very inconvenient, especially for an older person or very sick person. and that is my comment. back to that upshot column, that made the front page of the new york times about the relationship between income inels in life expectancy this country, there is the map the goes along with that story. theng that according to

data published from the journal of the american medical association, trying to understand what this data might a simple thatbe wealth buys higher quality medical care which allows people to live into old age, but a long line of evidence including the new work suggests it is less obvious than it might seem. less.ercise more, smoke people who are healthy are better able to hold down a demanding job and still have higher income. a new paper finds little correlation between regions bending rates for the portion of the population with health insurance and how long it's poor citizens live. you can see the traffic along with that, talking about the best and worst places for the poor to live in this country,

some of the cities that are highlighted and have the longest life expectancy for portman -- for poor men. cities with the longest life expectancy for poor women. the story is also noting the cities with the shortest life expected -- like expectations for men and women among the cities that are mentioned there, indianapolis, detroit, louisville, kentucky. oklahoma city, tulsa, honolulu and detroit. you can see that upshot column in the new york times. we're getting your concerns on public health. mary in virginia, good morning. caller: good morning. is account --ern

my health concern is accountability and compliance. to leadon't seem themselves-- blame if they are not compliant with her antibiotic and cause a superbug or if they have a chronic condition, and are not compliant with her medication or a healthy lifestyle, this just adds to the chronic condition. are you in the public health field? how were you involved in these issues? caller: i am a nurse. that isat do you see evidence of what you are talking about? we get a lot of copd

patients who continue to smoke. we have a lot of chs patients who are not compliant with food , as well as diet, exercise, diabetic patients who .re uncontrolled they do not control their blood sugar at home or check it regularly. they do not eat a healthy diet or exercise. and get hospitalized dependent on health care to fix it is alems, when behavioral modification that could prevent these hospitalizations. host: as a nurse, what do you find is the best way to try to make those modification? what works? believe that smoking

cessation is a very important modification, as well as healthy diet and exercise. caller: drinkwater, plenty of hydration. when you are ill and prescribed medication be compliant with it. if you have an antibiotic, finish it out as you are supposed to. if you're given a pain medication, take according to the directions. medicatein to over medica . if you have a headache, take a tylenol instead. host: how long have you been a nurse? caller: five years. host: is it frustrating at times? caller: sometimes it can be

frustrating. thatatient satisfaction someone else i pointed out earlier has become a little bit of an issue i -- as far as educating patients in pointing whenheir own compliance they don't want you to hold themselves accountable. sometimes if you don't tell people what they want to hear they're not satisfied. host: i appreciate the call. justin is waiting in california. he is next. good morning. caller: how's it going? host: good. go ahead. caller: i want to point out the america, i see all of these documentaries in mainstream media coming out and pointing out the epidemic of heroin and opium use yet on the

contrary our troops are in afghanistan where 90% of the heroin comes from our opioids. mainstream media never makes the connection between the two. i think it is the irresponsibility of modern-day journalism that they don't point out the two points. host: what is the connection they need to make? example, my family was watching a documentary last weekend on it locally. the heroin addiction and yet they are like, how do we find out where this epidemic is coming from and yet our troops are in a place where 90% of the heroin comes from but they never make the connection. i think that is unfair and unjust on their part as journalists. fresnohat is just and in

-- that is just and in california. a few articles to point out. secretary of state john kerry is set to make history with his hiroshima visit while in japan on monday. secretary kerry will become the highest-ranking u.s. official to attend a memorial service at the hiroshima peace park ground zero for the first -- were the first of two atomic arms dropped on japan by the united states at the end of world war ii. that for noting decades top u.s. officials avoided going to hiroshima because of the sensitive issue. then u.s. ambassador john boost was the first u.s. envoy to attend memorial service in 2010. caroline kennedy attended in 2014 and 2015. to the new york times story obama first lady michelle cost speaking schedule the spring, commencement speeches. give three commencement

speeches this spring including jackson state university, santa fe indian school and the city college of new york. the story noting that the jackson state university speech which is historically black university will be april 23. for most of her time in the white house mrs. obama made a point of addressing at least one historically black university or college each year. if you want to read more about her speeches and what she is expected to say, that story is in the new york times, the white house letter column. the front page of the usa today this morning, president obama making appearance on fox news sunday. in that appearance defending hillary clinton over her private e-mail server and her private e-mail address issue. here is a clip from fox news sunday yesterday. [video clip] >> as you know there have been investigations, hearings, congress is looking at this. i have not been sorting through each aspect of this. here's what i know.

hillary clinton was an outstanding secretary of state. she would never intentionally put america in any kind of jeopardy. why also know, because i handle a lot of classified information, is that there is classified and there is classified. there is stuff that is really top-secret and stuff that is being presented to the president or the secretary of state as -- that you might not want going out over the wire but is basically stuff that you could get -- >> last october you are prepared to say she had not jeopardized. can you still say that? >> i continue to believe that she has not jeopardized america possible national security. what i have also said is, and she has a knowledge -- she has acknowledged, there is a carelessness in terms of managing e-mails that she has

owned and recognizes. i also think it is important to keep this in perspective. this is somebody who has served her country for four years a secretary of state and did an outstanding job and no one has suggested that in some ways as a consequence of how she has handled e-mails that that detracted from her excellent ability to carry out her duties. host: president obama yesterday on fox news sunday. we have about 10 minutes left in this segment of the washington journal. phones are open to hear about .our top public health concerns why is it important to you? if you are in eastern or central .ime zones it is (202) 748-8000 not in a specific, (202) 748-8001 -- mountain and .pecifi pacific (202) 748-8001

runaway health-care and corrupting the united states. amy says my health concern is cost. my insurance premiums which are deducted from my paycheck each s have gone up 800% obamacare. don ritchie writes i am about the water and air quality. the flood situation makes me worried that there are more similar problems elsewhere in this country. some of those folks are followers on twitter. tweet about this program. you can join in the conversation . sean in lakeland, florida. good morning. caller: good morning. is layered but it starts off with -- why is health care a for-profit business in the first place?

that kind of is the reason why everyone is talking about my insurance went up, blame obamacare. where the countries health care is actually free, those countries -- health care nonprofits. once you make health care profit, -- if it was nonprofit we were not the biggest crooks in america, insurance companies. health insurance would not exist . when you talk about getting rid of the whole industry that makes billions of dollars a year. you see a big problem. some people are not going to like that. health care is for-profit. -- ife going to look out it comes to a profitability of actually healing someone, why would you even heal someone? it would cost you money to heal

somebody then it would for you to put a patch on it and have them come back to you next week and put another patch on. host: you're saying the incentives are all off in our health care system in this country. .aller: superduper messed up it will never get right if we keep going. they have to kill the whole system as far as those. on top of that, as a black man, with a son, my number one health concern is gun violence. that is a killer of him. if you took the top 10 and added them all up, guns is number one. two through nine were not come to number 10. those are my health concerns. i see nobody politically trying to address any of this. obama tried to do something with obamacare but people, now they have something to tag it to. my insurance went up, because obamacare.

your insurance was going up before obamacare. now you have a point to reference it. ton reagan was in office when obama got an office i guarantee your insurance went up more than since obama has been in office. host: do you have any optimism that any of the presidential candidates right

did not see outbreaks of it until 2007 and we have never seen an outbreak like what is going on now. we did not realize until this year or late 2015 that this

virus appears to be linked to birth defects. that's really why it's getting so much attention. in terms of the teenage population, that is a great question. the one virus that is similar to zika in terms of being a common virus that causes fever and rash but occasionally can cause birth defects is rebel a or german measles. the way we have prevented german isasles or rubella through vaccination. initially vaccination -- now we routinely vaccinate babies at 12 months of life and a second dose at four to five years. it is possible that the vaccine that gets developed against the zika virus would end up given to teenagers before they are in that reproductive age. we have to get a vaccine and it has to work first. if we get an effective vaccine it will be recommended for

travelers. it might be used widespread in regions of puerto rico where the virus can circulate. host: your area of expertise was immunizations, vaccinations. what do you say to folks who are concerned that we over vaccinate our children in this country? that ongoing discussion that seems to crop up every few months or years. guest: it is important for parents to ask questions and make sure they are comfortable with the care their children are getting. vaccines save lives. before we were using the childhood vaccines we had thousands and thousands of deaths a year. the last 20 years of vaccinating children in america has prevented about three quarters of one million deaths vaccine preventable disease it -- preventable diseases and saved about $1.4 trillion. as a physician and public health expert i recommend acceding your children. -- vaccinating your children. host: a new vaccine mandate.

do you think that will happen? guest: the outbreak of measles associated with disney sparked a new dialogue in this country. we saw a change in the conversation in many states. some states have been pushing to loosen up the requirements for measles vaccinations in schools. what we saw after the measles outbreak was an outpouring of concern for the innocent bystanders. a child with leukemia who could not get a measles vaccine who relied on the other kids around them to protect them. i think we will continue to have that discussion and dialogue over the years. i can tell you vaccines are saving lives in the united states and around the world. host: clara is up next in murphysboro, tennessee. good morning. caller: good morning. you just said you think all children should be vaccinated so that kind of brings me to my question. what arm of the government do by?fall under or are funded

with the illegal immigrant assume, i'm going to quite a few of those people don't have immunizations. how concerned should we be about zika andal population, other diseases? what the government ever step in to stop you from reporting on something? i would like your opinion on illegal immigration and how it affects the health of the population. .uest: thank you the centers for disease control and part of the department of health and human services in the executive branch. the thing about infectious diseases is they know no borders. it is important to protect americans. supports immunization efforts here in the u.s. and

works closely with other countries and with the world health organization on global immunization efforts. ,t is because latin america through the pan-american health organization, was able to control and eliminate measles and rubella, that we stop having measles problems in the u.s. it is very important that people's infectious diseases be addressed around the world because diseases -- we saw that with ebola. the way to keep americans protected against ebola was to tackle the virus where it was spreading in west africa. host: questions about illegal immigrants without immunizations that are required in the united states. guest: the way immunizations are given to children is really about that community protection. so clinicians do not ask for citizenship documentation before they give a vaccine.

it is about protecting the child and the people around them. host: she wanted to know what the government stepped in to keep you from reporting on some sort of public health issue. is there a firewall? guest: it is in that public health issues that are contagious be reported and there are ways for that information to be protected. host: how so? guest: in terms of health information being separate from other sources. are cdc gets diseases that nationally notified we are getting the event has occurred. host: let's go to hyattsville, maryland where jay is waiting. caller: thank you for taking my call. are you familiar with dr. julian micha mitch? guest: i'm not. in nih a lead biologist

up here in bethesda. currently a whistleblower and she is saying that there is overwhelming data to prove -- i have two questions. she says she has overwhelming vaccines cause autism. -- directly associated with causing autism. guest: as you know autism is a difficult problem for children, adults and families all over the country. research into what the causes are and how best to intervene. one thing that has been looked at extensively is the question of vaccines and autism. it was a reasonable question based on the age autism finds and symptoms presented. a dozen good studies looking at that and there is not a link. as a doctor, a public health expert, as an american, i can

tell you that vaccines are not the cause of autism but it is important that we get to the bottom of autism. we know vaccines prevent very serious conditions that can harm children. we recommend them strongly. it is important that we have a safe vaccines and we monitor their affect carefully. host: did you have a follow-up? caller: i incurred all the listeners to go to cdc truth.org . my second question is, recently bobby kennedy acknowledged the tists -- the mmr vaccine is affecting black and latino youth. guest: thank you for the comment. i'm not familiar with that issue but what i can tell you is the measles, mumps, rubella vaccine is used widely around the world.

we are seeing huge progress in measles prevention, mainly in africa and asia. we still have about 20 million measles cases around the world every year and we need to tackle that because measles does cause death. you think about 150,000 deaths in children around the world, we have our work to do. host: about 10 minutes left with dr. anne schuchat of the cdc. principal deputy director there. we will be talking about other cdc issues for the rest of our program as well so if you don't get your call in at this segment we will have other cdc officials here on our program. don is waiting in powell, tennessee for you. caller: i have two things. i am a chronic pain patient. i went in for a minor back surgery. the doctor has got me confused or something.

cut from my butt to my bra strap. my regular doctor sent me to this pain clinic. i can barely walk to the bathroom to be honest with you. i am on pain medicine. when they sent me over to this pain clinic, now i am the mother of what tro children. i am 42 years ash of four children. i am 42 years old and everyone looks at me like i'm a drug addict. when i take my prescription to the pharmacy everybody looks at me like i'm a drug addict. i would like to know -- you said exercise does wonders. if you can't walk, how are you going to do exercise? the injections don't help. what are you supposed to do? you go and you take your medicine like you are supposed to and you won't die.

the people out here getting this medicine and selling it on the streets, those are the people killing the other people. why does the chronic pain patient have to suffer for what these people -- they need to be a better system. going into these pain clinics. i did not like the idea of going into one because all of them have at that name. -- a bad name. i hate to be associated with it because i am a mother and i need help to take care of my children. that makes me cry. host: i want to give anne schuchat at chance to respond. guest: thank you for your comments and i'm sorry about the difficulties you are going through. you mention a couple of really important points. you talked about training for the clinicians. we think that is important. most doctors do not get great

training on pain management. it is not a big subject and we want to reverse that. there are a range of ways to try to adequately address pain. the cdc guidelines on prescribing, we are not about postsurgical pain or about cancer pain or end-of-life or pallet of care. they were about chronic pain, long-term over several months. i think the challenges you are going through with the changes in care are difficult and i really am sorry about that. we would like to address this at the system just as you described. host: what is the cdc doing on the statement issues she talked about? it is something a couple of our viewers have brought up this morning. it is a is a -- guest: huge issue. the surgeon general wants to take that up in a big way. a lot of diseases used to be stigmatized and we realized they are not. it's not an issue of blaming the

patient. we need to tackle them as a disease. the issue of addiction is widespread. something that can be managed. we are trying to take that on as a government in a more holistic way, working with a lot of the health care professional organizations. i would say look to the surgeon general will be putting out a report about addiction in the future. host: what is his relationship to the cdc? guest: as surgeon general he is the leader for the entire commission core of the u.s. public health service. he is a key partner for the cdc. as tom frieden leads the cdc the independent leader for us. host: let's go to richard in wisconsin. good morning. caller: hi. , now we areis hearing about this zika virus and i'm wondering what has

caused this? 20 years ago or so we never heard of such a thing. what has brought this on? if anybody knows. guest: that is a great question. i can tell you what we are thinking. we know this virus has been around for decades and there have been individual cases on small outbreaks in the pacific. it is when the virus arrived in brazil that we saw this huge spread of the mosquito borne virus. we think the population density in brazil and some of the parts of northeastern brazil was more concentrated. bite five to can 10 people in one blood meal and spread the virus to many people. it may be that where this virus was present through the mosquito populations until 2015 was either rural or not so concentrated population.

mosquitoes and people were not living as close proximity. we know in today's world travel and trade, disease could be on one part of the globe one day and the next part of the next they only at the other end of earth really. we think once the virus made it into south america it spread rapidly. -- the mosquito's resident throughout central, south america and the southern u.s. we are dealing with this challenge. it could be that the virus was causing disease including birth affects in africa or asia before and we had not recognized it. we think the numbers in brazil were so large that it came to clinical recognition. host: a question on a different disease. why has there been a spike in the number of tb cases in the united states? we had it contained at one point. guest: we don't actually have a spike nationally but we have what we are calling a plateau.

host: what's the meaning of that? guest: it is flattening instead of continuing to go down. that renewed in tent evaluation around cases is going to be important. the large part of the tb in the u.s. is occurring in people who were born in other countries and they are moving here and it reactivates later in life. the best way to tackle the tb problem in the u.s. is to do a better job around the world. we know it is possible to have effective tb control. we think other governments in investing in a better job at we have lowers. rates than 20 years ago but they are not as low as we would like. host: terry you are next. caller: i was wondering, if we have known about the gussets

1947 and there was an outbreak start7, why didn't we working on a vaccine in 2007? if we had developed a vaccine back then we would not have the problems we are seeing today that are so severe. guest: that is a great question. when the virus was recognized in 1947 it was just in a monkey i was being used to see if there was yellow fever in the area. in 2007 with that first outbreak cdc did go and help investigate the outbreak and we developed a lab test at the time because of that outbreak. the disease was considered sort of a nuisance. it cost fever, rash, mild illness. no severe competitions recognized. it was not a priority for vaccine development. now it is a big priority for vaccine development. i think i got the same question about the ebola. it has been known since 1976, why didn't we have a vaccine

when we got into that epidemic in 2014 and 2015? leaders around the world are really stepping back and looking at how can we do better at prioritizing diseases of epidemic potential for vaccine development so we could potentially have a short list of vaccines that might be useful in the future and get working on them? how can we use lexical technology, platform -- flexible technology, that form technology, where it will be a speedier time to develop a vaccine when we realize we need one? the movies suggest that you can develop a vaccine overnight but they actually do take time. we would like to get the timeline down as short as possible. host: mike in north carolina. caller: i wanted to make another comment in regards on the basis of the lady that called with the back injury. i suffer from a severe injury as accident.f an

agricultural farm accident. .evere nerve pain sometimes a could be like being stung all over by bees and the only way in the world to call me at -- two calm it is through medications and so forth. it is getting now to where people suffer from severe pain and all of that are being scrutinized to the point that they are being drug all over the place and having to pay visits to pain clinics even though they and all that, even though they are having an ongoing condition and it is pretty sad that the people out here that are suffering from longtime injuries and cancers and stuff like that are having to suffer simply they cannot seem to come up with a way to scrutinize patients.

that do not have a history that indicates they should have thing they have. difficultt extremely for middle-age and upper middle-age people to get medications. they pay an problem is really a challenge paradigm side for the suffering you are going through. we need to be cap all starting people and pain medication. time that is all of our with the principal director at the cdc. somell continue to talk to of your colleagues down in atlanta, georgia. up next, we will be joined by dr. beth bell for emerging and synodic infectious diseases --

zoonotic infectious diseases. opiate usea look at and heroine prevention. ♪ >> tonight, tom wheeler in his c-spannterview with since be nominated by president obama in 2013. he about net neutrality, expansion of the lifeline phone program, the internet, regulation of the internet and discussesnd he also the future of telecom and internet.

he is joined by technology reporter for the washington post. was fortunate enough to be able to do in the cable ,ndustry was to be involved they were bringing great change to the american economy and the way people live their life. that is what we are dealing with with the fcc. in a great revelation of all time. the job with the fcc is to say ok, how do we deal with the changes happening as a result of the technology? >> watch the committee caters tonight. >> washington journal continues. host: we head to atlanta to dr. beth bell, director of the national center for emerging and zoo not ache infected -- diseases.nfectious

one thing about microbes is that they are constantly changing and as they change, they present new challenges for people's health. that is what emerging infectious diseases are all about. there are a lot of current diseases on our mind including zika and ebola. are also serious infectious diseases caused by antibiotic resistance. important most threats of our time. really modern medicine is at risk. we assume we can treat infections when we are treating cancer patients, when we're doing organs transplantation, and antibiotic resistance really threaten any advancements over the last decade.

examples.some is no more than a plane ride away from any other country. we need to be aware and prepared and respond detect quickly to emerging and infectious diseases. go ahead. i was just going to say zoonotic , a funnys diseases word, but it is connected to the word is due -- word zoo. diseases transmitted from animals to people. many emerging infectious diseases are also zoonotic infectious diseases. ebola, which we think is transmitted probably from that is an example of the zoonotic infectious disease but foodborne diseases are also zoonotic.

oftentimes infections in food animals are transmitted to people. we are always discovering new ones. we generally discover at least one new infection every year. it is our job to stand top of all of these microbes so we can protect americans and people around the world from infectious disease threats. how the center fits into the cdc to overall, the budget requests, just under $7 billion. that 629r with in million dollars. dr. beth bell, how much of that -- spent onnt things like ebola and zika and things likespent on antibiotic resistance and other

things you are talking about? are fortunate that this year, and the president's fy 16 budget, there was a request for $240 million to fight antibiotic resistance. particularly to our center, 100 $50 million for cdc's antibiotic solutions initiative aired this provides us with an enormous opportunity to really start to get ahead of antibiotic resistant microbes, to prevent, and also too much more rapidly detect and respond. we will be using this $160 million in a number of different ways to build up programs in states. level at ccf the federal but really, the local and state health departments and localities is where the rubber meets the road. if we are going to successfully fight any of these emerging or antibiotic resistant threats, we

strong detection to prevent capabilities. a large part of the $160 million in fy 16 would go to state and local health departments. also so we can do a better job of understanding how these organisms move around communities and around the country. clusters andect respond quickly. we are interested in doing a better job, using the right eye at -- antibiotic at the right dose at the right time for the right infection. we know one of the major drivers of antibiotic resistance is overuse. programic stewardship that promote the idea of using the right antibiotic in the

right way or another important component of antibiotic solutions initiative. these microbes are always changing. they are always evolving. have prevention strategies in place to prevent these infections in the first place. host: if you want to ask dr. bell, our lines our -- our split of regionally -- split upnes are regionally. -- marcia called from pennsylvania. good morning. caller: i would like to find dr. to adjust the monsanto spray it used to control the mosquito population. nom everything i have read,

stuff latest connected with the zika virus and then they took --ank and science frankenscience to a whole new level. don't you find this frightening? guest: mosquito borne infections are really serious public health problems. have yellow fever, and now we have seek up. we arere many ways looking to control these mosquito borne infections. zika is actually a good example of an emerging infection in that while we first became aware of zika many years ago in 1947, we really did not see much in the way of problems with zika, just

occasional occasions there until now break was elected in 2007. in polynesiatbreak in 2013 and 2014. now, we have seen zika spread throughout latin america since last may. this is an example of how the infections can change and be unaffected in the scenario -- severity with which they manifest themselves. are so terribly concerned about the linkage between the zika virus and other adverse birth outcomes. there are certainly a lot of ways we have been working with our partners in the health organization to control zika, including many ways to protect

-- and to use well studied and it's --ious mess methods. host: researchers create mosquito as a weapon to fight, genetically programmed male mosquitoes these offsprings for adulthood. this is one of several new and innovative methods that are being researched by various -- to be to pity potentially better modality to zikat these mosquitoes, and many of these other infections. genetically modified mosquitoes is one of those and actually, there is an application now with geneticallythese

modified mosquitoes in the county and florida, is that environmental assessment open for public comment now? all of us would encourage people to comment if we had opinions on the sus -- on the subject. there are a number of these innovative strategies and none of them are really ready for prime time at this moment. that is why exploring the modalities, we are focusing on scaling up some of the tried and true strategies to fight the canal. let's go to new york where joe is waiting period caller: -- isting period caller: -- joe waiting. caller: ddt was just coming on board. millions were being killed through malaria. much pain and suffering. we were saving a lot of lives,

by the millions, with ddt. then in the 60's, the environmentalist, i think rachel carson was renamed. guest: i don't know her but i believe you are right. caller: she is one of the extreme environmentalists and ddt became banned and all the sudden the mosquito population expanded, exploded, and then malaria came back in again. cdc's's policy? i understand the doctor before you said the cdc banned ddt. i know the organizations are trying to get it back into the good graces. where does the cdc stand on using ddt to eliminate these terrible -- what was the mosquito that caused malaria? a number of mosquitoes caused malaria. it is a good question.

i appreciate your understanding of the history. involved, as i say, with using the current tools while at the same time exploring other options. question of mosquito control is actually quite complicated. there is a related issue of resistance to pesticides, another important concern we in fighting the mosquito which carries it zika. are quitelike you educated on the subject. you probably know there are many other insecticides that are currently being used to fight malaria and using many different modalities. for example, bed nets and other strategies. i think we open to considering any option. that is what we are doing.

i will say in terms of a factual statement, the cdc is not involved with regulating pesticides. that is the job of the environmental protection agency. certainly, promoting and supporting and looking at all kinds of novel strategies for mosquito control. host: reston, virginia, lisa is waiting period -- waiting. caller: thank you for taking my call. cleanrlines are trying to planes between passenger lines. specifically at all of the hand sanitizers were alcohol-based and would do nothing to stop us from spread -- spreading the virus or protecting anyone else.

all the antibacterial prevention methods would not work and thus a plane could read this very easily. guest: a tough microbe, it is very hearty in the environment .nd only takes a small number responsible for some of the outbreaks of gastroenteritis that we hear about that have been on cruise strips that are -- cruise ships and sometimes they have to shut down and completely decontaminate themselves. hand sanitizers and many of the antibacterial and antiviral agents will help. uses a very good idea to hand sanitizer.

in any of these kinds of environments. it is not going to ensure that will bevirus transmitted, but some of the business strategies, washing hands and using hand sanitizer, washing your hands after you go to the bathroom, are really the .ost important strategy much intbreaks we hear the news, are there more of them in this day and age or are we just better at getting headlines? we are making progress. there is less foodborne illness then there was 15 years ago. , we are doingght a much better job of protecting -- detecting foodborne outbreaks and we're seeing more multistate than we did before probably because of the way our food was supplied

internationally and distributed around the country. much better job of detecting foodborne outbreaks and some of that is because of the way we are able to supply cutting edge sequencing methods that allow us to really get a precise genetic fingerprint of a desk each of these microbes and detect very quickly. ofre is a network laboratories around the country called pulse that, in every state health department and another laboratory around the country and the world. using this network, all of the laboratories use the same method genetic fingerprint on each of the bacteria is that cause food worn illness. database has a shared

and we every week are monitoring summer between 40 and 60 potential clusters based on the genetic fingerprinting tech week that we think could turn into outbreak. we are getting much better at soecting outbreaks faster that we actually prevent a lot of disease. host: about my five minutes or so, we take your questions and comments are we will put the numbers on your screen for you and go to dr. bob waiting in illinois. good morning. caller: good morning. i was curious about all of the variety of skills we have been talking about this morning. is there a commonality about where they lie in the food chain? host: what kind of doctor are

you? , didr: a medical scientist original cancer research, worked on melanoma back at nyu and a lot of different things in terms worked in -- which i am sure the doctor is familiar with. mosquito we are focusing on in terms of zika is a mosquito called -- the causeso that carries -- transmission of yellow fever in addition to zika. particularly difficult mosquito to control because it is very adapted to living among humans. basically, humans -- carrying west nile -- exquisitely adapted

to biting humans and transmitting infections among them. in houses and bite during the day and at night. extremely small amounts of water, so there are many breeding sites around human habitation and they could write more than one human in the context of one blood meal. particularly well adapted to spreading disease among humans. that is one of the reasons it is so difficult to control over the years. dr. bob, do you have a follow-up? caller: not at the moment but thank you very much. atlanta,los in georgia, where the cdc is. good morning. caller: i have a question.

i want to know, last year, a tuberculosis outbreak in andnta, the cdc got behind said there was a follow-up a few days before. they believe they are a political organization. what happened -- they wanted the land because they were selling private real estate. straight out lie in order for a wealthy man to get land. all these stories about how great around the country in the world, just not true. he wants that land. do you want to respond? guest: i'm not familiar with the

story he is talking about. tv continues to be a problem here in the united dates and around the world. sorry that the caller had a bad experience and has those kinds of suspicions about public health. but i'm not familiar with that particular situation. say at the cdc, we will .aser focus sadly, there are many people around the country and around lovedrld who have lost ones because of infectious diseases, antibiotic resistant organisms, who are currently in fear of getting a zika

infection if they're pregnant who sadly have had a b's born with microcephaly who have lost fetuses because of microcephaly's. unfortunately, infectious diseases continue to take a toll here in the united states and the world. this is what we're focused on at the cdc. i have actually dedicated several decades of my life to try to improve the situation. i have been with the cdc for 24 years now. not an say it is .ccident with gray hair we are really working 24/7 to protect americans. progress but at the very beginning of the program, the microbes are always changing

and there is always a new threat we have to respond to. baltimore, maryland, you are on with dr. bell. caller: i blunt to africans against malaria. we found that ddt was 100% andctive against monopolies mosquito. i understand it is principally transmitted -- i am wondering why there is such resistance to advertising it is at about 10% of the way we used to apply it. could wipe out all of the mosquitoes within three months. we did it in one area in africa. yes, i think there is a

lot of history about ddt both in terms of its effectiveness and in terms of its limitation. i think the important thing to remember here is we are most likely going to need a multi-strategy to fight infections including zika and malaria. we have made a lot of progress and are continuing to work toward fighting new strategies, perhaps re-energizing older strategies in order to make further progress in order to fight mosquito borne infections. that how far along is strategy specifically with ddt? guest: i am sorry but i really don't know the answer to the question. it is not something i'm intimately involved with and i do not have the most up-to-date

information. host: georgia where david is waiting. good morning. caller: thank you for c-span. this is a great segment. , kind of off subject, contaminantent outbreaks, i am wondering if there is some staffing problems understaffing, or are there problems with safety protocol, going over and being enforced correctly? in what specific area? when you talk about outbreaks, what outbreak are you talking about? caller: it wasn't really outbreaks, but failures in some toxic stuff going on there. the couple of different stories

in the last year or so. i'm 50 miles south of atlanta. it is a concern to me and my community. a vile cut out of place and was placed in the wrong area. some infectious stuff. the protocol is not handled correctly. guest: you know, laboratory is our highest priority here at cdc. we take the question extremely seriously and we are always to improve our laboratory safety. we have a large number of laboratories here. we have been working extremely hard to improve laboratory safety.

we have had a number of different external groups come in and give us advice. we have responded and implemented the suggestions that many of the experts provided to toand we are continuing improve the situation. we really take this extremely and we are looking at this as our top priority. karen in alexandria, virginia. good morning. i have been diagnosed .ith an emerging pathogen and they cannot seem to get rid of it. i am wondering if you are familiar with that. host: what did you say was the name? caller: [indiscernible] host: dr. bell, something you are familiar with? not sounding very

familiar to me but i do know how difficult it is for people who are sick and get diagnosed with something not very well understood. it can be quite confusing and it sometimes can take quite a bit of time to sort out. i certainly recognize it is an extremely difficult situation. i cannot say that specific pathogen your mentioning is sounding at all familiar to me. host: antibiotic resistance is a you are of the things involved with at the cdc. drugs will be obsolete soon because of the emerging problem? guest: where is your top concern here? , there are a number of bacteria resistant to most antibiotics. cree is one kind called which is what we have often --

often times referred to as a nightmare bacteria. it is developing resistance to almost all antibiotics. one of the things we are most -- isned about is the carried by multigene elements. that means this resistance, the tolity to be resistant antibiotics can spread from one sort of bacteria to another and cause a whole new type or family of bacteria to develop resistance. this cre is something we have seen spreading throughout the country. it is one of our top threats that we are focused on and one of the reasons that we feel it is so important for communities to improve their ability to

detect so they can quickly detect cre and stop it from before we get large with infections that, as i say, we're kind of losing our ability to treat the current antibiotics. host: let's go to georgia were mike is waiting period caller: -- waiting. how come we blame so many of those diseases on monkeys, especially monkeys from africa? cows, and my, mad other question is how much of this is really medical? guest: zoonotic infectious diseases are spread from animals to humans. there are a lot of those. primates, we people are primates. nonhuman primates are very close

to us, genetically speaking. you can imagine how adapted to infecting nonhuman primates might not be a long way to go for them to be able to infect humans. idea that infections itanimals can infect people, is a very important source of emerging infectious diseases among people. ebola is an example of that. mers is another potential example of that. there are diseases like rift valley fever and many other infectious to is his that travel from animals to people. in terms of file terrorism, it is something we take extremely seriously.

we are always on the alert for bioterrorism and we have invested considerably in our ability to detect bioterrorism threats here and we have a laboratory response network in all of the state health departments, which has the capacity to protect these threat agents and are working identify any potential threats, bioterrorism threats. host: in georgia, good morning. you had to caller's earlier back to back that were not related, but i think the subject matter did kind of relate. was asking was there any kind of political influence with cdc, and the next one was talking about ddt eliminating the mosquito zika virus. i know in high school, immediately, we had to read rachel carson''s silent spring

about the ddt killing of the birds. i think since then, there has been a discrediting of her philosophy. i do think pseudoscience and the environmental realm does affect some of the decisions and sometimes, the supposedly meant ands out on the good and people and saving them, as the man said, could just be an attempt to eliminate that, not consider because of political type reasons. i would like to see your opinion of that. cdc is a data-driven agency. we are staffed with a large number of scientists who are iny committed to the best the most accurate science. we actually have an extremely to providingment the best information and the most scientifically valid

information and the most comprehensive information to the american public in a transparent way as soon as we learn it. iterative kind of process and we learn more every day. our commitment is to providing have,st information we the most scientifically valid information at any time, sharing that information and certainly sharing new information as it becomes available. that is a commitment that we stand by and if you look at the cdc's history, our website, our response to all of the global where we spend hundreds of sometimes of -- thousands of disease detections around the world to investigate the threats, to use our scientific tools to get to the bottom as quickly as possible, you can see we really do rely on

science and data and that is what we use to stop outbreaks and provide the best guidance we can to the american people at any given time. host: a couple of minutes left , she is theh bell director there. carolyn has been waiting there in maryland. good morning. thank you for taking my call. i think i just attract all kinds of interesting bugs and critters that carry diseases or something . i live in indonesia for years and i contracted malaria more times than i can count. just really went through the and i with those diseases am very familiar with them. when turning back to the united states to try and get some rest and recovery, i started feeling fatigue again.

i went to the doctor and i thought maybe some of these old illnesses i had better coming back or whatever, i was very shocked to find out i had attracted lyme disease right here in maryland in the nation's capital. i live near lots of wood. i am no familiarizing myself more with lyme disease and desk really an a epidemic in the country. it seems to be a really weird dynamic between the cdc and other doctors. i wonder if you would speak to lie there is such a difference in opinion online's disease and why many doctors are not educated on it and what can be done. i know some people believe they have chronic lyme's disease. i was wondering if you could speak to that. guest: happy to and i am sorry to hear all of your struggles with all these inspectors --

infectious diseases. they are terrible and debilitating diseases. you are right that it sounds like you have been through the ringer. lyme's disease is a serious problem in the united states and we are quite concerned about it. incidents isthe increasing and we estimate about 300,000 cases occur every year. it is an important and serious problem. peoples a proportion of of it not get better better treatment for lyme disease. clearly very difficult to live and ainvolving fatigue wide array of potential other symptoms. this is certainly something we are very concerned about and it is certainly possible that this kind of post infectious after otheran occur

infectious diseases as well. we are actually extremely concerned about that and have been working very hard to get andword out to physicians to just educate the public about what they can do to prevent lyme's disease, which would be the ideal on the first place, that is for people to protect themselves and prevent lyme disease. education, aspect of on the prevention side. andhe issue of treatment disagreements on treatment, there are some disagreements. i guess going back to the question of science, we really rely on the best available science. the best available science today it really does not demonstrate effectiveness or efficacy from

some of the longer term antibiotics or other kinds of treatments other physicians have been promoting. we wish we had a solution for people who do not get better with lyme disease. we support the national institute'self and other groups working hard to come up with that are solutions and better treatments for people. at the same time, it is not asponsible for us to promote treatment that is far as our reading of the science, there really is not just -- just is not the science there and they have the potential to do harm. you will be happy to note your boss is watching today. he tweeted out --

using the tag to participate in the conversation. helen is waiting in tennessee. good morning. caller: good morning. [indiscernible] a lotd like to point out of people do not speak out about all of the antibiotics in me poultry's, etc.. it is not just antibiotics being , but what by doctors really irritates me is we know all the data come we know all the guidelines, we know what transfers diseases, and there is a lack of adherence to the guidelines. you should not be a first or second or third type of problem. if people are not adhering to the guidelines that i asked no, the ceo's should fire them right on the spot.

thirdly, with respect to line people do not realize that it is purported that lyme disease is transmitted through sperm of the mail, so there are so many things we do not know about. everybody in europe is on one system. all that information goes to each nation there. i still remember a physician a few years ago being sanctioned by medicine there in virginia. she was using antibiotics to treat for like even a year and it took that long to get rid of lyme disease. license.her

people need to be a little more judicious and listen to patients. i want lot is there and to give dr. bell a chance to respond. i will give you the last minute. guest: a lot of good points there. it is certainly true that the overuse of antibiotics is not good for people, whether it is used ining people or agricultural animals. we are supportive of the food and drug administration knew new rules that allows amerian's to adopt some of the things i talked about in the beginning and will make some progress in terms of reducing antibiotics and food animals. thate same time, as i say,

we reduce the overuse of antibiotics among people. it is important to take a and look atroach reducing antibiotic use across the spectrum and the animal sector. host: dr. beth bell is the for emerging and infectious diseases. up next, we will be joined by houry, as well as her center's prevention work. president obama participated in a panel in atlanta. here is some of that discussion. lookdent obama: when you in terms of lives lost, productivity impacted, costs to communities, but most importantly the cost to

families, from this epidemic of it has to be something right up there at the top of the radar screen. it is important to recognize that today, we are seeing more of opioidause overdose than traffic accidents. think about this. a lot of people tragically die of car accidents and we spend a lot of time and resources to reduce those fatalities. the good news is we have been very successful. traffic fatalities are much lower today than they were when i was a kid, because we systematically looked at the data and we looked at the science and we develop education and public

that allowed us to be safer drivers. the problem is here, we have got a trip -- the trajectories going in the opposite direction. 2014, the last year we had accurate data for, you see an enormous, ongoing spike in the using opioidsle in a way that is unhealthy, and we are seeing a significant rise in the number of people being killed. i had a town hall in west where i do not think the people involved would mind me saying this because they are very open with their stories, the child of the mayor of , the child of the minority leader of the house of west virginia, a former state

senator, all of them had been impacted by opioid abuse. it gave you a sense that this was not something just small set of a communities. this is affecting everyone, young, old, men, women, children, royal, -- rural, urban, suburban. because it isis having an impact on so many , we are a bipartisan interest in addressing the , not just taking a one-size-fits-all approach, not just thinking in terms of criminalization and incarceration, which, unfortunately, has been the response to a disease of rather, all hands

.n deck we have to make sure our medical scientificour community, individuals, all of us are working together in order to address the problem. dr. debra houry serves at the cdc center for injury prevention and control. can you just give our viewers a sense of the scope of the prescription drug overdose problem and the main drivers here of that? guest: absolutely. in the past 15 years, we have seen a number of deaths from opioids skyrocket. at the same time, the prescriptions go up. this year or last year, 40 people died per day from an opioid overdose.

it happened because people take an addictive medication and go on to have long-term consequences. how much of this is due to availability and access and how much is due to the lethal miss of the drugs getting worse in this day and age? it is a combination of both. since 1999, the number and amount of opioid described has quadrupled. the u.s. considered -- consumes more than 80% in the world. you look at the number of opioids that have gone up. very lethal and potent. the combination has led to the epidemic where we are at today. is your program at

the cdc trying to do to help this problem? we try to protect the public 24/7. one thing we're trying to do his work directly with state health departments. we are currently working with approximately 29 states to look at how to do better monitoring the program through a prescription drug monitoring program, looking at how we can get better prescribing interventions to patients. we also developed last month prescribing guidelines for chronic pain. this will give care physicians tools they need to know how to have those conversations and went to prescribe opioids. host: what happens when the doctors do not follow those guidelines? is there a stick here as well, convey legal consequences? practicing a physician and guidelines guide

my practice. when you have a patient you are faced with, a complicated issue, a gives you the tools to know what to do and how to have the conversations. each patient is unique. doctors have the tools to decide what is best for the patients and have those conversations. theave been thrilled with number of medical organizations who have been welcoming of those guidelines. is are intended to assist physicians with the practice. give us a call. we are talking with dr. deb .owery --dr. debra houry if you are in the eastern or central time zones in the united states -- phone lines are open and we also look for your tweets as well. what are the other forms of injury prevention you study?

we are excited that later this month, we will release strategies to prevent these in communities. carocus on things like crashes and concussions as well as suicides. as well as many different types of unintentional injuries. democrat, he wrote last week, gun violence is a public health epidemic. what are you currently allowed to study when it comes to gun violence? we track all types of death, whether a stabbing or and we report on suicides and homicides and look at interventions. also, we would go out and do an investigation.

what the predictors are that lead to youth violence and gun violence and we determine where best to intervene early. congressionalad backing, if the ban were list -- were lifted, what would be most effective in your mind? if we could get the 10 million in the fy 17 budget, we would go with the institute of medicine report that we helped with. some things we would be looking at were risk and protective factors in firearm violence, predictors of firearm violence, looking at how we intervene as well as safe storage. another issue you brought up was sexual violence prevention, a big issue, especially headlines with college campuses. can you talk a little bit about

what you're doing with that area and how you are working with colleges on the topic? this is something personal to me. in my prior life, i worked as a university -- at a university. i have seen and conducted rate exams in emergency departments. one thing we are doing is looking at programs that really allow us to change social norms around sexual violence and engage toys and men as allies to really interrupt the cycle of violence. we have also been part of the white house task force and desk convened advocates to talk about best practices and how to get them integrated on campuses. host: a lot of topics. go over any of those issues and explore them more with your phone calls and your questions. soanya is up first in southfield, michigan. good morning. caller: how are you guys?

yes, i actually called on my cell, but i am not addicted, but i have so many friends that .eally take it how can they control it that people will not be alex? that is an important question. for many people, they can be maintained on that dose. we talked about really assessing the risks and benefits with each patient as we go on higher dosages. the higher you go, the more likely you are to have an overdose. start low and go slow. it is important to realize just because you're on opioid that use down it forever. it means your doctor needs to or other patients

to reassess, is there something that could work better? if you all have a high dose, is there a way to bring it down, like physical therapy and others to help manage your pain and medical issues. the director of the cdc has been tweeting at the c-span hashtag this morning. -- we are talking about these sus -- subjects in our last 30 minutes or so. taking your calls, we want to hear your stories. michelle is up next in washington. good morning. caller: i have spinal surgeries years ago. i had extreme pain.

as i was going through my recovery and physical therapy, that brought about a lot more pain. the doctors wanted to reduce my painkillers. what they would not do, and this is the problem with the insurance companies, no nopuncture, no massage, swimming, nothing to relieve my pain would be paid for by the insurance companies. i am quiet for years into the spirit i'm not an oath the arts opiatesat all -- anymore at all. this is the problem. it takes time and money. as we measure the lack of time can i'm at work, you measure it in dollars. i am measuring it in my health. that is really where the concern is. sharinghank you for

that story and congratulations for being able to manage this successfully. it is a long road, as you pointed out. agencies about vista we are working with our sister .gencies on more access o we do believe it is important to have more access to other therapies that can be really helpful, but there can be access issues and we want to work with partners and medical organizations to increase access to this. host: we often have veterans who watch this program. a question for you from one of the folks following along on twitter. does cdc investigate how many opioids and other narcotics drugs are going out of the va hospitals? guest: we have not looked at specifically at that but we work closely with the v.a. we welcome the opportunity to work with other federal agencies around this problem. host: do we know if it is worth

at va hospitals than other hospitals in this country? guest: i don't know. i can just tell you across the country in all demographic groups, we have seen the increase in uses of opioids. the highest rates are in those around the age of 45 and men so that would be a veterans population, but it has been increasing in all populations. host: talk a little bit about that. what of the demographics of the aboriginal be your user? that opioid user.age dosers,for over 55te and hispanic men ages to 64 and we see increases in all age groups as well but in the younger age groups, we have seen the sharpest increases.

host: the use of heroin has more than doubled among young adults 18 to 25 in the past decade. more than nine in 10 people use heroin also use at least one other drug. 45% of people who used were also addicted to prescription opioid painkillers. some stats we will go through in this segment of the "washington journal." we want to hear your calls and your stories. nancy from portsmouth, virginia, go ahead. caller: my question is really in three parts. i am really concerned about and would like to know what the cdc is doing to track deaths as a result of sports injuries, specifically football, soccer, from concussions resulting in chronic traumatic encephalopathy. i just saw the movie concussions i would like to know what they

are doing to track this and what trackre also doing to attrac other problems related to it like memory loss etc. is the cdcart is, doing anything to work with the national sports organizations, particularly high school and college levels, to change rules so these accidents are less likely to happen? have been working toward developing a national surveillance system for concussions. budget request17 to develop this national surveillance system. it is really important to be able to track concussions so we know the scope of the problem. many student please have a concussion and don't tell their parents or coaches so we don't see those. we don't know the true scope of the problem. to develop these surveillance system, we will get a lot of the questions you're asking about, memory loss of a long-term issues. it is important to do that --

memory loss, long-term issues. it is important to do that. we have a program called heads up that has been in existence for more than 10 years. we train millions of coaches on recognizing concussions and changing the culture so athletes know the right thing to do is report concussions. we worked with the sports theues from youth to professional sports leagues and consider them to be valuable partners as we know that athletics and physical activity is really important for our youth. we want to encourage it. we want to encourage it safely. host: to find more about the program, is it cdcd.ogv/ dc.gov/injury? guest: yes. host: go ahead, linda. caller: are there any cases of people being blacklisted because use and former opioid

having an infectious disease that the doctors did not want to deal with? maybe they had too many issues and they cannot get health care at all and they developed into long-term very serious health problems and even death. host: is this something you have had experience with someone you know? caller: yes it is. host: what is your story if you don't mind sharing? caller: my story is i was very sick for a long time. i finally went to usc. martiny the name of john , they gave me a diagnosis. a virus.r somethin i cannot get help after that.

i was with an hmo. i will not mention the name. they gave me a lot of heavy opioids. i have various symptoms. i do not know what the viral condition was. i had been dealing with it for a very long time. it made me very sick. doctors told me no matter what you do, you are not going to like the outcome. doctors have said do not come back here. help, there to get was just no one that would help me. my husband and i have been married for 40 years. this has been huge. i was addicted to opioids. i have often been completely now on my own. i have very little time because

i cannot get any help at all. . am trying to say very calm it is just huge. we are not very good on computers, my husband and i, but we managed to not be able to get able to let people together, but there are many individual people that i have met the have very much this problem. they are shoved under the carpet in this sense because the doctors do not want to deal with and are able to have no understanding of the because they don't want to see that this disease even exists in many cases. host: dr. debra houry, i will let you jump in. guest: i cannot speak to the

particulars. i am not familiar with them. emergency physicians are the safety net and that is one of the reasons why i love working in the emergency department because we can take care of patients regardless of illness or ability to pay. most physicians, that is what is in their heart, taking care of patients. developed,nes we many doctors including primary care physicians, have a lot of experience dealing with chronic pain. myself included. i had very little training around pain management and opioids and the risks and benefits. we are hoping these guidelines get providers tools to be more comfortable about knowing the different options for pain treatment, with use opioids, how to help patients get off of them so they are more comfortable with patients with more complicated issues. host: what is the first signal a

patient gets they might be addicted to a medication and what is their option at that point to solve the problem? guest: when you realize a medication is interfering with her daily life to where you need more and more of it. go without it. you have withdrawal systems. or you try to take other people's medication. you borrow it was medication, look for ways to get it even to the point of being intoxicated. those are signs of addiction. talk with your family and friends. look at the website where they have resources on addiction. talk to your physician. there is a medication. there is treatment that can help specifically with opioid addiction to help people get off the medication. host: less go to greenfield, massachusetts. joe is waiting. caller: my basic question is is there a rule for reform in

medical malpractice reform in dealing with opioid crisis because my question basically -- i went to the doctor over the last four years or so and even my dentist and they would give me prescriptions for opioids. even my dentist did i have after -- even my dentist did after i had my wisdom tooth removed. it is not really the doctors fault. patients will demand relief from their pain. in light of that last point, it is not the doctors dispensing too many bills just because they want to -- pills just because they want to. the expect the patient to demand it. perhaps a medical malpractice reform to allow them to more easily say no to a patient's demands may be in order, might be possible solution to this large problem. host: your thoughts.

guest: thank you for that. i think another way to look at and doctorstients to have that conversation about how to manage pain. it is not always an opioid. again, when i trained, i do not know the risks and benefits of opioids. in the past few years, we have a lot more evidence of the risk of opioids. but we can do is educate physicians and patients. we plan to launch a communication campaign around awareness of opioids for the public so the public is aware also of the risks of opioid medication. many patients come to a provider think they may not get the opioid that they are not getting their pain treated so having better awareness in the community around the risks and benefits of opioids is important as well as educating providers as to what our alternate treatments for opioids such as biofeedback, nonsteroidal medication, physical therapy,

some of the neurological medications can help. things like that. greater awareness and education and working in partnership with our patients. host: about 15 or 20 minutes left in today's program. phone numbers again if you want to call in here at the end of our session. mountain and pacific region, 202-748-8001. philip is an indiana, richmond, indiana. caller: good morning. i wanted to say i am a disabled veteran. i was injured in the first gulf war. i had some massive injuries, internal injuries that damaged the nerve in my leg pretty significantly. they didn't save my life, but it is always hurt. v.a. just threw me all kinds of pain medicatio .

they would eventually stop working so they would switch to another one. i have been on methadone for and and oxycodone eventually i was on a transdermal patch. you wear it every three days. in 2004, they just cut me off. i never did -- i guess because becauseave policies -- the the a policies have changed. i went through withdrawals. i was sick. i started using heroin. i have a job so i don't want to stay on heroin. i went to an outside doctor. they got me a dorsal column stimulator. that was a surgery done outside of the v.a. because the v.a. would not pay for it. , myg that and marijuana

pain is very manageable now. the v.a. will not recognize marijuana as a pay medicine. hepatitis, they will not give me the treatment for hepatitis because i continually test positive for marijuana. bad, but on drugs were marijuana is not that bad between marijuana or bets a ntanol. it is powerful stuff. you probably don't know anything about the v.a., by noted policies are changing drastically. but i know their policies are changing drastically. guest: over the next few years,

we will have better evidence on how it may or may not be effective for pain. your story is a great one to share with that. we need better studies to determine how effective it is. right now, it is legal in some states but not in others so it is difficult to do those studies, but it is something we will look further into. you mentioned hepatitis and heroine. had an hiv outbreak about a year ago from injecting prescription opioids. that is another aspect of the epidemic when you talk about opioid medication. it is the injection issue. crisis.nded to that i think we underscored the importance of safe prescribing for opioids. not sharing needles, all of that really plays into this crisis. you can go from being addicted to an opioid medication to developing hiv or hepatitis c,

all of the things we want to prevent with primary prevention focusing on people getting not addicted to these medications in the first place. jj on twitter asks are re-examining opioid use by other nations to determine impact of treatment, philosophies, demographics, geographic culture, etc.? guest: that is one of the things we are working with our federal partners on. 80%united states consumes of the opioids compare to other countries so we are looking at best practices in other countries. health care is different in other countries so we have to keep that in mind, but there is a lot that can be learned about different treatments from other countries. host: michael, you are on the "washington journal." caller: yes, hello dr. houry. think you for everything you are doing. one in three kids in america is abused, and it is by the age of

18. you guys are working along with simpson on trauma. i know the government as well. in thisiversity country, we are the six the largest school district in the country and we are seeing something caught institutional complex ptsd. is where you have institutions exhibit similarly to how you individuals exhibit it similar to borderline personality, kind of the black white personality. very reactive. self-interest versus group interest. what happens is the weakest segments of society, the ones that have the least voice, children to the elderly to the v.a., the infirm, special needs, incarcerated, all of those systems exhibit the exact same patterns. it is kind of like a fall through the fingers kind of

thing. it is implicit. it is not that you have bad actors. it is not a matter of one side or another. both sides within the system i was pointing at each other -- are both pointing at each other and not the person shaking the jar. when i am looking at is you and help coming down here to us because i present this to the board constantly. they are not experts on this. they expect you to be there and when i asked them to contact you, they are afraid. the reason they are afraid is some irony going on here. you are the cavalry. the issue is complex ptsd. there was a lawsuit in compton, california, as a result of everything going on there. and the students are on the same side of the lawsuit saying we all suffered the same damage. it is real.

it is not just like a pat on the head. that is where you come in to educate the people but this is a physical reality. it is measurable. these children are messed with for lack of a better word, there is no way you can do it and we cannot know. host: dr. houry. guest: thank you for bringing that up. it is a huge issue in the united states. you look at the long-term effect of child abuse. it can lead to heart disease, diabetes, post-traumatic stress this order, so we absolutely want to look at ways to prevent it. we welcome opportunities to work with partners and communities so we love to hear from you or from a county as to ways we can help. two things i can tell you about right now that may help is we have a program called essentials of childhood that is currently on our website that talks about strategies and policies that can be used in communities around preventing child abuse as well as measuring it. later this week, we will be

releasing a group of strategies based on the best available evidence on how to prevent or licensure of abuse and neglect. we call that a technical package. that will be coming out later this week. really work we can with communities and states on how to lessen the burden of child abuse. host: cdc also tracking stats on child abuse in the united states. these from 2013. victims of child abuse and neglect were reported to cps. 27% of victims are under the age of three. 1520 children died from abuse and neglect in that year. cdc keeping those numbers on their website. cdc.gov/injury. about 10 minutes left in this segment. lawrence is in pennsylvania. good morning. caller: good morning. dr. houry, cannabis has never

been a medical problem, and i suspect you know that. no one has ever died. no one has ever become addicted to marijuana. is absolute bad science -- this is absolute bad science which has led to a drug war led by marijuana prohibition. if you don't know that, you should educate yourself. , and i suspect you know this also, there was no opioid epidemic at that time. thank you very much. i will take my answer off the air. host: dr. houry, any response? guest: one of the things we are starting to look at a lot more as marijuana becomes legal throughout different states and our sister agency is really one of the key agencies looking at different types of drug abuse

within the center for injury prevention and control at the cdc, we are looking at merely deaths.e marijuana can impact on the aspect of health. it is important to look at it so we can see both the pros and today there is, not a lot of evidence when you look at randomized controlled trials or anything like that around marijuana. stories ofients's how it can be healthy but we may not be hearing the stories of those that may not have the same benefit so we need to wait until the is a bit more evidence out there. host: and it is waiting. you -- kenneth is waiting. you are on "washington journal." caller: morning. i wonder if you have something from brain accidents. i would expect the results should be similar to having a stroke inside of your brain. mri shouldese with

be very useful to have data on. you can see what part of the brain is being injured with each punch the head. thank you. guest: thanks for sharing that. i agree there are different ways we can look at the impact and the future damage on brains so the mri or virtual reality type helmets and many different ways to diagnose concussions. i think the area is still really early on to diagnose and manage concussions. this is one of the reasons why we think a surveillance system around concussion is very important. we have a better sense for how many people have mild to moderate to severe brain injuries as a result of sports and other activities. host: let's go to ray in little rock arkansas. good morning. caller: good morning. i am really starting to get very

agitated by all of the fear mongering that is going on regarding opioid pain medication. trulyare people who are suffering. work.ittle very little helps. anything except ter the lighting of your stomach the dea and other federal agencies absolutely scared doctors to death about prescribing drugs that work. for all of the fear mongering that goes on, these drugs do actually work for people that

suffer chronic pain. it is something they live with day in and day out. it really frustrates me to hear "oh my gosh, these drugs are so horrible, and we have to do something about it." if they are not taking into consideration those people, and i have a dear friend who is one , who need pain medication in order to have some sort of quality of life. host: got your point. let us let dr. houry respond. guest: what i would say is when we see that these drugs don't have evidence for long-term use, is because you look at the

agency for health care research and quality. they did a systematic review a few years ago. there have been no long-term studies longer than a year comparing opioid medication to a or essentially no pain medication. there has not been any studies doing that to show long-term effectiveness of it. we do know that opioids can be effective for acute pain for a short period. for longer amount of time, people can become dependent on it and call it to where your body may need 10 times of the dose you originally started on. i hear what you say about nonsteroidal. they can be effective for some people but there are also non-opioid medication and therapy secondly helpful and there is more effectiveness in the literature around this. when i was a is it is up to the patient and provider to have these discussions. the risks and benefits are different for each patient depending on what the medical

condition is and the other issues they might have liked renal or kidney disease, long-term illness. all of that really needs to be decided between a provider and the patient balancing the risks and benefits. host: let us go to hendersonville, tennessee. lynn is waiting. good morning. caller: morning. host: go ahead, lynn. caller: yes, my question is your regular doctor like a person who has a back surgery, they go to the regular doctor and they wind up sending them to a pain clinic. i've am not exactly sure how long the pain clinics have been in effect but it has been a few years. when they go to the pain clinic, what they do is they start them out with 2-3 high-powered pain medications. i had a friend that was on morphine.

and was that morphine was not needed to be given until it was cancer or something. aftereep switching around the two or three doesn't work. they build up a tolerance and then they put them on something else. it is a problem because it is the prescriptions that are doing it, but it is also the doctors that are doing it to the people instead of maybe giving them one medication or something to see how that works and then build them up or swap them over to a different one. out one time, you give these people that are addicted and people are wondering what is going on and these people are dying. i have a dear friend that is actually addicted now. it is a matter of how can they get off of it? can they get off of it? i just like to know what they if theng to do as far as

doctors are prescribing them and for the people that are already addicted. host: dr. houry, your last minute here. guest: treatment is really important for pain and including opioids the milano purex, physical therapy. we did not get here overnight. for the past 10 years, we have seen the number of prescriptions increasing with a number of overdoses increasing lockstep. one of the things we can do is say for prescribing and having conversations with patients and physicians and patients informing themselves more and we can turn the epidemic around. host: dr. debra houry is the director of the cdc prevention center for injury and control. thank you so much for your time this morning. guest: thank you. we look forward to hearing all of you. please check out our website for

all of the resources on the topics we mentioned today. host: things to all of our guests and the cdc for allowing us to bring you this program today. was the right back here tomorrow morning at 7:00 a.m. eastern, 4:00 a.m. pacific. in the meantime, have a great monday. [captions copyright national cable satellite corp. 2016] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> coming up in about three hours, live coverage and discussion of the future defense department personnel policy. brad carson is a former acting director of the pentagon's personnel office who left his