is a partnership that continues to grow, to change and adapt to the nature of the disease, the epidemiology and the challenges we face. as you see from this statement by the president last week in cairo. now if we look at what has been achieved just before we go on to some of the lessons, this is what the world look like in 1988 when the global initiative to eradicate polio was launched and the commitment was made to get beyond the 80% that had been achieved in immunization coverage globally by that time and to reach that final 20 percent of children. this is where we were 40 years -- sorry, nearly 40 years after the vaccine have been developed and was widely available in the industrialized world to concede that children are still being paralyzed in vast majority of the countries and nearly half million children a year. as a result of the implementation in eradication strategy is the disease was eliminated from all but four countries in the world by 2004. at that point the world got stock with of four parts of these countries, northern nigeria, northern india and parts of pakistan and afgha

much of the expertise in these fields lies in the nutrition, behavior and psychology and social epidemiology and some of that was covered in this morning's panel. and then all internet address these issues but just to review of issues surrounding the food supply characteristics to the amount of calories they take in directly tied into health status. salt intake, dependence on fast food and regarding eating outside the home. physical activities in the neighborhood and to what extent the encouraging optimal levels of physical activity. and finally the burden of persistent discrimination in a personal institutional or environmental. in conclusion the bottom line i believe is an honor to eliminate disparities and hypertension death and disease we must provide equitable chairman across socioeconomic clients and must decrease the number of african-americans that become hypertensive and the first place. if we are to reduce ruminate disparities in general we must reduce the number of persons to develop the risk factors discussed at the beginning of this presentation. our research strong suggests tha

as you can see here, the distribution of people reflects the epidemiology and the risks of the program to the program. the other thing you need to do is to be flexible and be able to respond with your human-resources to where your problems are. this is the last reservoir, we believe, of type i polio, this is the kosi river through the northern part of the country and this is the ganges river and this is where they meet. this area around the river is a massive flood plane. every time you see in the of flooding and people standing on their roof, you're looking at this part of india on tv. this, also, is where polioviruses are right along this area. when you look at what was in place to serve these people, to manage the program, there was one primary health care center within the flood zone area if i remember correctly, for an area of 100 kilometers, 20 kilometers wide, ten million people during the flooding periods. you need to be able to put in place if you want to reach these children, you have to put in place the infrastructure to do it and this is what our team in india did. they lai

as you can see here at least now the distribution of people reflects the epidemiology and the risk of the program dish to the program. the other thing you need to do to be able to be flexible and able to respond to and your resources where problems are. this is the last reservoir we are of type one polio in india. what you see here is a cozy river coming down from the north part of the country. along the bottom you see the ganges river running and this is where the two meet. this area around the river, is a massive floodplain basically. every time you see india flooding and you see people standing on the roads. you are looking at this part of india on tv. and is also as you can see is where polio viruses are right along this area when you map a fairly. when you look at what was in place there to serve these people to manage the program, there was one primary health care center within the flood zone area, if i were never correctly, an area of about a hundred kilometers long, 20 miles, kilometers wide. and i think a million people during the flooding period. so you need to be able to pu

it includes developing improved epidemiology tools and procedures to better detect food-borne disease clusters and improve trace backs to identify the contaminated food products. our state is proud to be the home of hormel and land of lakes and general mills -- many other food processing companies -- and they are eager to help with this. often they know the best way to trace back these food-borne illnesses and they want to have safe food and they are interested in helping. second, it directs the centers for disease control to improve food-borne illness surveillance including providing support to state laboratories and agencies for outbreak investigations with needed specialty expertise. it also includes, and this is key, developing model practices at the state and local levels for spending to food-borne illnesses and outbreaks. this is about the minnesota model, these best practices. what happens in minnesota, i tell you this, i bet it is as expensive in other states but what we do is smart. we take a team of graduate students that are food detectives working together instead of going

go for universal coverage 70 saying as we get to the periphery, geographically, cul turally, epidemiologicalpaid the disease and populations will surprise you and you need a research program that can adapt to that parkway couple of examples, 20 years after the initiative was launched we were still introducing new tools, vaccines were introduced in 2005 after a six-month development process thanks very much to our friends at sanofi who took on a 50 million dose order, your smallest ever and decided to help us to this. and new lab procedures implemented in 2006 that cut half the time we needed to eradicate polio. look at the implication of these tools on the left and side is india the one area that has never ever stopped polio. this area, with this is called the byrd negative cover this is the area of the country where every at various we have found since 2000 is june they should genetically linked we put in place a number tactical shifts and is in the beginning of 2000 and eight we got a full 12,000 months without polio in that area. it was reinfected and we are still trying to clear out of t

relates to specialized advisory panels and last but not at all least, as someone who's interested in epidemiology, enzi number 6 which says that the center may allow reports to assess whether treatments benefits sub populations. and as we have got feedback from our public health experts as well as the aarp they thought enzi number 96 was an excellent and outstanding amendment and so do i and i'm happy to accept it. we can accept all of those and it shows how we can find a center on the outcomes research. let me go to some others. senator murkowski has two -- five amendments that she had just in sin effois inserting th where they were. that's murkowski 3, 4, 5, 60 and 61. we are ready to accept one affected trauma programs, this was agreed to also by senator murray. thank you, senator murray. senator roberts, you have an amendment, hhs, you consider unique characteristics of rural hospitals and low volume hospitals when establishing reporting progress on hospital readmissions. again, i think that adds a great insight and dimension that my original framework was backing. i thank you for that. i'm h

this was early in epidemiology it may have been a shock to some people but the tobacco industry sought immediately they were facing problems. the founder of the world wide public-relations firm said you have a problem you have to address it in here is the strategy. hill had worked for the chemical industry before that and there is a congressional hearing on cancer-causing chemicals and food and he advised the chemical industry how to fend off propose legislation that would limit the chemicals in food. he was very successful. actually as the aside, the congressman that led the investigation was the lady from new york was able to get legislation passed was known as the delaney clause but for many years there's successful to push them back and hill was in charge. he said you need your own research to be be mercenary but you need opposing research to convince people that those other studies were not rob but they were not correct enough to reduce uncertainty and the tobacco industry successfully opposed the science for a long time all of the science which explains how the tobacco industry d

but we look at the epidemiology and with my colleague what we did is looked how many people self report those characteristics, and we found 15% of the obese individuals, 30% of overweight individuals and 20% of healthy weight individuals scored very high on all three characteristics. so certainly more people who are bigger have those characteristics but a significant percentage of people have those characteristics and if you extrapolate and there are risks of extrapolation that turns out to be some 70 million americans who self report loss of control, lack of space station or preoccupation thinking about foods. last piece of science and this is the most interesting. we took those individuals who have the constellation of characteristics, what we call condition hyper eating because those are the characteristics of a conditioned and driven behavior. and we study them and we study the bureau imaging. we designed the experiment and to phase is to read the first is the anticipation if we are not eating, the power of food comes from what? from the taste? yes, but it's also the anticipation of

my research discipline uses a hybrid of techniques from economics, epidemiology and statistics in order to gain an understanding of the healthcare delivery system. .. relevant. decade ago, my colleagues and i wondered if a higher mortality rate from cancer seen among blacks could be due to the receiving less a effective treatment, specifically in the setting of cancer. we chose to study a single cancer procedure to address our questions. surgery for early stage one cancer. we focused on this procedure because it treats the no. one cancer killer, you lung cancer, and is enormously effective. in an analysis we published in the new england journal in 1999, a decade ago, prior to the report that has been referenced many times, we showed that in medicare, blacks received this surgery 15% less often than bites with the same diagnosis. we showed that this was not due to greater morbidity amongst blacks or differences in socioeconomic status, we showed that we believed the achievement gap was the explanation for their survival lot comes. the study is memorable for me, one of the first major ana

linking one cancer to cigarette smoking and at that point it was overwhelming but this was early in epidemiology and have been a shock to some people but tobacco industry sought immediately there were facing a problem. john hill, the founder of the worldwide relations came and said you have a problem you have to address. here is the strategy and hill has some experience working for the chemical industry before that. it was a congressional hearing on carcinogens in cancer causing chemicals and food and hill and has the chemical industry how to fend off a proposed legislation that would limit the chemical contamination of food.

. >> is there any epidemiology cal research anybody has done on it? >> we've been working on it. >> there is research that's going on, but it's limited research. this is -- it's been described as an orphan disease. there's only, like, 30,000 people. only. that's a lot of people that come down with a disease that is absolutely, in my opinion, one of the ugliest ones out there. but the research has been limited. they have not had but one new drug placed on the market since literally lou gehrig named the disease. >> really? >> i didn't know about -- >> but why it's connected to the gulf war is is still unknown. >> yes. >> mr. chairman, just one comment. >> yeah. >> as you work towards -- if you work towards something like that, using alwae ining alzheim the wrong label. we should use dementia. there's different kinds of dementia. and alzheimer's. >> i'm not sure when i characterized pizzi hollings if i had that right. thank you for that correction. mike, let us know where we are in the number of minutes. >> there's two. >> i have three. >> that's five. >

and equipment, health care cost productivity and market, health promotion and disease promotion, epidemiology and medical liability. and you know, so i want to characterize that accurately. this does everything you want to do in your quality section does it for less cost with a whole lot less red tape with a whole lot more acceptance in the provider community. >> thank you and what i would suggest is that can be a discussion that can be revisited but at this point we want to move along and try to parcel out and break it out so i'm going to presume the recorded vote and the clerk will call the roll. [roll call] [roll call] [roll call] [roll call] [roll call] [roll call] >> [inaudible] murkowski is no and mikulski is yes. i voted no and the recent vote is aye. can i told you this goes back to when her dad was your. we get each other's mail, we get each other's e-mail. when her dad was here i was invited so much to the reagan white house. [laughter] thanking me and wanting to share their appreciation i just want us to be careful. >> the amendment is open for -- bill is open for further amendment

this is a hybrid of techniques from economics, epidemiology, and statistics in order to gain an idea about the health care system. for more than one ticket, but my main interest has been health disparities. i am grateful for the invitation to speak to you today about my research and others. i am humbled by this opportunity, and for more than one decade, the national institute of aging, and many others, and specifically credit my colleagues at sloan- kettering and those at the center for health change. we have for together on these problems. the names of their peer are less relevant. about one decade ago, my colleagues and i wondered if the higher mortality rates with cancer could be due to blacks receiving less affected treatment, specifically in the setting of cancer. we chose a simple procedure. this was for early stage lung cancer. the streets the no. 1 cancer killer, lung cancer, 25% of all cancer deaths, and it is enormously effective. in an analysis printed one decade ago, prior to the report that has been referenced many times, we show that in medicare, blacks with an incurabl

another piece of it was the predictive analysis using epidemiological models, looking at history, trying to project what might be. as this virus developed. so, i found in the intelligence committee we played a non-traditional but very important role in trying to inform the u.s. response to the u.s. response to the h1n1 flew phenomenon, which we don't know the final story of yet us so, this business of standing the environment, looking for threats and opportunities trying to project trends is sort of the day-to-day business that we do. the second broad area that we pursue it is, when the united states moves in an area, makes a policy, make strategic choices in terms of what is going to do to deal with the region or a situation. in that case, our responsibility in the intelligence community is to portray a fundamental understanding of what is really going on in the ground in the area were talking about. at least to my personal experience the united states is made many of its mistakes and national security by having a misguided understanding of the real situation on the ground right at the

excellent work done at universities in our respective home states in the area of food safety and epidemiology. the university of georgia is home to the world-class center for food safety, which has for more than 17 years assisted the c.d.c. with foodborne disease outbreak investigations. the university of georgia center for food safety is known for its leadership in developing new methods for detecting, controlling, and eliminating harmful microbes found in foods and is the go-to organization for the c.d.c., f.d.a. and food industry when seeking solutions to difficult food safety issues. the center for food safety frequently provides f.d.a., c.d.c. and state health departments advice and assistance in isolating harmful bacteria such as salmonella and e. coli, 0157 from foods. i am hopeful that the food safety response act of 2009 will be considered as a part of comprehensive food safety legislation in the months ahead. both senator klobuchar and myself are cosponsors of the f.d.a. food safety modernization act, a bipartisan measure to enhance current food and drug administration authority to

freedom of information act they were able to get the raw data and of course they did another epidemiological alchemy in the results go away and they conclude workers were never exposed above the current permissible exposure, did not experience long cancer excess risk. fortunately judge back here in philadelphia who died not so long ago said that is nonsense and threw it out. this is the only health standard that the bush administration, osha has actually issued and there were forced to by a federal judge who happens to be republican, dairy upstanding judge. the required osha to issue new standards. osha extended 1 microgram come as the still up the levels the studies done would be increased risk of lung cancer but far lot better than the level of 52. at when michael graham they figured out you can still get 71 cancer deaths for every 1,000 workers but of these they were better. osha said please give us anybody who has information about workers exposed to low levels because of the studies were done on old factories where people had higher levels of exposure. industry use this as a way to say,

the national public health information coalition and the society for health care epidemiology of america. at the current time, many parts of the local, state, federal disease surveillance system are fragmented, are based on paperwork. they have not been the beneficiaries of new technology that could improve the completeness and the timeliness of reporting. the amendment establishes national standard and authorizes existing grant programs to ensure that all state and local health departments and public health laboratories can readily receive, monitor and report infectious diseases and other urgent conditions of public health importance. the amendment will help ensure that everyone at state, local and federal level is communicating and equipped to rapidly detect and diagnose and respond in the event of a public health emergency such as the swine flu pandemic, which is currently ongoing. my amendment will return lost funding for surveillance and response activities for deadly viruses such as west nile, antivirus, monkey pox, sars and other. the funding will permit state localities to partic