Committee will come to order. The appropriations subcommittee on labor, health and human services, education and related agencies will come to order. Before my opening statement, i want to recognize melinda bikini, we had a chance to meet and talk about her cancer fight and the success shes made there when we were out in nih a few days ago, and we are glad youre here and i was just told that the youngest of your six children just got their drivers license so good luck with that. Good luck with all of that and we were glad to have a chance to meet with her, glad to have dr. Collins and the other Institute Directors here today. The budget, of course, proposes cuts that i think that you can rest assured the committee will find unacceptable. The 7. 5 billion cut from nih would according to analysts, this funding would cost nearly 90,000 jobs nationwide, result in 15. 3 billion of lost economic activity. In my home state of missouri that equates to a loss of nearly 1,700 jobs and 292 million in economic activity. The cut is one that i think you can rest assured this committee will not take. I certainly fundamentally disagree with the proposed funding reduction, however, this isnt the first president to propose a reduction. President obama proposed a 1 billion cut in his budget last year. We went 3 billion beyond his proposal. Im not sure we could do anything like that this year, but i also mentioned in a hearing earlier this week that when his budget was submitted to the senate, 98 senators voted against it and one senator voted for it. So we have a long history of the congress asserting itself on issues of how to allocate money. I believe this committee will do the same thing this year. In the last two years with significant encouragement from the whole committee and particularly from senator murray, senator alexander, senator durbin and the whole committee. We had nine of our committee out at nih recently. It was the Biggest Senate delegation to ever go to nih. We spent most of the afternoon i hope you dr. Collins and your Institute Directors know how much your work is appreciated. In the last two years weve increased nih funding by a little more than 13 and were going to be listening carefully to your presentations today but before that id like to turn to senator murray for her opening comments. Thank you, very much mr. Chairman. Thank you dr. Collins to you and to all of your team for being here. We appreciate all that you do to championing the critical work of nih. Youve been a great partner and appreciate your leadership and i too welcome ms. Bakini. Its good to see you again. And i look forward to having a discussion today about really the devastating impact that President Trumps budget would have on nih. As you all know President Trump has proposed cutting nih by 22 , most of it by arbitrarily capping indirect costs resulting in the lowest funding level for Biomedical Research since 2002. Three months after releasing this proposal we still do not have basic information from the administration about how nih would implement a 7. 5 billion reduction. Without severe consequences for thousands of Research Facilities and tens of thousands of scientists that rely on its grants to support their work. Facilities like Fred Hutchinson institute in my home state of washington just to cite one example where scientists have pioneered bone marrow transplants and searching for cures to cancer and hiv vaccines. But because of this proposal, could be forced to dramatically scale back their efforts to develop cures for patients. These cuts are deeply concerning which is why i said repeatedly, i really hope that both parties will once again reject President Trumps Budget Proposal and continue to Work Together as we have to ensure nih is able to carry out its vital work and booster Economic Growth and competitiveness. Before this discussion can happen i have to note that todays hearing take place in the very midst of Pivotal Moment for our Health Care System as a whole. As we have heard all week our republican colleagues appear to be dead set on jamming their version of trumpcare through the senate in just a matter of days. This is a bill that has been subject to no hearings, no public debate and no expert testimony. Its a bill so secret that apparently until just moments ago, many republicans senators were telling press and constituents they couldnt say what was in the bill. It was a bill so secret even President Trumps Top Health Care advisor, secretary of human and Health Services told us last week that he didnt know what was in it. It has been so seek create and seek credit and closely guarded that not even the 13 male senators who made up the socalled working group could comment on certainly on what was in there or when it would be brought up or by what procedure. And, in fact, its a bill so secret that even the White House Press secretary couldnt confirm whether President Trump or anybody in the white house, for that matter, had seen the bill. Which begs the question, as i have said this week, what are Republican Leaders so ashamed of . It is becoming very clear now that those who wrote the Trumpcare Bill knew they wouldnt be able to go back home and defend it because based on what we are now learning this bill is going to be the same kind of Trumpcare Bill that went in the house and it will have tremendous impact on patients and families. Higher costs for families especially seniors and people with preexisting conditions, Insurance Companies no longer will be required to cover basic health care, like Maternity Care or mental Health Services and more. Women would lose access to their doctors and to the care they need at planned parenthood and tens of millions of people across the country would see their medicaid coverage taken away. That means people nationwide who are finally getting treatment for Substance Use disorders like opioid addiction or Mental Health care or access to a primary care doctor under medicaid are going to lose that access. So as many of my democratic colleagues have said, this is not a health care bill. Its an attack on Families Health and financial security. Again i just want to reiterate my message to Republican Leadership, it is not too late to dump this Trumpcare Bill. Its not too late to make the right choices and work with us as democrats to fix our Health Care System. As the chairman and others on this committee should know by now, democrats stand ready. As we always have to Work Together to actually make health care more affordable and accessible for patients and families across the country. But we cannot begin that conversation until Republican Leadership reverses course. And lastly, i do have to say that after hearing this week about so many of my republican colleagues feeling frustrated about this bills process who are angered about being shut out are receiving conflicting information or who may be even shocked at the text that was just released, you have the power to do something about it, not just to complain. You can insist on full hearings, open debate, increased transparency, because lets be very clear, people across the country are really worried about the approach thats being taken. Theyre watching. Theyre going to be paying close attention and we need to get this right, not what is being jammed through the senate and with that mr. Chairman, ill turn it back to you. Thank you, senator murray. Were pleased to have the chairman of the full committee and Ranking Member of the full committee with us today. Chairman cochran does not have a statement but i think you do, mr. Leahy. I ask that a statement be printed in the record. Thank you. Thank you, chairman blunt, chairman cochran, glad to be here with you and of course with senator murray and i completely agree with her statement. I think this is an important meeting, dr. Collins. Good to have you here and your whole team. Just for a personal note, when my mother, when she was still with us she was first generation Italian American and when she saw my schedule she thought you say hello to that nice young man. Or she said bonjourno. I am worried about the budget. This affects all of us. You have to support the middle class, you have to lift up the most vulnerable. You have to serve our values and interests as a nation and nih has been a shining example of serving our nation, but sequestration has had devastating consequences for both defense and nondefense programs. I think those consequences are going to last for a generation, theyre going to affect my children and grandchildren and this budget makes it even worse. The budget cuts, those have drawn the most bipartisan opposition and you heard what the senator blunt said and others have about this budgets. The most bipartisan criticism has been the reductions for the National Institutes of health and i have want to commend chairman blunt and Ranking Member murray for their efforts to bolster the nih budget in recent years, but this one, this budget that weve been given by the white house turns that progress upside down, it slashes nih resources by 7. 2 billion, 21 , lowest nih budget since 2002. You know far better than i do, you cant medical research you cant say well just turn off for a few years those studies and trials and all, but well come back five years from now and pick it back up again. You just cant do it. You dont hit pause on studies. You cant have ups and downs based on the whims of an antiscience group. That hurts the medical search field. I think not only would it do to you, a cap on research around the nation, universities and other entities. Im not being parochial but i mentioned the university of vermont. They received millions of dollars of nih grants each year. They enrolled recently to wrote recently to director mulvaney and secretary price and noted its unlikely they could continue their research on this budget, and theyve been doing cuttingedge research in cancer, among other things. And id ask for full copy of the university of vermonts letter be placed in the record, mr. Chairman. Without objection. Thank you. So i think as vice chairman of the Overall Committee im committed to getting money back in. This science, this is where we can excel. Where we can lead the world. But not only that, we can make life so much better for our own people and people around the world. So i will fight for every dollar that i can and thank you very much, mr. Chairman. Thank you, senator leahy. Director collins, were pleased youre here and look forward to your Opening Statements and when youre through with that well go to questions. Let me introduce the folks at the panel table with me. Over on my left, your right, dr. Richard hodus the director of the National Institute on aging, next to him dr. Vol could have on drug abuse, next to me doug lowie whose the acting director of National Cancer institute, joshua gordon, and youve already recognized in one comment at least dr. Tony faucci. The director of the National Institute of allergy and Infectious Diseases. And at the far left on your side, gary gibbons who is the director of the national heart, lung and blood institute. We brought the ateam today so its a pleasure and an honor that we were able to host many of you on our campus earlier this month and its a great honor to be here with you today and im privileged to continue in that role as nih director. I want to thank all of you for your sustained commitment to nih, a commitment that will ensure that our nation remains the Global Leader in Biomedical Research with all that means for human health. Today id like to highlight several areas of exceptional scientific opportunity. Introduce you to a few patients and also talk about some young searchers who are working hard to make these dreams come true and ill show a few images over there on the screen. Lets start with an opportunity that shows the transformational power of investing in nih basic science. Imagine that you could determine the price molecular targeted by pharmaceuticals and see how they interact with each drug. This is starting to happen. Thanks to a new technology called cryoem. This image caused the structure of a promean channel that regulates salt and water balance in the lungs. This very protein is misfolded in Cystic Fibrosis, our nations most common fatal genetic disease. The genetic mutation was discovered in my own research lab many years ago, but only now is new structural information allowing us to design better drugs to help Cystic Fibrosis patients like little abalynn mahoney, who will be celebrating her 2nd birthday next week. Her life has not been easy. Shes required surgery. For an intestinal blockage shortly after birth. Shes doing pretty well now. Just a few decades ago she probably wouldnt have made it beyond her teens. No longer. Today we have two targeted drugs for cf and more to come all building on nihsupported basic research. Were not done. The goal is to turn cf into a 100 curable disease. For that we need the next generation of scientific talent. Among the early stage investigators tackling this challenge is steven allor of the university of alabama at birmingham. Trained in both Computer Science and biology, steven plans to transform in fundamental ways how we design and deliver drugs for all kinds of conditions. In fact, we need that. Treatments only exist today for about 500 of the 7,000 diseases for which a molecular cause is now known. Among those in desperate need of of a breakthrough is Sickle Cell Disease, a lifethreatening disorder in which red blood cells are deformed in a way that clogs small blood vessels. Sickle cell disease is caused by a genetic misspelling. And that was essentially understood 60 years ago, yet even today the only way it can be cured is by a bone mary transplant from an unaffected donor. That can work really well for some patients like chris sweet shown here with his family. Chris received a transplant at the Nih Clinical Center six years ago and is now essentially cured. But unfortunately, most dont have a wellmatched bone marrow donor. What if we could correct that sickle misspelling in the patients own blood cells . A few years ago i wouldve said thats pretty unlikely but thats all changing. Nihs Courtney Fitzhugh is seeking to use a new gene editing system called crisper to modify bone marrow cells in Sickle Cell Disease. The goal is to fix the underlying genetic defect and make the persons own cells healthy. If courtney and other young scientists can get this to work for Sickle Cell Disease, just think about what they might do for thousands of others still await ac cure. Imagine you could get a detailed understanding of the 86 billion neurons in the human brain. Thats what our Brain Initiative aims to do. I know that each member of this subcommittee is aware of the enormous toll that Brain Disorders are taking upon our Nations Health and economy. Alzheimers disease alone has an estimated Economic Cost of 259 billion this year and is projected to exceed 1. 1 trillion by 2050. Lets imagine that using tools and technologies created by the Brain Initiative you could easily identify someone at risk for alzheimers and use such advance warning to apply effective ways of preventing this disease thats touched so many. Including singer Glen Campbell who was on the hill with his family a few years ago to advocate for alzheimers disease research. Young investigator rose of Massachusetts General Hospital is among those taking on this challenge. Her work is focused on the largestknown group of people in the world with inherited alzheimers. An extended Family Living in the mountains of colombia. In the effort to capture subtle changes in the brain, her team is using p. E. T. Scans to compare the brains of family members who carry the alzheimers gene mutation with those who do not. Clearly, fighting alzheimers wont be easy but rose and other young researchers have the talent and drive to make it happen. And you all are part of this. Your emphasis on alzheimers and related Dementia Research in fiscal 2016 and 2017 is enabling progress toward our mutual goal of preventing and effectively treating these devastating conditions. All of us here are motivated today by a sense of urgency to help patients in need of breakthroughs. The next generat