Be funded from our core funding programs, both poor urban and rural areas, including section 53 of seven and 5311. The point being that there is an eligibility that was extended to these mobility Management Options that then can be funded with federal dollars because we would like to see them more and more. I think we had prehundred 25 325,000 dollars was being spent with a eligibility first happened back in 2005, and out is more than 40 million i think per year on these services. We have seen a huge jump in interest. I think that reflects the growing need of our increasingly elderly population. Im concerned that there is a aboutf Public Awareness these services and about the mobility managers. This is an issue that because of america ierica itn followed very closely. And somebody who represents a state by median age is the also havethe nation i a great interest in how we are going to meet this need. Prior to this hearing, i was not aware of these mobility managers. I wonder what is being done to increase Public Awareness, to work more closely with perhaps the seniors, groups in the state, whether it is aarp or just Senior Centers in various communities. What are you doing to increase the visibility . Well, there are a couple of things i would mention. I had mentioned before this coordinated plan that is required to access some of our funding. One recommendation that has been made is that there really needs to be an ongoing coordinating involves on an ongoing basis the very group we just mentioned besides whether it is aarp or senior community,in the faithbased organizations that can get the word out that these services are available. One thing that we did when we had our veteran Transportation CommunityLiving Initiative that we funded in fiscal year 11 and 12 that i mentioned, we synthetically included as part of that program a marketing program, so there was assistance that was allowed for some folks to come and simply too, as he will observe, be able to get the , serving not only veterans and their families but also other Community Members that needed those same services, that there was a way of getting the word out. So it is a very important point that we need to keep in mind Going Forward with these programs. Thank you. I think that one of the issues is that there is parallel with the element of mobility management. There is also an increasing thent of effort within aging network that provided General Information and assistance to address transportation because there he very often,ause transportation rises out of a panoply of needs. The patient may need health care or home a communitybased services, and transportation is an adjunct to that need. It is important that the equippedon lines are to know about the Transportation Resources and to connect with mobility managers where they exist in the community. I think a lot of that is happening. I would say that the association i work for administers an aoa funded service call the eldercare locator. Last year, the number one reason why people we got more than 18,000 calls about transportation between july of 2012 and june 2013. Those numbers are increasing. People struggle with financial issues, Health Care Issues and so forth, transportation remains number one. I also think there is a lot going on and communities to increase the expertise and connect this between the Human Services program and transportation so that when people call, they have the picture. You know there have been some problems with contractors who have been hired to individuals who receive services through the medicaid program. As part of i. T. And possibly laois and the reliability and quality and Customer Satisfaction, a few will, of your program . Have an annual Customer Satisfaction survey that we do for itn in maine and across the country. The Customer Satisfaction ratings have been consistent think number of years. I 98 of the people use the service would recommend it. The service. With 2 to 3 think it is too expensive for the services we receive and by about 10 to one, people think it is inexpensive for the service they received. Questions and we do a survey of all of our volunteers every year and affiliates every year because if you are doing something wrong, you want to know right away. I think it is such an Impressive Program and i have been excited to see it replicated through your leadership and so many other states. I think it is a great model that we can encourage to be spread. I hope the federal department of transportation, which has been generous in its support in the early years will take notice of the program and the High Satisfaction rates as well. This is a problem that is not going to go away and i think for rural states in particular, it poses a tremendous challenge for seniors living in very rural frankly there is no alternative to a car. That is one of the reasons im so grateful to the chairman is allowing us to have this hearing and i just want to thank all of you for adding to our knowledge. When i heard mr. Frank gave those satisfaction rates, i cant help but think congress would be happy to have half those levels. They are truly impressive, so thank you very much, mr. Chairman, and thank you all for testifying. It has been a great discussion, and it is a discussion about an obligation to society to take care of not only the very young, but very old. Susan and i are very grateful to be part of this, so thank you very much. The meeting is adjourned. Thank you. [captioning performed by national captioning institute] [captions Copyright National cable satellite corp. 2013] today, a Train Derailment in new york. The daily news has a picture. The ntsb investigating the new york train accident. Governor cuomo saying four people lost their lives today in the Holiday Season right after thanksgiving. They are in our thoughts and prayers. 63 people seriously injured and according to a press release, there is a go team to investigate the accident. Their team consists of specialists in tracks, mechanical systems and operations for performance. Opentsb has said they will the briefing later today. Span we bring Public Affairs events to washington directly to you, putting you in the room at congressional hearings, white house events, briefings, and conferences and offering complete gaveltogavel coverage of the u. S. House, all as a Public Service of high the industry. Tv cablereated by the industry artie years ago and funded by your local cable and satellite provider. Now, you can watch us in hd. Next, look at food policy and specifically sugar. We will hear from a pediatric endocrinologist at the university of california, semper cisco. He gave a presentation in 2009 called sugar, the bitter truth that went viral on youtube and he spoke recently to students at californiaity of Hastings Law School where he studied food policy law. The conversation is about one hour and 50 minutes. [applause] thank you, david. Thank all of you for coming. It is just wonderful to be back now at my alma mater. Marsha cohen even gave me a decal to put on my car. Im fully equipped. I really want to acknowledge so many of my mentors during this past year in the audience, david, pat davidson, marcia, and several other people here, as well, that have done a tremendous job. I have to say it was really an absolutely thrilling year. I wouldnt have given it up for the world. The homework was another story. [laughter] today, i want to talk to about what got me to law school in the first place, and hopefully, light a fire under all of you. In the way i first felt this as i started researching the topic. It is appropriate that this talk today be done on the 50th anniversary of the march on washington, because we are going to talk about a different form of oppression, one that is a little bit more pernicious. I also have a dream, and that dream is that our food supply would confer wellness, not illness. I have to take care of obese kids. We are losing the battle. The problem is, we are going to continue to lose the battle until we fix the food supply. Im going to try to explain to you why that is and what we can do about it during the course of this lecture. I hope it wont be so hyperbolic as to get you all shouting in the aisles. It is not quite a revival, but there is going to be a lot of science. The science should influence the policy. The problem is, politics get in the way. That is where law comes in. With that, lets go ahead and start. First of all, i have no disclosures, no Food Industry entity is putting me up to this. [laughter] in 2011, just two years ago, u. S. Secretary general announced that noncommunicable disease that is, type two diabetes, cardiovascular talese disease was now a bigger problem not just for the developed world, but for the developing world, than was infectious disease. This was a paradigm shift as to how medicine was going to be conducted from here on in and where the resources have to go. The question is, how do you deal with this . They plan to target tobacco, alcohol, and diet. Tobacco and alcohol, that is easy. We have paradigms that already work for those. We have 15 years of alcohol control policy, for instance, but what about diet . Are we going to influence total calories . We have been doing that for 30 years, and look where we are treated are we going to do that with changing fat . We did that for 30 years. Red meat, dairy, carbohydrates . What is the factor within our diet . We cannot stop eating. Something has to change. What is it . I think all of these are incorrect. I will let will smith tell you what the real answer to this story is. [phone ringing] i need some answers. I cant talk right now. I have a few cases im working on. All right. Im hanging up. [indiscernible] sugar. [laughter] you know, if hollywood knows this, why dont you . [laughter] anyway, here is the problem. It is very clearly delineated on this slide. This comes from cocacolas coming together youtube video. They are going to tackle childhood obesity. They say straight up, beating obesity will take action by all of us, based on one simple common sense fact all calories count, no matter where they come from, including cocacola and Everything Else with calories. In other words, a calorie is a calorie. You can get those calories from carrots or cheesecake or coca cola or anything else, but the bottom line is, it doesnt matter where it comes from a calorie is a calorie. That is based on common sense. Well, i dont believe in common sense. I believe in data. The data Say Something else entirely. What the data say is that some calories cause disease more than other calories, because different calories are metabolized differently in the body. Not every calorie is handled the same way. That means a calorie is not a calorie. That is what i have spent the last 16 years figuring out, and im not the only one who has figured this out. Many other investigators have figured this out. This is now a wave of controversy throughout the endocrine and nutritional literature and at meetings. I just debated the corn Refineries Association a week ago on exactly this point. So, the question is, if a calorie is not a calorie, could there be calories that are worse than others . Of course, we know there are certain environmental toxins that are bad for you. The question is, what about the stuff over here . Is this possible . Could this be the problem . Im going to be referring now to two papaers. Papers. One is an article written about our research at ucsf, and also our comment last year were we actually called for regulation. In order to regulate an environmental substance, society has said that you have to fulfill four criteria. Ubiquity. You cannot get away from it. Toxicity it has to be dangerous. Abuse you cant stop using it. Finally, externalities or negative impact on society how does your use affect me . Those are the four. I have to show you that sugar meets every single one of those four in order to be able to stand up here and talk about it. Lets start with an affordability. We are all eating more, no arguments. 275 calories in teen boys over the past 20 years. No arguments. We are eating more. What are we eating more of . Is it fat . We are told to go lowfat. We are not eating more fat. We are actually eating the same amount of fat as we were before. Five grams. If you look at the secular trends of specific food intake, here is a fat whole milk, meat and cheese up slightly, milk desserts up slightly. Bottom line, it is a wash. We are not eating more fat. In fact, as our percent of calories from fat has gone from 40 to 30 , because we were remanded to back in the 1980s as we were to go lowfat, our obesity and met a lot and metabolic syndrome prevalence has gone through the roof. No, it is not that. What are we eating more of . More carbohydrates. 228 calories, 57 grams in teen boys. Here is the trend in carbohydrate intake, all through the roof. That is what we are eating more of. That was the bottom of the food pyramid. Specifically, what carbohydrate . Beverages. 41 increase in soft drinks, a 35 increase in for drinks, etc. This slide sort of says it all. Here is the original bottle of cocacola, 6. 5 ounces, out of atlanta in 1915. If you drink one of those every day for a year, assuming that the formula hasnt changed we dont know if the formula has changed, because only three people in the world know the formula, and they are not allowed to ride planes at the same time that would be worth eight pounds of fat per year. In 1955 after sugar stopped being rationed, we got up to 10 ounces. 13 pounds of fat per year. Then the everubiquitous 12 ounce can, 16 pounds of fat per year. Here we have the current ever present 20ounce cocacola. Does everybody know how many servings you get out of the 20 ounces . It is supposed to be 2. 58ounce servings. Does anybody know who gets those servings . Then you have the 7eleven big gulp 44 ounces, 57 pounds per year if you do that everyday. My friend tells me that down in texas, they have a texassized big old. 50 ounces of cocacola and a snickers bar, all for . 99. You would say, that is the obesity acted epidemic . You would be only partially right. What is this stuff . High fructose corn syrup. Our annual consumption is 63 pounds per person. There is a problem. Only the u. S. , canada, and japan use it. There is very limited exposure in parts of europe, yet the rest of the world as just as much of an obesity metabolic syndrome epidemic as we do. In fact, everybody is so fond of mexican coke, mexico has the highest increase in the rate of obesity in the world today, and they dont have High Fructose Corn Syrup. They have sucrose. Here is High Fructose Corn Syrup up here. One fructose. They are free. They are not bound together. Here is sucrose. Your enzyme leaves this in about a nanosecond. Basically, it is a wash. They are the same. They are the equivalent. All of the studies pitting the two of them against each other show that they are equivalent. They are equivalent to data equivalently bad. That is why every other country has the exact same problem we do. Here is what u. S. Sugar consumption has done is we have developed the ability to refine isolated and market to refine, isolate, and market it. We have gone all the way up. You can see the different parts of the curve. Here is the growth of the sugar industry in the late 1890s through the early 1900s, and stabilization before world war ii here is the dip from rationing here is the introduction of High Fructose Corn Syrup and as we were remanded to reduce our fact. You will notice, in the last 56 years, there has been a decline, but that decline is nothing compared to the rest of the curve. If you believe that there is a limit to how much sugar you should consume, and the American Heart Association has set this threshold, and based on the analogy with alcohol that i have made, this would be the theoretical basis for alcohol right here the question is, do these actually work in terms of understanding how disease gets promulgated . Here is the emergence of cardiovascular disease as a health risk in the United States in 1931, due to Paul Dudley White famous treatise on Heart Disease. We can see, as things went above the threshold, that is when Heart Disease started to become an issue. Here is a 1988 when we started realizing that we have an epidemic of adolescent type 2 diabetes. You can see that the temporal relation between sugar consumption and our two biggest problems in terms of chronic metabolic disease Heart Disease and diabetes are at least temporally related to this increase. Of course, temporal relation is not causation. This is a worldwide per capita sugar supply. You will notice the light blue here is how much of the American Heart Association says you can consume everyday. Notice the entire world is darker than that. Here we are, 629 calories. The rest of the world is right behind us. Now sugar is cheap. The early history of the sugar epidemic was actually nicely delineated in this piece in the National Geographic this past month, for anybody who is interested in how we got here and the slave trade and all the other things, the political and broglie owes sugar has caused over the centuries. We are going to talk about the last 30 years right now. That is what i have experienced. That is what im interested in. That has that is what has led to this adolescent type 2 diabetes pandemic that i have to take care of. That is what im trying to fix. Lets talk about what happened in these 30 years. This is the perfect storm. It started with the fall of batista and the fact that we could now not rely on c