Before the u. S. China review commission. We will get going in a couple of minutes. Period ofly a short time for our first panel anyway. We will expand it a little by starting a few minutes early. Several commissioners are on the way. D morning, everywhere everybody, welcome to the seventh hearing of the u. S. China hearings. 19 court cycle. Thank you for joining us today. Todays hearing will examine chinas role in Global Health and the National Security, economic, and Public Health concerns stemming from american dependence on Chinese Health products. Our witnesses will also discuss the activities of Chinese Health and biotech firms in the u. S. As well as the opportunities and challenges u. S. Health firms encounter while operating in china or trying to sell into the china market. Globals the biggest source of generic drugs, pharmaceutical ingredients and other Health Products, including dietary supplements, biologics, and medical devices. There are serious deficiencies in health and Safety Standards in chinas medical market. Imports of these Health Products either directly from china or indirectly through companies and 30 countries continues to increase. Including according to the drug imports are from china, as well as 39. 3 of medical device imports. These numbers understate significantly the true sourcing of Health Products from china because china is also the primary supplier of precursors for pharmaceutical companies and other countries such as india, which in turn are major suppliers of the finished products to the u. S. China has emerged as the secondlargest pharmaceutical market in the world by revenue am only behind the u. S. There are several factors contributing to chinas attractiveness as both a market and production site, including the low cost of production, Large Consumer base, and deep talent pull. As the market continues to expand, u. S. Consumers are increasingly reliant on drugs sourced from that country, which presents economic and National Security risks that we will explore today. As the largest source of fentanyl, china plays a role in the ongoing u. S. Opioid epidemic, facing a week with forak regime allowing exploitation of controlled substances. Warrant aese topics thorough investigation and taken together, they raise a serious concerns for american leaders. I want to thank all of our witnesses, we have a number of great ones today, for sharing their expertise. Were looking forward to hearing from all of them. Before we get started, i would like to thank the Senate Committee on Small Business and entrepreneurship for reserving the are used today our used today. I turn it over to my cochair. Good morning. I would like to thank everyone for joining us and think our witnesses for the time and effort they have put into their testimonies. With this Commission Deals a variety of issues in the u. S. China relationship raging from economics to military and Security Affairs to media and freedom, the subject of todays hearing touches upon the daily lives of our citizens. Health care is an issue for every family. Millions take lifesustaining drugs on daily basis, including Blood Pressure medications, diabetes control pills, and a variety of other medications. Statistics, latest 68 take a dietary supplement on a regular basis. If you know where the ingredients in those products come from. The packaging rarely indicates. Increasingly, they are coming from china. What is the quality and safety of those products and what is our exposure . Should the public be concerned . Should they have more information . Are the regulatory standards sufficient to protect their interests and how is that how are the facilities being inspected . These are important questions but they just touch the surface. Understand theo current landscape as well as trace of emerging trends and potential risks. Consider the advances taking place in the field of biotechnology and its potential for new therapies, medicines, and other products. China has designated biotechnology as a strategic, emerging industry and is pouring billions into developing biotech as part of its industrial plans. The Chinese Government encourages investments through Venture Capital investments in u. S. Biotech and health firms. Through a variety of programs, china is seeking to acquire the knowledge of some of our key researchers into the intellectual property of leading companies, and both legal and illegal means are being used. Chinas activities in the u. S. Biotech sector has fueled Technology Transfer enabling the Rapid Development of chinas domestic industry. Chinese companies have accumulated private and medical data on millions of our people. Earlier this year, federal prosecutors charged to chinese nationals for the 2015 act of Health Insurance giant anthem that resulted in the theft of nearly 80 million Americans Health data. But unlike similar attacks, it was targeted at acquiring longitudinal patient data to support the health care sector, including new drugs and treatments. These are the Confidential Health records that are doctors and Health Care Professionals keep. While health care should be a area for corporation in addressing many of the worlds most challenging problems, we have to ask whether we can protect u. S. Intellectual property and valuable health data well deepening collaboration. Scientific research should not be subject to competitive games and strategies. Health and biotech firms meanwhile continue to face regulatory and other market barriers that limit their ability to compete with chinese firms in the Chinese Market. In recent years, the Chinese Government has approved procedures to allow foreign medical products to enter the Chinese Market more quickly. Overrns remain, however chinas week commitment to protecting Property Rights and willingness to favor domestic providers of services and products. We will question market access, outline regulatory challenges and Market Opportunities for u. S. Firms accessing Chinas Health market. I would like to remind our audience that witness testimonies and witness transcript is available on our website. Examining keyng place september 4. Its my honor to introduce our first panel that will provide the perspective of the Defense Health agency. Fda submitted a record for this Panel Available on our website. We will hear from christopher priest, who serves as the Deputy Director Health Care Operations under the Defense Health agency. He is responsible for the policy, procedures, and director of direction of health care in the military. Earlier in his career, he served in the u. S. Army and retired as a kernel after 30 years of service. Mr. Priest, welcome. Please keep your remarks to seven minutes so we can ask questions. We appreciate your time and effort to be here and also thank you for your service to this country. Senator talent, mr. Wessel, fellow commissioners, i am honored to represent the Health Agency to discuss the safety and sourcing of materials critical to medical support of Service Members and beat 9. 5 million and a fishy areas for whom we are a nsible have responsible. As a retired army officer followed by five years and civil onvice, my family has relied military medicine for our care. My colleagues still in uniform and those who have retired and all of their families have placed trust and confidence in the system to protect and care for them. Both on the battlefield and here at home. Tohare in the responsibility sustain the trust and ensure they receive highquality and safe care. Reliance by the u. S. On foreign sources is an issue. Hat must be addressed allowing other departments to address this piecemeal will solutions. Optimal way tot effective address this issue is to use the buying power of the federal government in conjunction with effective laws and funding, to partner with the nations pharmaceutical production producers as one example to obtain necessary and for structuring capabilities, to independently meet u. S. The mystic and to compensate producers adequately for maintaining these capabilities. Dod is wholly dependent on the Consumer Market to produce and distribute pharmaceutical products it requires, spending approximately 7. 5 billion annually. Dod must work with the constraints of the commercial sector and Market Forces that drive or shape it. Depending on the commercial sector is a twoway sword. To reapes dod efficiencies of the competitive commercial marketplace and also makes dod dependent on the sources that competition produces. Dod, through our colleagues at the Defense Logistics Agency and at the policy level monitor available stocks and capabilities to meet contingencies and work with other departments responsible for u. S. Pharmaceutical production capabilities. Like other federal agencies, we rely on existing laws and other federal agencies, including the department of health and Human Services and fda, and the department of commerce to monitor Foreign Investment in distribution medical supplies. Certainirs products are required to be manufactured in the United States or designated countries with which the u. S. Has a Free Trade Agreement or other trade relationship. It applies to all federal supply schedule contracts, including medical devices. The taa andes by ensures references are included in our procurement contracts. Products available. Although dod produces a small amount of finished products from chinese sources, we are aware that 80 of the active pharmaceutical agreements used by commercial sources to produce finished products come from china. Noncomplaint countries such as india. We are concerned about any situation where foreign actors, including china, control substantial access to critical, or fighting material appeared we expect the trend toward chinese dominance to continue following past trends. Increased raised by chinese dominance in the market cannot be overstated. There is risk that existing regulations, programs, and funding are insufficient to guarantee u. S. Independence from unreliable foreign suppliers. Our concern is the ability of domestic manufacturing capability to adjust to that risk come alternate sources if any, and how long it will take to produce results. Have existed for some time and they are growing as the Opening Statements said. There is not a single solution to these challenges. It requires a sophisticated approach that entails National Security, economic, health, and diplomatic considerations. We are working closely with colleagues in dod and across the federal government toward this end. Thank you again for inviting me tospeak with you today, and demonstrate how we currently integrate our efforts with dod and other agencies to better support health and readiness for those we are proud to serve. I look forward to answering your questions. Healthide and ensure delivery across a number of partners who are responsible for management and administration of our military Treatment Facilities. As you may know, we have transitioned that to the Defense Health agency. Tricareaintain the program, which falls under my pure view. If any my purview. If there are any questions i cant answer, i will ensure you have a timely response. Thank you for your testimony, your service, and i appreciate you be here. Senator talent. Want to thank you and i know the Defense Health agency has a wide range of challengesities and your confronting, and it is frustrating to have another one on your plate that, as you point out in your statement, is really that wasse of anything within the responsibilities of the department of defense. You mentioned in your statement, and 50 there is hundred lines of drugs or pharmaceuticals that out of over 6000, you are purchasing from countries outside the buy american act. By a special exception. Can you tell us how much of the total, which drugs are the most sensitive . In other words, if there were an issue, either National Security or otherwise, and access to drugs or precursors from china were substantially limited, do you know the areas where you would have immediate problems . Are you aware of that and at the point where you know that . I think we speak. There is a number of government there is a and policy looking at this. We have an inventory of this, i dont have that available. I think as stated in the written testimony, overall, the number we received directly from china is not very large. However, the risk still continues. As we collect that information and look at it, we do know, and i give one example i think ms. Gibson will talk about that in her panel. Medication that is produced not domestically. A large portion is produced in china. That is a leading indicator of the seriousness of the conversation. In certain aspects, this is a battlefield issue. I would think that you all would be preparing, at least on that level, and exploring the possibilities like stockpiling. I dont how feasible that is with a lot of these medications. Thank you. If we have another round, i might have another one or two. Mr. Wessel let me ask a couple of questions if i can. You talked about the trade agreements act, and having spent some time with buy american statutes, my understanding is that to qualify under the act, and i understand you may not be a trade lawyer, is simply pressing a pill into its final form, it will designate origination. When we say we will buy it from japan or wherever else, all of , 80 are coming from china, simply pressing the pill after they bought all of the supplies from china would designated as acceptable under the act. That is a trade policy issue. But what it says to me is we dont really have the ability to pierce through the supply chains as well as we might like. To protect the war fighters and their families. That as they are on the battlefield and subject to being an harms way and subject potentially to injury, our primary interest is in making sure they are able to come home to their families. Doddo a tremendous job, the come at the advances are startling in terms of survivability for what you, your colleagues, and people on the battlefield are able to do. But it seems to me we dont even have all of the information we need to assess the risks. And if we, if conflict potential increases, our vulnerability will increase as well, and we need to have some way of assessing that. Is that kind of assessment would that assessment be helpful to you and your colleagues as you look at the Treatment Options for the people under your care . Mr. Priest i think the answer is absolutely. I think the value of all of the work you are producing, along with the work being conducted within the administration, across all of the departments, absolutely gets to that point. Again, representing the bottom of that supply chain, and particularly the providerpatient interaction. I would like to give a shout out to my good friend, captain rick friedman, who is commanding a hospital. He is a dental officer but we dont hold that against him. Andink he represents, he his team, they are actively taking care of patients in an active theater, they represent the risks you talk about. The risk to the supply chain. I do believe, and i think the fda comments in their written statements also point to the murkiness of that data, and that just adds to the risk. Youre absolutely right. Lawyer, and aade Simple Healthcare administrator, simile having simply being compliant is not guarantee safety either from the sources from china, or frankly, any source of reduction. It was always the risk that those drugs are not as effective as they should be. There may be manufacturing defects. A lot of this conversation we are talking about is on the pharmaceutical side. There are a host of implications when you start looking at devices, laboratory services, the whole sphere of bio economics of which health care is one small piece. I agree with you that that is our concern. Theobligation is to provide best Services Using those materials, and again, what we have achieved in almost 20 years of operation and across those rateers, the survivability is highly dependent on technology, research and development, and having the tools, including supplies and equipment, that we know are safe. Thank you. I have a couple of questions. Spend 7. 5 that you billion per year on pharmaceuticals. Obviously the u. S. Pharmaceutical companies are going to china for lowcost production. Any did munition reduction in the cost of pharmaceuticals . The cost of pharmaceuticals is on everyones mind. Mr. Priest the military Health System is not immune to the pressures of cost. We work hard in there are certain provisions and how we are able to deliver that service, and we use it through three points of delivery and there are different economic mechanisms to control the cost. The impactto gauge overall, but i will give you some examples of how we execute the pharmacy benefit. We obviously have inpatient and Outpatient Pharmaceuticals we deliver to patients. [indiscernible] we also deliver our benefit through the Mail Order Program and our commercial partner, esi. Mr. Priest clearly those are somewhat limited, although i think there are across other trauma systems in the u. S. And dod is proud to have led the way. Ratesttlefield survival are unparalleled in history, but i think it points to those very specific items that would be military items that could be traceable from that perspective. Ms. Bartholomew thank you, i look forward to the answer from the record. Sen. Goodwin as a followup to the question where you were discussing the purchasing power of the federal government and bringing that to bear, in your role as someone who procures pharmaceuticals, the focus of course is on keeping price down. Gibson, herto ms. Testimony that we will hear later today, suggesting that the focus on cost exclusively is part of the problem, to the extent that it is resulted in the concentration of asos of a single supply source. Resulting in shortages and contamination issues we have seen. I want to get your sense of that assertion and also, she discusses in her testimony, not to put you on the spot, some private initiatives i believe, private hospitals have undertaken to broaden their perspective on negotiation for drug procurement. Not focusing on cost alone but also quality. Mr. Priest thank you, senator. As a healthcare administrator, we always look through the paradigm of cost, quality, and access. That is the trio of things important to delivering health care. The Defense Health agency and the military Health System operates under a paradigm. Readiness is the focus. The main thing we are focused on. Besides that, were talking up at her health, that her care, and lower cost. As i specified in the written statement, to drive on cost is huge. For 7. 6y the budget billion dollars, we have done well to maintain and sustain that at our reasonable rate, lower than the u. S. Average, but a lot of this is because again, of assistance we get with federal price discounts and sharing with patients on copays when necessary. But i do think that willie focus on the readiness thats when we focus on the readiness, we should not be solely focused on of the cost. Yet that is a major piece within we areced the line responsible for pete responsible for. Even though by law we can go outside how they do the procurement, and this to be patient be right into National Contracts and the stipulations we write into our ,ational contracts, we know like you stated, there are other civilian and commercial entities that have formed conglomeration to look at other ways to do that. To leverage their own buying power or manufacturing capability. I think that, as we look at Strategic Partners for the military Health System, these are ones we would like to explore further. Was this subject included in the Defense Industrial base study . Mr. Priest i do not know p it rep. Talent mike b it might be a good idea to consider that a recommendation. Mr. Lewis thank you for appearing today. This is a subject that a standard me when i found out what the facts are what it comes to our reliance on china for so many of the drugs that are consumed in the u. S. It seemed to me, the briefing paper the staff gave us indicated that the fda was inspecting some of the pharmaceutical companies from china to make sure the ingredients were proper, and they found was one particular drug used for high Blood Pressure, that they were using degraded materials. Rather than stopping the import of those items, the inspector was overruled by fda because we needed the drugs, even though they might be bad. It seems to me there are two reasons why we need to find alternative sources. Number one, if the fda cannot inspect the way the Chinese Companies are producing these goods, we dont really know whether they are good or not, similar to the way food is inspected before it comes into the country. That also impact the military. The second reason is if china were to stop producing these goods or restrict the export to would not have these drugs. It seems that we need to arrange an alternative source from European Drug manufacturers or other places in the world. What is the dod doing to make sure we are not totally dependent on chinese goods that are not fully inspected . , theriest as you stated fda has primary responsibility, the department of commerce as well. Mr. Lewis we heard that budget restraints are stopping them from doing things that need to be done. I. Priest yes, but again, think that responsibility within the administration falls on those departments. Perspective, we dont have the ability put ability to procure or test. But i would agree with you that the risks you stated are accurate. Mr. Lewis are there alternative sources, even if the price is higher . Mr. Priest yes, and i think i commented on that in the statement. My understanding, again, not being a procurement specialist, but if i can paraphrase from the know ist, what we also the process we have to manage by exception, the department cannot find if the department cannot insufficient find quality and quantitys to buy thatneeds, we must from elsewhere. Once a manufacturer meets the demands, nonavailability determination will be issued, opening the availability to noncompliant projects. What that indicates from our partners is that they can exhaust whatever sources they can to meet our needs. Mr. Lewis if in fact we cant , find alternative sources to give us the quantity we need, what did wouldnt it is worthwhile to make a large enough contract over several years that it would encourage alternative manufacturers to build facilities so that we would have the quantities we need in the future . Mr. Priest i think thats exactly what was pointed to in the statement about using the buying power of the federal government. And looking at domestic capability. Those are longterm solutions, but not quick fixes. I think what you are stressing is what we do in the current procurement side, for those that we do have sufficient quantities good quantities. We do have stocks worldwide of equipment and material for war fighters and we do that. The problem with the overall stock becomes those drugs in particular become dated and out of compliance. Mr. Lewis if the fda cannot inspect the drugs being exported to the u. S. , i dont understand why we would be any why we would buy any goods from china that would not meet our need, even if European Drugs are a higher price. Mr. Priest i think, and i believe, i will go back and be assured that im speaking correctly, but i think we would. Was another shortage recently and thats exactly where we went and looked at buying from europe, particular western europe. Mr. Lewis thank you very much. I dont understand why we are buying products from china. Ms. Bartholomew thank you again. Are you a californian . Excellent. Always good to see californians out here. I want to make sure that i understand, even when we are getting drugs from a taacompliant country, the areonents of those drugs still being produced in china or india or somewhere else, right . There is no guarantee of the , even of the component though we are buying it through a system that is acceptable to us, is that right . Mr. Priest i think thats a fair assessment. We would agree based on our understanding that that is true. Taa compliance doesnt guarantee safety that safety. Thats why we agree with the opening comments that it poses a risk to beneficiaries. Of this isomew some just a level of education and understanding. It was mentioned in the opening statement. Get updod related or not in the morning, they take vitamins, Blood Pressure pills, antidepressants, whatever, and dont think about or dont have to think about about what has gone into what they are taking. Its an important issue. Also in terms of public education. I think that would be part of the answer, if people knew the potential daily risk of what they are doing, they might be more concerned and raising concerns to people who make decisions. Mr. Priest, appreciating the context and rules within which you need to operate, the trade agreement authorities limit what you can do, and so for example, chinese products simply stamped into a pill form in another country under the trade agreements confers transformation. And you dont have the ability to look through, you have to comply with existing law. Thats were some of the risks are and something we might want to look at. Mr. Fielder the commission a couple of years ago, staff did a good report on fentanyl importation. There is other testimony we will morphine, which i still imagine served immediately to wounded war fighters. Problem thatpioid exists in society, how does it exist within the defense department, the military . Mr. Priest overall incidence of opioid issues is lower than the u. S. Added rich u. S. Average, as you would imagine. You have greater control over issuance than the civilian world . Mr. Priest yes, and i think it is something to be proud of. We have been looking at chronic will has beennd prescribed, and in a lot of Treatment Facilities we have pain clinics, but we look at what they do versus the average provider and we were able to drill down to the provider level to ensure that what we are giving is the accurate dosage and is being properly in accordance with Clinical Practice Guidelines it we take a hard look at that and want our provider forced to be well aware of what they are prescribing. Our chief medical officer is leading the effort in the dha. We cochair a group, the medical operations group, and that is one of our key topics. We want to make sure that therapeutically, we are providing those trucks when necessary but we also want to ensure it is done in a safe and effective manner. We are watching how the drugs are being prescribed. Again, our providers are to be commended for what we are able to achieve. Were also looking at pain overall to try and determine if there are alternative sources pretty sources. Alternative medical sources reduce our reliance on opioids, and that is the direction we are headed in with policies. [indiscernible] mr. Priest good to see you, sir. Thank you for your willingness to be here. I am sorry to have shown up late and still ask a question, but the line of questions and isponses just struck me, and have to say, i am a military retiree. Takeconsequence, if i regular prescriptions, i have to use express scripts. They do a terrific job. In the past three months, i have pressureblood medications recalled. When i tracked down the sourcing, they all came out of india but were originally sourced in china from four different suppose it u. S. Manufacturers, or at least providers. In each case, that particular medication was contaminated with rocket fuel. You do a little work on the internet, you can figure that out. I know it is not your fault, but i think it is really important that something be done about this by the department of defense and the u. S. Government in general. The other medication wasnt contaminated with rocket fuel, but again, three recalls in three months. I imagine activeduty people have the same problem, and that affects the readiness of our force. Mr. Priest i think that risk is well stated. Im not sure if you were ortin, we to vals talked about that in a previous question. From my perspective, having the pharmacy benefit under my it was disturbing for exactly the reasons you stated. The fact that we couldnt come and i will restate briefly, the fact that as you indicated, antiple recalls over extended time, different doses and a from packaging, not knowing what was next, thinking as we normally see recalls are one and done. , selfis a particular lot disclose for the manufacturer. But this has been an unending saga and i think it is a trend. Something we is needed pay close attention to and identify, because part of my obligation is to be able to inform patients like yourself, again, as a fellow veteran, and other veterans as well. There is an obligation to do that so we can provide drugs that we know are safe and effective. Mr. Wortzel the interesting thing is, probably six times i had to get emergency refills at a local pharmacy, and in each from ahey had tons of it manufacturer that the department of defense did not use that were not contaminated. So they solve the problem early, apparently. Mr. Priest sir mr. Wortzel it is a bureaucratic problem but a big one. Mr. Priest i understand. Our sources are not necessarily taa compliant, so it goes both ways. What we want to make sure, and i said, as youwessel go through the process of looking at the sources that are taa compliance. And iis a murkiness, think the fda commented on it in testimony, that is troubling for all of us. It is not unique to the department of defense. The fact that the retail sources can buy from other sources when we have to use taa compliance sources, in this particular case that may have been true. But think about the implications on the other end of the spectrum, where retail pharmacies are buying drugs that are not taa compliance it i understand compliant. I understand and appreciate your comment. Thank you for your testimony. Mr. Lewis. Mr. Lewis the more i think about this problem, the more i dont understand why large contracts are not being given to european or american manufacturers, which encourages them to create the components that commissioner bartholomew talked about, for two reasons. Number one, it avoids the contaminations. Number two, it ensures the supply chain. I dont understand why barch contracts are not being considered by the department of defense to encourage the construction of facilities that make components that go into the drugs. Mr. Priest i appreciate the sentiment and your question and comment, and i will carry them back to my colleagues in the department. Part of the issue is what is occurring today. I think as the chairs have stated and others have stated, we are relying on where right now, there are ingredients that actually exist. Thats why in my opening statement, i referenced the fact that we think that through the federal response and interagency response, we should be looking at alternative sources. Factsd imagine, i have no to back up my point, that we do do those contracts where we can today. Manufacturing capability in u. S. ,n countries or the those are alternative sources, which is the point i was trying to make. I agree with your assessment. Can i getlomew clarification, which is even the european pharmaceutical companies are having to purchase the precursors and components of the drugs from china, correct . So i think it is a great idea, but simply shifting to a different Pharmaceutical Company is not necessarily going to solve the problem if everybody is buying the pieces that go into the truck from someplace else. A. Priest china doesnt have monopoly on the construction of these components. Mr. Lewis why do we need to have European Companies buying those . We can put it in the contract they cannot use components made in china . Hear more we will today from some of our other witnesses about the change in the supply chains over the past couple of years. There are certain apis only sourced from china. Are here today, and mr. Priest, we appreciate all you are doing. We understand the regulations often prescribe certain activities. I think todays hearing, and i , will helpowon work us on capitol hill understand some of the challenges that exist and the changing sourcing landscape. We didnt talk about technology and etc. , as we talked about offline earlier today. Remote technologies that are subject to hacking, and remote medicine for the battlefield, etc. All of those are a different vector that poses new challenges as well, and we are appreciative of your testimony. We know that your primary duty and what you do so well is to protect our war fighters, their families, and retirees, and thats what we are hoping to do. We are proud of the fact that over the last i think 11 years, eight of our reports have been bipartisan and unanimous. I think the issue we hear about today is not partisan, if the question of how to we serve our men and women in uniform and their families, and thank you for what you and your colleagues do. We spend most of our time talking about pharmaceuticals. If we had more time, there are a plethora of things we would love to discuss. As you know, yesterday, the v. A. Transitioned their Medical Center to the millennium we now share with them. To join the information in the medical records, that we will have a single instance of an Electronic Health record, so that those that are veterans dont have to carry paper records around and one system can show what is on the other system. Were also partnering more closely with the v. A. , and i think this allows us to do that. Medical devices, one quick comment on medical devices, we know the risk that potentially has as well. Doing witht we are the Electronic Health record in a secure space has been tying in those devices. That goes to our procurement activities. We are looking at our hospital commanders can buy generally what they need. We are saying that adds additional risks and we will centralize those procurements. That way we can ensure that we look at the cyber implications of those devices and certify them for a connection with our networks. Lab services, that is another plethora of issues, looking at sequencing and data sharing am aware that information is going. Were also looking at what we tryingng inside dod with to not rely solely on external sources for our own genetic testing. The fear. It can the therapeutic and clinical value. It obviously we are very focused on pharmaceuticals. Again, thank you, we look forward to continuing to collaborate with your staff. We will take a 15 minute break. Mr. Priest thank you, ladies and gentlemen. [captions Copyright National cable satellite corp. 2019] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] several members of the texas congressional delegation tweeted about the el paso shooting. One wrote, my heart truly goes out to the victims and family of those and el paso. Praying for all affected by this horrible tragedy. Another representative tweeted, sending love and prayers to brothers and sisters killed or wounded in el paso today, detail still coming. If you know someone in el paso, ask them to go now to give muchneeded blood. We are el paso and texas strong. Representative, i am committed to pass commonsense gun safety laws to keep all americans safer. We will keep working and the senate must, too. Tweeted, ion lee am devastated to learn of the shooting and el paso. I mourn those lost and hold their love ones in my heart. Morning on cspan, the second round of democratic president ial primary debates in detroit, hosted by cnn. A. M. Sunday at 10 30 eastern on cspan, cspan. Org, or listen with the free cspan radio app. Reagan is an intellectual. He is an intellectual. He is comfortable with ideas and he understands the power of ideas. With that kind of intellectual foundation, a political leader can do all kinds of marvelous things. Author and historian lee edwards is our guest on indepth sunday. He is the author of just right, and a collection of biographies of william f buckley, william goldwater, and ronald reagan. Join our live conversation. Watch indepth with author lee sureds live sunday and be to watch our live coverage of the 2019 National Book festival on saturday, august 31, on book tv on cspan2. Next, he said on how to protect a Senate Hearing on how to protect children online. Announces a powell cut to interest rates. And that discussion of those rates. Now, a Senate Judiciary protectingearing on children online. This is an hour and 45 minutes. Good morning. We will wait a minute to start. Complement senator lee for bringing thi
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