The overall goal, as you point out is to deliver the right medication to the right patient at the right time and not to over treat people because we know that overtreatment can sometimes actually have serious side effects. Recently, for example within the i supported research it was reported that giving people with Colorectal Cancer less treatment they actually did better than people with more treatment, an important part of the Precision Medicine initiative which, thanks to your committee and congress has been strongly supported, we have been conducting research that is trying to understand better how the molecular abnormalities with Breast Cancer and other cancers can have implications for what treatments should different patients be obtaining as we try to refine those opportunities and interventions. Doctor gibbons, there is new research that would suggest having the stroke more than doubles the risk of dementia. Could you talk about that a little bit and in that area you might further define as people get older a stroke may not even be a apparent but what is the cumulative impact, my question, stroke as it relates to dementia . An important question you bring out in which we now appreciate that there are many forms and pathways that promote dementia. You are very familiar with alzheimers but theres also another category called vascular dementia that could affect one in 5 individuals affected by the debilitating condition. It can be insidious as you imply, in which it may be cumulative effect of vascular disease overtime that leads to cognitive decline promoted by risk factors such as high Blood Pressure and other risk factors for not only Heart Disease but compromise brain health. This is an area of investigation. It is one area where women appear to be particularly predisposed in terms of the cause of dementia as well as africanamericans, relating to an earlier question by senator cochran as to why in the jackson heart study we are particularly interested in the study of africanamericans, the causes of dementia vascular and alzheimers might give insights in that regard and in collaboration with our colleagues at National Institute of aging and stroke are engaged in the sprint trial, looking at lowering Blood Pressure in terms of preserving cognitive function so this is an active area of research. I would think that is another verification of my view and the committees view that while prescribing funding in some areas is helpful to get these funds increased and make the case, as in alzheimers we have gone from 400 million to 1. 3 billion in two years, but one, you are better at knowing where the pathways are than we are and 2, there is more than even chance that you will find something somewhere differently than you were looking for and theres lots of research that suggests that is the case. Perhaps this is for doctor honus, we have had a number of topics of dementia and alzheimers. What is the current state, one of the things i think, i have told chairman blunt this and we are in agreement that one of the opportunities the subcommittee has is to highlight to americans ways in which they can change their lifestyle, dietary intake, what is the status of the research regarding alzheimers and dementia that we would want every american to know in regard to their activities, behavior and nutrition and diet . That is a very important question. All of us want to make sure we are doing all we can to decrease the risk of dementia, it is an important enough question that nih commissioned a study on the level of evidence for the kinds of interventions which might have the desired effect in reducing risk. It was released today and some of your staff may have been briefed as recently as yesterday about it. The keywords were that there were a great deal of encouraging but in most cases inconclusive evidence for what we can do. I can identify three critical areas, the implication for what we know now, what we need to do, what is control of hypertension. There is very Strong Association between hypertension and its control and the risk of alzheimers disease and dementia. One study, sprint was designed to look at the impact of aggressive control of Blood Pressure on multiple outcomes and this is a case where the institute is working together, using alzheimers funding have supplemented that study to look at it impact on dementia. Those studies are ongoing. It is an area of great promise for Clinical Trials may give conclusive evidence but we have to take out the evidence of controlling Blood Pressure and decreasing stroke is so critical that it must be part of our Public Health imperative as we communicate. Another area is physical activity and exercise, shown to decrease the risk of death, cardiovascular disease and where again there is suggestive evidence it may play a role in decreasing risk of dementia. Number of studies including some going on at university of kansas which we discussed last year that are looking directly at randomized Clinical Trials to see what forms of physical activity may make a difference in lowering the risk of cognitive decline and dementia. The other area is cognitive training and one study supported by nih some year ago caused cognitive training was able to induce sustained improvements in cognitive function as individuals age. That study needs to be extended further to see if it will have an impact on dementia. What is the example of cognitive training . There was a specific studies called active that looked at older americans, men and women who have normal cognitive function and trained them in speed, reasoning or memory and studied them over years to see the impact of that training and it was an extremely positive outcome. Those individuals were trained in those areas did have improved function in 5 to 10 years in that domain. The National Academy report stresses that there is not yet compelling evidence for the other activities including computerdriven games that identify whether they provide similar outcomes. Good number of studies, where thanks to the increased funding in all dimers research we were able to look what might play a longterm role in decreasing decline and dementia. In response to the suggestion that nih should receive more credit for its work, certainly want that to occur. One way americans could relate to nih is hearing the things that if you do, chances of your Health Improving or being maintained, theres a consequence to this behavior. It is a way that you can tie nih to Everyday Americans and their lives, their worry about themselves and their families. Let me tie another topic that i care about, down syndrome. We have had conversations in which down syndrome and alzheimers, perhaps there is a connection. What is the status of our research and down syndrome . I will keep looking to my right. What is the status of that research and what do we know about the relationship between down syndrome and alzheimers . It is an important area of research that begins on a genetic basis, down syndrome associated with an extra copy of one chromosome, chromosome 21 which is the chromosome on which the amyloid protein and peptide lie, reflecting off of that, we have seen an increase in Life Expectancy, remarkable accomplishment over 30 years, average Life Expectancy not 30 but 50, and 60, individuals at an early age in high proportion i developing alzheimers like dementia in terms of symptoms and brain function. Because this population is a special high risk deserving of attention and because studying this population is likely to inform what we know about Alzheimers Research we have in collaboration with the child health institute, using some of the funding provided over the last fiscal year and initiated longitudinal studies in individuals over a range of age with down syndrome to study what is happening in the brain through imaging, bio markers to better understand the basis for ultimately intervening in these people, highly vulnerable population in learning more about the more general problems surrounding alzheimers type dementia. Thank you all for being so capable of speaking a language in terms that are reasonably understandable to me. Senator alexander. Let me thank you for what you do for our country, we are all excited about the future of the National Institutes of hope as doctor collins calls it, we are delighted the president has asked doctor collins to lead that, we look forward to your implementation of the 21st century cures act which we worked on, voted for and in effect past, what could we make it easier for you to succeed and i want to salute senator blunt, senator murray, senator cochran, senator durbin, senator more and for their bipartisan support, increasing Biomedical Research. Very little has happened in terms of technological change in our country since world war zero max it hasnt had some Government Research as part of it. We are leading the world in Biomedical Research and want to what accelerated, not slow down. Doctor collins, am i correct that a goal of the trump administration, to keep more american jobs in the United States . That is my understanding. We have 50 Major Research universities, 17 national laboratories, no other country in the world has anything like them. Is it true that around those and we spent a lot of money on them, the office of science supports 5. 3 billion in the laboratories, the energy departments, 28 billion goes through your agency to universities for research. Is a true that around these universities like stanford university, Oklahoma University of kansas, tennessee, missouri, grow complexes of industries attracted by the research and as a result create jobs around the centers of research . Absolutely true. If you look at the geography of where those places have sprung up it is very much attached oftentimes to a university that is a generator of a lot of interesting ideas, a credit mass of visionary scientists. Is a true the china is making extraordinary investment in new Research Even though they have one fourth out goes to mystic product they may exceed us in the amount of funding for research and as a result, a number of chinese scholars at graduate schools or universities are being attracted back home . That is also true. Recent paper pointed out in 2000 china spent 12 of what the us does on by a medical research. By 2015 it was 75 . Not talking about gdp, on track to surpass us in the next three or four years. One of the more harebrained recommendations that came to us is we lower the amount of indirect cost allowable for research grants, and average of 28 to 10 . This came up when i was education secretary, a huge uproar. Most universities and colleges said to us at the time we spend a lot more on research and the net effect of taking that would be Less Research. To cluster around the research wherever it is in the world. And losing 10 million when the new policy went into effect, kansas, 4 million, tennessee, missouri, kansas might not be. Only way i can think of to make that money up is either higher tuition or Less Research, Less Research is not our goal because Less Research means more jobs overseas. I understand you may be asked, because of your agency to your universities for the kind of research we are trying to increase, not decrease, to report to secretary price, the office of management and budget, what the effect of this would be. I ask you put in your report the following. If there is to be any change, Congress Wants to be involved. I want to get in the middle of that and i bet i can get a Bipartisan Group to make sure we are. Number 2, will us the university especially the state universities how much they would lose in funding, how much they contribute to their own administrative funding for the money you give them and whether there would be more or Less Research as a result of this policy, include that in your report, let us know about that as well. I hope we can nip this idea in the blood, one of those ideas in the president s budget out there to stir up conversation but it is a thoroughly awful idea, bad policy, it would not do what i know the president whats to do which is create more american jobs, not fewer. More research, not less. This policy would be less. My time is up but if you want a constructive way to get more money out of nih, look at the national academies, just to finish up, the national academies, two report said 40 of Research Time is spent on administrative tasks. Most of those come from the office of management and budget too so if they want to reduce those administrative attacks and free up more money for research grants, that would be a good area to work on, we could talk about that at some time in the future. My time is up but i want to register my strong concern about indirect cost policy and ask that you be so pacific and polling universities around the country about how much money would you lose, how much do you put into research your self and would there be more or Less Research as a result of this policy, thank you for your courtesy. Im happy to work with you on that. For senator alexander as well, your extra 60 seconds, that is where i was beginning. I appreciate your hospitality and a chance to see what is going on. We are looking forward to quite a bit of what we saw in research in initial levels and clinicals after the general population and a chance to see that. Everyone would benefit from universal flu vaccines, zika vaccine that is progressing, aids vaccine which is progressing, getting closer and closer, those are remarkable discoveries and a tremendous amount of people, cancer, Mental Health and everything else, we appreciate the Ongoing Research benefiting families all over the country and all over the world. Lets talk about what senator alexander was talking about administrative costs. How grants are done and approved talking to great recipients, i apply at nih and anywhere else i think it is close, to do their research. It is up to the entities to determine we got this one, you shouldnt take this one, they what they have. In the Research Area it is tougher to do blues not from the grant recipients, they are eager to get the grant money from our end, how do you coordinate that to make sure we have good coordination, that doubling up on research and other areas, and 40 of the costs with Research Dollars are paperwork being completed, get to greater discovery. How do we simplify the process on research and reduce the burden of the researcher but make sure we are coordinating from a federal level. Those are two great questions. In terms of the Administrative Burden we are interested in how to achieve at. This 42 never came out of the National Academy, 22 of that may be the part, the grant proposal, making sure there were great science ideas putting them forward and giving us annual progress reports so we know what they are doing, but that leaves a lot and we have some levers we could pool to reduce those things or oversight of conflict of interest. Some of those levers we dont hold and that includes other discussions, and that will ask us for a summary, responsibilities and where those are decided, a good list of those if that would be useful. Others included. The National Academy of published a report on this going through a good deal of that information as well. To increase others. Without duplication, and nip it in the but if it was starting to happen. We have better tools for doing analytics in our portfolio and what is in the portfolio, the National Science foundation and the permit of Defense Medical Research and the permit of energy efforts, and increasing intensity to be able to identify if there are unintended duplications. Sometimes it is good to have efforts going on in different ways. Certainly nsf has a lot of areas we specifically coordinate. The brain initiative, the nih and a few other organizations, we are meeting regularly to make sure that is going the way it is supposed to. We have a pretty good swim lane definition, and usda does agricultural plants and animals, nih does those that are relevant to human health and pretty good taps on those things, and listing their support. You have to look at that and make sure what they put their doesnt sound familiar. We ask carefully if that is the case, we dont have a lot of unintended overlaps, but there may be an opportunity to do a better job. Would love to follow up. The grant recipients and other fundings that is the area i see is a weak spot. There has to be a way to coordinate, and who has what lane. And the Research Done efficiently. Senator shelby. Very sorry. How much money overall in the us, all of the governmental ages. And Biomedical Research, the private sector, whatever it is and isnt enough. The budget you have overseen. Over many decades, in fiscal year 17. The number in front of me, 1 billion i am happy to do that. The private sector outspend government supported by medical research by a factor of two or more than two. And an overall spend in the neighborhood of 100 billion. How much is complementary, do you coordinate some degree, investigators in the private sector, nih and government, a lot of overlap. A personal priority to identify ways that we could avoid the overlap but also encourage the appropriate collaborative project. We have a model working pretty well. Accelerating medicine partnership, and the scientific leaders from the private sector mostly funded by nih and the private sector, big pharma and get around the table and say what are the needs neither of us can do ourselves that would speed up getting treatment, in the precompetitive space. The industry people, finding its way in. There was a lot of that. We have a project on alzheimers disease and Rheumatoid Arthritis and just started a new one, part of this effort, it puts money in both places. And these projects are turning out to be successful. Hundreds of millions of dollars going into this. How much coordination, investigating challenges we have, internationally. Happy to say. What is the cure for this. Happy is that science has always been an international enterprise. When it comes to this, some kind of effort called i am i, the medical initiative, i am i 2. What they are doing, served as chair of the head of international organizations, all of the funders in the private sector of the world, 95 of those dollars, and that is good to hear. We discussed research. Privately and many times, involving Cystic Fibrosis, autoimmune disease such as lupus several times, nih is involved in research and you made a lot of progress. Where they are, we made progress, where we are going. We are. We are bold enough to say we are on a path toward getting there. The Cystic Fibrosis cause, the genetic glitch was discovered in my own laboratory, at this moment, the development of very effective targeted drugs, only treated 5 of Cystic Fibrosis with a particular misspelling, the next one brought us to 50 of patients qualified for that and when you look at what is happening now, wonderful example of Academic Research in the private sector, the ceo is bold enough to say when i saw that a couple days ago. 20 years from now. With a lot of children. In the last year, a milestone in itself. A big assortment of Cystic Fibrosis foundation that have been incredible supporters of this effort from a philanthropic perspective. How many children become adults, more and more are affected . In the us it is 30,000 people. Worldwide. Primarily people of Northern European backgrounds, it is 100,000. What about lupus . It is difficult. The sample project i just mentioned, what they have been doing which is advanced technologically, and consequences of this disease is affecting the kidney. They are looking at the immune cells in those kidneys to see what is going on, not just as a bunch of cells together but one cell at a time. This is brandnew, single cell biology applied, and the types of immune cells in the kidney we didnt know where playing a role because they are rather rare. One cell at a time, you can find them. Where that will take us in terms of new therapeutics i cant tell you but this is another example, what this could lead to. For all autoimmune related to the autoimmune system. I should ask the answer is absolutely yes. There is a major effort from multiple institutes where the lead institute, other institutes doing the same thing. The concept of the induction of immune tolerance. And the immune system, depending on what the tissue is, Rheumatoid Arthritis, what we are trying to do is in the development of an individual and try and get the cells that normally would have been deleted or suppressed from the time you were developing a fetus because when you develop the first part of the fetus you have cells that have the capability of attacking our tissues. And it is deleted or they get colorized, they dont recognize or respond inappropriately to their own tissues and we have this immune Tolerance Network working by a number of mechanisms to determine how you can shut off the inappropriate response without suppressing your appropriate response because today the crude approach to autoimmunity is to suppress the entire immune system which leads to complications like infection this, we like to be precise, under the umbrella of precision. Kidney failure, one of the big things dealing with lupus . There are other things but that is the big one. It is a multisystem disease and you share your wifes struggle with this. She has done well. It affected joints, kidneys, can certainly affect other parts of the body including causing difficulties with the brain. What is the best way to intervene and prevent it altogether. What role . I will say dna is a reported role. It happened to be true in this case. And sufficient, and the trigger on top of that. Lupus is particularly common in africanamerican women, we dont entirely understand that, it may be environmental. Likely both which is often the case with diseases that have a genetic predisposition and that is one of the things we see in old diseases of autoimmunity, or a modest relationship to some genetic predisposition or some link. It isnt like one gene one disease, but certainly a link. Senator shelby took his two, 5minute rounds all at once. The is our big investment thats new on the scene here the try to answer this kind of a question. Do you want to very quickly Say Something about autism. No, thats okay. So the autism is really not just a transnih initiative, but its actually a transgovernmental initiative. I chair the coordinating committee that involves colleagues from really across the government, from the dod, from department of education, of course, from the nih, nsf. And our goal is to really try to understand and form iulate a Strategic Plan for research or around autism. I would say the three really exciting ongoing things that were trying to do, first, were really trying to understand what makes a difference in terms of interventions during childhood and how that translates into longterm outcome. The second, were trying to get a better handle on screening, particularly the younger and younger that we can identify people at high risk for autism so that we can intervene earlier and also so that we can learn more about what happens in these early ages. And the third is really recent developments in both genetics and environmenten influences environmental influences that suggest things are going on in the womb. So were learning we have to understand Early Development so that we can really understand the risks for autism and do manager about them. Thank you manager about them. Thank you for answering that in a timely fashion such that senator shelby still owes me. [laughter] one of the lightbulbs that went off as you were describing this new initiative such as echo, one of the things that suggests to me that increasing funding for nihr, theres always research, theres always science brings new knowledge which then causes us to look in a new area, and a new initiative arises which suggests the resources are growing, the need for resources continue to grow. Very few things do we get to put the check in the box and say we no longer need to look at this, but research allows us to say, oh, heres a new way, a new place, a new opportunity for us to find information through research and science that otherwise didnt exist. So theres lots of reasons ive advocated for increased funding of nih. It never to occurred to me your success breeds the need for more resources to find more information. So, dr. Gore dork before we go to senator kennedy, there are 19 places including Washington University that are looking at the adolescent brain, Cognitive Development and wonder if youd give us a little update on what were seeing in those 19 locations. Id be happy to, but thats an initiative that dr [inaudible] really spearheaded. We contribute funds and intellectual opportunities and also the data base, but he might be in a better thatd be great. Thanks very much. And thanks, josh. The idea the adolescent [inaudible] to actually image the human brain in its structure and its function. And this is a Noninvasive Technology that is widely available across Different HealthScience Centers in the country. And we wanted to so we now have the capabilities to actually monitor how the Human Brain Development develops from childhood, through adolescence, through adulthood. And the idea if you can get the standard then like we currently do in pediatrics where you have a norm that tells you whether a child is growing faster or slower, we should be able to get what are the normal distribution of Human Brain Development. So a parent comes to a physician blaming the child who has problems, you can determine the extent to which the brain is changing. This allow us to understand, for example, the effects of early exposure to drugs in brain development. Very relevant as states are legalizing marijuana, the concept this is not harmful. It will allow us to understand, for example, how Mental Illness emerges. Can we detect it early on the basis of these brain changes. It will allow us to understand how physical trauma like doing sports may negatively influence the ability of the brain, how alcohol, how tobacco. This will be a prospective study, well follow 10,000 children from ages 9, 10 until they reach adulthood, and we will evaluate not just their brain, but also their cognitive performance, their performance at schools, their social networks. Any investor will be able to analyze and extract data and information from that study. Thank you. Senator kennedy. Thank you, mr. Chairman. And thanks to all of you doctors. I have two brothers in the medal field medical field p ive heard them talk for years with respect and admiration on the nih, so i was especially pleased to be able to attend the meetings that we had at nih a few weeks ago that senator blunt organized. Very, very, very impressive. Heres my question. Lets suppose, as you often do, that nih or one of the institutes develops a new pharmaceutical drug or a new vaccine. And, obviously, its developed with your create it and intense creativity and intelligence and experience, but the money comes from the american taxpayer. And you develop it, its successful, it works. At some point that vaccine or that new pharmaceutical drug is turned over to the private sector to develop further and market. When that happens, how much in terms of royalty or shared compensation does nih, and more to the point, the american taxpayer get . So the connection between nih research and the development of successful drugs, vaccines and devices is very strong. You can certainly point to nihfunded discoveries in the majority of such instances upon which the Research Track was traveled. In some instances, the nih funding was for very basic science, but it made a lightbulb go on that then led a company to figure out how to turn that into a treatment. In other instances, nih carries the scrowfers further down the line to something that is patentable and can be licensed out to a company to develop a product. If that is done by one of our grantees in one of those institutions that we support, because of the bayhdole act, that institution holds the property pardon me for interrupting, doc. Please. But as you know, were limited by time. Im talking about when its not one of our grantees, its nih itself. Yes. Who negotiates the deal . Do you have a law firm you use . Do you use inhouse counsel . What is the standard royalty . How do we know, how do you know youre getting a good deal . Im not suggesting youre not. Give me the details about how you do it. Sure. If its a discovery made by one of our own investigators, we have an office of tech transfer which regularly is looking around to see if people have made such discoveries to make sure they claim them appropriately if they have. And then a patent gets filed if it seems like it might ultimately be worth smsmght then our office of tech transfer, working with the scientists, try to figure out who would be interested in licensing that. So they put it out there. An industry that steps forward and says were interested, then a negotiation begins. I think our negotiators are pretty good they inhouse . Yes. We do also employ consultants, contractors to help us if we have a special area of legal expertise, but we have very strong intramural staff. That has resulted roughly each year in the return of about 90 million to the nih from those discoveries that did get licensed and from royalties are flowing back. And again, im sorry to interrupt you. No, please. Im down to 1 06, and i want to senator kennedy, you can take a little extra time. Youre being much more disciplined than your colleagues, i think. [laughter] thank you. Have any of you ever had the development of a a pharmaceutical drug or a procedure or a vaccine that you looked at and you with said this works, its a [inaudible] i know maybe you havent completed all the different phases that you need to do to convince the fda, but based on your intelligence which is considerable and your experience, i know this is it . Have you ever had one of those . Oh, yeah, all the time. Okay. Have we ever thought in those instances, ill call them lead pipe cinches. I dont know where that phrase came from. A certainty, that might be more senatorial. [laughter] youve got a certainty. Have you ever given thought instead of farming it out to someone, lets do it ourselves . Be. Yes. The trick there, senator, is whether the manufacturing process is something that we want to take on. We dont make pills in general, except in very could you [inaudible] be. You mean instead of to a pharmaceutical company, just contract it out . I suppose thats a theoretical responsibility. Im going to ask tony fauci whether he knows of an example when that might be done. The times we might do this is when its a rare disease. We try very hard not to step into the for story are the private sector naturally is most capable, and we dont want to mess with their success in those circumstances where theyre willing to take something on. But if theyre not, well, tony, can you say . You know, we have discussed this, senator. Its an excellent question and something that a you know, crossed our minds multiple times. As it turns out, the sign terrific and it can call capability and Technical Capability of putting, for example, i deal mostly with vaccines. Yes, sir. To get a vaccine production capability outside of the alreadyestablished pharmaceutical industry is almost impossible to do. Its just not out there. And our experience has been that it just makes sense in the scenario that you developed if we develop the very early stages of a vaccine, which were in the process of doing it right now with zika and we did it with ebola. You do it in an animal, a phase one trial, and youre never sure its going to work until you do the trial, but there are some you just kind of have a feeling its going to work. At that stage you have to develop a relationship with a pharmaceutical company, because our experience in the past is when weve tried to get into the pharmaceutical type of approach, the expertise of ongoing, doing that all the time, at the end of the day its much more economical to essentially license it to them, get the kinds of royalties that dr. Collins has spoken about and let them take the ball and run with it. But we certainly have considered your mold, but it just doesnt work. Well, i want to thank you. I dont doubt for a moment that any one of you could go into the private sector and quadruple your income. And, you know, moneys not everything. And i think you live that. You dont just talk it, and i just want to thank you. I was so impressed with the tour and talking to your researchers and your physicians and to the patients who were willing to talk to us. And i just want to thank all of you. Thank you, senator. Mr. Chairman . Thank you, senator kennedy. Senator shelby. Ill try to take some more time. Thisll be your third round. [laughter] leveraging, this slide here, leveraging basic science, can you put that back up there . Where the Cystic Fibrosis cells, shows the outside the cell, inside the cell . Im afraid [inaudible] you cant do it . But this is, youre very familiar yes, we showed that in the opening is that the long . That diagram on the left, what is that . That is actually a photograph at a very high magnification using a technique, its a protein. That is the protein that is responsible for cf. Its there in the lining cells of the lung as the channel that moves chloride and salt around x. Until a few months ago, we didnt really quite know what it looked like, and now we do. And this is where youre talking about targeting things rather than perhaps, rather than just do the shotgun approach. Exactly. It gives you the opportunity to be much more sophisticated in your drug design than just hoping youre going to hit something that was going to work. Dr. Gibbons, youre or involved in the lung, heart, lung and blood. Do you overlap into Cystic Fibrosis in dealing with the lung there . Yes, we do, senator. Would you like to comment on this . I hadnt given you a chance. Well, certainly dr. Collins clearly is a pioneer in this area, but its also critical that there have been other elements of the research. For example, he alluded to the fact that certain misspellings changed how i that protein traffics in the cell. And a lot of that involved basic Cell Biology Research of those epithelial cells and where they got stuck and why. And that was very instrumental in understanding how to make a target that would then change that trajectory or that trafficking. So theres always this back and forth between not only understanding mutation, but how it affects the cell, the cell function and, therefore, the organs function and effect on the patient. Moreover, there are other elements of the disease, unfortunately. How much microbial agents invade and affect the lung, the progeneration of the mucus thats so important in, as a barrier function. And so there are other treatment strategies the stimulation of mucus in the lungs . Thats correct, sir. How do you prevent it, is that correct, doctor . Exactly. And so understanding that in addition to influencing how the channel works, there are other strategies that can be taken to help the patient. And as you target these cells there, what are you i guess youre trying to up press the mucus some way suppress the mucus some way. Doctor . Its a great question. You try every tack you can. One of the drugs thats turned out to be most useful of but now 15 years ago is actually something called dnsase which makes that mucus be able to be removed. Its not so thick and sticky. So thats one approach. And, of course, theres infections that in Cystic Fibrosis including infection. I think all of us are looking primarily to the time where you have a drug thats actually treating the fundamental problem the underlying cause. Thats exactly right. And when i talked about this, i have to point out that the investigator i highlighted was from the the university of alabama at birmingham who is one of those folks who is doing this amazing work to look at the structure of the protein at the atomic level. I think he went to med school at lsu though. [laughter] might be, i dont know. Dr. Gibbons, if you what kind of timeline do you see as far as i know its hard to say its going to be three year, two years or what. But so much time youve made so many breakthroughs in Cystic Fibrosis. Now youve made a big one you think, right . The fundamental thing in and if you can target that, that will change the game, would it not . Oh, absolutely. Millions of lives we should save of so many promising young people. Absolutely. It also is perhaps a forerunner for other Rare Diseases that we understand the genetic cause of, ones that are high priority for us, sickling cell disease. So were excited about the emerging new technologies that exist where we can modify that misspelling and turn it back into the correct spelling with this Gene Editing Technology thats emerging. And thats really something that was more just a glimmer before but now i think were on the threshold of. So were looking forward to Rapid Advances related to correcting at a fundamental level these genetic disorders. Thank you both. Thank you, mr. Chairman. Thank you, senator shelby. Well, as you can see, lots of continued interest in everything youre doing, and were glad youre here. Do you have a final comment . I just wanted to say thank you, mr. Chairman, to you and the members of the committee for your support of what all my colleagues and i believe is a rea mark bl moment in history. And i also wanted to take a moment to allow me to introduce the future senator from michigan, my idea, bailey, whos sitting back will. Bailey, stand up. [applause] i dream of a day where she doesnt have to worry about the health of herself or her children or maybe even her grandfather if hes still interested in playing his guitar and riding his motorcycle 20 years from now. But i just want to say thank you. Thank you for being here, and we hope youre playing your guitar and riding your motorcycle with enthusiasm 20 years from now. Thanks to the directors for joining you tad. The will stay open for one week, and subcommittee will stand in recess until june 27th at 10 30 a. M. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] youre watching booktv on cspan2 with top nonfiction books and authors every weekend. Booktv, television for serious readers. And this weekend on booktvst the annual roosevelt reeding festival reading festival held in hyde park, new york. The festival features books about the 32nd president and rooseveltera politics. Today youll hear from authors steve toomey, kathy smith, howard bloom and more. For a complete schedule, visit our web site, booktv. Org. On after words this week, economist jonathan more dock and Rachel Snyder report on how low and moderate income families manage money. Also this weekend, gay talese reflects on his 60year career, and historian herb boyd provides a history of africanamericans in detroit. Mr. Boyd will be our guest next sunday live on in depth to answer questions about his work. You can visit booktv. Org for more information. Thats just a few of the authors youll see this weekend on booktv on cspan2. 48 hours of nonfiction authors and books, television for serious readers. And now we kick off the weekend with shane weinberger who reports on Sharon Weinberger who reports on the pentagon agency, darpa. [inaudible conversations]