dr. collins, we're eager to hear from you. dr. collins: it is an honor to appear before this panel given its long history of supporting nih's mission. so seek fundamental knowledge and apply it in ways that enhance human health, lengthen life. as a federal reform agency we're acutely aware that to achieve our mission, we must serve as effective and efficient stewards of the resources provided by the american people. one way we're doing this is by focusing on prioritization of nih resources. this involves developing methods of portfolio analysis, of identifying scientific opportunities, fostering creative trends. enhancing the use of the common fund. we're also forging novel interagency partnerships like the nih f.d.a. project to build human biochips to test for human drug toxicity like the one i'm holding. seeking to identify new drug targets for alzheimer's disease, type 2 diabetes and autoimmune disorders. to help set priorities, we are developing an overarching nih strategic plan to be linked with institute and center plans and

dr. collins. >> thank you very much, chairman blunt. thank you, dr. collins for being here. i look forward to this discussion today. all of us today can agree there's more we need to do to keep families and communities healthy and continue investing in priorities that strengthen our economy from the middle out. financial institute of health is vitally important to this effort. the nih supports basic research that make medical advances possible. it gives hope to those living with chronic and life-threatening disease and helps drive economic growth and competitiveness. with all been touched in one way or another by the research nih has supported from its pioneering use of gene therapies to treat cancer, to development of antiviral and repeat to treat hiv or effort to reduce incidence of diabetes in preterm birth. biomedical research is an important investment to ensure our government works for all of our families. the investments we make as well as an education and other programs in this bill suppor

dr. collins. dr. collins: good afternoon, chairman alexander ranking member murray, and distinguished committee members. it's an honor to appear before you today to discuss how we can advance america's health by accelerating progress towards a new era of precision medicine. earlier this year, the ministration unveiled the precision medicine initiative able to research effort to change how we diagnose and treat disease. we believe the time is right. -- a bold, new research effort. historically physicians that have to make most recommendations about disease prevention and treatment based on the expected response of the average patient. this one-size-fits-all approach works for some patients and some conditions but not others. precision medicine is an innovative approach that takes into account individual differences in patient's genes, environments, and lifestyles. the concept is not entirely new. blood typing, for example, has been used to guide blood transfusions for almost a century. dedications have

dr. collins. >> well, good afternoon, chairman alexander, ranking member murray and distinguished committee members. it's an honor to appear before you to discuss how we can advanced americans' health. earlier this year the administration unveiled the precision medicine effort, a bold new initiative. we believe the time is right for this ambitious initiative and the nih and our partners will work hard to achieve the initiative. we've had to make decisions based on the expected response of the patient. this one size fits all works for some patients in some conditions but not e others. precision medicine takes into account individual differences in patient's genes, lifestyles. blood typing, for example with has been used to guide blood transfusions for almost a century. the identification of the brca one and 2 genes has made it possible to provide options for women at high risk of breast or ovarian cancer. and the gene discovered in my own laboratory 25 years ago has led to wide spread ability of ta

dr. collins, why is one million the right number? dr. collins: it is a great question. there is nothing magic about one million except it is a nice round number we could aim for. i will admit that i would love if we could go beyond that. a minutes ago this is all about numbers. that is where you get the power of the analysis to find out what works. a million is ambitious. it seemed like a goal to set for ourselves to achieve. given the fact that we already know there are cohorts out there which collectively have enrolled more than one million people, if we can figure out how to do this maybe we will do better. senator murray: listening to the members you have been talking about everyone of our states has developed a database. i don't how you are going to work through all of this. diversity, making sure we represent everybody is important. i'm going to look forward to how you do that. dr. collins: totally agree with that. i don't think we would have the representation we need of the country. senator murray: thank you. >> on your following up, this was the high risk, low

dr. collins. >> well, good afternoon, chairman alexander ranking member murray and distinguished committee members. it's an honor to appear before you to discuss how we can advanced americans' health. earlier this year the administration unveiled the precision medicine effort a bold new initiative. we believe the time is right for this ambitious initiative and the nih and our partners will work hard to achieve the initiative. we've had to make decisions based on the expected response of the patient. this one size fits all works for some patients in some conditions but not e others. precision medicine takes into account individual differences in patient's genes, vief styles. blood typing for example with has been used to guide blood transfusions for almost a century. the identification of the brca one and 2 genes has made it possible to provide options for women at high risk of breast or ovarian cancer. and the gene discovered in my own laboratory 25 years ago has led to wide spread ability of targ

dr. collins and dr. suren. i'm karen desalvo were the national coordinate at the department of health and human services. when i was a medical student at tulane i could never imagine that in my career i would see me medicine on the frontier of such a significant transformation. as a still practicing doctor it is thrilling for me to know we are on the cusp of being able to customize treatment for the patient in front of me based on their genetics, preferences and other key information, instead of having to treat them as the average patient. what is even more exciting is that precision medicine is not just a theory. it's already changing practice and saving lives in the u.s. we wouldn't be on this cusp but for health information technology, which is foundational to the president's precision medicine initiative. the the office of the national coordinator is the federal lead for health information technology. and onc's responsibility is to advance the health i.t. infrastructure for what is six of the u.s. economy h

dr. collins. dr. desalvo, welcome. >> thank you, senator alexander and ranking member murray and to the other distinguished senators. thank you for the opportunity to be here today with my colleagues dr. collins and dr. shuren. i'm karen desalvo were the national coordinate at the department of health and human services. when i was a medical student at tulane i could never imagine that in my career i would see medicine on such a track. we are on the cusp of being able to customize treatment for the patient in front of me based on genetic preferences and other key information instead of having to treat them as the average patient. what is more exciting is that precision medicine is not just a theory. it's already changing practice and saving lives in the u.s. we wouldn't be on this cusp but for health information technology which is foundational to the president's precision medicine initiative. the office of the national coordinator is the federal lead for health information technology. and onc's respo

dr. collins: or a delay in the onset. a major advance in terms of preventing or delaying the onset. >> and we should expect that report by when? i think you've already said and i am sorry i did not -- dr. collins: in terms of what we were asked for specifically in the new piece of the omnibus is not only a plan but a bypass budget of what it would take to get there. the plan itself gets refreshed every year and there will be a new version of the research plan tomorrow. but we are also then going to attach that to an estimate of what it would take to accomplish that because we have been asked to do so by the omnibus language. >> we will be seeing something tomorrow? dr. collins tomorrow you will : see the outcome of the summit on research that was held in february, bringing people from the u.s. and outside the u.s. to nail down what are the highest priorities right now for research in this space. this will be a second time we have had such a summit and this is a major refresh of what the research agenda is. >> i think the

dr. francis collins is the director of the n.i.h. and has been pushing for more research funding. >> whether it's in cancer or alzheimer's disease, basic science, clinical applications we're at a remarkable moment scientifically. but paradoxically we're at about the worst moment we've been to support that, at least in this country. >> reporter: one would think that when you're in an environment that's this competitive for dollars, that only the best of the best science is gonna get funded. >> turns out that's not true. cause we can look back now, can we actually say that the top sixth was better than the next sixth? turns out we can't. you can't tell them apart. so what does that say? that says we're leaving half of the great science on the table that's coming to us now because we can't find the funds for it. >> reporter: dr. collins recently testified before a house appropriations committee, asking for a three percent increase to the n.i.h.'s budget, enough money for 1,200 new grants. but subcommittee chairman tom cole warned that w

dr. collins. $it $2 billion a year for five years is better than nothing, but not pretend that a small temporary investment billions of dollars short of what we need to do the job, there is gaping holes in our nih budget, and we need a serious plan to fix it. there are many ways to make that happen. i have a medical innovation act for example, that could add another $6 billion in a year not costing taxpayers a dime, but whatever we do, this committee has to get serious about medical innovation, and that means we have to do better than the house proposal on this. thank you, mr. chairman. >> thank you senator warren. senator whitehouse. >> thank you, mr. chairman. let me start by echoing the chairman's interest in having a review of where we are on health information technology. i read with interest by your predecessor, and i think it makes a lot of sense and provides, i hope, bipartisan foundation, for us to work forward, and i think that the meaningful use program is obsolete and needs to be tuned

dr. collins, i wanted to ask you about your opinion about some work i've been doing to drive this senate appropriations committee to have one unified federal electronic health record between d.o.d. and v.a. my hope is to make sure that using the 25 million patients that the v.a. has and the 2 million patients that d.o.d. has we have one unified record. my hope we have this all with open code and open source to repeat the success that moat rolea had with the android system where they had 70,000 aps from the industry that was written to the open code of android. could you give me a comment on that? i will be coming to you with a stroke net consorsha that we're putting together across illinois with five hospitals including barnes jewish which is particularly good at working with n.i.h. >> well, i am really -- my hat is off to you for what you're doing with d.o.d. and v.a. to try to make this into a seamless health record because i know all people in the service are anxious to see that happen. it's been difficult i think with those transitions. this fits together with a broader effort to try

dr. collins. there is an enormous opportunity. and we need not to screw it up there.is a possibility to do this if we are not thought full. and the role that we would be very helpful is to collect data that the various types of wearable sense ors would improve health. by improving the likelihood of staying healthy and managing chronic illness like hypertension. diabetes. you are right this. will get more complicated if the monitor is doing something that could potentially be harmful. if have you an artificial pancreas on your wrist. instead something telling you how many steps that you took, the difference will become a cute. and we are aware of that obviously, the fda has an incredibly important role here. we are working closely with the fda in space like this. and we are having an of the four work shops here on the precision med since. the fourth in late july will be from intest. and california. we are inviting a lot of the people that have most inspiring ideas about health to come and talk about what they need, and in order to have the precision me sin to be a plat

dr. collins, you've got a tough job. as a guy with an average lasting, congratulations for being irish all -- hall of fame. but when they hear about this and again i'm guessing we've only spent $500 per death if you want to talk about dying before the age of what someone should ordinarily die. i would just hope that rebalancing would invest their dollars into basic science and we can say with some success amanita continue to find that success well. i don't mean to slight any of the condition except to say the policymaker, everyone of us knows somebody with a major mental illness. and the fact that the funding for that seems to be so woefully less and document it objectively relative to other diseases puts the onus upon us is in the address of that to all for your work. we all stand in the shadow of the. i yield back. >> thank you. a couple of things. doctor gibbons, the budget request talks but a new program to less expensively identified recruiting animal patients in clinical trials. how does that impact your work? help

dr. collins why is one million the right number? >> well, it's a great question and there's nothing magic about one million other than it's a nice round number that we could aim for. i actually will admit i'd love to go beyond that. as i said a minute ago with conversation with senator baldwin, this is all about numbers and that's where you gets poir of analysis to see what works. million is ambitious. seemed like a goal we could set for ourselves to try to achieve but given the fact we already know there's cohorsets out there collectively enrolling more than a million people, if we figure out how to do it, we'll do better than that. >> listening to the committee members over the last few weeks, every one of our straits has -- we have fred hutch in my state developing a data base, so i don't know how you're going to work through all this to get it but, again, diversity, represent everybody is really important. i'm going to look forward to hearing how you do that. >> i agree with you on that. if we just tact together the existing coh

dr. collins. he are so glad to see you once again.ave talked among ourselves under the leadership of senator blunt. we want for the subcommittee to visit nih to another you can more depth and firsthand to see the great work that is being done by the people that work there. and of course you know if you are senator from maryland and the nih. hopkins and the university of maryland. so we will see you to new friends. and we will get right to my appropriations question. the president has put into his request a billion dollar increase. and i want to know what it means. is that enough? i understand that the nih has lost 20% of the purchasing power since ending in 2003 due to the inflation. and i am concerned that to set the priorities. would you have to end up picking winners and losers. winners and losers in united states of america. you cannot doll up the nh because the headline or the world crisis. we turn to the ebola crisis from aids and other issues. you cannot dial up a national institute of this. we wanted to for alzheimers'. and we

dr. collins, thank you so much. i'm very pleased to say nimh involved in this activity. part of the journey of focusing on this note that the small numbers of people. they will point to the large numbers of deaths in sub-saharan africa if you're allocating funds to try to know what the large number of people's are. but these are u.s. citizens. i am greatly appreciative initiative you doing there. but a question for you is, you mentioned rigorous evaluations. samhsa funds a lot of services. some people would argue that truly don't look at the root cause research wise in terms of -- the commission unsuccessfully tried to get an institute of medicine study focusing on this. we failed because we did not adequate engage with alaska native communities in developing this and explaining what this study was come explaining how committees are formed and how editorial control is done. dude you think an iom study if we tried it again would be a useful way to do a rigorous evaluation of this issue in the north? and voted on in that question is, very hard to get capacity, even if you

dr. matias' concerns became reality. collins had been accused of fighting with another inmate and was confined to his cell while officials investigated the matter. >> apparently another guy over there said that i hit him and that's all it took because of my, you know, my history for violence on the idu. it means a setback. a serious setback. i'm not allowed to come out but one hour a day. no matter what i do. i can whistle dixie all day long, not talk to nobody, cause no problems, not say nothing, i'll still be over there. he told me that. >> how badly injured was this man? >> no injuries. not a mark on him. >> i got the impression he was vastly minimizing what had happened. i think that part of the problem is we're a television crew standing in front of his cell, and for him to admit it, other people would have heard the truth. indiana state prison allowed us to give certain inmates little personal cameras that we would leave with them and they could film themselves. i gave a camera to brian, and all i asked of him was to be ho

dr. mccarthy: i believe that is the correct figure. senator collins: is this happening from the community-based clinics and your v.a. hospital? it is not individual, outside providers that you are contracting with. dr. mccarthy: could include that, but that is primarily v.a. driven. some of the sites where the care is provided with the other clinics or other parts across the country. as a network we are supporting one another, but also at home as much as possible, too. senator collins: the cost to savings you have quoted, you star multiplying that, you get into real numbers very quickly. this has been an interesting hearing. i want to call on senator mccaskill for any final questions. senator mccaskill: i think we need to go back and look and see how we began distributing scooters with reckless abandon at one point in time in the medicare program. when i began talking about scooters, we found a couple of -- one woman worked in my office, her grandmother had three. the lift chairs and all of those things, in many cases, they are needed, but how do we g

dr. mccarthy: i believe that is the correct figure. senator collins: is this happening from the community-based clinics and your va hospital? it is not individual, outside providers that you are contracting with. dr. mccarthy eight could include that, but that is primarily v.a. driven. some of the sites where the care is provided with the other clinics or other parts across the country. as a network we are supporting one another. also, -- at home as much as possible, too. senator collins: the cost to savings you have quoted, you star multiplying that, you get into real numbers very quickly. this has been an interesting hearing. i want to call on senator mccaskill for any final questions. senator mccaskill: i think we need to go back and look and see how we began distributing scooters with reckless abandon out one point in time in the medicare program. when i began talking about scooters, we found a couple of -- one woman worked in my office, her grandmother had three. the lift chairs and all of those things in many cases, they are needed, but how do w

dr. collins, thank you so much. i'm very pleased to see nimh involved in this activeityactivity. it's a challenge. part of the tyranny is the small numbers of people. you can have discussions in full in other places and they will point to the large numbers of deaths in sub-sahara africa. so if you're allocating funds you try to go where the large numbers of people are. but these are u.s. citizens. so i'm greatly appreciative of the initiatives you're doing there. a question for you, you mentioned rigorous evaluations. samsa funds a lot of services. some people would argue that's really not looking at the root cause researchwise in terms of suicidality. we tried at the commission unsuccessfully to get an institute of medicine study focusing on this. and we failed because we did not adequately engage with alaska native communities in developing this, and explaining what an iom study was. explaining how committees are formed, and how editorial control is done. do you think an iom study if we tried again would be a useful way to do a rigorous evaluation of this issue in the north? an

dr. francis collins the director of the national institutes of health recently stated alzheimer's research is entering a new era in which creative approaches for detecting, measuring and analyzing a wide range of biomedical data sets are leading to new insights about the causes and course of the disease. dr. collins calls on our nation's medical researchers to work smarter faster, more collaboratively to determine the best path for progress in alzheimer's disease research. as an example n.i.h. is implementing a new initiative called the accelerating medicines partnership working together with pharmaceutical companies to develop the next generation of drug targets for alzheimer's disease as well as rheumatoid arthritis type two diabetes and lupus. n.i.h. is also leading the brain research through advancing innovative neurotechnologies initiatives or brain. the brain initiative is a multi-agency effort to revolutionize our understanding of the human brain. the objective of the brain initiative is to enable the development and use of innovative technologies to produce a clearer understanding

dr. francis collins recently testified on capitol hill before the senate health education labor and pen gensommittee. that initiative funded through the 2016 budget is a research effort designed to improve treatment for diseases like cancer and leukemia by tayloring health care, not a one sized fits all approach.