The subcommittee will come to order. Thank you all very, very much and, again, we apologize for being late. Days take on a life of their own. But i wanted to say good morning, dr. Collins. Welcome back to labor hhs, the appropriations subcommittee. Let me just say thank you on behalf of the of the subcommittee for hosting members of the subcommittee for the site visit at the nih campus last week. We had a wonderful opportunity to learn more about nihs work. We met with the researchers who were working to cure Sickle Cell Disease, to develop treatments for major depression, shrink and treat cancer tumors in children. We heard from participants whose lives have been changed by Clinical Trials. So it was a moving an informative but a very moving experience as well. Let me welcome our witnesses, including the five institute and Center Directors who join us today and in addition, and always a great addition, dr. Francis collins whos joined us many times, director of the National Institutes of health. Today joined by dr. Bruce tromberg, director of the National Institute of biomedical imaging and bioengineering. Dr. Helene langevin director of the National Center for complimentary and Integrative Health. Dr. Eliseo perezstable, director of the National Institute on Minority Health and disparities. Dr. Patricia flatley brennan, r. N. And ph. D. , director, National Library of medicine. And dr. Christopher austin, director for the National Center for advancing translational sciences. Your work leads to treatment and cures for diseases and conditions that affect people around the globe. Its transformative and some of the greatest good that we can do in government. And each year the subcommittee holds a Budget Hearing to hear from the nih director as well as directors of five or six of the institutes or the centers. But todays hearing is an opportunity for the subcommittee members to hear more and to hear from directors of an additional five institutes and centers which was very, very important to all of us. When i joined the subcommittee about 25 years ago, we used to invite every director to testify. Its been a long time since we have heard from many of them. So in fact, im going to be plain spoken about this and my Ranking Member knows about this, i wanted to include the National Institute of nursing, i wanted to include the fogarty interNational Center and the National Eye Institute as well this morning. Unfortunately, the administration denied our request on the rounds that we did not provide twoweek notice. Im disappointed, but nevertheless we will find another opportunity to hear from other directors. Let me again, i think we ought to be inviting every director at least every two or three years to be able to listen to what you are doing and how we can assistant in that process. Its critical for this subcommittee to get a full picture of the nihs portfolio as well as the research landscape. So youve heard me say before with each scientific discovery, each medical breakthrough, the nih advances human knowledge. It improves our quality of life and above all, it saves lives. Im so proud of the congress increasing the nih funding by 9 billion or 30 over the past four years and i will note that the subcommittee did this on a bipartisan basis. So in fact for 2020, the house passed appropriations included increased funding consistent with significant annual increases over the last four years. The house bill increases funding for each of the institutes by at least 5 . Our funding bill is a statement of our values and a reflection of our commitment to investing in basic Biomedical Research at the nih. It is not overstating the case to say that the nih has prolonged or improved the life of every american. Because of nih research, we have childhood decreased cancer mortality, 50 in 35 years. We have a vaccine to prevent cervical cancer. We have a drug that prevents hiv transmission with 99 effectiveness. In fact, a recent study in the proceedings of the National Academy of sciences in february found that nihfunded research contributed directly or indirectly to every single one of the 210 drugs approved by the fda between 2010 and 2016. That is your impact and it is amazing. So to our guests, we say thank you for everything that you do. We look forward to our conversation today and now let me turn this over to my colleague from oklahoma, the Ranking Member of the subcommittee, mr. Cole. Thank you very much. A couple housekeeping things, first, if i may, i want to say its wonderful to have our friend ms. Herrera butler here. Shes had the most excused absence of all time. But its great to have her back. And just so our witnesses know, ive already told the chair this, at some point, i have to get up and go to a Republican Leadership meeting. Ill be coming back. It has nothing to do with your testimony. Ive been called away. I want to congratulate our chair for scheduling a perfectly timed hearing because we need something up here to bring this together. And you guys actually do that. Its wonderful to see you and as always the chair of the full committee. Today weve got our second Budget Hearing on the National Institute of health. And again, i want to thank the chair for having this hearing and inviting some of the institutes and centers we do not get to hear from as often as we should. And i associate myself with the remarks she made about that. I look forward to learning more about the research being done and learning about the promising cures in the future. However, i would also be remiss if i did not recognize dr. Francis collins. I want to congratulate dr. Collins on reaching an amazing accomplishment of leading the nih for 10 years as director and hes heard me say it before, but hes clearly the best politician in washington, d. C. If he can get appointed by both barack obama and President Trump. Thats Pretty Amazing span of appreciation for the manner in which hes led the nih and a great deal of National Confidence in his ability and the Wonderful Team that hes assembled there and has been there for many, many years. Obviously, dr. Collins is an advocate for groundbreaking research down at the nih and supported by nih funding and, again, ive said it here, the four years of sustained funding increase which was as the chair said very bipartisan owes a great deal to frankly our confidence in dr. Collins as the leader of this institute as well and hes made the case up here for a lot of years as to why this is important investment and this committee in a bipartisan fashion has listened to that. I want to highlight some of the work being done, frankly, local and universities in my district through the support of the nih, somehow, they always seem to miss that when they announce some new cures that it never says funded by the nih or awarded. We need to work on that. Maybe require them when they get grants. But working with colleagues at Oklahoma State university and the university of Oklahoma Health science centers, researchers at the Oklahoma Medical Research foundation are using a novel threedimensional model made up of human tissue to study the now respiratory and ill get this wrong, syncytial virus. I wont try it twice, thank you, a virus that affects the lungs. This virus is a leading cause of pneumonia worldwide. It can take a particularly heavy toll on children affecting more than half of their first year of life and nearly 100 by age 2. The virus is highly contagious and for those with weakened immune systems from conditions like asthma, it can be dangerous and even deadly. These researchers hope to reveal what predisposes infants to severe infection and create a launching pad for therapies down the line. This lung in a petri dish model could prove to be valuable for studying other lung infections like flu, allergies and asthma. Another area of focus for the foundation is lupus. Lupus affects up to a million and a half of americans but a particularly heavy toll on africanamericans, hispanics and native americans. Lupus is an autoimmune disease that causes inflammation around your body. Its a condition in which your bodys own immune system is responsible for the breakdown of its own cells. The inflammation seen in liupus organs of the body. And to understand more about it, scientists are conducting largescale genetic analysis of thousands of health volunteers. It will focus on 25 genes that have been link today the disease. The goal is to identify the culprits that burden africanamericans with lupus. It builds on the Ground Breaking work of the Oklahoma Medical Research foundation has already done in the lupus space. Because of dr. Jamess discoveries, these medications are part of the standard treatment of care for many lupus patients. Nih fosters such i thinja annui. All americans benefit from this research. Future generations will benefit from the research being done today. Despite some of the controversy that can surround this bill, support for research has been broad, bipartisan and been supported by leadership in the house and senate alike. I do not want to take up any additional time recognizing all of the directors before us today because quite frankly i would rather hear from them about their exciting research. But i do want to thank each of you and your colleagues and those leaders who are not with us for their passion, dedication and hard work. I believe the work of the nih will change the course of disease, detection and treatment for generations to come. I Hope Congress continues to be a supportive partner in these efforts. Thank you for holding this hearing and i yelled baield bac time. I would just say, im not going to go into what they do, but im proud that the yale school of medicine has one of the clinical and translational science awards. We are a hub and it is amazing work that gets done there as well. We thank you for that. And with that, let me yield to the chairman of the appropriations committee, my colleague. And i thank my chair of this Extraordinary Committee for this hearing which is so very, very important. And i thank im sorry youre leaving, but i thank my good friend mr. Cole for holding this hearing. Theres no question that whether its chairman cole or not chairman cole, there is bipartisan support for the outstanding work youre doing and i really thank my good friend, the share woman for holding this hearing. And i thank our extraordinary panelists. Ive been greeting you with a big smile for many, many years and i really appreciate all that you and your team are doing. Earlier in the year, however, the Trump Administration submitted a budget that would cut the nih by almost 5 billion. Its Crystal Clear that President Trump doesnt really understand the nature of this committee and how bipartisan it is. And so no regard for the National Institutes of health and the cuttingedge work you do to save lives and improve the lives of americans. Despite the president s efforts to gut the nih, we have responded resoundingly, unlike the president , my colleagues and i prioritize the health of all americans. We are on track to invest billions more than the president would for our world class National Institutes of health. Our house passed fiscal year 2020, labor health and Human Services bill would provide 2 billion more for the nih including a critical across the board increase for all the nih institutes and centers. This would allow the nih better respond to scientific breakthroughs that result from astonishing national Research Done at the institutes such as though with us today. We have the distinct pleasure to hear from several directors who are leading innovation in their respective fields and theres so much innovation going on. Dr. Collins, i dont know if you just threw the numbers in a hat to try and pick ones are here today. But i really look forward to hearing your marks. Not only will we hear about the encouraging advances achieved to date, but also the exciting innovations that are just over the horizon. Were talking about lifesaving achievements that with our continued commitment and investment, could soon been on our doorstep thanks to the nihs extraordinary work. So rest assured, the attempts to slash your budget will not stand. We remain committed to ensuring you have the tools and resources you need to deliver for the american people. So i really do want to thank you and i look forward to our discussion. Thank you all for everything you do, just to improve lives. Thank you. Thank you. We will now proceed to Opening Statements from the nih panel. We have six witnesses today, so what we have done is to ask you to please offer three minutes of opening remarks. Im sorry to curtail the five minutes, but we want to get it all in and the opportunity to to be able to ask questions. And dr. Collins, welcome, thank you for being here today, and you know the drill. The full testimony will be entered into the hearing record. You are now recognized for three minutes. Thank you. Good morning, distinguished subcommittee members. Im francis collins, director for slightly over ten years of the National Institutes of health. On behalf of nih, i want to thank the committee for your work on the fy 20 funding bill that passed the house in june. Were really grateful for your ongoing support and we were very pleased to host a visit by some of you last week. Today im joined by the leaders of five of the nihs 27 institutes and centers. Let me start by introducing dr. Christopher austin, whos director of the National Center for advancing translational sciences. Like you, im always impatient for basic Research Discoveries to be translated into new ways of combatting diseases. Today weve identified the causes for more than 6,500 diseases, yet treatment exists for only about 500. One of my first initiatives was to ask congress to create ncats to speed that. Next up is patricia flatly brennan. Like everything at nih, the activities are focused on innovation that advances Biomedical Research. It does this through a database that provides access to more than 5 million articles and another one is through Clinical Trials. Gov. Its a great resource to share with any of your constituents looking to take part in medical research. Thats where you can find those trials. And then the director of the center for Integrative Health which celebrated their 20th anniversary. It was you that established this center back in 1999 citing the need for more evidence on health practices. That need remains great today. Next, let me introduce dr. Stable, i think its important for you to meet him for many reasons, including at your april hearing many of you asked about this. At the end, bruce tromberg. His institute engages, engineers and other new types of investigators to push the innovation envelope to create smaller, faster and less expensive medical technologies. I hope what you hear today explains why i am so excited to lead all of the institutes and centers, working together to encourage this next generation of researchers. I can assure you we will speed the path. Well be happy to entertain your questions. Thank you, very, very much and for being so succinct. Its usual for me, i know. Please, let me just recognize dr. Tromberg. Thank you again. Your full testimony will be entered into the hearing record. Youre recognized for three minutes. Thank you. Madam chairwoman and members of the subcommittee, its an honor to participate in your hearing and represent the thousands of scientists across the country who are developing new technologies to improve human health. Ive only been the director for about nine months but spent 30 years pioneering new technologies at the university of california. The mission is to transform through engineering the understanding of disease and its prevention, detection, diagnosis and treatment. We support research that can be applied to a broad range of problems, by building strong partnerships with industry, academia, federal agencies and every nih institute and center. Our programs lead to better, faster and less costly ways to advance technologies from black board to bench top to bedside. We support about 1,000 grants each year in four areas, computation, engineered biology, sensing and imaging and advanced therapeutics. One of our platforms has been developed to address food allergies. We all know eating out can be a challenge for millions of americans. Recognizing this widespread problem, researchers have developed a rapid point of Care Technology. Its small enough to fit on a key chain and can test for certain allergies at your table in less than ten minutes. Its also helping drive the development of imaging platforms. Researchers are using invisible laser light pulses that are one billionth of a second to create ultrasonic sound waves deep in tissue. 3d images of tissue are formed that can be used for tumor detection, diagnosis and guiding therapies. In the same way that advanced Imaging Technologies have practically eliminated exploratory surgery, new technologies are rev