Days take on a life of their own. I want to say good morning. Good morning, dr. Collins, welcome back to hhs to the appropriations subcommittee. Let me just say a thank you on behalf of the on behalf of the sub come they for hosting members of the subcommittee for the site visit at the nih campus last week. We had a real wonderful opportunity to learn more about nihs work. We met with the researchers who were working to cure Sickle Cell Disease and develop treatments for major depression and shrink cancer tumors in children. We heard from participants whose lives have been changed by Clinical Trials and it was a moving and informative, but a very moving experience, as well. Let me welcome our witnesses including the five institute and senate directors who join us today and in addition, and always a great addition, dr. Francis collins and joined us many times director of the National Institutes of health today joined by dr. Bruce tromberg director of biomedical engineer, the director of the National Center for complimentary and Integrative Health, and dr. Eliseo perez on Minority Health and disparities and dr. Patricia flatly brennan, and the National Library of medicine and dr. Christopher austin, director of the National Center for advancing Translational Sciences. Your work, all of the 27 institutes and centers leads to treatments 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 of the center, but todays hearing is an opportunity for the subcommittee members to hear more and to hear from directors of the 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 and in fact, i dont know if theyve spoken about this, i wanted to include the National Institute of nursing. I wanted to include the foghery interNational Center and the national eye institute, as well this morning. Unfortunately, the administration denied our request on the grounds that we did not provide twoweek notice. Im disappointed, but nevertheless, we will find another opportunity to hear from other directors. 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 assist in that process. Its critical for the Sub Committee to get a picture, a full picture of the nihs portfolio as well as the research landscape. Youve heard me say before w each scientific discovery, each medical breakthrough, the nih advances Human Knowledge and above all, it saves lives and i am so proud it increases the nih funding 30 and the subcommittee did this on a bipartisan basis. In fact, for 2020, the house passed appropriations including 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 basic Biomedical Research thea 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 25 years. We have a vaccine to prevent Cervical Cancer and a drug that prevents hiv transmission with the 9 effectiveness. In fact, a recent study in the proceedings of the National Academy of Sciences Found that nihfunded research contributed directly or indirectly to every single one of the 210 drug approved by the fda between 2010 and 2016. That is your impact and it is amazing. So to our guest, we say a 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 of the subcommittee, mr. Cole. A couple of housekeeping things if i may. Its wonder have our friend here, and weve not had her back for a while and she has the most excused excused absence of all time. 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 and i want to congratulate our chair to schedule a perfectly timed hearing because we need something up here to bring this together and you guys actually do that. So 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 that we do not get to hear from as often as we should and i look forward to learning more about the research being done and learning about the promising cures of the future and i would be remiss if i did not recognize dr. Francis collins. I would like to congratulate dr. Collins on reaching an amazing accomplishment of leading the nih as director and hes heard me say it before and 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. Dr. Collins, as an advocate for Ground Breaking research in nih and supported by nih funding and again, ive said it here, but the four years of sustained funding increase which was as the chair said very bipartisan owes a great deal to, frankly, our confidence and dr. Collins as the leader of this institute, as well and hes made the case as to why this is an Important Committee and the bipartisan fashion has highlighted that. I want to highlight some of the work being done at local universities in my district through the support of the nih. Somehow they always seem to miss that when they announce some new cure. It never said funded by the nih or awarded, so we need to work on that and maybe require it when they get grants and working with colleagues at Oklahoma State and the university of Oklahoma HealthScience Centers and researchers at the Oklahoma Medical Research foundation are using a novel threedimensional model to use the human tissue for the and its the interstitial virus that affects the lungs. This virus is the leading cause of pneumonia worldwide. It can take a particularly heavy toll on children infecting 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 to create a launching pad for therapies down the line. This petrie dish model could be valuable for studying other infects like flu, allergies and asthma. Another focus for the american medical Research Foundation is lupus. Lupus affects up to 1. 5 million americans and it exacts a particularly toll on africanamerican, hispanics and lupus is a chronic autoimmune disease that causes inflammation throughout your body, an auto immune disease in which your bodys own immune system is involved with the breakdown of its own cells and the information can affect various organs and tissues in the body including ones joints, skin, blood and internal organs. The disease can be severe and potentially lifethreatening. It can cause organ damage and currently theres no known cure for lupus and it is the cause of death in africanamerican women between the ages of 15 and 45 and to understand more about it, scientists are conducting largescale genetic analysis of thousands of lupus patients and thousands of healthy volunteers. No focus on 25 genes that had been previously linked to the disease and the goal is to identify the genetic culprits that disproportionately burden africanamericans with lupus. The study builds on the groundbreaking work of the oklahoma medical foundation is done with the lupus space including the discovery of one of its own researchers dr. Judith james and antimalaria medications can delay the symptoms of lupus. These medications are now part of the standard treatment of care for many lupus patients. There are countless stories like these of Ground Breaking research taking part across the United States as a direct result of nih funding. Nih fosters such ingenuity and one lone researcher can open an entire field of medicine in Biomedical Research. Future generations will benefit from the unfold promises from the research being done today. Despite the controversy that can surround this bill, support for nih bz are has been broad, bipartisan a bipartisan and been supported by nonleadership and the like and i will not take up the time to address all today, because quite frankly i would rather hear from them about their Exciting Research and i do want to thank each of you and your colleagues for your passion, dedication and hard work. I believe the work that the nih has and 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, madam chair for holding this hearing and i yield back my time. Thank you very much, congressman cole. I would just say im not going to go into what they do, but i am so 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 and we thank you for that and with that, let me yield to the chairman of the appropriations committee, my colleague, congresswoman gnida lowey, and i thank the chair and this committee which is very, very important, and i think sorry youre leaving, but i thank my good friend mr. Cole for holding this hearing. Theres no question whether its chairman cole or not chairman cole. There is bipartisan support for the outstanding work you are doing and i thank my good friend the chairwoman for holding this hearing and i welcome our esteemed panelists, dr. Trumberg, dr. Perez, and dr. Langvin, and dr. Austin, dr. Brennan and of course, dr. Collins. Ive been reading 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 million. It is Crystal Clear that President Trump doesnt really understand the nature of this committee and how bipartisan it is and no regard for the National Institutes of health and the cutting edge work you do to save lives to improve the health of americans, despite the president s heartless and misinformed 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 worldclass National Institutes of health. Our house passed fiscal year 1520 and the Services Education and related agencies 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 to better respond to scientific breakthroughs that result from astonishing foundational Research Done at the institutes such as those with us today. We have the distinct pleasure to hear from Institute 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 of the institutes in a hat to try and pick which ones are here today, but i really look forward to hearing your remarks. Not only will we hear from the encouraging advances achieved to date, but also the exciting innovations that are just over the horizon. We are talking about lifesaving achievements that with our continued commitment and investment could soon be on our doorstep thanks to the nihs extraordinary work. So rest assured, the administrations attempt to slash your budget will not stand. We remain committed to ensuring that you have the tools and the 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 now will 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 and im sorry to curtail the five minutes and we want to get them all in for an opportunity to get in the questions and dr. Collins, welcome, you know the drill. The full testimony will be entered into the hearing record. You are now recognized for three minutes. Dr. Collins . Thank you. Good morning chairwoman delauro and distinguished committee members, yes, im francis collins, on behalf of nih, i want to thank the committee for your work on the fy20 labor hhs funding bill that passed the house in june. We are grateful for your ongoing and bipartisan support and we are very pleased to host a visit by some of you last week. Today, i am joined by the leaders of five of the nihs 27 institutes and centers. Let me start by introducing dr. Christopher austin who is director of the National Center for advancing Translational Sciences and cats like you, im always impatient for Research Discoveries to be translated into new ways of combatting disease. To date, weve identified the molecular causes for more than 6500 diseases, yet treatments exist for only about 500. So addressing that gap requires translational research, one of my first initiatives upon becoming nih director was to ask congress to create ncats to speed this process and you did and here is the director. Next up is patricia flatly brennan who is next to me to my left and director of medicine, mlm. Like everything at nih, mlms activities are focused on innovation that advances Biomedical Research and one way it does this is a database that provides access to more than 5 million articles from biomedical journals and another is through Clinical Trials. Gov. The online catalog of private and public Clinical Trials which by the way, is a great resource to share with any constituents looking to take part in medical research ask thats where you can find the trials. Now meet the director of the National Center for complimentary and Integrative Health nccih which for this very week celebrated their 20th anniversary. In fact, it was you, this subcommittee that established this in 1999, citing the need for more Scientific Evidence on Complimentary Health practices. That need remains great today. Next, let me introduce dr. Is eliseo stable director of Minority Health and Health Disparities and nihhd, including at the april hearings, many of you asked for Maternal Mortality and also a part of today a distinguished lineup, bruce tromberg, director of the shall nah institute of Biomedical Engineering and mibib. His institute engages, engineering in other new types of investigators to push the innovation envelope to create smart, faster and less expensive medical technologies. I thank you for this opportunity and i hope what you hear today helps explain why i am so excited to lead all of nihs institutes and centers and working together to encourage this next generation of researchers. I can assure you, we will speed the path from discovery to health and my colleagues and i will be happy to entertain your questions. . Thank you very, very much, dr. Collins and for being so su succinct. Its unusual for me. Please, let me recognize dr. Tromberg, thank you again, your full testimony will be entered into the hearing record. You are recognized for three minutes. Thank you. Madam chairwoman and members of the subcommittee, it is an honor to participate in the subcommittee and others across the country who are developing technologies to improve human health. Ive only been director of the bib for nine months and i have new opportunity ijs and photonic technologies as a professor of Biomedical Engineering and surgery at university of californ