treating a few inoperable cancers by stimulating patients' immune systems with back material toxins. -- with bacterial toxins.

but his results were highly variable, the treatment was very toxic, and this largely fell by the wayside until the mid 1980s. then, at the national cancer institute, steve explored the ability of certain immune cells to destroy tumor cells. he wondered why the immune system doesn't recognize cancer cells all the time and eliminate them and whether the immune system could be helped to do this by taking the t-cells out of the body, stimulating them with an activating factor and then reinfusing them. it did not always work but there were some dramatic responses. steve was and is a true pioneer. and in a wonderful stroke of timing steve was named this morning as the federal employee of the year by the partnership for public service and will be recognized in the same ceremony this evening. meanwhile, the dna revolution was gathering momentum. basic research spearheaded again in large part by nih led to methods to splice fragments together giving birth to the whole

field of biotechnology. armed with this powerful set of tools and technologies, james alison you see here pioneered one particular form of cancer immuno therapy. he discovered that a particular protein on the surface of the t-cells actually acts as a braking system preventing the full system. by designing an immuno body to block that, brakes can be released, dramatic responses to previously untreatable cancers began to appear. another award. alison just rereceived america's nobel prize for this work last month. building on this growing momentum, other scientists like carl juhn, and whose lab chairman blunt has visited have been developing even more precise therapies. t cells are collected from

cancer patients and engineered in the lab using dna so that they can produce special proteins on their surface. when those modified cells are infused back foot patients they multiply. and with guidance from their newly engineered receptors they seek and destroy the tumor cells. let me show you how these seek and destroy cancer cells with a quick video. this is pretty dynamic and the results can be dramatic. so that's a t-cell that you see there lit up in red busy migrating around. it's looking for foreign invaders. you can see, when it finds a cancer cell it's going to get really excited. the cancer cells in blue the t-cell going after it. i'm going to change the colors. the t cells are now in green. the cancer cells are red.

watch for the red flash. that is where the t-cells just ruptured the membrane of the cancer cell and sent it off to the cancer cell graveyard. you can watch this happening repeatedly with different cancer cells being targeted by these t-cells that go after them and figure out how to do away with them. you can see why one of these recent patients refers to those t-cells as little ninja warriors. they do their job. this isn't just the future of cancer treatment. it's the present. again, note this is built on decades of work. in fact, going back to jim, a recent analso sis shows that the pathway that led to his award include it had contributions of 7,000 scientists over more than a century with many of those scientists pursuing basic questions that had no apparent connection to cancer. so i tell you this story to emphasize critical need for federal investment. if we do that we can realize

accelerating discovery across this vast landscape of biomedicine and ultimately save lives. remember emily? here she is today. a junior bridesmade, the picture of health. this happy picture made possible by her parents' decision to go ahead and enroll her in that pioneering cancer immuno therapy trial. 28 days after that treatment emily was cancer free and more than 5 years later she remains cancer free. emily is just one success story. i could tell you many more including all these folks across the entire nih portfolio about how this is leading to a healthier future for americans. from the development of neuro technologies to the brain initiative to the million or more cohorts person in the precision medicine initiative that will generate knowledge applicable to an entire range of health disease. you would say our future has

never been brighter. to realize that future nih needs your sustained report. so thank you, mr. chairman. my colleagues and i very much welcome your questions. >> well, thank you. i'm certainly glad you're here. let me ask a couple of questions. i did visit with senator toomey and i went to see what dr. carl juhn was doing. that effort which very much -- and you can correct me where i'm wrong here. very much focused on what the individual patients needs, dozens of individual patients at all age groups have been seeing success in that particular effort. but two thoughts about that. one is what -- how does this -- is this likely in cases like this to go beyond treatment to the level of where in this particular case this particular fighting agent is always there so you're talking about cure instead of treatment?

and i would be interested what discussion is going on, how we look at the world where cure is one of the options as opposed to a health care world that is largely been defined by treatment up until now. and i was going to ask my second question at the same time, which is on these individual cases, i would assume at some point one of the challenges are what do we do that makes that most likely to be scaleable? so that every patient doesn't have all of the expense of a unique treatment baw scaleable effort made that will -- i think will come naturally? but talk to me about those two things and whoever you would like to answer those questions. dr. collins: those are great questions, mr.

chairman. and i think i will turn to dr. lowy who is investing in big ways in cancer immunotherapy. lowy: thank you, senator blunt. this is really a critical juncture right now because we have opportunities for long-term responses. and what you're asking is are a subset of those responses going to lead to cure? and we certainly are optimistic and hopeful that this will happen at least in some cases. but we need to understand better as you point out what the mechanisms are that drive the important clinical responses to immuno therapy. and if we can understand them better, we may be able to devise even more effective immuno therapies that also will have fewer side effects. and that's an area that we really are actively supporting investigations in because we do hope eventually that we can get to the area of precision and

predictive oncology where patients we know what treatment to give to them and we know what kinds of immuno therapy to give to them in addition to targeted treatments. thank you. dr. collins: in terms of the scaleability, which is a tough question for some of the very personalized immuno therapy that you saw in carl juhn's lab, there are strong interests in companies and figuring out how to do this where you can make this available to thousands of patients instead of in small trials. we would think that is a very appropriate kind of place for public-private partnerships to spring up so that this idea of engineering your own t-cells to go after your cancer could be done for more and more individuals. senator blunt: i think this is a topic that even i'm having some discussions with people

representing health insurance companies. are you thinking about a future where traditional treatment may be less expensive initially but a long-term potential cure, more expensive initially but less expensive over time? what are your standards going to be? are you thinking what we can do now, which really the whole concept i'm sure will get to of designer medicine, what can happen with the efforts on the brain and how that impacts. and i think we will have time for more than one round of questions. we have a couple of people on a time frame. we will try to get to them quickly and we will do this by order of both appearance and if we're here on time seniority on the committee. but the first person is senator murray. senator murray: thank you. as you know we are working on a continuing resolution until december 11.

i wanted to ask you what effect would a year lonk cr have at the current rate, have on the the nrn ih research? dr. collins: we're thinking and worrying a lot about that. here we are in a circumstance where perhaps emboldened by the enthusiasm we have seen in both the senate and the house in the fy 16 budget process have a number of very exciting initiatives that we would like to launch in fy 2016. the precision medicine initiative, the brain initiative under way for two years but at a critical point to ramp up and build on what has already been done, the ability to be able to push our vaccine strategies for influenza, for hiv aids. all of those are at a critical point where more investment is needed and we have been heartened greatly by the actions of this committee and similar committee in the house to

combleeve we might have a chance to do those things. a year-long cr would be simply devastating. the precision medicine initiative for instance would basically have to go into the freezer or moth balls or whatever the appropriate discouraging metaphor would be. we would just be at the point of starting to enroll a million americans in this study and carry out exciting study and those would basically have to go on hold. that would be enormously disappointing. similarly imagine the brain initiative, it would have to basically take a pause for a year just at the point when the momentum is building. so i can't emphasize enough how much we are worried about this. we can struggle along with the cr until december 11. but if it is a year long cr it is going to be a dark year, indeed a dark year. senator murray: more than 20 million people in the united states have a substance abuse problem. and we know that only a small

percent of that possible lation will get help and those looking for treatment often can't find it because of long waiting times for cure or limited inshurens coverage. the work that nida is critical but i worry that cutting funds would make it hard for addicts to get the help they need, especially at a time when 10,000 more americans now die annually from overdoses than they do in car crashes. the substance abuse block grant that represented 42% of state spending on substance abuse as recently as 2007, that sure would likely drop to 32% under the subcommittee's bill. i wanted to ask you and take advantage of your being here today. are you seeing shortages in treatment services around the country for addict that is want help? and if so does that concern you? volkow: unfortunately,

the answer is yes. and of course it concerns us. because the problem of drug addiction is actually one that has been increasing in our country and we've known all along that only 15% of those addicted have access to treatment. senator murray: 15%? only 15% of the people who ask for help? volkow: no. 15% of individual that is have addiction to have access. they know all of them search for treatment. but one of the reasons why they don't search is they are discouraged by the lack of infrastructure to support their needs. as well as the issue of stigma. so those are two aspect that is have made it very, very difficult to provide treatment. what nida is doing is try to take advantage of infrastructure that we have in our country to maximize their involvement in substance abuse disorders. that includes the health, criminal justice systems. those two are structures that we are engaging to provide with evidence-based treatment that can provide outcomes.

senator murray: i wanted to ask you, i know the brain initiative recently released its second round of awards bringing nih investments to 2015. could you tell us about the progress that you've already made under the brain initiative? koroshetz: yes. so the brain initiative is incredibly exciting and off to a great start. the sfert of the brain initiative develop new technologies to allow us to monitor interrogate and also mod late brain circuit activity. and if you think about it that's really what patients are suffering from is disorders in brain circuitry activity. the problem is that we don't have the neck nolings to monitor or modulate those except in a very unsophisticated manner. so some things have already come out that are really exciting. a couple of examples.

there's a new technology which you can put artificial geen into particular nuerons in the brain and with a drug that has no other effects you can turn on or turn off precisely certain neuron types in the brain. this is really an amazing fete to be able to do that. so just to contrast that with treatment for parkinson's disease, where a wire is put into is the brain and electric current is sent in and it goes willy nilly no one knows exactly what it's doing. it turned out to be quite effective. you can imagine how this technology can completely change how we can basically normalize or cause compensation in brain circuits for patients neurologic deficits. so it's really quite exciting. senator murray: thank you. unfortunately, time is the out. i will wait for the second round. senator blunt: senator cochran.

senator cochran: in my state of mississippi we have one of the highest rates of type two diabetes in the nation. we're told that over 12.5% of our state's adults have the disease and the problem is growing rampantly. are there any new approaches that you have in mind in dealing with hot spots, outbreaks, whatever you want to call it, in areas like our state? dr. collins: that's a great question for dr. rogers since his institutes oversees diabetes research at nih. dr. rogers: thank you for the question. tibe two diabetes is increasing at an alarming level there. currently about 29 million people in the u.s. with diabetes and 86 million who have pre-diabetes. and there are two things we're doing about that.

number one, for people who are established diabetes there's a common drug that started on patients. but unfortunately, in the great majority of patients, that drug will no longer be effective. we started a trial in which we are characaterizing the combination of this with one or four different classes of drugs to see what the next effective drug would be for a given individuals. this is actually a trial that involves 5,000 individuals in 45 centers around the country to determine the effectiveness. this really will eventually get to the area of precision medicine. the second thing for those people who are sort of underneets the iceberg, the 86 million americans who have a possibility of going on to develop diabetes, we have tried to translate a very effective diabetes prevention program to scale this up in a way to offer this lifestyle which was quite effective in these patients to prevent them or delay them from becoming a diabetic.

these will have an important financial role in the future in terms of cutting costs. senator mikulski: thank you so much for organizing this hearing. to our colleagues from nih, this is a committee and the members here today are the pragmatists. when you look at it, we have a chairman that's very much dedicated to nih, certainly a vice chairman that is. we have the authorizers here in terms of murray and alexander. all of us here going around have a history of support for this. so you've got people who really want to be nonpartisan. so i want you to know that. but we are sometimied. -- but we are stymied.

we are stymied by our own process. when i first arrived in the senate we had a triad that worked. authorizing. they would often create great policy on a bipartisan basis. kennedy-hatch, kennedy-cassabel, et cetera. we had appropriations that really could move the ball forward. and we had a budget process that gave us an orderly methodology process for doing that. so we've got problems here. so we've got big problems here. and i know that you live them out every single day. colleagues, when i visit the national institute, which has been my great joy to represent for 28 years, i call it the national institutes of hope. this is what we just heard here. the national institutes of hope in both what they do on the campus in bethesda but also what they do through the great extra nueral research like in the university of maryland and johns hopkins. you're a hopkins guy. they're going to dedicate a room

at the hopkins club, the faculty club two weeks from now. 38 people associated with hopkins have won the nobel prize. two thirds of that have been in life science. 38 people, one university. but because of the role that our government plays in doing that. but we're an economic engine. when you think about the jobs that are created because of that, in pharmaceuticals, biomedicals, medical devices, you are a turbo engine. so rather than seeing a cost factor, we should see you as an economic generator, an economic generator. and i hope we can be able to do that. i am deeply concerned about the caps. i don't like budget caps. but most of all, i don't like the caps on innovations. we cannot continue to continue to cap innovation. we cannot cap breakthroughs. we cannot cap the opportunity for young people to train for

these careers by dr. rosenberg and all of you have here. so here is my question to you. that when we look at both the research to be done and the workforce that needs to do it, i worry about the young investigator and the debt that they carry that's a deterrent to pursuing this. could you tell me if we could go down the table, if we lifted the caps and went to president obama's budget -- nothing more. president obama's budget. what would be the three things each and every one of you could do, and how would it also impact young investigators? dr. collins ok, folks. : there's the challenge. maybe we should just quickly go down the table. : number one is we would accelerate the development of medications for addiction. there are many very potential interesting targets.

but pharmaceutical industry is not investing, the responsibility relies on federal government money predominantly through the nih. so that would be one. the second one would be to have, expand the story to study the human brain. that will inform prevention efforts. the third will make research more accessible to young investigators so we don't lose talent. dr. rodgers: i would just expand upon that. the three areas i would focus on are the young investigators. we know that there are two critical points in which an investigator is likely to stay in research or exit. one is on their first application to get a grant. the second is getting that renewed. and they get that through that second hurdle it's likely that they will be with us a long time. so we would like to encourage

them by making incentives for both the first application as well as the first renewal. the other point i would make is with expanded funds we would be able to allow for expansion of some of our existing clinical studies which are very expensive because of the curtail that we would have to do. and one way to amplify the investment in infrastructures in these clinical trials is by using -- by having ancillary studies of these trials. so i would expand existing trials as well as ancillary studies of these trials. lowy: the question of young people we at nci are in the process of trying to develop new approaches to enhance their ability to move from being graduate students and post doctoral fellows to starting their own laboratories. the areas where we would invest would be in cancer prevention, cancer screening, and cancer treatment using molecular precision medicine approaches,

which have enormous potential in those areas. and i would highlight the potential of immuno therapy as was discussed earlier because of the issue of its potential for improved responses, decreased side effects, and scaleability, as senator blunt mentioned. dr. koroshetz: in terms of research projects, we talked about the brain initiative. it's also the national action plan for alzheimer's disease research. and all of those have milestones. it's all planned out. if we had funding we could really accelerate both of those major projects. in terms of the young people, i think it is incredibly important. the average age of becoming independent with an nih grant is now gunning towards the mid 40's. we have to move that down. i think we have a couple of

things we are playing with to just take a shot at somebody who is really young who really looks bright and just give them a chance much, much earlier in their career. mr. lorsch: so my institute mostly funds fundamental basic research. and the great ideas that lead to the discoveries that dr. collins told you about and basic research don't come from me. as much as my esteemed colleagues, don't come from them. they come from the great brilliant minds in your districts across the country. so we would focus on supporting investigator research to promote these brilliant scientists to do their work. as a measure of that and the success of that, my institute has funded a number of nobel prizes. i would have said 81 yesterday but as of this morning it's 83. i think that's an indication of the power of investigative research. we would certainly have a focus on promoting the careers of the young scientists who will win the nobel prizes of the future.

sen. blunt: i will point out that only senator mikulski gets 50% more time than she is allocated. [laughter] that is totally fine with me. one of the things i did want to do today is get on the records the kinds of things you would do now. strictly speaking to senator mikulski's question, senator asked for the increase. but i'm going to look very carefully that you said you would do if you had the president's number and assume i could multiply that by two. that you get at nih. mr. shelby. sen. shelby: thank you. dr. collins, picking up on what senator blunt says talking about money, funding, is important. say you had $3 billion more above. what could you do with it as far

as investigating and hoping to turn a lot of -- you're just investigating results into better health and better treatment? what would $3 billion -- use that as -- i made it up. [laughter] but i hope we could do something for you. what would it do for you? what would it do for us? dr. collins: for america, for the world. i appreciate the question. it's a lovely thing to contemplate. because as you've heard, we have lost over the last 12 years about 22% of our purchasing power. this would be about a 10% increase. it wouldn't get us back to 2003 but it would be an enormous shot in the arm to a community that has such talent and such energy and is basically being squeezed at the point where a lot of innovation is just not happening. you heard from my colleagues the areas that they would pick and i'm sitting here thinking about the other institute directors, i will mention a couple others that i would want to put on that

short list. vaccines. i mean, we are on the brink of being able to develop a vaccine that would work against all influenza strains. if dr. fauci was here, he would tell you about that. we have a path towards something that would be able to then result in not needing your yearly flu shot that has to be reengineered and sometimes it works sometimes it doesn't. but more importantly, protecting against that worldwide pandemic which is overdue. we aren't pushing that because the resources aren't there. we do see a path to make that happen after 30 very frustrating years but yet we can't do on hiv-aids. the precision medicine initiative, which i think has a lot of bipartisan support which the scientific community after many workshops and working group that debated about this is very jazzed about -- we can't start

that if we have a year-long cr, in answer to senator murray but we could start it and ramp it up much faster if we have this kind of a curve to work with as far as research. and then there's this whole area that we call high risk, high reward research. we just announced a couple days ago the funding that 78 of these new awards, these are pioneer awards, new innovators, new awards transformative awards. these are ones you can't apply unless you have an idea out of the box. but if your idea is exciting we want to see what you can do. give the person the money and let them run with it. many of the institutes are taking that path. but we could go faster and inspire people to be more risk taking if we had that kind of opportunity. put all that together and with $3 billion, let's try it. let's try the experiment and see

how that turns out. i promise you, it would be amazing. sen. shelby: not only health. it would be a good economic investment. dr. collins: you repeat an economic analysis demonstrates the return is about 2.2 fold in the first year to the local community and of course our dollars go out to all 50 states. sen. shelby: i would like to touch on quickly, where are we today as far as cutting-edge research on sistic fibrosis and also a lot of the auto immune diseases such as lupus? dr. collins: thank you again. great question. and great progress being made. i have a personal deep and long-standing interest in cystic fibrosis as my own laboratory , found the cause of that back in 1989 when i was at the university of michigan. and this is a very exciting time for that disorder. because after all those years figuring out how that small glitch in the genome was capable of causing this disease, we now know a great deal about the protein that's normally made and why it doesn't do what it's

supposed to in cystic fibrosis. just in the last few months we have now seen the second drug strategy approved by the f.d.a. for the treatment of more than half of those. based upon a small molecue, a drug that is based upon molecular understanding of the disease. very exciting times indeed. autoimmune diseases -- lupus, rheumatoid arthritis, i want to mention one very exciting public-private partnership, the accelerating medicine's partnership which several have been working to bring together. 10 drug companies within nih work together, and one of the targets is in fact lupus and rheumatoid arthritis trying to figure out -- again i showed that picture about t cells. are they overactive? are they going after normal tissues when they shouldn't? what could we do with the new technologies to understand how single cells are behaving in order to come up with strategies that work better than what we currently have? so all of these areas are just full of potential.

sen. blunt: thank you, senator. senator durbin. sen. durbin: thank you all for being here. let me just say at the outset to address this side of the room for a moment. gathered in this room at this moment in the united states senate are the people, 11 or 12 people who could literally make a difference for generations in medical research. as was noted by senator milkulski, we have the committee in the senate. if we took a bipartisan stand on medical research and said come hell or high water we are not going to tolerate a shutdown, sequestration, cr, we are going to increase the funding for nih and related medical research agencies, we can make a difference. we can just make it clear. don't try to get through the senate if you're going to touch it. and i want to commend the chairman because i bothered, begged, challenged him for a long long time based on dr. collins' admonition to me. give me 5% real growth for 10

years and i will light up the scoreboard. and we've done it in this bill. i might add parenthetically at the expense of some other things that are equally or i should say important as well. but i want to commend the chairman for making this commitment for 7% growth at nih which includes 5% real growth at nih. as you said, and was asked by senator shelby, one time infusion is a good thing. but constancy, predictability, is what leads to researcher commitments and long-term success in what we achieve. i would like to just throw out as a possibility that we rally around one particular person who is up here. for 28 years, barbara mikulski has been the strongest voice for the national institutes of health on capitol hill. and she is leaving soon, unfortunately for all of us. but i hope we can make a promise that we are not going to forget

the commitment of this budget and the commitment of years to come. and in the time i've been in the senate, you don't want to break a promise to barbara mikulski. something you will hear about. [laughter] well said.ki: sen. durbin: so i hope we can be inspired by that. let me try to bring this down to ground level, if i can. i have two questions if i can get to them. the first is when we talk about $2 billion in growth, $2 billion in growth, in this coming year, i need to ask you, when it comes to areas like alzheimer's, we know that we spent $226 billion on alzheimer's treatment, just medicare and medicaid. we estimate that the private contribution of families is almost equal to that in value. so we are talking about one half of 1% of what we are spending as a nation on alzheimer's is the delta, the $2 billion that we are looking for here.

and when it comes to brain research, we now have reached, i think, a point -- and please confirm if i'm right -- where we can start to visualize the development of alzheimer's in the brain and know many years before the obvious onset that a person is moving in that direction. what do you see, dr. collins, or those who are with you, in terms of what we could do if we knew 15 years in advance that alzheimer's was likely to occur? what could we look forward to do soon to delay it or, god willing, find a cure? dr. collins: so i'm just showing you a picture that outlines the statistics. i didn't know you were going to ask the question. you can see what the relative numbers are here in terms of what's currently being spent on alzheimer's disease. this is 2013 numbers. obviously, that number is going up. and we need it to. but comparing that to what we're spending, $203 billion in 2013 and an estimated $1.2 trillion

if nothing gets done. this is a matter of great urgency, not just because of economics of course but the enormous human tragedies. a neurologist can tell you something about where we are on this and why we are optimistic that we can actually get to a place that doesn't result in that enormous blue arrow. dr. koroshetz: thanks, senator. i think you made a really interesting point that for the first time we can actually see what is going on in the brain and people with alzheimer's disease. so in the past, we knew what happened when people died but we couldn't see that happening in the living people. but now we have markers scanning markers for anlloyd and tal, which are the major culprits. we can see that in the brain now of living people. as you said, the anlloyd we can see developing years before that starts to hit in and that seems to be the thing that kills the cells.

so alzheimer's is like the gun, tau is like the bullet. so the vision is that we develop a screening tool for people who are developing the amyloyd know that they are going to develop alzheimer's and then come in with a drug to block that process. in actual fact, those are being tested in clinical trials. so we could get lucky. this looks very, very promising at this point in time. sen. durbin: let me add, because secretary moniz would hope that i would add that this technology which allows us to visualize our department of energy and office of science had a lot to do with it. so when you talk about medical research, the technology side of this equation relies on other agencies. do i have ten seconds? darn it. i will try to be here for the second round. dr. collins: i would like to

quickly say that is a very good point and we have a joint meeting about the brain between the department of energy and nih coming up in two weeks in chicago. sen. blunt: senator alexander. sen. alexander: thanks, mr. chairman. i'm sorry barbara left because i would like for her to know that dr. collins played the guitar and sang at a place senator durbin has been and barbara likes to go, blue bird cafe in nashville. it was quite a show. [laughter] what is that song, "knockout disease"? dr. collins: that was it. i'm surprised you remember. i thought you might have suppressed -- sen. alexander: it's a great hit. i want to thank -- we all admire your work but we admire the work of your team. we know they could be making more money some other place. but the fact that they are here and working to help other people is something we all respect and appreciate. i would ask you, dr. collins, earlier, for the bill that senator murray mentioned. she and i are working on. we are trying to create environments where precision medicine can succeed where we

get discoveries through the process more rapidly. one of the problems we have is that the national academies groups have identified that investigators, these ones that are wanting to get more money for, spend 42% of their time on administrative tasks. now, if we're talking about millions more for investigators, shouldn't with be spending an equal amount of time getting that 42% down so we create more dollars there? there's a new report headed by the former chancellor of the university of texas which makes a number of serious specific recommendations about how to deal with that. one includes a research board that would coordinate an approach toward the spending of the $42 billion we put out. not all that through nih. the colleges and universities. to try to eliminate duplication and make it more efficient. my question is, would you -- a lot of their recommendations have to do with nih.

will you review that report and over the next year set up a up a systematic way to consider making the changes that it makes? and if you have impediments either within the administration or the law that would keep you from doing that, if you let us know we might be able to include them in the legislation senator murray and i are working on. specifically, the research policy board. dr. collins: senator, i appreciate very much the role you played in bringing this important issue to the attention of the academic community and other constituents as well as including the government. sen. alexander: thank you. i'm going to ask you to leave me about two minutes because i have another question i want to ask. dr. collins: we will take with great seriousness this report. we've looked at it in a preliminary way. we will look at it much more deeply. i think we do have a number of ideas and responses i will be glad to share about how to reduce that 42%. sen. alexander: thank you. i want to ask you questions about funding but i don't need the answers today but all of us need the answers in the next few weeks.

the house included something called mandatory funding as well as the discretionary funding. for many of us mandatory funding is the villain. the reason you don't have mun is the reason you don't have money is because that part of the budget has gone up like this and the discretionary side is like this and you're in the discretionary side. so our visceral reaction is against new mandatory funding. but i'm convinced that this is a critical time in science and a critical time of opportunity. so i'm willing to think about that. and i have these questions as i think about that. and these are the questions i would like to talk with you about sometime. what happens at the end of the 5 years that the house proposed? there's a cliff and you lose $2 billion. what happens then? what's the purpose of the mandatory funding? if there's a difference between discretionary funding or mandatory funding you just mix it all up or is there some distinct purpose that would

justify a steadier stream of money toward mandatory funding? and what would that be? should there be a focus for the mandatory funding on preventive medicine, for example, or on precision medicine, for example, or on investigators or -- for example? and what about oversight? we had an embarrassing thing happen at the nih about its manufacturing of sterile drugs recently. if you're not accountable to us for what happens there, then you're not accountable to anybody, really. and that's our job as appropriators. so as a republican, when i read ben bernanke's column that says that the fed can't create a growth economy, it takes education, capital formation, infrastructure, and research and technology, i agree with that. i'm all for more research.

i think we should be doubling energy research rather than subsidizing wind mills and putting money in the pockets of rich investors somewhere for after 22 or 23 years. i think we should be setting priorities. my priorities very well do include your work and dr. moniz's work. but i would like you to think about the questions i ask about that type of funding and maybe one of the days we will have a chance to talk about it. dr. collins: i will certainly do so. sen. blunt: thank you. senator merkley. sen. merkley: thank you very much. and thank you for your team for the vision. the video of the t cells destroying the t cells is -- cancer cells is inspiring. we hope that over the years ahead every possible type of receptor on every possible type of cancer cell, the ability to program t cells to attack them will continue to develop. i think that's the vision that we're anticipating. one of the concerns that i've heard often -- and oregon health

sciences university is a major research partner with nih. a lot of grant funding goes there. is the stranding of young researchers. i believe dr. rodgers mentioned the young investigators, folks who were partway into their career, they've gone through their post graduate work, they're in a laboratory, and then the grants don't come through. and then they have this incredible specialty about some form of nerve communication or chemistry deep within the cell that may be the key but who knows. but about suddenly they're going, what do i do now? does this continue to be a problem? and to what degree should we be deeply concerned about the loss of this? we expend a huge amount of resources to develop that talent and then suddenly its ability to be applied is cut short. dr. collins: i think we should be deeply concerned. we do put a great deal of

resources into the training of this generation of young scientists. the talents and the skills that they possess are incredibly impressive. and yet if you, as i often do, go and visit universities across this country and meet with graduate students, post-doctoral fellows, it used to be when i made those visits they want to tell me about the science they're doing. now they want to tell me about their anxiety about whether there's a career path for them or not or whether they ought to be doing something else. and some of them have decided to do other things or have gone to other countries where biomedical research continues to grow. even as ours has been shrinking. every institute at nih thinks about this, worries about this and we sit around and try to figure out strategies. chybe i will ask dr. lors

because his institute is deeply involved in our training programs. although i will tell you, there's no magic here without seeing some relief from the budget squeeze in terms of what we can do. we can try to make every dollar count. sen. merkley: thank you. i will ask you to be very brief. mr. lorsch: sure. we are starting a new pilot program to explore a new grant mechanism that would be a single grant per researcher. i would address some of senator alexander's issues. but it would be more stable for investigators because it would be a single grant. that would, as dr. rodgers alluded to, help carry them through that sort of valley of death after that first grant when it's very hard. that's something we're focusing on. sen. merkley: thank you. i want to go back to where i started in terms of the receptors and the t-cells. early in the dna world that you were centrally positioned in, it took an enormous amount of time to do sequenving. now, that probably, i don't

know, 1/10,000 of the time. do you see a similar curve in terms of the time and effort to identify key receptors and be able to read -- to identify t cells? dr. collins: you can now get yours sequenced in a day or less. in terms of looking at proteins, they are encoded by genes, so we have a connection there were we can take full advantage of what we have learned through the last several decades. we have a good senses of what are the proteins on the surface of various cells including cancer. the trick is that every cancer is a little different and that's where the precision medicine fits in. i think that's at the cutting-edge of trying to bring immunology and genomics and cancer biology together is to figure out how to make that strategy work not in a one-size-fits-all because it won't work that way but in a precision individualized way. shifting topics

completely in the last 30 seconds here, e-cigarettes -- we have seen a tremendous growth and there have been studies at nih about high school students tripling their use in a single year and so forth. what do you see as the role of nih in terms of this new form of tobacco and tobacco addiction? dr. lowy: thank you, senator. the nih is concerned about tobacco consumption because it has such an impact on disease. in addition, the issue of the e-cigarettes where we do not know with the short-term or long-term impact is from the cigarettes themselves nor do we know what the implications are for behavior. therefore, the nih in conjunction with the fda is conducting research to investigate these critically important areas. sen. merkley: thank you very

much. sen. blunt: thank you, senator. senator cassidy. doctors. dy: hey, as a practicing physician, i am so aware of your good work and i think we should double your budget. i understand the impact it would have upon my patients. when i did my residency in 1983 in los angeles, i am very aware of what is formally a death sentence is something you live with. dr. collins, i have been concerned that 20 years ago it was suggested that nih rebalance its hiv spending from the 10% it had become to diseases like alzheimer's/dementia which are more important now. if you receive the 7% increase the chair and ranking member aspire for, we all do, will 10% of that budget continue to go to hiv research? dr. collins: senator, you and i

have discussed this on occasion and i think you raise a good point about whether it makes sense to have a formula driven way in which we define how resources are to be spent or should we focus that entirely on what the public health needs are and the scientific opportunities, the things that nih usually does. i do not think that if we had the good fortune to receive this kind of increase that there should be a lockstep 10% formula driven basis upon which we would define the hiv-aids research budget. i think we should not take our foot off the accelerator at a time when hiv-aids is poised for some major advances including the potential development of a vaccine. i think we should step away from the formula. sen. cassidy: i don't mean to interrupt, i just have limited time. in your directive, i don't have it in front of me, but you mention among the focal points in terms of the hiv research

would be an emphasis on comorbidities. one way for young researchers not having dollars, this is a concern for me. we pull the minutes from the 2013 national institute of heart, lung, blood and they speak about how the success rate of application, non-aids applications are 10% but for aids applications, 42% meaning that it took a less quality project to be approved and they hope to encourage more submissions of a project -- of aids projects. then i see that the project currently being done is looking at the comorbidities. i think we found out that the 610,000 people die every year from heart disease, only roughly 1800 have hiv as determinitive cause. we spend 21% of their budget. we are spending 21% of a budget for .29% of those who die from hiv.

if we are going to focus on co-morbidities, spending 21% of a budget on .29%, it seems like we're going in the wrong direction. what are your thoughts? dr. collins: i am not totally familiar with the numbers but i will certainly look at those. we are in the process of trying to right size the way in which our hiv research budget is being allocated. the office of aids research has the potential to move dollars around between institutes and between programs. sen. cassidy: can we move it out of hiv? for example, i have a study here, there is $1 million to have chinese men having sex with chinese men in china. $1 million over the last four years. it would have been great to put that to alzheimer's in oregon. the guy where merkley's

researcher -- one of your predecessors said we are not the international institute of health, we are the national institute of health. why are we spending this on china? dr. collins: again, we have now identified the 4 areas of high priority and i don't think that study would fit those rarities. -- those priorities. sen. cassidy: i guess my question -- you mentioned the office of aids research moving dollars between institutes but if this is the kind of study -- if the national heart lung is 42% approval rate for the hiv-aids study, frankly, they are getting too much money for hiv-aids. they have to find people to apply for something that is 21% of the budget. can we move money out of that area into other diseases like new regenerative diseases -- alzheimer's, parkinson's, als? dr. collins: i agree we should be making decisions across nih on the basis of public health

needs and scientific priorities. i would say there are scientific priorities emerging in hiv i would not want to see neglected particularly the opportunity to end this epidemic and the investment in the vaccine which is likely to be quite expensive. taking your point, i don't think in the process of rethinking this portfolio, which we do actively now, we should not neglect the potential of investing in different ways in hiv-aids that will bring an end to this epidemic. sen. cassidy: there is something else i read -- i have read so much about this. if you decide to focus exclusively on the cure of one disease, and inevitably, you ignore other more pressing needs . we are spending $600 million right now on aids vaccines domestically. i think $24 million on the international aids vaccine initiative. not that we cannot spend more but to justify 10% of the budget on the basis on that looks like it will neglect other diseases. i yield back. sen. blunt: