good afternoon the domestic policy subcommittee of the oversight and government reform committee will now come to order this hearing will explore efforts to expand knowledge and treatments to help individuals afflicted with  logical and mental health disorders without objection the chair and ranking minority member with five minutes to make opening statements fall by opening statements that exceed three minutes by any other member seeks recognition without objection members and witnesses to five legislative days submit a written statement extraneous materials for the record and without objection for the purpose of participation in today's hearing we welcome congressman mike thompson to the subcommittee today's hearing will address the critical needs for better treatment for neurologic and psychiatric disorders and how the neuro science community can best facilitate research to advance and accelerate discovery of treatments and cures every year the more than one thousand disorders of the brain and nervous system result in more hospitalizations than any other disease group even more than heart disease and cancer neurological illnesses affect more than fifty million americans annually at cost exceeding four and sixty billion dollars neuro psychiatric illnesses like schizophrenia mood disorders and autism are the leading cause of disability in north america and europe in the united states the cost in lost earnings due to psychiatric disease is estimated conservatively to be two hundred billion dollars per year the toll of brain related disorders is enormous for individuals and for families veterans returning from wars in iraq and afghanistan have been particularly hard hit by neurologic disorders traumatic brain injury defined as a disruption in brain function a squad caused by head injury has become known as one of the signature wounds of the wars in iraq and afghanistan because of the insurgents heavy use of explosive devices an armor which is better protected soldiers from life threatening injuries and that's just you know despite the fact that we have better protected soldiers a disproportionately number of returning military personnel also struggle with psychological health issues like post traumatic stress stress disorder clinical depression anxiety disorder sleep disturbances and substance abuse the psychological toll of these wars has been particularly harsh because a prolonged exposure to combat related stress over multiple rotations unlike the physical wounds of war that maim or disfigure these conditions remain in invisible to other service members to family members and to society in general but emblematic of the great tragedy of war especially this war the toll these individual invisible wounds take on lives as great treatments to reverse a delay these injuries and disorders are critical and would benefit both the military and civilian populations alike as approximately one point seven million civilian sustained a traumatic brain injury as a result of car accidents falls or other blows to the head every year the field of neuro science which is the study of the nervous system has made significant advances in the last decade providing new insights into the functioning of the brain and underlying disease mechanisms yet many questions remain spanning the most fundamental such as how to keep our brains healthy to the specific challenges of finding diagnostic tools for diseases like alzheimer's or schizophrenia and determining ways to effectively treat t b i and p t s d the federal government is a vast array of research initiatives devoted to advance as a neuro science in our ability to treat brain injuries and mental health disorders affecting both military and civilian populations many of these federal initiatives involve extensive coordination with civilian announced governmental sectors including multi disciplinary multi sector research programs and cent where about these efforts today likewise private foundations have played an increasingly important role in expediting the drug development process by bridging the gap between promising scientific discoveries and entrepreneurial expertise and funding needed to move them forward the role of government to private foundations has become especially critical to progress because unfortunately despite their immense profits the pharmaceutical industry has been cutting back the research and development of central nervous system medications due to the high costs and high risks as we he this could have a devastating impact on the drug development pipeline for neurologic disorders without collaboration across all sectors government industry and nonprofit neuroscience breakthroughs will stall and much needed treatments for all americans especially for men and women in uniform women do cord injuries in service to their country will not materialize i hope this hearing will raise awareness about the critical role neuroscience has in developing treatments to reverse or delay some of the impacts of neurological or psychiatric disorders that millions of americans are afflicted with and will stimulate creative thinking about how to best advance discoveries and treatments for the broad spectrum of devastating brain related injuries and disorders that continue to impose a heavy burden on individuals and society today  recognize our ranking member of mr jordan i want to say that the reason why this hearing came about is because representing the kennedy who has throughout a great  communicated to me his concern that we delve into this subject in a without a way that we contact all sectors and we try to find ways of creating benefits for people through either recognizing the synergies that exist or where they don't exist in sufficient numbers helping to make sure that resources at some point will be available to help facilitate greater coordination representative patrick kennedy has been a tireless advocate for innovative cross disciplinary collaborative biomedical research and has provided unwavering support to those with psychiatric disorders and as well as returning veterans suffering from signature war injuries affecting the nervous system so ted i want to thank you and not just on behalf of this committee but i'm to have the members of congress for your assistance in this vital area you have made so many contributions congress but i think that as life goes on this is going to be an area where you're leaving and doing mark for your wisdom  thank you for your being here to help kick a supporting hearing off and to my other colleagues and mike thompson whose work in this area but also his service today is highlighted because of his service to our country as a veteran in our military and that perspective that he brings and his work in this area appreciated mr foster thank you very much both for your being here and your efforts and i think i want to thank you mr chairman for  putting this hearing together and also your staff who have been so instrumental jaron burke and claire coleman who's been helpful and just in baker and all of those who've been so critical in putting this event together in my own staff i want to thank dan murphy and laurel have us and my whole office for all the work that they did and putting up with my aggravation and trying to get all this pulled together they've just been the best and when thank them tremendously for this and  doing that in october fifth and road to over twenty fifth in rhode island thank chris for his work on that and i want to thank john sack for all the efforts that he put in as well mr chairman i also want to acknowledge some real other heroes here in this audience and none the least of which has been the former secretary of veterans affairs former u s senator but most important to all of us an american hero in the truest sense of the word and that's max cle we have an amazing lineup of people who have come to testified today i want to thank all of them for being here and say we're really at a point today where we're going to examine where we are today and neuro science and most importantly what the stage is for us to set for us to really move forward much faster more effectively and certainly to deliver the answers to neurological disorders and disability now more than ever because of how it effects our american heroes our nation's veterans the signature one on this war brain injury and p t s d we have the biggest burn of illness amongst the civilian population but the civilian population today is going to be looking to the fact that our heroes are going to be the catalyst to bring us to one mind on brain research no more divisiveness let's unify let's get behind our veteran when they when it we all went as i always the case with our nation's heroes and in this case especially so we have a bunch of great testimony today will learn from those in the civilian sector how they can be helpful in their research to help our veterans which should be our number one thank you for having the hearing and thanks to you and representative kennedy for inviting me to provide testimony today and my thanks to everyone who's here who recognizes this as not only a huge problem but one that we can really get  it's really hard to find a family that isn't somehow touched by mental illness and as as patrick kennedy said our veterans are certainly a cause that we all can rally around  and i'm pleased to be able to say something on their behalf and on or to be in the same hearing room with senator clinton who is in fact a true true hero and we see more of our military personnel returning from iraq and afghanistan  not with physical injuries although there are a huge issue porton issue as well but with mental injuries including p t s d exact anxiety disorder or depression so the call for research and support for a cure for brain illness grows louder and louder each time one of these veterans returns home reports indicate that nineteen percent of iraq war veterans and eleven percent of ask afghanistan veterans suffer from from mental illness the brain has been called the last front here for medicine and the time for that and i believe is right now it's time to bring together all of the different groups including the federal government the congress private industry academia everyone who has an interest in brain illness to fully explore and to tackle this problem once and for all every year in my congressional district they hold the single largest fundraiser for mental health it's called the stag win music festival for mental health and the proceeds from this fund raise annual fund raiser has now reached over ninety four million dollars it's used to fund research  better treatments and cures for schizophrenia bipolar bipolar disorder and depression another great hero who is with us today is karen stagg and i see him in the in the front row and i don't know where his wonderful wife sherry as if she's here  or are not but the two of them work tirelessly for mental health and for to raise the money to provide research funding for for mental health their work to find a cure and to improve treatment for brain illness is inspired and it's driven by a very personal story in one thousand nine hundred their son was diagnosed with schizophrenia it was heartbreaking it was a scary time for them and for their son but they took that heartbreak and they turned it into a benefit for everyone who cares about the advancement of mental health in one thousand nine hundred five they started the international mental health research organization which raises money for mental health research collaborate s and affiliates with organizations and works to build awareness of scientific achievements in the field of mental health research the stag was very fond of saying the rewards are much greater if you run toward the problem not away from it and we're fortunate that both gerund and sherry are running towards a problem of mental health and not away from it and the rewards as i mentioned have been great so i want to make sure we recognize that they're making an immediate difference in the lives of millions of people and i'm really proud that you're here again and of the work that you're doing and then i too would like to join the chairman and recognizing our friend  colleague congressman kennedy for his work on mental health issues he's been tireless the entire twelve years that i've been in congress i don't know anyone who's worked any harder on any single subject than patrick has worked on this he's done so much good for so many people and it really saddens me that you're leaving congress because so many people are going to lose in congress a great advocate i know you'll always be be working on the stuff that he's just a tireless fighter so i want to pledge to you patrick that i'll keep doing everything you tell me to do to make sure that we can not as i say get ahead of this everything you tell me do in regard to working on mental illness but then you made that distinction and and it everyone has said it is right on now's the time and and and the emphasis on our veterans i  think it just punctuates the need to really double down and get this done so i thank you very much in the back and thank you for let me just by i think the gentleman any other members who appear will be given five legislative days to be able to make an opening statement congressman walter jones arrived congressman jones and you have a statement that you want to make problems with families stand together i want to fight patrick kennedy for taking the lead on this and asking me to join you mr chairman and all the members here my biggest concern is that at some point in time in the very near future we're not convey the do what we should do for those who are suffering from p t s d and t b i wanted to be here today to listen to learn and also to be very proactive with my friends thank you i think the gentleman the other in members who appear when once the testimony begins will begin five legislative days to submit statements for the record before i begin introducing our panel of witnesses  for being a few minutes late but i ran right into the room and focused on my script and get the hearing often up and running but had i noticed max clean limbed in the room  i would have i would have spoken as some of my colleagues have and to his exemplary service to our country in so many ways when i came into room i am so grateful that you continue to sir in other capacities i mean you really i mean you know you know i feel about you and when i saw you i thought wow cleveland's and he in the audience so thank you groundbreaking findings in the areas of practical clinical trials autism research in the role of genetics and mental illnesses prior to his appointment as and i m h director in fall two thousand and two dr insel was professor of psychiatry neurological disorders and stroke before joining and i n d s dr corey schatz served as vice chair of the neurology service and director of stroke and neuron tension care services and massachusetts general hospital he was also professor of neurology at harvard medical joel coopersmith m d dr coopersmith is chief research and development officer for the veterans health administration the u s department of veteran affairs prior to joining v a dr coopersmith was dean of the school of medicine and graduate school violence and graduate school of biomedical sciences and vice president for clinical affairs at texas tech university finally terri rouch ph d currently serves as the director of the defense medical research and development program within the office of the assistant secretary of defense for health affairs has responsibility for the french health program r and d portfolio  over thirty years of experience in many facets of the military health system and it's held numerous senior level positions in the army an office of secretary defense i want to thank each and every one of the distinguished panelists for their presence here today it's a policy of the committee on oversight and government reform to swear in all witnesses before they testify i would i would now ask that each of the witnesses rise raise your right hand you sound we swear to tell the truth the whole truth and nothing but the truth thank you very much let the record reflect that each of the witnesses answered in the affirmative i would now ask that each witness give a brief summary of your testimony keep the summary under five minutes in duration if you can your complete written statement will be in the hearing record and i don't know if you can see the clock there there's  start well thank you mr chairman and over the appreciate the committee's interest in this issue and i also want to thank congressman kennedy for what has been a very long period of passionate leadership we're going to miss you tremendously as you move to your next post i can only hope that you'll come work for us at some point so that health and human services and dr core shots and i will talk about this perspective on these disorders in the needs we have from the and i each side both for and i and d s and i m h i think rather than go into  the details of my testimony which you have in front of you i'd like to just take you through the pictures that may be more helpful for you to expand on some of the things chairman baucus and it's that you already mentioned in your opening statements so  next slide let me talk a little bit about what it is when we talk about this burden of illness that people refer to when we think about this in numerical terms we use something called a disability adjusted life years to the unfortunate term that has to do with how many years are lost to disability and you can see from this graph i hope from the world health organization numbers put together in two thousand and eight that neuro psychiatric illnesses probably represent almost thirty percent of all the disability from all medical causes from non communicable diseases so that ranks them well above heart disease cancer and many of the things that most of us often think about as the big killers part of the reason why the disability rate is so high is that some of these actually become chronic diseases and they begin early and as was already mentioned they're common so the high prevalence also drives these kinds of numbers in the next slide you'll see that if you break this down next slide please i'm sorry we skipped one here come and go back one that's possible that the actual disorders within this category include depression alcohol alzheimer's disease and many others with depression being really the number one driver for the sources of disability it's really a powerful statement that the so much of medical disability is driven by this one group of illnesses all of which occur quite early in life we tend to think of these as the chronic disorders of young people but it's not just that they're chronic they're also and not only that they cause more pretty they also or a source of mortality you'll see in the next slide that suicide which is ninety percent of the time involved is a mental illness accounts for over thirty four thousand deaths each year in this country which is an extraordinary number when you put this in context as you'll see in the next bullet that that's almost double the number of homicides and at this point based on the numbers released about a week ago from the national safety transportation board more than the number of deaths from traffic fatalities which is just extraordinary now we have a whole criminal justice system to deal with the homicides and  transportation safety system to deal with traffic fatalities someone might ask what do we have by comparison to handle this growing issue of suicides in america and it's not only suicides that are driving mortality but lots of other sources of medical illness and you can see in the next bullet that in fact in the united states the life expectancy today for someone with a serious mental illness is about fifty six years which according to what i looked at on google about a week ago is about the life expectancy today in bangladesh so this is not where we want to be in two thousand and ten it was already mentioned before about the economic cost involved here in the next so i do have a picture of that when you maybe this will be difficult for you to see but the last column over shows that if you hit the next bullet that it's about fifty seven and a half billion dollars in healthcare costs that go to mental illnesses which is just about what we're spending each year for cancer in the united states what's dramatic about that are two things first that that is a huge increase from where we were a decade ago so these are really now driving upwards relative to many other medical sources and maybe second even more importantly this barely captures the real costs economically because most of the costs of mental illnesses or outside the health care system next bullet you'll see involve next  costs of lost earnings of welfare next and that incarceration homelessness school and home care all the places where most care or failure of care for health care mental illnesses really play out next so we  estimate that the actual total comes to about one thousand dollars per american per year that we're spending the way we do this now to provide what is obviously mediocre help to people with these very disabling and chronic illnesses next if that's the bad news i need to tell you that we're not just facing huge challenges but really unprecedented opportunities and i wanted to take just a couple of minutes if i can to plus those out there really to that also make a very quickly the first has to do with the recognition in the next bullet that these are indeed brain disorders not disorders in the brain disorders the way stroke or alzheimer's might be but they're disorders the brain circuits and we've been able to now to find those with the help of genetics and with the help of new technologies we also now recognize in the next bullet that these are developmental disorders i mention that they start early in childhood most of the time at a time when the brain is still developing but this gives us a real opportunity for thinking about how to intervene and you'll see in the next slide that we have a whole range of technologies that have been developed over the last five to ten years that are real game changers here for the first time we can study brain circuits and it with a kind of precision that we can only dream about fifteen to twenty years ago and that has made this a tractable problem where we should expect to see tremendous progress over the next decade you'll see in the next slide and which is run through these very quickly that we've already begun to describe the circuit basis  most of the major disorders this is depression next is obsessive compulsive disorder next p t s d one that we're going to talk much more about this afternoon but in each case we've begun to identify the major nodes in the brain the importance of the prefrontal cortex which is really a kind of great last frontier for neuroscience and it we've begun to open up real opportunities for new therapeutics let me finish up by saying that this is an enormous challenge i don't want to give you for a moment the sense that we've mastered this problem i'd like to say that we probably know about two percent of what we need to know but we need to do this in a way that as congressman kennedy said will be collaborative and will be a joint effort there's an old african proverb that says if you need to go fast go alone if you need to go far go together and we need to do both so i'll show you in the next couple of slides how we're thinking about that in the next slide you'll see kind of the next sli please let's go ahead and hit the run through this we have a number of projects with the v a next with a total of about zero nearly one hundred grants across twenty three states with about forty one million dollars in investments that we're now doing and just keep hitting the bullets because we don't have time to go through much of this but all i want i want to make sure you understand that this is by no means a siloed effort we're not balkanized any longer there's a lot of effort going on intellectually and practically to make sure that we're working very closely together and finally in the last slide let me just say that probably the largest effort that we've mounted at the n i m h in the past eighteen months has been the stars the army stores initiative which we're doing very closely with the department of defense the this really responds to the increase in suicide which we've heard a little bit about already the increase has gone to one hundred sixty in two thousand and nine  and two hundred thirty nine if you include reserve forces as well in a recent publication in the vice chief of staff he can rarely mention that from his perspective it appears that we may be losing more soldiers to suicide into high risk behaviors than we are to combat and this has to be the highest priority and we have now entered in with them a very large study we call it a framingham like study because it's really looking at the entire army and trying to understand risk and resilience for the forces in providing information back as quickly as we can to promote risk in order to promote a resilience and to reduce risk so we can to put up the last slide i want to thank you for your leadership in this disorders there are some people count six hundred or a logical thought is that is that our institute is trying to attack but the message here is that you know we have to go one by one to get a drug but to make real progress we need basic science discoveries are going to come across multiple as oppose because one on one and one by one to take such a long time next fight so this slide basically gets away from the numbers and just reminds you of the real tragedy that occurs when you lose part of your nervous system function it it really defines what is a human being what may access different from the next person and and so there's real real personal tragedy behind all of these diseases unfortunately the people who are interested i refer you to the web site we actually did a very kind of in depth barebones look at how the end i n t s works how where we need to improve we got experts from the extramural community different government agencies industry academia disease organization leaders to look at to report them and we care to also show them how these it works we got really good recommendations to move forward and out of this you much of what we think happens in repair when there's a brain injury is just beginning that developmental program all over again so will the more we learn about how the brain develops we think the more we're going to know about how to affect repair once it's injured we need to know what goes wrong in diseases and then we need to be able to translate this knowledge from basic and clinical discoveries into better ways to prevent and treat neurological disorders there's a number of other points here which you could read more about but i'm going to hit some of them as we go along next slide please now this point has come up already in the chairman statements and i hope will come up again and it's the fact that when when when push comes to shove if you have a neurological disease you need a particular treatment a particular drug a particular type of treatment is going to help you and it's got to be specific and we eventually have to go from our basic knowledge to a very specific treatment and if we don't do that if we don't take advantage of our preeminence and biological risky investments they have very high development costs they have a high failure rate when they go into the clinic and the more and more we know about the diseases we get smaller and smaller markets for them to make profits on so we have to try and solve this problem and the word that you use around and i now is the word the risk so when i ate sees is that their role currently is to try to take the basic knowledge try and actually develop molecules that will be treatments and bring them as far along the pipeline as we can to and instill the risk is so low that an industry will pick them up and that's kind of the general idea or the big problem that we've we are a lot of problems but one of the big problems that we have hit is that if the sad but true saying that if you are a mouse and you have disease x don't worry about it we can fix you but if you're a human with disease x you better worry because we don't have something so we've been able to do really well for the mice the problem is and we go from the mouse to the human something we're missing something and and we need a bridge and we talk about biomarkers and maybe this will come up later a biomarker in my mind is a way to bridge what we know from the animal disease to the human disease so that we know we go into the human at it we hit this biomarker it's going to give a high chance of success if we just go into the human and treat the brain as a black box that has a lot of guesswork a lot of things can go wrong and that's the idea of this bridging bio mark and so there's a big emphasis alone we have so many disorders we i need everybody working together and we basically work very closely with the tremendous numbers of really innovative neuroscientists that you know most belong to this is i have a neuro science the professionals in the neurology neurosurgical psychiatry emergency medicine many different professional societies and and these private organizations these organizations that are disease related that have the real motivation  and dedication and persistence to galvanize communities are essential for us to carry out our mission and perform tremendous really tremendous research now thanks next like now this is a really busy slide and this is basically a slide of how we conceive of the pipeline going from on the left the the the basic science are zero one investigator grants which are the mainstream of the and i invest meant to really make most of the innovation in the american scientists pool to bring out new basic knowledge and that's really the critical thing that everything is based upon but once you have that knowledge you have somebody who is interested in this other area has to go in and try and pick out from that knowledge something that's going to be useful treatment and then there are a number of steps one has to go to until you get to the proof of principle and the animal model show it working and then go into the human so this is not rocket science but it's a process that's well known to the pharmaceutical companies and now and i was really getting interested in how how we can move this further to the left taking the risk at a drug development what i've listed here is a number of the programs and i in the ass has in this arena and blue ones in green ones that we do with many institutes and i ates the ones in blue ones that we generally have disease organizations are partners and the ones in red are the ones we usually have industry as our partners and just a couple of point out just yesterday we announced we will be working on a public private partnership much like all timers disease develop our markets for parkinson's disease drug development we have a network that we're going to set up that will be nimble be able to move from disease disease to test the best therapies available at coming out of neuroscience and bio market inform trials and we and then the nearer the ais blueprint important to know about the blueprint it's all the institutes and i they come together and they decide what they can do together as a group and here they put together this neuro therapeutic grand challenge which is trying to really fill the pipeline with really creative agents that can help many different kind of neuroscience is ease not just an i in the ses or and i that will improve the recovery of our soldiers and protect them potentially in the future so and i in the us is a leading funding agency and has been for traumatic brain injury research t b i is the leading killer of young adults what a couple of things we've done recently is we have set up and i'm the co director of this with dr armstrong at the uniformed services university across the street a center for t b i research and this is investigated at walter reed national navy medical center u se uniformed services university and i h it's about fifty six investigators working with a fairly good budget trying to make a dent in many different areas of traumatic brain injury searches intramural program and i h and uses we have  accommodated elements project that's been done with the federal into agency group that has has members from almost any federal agency related works in the area of t b i and what they've been working on most recently is standard ways of collecting data so that no matter who's doing the study what agency is funding it they collect in the same type of data so this data can be combined and mind and the value of the data goes up substantially we also have a working on projects with diaper they have an amazing activity the the and i was also participates in d o d grant review and we're working now with uniformed services and some of the other d o d groups to develop an m r i scanner that will be just through brains but can be small enough to be taken f one trauma center and that's why i'm going to end really where the beginning is and that's kind of in the basic science i just want to tell this one story there's lots of stories like this in the and the and the the details change but there's an example of how really basic science that you had no idea that it was going to be helpful to brain diseases turns out that it really is so they sickly these little pictures here are microbes the not even real bacteria that's so primitive  but they have these channels in their membranes that when light is shown to shine upon the membrane the channels open and really in innovative scientists been able to take this gene from these microbes put it in viruses transfer ect brain cells now the brain cells have these channels and then go in with laser lights and with amazing temporal and spatial accuracy they can then shine the light the channels will open some of them will shut the cells off depending on what channels some will turn the cells on and for the first time with this technology you can actually activate circuits in the brain as opposed to what we did before was just and electricity and with the wire and nobody knew electrons went this is really specific really tremendous and it's only been out a couple years but you can see from these papers mention that real disease related work that's come from this stuff that started microbes so for instance they've been able to show that you when someone has a spinal cord injury they lose their ability to breathe they can now put these channels and to mice with the spinal cord injury activated breathing circuits and then i start breathing again so just a great example lots of stories like this where the basic science you can't tell where the advance the coming from but a tool that comes out of this that that you didn't have before and really allows country one of the largest research programs and it includes close academic affiliations with major universities and medical schools we have over three thousand four hundred researchers working on two thousand three hundred projects and supported by approximately one point nine billion dollars in funding from all sources we are widely supported by the department of defense and national institute of health grants or pharmacy coordinating center that is part of our nationwide clinical trials program science research has extended from seminal studies on how memory is organized to the only avenue space treatment for p t s d two nobel prize work on neuropeptides to a variety of genomic advances and i will highlight some of our findings in some of our research n p t s the traumatic brain injury spinal cord injuries and our work on the deck dark arm that was just mentioned we are a leader in p t s d research currently supporting over one hundred studies and spearheading the national dissemination of two evidence based psychotherapies that we have proven to be most effective for p t s d cognitive processing therapy and for long disposer therapy we're also undertaking three large studies in the long term assessment of p t s d and associated health conditions and vietnam veterans and we have other studies which include genetic assessment of p t s d genetic assessment of resilience to p t s d treatment for developed jointly with the department of defense we have increased our research funding and dramatic brain injury and at the end of the beginning of f y two thousand and ten started three research centers dedicated to detecting and treating t b deal with other aspects of t b i v a is at the cutting edge of beth is for the taking my own t b i through the use of biomarkers imaging and eye tracking assessments and is investigating as i said the links between tb and p t s d and how to improve diagnosis each we are also studying repetitive brain injuries combined with aging to determine whether these injuries can lead to neurodegenerative diseases and there are some initial findings in that we'll also and have always vested substantially in spinal cord injury research and recently started a spinal cord injury consortium to better address the needs of veterans with these conditions one project involves combination therapy using bio in nine nine human primates and it does hold promise to restore spinal cord function over the long haul another group of studies we're doing is on functional electrical stimulation that applies low level currents to nerves of spinal cord injured patients to simulate muscle activity for movement of limbs as well as for bladder function now work on the new generation prosthetic arm i think is an excellent example of mutual beneficial results of collaboration this is the arm that dr course has mentioned it was it was developed by darpa we are doing the clinical trials an optimization of it and we have completed studies in twenty two male and female veterans and military personnel and others we are testing that the prototype which has flexible socket design and innovative control features and one of the important develops and this is also been mentioned is that we will add the addition of brain computer interface technology this is a group that is working at the providence v a with a number of associated medical schools funded by us and also funded by the national institute of health and right now the deck arm is control by sensors that are in the feet so it can only be used while sitting or standing not fall walking with this brain computer interface we will enable individuals to walk and to command this  through thoughts in the brain time does not permit me to discuss other v a neuro science studies of these are included in my written statement and i'm happy to answer your questions thank you very much appreciates your efforts in this critical air mr chairman members that a committee thank you for the opportunity to discuss department of defense research efforts to advance our understanding of neurological and psychological trauma we greatly appreciate the committee support of our efforts to discover and develop diagnostic treatment and prevention strategies to help the many brave men and women who have been afflicted with these debilitating disorders mr chairman without a doubt the devastating nature of neurological and psychological trauma is one of the most difficult challenges we face with respect to research and development and translation of discoveries and clinical care the central nervous system allows us to interact with the world around us therefore any neurological or psychological injury can be devastating not only to the service member but also to the family members as as well psychological trauma in many cases has proven responsive to various therapies but it remains a difficult challenge to identify by and effectively treat recovery from psychological trauma is often complicated co occurring physical injury depression substance abuse and the threat of suicide even mild cases of neurological and psychological trauma can have devastating effects on lives careers and in families the department of defense says developed a comprehensive research and development program for the study of neuro trauma and psychological health the focus on on basic mechanisms of of disease and applied in clinical research that address prevention diagnosis treatment and rehab this research and development is conducted by investigators with indio de within the v a within and i h and within leading academic institutions and also in industry partners psychological trauma has posed a significant threat to service members during operations iraqi freedom now operation new dawn and enduring freedom an estimated twenty to forty percent of service members experience behavioral health problems post deployment most often p t s d depression and interpersonal conflict studies have also shown evidence of increased strain on on families are highest priority in neuro trauma research is the diagnosis of t b i specifically mild v i while moderate in severe t v are relatively straightforward to diagnose mild t v i can be difficult to assess particularly if the service member has an injury that wasn't witnessed our our goal in diagnostics has been to identify the unique biological effects of t v i and to leverage that knowledge to identify or develop more effective objective diagnostic tools that will determine the presence and severity of brain injury to meet this challenge we have funded research on more than sixty different technologies over the past four years these include blood biomarkers of t v i den a fine unique collectible patterns of the brain indicative of injury and the severity of that injury and more valid and reliable neuro neuro cognitive diagnostic tests with regard to treatment and rehab research on neuro trauma recurrently sponsor more than seventy projects investigating drug and drug combinations nutritional compounds with therapeutic potential  gene therapies used in regenerative medicine deep brain stimulation and rehab methods and devices we sponsor a significant amount of work to better understand the neuro biological basis  leading cause of death and young people in the eleventh overall leading cause of death in the us population you know until recently military suicide rates have been significantly lower  then general population rates however in two thousand and four military suicide rates began to climb and today exceed the age of just a civilian rate in order to better understand the factors are related to suicide the d o d and then i am are involved in an ongoing collaboration as we as my colleague described before to conduct the largest scale study of suicide in the military the project is the largest epidemiologic study of mental health psychological resilience suicide risk suicide related behaviors and suicide deaths in the u s army  drug including prescription drugs and alcohol abuse is the significant health problem in the military almost thirty percent of the army suicide rates or suicide deaths from two thousand and three to two thousand and nine and more than forty five percent of the non fatal suicide behavior from two thousand and five to two thousand and nine involved the use of drugs or alcohol increased prescription use among the military has led to heightened concern with overdoses we have sponsored a significant amount of substance abuse research that addresses that if it includes up  studies as well as studies investigating prevention and treatment interventions further epidemiologic research is needed to accurately characterize drug use and misuse to include risk factors and to a down to five potential barriers to treatment seeking behavior mr chairman the department of defense continues to perform and manage exceptional medical research and development for the population that the man's and deserves the finest care available i'm proud to be here today to represent the men and women who conduct these programs and i thank them for their  service thank you mr chairman for the opportunity to be with the a today and i look forward to your questions thank you very much mr rounds we have a vote on we're going to go for another five minutes many votes on this and then we will come back here at four o'clock because it's going to five votes will take up about an hour get into of the course of time when we come back i think really brings some more illumination to all that be very useful but i want to take this opportunity in response to dr rush's point first thank him for his service to our country  military to hit one point home that i believe needs to get hit home hard and that is there is no difference between psychological and neurological and if you want to know why the there's the highest suicide rates now monks militaries they're not supposed to have problems but when we have a military that's talking about their problems in terms of thirty percent of the suicides are caused by alcohol alcohol is caused by their combat wont so that thirty percent isn't alcohol that thirty percent is result of their combat won't and the last were about drug seeking behaviors no self medicating because they got a combat won't physical and that we have a dual track one objective diagnostic tools for t b i as like a separate track from objective diagnostic tools from what you said behavioral sought to havior all it's physiological you want to know why there's a stigma because the military refuses to talk about this as a combat womb p t s d physical changes in the brain as a result of prolonged exposure to cortisol we still have the leading medical experts coming up here and testifying in spite of the report that was just released last week which i'd like to submit for the record that's all right with the chairman without objection i think you are right to rush about it's being nerve trauma but that doesn't apply to t b i it applies to notion that there is a dual track between the psychological versus the neurological no what wait a second let me just say psychological is neurological that's what we just learned on the board from the director of the national institutes  mental health it's neurological stop calling it psychological stop calling it behavioral start calling it mental health and you'll have less veterans feeling stigmatized by it because we are the biggest stigmatizes with that nomenclature when you have and it's a fact more veterans killing themselves in active service than are being killed in combat there should be a wake up as to what we're doing the last commission report just released no mention of the physiological impact war impacting suicide although we have psychological behavioral mental health we stigmatize it that suicide commission was an utter disaster my point because all it ended up doing is laying on top to these veterans that somehow they have something that happens to them after war you know this happened to them while they were serving it's a combat  alcoholic drug seeking to combat wounds that ends up manifesting itself in these symptoms that then ultimately ends up as a suicide and if we refer to it as alcohol so you can behavior drug seeking behavior or something else we do injustice to the fact that these veterans are stigmatized by their behavior because it's a result of the neurological changes that their service incurred on their brains and we can talk all day about science but if we don't get this issue a stigma out on the table we're never going to get anywhere as far as i'm concerned mr chairman thank you for allowing me and i will have time to come thank you very much mr kennedy we're going to recess until four o'clock at which time i will come back and i have questions for the panelists and then we'll go to the next panel after i appreciate your patience and we will come back and  yeah yeah thank you very much for your patience we were going to resume the hearing dr corey schatz had to leave due to a previously scheduled engagement so we excuse him from the panel of witnesses during the break we're kennedy thank you for your leadership on this issue regarding mental health but also the mental health of soldiers and and their families i want to very briefly gana talked about camp june a year ago dr kenya mannion psychologist was released from his contract at camp june because of that i asked for an investigation and the i g is investigating his situation but also from that situation it has kind of expanded tom the go see was a sergeant marine sergeant that had been overseas twice and he clinic at camp june and on match mchugh boulevard he stopped his car and committed suicide at eleven thirty in the morning i want to ask you experts from a little bit from neuroscience is to this point do you believe that the military mental health system could be helped if there was a national committee set up to evaluate military mental health to make recommendations to the department of finance and to the congress and the reason i bring this up because i've been very impressed with you you professionals your experts into an area that i'm not but as a layman who has a military district in his district let's give it a base in his district scares me and see in the pain and the hurt that i've s seen over the last few years the last story that would preset your answer about what can we do to strengthen military mental health can you imagine having a be unable to speak at an elementary school camp the june johnson elementary school national reading day we're home because of the easter break i'm reading datta sees two twelve kids sitting on the floor and as i take questions at end of it i said you can ask me anything the questions went have you seen the president do you have a wife do you have a doll those kind of things the last child is a six year old child children the last challenge said this is my last question he looked up at me and he said my but he's not dead yet my daddy's not dead yet and on the mouth of a six year old child now i want to come back to what would be my only question of you are we at a point that the congress needs to say to the president whomever he is maybe one day see we need to put together a mental health commission of experts like yourself at the table to help military develop a strong mental health program whether we be we'd be at peace  does this have any validity because what i'm hearing i know hyperbaric oxygen treatment we've now finally got it down to camp and it's not this not they don't have the staff yet but we see what we're doing everything we can to deal with the mental health of our military protected those that war but yet it seems like they're just so many different aspects of it that somebody is going to kind of bring it together and have it focus does it make sense to have a commission to recommend to the military to the congress to the president we need to do to make the mental health program in our military stronger and better for the families robust with the v a and and i h you know i've tried in my in my statement to to focus on on some examples and in my written statement i have i have more more examples but i think from my my professional point point of view as a as a as a psychologist i think we place to start is is to work hard to leverage the existing relationships and collaboration's that we have thus far with and i h and in the v a on this issue of family family studies  specific to to the military walter could i interject here yes or do we have standard data points for t b i so that we can collaborate so that a scientists from rhode island can talk to a scientist in his district on neuro science because apparently in the second testimony that we heard that we don't from dr chorused testimony there is no standard t b i data input so how can you talk about collaboration out a that's a that's a good point now remember that when we talk about traumatic brain injury we're talking about a pretty broad spectrum so that can range from mild and concussion too severe and penetrating and and everything in between there's there is a lot of differences in there so it's a it's a very very broad very broad spectrum you know i'll turn it over to my colleagues and if they have a different view of the range of t v i take and i think the whole purpose here is while they're saying is that we are all in it together civilian research can benefit that are in research is not of that right so but if we don't have common data points and there's t b i s every night of the week from car accidents and we can't collect anything that's useful to the veteran in terms of recovery response function how can we be saying we're in a to win it for the vets and they taught you've got the blueprint at the end i h for the right ration so there's the blueprint has developed these programs for collaboration and a s walter of course gets mentioned there's a real interest in what they're calling come in data elements which the neurology institute is putting out for all investigators to use for each of the disorders that they support so that i think will be an important resource but if i may can i can i go back to to your original question because i think the perspective that you're describing is just very different from the personal experience i've had with as a civilian sure it's representing a government agency dealing with the leadership in the pentagon and i have to say this as clearly as i can that the level of commitment to  reducing suicide to ensuring that resilience is supported and to changing culture is greater amongst the leadership in the pentagon than anything i have ever seen in the civilian  sector these people really believe that this is their highest priority right now they are very concerned about this issue i have never seen that level of concern from anyone in the civilian sector where in fact the suicide rate continues to take thirty four thousand lives a year so i i think i mean i understand your wish to be helpful but i do think that it  underestimates what's already happening from an administration that really wants to make a difference here and is looking for answers quickly and is trying out things quickly to try to bring great respect but this hyper beric oxygen treatment that has been studied for years and years and years by the military and that's why they put a chamber down at camp and soon they can continue to study i found that he paid for him to go to the high for paris program at l a s u i called him he said my son is just remarkably recovered he can function and he's not on drugs so your point i don't disagree with you but this still is now i'm not saying it's the only treatment you're the scientists i'm not but i have talked to three different individuals including a general mandy down at  florida you know when you smile he didn't know who in town that he was under the treatment at walter reed for months and months and months so no improvement his wife talked to the doctor at walter reed and she was went to see i think it was hundred ten percent but if he had stayed in the military they would have kept him probably drugs for a quite a bit of his life and with no real improvement so this mock concern i don't fault anybody in the military i think they do a magnificent job a formula that we can can have for the military to know what is available without havin people trying to to duplicate all those studies i just don't know and that's reason i want to sit here today and with that i yield back but i think well there you hit the nail there isn't to answer your question because there are common data points and t b i which is signature wound on the war to help us instruct on whether those are injuries that affect an increased suicide rates and just as of september twenty fourth appreciate tom said for his compatriots who are working hard but the walter reed army hospital chief of psychiatry colonel john bradley said shoddy training and coordination has left us a failure in taking on suicides in the military from his own words i appreciate your standing up for him but when we don't have the lead expert on mental health in suicides not differentiate between this or differentiate psychological from neurological after your testimony saying it's all neurological you've got a big problem here i'm going to ask the gentleman to hold some of that for the next round of questions i've got some questions and then we can we're going to go one more round which gentleman may lead off again thank you want to talk about the nature of stress stress produces chemicals which affect the brain has every right correct and can an abundance of stress in certain individuals bring about organic brain changes we know that some of the stress hormone alter the way in which cells are born and cells die within the brain so there's every reason to think that stress does have direct effect on the health of the brain you'll be able to hear a lot more about this from dr akil who's in the next panel is really experts on this is there an area of the brain where frequent stress breaks down inhibition towards suicide well the a lot of the research is focused on the effect of stress on an area called the hippocampus which is certainly very important for higher cortical function for memory for the way in which memories get included in the brain but the relationship of stress to the brain anatomy of brain morphology and suicide remains now a very vague one there are a lot of gaps in our understanding of of how these things connect well you know i ask this question because  if it's not site specific then the work of someone like karl priebus is hollow nomic theory comes into play i'm sure you're familiar with this series so there are the places where stress is likely to have the greatest impact is where the receptors for for hormones like cortisol are found in the brain and they're not everywhere they're areas that are highly enriched and those is the places that we look and in fact those are the places where we see changes but again it's it's a there's a gap here between our understanding of the cellular effects of stress and our understanding of what causes suicide it's a very complicated area when you try to predict for instance who's likely to take their own life we know some of the factors from a population but within an individual person we're not very good yet at being able to have high levels of prediction i heard you response to observation by my friend from north carolina indicate the work that's being done in the department of defense on matters related to suicide you did say that correct but this is a joint project between and i m h n d o t what's ironic about that if i may is that the stress or in this place is in this case is war there's a dog factor about this the latest book about president obama and the afghanistan war indicates the tension between the administration and the white house rather the administration and the pentagon and the  difficulty that the administration was having in having a pentagon produce a plan to exit the war and i think that my friend from north carolina would it would agree you can study the nature of suicide all you want but if you've got increasing a side that's coming from people who are in combat under horrendous conditions where there's all kinds of atrocities being committed how smart do you have to be to figure this out that's right you know so i appreciate that you're studying it but  it would be more productive i think if a group of scientists would come forward and have the opportunity to do some real tests and how stress breaks down people and how that puts them in that soft circumference of suicidal ideation which then may lead to people acting and taking their own life you know so you can't you can't really speak to that because that's not your area of of decision making but no matter what kind of how caring the people in the pentagon are about the troops as long as you're sending people into this mixmaster war you're going to put suicides i mean that's you know they're you again i don't think you have to be a neuro physiologist to understand this i don't think you have to be a cognitive psychologist or cognitive neuroscientist to understand this war is you know we put these young people into an impossible situation they're killing themselves you know i don't deserve a p i'm not sure i understand a question like skinner skinner in approach stimulus response you know if you do certain stimuli you get a certain effect are we what are you a student of that particular type of neuroscience well that that actually falls into the category corey of what we call behavioral science and it really has to do with predicting behavior based on stimulus and response and one of the things that's perhaps most conspicuous about that is the leaves out the brain so neuro scientists tend to think more about the mechanisms by which behavior gets regulated and they tend to be a little more complicated than just a sampling gate that's a good word so tell me about it the complications of how we predict behavior i'm i'm interested as you know as compared with cognitive neuroscience with encompasses the possibilities of quantum physics in a face with n science where you actually create the potential of of change that cannot necessarily be explained by by the more linear progression of a of a more cannibal approach is that not register with you at all so i think what it does now with your other quite well i'm not sure i heard the question but if that if the question is does neuroscience provide a basis approaching that complexity and trying to understand that complexity i think the answer is yes i think we have the tools now many of which come from very different fields such as higher math or from from physics from dealing with large amounts of information that we are able to actually begin to make sense of the complexity of how the brain works with models that become predictive so we have a long way to go but i would say that we've come a long way from a simple skinnerian model of stimulus and response that's good to hear because every in the testimony that i gave mr chairman i use the term disruptive innovations and from my perspective this last decade has been a series of truly disruptive innovations as we've begun to understand to go back to congressman kennedy's point that the brain really is the gateway to understanding the mind and i don't believe that we had fully appreciated that in previous decades i just want to conclude by saying i may have been in  so what you're talking about well that's a that's a technique which has been used actually be able to to study circuitry in the brain in a very precise way but i think you understand the the possibilities of neuroscience to go into areas which would make the work that you're seeming to working out right now seem primitive in years to come with all due respect i think you i think i really i'm a fan of what neuroscience is capabilities and so i appreciate your presence here thank you for may just as a final comment about this i think it needs to be said we're in the middle of a revolution and in  twenty to thirty years we'll look back on this period to realize held little we knew but the tools are there to transform the way we think about the brain and this someone said in the opening comments this is really the last great frontier of science and for the first time i think we have the discovery tools that we've needed to really explore and to colonize that frontier in a different way is one of the question occurs to me i don't know if you're able to  since you work with and since people neuroscience discipline work with the department of defense has anyone doing any studies about  macro cosmic level the precursor of war means every anybody ever think about that i'm not sure that we're where you are on these on this idea so there's a tremendous amount of research right now on the fundamental neurobiology of fear and fear responses and particularly what we call extinction the ability to overcome fear but it the relationship of that two to war is  a place where i think most neuroscientists haven't gone thank you that is to get a second round thank you i think the most significant issue is how to do the research so we make the most of what we know so how much we know it's how much we you know don't know that we know and that gets back to the common data points for t b i we can't do the data mining and find out what's working or what isn't if there day and terry the ability to have a common program computer program to put you know these data points or or not first time so just very quickly d on a few of those does not involve d o d v a or many of the other instituted an i h even so it's it is truly a kind of home grown project but it hasn't in any way inhibited many of the institutes my own included n i m h from these very large collaboration's as i said the the biggest project we're doing is the collaboration with d o d and it's it's really become our signature project for two thousand and ten and probably will be for the next few years so doesn't the blueprints not part of that but it almost doesn't need to be we've got a lot going on just out of the institute itself we don't we don't have a program that allows for all this data to be put in so we're all scientists in one area the country conf find out what the scientists and the others countries doing so we can work to a greater effect to everybody's advantage we don't have that we don't have a single  data repository at this point for other than for autism i don't think that exists for any area that our institutes working in it would it be useful to everybody i know you have these collaboration's and it's helpful but could we dedicate funding that would leverage what the institutes do by giving a little money to help bring them and their work together to help them maximize each other in a coordinated way so we have done that in autism and i think it's been transformative  have an opportunity now for virtually every project to flow into the same database called the national database for autism research and that's a model that could be followed in a number of areas that's terrific  communities have not merged yet with the o t but there's tremendous amount of work on that and that is a goal certainly of this administration but you know our computer system a volved out of a clinical computer system sort of from the ground up  with investigators creating software merging into a large system so that is clearly a goal of this administration it's not a research topic for say all the research will benefit greatly from it that's right and we are looking forward to be able to do that because if we don't know what we know we're just doomed to repeat the science absolutely and i think that quotes that einstein actually  d department of education it's called the common data elements project and its purpose is to do exactly what you charged us to do and that is to standardize terminology within t v i and the psych health portfolio it's it's in development it's in progress but it's it has started and you know  i think i probably need to take this for the record and give you some more information because that your question really deserves a more detailed answer and i'd like to provide more detail on the common data elements super well thank you and that's what the hearings about what can we do in congress to help leverage what you're already doing and what the science shows us out there already spoke to science as a structure specific language constructed for the representation of what there is and so semantics do count because they link through their expression to a specific structures that help either to confirm preexisting notions of a science or disconfirm them  so the point that you raised about the the nomenclature is not a small matter it's actually quite significant not just for the subject of a particular type of behavior but there are implications broader social implications now are you done i just repeat what you said you go fast go alone but go far you go together we need to go far together but we need to go faster and if you can provide us some recommendations from your point of view as to what f d a can do since air and trickle and whatever comes up on your researchers to get if we get a finding right into the field for our soldier and our pattern that would be very useful if you could give us some ideas on regulatory side so again this is process issues you just said dr coopersmith it doesn't involve the science but the science can't be maximized unless you get the process right so if you can provide us some input on that as you have already kind of your testimony it helps us make a better case politically if we just put some dollars here we leverage a whole bunch we work as a team we get further and you're blueprints a perfect how do we institutionalize that more get the common data sets and standardized terminology together and so that would be useful john robbins the author has has written extensively about the impact adverse impact on human health of certain types of  foods there's been plenty of research about the adverse impact on physical and mental states of let's say a large concern consuming large amounts of sugar  we know it's true like amounts of salt  there have been studies done and in prison populations whose diets have changed and it has  really urgent that we use whatever means we have available to help folks fill this potential so i want to thank the members of the first panel for your commitment in your respective disciplines for the thoughtful testimony and question answering that you provided this is an area  research collaboration between and among federal agencies and what you've done is to remind people in the community that it's important to collaborate with each other and and whether it's done on an hoc process or on a regular basis i think that it is and can be productive because of the synergy that always comes from interdisciplinary thinking and so i would urge that approach of interdisciplinary thinking to continue through encouraging all the parties to this to keep talking if they are and to start talking together if they're not and to i think it's a good idea to work collaboratively with your friends in congress who will advocate on your behalf in the appropriate venue so thank you for being here and good luck with your work and we're going to call the second panel well the second panel is getting into place  i want to thank them and the members of the audience for their patients because of the congressional voting schedule we've had kind of a prolonged hearing here and you're willing to come here today offer testimony answer questions much appreciated i'm going to introduce our second panel six from which he retired in january of this year thank you very much doctor timothy coetzee is that right ph d is the executive director of fast forward l l c the national multiple sclerosis is society's drug discovery and development affiliate in this capacity dr cozzi is responsible for the society strategic funding of early stage biotechnology and pharmaceutical companies engaged in to discover in development of new treatments and sciences harvard professor parkers the director of the disease bio physics group and a member of the systems biology department harvard medical school and harvard stem cell institute and harvard mit health sciences and technology program he's also made a major in rhode island army national guard and has completed two combat tours in afghanistan with the eighty second airborne in the tenth mountain division snake for being here sir john h morrison ph d is the dean of basic science before they testify i would ask that the witnesses stand raise your right hand minutes and as with the members of the first panel i let them go on because they had something to say are very important so jim and i just want to thank everybody who showed up today all of  represent different organizations groups and very useful in helping put this hearing together and i thank zack lynch for the neuro technology industry organization been very useful in helping to put together some very helpful statistics and points for us in the hearing and just say we wish we could get everybody up here because everybody in this audience from looking out in the audience i know you're within this field but just appreciate that we understand it incorporate a lot of your recommendations and suggestions into the hearing and thank everybody for being here today ok thank you dr keogh you may begin thank you thank you for this opportunity to testify here today i wanted to mention that beyond my service in the president as past president of the society for neuroscience i am a member of the  institute of medicine and its forum on no science i'm also a co chair of the student committee of the biomarkers consortium at the foundation for and i i currently hold funding from the and i h the office of naval research and pritzker foundation to conduct work on the biology of stress emotions addiction and mood disorder and as an aside given the discussion in the earlier period we are studying in the priscus consortium the brains of people who were depressed and committed suicide there says the brains of people who did not and whether they were being treated or not and i would beginning to get some insights to your question about where in the brain the changes might happen that's not the focus of my testimony today but i'm happy to answer questions about it so as we've heard the global burden of brain disease is staggering and the challenge of understanding preventing and curing brain disorders  very much before us today what i wanted to do is outline what i believe to be the central grand challenge of neuroscience one that is relevant to all the brain disorders that we've been talking about and i would like to suggest a couple of strategies activity each brain cell is a breathtaking piece of biological machinery but a single cell can never perceive beauty or feel sadness or solve a mathematical problem through the magic of integration completely new capabilities emerge when networks of brain cells come together to form brain circuits each of which performs specific functions such as vision hunger cognition emotion i call choreography by the time a brain disorder is evident it has affected not a single group of cells but the entire circuit it's the in this direction of the whole network that leads to the symptoms of the illness is that we are concerned about the problem is not that a ballerina has stumbled but that the choreography of the whole ensemble has fallen apart so when we're thinking about the impact the brain injury on movement the exaggerated response to threat to a threat signal in a soldier understand the workings of a brain circuit circuit and learn how it controls itself as dr insel has indicated we know the elements of many of these circuits but we need to watch them perform in real life in real time and discover how their choreography fails and how that causes disease the idea that brain disorders are the result of faulty brain circuits also explains why it's been so hard to uncovers genetic causes of some disorders that we know to be very heritable like bipolar illness it's because the symptoms that clinicians diagnose are manifestations of a destructive brain circuit and there are countless ways to screw that up so different families can suffer from completely different genetic problems and still share the same medical diagnosis and like any given the answer in the troop can fail and the strop the whole dance but the idea also means that there are multiple ways to repair the problem we don't need to devise a new treatment for each family we need to learn how to retune the circuits to the networks so how do we take on the neural choreography challenge my inspiration for tackling it comes from the brain itself the creation of well orchestrated networks of scientists who work together to achieve what can never be achieved separately this effort needs to be grounded in some hard earned realities in the words of president kennedy we need to be idealists without illusions understanding the brain and mind is hard and we need help not only from each other but from our colleagues in math physics chemistry and engineering we also need to engage our friends in the social sciences since our brains are constantly being remodeled by our social environment but the knowledge that can emerge from such networks can be transformative and the discoveries unimaginable i've suggested in my written testimony three types of integration horizontal integration where a large number of investigators with the same general expertise focus on a given slice of a problem for example validating biomarkers of a disrupted brain circuits say in p t s d vertical integration among different types of scientists who are focusing on a scientific question or disorder an e trying to solve it from molecule to mind and back and no choreography is right in the middle of the path and finally two dimensional integration that represents special large scale projects that combine vertical and horizontal effort the goal would be to advance our fundamental knowledge of neural circuitry and relate the discoveries not to one disease but to several disorders but whatever the model rather than being entirely investigator driven or agency driven i believe that this process needs to arise from a partnership between the scientific community and the federal agencies to get buy in and to the find the specific approaches that would be most fruit in summary understanding the brain and healing it when it is sick may well be the most difficult challenge that humanity has ever undertaken we need to give this amazing organ its due by bringing together every tool we have at our disposal and public health service and practicing psychiatrist and i served in interim your programs of the national institutes of health for twenty five years and i've just retired from the pharmaceutical industry where for the last fifteen years years i worked with a couple of big companies eli lilly and merck which had big investments in cns drugs and despite the sensational advances in euro science during this period and the explosion of sophisticated technologies you've been hearing about we have not delivered truly novel drugs for diseases of the brain arguably the current generation of psychiatric medications for treating schizophrenia depression and severe anxiety are no more effective than the first generation of medications discovered over fifty years ago and those by accident this sumption back in the eighty's at all levels of government and industry was that that scientific explosion would rapidly lead to more effective treatments but that was overly optimistic if anything the opposite has been the case it's become much more difficult to develop the novel targets that were i d and bring a single new in the d to market now costs on average one point eight billion dollars which is actually a pretty conservative estimate of the real cost the new drugs and this is for all drugs new drugs for brain diseases emerge and even lower rate and prove more expensive to developing and carry extremely high risk so what went wrong with our predictions from the eighty's and as dr insel has has pointed out we have a new revolution to incorporate into our future thinking so what went wrong was the assumptions were too simple as as dr keil has currently addressed and so the complexity of both the genetic and physiological level was much greater than we ever anticipated and we did not have the maps or navigational tools to go through all of this data and pick out the right targets so what we're up against sort of this wall of what we call target validation what are the right things to make drugs for instead of a few drug targets we have hundreds now have need to sort through and it requires to sort through a single one that we think might be valid it takes an average of almost over thirteen to fourteen years and get it through regulatory view and through the market if you are in the business of china of the of the industry for the central nervous system area at best a one in twenty of things that we take into this very expensive and long development actually deliver so obviously with that sort of numbers it is not possible for the pharmaceutical industry to survive by investing in the cns field without a huge paradigm shift given long development times in the current laws most drugs will have ten years or less a patent protection by the time you've been through this and ironically the me too drugs which are easier to develop actually the ones that enjoy the longer patent protection so the incentive structure actually rewards coming up with me too drugs and says don't waste your money on coming up with novel better drugs so that this is basically why many companies have reduced their investment so in one area we have we have an exception fortunately and that is around the field of all timers and there will in the end i h clinical scientist patient advocacy groups  after appease the f d a and industry joined together under this remarkable effort sponsored by the national institute of aging called the all timers disease in your imaging initiative and in keeping with some of what mr kennedy's already discussed the da findings become available on computer available all in the public domain as soon as the data is gathered and process this as a model has taken hold worldwide and is currently trying to be implemented in european year on year in japan australia and korea and fundamentally their governments have said this area of translation of medicine and the tools and the data sharing this is scary to support it our national priorities we use this term translation oh man the medicine the cover all the science and technology to help us translate the basic science that dr calle was talking about into something that might be useful for patients but to realize the promise of these scientific advances we have to invest a great deal more in the tools of translation of medicine an area which falls in the middle and less support than the basic science at one end or the large clinical trials of the drug companies at others so the right balance of resources across the domains of basic research translational medicine and clinical trials has yet to be obviously need to protect individual privacy and the second big push with these put the research tools and compounds held by both commercial entities and universities and private investment and spit and funded investigators into the public domain into what we call pre competitive space and get that out there as quickly as possible and to make that possible we probably do need innovative approaches to the intellectual property issues which are currently in p this sharing of technology and dat so actually i'll stop there but i can go into much greater detail how this is your entire statement of being a record doctor pattern but i would like to mention one thing that we do have an initiative which dr kills are referred to the foundation of the national institutes of health where we are beginning to try to bring us all together to work in this pre computed manner but i want to emphasize that the funding and infrastructure and degree of support to really do it at a proper national  venture philanthropy arm of the national multiple sclerosis society i'm here today on behalf of the estimated four hundred thousand americans and the many thousands of veterans who live with m s every day together we ask you to help us advance m research and really neurological research across the board for all of our colleagues who are affected by neurological disease we need your help in providing resources and policies to expand collaboration and networks between government patient advocates private foundations and the pharmaceutical and by technology industries and of course academic investigators all my remarks focus on m s really they can be applied across the board multiple sclerosis is a chronic predictable often disabling disease of the central nervous system that interrupts the flow of information from the brain to the body and stops people from moving m s is the most common or logical disease leading to disability in young adults but despite many decades of research its cause remains unclear and there is indeed no cure and while we are grateful for the availability of a number of f d a approved disease modifying therapies we still need more and better cost effective therapies finding these new therapies hinges on research and the kinds of collaborative efforts that we're talking about today amongst all the stakeholders it's been our experience that research discoveries can happen a lot of different ways as you've heard today some require lots of years of careful shepherding while a lot can happen overnight whether it's a molecule or a tool they all need a number of steps to be taken in order to translate those discoveries into actual application that can be used in people with m s as well as other neurological diseases this involves collaborators commercial development accessed of clinical trial participants and a lot of money we were created as an organization by the national m s s i t specifically to drive commercial development for m s therapies we've made a commitment to ensure that potential new therapies actually make it into the clinic and are developed and are able to be used for people with all forms of m s we have found that all too often promising drug treatments language languished because companies lack the funding focus to conduct pivotal research that will break through barriers and move a compound through the development pipeline and ultimately into clinical trials we fill the gap that's often called the valley of death by creating a collaborative environment between scientists clinicians academic researchers and of course commercial visionaries and by creating these vital networks fastforward increases the focus on m s and speeds the process of bringing drugs to market today we join with our patient advocacy colleagues and calling for more investments in in policies to sustain innovation or science research and development in our view expanding and sustaining innovation in neuro science r and d really requires three core critical elements as you've heard today we need to sustain a large and vibrant medical research community in the united states medical innovation doesn't happen in isolation it happens amongst a community of scientists and physicians actively involved in understanding knowledge and disease about biology and human disease it is vital that we continue to expand our commitment to the national institutes of health and work also funded through the department of defense and veterans administration second we also believe that we have to create an environment conducive to the formation of what we call fluid networks of scientists engaged in translational research we know that research and innovation happens faster when scientists work together across networks fields institutions and borders for that matter coordination by the government agencies private foundations and patient advocates is critical to ensure in these networks and lastly we believe that government foundations and patient advocates have to use their influence and financial resources to connect people together across sectors but we know from our own experience that young companies and innovators work smarter and faster when you have experts in the private sector working with experts in the academic sector we need to do more of this so that all of the stakeholders can enhance no science  conclusion mr chairman the united states has a long history of being a leader and driver of neuroscience research and development unfortunately we do find ourselves in a environment where economic challenges are begin to threaten this leadership as patient advocates we urge action to ensure that there's greater coordination among the stakeholders every day americans receive the diagnosis that they have the neurological disease on these individuals do not have the luxury of time they need our help to create a research and development environment where they can have access to the best treatments to stop their disease and restore lost function thank you for helping us move closer to that world and thank you for your time thank you very much dr parker term because senator congressman kennedy  vehicle we've been fighting since about often answers about eight o'clock that morning we had an i e d it flipped over the m rap and there you see running up to check the soldiers about thirty seconds after this photograph was taken an r p g hit that cliff right above our heads when we neural scientist i was doing the heart when someone start trying to kill my friends with ideas i figured i better get a piece of this fight so if you take a look you imagine that the whole patient the soldier the behavior those functional disorders that injuries that goes from the centimeter scale this brain to the neural networks that allow you to recognize a friend speak to a loved one count your change of the burger king it disrupts the neurons to break the synapses all the way down to the nanometer scale at the bottom where you see combining to exercise your matrix this is where mechanical forces get transduced into physiological signals called macand transduction pathways in this case it's a path of physiological signal because we're activating signal pathways that we don't necessarily want to activate it's like this is the temporal scale of t v and i'm going to look mostly to on this timeline to the right of the blast what we call right of boom so you can assume that prior to the blast we assume we get stable neural structures stable vascular structures stable gene expression now that's there's a big asterisk next to that right because these guys are in combat they're facing physical danger moral jeopardy there's a lot of stress hormones there we don't know exactly how they might be impacting all those structures once that boom happens things start happening on the nanometer scale proteins undergo conformational changes that turn on those signalling pathways that cause excited toxicity that causes neurons to have their membranes torn to activate signaling pathways in mild cases of t b i that you might not see for some time you can't diagnose them currently and if you follow that timeline going all the way across to the right spending out the rest of the epidemiological lifespan of that soldier you're going to see a variety of problems emerge they might not emerge right away but eventually they might and when they might when they do emerge every time they emerge if it's twenty thirty years on down the road that's one more victory for the poems that we're face on the battlefield when they take another soldier down with parkinson's disease or all timers or dementia on down the road they're still one in that fight we talk about counterinsurgency is a long war taking care of these casualties is the longer war and what we need to do is develop a cohesive plan to address this longer war interagency just like we've got on the battlefield right now but interagency like you heard from the first panel is the only way to go solve this problem so i want to couple recommendations before close here when you start taking a look at putting people on to this problem i  think there's as an outsider coming in there's a need to evangelize the scientific community about t b i we talk about job retraining for people that in textiles and in an automotive industry that need a new job we need retraining for scientists who want to come into this field who are trying to make that jump that's very difficult for them so this might be as simple as running courses at the marine biological lab woods hole massachusetts or cold spring harbor labs in new york it could be as simple as that it could be something more complex for an i n d s the a d l d n n i m program manager for that is geoffrey ling who's the only neuro intensive care doc in the army he's also the program manager for my darpa funding the t b i program called prevent preventing explosive violent neurological trauma you've got one guy doing this thing all by himself over there dar a but these kind of interdisciplinary fights where you need people to understand shock physics sellon tissue mechanics molecular biology neurobiology psychiatry that's very complex and you probably won't find an instance in american or scientific history where all those scientists have been represented in the same room at one time but the only people who can pull that together is darpa but darpa the short term funding they come in they impact the field and they move on and let another agency pick it up we need a longer term more sustained effort of bringing these people together for a long time now i think that two things need to happen in terms of establishing goals for this field one is i'm not going to surrender that turf that you see just to the right of boom right now if you get a mile to be on the battlefield we're going to you might get treated you might get evaluate you might get pushed back into the fight and one of those soldiers those in that photograph i showed you earlier has been blown up ten times between tours in iraq and afghanistan what's going to happen when suddenly he goes home one day and he can't remember his son's name that's a victory for the enemy i'm not going to surrender that turf to the enemy if you take a look just to the right a boom when i run up there and i take care of that soldier when i pull up on the m red door to see if he's ok the treatment for that t b i needs to start right then so one of the goals that we need to b i it might be p t s d to but the d o d in the v a keep great medical records i'm from i live in massachusetts the frame and heart study run by boston university has revealed all kinds of great things about heart disease that scientists like me who traditionally work in the cardiac field now i split my time between t b i and in the heart i have used to guide our scientific studies we currently don't have that database we need that database framingham heart study and in short term goals so over the entire kevin awesome thank you for your service every which way yes dr morrison yes i'd also like to thank the chairman and mr kennedy for the opportunity to be here today this it's the potential and promise of neuroscience i'm here today on behalf of the society for neuroscience which is a nonprofit membership organization of more than forty thousand basic scientists and clinicians from around the world who study the brain and central nervous system are members work across the entire research spectrum to advance basic understanding of brain function and to translate basic science discoveries into treatment strategies for more than a thousand brain illnesses exciting it's even since scientific discoveries have fueled tremendous progress over the last decades positioning the neuroscience community for transformational progress thanks to new tools and technologies that enable us to study the brain as never before and you've heard about some of those today today i just like to offer two brief examples of emerging discoveries that hold promise for research in the american people first neuro scientists are making great strides in understanding the brain circuits involved in p t s d and how the how these circuits are altered by stress we know now a number of altered bra chemicals and systems associated with p t s d and the part of the brain that links learning and memory to emotion is smaller in people with p t s d as mr kennedy pointed out earlier p t s d is circuit based in specific circuits are malfunctioning you know scientists are also making tremendous progress in understanding the neurobiology of aging we know that a part of brain cells called spines in the prefrontal cortex are depleted as we age and this leads to cognitive decline these basic research findings have already provided scientists and clinicians with new therapeutic targets to prevent the loss of spines and retain cognitive health and the same observations will help form a new approach to therapeutics for alzheimer's disease the importance of neuroscience research is reflected in and you heard about this already today in the fact that brain and nervous system disorders result in more hospitalizations in any other group affecting more than fifty million americans a year that cost exceeding four hundred sixty billion dollars a strong investment in basic science innovation is also critical to our national economy and create thousands of high wage jobs at a critical time biomedical research must be seen as one primary solution for diseases and disorders that already cost society hundreds of billions of dollars a year several of which increasingly threaten our social fabric including my area of expertise alzheimer's disease two years ago the bipartisan alzheimer's study group co chaired by newt gingrich and bob kerrey painted a very troubling picture of the social impact of alzheimer's disease if we don't do more to delay or prevent progression of the disease the outlook for al morally sustainable for those millions who we know will suffer terribly or for their families nor is it economically sustainable for our nation the situation is repeated for a thousand other brain disorders at a time of economic challenge for our nation the economic question is not how can we afford to invest in research rather is how can we afford not to invest in research that has the potential to save many times the dollars invested the issues discussed today remind us that scientists and medical practitioners must be much more engaged in a two way dialogue if we aren't sure that discoveries translate into treatments and clinical observations are integrated into research development we've seen this referred to several times today no science research that benefits one condition or disorder has broad potential applications for many conditions making it critical that we encourage more collaboration that crosses traditional scientific boundaries one of the most critical collaboration is across what has traditionally thought of as two largely independent enterprises basic science and clinical research in fact we must recognize that both endeavors are necessary components of a continuum that leads to translation we must encourag silicate scientists in clinicians to work together at the team to translate scientific knowledge and discoveries into specific personalized approaches to diagnosis treatment and prevention of disease one example of the importance of practical scientific application and translation is our increased understanding of synaptic plasticity which is in essence the brain's ability to modify neural circuits to better cope with new circumstances this incredible capacity for adaptation is a fundamental property of the synopsis and our understanding of it emerge from basic science yet it is already having a revolutionary impact on therapeutic strategies for multiple brain disorders and closing with on the forefront of an era of  breathtaking potential to advance biological knowledge and human health our future success will depend in large measure on sustaining the look the strong investment in basic narrow science discovery as well as team oriented collaborative approach is between the basic researcher and the clinical research or i look forward to the road ahead in this exciting field and what our success stories will mean the american people thank you very much we have we have another series of votes mr kennedy i conferred and we're each going to take three minutes for questions or comments and then we're going to adjourn this but i would just say that there will be follow up questions that myself and others will submit to you and we'd ask that you for your thoughtful consideration on what questions members of the committee submit mr kennedy recognized for three minutes and then i'll wrap it up thank you very much mr chairman as we are speaking  today at rhode island or in the fort hood committed suicide as we are conducting this hearing from middletown rhode island my district he committed suicide and murders wife  most poignantly these are combat deaths and they're part of the enemy strategy and whether they're killed in action or they're killed over here because of their wounds of that action that they saw it's a death as a result of this war and if we don't take it as such we're not going to approach it as such because we'll think of it as something else other than part of our war effort so urgency that you gave us kip in terms of fighting this fight as it were fighting the enemy because this is the enemy's fight that they're taking to us we've got to take it back to them and that kind of call to action you gave us so poignant so powerful and i think serves to act as a catalyst for all the things that dr paul potter was saying about the need for a national priority to be put on this that's going to return the science in short order on the emergency level that it demanded because we're not turning around fast for everybody here who acted tim as well that open source need for sharing of science because we're all in it together and the need for us to do it fast and furious for the benefit of the people who come to benefit from this and bring it to a national scale is so welcome and i thank you all for that and that image him of the valley of death valley of death and translational research from moving that research and in the lab to the bedside to benefit people that's a valley of death that's the con that's the word you use it is the valley of death every day longer we leave these veterans in that valley where shirking our responsibility go inside fred thank you for your comments and dr potter if you could keep submitting for us the kinds of regulatory science reform you think would be necessary at the a to give dr hamburg her support along with what we asked the n i m h and other directors to talk about so that when they come up with something we can move it right into practice and if you could just to make sure that we can get the vote here i want to thank pat kennedy again for being instrumental in creating this hearing  there's no question they can ok dr calle you talked you said something that i thought was you know everything you've said all the witness has been very important but you said our brains are modeled by the social environment that parallels the studies david bohm the quantum physicist who said that the world is a hologram of the brain which is a hologram of the world of the world he was he was really looking at the whole anomic theories of carl pre buy and they basically got and they got together and you know addressed the issue of the brain in a more global way which is what your testimony i assume  is is advocating when you talk about the choreography the brain you're speaking the brain in a more in a much broader sense a set of things that are site specific you're looking at at the brain in terms of its vast vastness is that yes i think the idea is that things are integrated both in space and in time in the brain and that's how you functions emerge that we cannot comprehend by looking to molecularly and that the brain is the place with nature to should meet and so the social environment is just as important as the genes we are born with well you know the work the work then of let's say mass flow becomes relevant soldiers in dr parker thank you for bringing this very specific study the impact of of war and physical impact of war and then the long term impact of war we also need to look the post nine eleven america when you talk about the social environment the brain being modeled by social environment we've got an america that's been filled with fear and  and violence whether it's vicariously through the media and that has to have an effect yes it just does that's going to i'd like that to be a subject of perhaps another hearing in which maybe we can ask some doing is important to future the world thank you