a little bit earlier what i've asked every subcommittee to do this year is to begin by asking the question what will this country look like in ten years what what are the scientific opportunities that we should be thinking about in your case and basically i just want people to look at every program in this budget at least those under the jurisdiction of this committee in those terms rather than simply looking at the numbers and not understanding what's behind them i mean this country is going to be larger it's going to be older it's going to have a lot more environmental pressures it's it has huge house and needs we have a huge gap between the wealthiest people in the society and the poorest  d we will have a if we continue on the present course we will have well over seventy million people without health insurance and i think that requires that we a look at this year's budget in terms of what it does to get us where we want to be so that we can deal with the kind of country that we're going to be living in ten years from now and we're especially interested in hearing what you have say let me simply say in opening that budgets are often sent down here by presidents and if a budget item contains the same dollar amount that it had the last year the president says well it's a status quo budget and we're just keeping up with what we did last year but the fact is that that doesn't reflect reality because something which is level funded in nominal terms represents a step backwards if we don't adjust these budgets for inflation and for population so that we're looking at real per capita  expenditures then we are simply going backwards and as you know the budget that the administration presented for this year at least in my view represents a step backwards we were when party control switched in the vendor the incoming majority was faced with the problem of having to pass last year's budget because no domestic procreation had been passed by the previous majority and so we had to make some tough decisions and we cut about sixty programs one of them we did not cut was yours we increase grants provided by age than was the case two years ago and i don't think that that kind of pathway would define progress but because we increase that funding it means that the budget presented the president this year is actually a decrease from the previous year and so i would be very interested in knowing whether the administration is willing to recognize that under those circumstances the budget that it's presented is inadequate and needs to be other augment the certainly in the case of the national institutes of health i would also note that the  funding the global aids initiative now that happens to be a high priority i think of every member of this committee certainly is a mine but and it might have been might have made sense when i was in the process of almost doubling its its budget it might have made sense to ask and i had to fork over one hundred million dollars to that effort but i question whether whether it makes sense now that we're asking in an area of or  era of virtually level funding and perhaps even declining funding that i would question whether or not it makes sense to continue to divert that kind of bucks from your institution to the international program seems to me that we ought to find other ways to augment the program but we'll get into that later i'm going to ask mr walsh whatever comments he has and then i would ask it introduce all of those not just those at the table but the other institute directors or any other figures of note you would like the committee to recognize before we begin the proceedings  chairman good morning doctors or hony and welcome all the leaders of the national institutes of health i'd like to be clear at the outset that i'm continually impressed with the discoveries that come from n h and the research that's done the each day there's no question in my mind that these discoveries have the potential to change medicine not only here in the united states but around the world and to cure disease prevent disease and promote  health i'm also concerned that we do everything possible to make sure that those advances reach local doctors and community hospitals that's where the rubber meets the road i understand their reasons for the lays in taking this research to that level including safety and cost but i think we need to look for ways to move this research into practice as quickly as possible without sacrificing safety i'd also like to underscore the need for sound financial management which i know has been something that you and your leadership staff have stressed twenty nine billion dollars isn't chicken feed congress has i think strongly over the last eight years or so  dramatically increased national institutes of health funding to respond to the needs of the country and we need to make sure that that investment is being placed wisely and where it can do the most good finally i'm very pleased to see the focus on preemptive predictive in personalized medicine we have as you know and as you will note as you noted in your testimony now become a country that deals predominantly with with chronic disease and the costs are growing dramatically the hope is that through the research that you do and the ability to personalize medicine we can better get at these diseases at a very early stage in human in that humans development i think the sequencing of the of the genome and the creation of the hat map have provided researchers with the tools they need to accomplish this so we're very hopeful and we look forward your budget you mentioned before i go forward i'd like to have my colleagues introduce themselves i couldn't do this job with the outstanding directors of all the twenty seven this isn't centers of the national i'm doing oleksandr director of the national institute of child health and human development thank you what i would like to do in the next few minutes is share with you know only where and ice has been for the past thirty years what we are today and what is our vision for the future as you know you can't you can't follow a strategy unless you have a clear sense of where the field of the fields of science that we fund are going and what is the vision that i think and i am sure the nation and general needs to have in terms of improving our ability to reduce pain and suffering and reduce the burden of disease what i'd like to do is very quickly give you a sense of where the nation has moved over the past thirty years clearly americans leave live longer and healthier li there's no doubt about that and that's due to a majority of the rally if advances if you look at cancer this year for the second consecutive year annual cancer deaths in the united states have fallen this is unprecedented and this is the spike the fact that the population has aged in the number of the number of our citizens has increased and if you look at the investment that each one of us has made per capita as the chairman said the average investment for a year  cancer research between one thousand nine hundred four and two thousand and four was nine dollars per year when you look at progress in heart disease the progress is absolutely remarkable there's been a sixty percent drop in mortality for heart disease and stroke and in two thousand and four we've seen a drop now in women's heart disease in women going from about one in three women being affected by heart disease to one in four if you look at the investment and then i was four dollars per year per american over the past thirty years when you look at the impact of this advance this has reduced the number of early deaths by about one point three million it is an enormous advance and it has eight enormous economic return evaluated by economists that between one point five two point five trillion dollars if you look at how well americans are aging you're seeing a drop in the chronic disability indices that we have measured since the  and the drop is remarkable there's been a decrease of thirty percent in disability rates for americans over the age of sixty five and that the reason is in is actually accelerating life expectancy has risen to seventy eight years up six this these discoveries have changed in fact the challenges that we face today and that doesn't mean that our efforts have have been sufficient there's no doubt that we're facing as the chairman said major factors which will force force a transformation of medicine and health let me say very simply free practice medicine in fifteen years the way we practice medicine today we will not be able to overcome the challenges that are facing us the challenges that come from the social economics drivers that we have the demographics of our country with an aging population with a change in the landscape of our population in terms of prevalence of disease in different ethnic groups and different in the diversity of our country as i said the landscape of diseases change global health issues have become much more important than they were twenty thirty years ago at the same time though we face scientific and challenges that we never had before but the key thing is there has been great progress over the past ten years and i will show you how this progress for example in the human genome and other areas of research are really offering us unprecedented opportunities to address these challenges when you look at these challenges if i can summarize them i think you can see that we've made great progress in treating acute conditions seventy five percent of our health care expenditures today are related to chronic conditions that last year's the driver of demographics is a major driver aging population as you know as you age you consume more health care there is a different paradigm if you will in the kinds of diseases that we have to deal with which we didn't have to research maybe thirty years ago but we will have to tackle that health disparities remain of a great concern of an age it is actually true that we've seen progress across indices but the disparity is still there and it is not a guarantee that the disparity will continue to decrease unless we do something about it it's clear that we are dealing with emerging and reemerging infectious diseases both locally as well as globally and we're dealing with not infectious diseases are emerging like obesity and its consequences as well as having to deal with national priorities such as by defense which is a new mission for and i each and that i think represents in my view the mega trends that we will have to deal with ten fifteen years from now when you look at that i mean obviously everyone is concerned about the the challenge of rising us health care expenditures and by medical research must be part of that of solution to that there's no doubt that the curve is worrisome in terms of percent of g d p and it's been flat in the ninety's because the population was not aging it is the amount of consumption of health care that is driving in part the rise as well as the cost of health care services if you look at that the health of the latest report from  in ten years will double our expenditures in health to four point one trillion dollars so the real question is how can and i each how can we help with this situation what is our view what is the one of the opportunities where the prospects of science helping in this context first and foremost let me show you in a very short graph what i think is the key to the paradigm change that we are talking about if you look at this graph there are three  layers to this graph is what we call the burden of disease the yellow part is when the patients do not feel any any symptoms this is the pre clinical phase which is something manic phase of the disease the middle bar is what we call the compensated phase of the disease or tolerable phase and then at the end of the disease process comes a phase of acute decamping stations and where interventions tend to occur in the past we've always intervene late in the disease process in what we call the curative paradox patients would come to the doctor have to have after having suffered a deficit of one kind or another or having discovered a cancer or having discovered that they are suffering from  heart disease and that treatment at that time is actually at the most expensive part of the cost curve if you look at that curve what you realize is that cost do not go linearly in proportion to the severity of the disease they actually grow exponentially so it is the least the porton time to intervene and i drove the past twenty years has developed what we call an approach to advance our science so that we can intervene earlier and earlier and we've done so it stream lee well this is why we've had the success we've had over the past thirty years we call it symptom management so for example high cholesterol and h l b i showed many years ago that this was a driver of heart disease and reducing high cholesterol has had a thirty percent impact on the decrease in mortality high blood pressure so managing the symptoms managing high blood sugars in diabetes is important to reduce the cost to patients with diabetes and that does achieve a significant gain for patients in terms of their disability rates decreasing and a potential cost saving if we can avoid the complications of hospitalization and we've seen that happen but at the end of the day we need to really go further than that and i think our science allows us to see a world where we could and that's the paradigm of the twenty first century which is to preempt disease and prevent disease means intervening even earlier in the natural history of the disease process and turning in at the stage that we call molecular preemption that doesn't mean that intervening that early will only be solved by pills and medication it may require interventions in  behavioral science area or the social science area but the potential is enormous if we can succeed in this race against time to discover whether the fundamental drivers of a disease process twenty five years before it hits the patient can we strike the disease before the disease strikes us is the paradigm shift that we're talking about and it is the focus of and i research for the next fifteen twenty years having said that you might ask give me an example how does this work i'm just going to give you the example of rheumatoid arthritis if you look at the images i've shown you you can see the three phases of the disease early when it started this compensator that's tolerable intermediate where you can still function and late when there's no possibility for you to recover in fact the loss of function that has affected these patients in the past ten years we've made progress we've discovered that a tremendous impact on the pain and suffering of patients with arthritis but at the same time we know that we are not done this is symptom management we need to really understand at the fundamental level how the disease develops in the first place how do we do this first try to identify the genes that are involved that's why the n h s launched the gene environment initiative so that we can find over the next three years all of the genes potentially involved but that is not the end of the of the work for of the work we have to do gene all the codes for a particular process we need to do the research on every one of these genes and hopefully find out which is the primary deficit in one disease what is the primary event and hopefully preempt it as we as we look forward so the future paradigm of medicine it's going to be driven not by intervening late but by being able to one predict who how when a disease will develop in one environment what kind of behaviors drive a disease what kind of social construct can tell us that in fact you'll be at higher risk for a disease this is what was what we call predictive medicine and here is a chip for example that i'd like to pass along when i became an ice director this trip had already been developed and was able to track about four thousand genes when i testify in america confirmation hearing today this can track every single gene not only in the human genome but in thousands of other organisms and scientists are using this every day to be able to find out what in fact is the fundamental driver or drivers of the disease process and like to pass this along to the members of the committee the second leg of this is personalized medicine none of us respond the same way to either and environmental factor or behavioral factor or genetics and we need to really personalize the treatment that we give and hopefully again the dream is to be preemptive the dream is to truly intervene when patients are not sick but if you intervene when patients are not sick that also requires a fundamental change in the health care system that we know it will require participation and this is wh we call this the hero the four p s of medicine because patients will have to participate communities will have to participate you will have to take more responsibility for your own care earlier than ever before you can just wait to go and see the doctor this is what we call the euro precision medicine now to get there obviously we where are we today are we there is this just science fiction no in fact i'll just show you show show i showed you a gene chip and i says many of the biomarkers that we need to understand at that level the medicine of the future is going to be driven by object of measurements of biomarkers what is a biomarker any biological measurement that tells us whether a disease is present or not so i'm showing you he sensor chip which is used right now to detect infections and in the urine within thirty minutes this is what we call point of care diagnostics you want to have to wait two days three days to know which infection you have we  have remote glucose sensors now where by telling a tree by radio we can control the glucose level in any particular patient we have here what we call labs on chips this is from nanotechnology in microfluidics where you can take saliva and in fact analyze all the contents that you are interested in in terms of biomarkers from the saliva these advances are going to change in fact the way we manage disease for example the national  hemorrhage you have a lot of complications that come from that if the hemorrhage is enter a cerebral by having the genetic tests we can actually personalize and tailor the treatment in terms of dose to the patients reducing complications and improving the outcome of the treatments preemptive this year i mean i think this is one of probably the greatest breakthrough assured by the national cancer institute the development of the first anti cancer vaccine the h p v vaccine first f d a approved the weakest spot in the virus which has a skin had escaped our detection for twenty research at the nih id showed now that there is in fact a hidden weakness in the virus which we are going to accelerate our research and and put more resources to find out if we can use that to change the face of this disease this cannot be done without a continued focus on basic research at the fundamental level and i cannot stop funding creative investigators new investigators in new areas of science and the priorities of our budget as i described to you are in fact driven towards making sure that our fundamental breakthroughs continue a majority of our budget is driven towards investigator initiated research and a good example is the nobel prize winners this year two of our scientists dr fire and dr mello received the nobel prize in two thousand and six for a discovery that was considered the breakthrough of the year  thousand and two and was made in one thousand nine hundred eighty eight and the speed at which science advances is such that it is absolutely impossible for us as an agency to remain static we have to completely renew our portfolio at a very fast pace so it's important for me to show you for example that this basic science needs to continue last i think the scientific challenge in front of us is the one of scientific of biological complexity if you look for example at the circuitry that our scientists are discovering every day in understanding biology it's not unlike electronic circuits except that electronic circuits were designed by us we are really in a race to understand in this century what the life  sciences need to do and that is to advance as much as the physical sciences there in the twentieth century because if we do not understand the circuitry will be very hard for me to see how we can in fact advance in our vision of a new health care system cell research is a very difficult and emotional issue for many americans i'm aware that perhaps there are additional avenues for research that do not require the use of embryonic stem cells frankly it's my hope that the science will progress to the point at which we can put the embryonic stem cell to bait debate to rest i have read that larry potent adult stem cells were discovered in various human tissues such as spinal cord brain connective tissue of various organs in and blood of the umbilical cord in addition where that research conducted at harvard and in japan believe it kyoto suggests that it may be possible to use chemical and genetic factors to reprogram an adult stem cell to function like an embryonic stem cell in other words to him induce pluri potency finally we have also heard that researchers at wake forest university believe that the amniotic stem cells may be fully as  flexible as embryonic stem cells although i understand that further research on this topic is needed in your opinion is it possible that these in similar discoveries will grow bost stem cell research that will put to rest the divison  debate we have had in this country over the use of embryonic stem cells in research differentiated the differentiating and trying to try to see if it can do something else that it was intended to do and there is research an adult stem cells that is driven towards that however it's clear that the this research has those can in fact be programmed in any different directions our view from the scientific standpoint is that all directions of research should be continued because the fundamental issue here is not so much whether we treating something with one kind or another the fundamental issues perhaps that we need to understand the molecular drivers that make d n a programming possible to treat disease so the scientific challenge a understanding d n a programming and reprogramming and for that scientists will tell you we need all cell lines and brian excel lines which is like a blank page in software that you're trying to understand how to write or take a fully differentiated cell adult stem cells and say well i'm going to try to rewrite the code make no mistake this is probably the greatest challenge but the greatest opportunity in science this century anybody who understands how d n a is program is going to be in the same position as we did in the computer industry when we understood how to write software for computers it is that ability that i think scientists are asking to be able to do so from the scientific standpoint  believe that at this point it is important to pursue both lines of research as vigorously as we can i aware that in august of two thousand and six and two pose stem cells by reprogramming ordinary adult stem cells is that what is the state of play with with that research the team of the team at harvard used an embryonic stem cells infused with an adult stem cell the two together had characteristics that indicated multipotent c and potentially pluripotency but it also had to double the number of chromosomes that you would have in a normal cell so there are lots of questions as to whether or not that whole thing was reprogrammed it's almost as if you took a blank software and then reprogram the software of a programmed desk if you will the japanese did something else the japanese took in adult stem cell and then based on the research that was done in iran the stem cell world took factors molecules which they thought could be the codes to reprogram the d n a of that cell so they use four factors which we know have in importance in what we call research to continue at the end of the day what what scientists are hoping for is if we understand all this code and all these molecules at the end will be able to do all this without embryonic cells or adult stem cells will be able to be reprogrammed these cells on demand if you will by knowing what the codes are that's what the japanese have done with four molecules that seem to be driving that but again very early research not ready for prime time thank you very much mr jackson thank you mr chairman dr zoning welcome back to other subcommittee and thanks for your testimony doug schoen you have a couple of questions regarding the national center for minority health and health disparities i know the but health disparities are one of your top priorities head and i h which means we share a common vision i realize that there are many public laws that the and i have to implement but i want to make sure that in i h does not overlook or misinterpret the intent of the minority health and health disparities research education of two thousand that focuses on the health of the health of the nation's disadvantaged populations primarily minorities low income and rural people i'm interested in knowing what your vision is for advancing the n i m h health disparities agenda over the next two years and what specific role will the national center for minority health and health disparities have in shaping and realising your vision thank you as you know we just held asperities on one of the top six priorities of the and i i think in health disparities we are also dealing with a changing world and i think to do two directions of of action that we need to take one is to truly look again at a complete review of our programs both intramural in extramural e and work with the national center of minority health which has the the responsibility of coordinating all of our actions it is the national center for minority health represents the ten percent of our budget for health disparities so redefine a you know an adaptive strategic plan to this as we know the situation on the ground has evolved the second is training i think we need to review all of our strategy in terms of ensuring a diverse scientific work force in medical research it's very hard to do medical research on this you have a scientific work force the diversity of which reflects the diversity of the population you're researching and so i'd like d echoed many of the concerns that i've raised over the years on this committee about the n h s attention and commitment to minority health and health disparities today i want to revisit some of the issues and observations of the i o m in its report the i o m pointed out that the second i h r t j plan for two thousand and four in two thousand and eight had not been approved and if i can remember it still had not been approved when you appeared before this committee last year we're close to the in the fiscal year or close to fiscal year two thousand and eight that's almost time for third version of the strategic plan but i don't recall seeing the two thousand and four version i found the first version you gave me another and i should teach it plans to be useful so of my staffers and our constituents i'm sure my colleagues also find them useful the hiv aids and cancer t j plans are two that also stand out but it seems like somehow now since i have seen health disparities plan for men i h that the two thousand and four version has somehow not been prepared not been approved or doesn't exist and we should be moving to the third plan is there in approved two thousand and four two thousand and eight and i should teach a plan and budget on health disparities that this committee can have and if you could provide us with that we'd be grateful ruffin expand on that i mean obviously the plan is under his responsibility but we have published the plan the plan is is the approval process that are you referring to is the issue of whether or not it was transferred to congress and what we believe is important here is to modernize the plan and we have in fact and i'm a doctor often comment but we have published the second plan the plan doctors or who me again public law one o six five twenty five identifies the n c m h d director as the federal official for minority health and health disparities and i it also cites that in c m h d as having press possibility for coordinating all minority health and health disparities research and a strategic plan and i furthermore give the n c m h d legislative authority to grant grant awards and this clearly remains the intent of the law the i o m report examining the health disparities research plan of the n i m h suggests that in i h continues to struggle with coordinating the role of the national center and it appears that the authority of the national center is not widely understood by the various institute centers that are present i am interested in you sharing with the committee what steps you as the in i each director have taken to clarify for each of these institutes and centers the authority of the national center and the responsibility of the centers for the institute and centers for health disparities i think director for responding i thank you mr chairman for the time well first of all let me tell you we take the i o m report very seriously number one number two as i said we're working on the strategic plan and through that process through the discussions we've had for the roadmap for medical research for example we've talked about health disparities as a special area and what steps we're taking is essentially to  redefine the third version of the strategic plan in coordination with and see m h d and all the institutes so i'll get back on the record to give you the details and each of the each of the directors of the institutes are clear on that public law and its coordination with d you as you all know more than better than i we are a crises oriented society and it was my intention to be with you the entire morning along with our chairman but the military construction subcommittee is meeting at this moment they were not on my agenda today and suddenly there's a question that c b s is interested in over there i think has to do with have we have a lot of really long term or not so probably i'll have to leave shortly but  i wanted to come for any number of reasons and the years i've observed our work at the subcommittee level in the congress one of the most encouraging signs is that there has been pretty persistently available kind of an almost nonpartisan support for a thing called research focus applied and basic research that is a part of our congress today and it very much dramatically affects your work i might mention mr chairman a very special way since this is a crises oriented society i became aware of the fabulous work that's going on with it and i guess that affects individualize my wife's granddaughter was who was four months four years seven months old was diagnosed and and beautiful downtown the vet with stage five melanoma i had noted a bump on her arm when she was back here julie had her examined we talked to the children's hospital at loma linda the fellow there a fabulous guy couldn't quite believe this was existing that plugged him into the pediatric oncology people at the cancer institute here and a dialogue took place and i each because of the rarity  circumstance and courage to our daughter bring the granddaughter back here at which she packed herself up and did it didn't take very long since it was an unusual circumstance special evaluating they even sent a separate when she's coming back in just a couple of weeks we're on examination is an illustration of what that research is all about and how dramatically effects all of our lives and for that i want you to know grateful we are but i think the country should be for the work that you're about moving on quickly doctors are united had conversations about the fact that there are limited budgets and no matter what we do there are and the chairman is more frustrated even then i about this he had a very serious discussion was one of the country's more prominent entertainers recently who sought most of our research money and apical dollars out to be going to africa for two very specific reasons that priority with him was greater than your priorities as we had our conversation last year i suggested to you that from the outside a lot of people look and i just kind of the club if you're in the club you're in the club and if you ain't  energy and water subcommittee appropriated money for a proton beam development a process developing at loma linda california which is proving to be canonical attorneys of its results for noninvasive treatment of certain kinds of circumstances  the point i'm making here is that within the club there's a tendency for people going to divide up the pie and spend money on everything and i asked dr hony working with dr fouts you know others to go back and say look all of our guys ain't doing great work some are doing wonderful work and getting lots of results others have been kind of piddling along it's been a money anyway when do we ever cut them off or do we do about making sure this club changes its color and tone and otherwise over time feeling is out there is not justified by facts in fact when you look at the portfolio and and try to analyze what it is that we do two facts emerge one only fifty percent of five grants get  renewed after the first time approval so the number of grants that get funded year one get renewed is only fifty percent and then five years later is only twenty five percent five years later only twelve percent if you look at the number of scientists who receive more funding more than twenty years a just less than five percent so the turnover is actually there but the peer review system which is what you have to go through and convince the scientific community is what i think people refer to i was just in germany last week and they invited me from all european societies of funding agencies to tell them about the american peer review system and they are adopting that review so there is it's like democracy it's the worst system until you try way to really look at what's taking place now as a relates to health disparities and where we're going to be in ten years and you mentioned doctors of the who me in your testimony to heart disease cancer diabetes we're making some gains in the general population yet as a relates to communities of color african americans latinos asians difficult merican specifically these gains i don't see i'm wondering where will be ten years out for example in my district in alameda county we had an average of two thousand people die of coronary heart disease which is a mortality rate of about one hundred sixty per one hundred thousand but across every category african american men and women in my district i had higher rates of mortality than any other group two hundred and eighty fixed her one hundred thousand for african american men and women one hundred ninety nine thousand or one hundred thousand for african american women and so the overall mortality rate has declined in my district and it's just an example a microcosm of the rest of america the gap between african americans and communities of color and the overall county rate in the general and this is an coronary heart disease but the story is the same when it comes to cancer and diabetes so i'm just asking where are we going to be in ten more years and then the second part of my question i really like to direct to dr rogers if that's possible you know there's an issue with regard again this speaks to disparities as it relates to diabetes and some of the lab tests it has come to my attention that course we know african americans have sickle cell trait not recognize you and thank you for your work that you've done in sickle cell anemia dr oz's but the a one c test that has used quite frequently to diagnose diabetes if an individual has the sickle cell trait oftentimes that a one c test shows false positive results and this came to my attention several years ago and i've talked to nine or ten people who subsequently went back and talk to their physicians and retest with a different type of a test they came out negative and they had been taking medicine for diabetes all of these years so i'd like to find out a little bit more about that and how what's going on and what we can do to correct that because i'm terrified of what is taking place out there given these false positive ratings first doctors are who now and then i'm like to dr rogers to commonplace let me just echo what you said i think there is if you look at global statistics you see some improvement across all in the seas but you are absolutely right it's unequal improvements in even if you look at hiv aids for example there is this for the impact if you look at obesity there's a disparate impact and that impact is going to grow over time  i don't want to take all the time i'd like to ask both after rogers and also that unable to address the programs that they're focused on and thank you thank you for the question let me first address the issue since you mentioned diabetes and what specifically doing to try to to change that in terms of making available treatments making seminal trial called the diabetes prevention program and we wanted to determine whether in fact people with pre diabetes could be one could diminish or reduce the rate at which they go on to develop frank diabetes because of the large proportion of people in certain ethnic groups that go on to tell of diabetes we all sample from this population over forty five percent of the enrollees in this study that would include over three thousand or from ethnic minority populations this study involved modest lifestyle adjustments and it was certainly show that just with those lifestyle adjustments that is a diet in certain types of exercise that one could reduce or eliminate the rate at which these people went on to develop diabetes by fifty eight percent almost sixty percent the message now is that that's out how do you translate that into the level of practice something that that one of the other congressman referred to and in order to to translate these evidence based approaches are developed in conjunction with the c d c the national diabetes education program and from that we bring  in with two hundred private partners public partners a whole range of people to really test how to best get that message out to individuals and and i'd be happy to hear dr oz i'm just asking you though and i thank you for that response because clearly diabetes is a disease that among all ethnic groups has to be addressed and i think you all are doing so from now on the work i want to ask and get you to respond specifically to the the relationship or the correlation between the a one three test and the and individuals gene one parent in a normal aging from the other parent a one c is what's called an adult as red cells stay around for about three months some of the glucose that's in the body will bind to the h n if you have about fifty percent of your cells in the case of people with sickle cell trait being a but the other fifty percent actually sixty five percent of sickle hemoglobin one isn't actually measuring the s one and that's where there is a problem now people are sort of looking at that with different techniques using chromatography to try to quantitate overall like opportunity i'm a global and that's a standard that people are are working on  patient has sickle cell trait that this a one c test is not valid there are many thousands of people i'm sure who receive positive results who are subsequently provided medications for diabetes when they possibly don't need those medications and they may not be diabetic and so we need to figure out how physicians and lab to work together to make sure that individuals primarily african i can certainly follow up with you on the specifics of the laboratories who are actually a participant in this national diabetes education program we do it representatives from the laboratories to try to get that information just described and doctors are honey it's great to see you and all the institute directors and let me just start out by thanking you for acting promptly to convene the  calling for this study there had been two significant studies published using the the s d data purporting to show that there was no evidence that mercury in childhood vaccines was involved in the increase incidence of autism and autism spectrum disorders i had many scientists come to me complaining about the quality of the v s d and the workshop you conven saul for most childhood vaccines would be an informative and potentially misleading both of those studies were published in pediatrics the lay press did headline stories purporting to show that no link so this this issue is not resolved so i want to commend you and i just have a number of questions i want to ask  you i guess the first one is you had spoken to me a couple years ago about translation of research taking the basic science research and moving it to the clinic getting it out of the rat and mouse phase and into the place where it's actually helping people how much progress are would you say you're seeing in that and in particular i know you have a limited budget that you actually control a lot of the money automatically goes to the institutes do you see this reflected in the various institutes and their initiatives i know you've mentioned a couple of very interesting things in your presentation here what i'm more interested in is the global effect here do you see more of a trend in that direction i have to say the institute themselves contributed across the board in terms of finding ways of accelerating translation there's no doubt that this is a component of the research enterprise that needs to be reinforced and through the roadmap for medical research to which all institutes contribute that was one area translation which led to the development of a really the first redesign of our translational strategy in the united states since one thousand in the fifty's and that's called clinical translational science awards for institutions to come together in a different and time taken to go from discovery to implementation well if i could just interrupt you for a second one of the issues associated one of the problems with this that has been brought to my attention by researchers is the cost of those clinical studies that that is really a big problem and that a lot of those costs were previously shifted off to other payers at the medical center level and that is i know i had a bill in the last congress i'm thinking of reintroducing it this year to try to address this issue is that still a problem generally speaking that the universities just can't afford to do these clinical trials anymore by and large it's a problem of the cost of clinical trials in the clinical care just like health care in general go faster than inflation i think to also do it safely is more costly than just practicing medicine so we're seeing in fact whenever there is a constraint on resources not clinical trials become much more difficult to sustain by institutes across and i you in your presentation you very quickly buzz through something about  it's its structure what is it by the way that the current vaccines that are in trial are gauge to develop cell mediated immunity which in animal models has been shown to prevent the progression of disease but not to prevent the actual infection herself everyone agrees that in order to prevent infection you'll have to get a neutralizing antibody that actually recognizes all components of the different subtypes broadly reacting neutralizing antibody that has been a very very elusive component of vaccine research with dr who he mentioned that just came out in the journal nature it was a discovery from the vaccine research center a city for molecule and then there's a conformational change and it exposes an epitaph ohp that has been very cryptic in other words it's something that the body doesn't see very well so therefore it doesn't make an antibody at it so what they were able to do was to get an antibody binds it to that part freeze it and actually by crystal a graphic and molecular modeling showing exactly what that epitope is that is really a breakthrough because with that means now that we know what the molecular structure is the next step is to make that molecule in a form that when you inject it into an animal and ultimately a human you will list it these very elusive cross reacting neutralizing antibodies so it really is a very important step forward i just said one of the quick question the reduction in cardiovascular disease is only thirty percent attributable to the wants to spread application to staten drugs sent right said what i heard you say right generally when you it's hard really to to match a budget paradigm in each institute different institutes will have different folks focus areas for example biomarkers this year we worked with the foundation how they are looking at your budget and how they're billing the budget to address future paradise i mean if we don't do that then when i get there it's like nasa set up their budget based upon f t s rather their mission can be convincing to english so that policy makers wonders down what the hell we're talking about because you know if we don't understand what we're doing in the area we should make it we shouldn't be making decisions on it because it's just too it's too out impactful to dr ruff and i want to thank you for your funniness study in california focusing on reducing liver cancer disparities among asian american pacific islanders by preventing hep b infections  you know the c d c recently called for more focused detection and immunization efforts in order to halt the spread of hepatitis b among at risk populations to what extent does your agency collaborate with c d c on the b efforts and what if any future studies are your office planning around the hep b disparities in the asian pacific islander community and let me ask a question of dr mabel this is the national sleep awareness we and sleep apnea and other sleep disorders have been linked to major diseases diseases like cardiovascular i have obstructive sleep apnea so it's important that we have this morning public can you expand on the sleep disorder related research being conducted by the institute and then back to doctors or how many of the the mandate that's being formulated within and i h that we require any articles published by authors funded by n h be published in a publicly available trunk database within six months of the publications there's a concern out there by different scientific societies that the peer review will be done on by taxpayer mon this is a shared study that that we call fun with the national cancer institute which is indicative of a lot of collaborative studies in partnerships that we have with the with the i c s but the n c i i think is responsible for a lot of the science that's happening with that particular project thank you very much for your question regarding sleep related disorders as you know the national heart lung and blood institute is very proud to be the home for the national center for sleep disorders research we have a very very vigorous research program very active advisory board and it's interesting as you watch the research of over a number of years well it initially may have been focused on sleep per se we  now recognize that there are many sleep related disorders as you've articulated we know that that sleep is very important in terms of the development of lung diseases heart neurological diseases stroke and so what we've really seen is an infiltration and integration of sleep related research into all of these areas not just in the heart lung blood institute but in the neurological in other inst the articulation one on the call we can access policy we agree with the principle of not damaging peer review and i'll get back to you on the record thank you thank you it's very very helpful it also shows us when there is a detour and i guess i'd like to have specifically about the third generation anthrax vaccine research there is r f p that was put out recently and then rescinded and so you alternately put off the the research of the grants in that particular area at least until the end of two thousand and eight or maybe two thousand and nine what's the rationale based upon your your own determination of priorities within the agency generation anthrax was actually pulled just for the clarity the first generation is the aviator the one that's been given to the military for a long period of time the second generation is the r p recombinant protective an engine the one that first faction was trying to make and now it is also making in our attempts to get a third generation we put out a request for proposals and upon looking at what was submitted we felt that none of them were mature enough to go ahead and essentially set the companies up for failure they were not ready to meet the milestones that were in the contract proposal that is the reason why it was recent does that make you nervous that they're not to that point because it makes us vulnerable are we is there anything that can be done to help that along well i always like to see good science come in and when it isn't and the midfield isn't ready and mature different that's one of the reasons why to keep feeding in with some basic research as opposed to a contract that actually does the application i'm concerned about that but my concern is somewhat assuaged by the fact that we do have though it has been having somewhat of a checkered past a first generation a v a that strategic national stockpile but also we're working on the recombinant protect advantage and if we had absolutely no vaccine at all and we put out a progress for proposals and we had to reject them i'd be much more nervous than if i were looking at a third generation one which is very going on right now but my second question might be a little odd but staff will tell you that you know in politics and specially in communications creativity is great but plagiarism is a lot faster so we're always looking for other people's good ideas that we can steal or not we thought it was at least interesting based upon our relationship with that country or other countries that maybe we don't get along with as well are there ideas that you can share research are you precluded from that for a entirely different and that is a state department reason or whatever reason that we don't communicate with a country like cuba and we can sell negra cultural products i would like to think that if they actually do come up with a good idea we can steal it and use it for ourselves well first of all our strategy in science is to be absolutely out within tennis to find out what is all titians not always agree with yes i guess right question is do you have a free flow of information you do through scientific society's publications there is no real difference in for us to analyze a paper that comes from any part of the world the national library of medicine and us and xs all of the publications in the world so we thought you would be precluded sending any not i'm aware of and none come this way and that's just one example i assume there are other political decisions made with countries but it would seem like that if we can sell agricultural products for feeding the poor in cuba we ought to have an opportunity to be sharing information or people back and forth i just wondered if that is done now it's from a scientific standpoint the more exchange the better but it's not being done now as far as people know that i'm aware of that i can get back to you and i would like to know that thank you thank you  passive funding would it be easier in doing your budget documents and preparing and really showing the increases and the decreases that the n h is  facing if if the n a s was not used for use for this this conduit to pass these these these important dollars through but if it was not if you were not used as is the kind of went if we could find a better way of doing that housekeeping for the budget transfer well the again the budget was increased by two hundred thirty two million two hundred of which was the contra the u s contribution to the global fund for hiv aids malaria and our contribution was one hundred million dollars through and i idea it was increased to three hundred and it was part of that the two hundred difference obviously this is an activity that relates to health are there other categories of the budget in which you if i could have you just talk more about some of the losses programatic losses to global health and some of the losses to leadership capability of for the united states to compete globally when i see things you know i strongly support funny more basic research but i noticed also some of the lost opportunities for us supporting scientists the dollars for levels of scientists being funded in an entrenched in order to help the united states become more competitive could i ask to basic research i like to comment first the global leadership issue and the competitive this issue from my standpoint it's clear that worldwide as i travel around the world life sciences  the battle field of science today in every country there's no doubt that all governments are increasing their investments in fundamental research in applied research to increase their potential return to biotech and new industries i was in europe just last week and they have launched a new program of science so if you look at publications worldwide there's no doubt that we're not as predominant preeminent as we were and we're still the number one nation in terms of research productivity but not you know you can see that there is a collaboration so there is definitely increased competitiveness i'd like to have me my colleagues talk about global scien scientific exchanges and perhaps impact on new investigator for my well every every institute would have a similar story that's related specifically to that area of interest in the arena of infectious diseases and global health and global emerging infectious diseases we clearly are now and have been for a considerable period of time the leaders in that field one of the concerns we have is that as the world becomes more global in the sense of global economies and global securities and things like that global health becomes a very very important component of what we do and we want to make sure that we maintain the leadership in training people to do that which becomes progressively more difficult when you have  a constrained budget we could always do more we're doing very well now with what we have but the opportunities now in the arena are of global health or really exploding  just my comment in the area of heart disease obviously there needs to be a lot of emphasis on the infectious diseases but the next most common disease worldwide is heart disease and predominately hypertension and we're very concerned that in many developing parts of the world there really aren't the tools even to detect high blood pressure often many individuals present with heart failure very late because they didn't know that they've had high blood pressure and didn't have the means to treat it for many years we recognize that we need to be a catalyst for coordinating and helping to simulate and lead global efforts in the cardiovascular arena as well it's something that we haven't historically done much of but we see it as our increasing role and responsibility to do so you talked about training of scientists are intermural program on the campus we train many individuals from the walk around the world are very proud of the fact that those individuals go back to be leaders scientific leaders in their country because of our budgets i've noticed in our own interest programs we've had a forty always great to have you here keep reading articles in and about this may be the current youthful generation that is the first generation in our lifetime that doesn't have a longer life expectancy i mean we've come a long ways is that accurate that it will depend on the evolution of obesity and its impact on co morbidities it is impossible for us to say that but there are long range demographers who look at public health who are concerned about the impact of obesity on our in our country worldwide i think you are seeing a increase in emerging  and that clearly may have a in impact on life expectancy worldwide especially in developing countries and the last ten years are we are less fit nation or more fit nation physical fitness merely from the statistics we have increased life expectancy the disability rates in older populations is decreased the concern is what we're seeing in the younger generation with the rate of obesity having really increased that much more than than expected diabetes and how about mental illness at the nearest to mental depression mental illness mental illness if you look at the two measures of impact one probably the typical mortality morbidity but also we measure quality of life adjusted life years and if you look at the population between twenty five and forty four mental how the issues of now become a very if not the top the second category of loss of  health quality of life while i represent rural are the most rural districts to mississippi or second most or all districts mississippi and and i see and i've been working on health care for thirty years at the state now in washington and i see a real disparity i mean rural america does not have equal access to urban suburban america and especially mental health you know may my counties do not have a psychiatrist or they're not you know they're not they're not around and so doctors family physicians and internists treat them  i've been with groups of doctors they all agreed that the majority of their patients more than half come to them for an illness but also have depression is that a big number that i mean they said the majority more than half of their patients is that is that common in the general population do you think that's a rural issue the expert i don't know the details of the numbers but i can tell you that it is a growing concern both in urban and rural areas i think the methods of interventions of improved but still one of the issues that congressman walsh was mentioning is how do you reduce not to projectile practice and we're doing what we call practical clinical trials the national institute of mental health is doing that to try to best evaluate advise physicians in private practice about in primary practice or practice on how to handle that but you are absolutely correct though that if you look at the twenty five to forty four population there is definitely a mental health issues have become the are the forefront of the issues we're seeing that also in younger populations perhaps dr alexander can mention that in terms of  childhood depression and mental health there's two conditions in childhood that are particularly concerned because of their increased frequency of diagnosis one is depression that we used to think didn't occur in children and the second is attention deficit hyperactivity disorder where an increasing proportion of children are being diagnosed with this condition some of them treated well some of them treated not so well we have drugs that are effective in children  for depression as well as affective for attention deficit hyperactivity disorder they're not always used as effectively as they could be and there probably is an urban rural discrepancy and disparity in how well these are used  how important is physical activity mental health mental health that link is there people dispute the size and extent of it but clearly there is a relationship between increased physical activity exercise and good mental health there's also increasing evidence that the children are missing an outdoor environmentally experience that does that is a contributor a less good mental health and a less healthy development and appreciation for the natural world around us that's of concern and people are focusing increasing attention on this as well it's my  news that i have from watching people you don't find many people who work out four five times a week that are depressed or stay depressed they may have a short period but but there's something about physical but but i don't find the mental health community i don't find physicians often prescribing physical activity which is a free prescription you know even cost us money taking a walk swimming doing something physical doing something that gets the blood flowing i mean what's got only brings about mental health but physical health i mean is the medical community going to realise that a lack of physical activity prevents healing in all i think it's might be more important than these wonderful new drugs are coming out to how do we whose role is it to convince america that they've got to get off the couch and get to walk whose role is that in america who thought who should do that i think is a jointly shared role we're seeing more and more publicity about in the media about the importance of  physical activity in relationship to both physical and mental health i think more physicians are in fact are advising their patients to get off the couch and engage in physical activity an exercise the problem with that is the compliance issue just as with the compliance with medication it's probably even more difficult to get compassions to comply with that court sort of advice and we need to do a better job there but one i just want to make once you once you do learn that i mean you use a person i've learned i come from a family with some mental health problems i don't have a man helpful i said i'm going to but i'm pretty physically active and physical activity is the best medicine i've ever met to be on th group in the united states and account for almost half of the u s population growth as we look at ten years out it is truly imperative to our nation's a future that we understand the risk factors mitigating disparities in the health of this population i understand that the plan is to enroll sixteen thousand participants and to follow them for six years at an estimated cost of sixty one million dollars over the course of the study how much will be needed to get the study started the initially and then how much money will you need of for the subsequent years until the completion of the study also  id and d s and o d s are also participating as you indicated this study will be sixty one million over six and a half years from our instance perspective we have done our best to budget that in the out years so that we can meet that commitment we don't like to start a study unless we are confident that we can meet those financial commitments over the next six and a half years as you mentioned we're very proud of this study because we believe that it will be the largest launcher to know cohort study of health and disease in a span of americans in this country and it's about time we got this going our intent is that this study is something that we want to continue for many many years in the future the reason i ask the question is because i concerned that it may meet the same fate as the children's health study where the president zeros out the money longstanding commitment to the jack of hearts study which is a launch title study of heart disease and if americans and our commitment to the framingham heart study we desperately want to see the study go forward i also understand that the suspended commu health study is only focused on participants between the ages of eighteen and seventy four however science tells us that many adult onset chronic diseases have their foundations in risk factors and behavioral influences that occur well before the age of eighteen why was this particular age group pick and will your study be able to capture this important  expanding that to younger younger ages is what you're suggesting well i mean based on on on studies that shows what happens well before a teen has a direct impact on the health of you know of anyone  i'm just curious why they chose this particular age group and i thought if you could get that answer for me i would really we would be fairly appreciative to do so dr alexander one of my interests is the early screening and appropriate follow up of genetic disorders as you know early diagnosis and treatment again can make a difference between life long disability and optimal development in fact this week congressman simpson and i will be introducing the newborn screening saves life active two thousand and seven which is the house companion to senator dodd and senator hatch's legislation because of my interest and i was pleased to learn last fall of a new and i h initiative focused on the development of innovative strategies for them in molecular genetics screening of diseases in newborns and i was also impressed to see that this initiative included a patient education piece called the health info are exposed gram designed to direct patients to a patient friendly website that will supply reliable information on newborn screening and genetic diagnosis what is the pome brogue matic budget for this initiative in two thousand and eight and will the president's request for a one million dollars increase in i c h t's total budget will that be enough to ensure that all facets of the initiative are carried o this is a one of the techniques that does high on the list of doctors or who needs preemptive methods for improving health by identifying these disorders in the newborn period we're often able to intervene if effectively and the year ago we launched a special initiative from nic h d on newborn screening expansion this is a more massively underutilized technology at the present time we could potentially diagnose far more conditions than we do and initiative was twofold first of all to try and use new technology one being the chip the doctored sunni displayed another doing micro beast technology where we're able to make a genetic diagnosis directly rather than a secondary diagnosis and then vice after the screening do definitive testing for diagnosis and initiation of affective treatment  that you know the next on education the next generation may be the first generation to not have the kind of quality of life than the previous generation and now hearing that the life expectancy may be less than the previous generation i think speaks to our chairman's vision here and what we need to do in a real called action for all of us whether in education or health we have some real serious issues that we need to deal with i want to first thank all of you for doing what you've been doing on forty four dollars a year for america and i think it's just been absolutely astonishing that you've been able to do that and i just want to say thank you i have two questions one  regarding the stem cell research issue it seems that the bans that we've had here on funding in the united states on embryonic stem cell research has led to some openings  in asia and singapore china japan some of the other asian countries what is the long term effect of this on our ability to reach these kind of discoveries that some of these other countries may make on the brain drain here in the united states i know you have some programs the pathway to independence and some other programs for young scientists what has the effect of on the fact that there was no funding before two thousand and one in the ceiling started so we've been able to really build an infrastructure train scientists and using the twenty one cell lines but a bit of research can be done with that so that we've been able to do things that would not have been possible otherwise but i view as you look forward my sense from the purely scientific standpoint is that we should find a way of allowing our scientists to have access to more experimental models including embryonic stem cells to understand the fundamental issue from my standpoint as head of the agency if you really what you try to do is always try to reduce the problem to its essence and the problem to its essence is the race to understand one another we have the human genome and the human genome variation how is d n a control program regulated just like in that circuit that i showed you that is the mystery and others are really jumping in and as you said there is a sense worldwide that this would be a major prize for scientists worldwide to understand how that's done if you look in real terms  brain drain for example i'm not aware of major brain drains out of the u s because of embryonic stem cells because we do fund embryonic stem cells we support a lot of laboratories if you look at publications there's again there's no doubt that international publications are rising in relationship to our publication but we're still the dominant create whore of intellectual property and licenses and so on so i think we're holding our own  we're not in a dire situation but i think the project forward i'm concerned we need to really allow our scientists to do more of what they need to do sort of crack that code and cracking that code will be just like creating microsoft again and the country that does it is going to be in a strong position to understand life sciences because at the end of the day this is one of the fundamental issues in life sciences how do you regulate program change d n a d n a functions so that you can use it for preemption or or or therapy final question one of the issues i didn't see an error of all the research that has been fascinating to me is the issue of stress in our society in america in particular and i don't see the kind of research done on it maybe that i think we need to see i'm sure you have some some research on it and when you talk about heart disease and you talk about high blood pressure and you talk about some of these other chronic issues that that we're going to have to deal with long term it seems to me that a lot of this is caused by stress and a kind of piggyback on what mr peterson was saying it seems like we're not and we're not teaching as a major component of our health care system the ability to deal with this the pressures and you know the health care pressures and job pressures and globalization and all this stuff in youngstown ohio that people are dealing with we're not i don't think teaching from a health perspective the importance of being able to manage this whether it's physical activity lack of quite frankly funding in our schools for physical education and wellness programs  what do we need to do what do we need to provide more research do we know enough about it help me i'll try it's a multifactorial problem i think it's in mistake to think this is just a health care issue in fact our research and we are encouraging behavioral social sciences research at it to a great degree dr abrams who is our director of behavioral social science research is just finishing a strategic plan in the outcome of the research is this you cannot look at physical education in isolation of the behavioral change of that person the environment of that person in the social changes around that person let me give you a very straight example the national institute of environmental health sciences is looking at the environment around obesity and we launched a strategic plan for obesity research let me give you an example architects and and health plan is working together came up with the idea that if you had our buildings if you the first three floors had no elevators except for disabled individuals and we all took the first three floors and down the first walking because your environment then will drive you to exercise if you will just for three floors a time at a time we would reduce obesity but twenty five percent so what i'm saying is that there is a combination of policy urban environment the built environment how we design our buildings how we design in fact our life telecommuting is an example reduces stress i mean why is not telecommuting more adopted you could have work so there is a social economic behavioral science aspect to this which cannot be resolved by a doctor visits important for doctors to play the role but this is what we call participatory medicine in the future unless our health care system changes not just how it delivers things but what did the livers i can't i can't see a solution it's much more complex we provide the evidence will you have trials like that and like that we can try which is ways of children's activity in nutrition working through schools dr rogers will tell you about trials in six seven eight grays that we're doing looking at the both the environment and the behavioral changes that that work versus those that don't work the issue is a major issue if a systems what is our social societal system that forces behaviors and incentives to was good behaviors or bad or  as you know some of us in congress have been frustrated by and i had his reluctance to support that study which is an major nationwide effort to follow a large sample of children from before birth until age twenty one to  let me ask you is and i h's opposition to that study or i should say perhaps a reluctance to support that study is it based upon scientific opposition to the study or simply  budget considerations it's simply an issue or priorities ation within the budgetary constraints constrain environment or we have we had to make calls on what is number one number two number three priorities and we felt it was very important to dedicate resources to and vigil investigator initiated research new investigators to maintain the next generation of scientists because we are sir not i don't loss fi full generation during these constrained times in consult a sion i mean we talked to dr alexander and his advisory council clearly unless there were additional resources it would have been wise to sacrifice the next generation for the study which is  basically a budgetary decision that there's no opposition or scientific reluctance on our part all right well we're going to put that money back next year too and it will not schoolies other research because we will expand the institutes budgets just as we did last year i want to ask you a question i'll supply for the record we don't have time to get into it now but i want to ask you several questions with respect to your conflict of interest regulations and also as they apply to two grantees i also have a series of questions which i need to ask you with respect to contracting there's a long list of questions we'll give you those before you leave the room and i would ask that you respond that without the benefit of all and b s interference if i could be quite clear about that thirdly let me ask you  and i've asked this question several times for the years why does and i h s have the largest reduction in your budget proposal out of the gene environment initiative as you know this is a forty million dollars a year program twenty six million dollars of that is going to use is going to we used to do what we called genome wide association studies that dr francis collins and his team have to have developed the technology for so we're going to study the ten most common diseases and take patients who have the disease patients who don't have the disease and study their genes out of the forty million fourteen million dollars will be dedicated to developing new measures of environmental exposures at the individual level and this is a an issue that both dr collins dr schwartz dr alexander have been interested in developing if we can measure biomarkers  at the individual level the same is not true of individual exposure it's very hard for example to measure exactly what did you eat when how and that technology needs to be developed and i h s is the beneficiary of that but i have a you mentioned dr collins i have a question for dr collins which i'll also ask him to or at respond to for the record with respect to a genetic discrimination since i would hope that the sear we would actually finally have some of the legislation on the floor to deal with it could i ask doctor we've been talking about what happens you know years  you take a look at and i just budget in real per capita terms which is the way of the only way i think it's acceptable to look at things if you want to clear picture of what's happening in a real per capita terms his budget has actually declined by over twelve percent since zero five what would happen if over the next ten years that path were to continue what would be the result what would be the loss what would be the damage in your ability to conduct research and follow up leads that the research would provide over the next ten years and what would it mean to a scientist and field as science leaders and managers we always ask ourselves the questions we've had several retreats with the directors and and clearly there will be an impact there's no magic to numbers i mean if you reduce your purchasing power something has to give and in our context seventy five percent of our expenditures go to support scientist we support about three hundred thousand scientists in various to various degrees and i support those scientists so at the end of the day as you decrease your purchasing power it affects the number of scientists you can support and will reduce essentially the human capital components but that is not an equal hit and you have to be more specific than that what categories are most vulnerable the most vulnerable ones are the young scientists who just come online and have to compete with various stablish scientist and they're the ones who tend to suffer the most so in that context we've tried to protect those scientists with new pathway to independence awards pioneer awards and all kinds of mechanisms by improving as much as we can the number of grants the others clinical trials and this is the most expensive part of our portfolio if you ask are our directors what is the immediate impact is it's really reduction of infrastructure funding in clinical trials if you like to for example have d clearly the impact on our clinical trials program is probably the most dramatic we've taken out about sixteen point five million dollars out of our clinical cooperative groups which is the infrastructure across our country its employees between one week tween two thousand and three and two thousand and six and that translates into probably about thirty fewer trials that were opened by the groups  phase three and about sixty and phase two the earlier parts of the clinical trials program and it's about probably you can estimate about three thousand less patients that went on clinical trials research so this is a significant impact it impacts further in our community cancers program as well in our community oncology program i could supply those numbers as well all right thank you very much with the chairman y a notice in this report for the first time you've included a prediction of biomedical research and development inflation versus productivity how important factor is that in terms of the resources that we provide in other words is there a straight reduction of twelve percent in funding and what would how would productivity impact on that i guess is the question this is an excellent point that's why i make the point the seventy five percent is human capital and the product to human capital is going to be determined by what you can do in improving for example the technologies that human capital uses for research but you know you can do it once you can do it twice but you can do it for a long period of time at the end you have to reduce your total human capital and clearly i think it's not that i want to stop doing the work we do will continue to do that and focus it towards the priority areas that i've described at the end of the day what you have to to do is the speed at which you make i mean the impact you'll have is the speed at which you will make those changes so proximity gains are absolutely essential and we try to do that especially on the technology side for example today you can search a gene pool for a patient group in two years for one gene in the eighty's dr collins took seven eight years to identify one so there is an improvement in the  loss of of top of effectiveness if you well i'm sure i would just observe that i get a little nervous when politicians of all people talk about increasing productivity  i would simply note that your budget requests for this year is five hundred eleven million dollars in program level below last year and  that would simply continue that downward real per capita loss of purchasing power in your budget and i would just remind budget crunchers especially in my blue dog friends  in our own caucus that sometimes there are more effective ways to reduce the deficit than simply cutting appropriated programs i remember in one nine hundred seventy nine when poker told the president that we would have to cut sixteen billion dollars or thirteen billion dollars of of the out of the president carter's budget or else the deficit would rise to thirty five billion dollars and so we met in senator byrd's office for three weeks and cut sixteen billion dollars out of the budget and at the end of the year the deficit had doubled to almost seventy billion dollars so we were chasing our tail and the deficit increased not because of what had happened with appropriations but because of what had happened in the economy and i'd suggest that the investments that you're talking about in this area are committee and they mention that they are staffing pandemic people for pandemic threats and i raised the question with the director of o p m doesn't that conflict with what you do know more than i do  to be honest with you mr regular i'm not really sure what they're talking about about the people who are specific for pandemic flu and o p m they may have been referring to the fact that in the admin not only h h s but also the  homeland security the bomb the homeland security and d o d they're all people who are now being hired for the implementation of the broad presidential plan for a merging threats and i believe that's what they were doing probably what they're re six that number has been reduced to fourteen million would you explain this reduction especially when at a time when new discoveries are giving hope to families and children with this genetic disorder models that we have for down syndrome to try and build on some of the successful research using neuropeptides in in these mouse models to improve improve cognitive function and reduce some of the physical s build on some of the other improved jetton genetic technologies that we have for down syndrome research we also want to try to emphasize some of the work on cognitive and language development research that's been she i met with a gentleman last year who has developed a technology that can be incorporated into infant formula packaging guaranteeing individual mothers sterile fluids from any water source given the high rate of mother to child transmission of h i v due to breastfeeding in africa this technology seems to be a safe way to make formula for infants usa id has been impressed by this technology however the challenge is that this company is required to do a clinical trial before their products are utilized for distribution meanwhile thousands of children are at risk of malnutrition and transmission of h this is a small company that is unable to invest millions of dollars necessary for a clinical trial question in a situation like this does and defund a clinical trial i does fund a clinical trial we fund clinical trials together with the child health institute and mother to child transmission i might point out that in this regard you should be aware that there has been a recent real problematic issue that has arisen in africa in which they try to switch over to formula feeding and they did a study an actuarial study and they said that the benefit of preventing transmission through breast feeding balanced against the diseases that the children got because the water was not pure enough for them was far balanced in the detrimental effect of using formula versus using breastfeeding so from the standpoint other than doing a clinical trial on the sterility of water we're continuing to push the on belo to try and block the transmission from mother to child by treating the mother who needs to be appropriately treated as well as looking at how we might in fact even prophylactic the infants who are being breastfed by mothers who are infected so that's the arena in which we would likely do a clinical trial but i think this process through us mosis or whatever would that they've developed is to get use any water no matter how impure and end up with a product that would not transmitting any disease to ask for a clinical trial because of the sensitivity of that issue and the danger that you put children in when you give them breastfeeding and you're not absolutely certain of the purity of the water so they should be a clinical trial whatever you possible chairman i would like to just ask in the request for information on contracts and grants that we get information with regard to minority medical colleges and the the percentage of grants and contracts in the types of grants and contracts that go to minority medical colleges secondly let me just ask you about the national center for research resources i understand that this instant this is the national center is considering funding a translational research network program within the research centers and minority institutions and translational research i'd like more information about this and i want to find out how much you intend to spend and how much of this is dedicated to the translational research network and also with regard to the status of the an aids vaccine how close are we i know last year we were told that there was a new and promising h i b an aids vaccine that was on track and i'd like to hear just the status of that sam i will respond are studies that are using a new what we call a platform a new type of a vaccine and answer to the question before to congressman weldon it's a vaccine that is geared at inducing what we call a cell mediated immune response we have now moved to the next stage of that and there are two trials that are very similar one is coming from merck and is being collaborated with by an i h two our vaccine trials network and the other is a trial that is from the vaccine research center at an i d which is probably from a conceptual standpoint the most advanced because it uses the types of viruses that are seen throughout the world namely multi clade and there are a multi components of the virus that are used in it so if you look purely conceptually it is probably the best that we have so far it's getting ready to go with what we call a face to be trial which to be means that it's not quite yet a full eff trial but we feel we'll get enough information at the end of the trial that will be able to make some decisions about how far to push it with regard to minority institutions many like