The appropriations subcommittee on labor health and Human Services education and related agencies will come to order. Im certainly pleased we could have this opportunity this morning, dr. Collins, to talk to you and the other Institute Directors about the work youre doing and the work youd like to do. Certainly every family faces Health Concerns during their lifetime and there are so many things that can be done by nih that i think cant be done as well anywhere else. A new drug, a new device, new treatment can take anywhere from a decade to longer to develop, can cost billions of dollars on occasion with a pretty high failure rate, even when you think youre on the right path. Certainly its necessary for the federal government to invest in Biomedical Research. It represents the hopes of lots of people and lots of families and particularly now as we see conditions growing as people survive heart problems and stroke problems, we see more people with alzheimers and cancer challenges. We see the potential for designer medicine, largely because of the great work that was done to figure out how to define and understand the human genome system in a better way. This year, this committee, the subcommittee and full committee, have placed a high priority on this research. We have planned for and have a bill that includes 2 billion of extra money for that research of increase of about 7 over current years spending. Over the past decade, with not much new money going in to nih, the purchasing power at nih has decreased by about 22 . We hope to see that reverse if were successful with what were trying to do to provide the increase that were looking at here. These are clearly difficult budgetary times and im sure we could spend a lot of this hearing talking about how there should be more money for other things in this budget and theres a disagreement on that and an agreement in some cases, if we had all of the money in the world, the priorities might be a whole lot easier to achieve. But i look forward to hearing from you, dr. Collins, from your team that you bought and i specifically said this morning, can you bring some of the people that we havent seen lately that are focused on the individual areas of research so we can get a greater sense of understanding of what the potential is, what the needs are, what is out there that you are seeing and begin to see and also the challenge of young researchers having a Research Grant approved are dramatically less than they were a decade ago and im sure that thats a topic well want to discuss as well. How long do young researchers stay in research if they continue to have their ideas not allow them to move forward. So those are all things we want to talk about today. Were glad youre here. I want to turn to senator murray, a big supporter of your work as well for her Opening Statement. Well, thank you very much, mr. Chairman, and especially for your focus on this. I think we all appreciate it. Dr. Collins, thank you for being here. Im grateful, as we all are, for all youve done to champion the critical work that nih does. You have been a great partner and its great to see you here and thank you to all of your team that is with us today. We look forward to hearing from all of you. All of us here today agree theres a lot more we need to do to keep our families and communities healthy and continue investing in priorities that strengthen our economy from the middle out. And the work of the National Institutes of health is vitally important to that effort. The nih supports basic research that makes medical advancements possible and helps drive Economic Growth and competitiveness. In my own home state of washington, we have researchers working on ways to repair heart tissue thats been damaged by disease and injury. We have people decoding on difficult to treat forms of breast cancer. We use Precision Medicine to tackle eye disease and alzheimers. The list goes on. Those are just a few examples of the incredible work done to improve health and wellbeing for families across the country and really around the globe and at the same time, the Life Sciences are helping to drive Economic Growth and job creation. In my state, the director directly employs 34,000 people. The investments that we make in nih and in education and other programs under this subcommittees jurisdiction that supports the Life Sciences indirectly will help our economy create the jobs of the 21st century and help ensure a workforce that can take them on. Thats why like chairman blunt i see maintaining our countrys central role in the Life Sciences as a top priority and federal investments in medical research could not be more important to this effort. Supporting medical Research Starts with making sure shortsided budgeting doesnt get in the way. For far too long, weve seen inflation erode federal investments and r d making it hard for researchers to get the support that they need. In fact, i know that you, dr. Collins, have said that increasing the nih is having to turn promising projects away. For patients and families who are waiting and hoping for medical breakthroughs, that is unacceptable. Im very proud that in late 2013 democrats and republicans were able to reach a budget agreement, to roll back sequestration for fiscal years 2014 and 2015. And as we all know, that deal expired last week, which Means Congress is going to, once again, have to come together and find a solution. As ive made clear, i believe we need an agreement that builds on the bipartisan Foundation Set in the budget deal from last congress, rolls back the cuts to defense and nondefense investments equally and protects priorities that are essential to promoting a strong and growing middle class, Like Research and education and infrastructure. Ive been encouraging my colleagues on the other side of the aisle to come to the table and work with us so we can reach another bipartisan budget deal and avoid those automatic cuts that impact these and other important investments in our countrys future. Im also currently working with chairman alexander who is here today on the help committee on the Bipartisan Initiative to advance medical innovation that is an effort that is very much related to the conversation today. I see that initiative as an opportunity to help patients get the best, most effective cures in treatments as quickly as possible while upholding the highest standards of patient and consumer safety. And to me, a central part of accomplishing this goal and tackling the tough medical challenges our country faces is making sure that research and development can thrive. Im pleased that so far weve seen bipartisan interest in ramping up investments in the nih and fda and ive made clear that ill only support a bill that does just that. Im going to be very focused on finding a path forward on this goal in the coming weeks because, put simply, stronger investments in medical Research Means a stronger, healthier country. Im hopeful that republicans and democrats can come together to build on the bipartisan foundation we set in the budget deal last congress and make the investments we need to help our economy and country work better for our families. Thank you, mr. Chairman. Thank you. Dr. Collins, do you want to make an Opening Statement and a brief review of the team you brought with you . We wont count that against your opening time. Thank you, mr. Chairman. Yes, id be glad to introduce the folks with me. Were happy at nih that we have a deep bench of science and leaders, 22 institutes and centers. Youll see in front of you five of those folks. To my left, your right, dr. John lorsh, an institute which is having a pretty big day today because the nobel prizes in chemistry were given to a nice moment for nih. And then next to him, the director of neurological diseases and stroke, distinguished neurologist and basic scientist as well as a clinician. The acting director of the National Cancer institute to my right. Much recognized for his work in the development of a vaccine against hpv which is saving many lives from cervical cancer. Next to him, dr. Rodgers. And also one of those folks who is being honored this evening at the sammys awards because hes one of the nominees for this years awards for Public Service. And over on the far end, dr. Volkow, highly educated in addiction science and highly recognized by the press because shes often in front of them talking about addiction, the National Institute of drug abuse. Thats my team. I would like you to start the clock and id like to tell you a few things by way of an Opening Statement. Its a great day for my colleagues and i to be before you to discuss how nih is investing in a healthier future for all americans. Longevity, you can see what has happened, breakthroughs by nihsupported research. For example, cardiovascular diseases, death rates have fallen by more than 70 in the last 60 years. Cancer death rates are now dropping by 1 or 2 annually. Likewise, hiv aids, when first being written about as a death sentence, greatly extends lives and an increasing potential of a vaccine are enabling us to envision in real terms the first aidsfree generation. The Patient Community and employees, i want to thank all of you for your support and for holding this hearing today. We see in front of us a remarkable landscape powered by exceptional advances in scientific knowledge and technological innovation. This mornings announcement of the nobel prizes in chemistry for dna repair is an example of how these investments have been paying off, building upon work thats gone on over decades. Id like to share with you an inspiring story, another one emerged from decades worth of n nihfunded basic research. Its harnessing the own immune system to fight this dreaded disease. Id like you to meet emily. Emily whitehead, back in 2010, when this photo was taken, she was struggling with acute ly mph osat particular disease. She was in the other 10 . Her prognosis after failed chemotherapy was grim. But doctors approached her parents about trying something radically different. A Clinical Trial of an experimental approach called immune know therapy. Id like to make this point about the long arc of medical research involving many years of work ultimately leading to emily. Lets take a brief journey back in time. The history of cancer immunotherapy can be dated back to the 1890s. A new york surgeon, william coley, stimulated patients immune systems with bacterial toxins. But his results were highly variable, the treatments were very toxic and this treatment fell by the wayside until the mid1980s. Then, at the National Cancer institute, Steve Rosenberg explored the ability of site toe toxic tcells to destroy cancer cells. He wondered whether the immune system could be helped to do this by taking these tcells out of the body, stimulating them with an activateling factor and reinfusing them to the cancer patient. It did not always work but there were dramatic responses. Steve is a true pioneer. Steve was made this morning the federal employee of the year by the partnership for Public Service and will be recognized in the sammys awards ceremony this evening. Meanwhile, basic research spearheaded again in large part by nih led to the discovery of methods to supplies fragments of dna together, giving birth to the whole field of biotechnology. Armed with this set of tools and technologies, nih supported researcher james alison, you see here, pioneered one form of immunotherapy and discovered a protein on those tcs tcells by designing an anti body, he showed that the breaks could be released and advances to untreatable cancers began to appear. Another award. Alison just received americas nobel prize for this last month. Building on this building momentum, scientist carl june, one of emilys doctors and whose lab i know chairman blunt has recently visited have been designing more precise ichlt mmunotherapies. Tcells are collected from Cancer Patients and engineered in the lab so they could produce special proteins on their surfaces calls c. A. R. S. They multiply and with guidance they seek and destroy the tumor cells. Let me just show you how these killer tcells seek and destroy cancer cells with a quick video. This is pretty dynamic and the results can be dramatic. Thats a tcell that you see there lit up in red and its busy migrating around on this petri dish looking for foreign invaders. You will see, when it finds a cancer cell, its going to get really excited. There you, see, the cancer cell in blue, the tcell is really going after it. Im going to change the colors on you in this next little clip. They are now in green. The cancer cells are red and watch for the red flash. Thats where the tcell just ruptured the membrane of the cancer cell and sent it off to the cancer cell graveyard. You can see it happening with them being attacked by tcells to figure out how to do away with them. One of the recent patients refers to those little tcells as ninja warriors. And they do their job. This isnt just of the future of Cancer Treatment. Its the present. Note, this was built on decades of work. In fact, going back to jim alison, a recent Analysis Shows that the pathway that led to his award included the contributions of 7,000 scientists for more than a century with many pursing questions that had no apparent connection to cancer. So i tell you this story to emphasize the critical need for federal investment in this whole spectrum from translation to clinical research. If we do that, we can accelerate discovery across this vast landscape of biomedicine and ultimately save many lives. Remember little emily . Here she is today. A junior bridesmaid, this picture of health. Her parents decision to go ahead and enroll her in that trial. 28 days after that treatment, emily was cancerfree. And more than five years later, she remains cancerfree. Emily is just one success story. I could tell you many more, including all of these folks across the entire nih portfolio about how basic scientific inquiry is leading to a healthier future for all americans, from the development of Brain Initiative to the cohurt person and am i would say our future has never been brighter. And my colleagues and i welcome your questions. Im certainly glad youre here. I did senator toomey went to see what dr. Carl june was doing and that effort was very much you can correct me where im wrong here, very much focused on the patients needs and at all age groups have been seeing success in that particular effort but two thoughts about that. One is, what is how does this is this likely in cases like this to go beyond treatment to the level of where, in this particular case, this particular fighting agent is always there so youve got youre talking about cure instead of treatment and id be interested what discussion is going on, how we look at a world where cure is one of the options as opposed to a Health Care World thats largely been defined by treatment up until now. And ill just go ahead and ask my second question at the same time, which is, on these individual cases, i would assume at some point, one of the challenges are, what do we do that makes that most likely to be scaleable so that every patient doesnt have all of the expense of a unique treatment but a scaleable effort made that will i think will become naturally but talk to me about those two things and then whoever youd like to answer those questions. Those are great questions, mr. Chairman. I think ill turn to dr. Lowy as the acting director of the Cancer Institute whos investing in big ways to address both of those. Thank you, senator blunt. This is really a critical juncture right now because we have opportunities for longterm responses and what youre asking is are a subset of those responses going to lead to cure and we certainly are optimistic and hopeful that this will happen, at least in some cases. But we need to understand better, as you point out, what the mechanisms are that drive the important clinical responses to immunotherapy and if we can understand them better, we may be able to devise effective immu immunotherapy because we hope eventually we can get to the area of precision and predictive oncology where patients we know what treatment to give to them and what kind of therapy to give to them in addition to targeted treatments. Thank you. In terms of a scaleability, which is a tough question for some of the very personalized immune know therapy that you saw in carl junes lab, there are strong interest from companies figuring out how to do this where you can make it available to thousands of patients instead of small trials and we would think thats a very appropriate kind of place for private Public Partnerships to spring up so this idea of engineering your own tcells to go after your cancer could be done for more individuals. I would just say, before i turned to senator murray, i think this is a topic that im having some discussions which people representing Health Insurance companies are thinking about a future where traditional treatment may be less expensive initially but a longterm potential cure, the more expensive initially but less expensive over time. What are your standards going to be . Are you thinking what we can do now, which really the whole concept, im sure well get to, of designer medicine, what can happen with the efforts, doctor, on the brain and that impacts. I think well have time for more than one round of questions. We have a couple of people on a time frame. Well try to get to them quickly and do this by order of both appearance and first person to go to is senator murray. Well, thank you very much. Dr. Collins, were working on a continuing resolution. What affect would a year long cr, at the current rat