tv U.S. House of Representatives CSPAN August 5, 2009 1:00pm-5:00pm EDT
did not have health insurance, i did with out and did the best i could. there were times when i did not have a phone but i have health insurance. i had to make a choice. if they want health insurance, they can get up off their sorry butts and get a job and pay for it. if it takes a second job, pay for it. . >> we are leaving this recorded segment and taking you live to conference with administrator of
the federal aviation administration, randolph babbitt. he will be addressing the airline pilots association at the airline safety forum in washington. live coverage on c-span. >> it is wonderful to see all of you here. we have an exciting and full program plan for the next two days, with many informative and thought-provoking presentations. to help you better to these presentations, may i request that you confirm that any personal communication devices you have are in the silent mode? turn off your cell phones, for those who did not understand that. at the start of this meeting, i will give a couple of -- i will give a minute for a couple of folks to come in and finish putting their seats. we are glad to have you folks here. i know it is a busy program. as is our custom at the start of this meeting, we will begin with the playing of the national anthems of canada and the united states, music that reminds us of our history, our traditions, our
as we begin today, i am especially honored to be here and see for this year's air safety program -- yhour mc for this year's a safety program. we have but to get all the representatives of safety, security, jumpseat, and pilot assistance. and has been quite an undertaking. i am grateful for all the long and hard work of those who made it possible. it is my pleasure to introduce the committee chairs whose efforts led to this historic week. on my far right, united capt. rory kay. on my far left, first officer rich obert. i might direct left, national security committee chair robert
powers. there are two more individuals on stage for us to welcome. first, the president of the airline pilots association, captain john prater, and the " honorable capt. randy that it -- babbitt. he is no. 1 in the faa. you get a pilots said it, it is it his signature on your license. that is pretty cool. the theme of this year's forum is one simple phrase -- it takes a pilot. as you listen to the subthemes for each group, reflect on how they apply to our group and challenges. it takes a pilot to listen to a pilot. it is one of the fundamental premises, not a bad one, frankly, for all of us. for the jumpseat committee, promoting captains authority is
key in their efforts to reclaim our rights to jumpseat access. for the security committee, pilots are the last line of defense, a multilayered approach to enhancing safety. for safety, it takes a pilot, trained, experienced, prepared for the unexpected. these are very interesting, and certainly very challenging times for airline pilots today. we have prepared a video that reminds us of our work, of what it takes to be a pilot, and to be and off a pilot. please turn your attention to the screens at the front of the world. at the fred -- of the room. -- at the front of the room. >> for every one of us, a time will come, a defining moment when our lives are changed forever. this is that moment.
>> requesting a jumpseat. >> welcome aboard. >> we all have a defining moment. we decide to make our dream out reality. let the tradition continue. born to fly, born to serve, board to succeed. it takes a pilot, it takes alpa. [applause] >> ladies and gentlemen, please welcome alpa president, capt. john prater. >> good afternoon, ladies and gentlemen, alpa brothers and sisters. this has been an historic week for our union. for the first time, as linda said, we brought together all of our canadian and u.s.
representatives in the areas of safety, security, jumpseat, and pilot assistance. as the video depicted, the theme "it takes a pilot" carries through the many ways our pilot representatives are leading the ongoing efforts to improve our industry and enhance our profession, especially in those mentioned areas. this year, airline pilots have been front and center in the news, and in conversations around the water cooler, and in the halls of congress and parliament. it seems that everyone is talking about airline pilots, whether praising them for expressing their gratitude for their heroic actions on the line to ensure the safety and security of the passengers, crew, and cargo, or expressing their sympathy and shocked at learning of the difficult challenges that pilots often
face in carrying out of their professional duties. recent incidents that have brought the spotlight on our profession -- the tragic cash of flight 34 07, as well as the state outcomes of the u.s. airways flight 1549, and the flight 918. as examples, they reinforce how much we rely on airline pilots for every aspect of our travel experience. that is a tremendous responsibility, our responsibility that pilots are able to fulfill because of the efforts of all of you, our alpa pilot representatives, undertake to make a safe and secure air travel. it is also our responsibility they can fulfill because of the support and assistance they
receive from their fellow union brothers and sisters, especially during times of crisis. alpa pilots' share that responsibility, and through our ongoing collaboration with government agencies, legislators, and industry stakeholders, we have been able to improve pilots' ability to do their job, and enhance our profession and enter our industry as a result. last fall, when the board of directors began work on the the alpa-wide strategic plan, did recognized this, and made the safety and security initiatives a top priority for our union. i am proud to say that in the short time since we laid out our safety and security priorities in that strategic plan, alpa has, through your leadership and hard work, already made significant progress on a number of initiatives a.
alpa has long advocated for an overhaul of flight time to the time regulations, and the faa is taking a comprehensive review of those regulations. the industry is to be a rule making committee with seven -- has convened a rule making committee with seven alpa pilots. our representatives will be crucial in helping other participants understand the practical applications of the rules, and with the pilot perspective. we anticipate the outcomes will also be considered in canada, and we are fully prepared to work with transport canada to undertake a review of canadian regulations and modify and update them as well. alpa representatives also serve on the faa safety management system, including co-chair
linda, to take us off this morning, and the office of alpa executive air safety, and who serves as the alpa executive vice chair. alpa also is involved in the city council -- the safety council. among our unions notable accomplishments, alpa also shared in the success of all commercial aviation safety team participating organizations in receiving the prestigious 2008 trophy -- collier trophy. this marks the third time in the last 14 years that alpa has been awarded to the collier trophy, and we are the only organization that has continued to do so. we continue to respond to incidents and accidents with an experienced team of experienced alpa pilots and staff.
alpa safety teams respond quickly when the calls came in after the continental accident in denver, at the accident in buffalo, and the fedex accident in japan. the outpouring of support did not support there. our critical incident response team provided critical support and assistance to pilots and their families affected by those incidents. the critical incident response program, cirp, is one of the five pillar committees that make up alpa's pilot assistance committee, most often working behind the scenes, the assistance and support the peace committees -- paramedical, cirp, professional standards, canadian pilot assistance -- provide is in it a valuable benefit to our members.
alpa's role as the voice of airline pilots on capitol hill and in parliament is unwavering. this year, alpa has testified before several subcommittees of the u.s. house of representatives and the senate, most recently on airline safety and pilot workforce issues in the regional sector of our industry. that has led to last week's announcement of new legislation entitled "the airline safety and pilot training improvement act of 2009." provisions in this legislation and in the faa reauthorization legislation could improve advance our profession and our members' quality of life. alpa remains fully engaged with congress and the administration to advocate for our members. alpa also continues to advocate for long-term funding of the air traffic and control if a doctor
at the push for modernization. as well, alpa holds a leadership position in a number of industry-government committees that are working with the fda regarding the transition to next june. turning to our security priorities, we are making progress on several fronts, especially regarding expedited airport access for pilots in both the united states and in canada. in canada, the restricted access identity card, or raic, is recognized as a huge success. transport canada has agreed in concept to permit raic holders to use the cards for jumpseat access and to grant temporary access on an exception to the canadian aviation regulations. we continue to encourage the agency to make this access to permanent. in the united states, the crew personnel advance screening
system, better known to us as crewpass, has been successfully implemented at three u.s. airports as part of a pilot program begun in july of last year. earlier this year, alpa, and our partner in this program, called on the tsa to issue necessary standards to enhance the program. the tsa responded by enacting security standards that include adding a fingerprint biometric component to this system. we continue to press to make crewpass available nationwide. alpa has advocated for secondary barriers as an added layer to protect the carrier and the aircraft. we requested that the special committee be enacted so that airlines may voluntarily
install added barriers. the committee's work continues and we are encouraged to see greater acceptance of the concept of a physical secondary barrier to the main cockpit door. the federal flight deck officer, ffdo program, continues to be an overwhelming success, but for our pilots and our nation. it provides another critical air defense intended to protect airline conflicts from hostile takeover. i am happy to report that the transportation security administration has signaled publicly that it is seeking to expand resources for oversight and training, and in june, the u.s. house of representatives passed by a strong majority in the tsa authorization act, which includes a number of alpa- recommended improvements to the ffdo program.
it also includes provisions to many additional security training to the all cargo pallets that were recommended, again, by alpa. however, we believe that much more work is still needs to be done to raise all cargo security to the level already seen in the passenger airline domain, and to reach our goal of one level of security. in touch on alpa's ongoing work and most recent accomplishments, i must mention the no pilot left behind initiative, blanched -- launched by our national jumpseat committee. this approach stresses the authority of the pilot in command. based on the tenet that having an additional trained pilot in the cockpit further enhances the safety and security of our passengers, crew members, and the aircraft. no pilot left behind emphasizes the critical need to ensure the
integrity of the cockpit access security system, while expanding the system to include international travel at the same time. this week, we celebrate the pilots who have shown us, through their heroic actions on the line and in their full participation with government officials and industry representatives and in their dedication to providing support and assistance to their fellow aviators that it takes pilots to meet the challenges in the piloting profession and to manage the ever-changing dynamics of airline operations that lie before us today and far into the future. it also took pilots working with alpa staff and with our partners in industry and government to put on all the events held here this week. at this time i would like to thank our national committee chairmen, capt. rory kay, rob
powers, jeff kilmer, and rich ogbert, for your months of planning for the events taking place this week. i want to thank our pilots and world-class staff for their deep commitment to the work being done in the areas of safety and security, jumpseat, and pilot assistance. alpa's leadership in these disciplines in the united states, in canada, and through our work with the international federation of air line pilots association's, is due to the pilot representatives who bring their best knowledge, a unique flight experience, ingenuity, and shared commitment to our profession, both as airline pilots and its union advocates. please join me in thanking all of the people who have put this week on. [applause]
now it is my distinct pleasure to formally introduce you to our keynote speaker, the hon. capt. randy babbitt, the new administrator of the federal aviation administration. you know what? let's get it over with. [applause] i most of our world, a know him as randy. in june, when he was confirmed as the faa administrator, airline pilots across the country welcomed the news. he is well known to all of us,
both as a former president of our great union, and as a highly regarded aviation consultant, and an influential member of numerous government and industry advisory committees. he began his career as a pilot, flying 25 years for eastern airlines. he served two terms as president of alpa, during which he championed the one level of safety initiative, implemented in 1995 to improve safety standards across our industry. he also promoted the international expansion of alpa through a merger with the canadian air line pilots association in 1997. this has had a profound impact on our union boss to effort to advance our safety and security goals throughout north america and around the world. in 1993, the administrator served as a presidential appointee for the national commission to ensure a strong, competitive airline industry.
he was also a presidential appointee to the faa management advisory council, created by the fda reauthorization act of 1996 -- fha reauthorization act of 1996. he provided guidance to the administrator on a variety of topics, ranging from air traffic modernization to regulatory policy. he served as chairman of the council from 2004 to 2006. administrator babbityt came to the faa from a consulting firm where he served as part retreat prior to that, he was a founding partner of a highly successful aviation firm in 2001. he was the president and ceo until it was acquired by oliver wyman in 2007. he was recognized in "aviation week" and "space technology"
magazine for an award for an outstanding achievement in commercial transport. in 2008, he was named by then- secretary of transportation at mary peters to an independent review team of aviation and safety experts tasked with evaluating and crafting recommendations to improve the faa's implementation of the aviation safety system and its safety culture. in a few months since he became the administrator, he has already shown a keen interest in bringing together faa representatives, alpa, airline management representatives, and others, to focus on a number of pilot workplace issues, including pilot training and improving airline safety and the underlying culture. the work has begun with a series of road shows that the faa is hosting around the country as we speak. i am sure that he will expand on
that. but suffice it to say that alpa is police engaged in this effort, and we look forward to continuing to work with the administrator and the faa on all of these and other initiatives that advance our mutual safety goals. ladies and gentlemen, please give a warm welcome to the faa administrator, capt. randy babbitt. [applause] >> thank you. that you. thank you very much. john, thank you for that very warm and kind introduction. it is a pleasure for me to be here. my tenure is short. i have been the administrator for now 66 the day.
i am not exactly a seasoned veteran here. i have been quite busy, but i did have a chance last week to find a little bit of a break. i got a chance to go all-out to oshkosh. i do not know if you have ever been to oshkosh, the air show up there, but if you ever want to see the roots of aviation and feel the passion of life and up close, it is the greatest show on earth. it also gave me a chance to do something -- i got to ride out there in an faa airplane, which i don't get to do often. i got to go up into the cockpit, and i've got to say a phrase that for 40 years would put a tingle in my spine -- i got to walk into the cockpit and say, "hi, i am from the faa and i will be writing along with you today." [laughter] [applause] now, as far as my schedule goes, i have been busy. i have four congressional
hearings in my first three weeks. in the middle, i had a call to action. that brought in 50 aviation players from around the industry, the airline management, regional management, and of course, the union representation, to all take a good hard look at safety. i did back and forth to capitol hill or times that i would really like to count. i been called to the white house four times in the midst of all of that. my schedule was only a reflection of our issues, and i say our issues, they are your issues. i want to say that when we talk about these issues come up first, john, thank you for calling this forum. i am pleased that you invited me and i am happy to be here. i had a chance to look at the agenda. i want to thank you all for covering the right stuff at the right time. this is an important format, and i think a lot of progress can be made here. i would like to make a few observations, if i could. when we talk about the things that are going on, there is a
lot going on, and in the midst of things like the inspector general looking at things we do, omb, gao, "new york times," " "usa today," people complaining that they are late. it's easy to forget something that has become close to us, and that is the issue of professionalism, the fact that we cannot simply regulate professionalism. no matter how many rules or regulations, advisories, mandatory training sessions, a voluntary training sessions, pull them all together, at the end of the day, it still comes down to one thing -- it is us, and by us, i mean every pilot. each of us has a responsibility here. each of us knows that as professionals, it is up to us to our respect and to operate the aircraft professionally. the tools are there.
we spend a lot of time in the building and refunding those tools of cockpit resource management and other things that we have at our disposal. but chief pilot cannot make you use it, at the air safety inspector, line check pilot cannot make you use them, i cannot make you use them. none of us. only you can make certain that those tools are used and applied properly to enhance our professionalism it. now, if you have not read the transcript of the cockpit voice recorder, i would increase to to do that. the professionalism of that flight crew has been raised as an issue. this is not the first time that we have had that come up as an issue. the accidents we have seen in the call to action that i've made have focused on the need for all of us to be focused on professionalism, and that is a theme that runs through all of those investigations. don't get me wrong, i am not saying the pilots as a group are unprofessional. quite the contrary. what i am saying is that it is
time for our veterans, the people with experience, to take the extra effort to mentor the young pilots that are coming up in this industry so that they have instill in them the need and demand to maintain the highest levels of professionalism all the time they operate aircraft. this not only deals with safety, but this needs -- is deals with the need for all of us, you in particular, to help the new pilots learn how to adopt bill, how to change, things that you have learned over the years with your experience picked up in the cockpits. let's face it, a number of us to come back in the day, came up in a different environment, you could not find that their plan that did not have somebody in the left seat that did not have at least 10 years of experience when you came on board. those captains, let me tell you, might as well have been carrying tablets of stone direct from the mountain. if they said it, you did it. there was no question. you listened and learned.
somewhere, with our expansion, we have lost a little bit of that. we have actually, i never of us here -- i am sure that some of you are not even familiar with their plans that had flight engineers, but if he started in that area, you got to watch two pilots flying in those years. that was great experience. we need to find a different light, because that is not happening today. there are airline that there were the senior pilots have a three years of experience. and unlike back then, they are going into jets and they are flying some of the busiest airspace in the world with a three years of experience. we have got to offer them better tools. i am not saying that you have to have 10,000 or 15,000 hours under your belt to prove yourself. but there is something to be said for having flying around the system for a few seasons as you develop your assist -- as you develop your experience. but having experience is not enough. the people who have experience
need to make certain that we are exchanging it. we need to make certain that we are mentoring the ones that do not have it. this needs to become a part of our professional dna. this transfer. if you have that experience and you are not sharing it, you are doing a disservice to the profession. this not a time to be a man or woman of few words. no, these new pilots need to hear from you, you need to point out the things that you have learned and have this experience exchanges, because this is about safety, and safety is the saving lives -- safety is about saving lives. there is a rule making committee that john alluded to, studying a fatigue. that is a huge issue for all of us. i know how big an issue is, because i tried to have it addressed in 1992. every predecessor of mine has worked on it. we are at a point now where we have a timeline of 45 days in that rule making committee, and that brings us to september 1.
we will vet that rule inside the faa by statute and process and turn it over to the department of transportation, and i have up to 90 days to look at it. -- they have up to 90 days to the credit. at that time, it will go up for public comment. both the omb and the department of transportation accelerate the review of this important role. why does this take us along? people said that it seems like an exceptionally long time. i think this audience to appreciates just how complex this particular role is. rulemaking in general is delivered a tip, and it is delivered to by its very design. -- deliberate tiv by its very design. i can tell you that this committee is giving all of these issues a very good luck.
what person to you think is concerned more with fatigue -- the pilot flying from detroit overnight with backers and box for rest, or the pilot who has eight takeoffs and landings, and he or she is right to make those, and whether it never gets better than 401, and they will do without leaving the east coast. who is going to be the better pilot? we all that adds to that, but the regulations to not reflect the difference. that is what this team is looking at. i want to make sure that the answers we get as working men and women aviators are actually the right rules. rulemaking not only does -- in rulemaking, not only does once is not fit all, but it is not safe to think that it can. the early that the flight time
and do the time so far is progressing well. they are looking at the subject of fatigue science, which is something new, bringing science into the rule making, which i highly applied. they are also looking to see the difference in the hourly limitations, again, based on scientific data as they go through this process. they have presented to physiological concepts of time and flight time and duty and rest limitations and how they vary. we have definitions of duty and rest. the scientists who specialize in fatigue have made presentations about sleep opportunities and when they are best captured. all of these things, including circadian rhythms and potential schedule changes, will be a short and commented on by this committee. by regarding regional safety, john mentioned a, i am happy to have so much participation and contribution to the -- from the
alpa pilots and other pilots around the nation. we held forums starting on july 21. the goal is to stimulate a safer and more professional environment at our regional carriers. i am pleased to report that the airlines and unions have all responded incredibly well to the call. the meetings will continue through august, and they are all over. it will be in places like detroit, chicago, seattle, twin cities, denver, st. louis, las vegas, and boston. everyone should have an opportunity. people say that they missed the first and the which they could have commented. trust me, you will have more opportunities. it will focus to some degree on our own responsibilities. some of the very things that you will be talking about at this very conference -- professional
standards, flight discipline, performance -- all of these will be discussed. and as you expect, the term i've used a lot, mentoring, and experienced transfer, coming up over and over again. we plan to collect the best practices and innovative ideas, and i will be sharing the results of that with the airlines and the unions. we can maximize what benefit and how we take the information for a -- how we take the information forward and make the best use. i am asking everyone to ratchet up their approach to excellence and taking us to the next level of safety. i cannot say this any more directly than i am going to say it now -- we all have to take on additional responsibilities, whether we are required to legally or not. this is about safety, and again, safety is about saving lives. recently i spoke during a question and answers, or a pilot told me not to set the bar to
the for start-ups. let me repeat what i said then -- i absolutely agree. we are working to provide training rules. i think we have had discussion on that here. we are working in several other areas. we are talking about raising the requirements hired to be the first officer in a multi crew pilot operation or airline operation. i might not be in the cockpit every day like i used to be, but that is certainly a perspective i hold. safety is what got me there. michael s. faa administrator is to make certain that safety is paramoun -- my goal as faa administrator is to make certain that safety is paramount in everything we say in everything we do. if you think the bar is said to hide, then your standards are set too low. it is time for us to stand up, and without all of us in this room standing up, we will not reach the next level of safety.
with that, i thank you, and i applaud you for the wonderful opportunity to come and visit with you today. thank you. [applause] >> well, the captain has graciously asked to spend a few minutes with us, if there were any questions. i told him at the end of the week that we might have questions and we might also have statements and actions ready to go. at this time, if there is a pressing question, let us take the opportunity. if you stand, you will have to come up here. i don't know if we have a microphone are not. it looks like we have one here. over here? >> i'm capt. out of chicago for
united. just about the fatigue, i understand we are looking into the-based, which is probably quite the improvement. the ata alpa sometimes i themselves on opposite sides of things, and while the service comes out about the teeth, we will likely be taking a different look at it than ata is. they are saying basically that we need to slow this thing down. is the faa -- you are a political body, and so the reality of the situation is that they wield a good steak in beating you above the head and shoulders about it. you know this is coming and you know this is something that you have to address as a difference between the operators and airlines themselves. >> that is a very good question. in the past, we made this
attempt before. usually, the rule making committee process, we tried to bring the parties together and let them resolve and come to a conclusion. that always be somebody, unfortunately, the opportunity to set -- if we cannot come up with a consensus, we walk away for the process and say we are better up -- better off than what we are pr. but we know too much about fatigue, recognition of the key, the management of fatigue. we are looking at the rules written in the propeller era for aircraft that can fly long for and further than we ever dreamed airlines -- airplanes could stay in the air. they have 45 days and it will either come to a consensual agreement and have a rule, or we will take whatever they have come as close as we got, and we will close the gap and have a rule. [applause] right there, yes, sir.
>> good afternoon, members of the panel. my name is michael and i am the first officer and a gatekeeper. i have a piece of proposed legislation for the senate which would mandate part 121 operators to operate asap and other programs into their system. there is one paragraph that caught my eye here, and i will quote it from here -- "the administrator, acting and collaborate with industry and interested parties, at shock consider the merits and feasibility of contact voice recorder data and safety oversight practices." my question to you is how to you do this? how could this benefit safety? do you support this? >> first of all, let me back up to about 30,000-foot in view of
what is being proposed there. some caution needs to be used in how we do this. if this is mandated, one of the reasons that those programs are voluntary is that by not mandating them, the faa has no requirement to have that data, and therefore it is not discovered. one of the reasons that the programs work, and i'm a huge proponent -- signed the very first agreement with david, which was heavy lifting among my colleagues -- i think we have found that it has proven to be any credible source of gathering data, trends, and spotting -- and a credible source of gathering data, trends come and spotting it. but my concern is that a lot of people will not put their hand up any more. i think the idea of a spot check on the voice recorder -- i heard first from an alpa group.
i can we do a spot check to make sure we have -- why can we add to a spot check to make sure that we have a sterile cockpit occasionally? while the paragraph caught your eye -- several caught my eye -- when we look at that, we need to make certain that all the interested parties are not unduly exposed, or that we do not to unintended consequences by damaging another program. we will work as closely as we can with congress and, of course, with the representatives from alpa, to make sure that we get is the best collection of data to enhance safety, and that would be its sole purpose. you will insist on those protections, and we will have explaining to do to make sure that people appreciate the unintended consequences of not writing something well.
i am sure we will come up with something in the end enhances safety. yes, sir. any others? >> good afternoon, folks. i am not sure whether it was captain babbitt or mr. administrator. >> or randy. >> i appreciate your coming here and your comments on a fatigued. ntsb has mentioned on several occasions that reduced rest was never meant to be a scheduling tool. as my peers already mentioned, ata is thought that on numerous occasions. at some of your comments on oshkosh, he mentioned voluntary compliance and other things. i wonder how you will address the situation between fatigue, using the minimum allowed by the airline voluntary compliance.
>> let us separate the issues. first of all, the fatigue issue is a valid one. i think what you'll see addressed -- when i talked about the differences, and i tried to side in my remarks that the difference between someone on a long haul with the box, and someone doing a duty with takeoffs and landings, there is a huge difference there. there is also a difference between going to work at 10:00 at night and getting through at 8:00 in the morning, which would still be a 10-hour to the day. -- 10-hour duty day. the regulations to not recognize in anyway whatsoever the difference between the two duty. -- two do uty periods.
those are two different to the times and they need different scheduling. i hope those are addressed. when we talk about voluntary compliance, some of the things we're talking about, and again, with the understanding that we have the constraints that if we mandated, the information becomes hours and it becomes discovereable. but i would like to see for every major carrier is that when you make an agreement with a major carrier, you have a right to say, "i do not want you carrying my passengers unless you have a program and have looked into some of these other things." aqp has proven to be a tremendous benefit. carriers use it in the mainline world. this is about taking the best practices and a bracing them, as a opposed to managing them.
maybe time for one more. two more. ok, two standing. >> i am delighted to hear support for asap. those will be an important part of reaching the next level of safety, in realizing the potential of those programs. but we sometimes find that realizing the potential is impeded by dinosaurs within the administration whose thinking is more in keeping with the law enforcement organization that the safety culture. i would like to know what you plan to do to address the culture of the faa and in light of those who did not get it yet, or to purge them if they refuse to come around. [laughter] [applause] >> what was the ntsb part of it? i missed the ntsb part of that question. [laughter]
i did. the faa culture -- let me address that. that is sort of a misnomer sometimes. i want to emphasize that i've said this in public speaking before and i will sit here -- say it here -- i just have a windshield. i did not spend a lot of time in the rearview mirror. but we want to do going forward is have a culture within the faa, and there are great people who work there. i am absolutely desolate by the professionalism, -- i am absolutely dazzled by the professionalism that is there. every time i turn around, i see folks from the faa working in collaboration with alpa and many factors, and feedback i get is terrific.
it might be of some benefit to me to have a background, but i know that what i am seeing going forward is very positive. you have someone to complain to if you do not see it happening that way. i will certainly do my best. i will try to meet all the people in the faa. i am very encouraged. i'm excited about what these folks are doing. they have to challenges in front of us. we have -- we have huge challenges in front of us. regulations, we are going to of approaches. equipment that we never even dreamed of 10 years ago. we need everybody pulling the wagon. i can assure you that you will need all the horses with the fda pulling hard. that is not the case, you have my phone number. >> capt., alpa said the chairmen. i commend you on the aggressive safety agenda.
what is your plan to balance that with promoting air safety? we all know that the two primary missions are to promote air travel and to promote air safety. how do you plan on balancing that to a better degree that your predecessors? >> congress sought a little that for us. -- solve a little bit of that for us. it is not an obligation for us to promote -- interestingly, it is for space travel, but not for commercial, and i am not making that up. [laughter] what i want to do, i think this is an area where you will see me working there, i will ask you to help me work there -- it always troubles may, when i sat in this seat and when i sat in this seat -- i have proof that if you stick around long enough, it is like an airline, you get to sit in all the seats -- and it troubles me that last year we
carried 753 million people, conducted 73,000 operations every single day. we did not stretch anybody, we did not hurt anybody. we had one accident and it was a tragedy and it made the front page. if we tell one person, that is one too many. -- if we killed one person, that is one too many. but 49 -- every day we kill 49 people in rush hour. we take an incredible amount of front-page, spectacular, bad press for something that is a tragedy. i met with the families and it is terrible at all of us wish that no accidents ever happened. but i think we have been charged guilty of -- we get look past for all the incredible things that we do, and this incredibly safe system we have comes under
a significant amount of undue scrutiny, and we sort of look past all the wonderful things that we do. we will work together better to make people appreciate -- it is your livelihood, your profession, you are professionals in, and you have a lot of colleagues, flight attendants, mechanics, all the people at the faa, all the way from accounting to regulatory writing, and all those things make this system work. i do not think we give quite enough credit for what a great system is. so i will ask for your help so people can appreciate that. it would not work this fall, whether it is voluntary are regulated, without the professionalism of everybody involved. i will ask for your help there. that is it, i think. >> thank you, randy, for taking that few minutes, before i turned the left seat back over,
i will make a few comments. one of our roles as alpa is to get the views of 54,000 airline pilots from 36 different airlines, two different countries, and develop our positions on many, many issues. not every idea that comes out of congress or the fda or ntsb or, heaven forbid, our union, is a good one, one that should be put into place. .
>> we will have someone who will listen to our views after we determine what those views are. once again, would you join me in thanking captain babbitt? [laughter] [applause] >> what a great way to start the forum. we appreciate the words that were spoken. we welcome your leadership. we work week -- we look forward to working with you. we have an exciting program that is planned over the next day and a half. the program that you pick up
when you registered contains a detailed agenda as well as brief biographies of all speakers, all panelist, is a good read. i think you'll be impressed by their experience, expertise, and commitment to aviation. you will notice a critique form on your table. all suggestions and comments and critiques are solicited and welcome. it is permissible. your feedback helps us make the next form better. we have a couple of breaks scheduled an hour program. during these breaks i encourage you strongly to visit with our super sponsors and exhibitors who are set up in the ambassador room, right across the way. we appreciate sponsors in these difficult financial times. we appreciate their participation and help in defraying the cost of this event. i particularly would like to thank sennheiser aerospace. they have provided us with most of the audio equipment being
used throughout the week, performing so expertly so far. that includes the audio for this ballroom. their generosity does not stop there. they made a generous donation to support our audio-visual needs this week. special thanks to sennheiser aerospace. we would also like to think casa palmera. let us begin to break. we will start promptly again at 2:30. we will examine some of the ramifications of the questions of being trapped by cockpit automation. we'll see you back here in 30 minutes. [no audio] >> iberg debate continues in the
u.s. out the section on the nomination of judge sonia sotomayor to be a justice on the u.s. supreme court. the final confirmation vote will likely be reached before the senate goes on break. there'll be a bill that promotes tourism as well as the cash for clunkers. the senate is live. you can follow it on c-span 2. >> sunday, frank rich reflects on 15 years of political columns for ""the new york times." >> how is cspan funded? >> i have no clue. >> maybe some government grants? >> i would say donations. >> advertising for products. >> public money, i am sure. >> by taxes? >> palle cspan funded?
america's cable companies created cspan as a public service. it is a private business initiative. there is no government mandate or government money. >> mahmoud ahmadinejad was sworn in today in tehran for a second term. protesters gathered outside parliament to protest the inauguration. in his inaugural speech, he called for national unity and criticized foreign governments for questioning the validity of the election. this is courtesy of state-run channel the iran-english channel. >> i, as the president, in the presence of the holy koran and in the presence of the iranian nation. , i hereby swear in the name of almighty god to protect the official faith, the system of
the islamic revolution, and the constitution. and to use all my expertise and all i have in my power into this charge of responsibilities that i have undertaken, and to devote myself to serve the people, and to the glory of the country, to the promotion of religion and morality, and to support righteousness and to spread justice. and to refrain from being autocratic and to protect the freedom and dignity of individuals and the rights that the constitution recognizes for the people. i will safeguard the frontiers of the political and economic values of the country.
i will spare no efforts in safeguarding peace. through the assistance of god, and following the guidelines of the holy prophet of islam and the imams, i will guard the power that the people have entrusted me as a sacred trust. i will safeguard the like an honest and faithful trustee. will relate that to the person elected to the position after me. now we invite the president to address.
i praise god almighty for giving the iranian people the chance, who came to the scene and created an unprecedented epic on the election day. it was the epic that with without a doubt will lead to great developments in a iran and major changes on an international level. all those people who have helped -- who are thinking of the great aspirations of the nation and in respect to members of the parliament, i would like to thank them all. the people of iran have always been active and have had a major
role, a great role, and today to, they are fully present and they are actually giving rise to a humane government with divine characteristics. for 30 years, we have been bearing the flag of justice and dignity. in recent years, we have had more fervor and experience and ever more determined,, the people have been present on the st.. the latest election, the presidential election, was a clear manifestation of experience and people's faith in following through the sublime aspirations of the islamic revolution, the epic of 40 million votes and actually
testing 25 million votes to their elected person is another source of pride for the iranian nation. the magnitude of this can be seen in the anger and outrage of the enemies, the sworn enemies, of human values. you can see these four yourself. there is a lot of dust in the air. they have raised lots of questions. they tried to depict a bleak prospect in the future for the iranian nation. but people are vigilant and they are aware and they rely on god. they have shown their will and determination. they have exercised their power. the victor is all the people, the revolutionary values, and
the establishment -- and the islamic establishment. the people's vote is the continuation of the path of the revolution, the activities of the past four years, all these have been symbolized by boats and confirmed. prevailing justice, fighting, concessions, the national dignity, and defending the repressed and persisting at resisting against the demands or believes and also prevailing the brotherhood and friendship and social justice are the major basis of this dialogue. people, through their presence, have again stressed the self-
reliance and a great capacity is on a national level for moving toward their aspirations. they have expressed this through their presence. in the election, the need for maintaining independence and dignity of the people, as well as national unity, all these were demanded and in this epic, the stress was laid upon protecting the iranian and islamic culture, arts, and human resources. purity, serving the people without expectations and protecting human dignity's and moral and spiritual values, affection and value -- affection and love for other people, freedom and, actually, acting
independently from world powers. these are what is demanded by the people in the election. they want monotheism and they want a model. this is what they voted for. i respect the participants, all brothers and sisters. i do not have any incentive other than serving the people and the country and i do not think of anything but progress and development of the nation. i am committed to all of these commitments and aspirations. i have sworn, in the presence of god and you people, i am committed to all these points and i have no doubt that you
also feel committed to the same principles. the outlines of my plans, i mentioned to them, i informed the people during the presidential campaign. people strongly endorsed them. in the endorsement ceremony, i briefly highlighted those and the leader of the islamic revolution, ayatollah khomeini, confirmed that. bthe plans today have turned toa demand by all the people and everyone is responsible for that. we're all responsible for that. we should join hands and try to fill these.
it is not the question who voted for home. we need a national will. we need to join forces. i am confident that everyone will be supporting the government, in line with the fulfillment of these plans. the recent presidential election indicated the great aspirations of the iranian nation. the people of iran have their eyes on far-fetched peaks and horizons and they are following -- they are going after sublime aspirations. the speed of the running of the country's affairs should deserve the iranian people who
elected us and you, the representatives of the parliament. we are representing a great nation. our nation has great goals. great goals require great decisions and great measures become a great action, strides need to be taken. of course, we are not given chances all the time. we should make the best of this chance. the past four years showed that semi-active capacity usies are abundant in the country. there have been some shortcomings but some problems did not allow us to make use of all of them in the progress of the country. as a representative of the people, i hereby announce that in the tent government, in the
new term, the government is determined to use all its force and to serve the nation and to use all the potentialities and activate the mall. -- them all. this requires cooperation and support of the iranian parliament and other branches of the government. i once again would like to mention some of the outlines of the plants. the first one is culture. we want to maintain the identity of our culture and that requires maintaining the elements, our cultural elements, seeking justice and dignity, requiring knowledge, affection, sacrifice, love, purity, and good deeds and moral values, arts, literature,
and culture, they all need to be dealt with. this needs to happen in all cultural spheres of the country. great thoughts and man of letters and literature, what ever they are and the academia, thinkers, and the leaks of all kinds, they are our main asset in this country and the model and dynamism for movement. we need to take more effective means for their presence in policy-making of the country and planning and execution of the plants. -- plans. i would like to invite everyone here to join forces to move with us forward. the cultural diversity it is our
assets. we need to protect this. it is incumbent upon all of us. the spread of tourism as a main factor of cultural exchanges between iran and other nations, this should be given due attention. youths and teenagers are the main assets of our country. they deserve to be active in different spheres like sports and scientific areas. the women, girls in this country, they are the purest and kindest, the most noble women and girls in the world. they need to have a more constructive role in all social,
scientific, sports, arts, political, and executive field. these should all be planned. they need to be active in policy making, as well. iranians are able to inspire hope in the region and in the world. this requires sparing no effort in getting the chances to everyone to take part. the second point is social issues. family is the main pillar for up bringing of mankind as security and peace in the country. the mothers of this land are the best. everyone should respect the boundaries of the family and protect it. everyone must feel, and
tranquililty. they should feel secure within families. honesty, fervor, brotherhood, and affection, and bravery in defending the oppressed. all these should prevail everywhere in the country. all individuals are citizens and they enjoy equal rights. they are equal in the face of law. no one has any special concession or privilege over anyone else. no one should feel that their rights are trampled upon or they are not given a chance to flourish. no single individual should feel he is discriminated against. no one should feel their dignity is being infringed.
freedom is a divine blessing and gift and achievement of the islamic revolution. everyone should in boy -- enjoy and protect all this. no one has the right, under different pretexts, to limit social freedoms. the third point is the economic affairs. we need to do major things. distribution of wealth, the unequal distribution of wealth should be stopped. production of wealth should be looked upon as a national service. they should be protected. concessions that will create discrimination and would destroy incentives and a source of corruption, this should be upgraded.
structures -- uprooted. the economic development plan as eight preludes to the overall plan and the execution of article 44 of the constitution, this must be implemented as soon as possible targeted subsidies and correcting the banking system ensures the taxing system and distribution and a strengthening the running currency. these are the pillars of the economic development as needs to be materialized as soon as possible. government for the scientific and the expert work it has done, it has made relative plans and they need to be correctly implemented. that requires brave decisions made by you, the parliamentarians.
i do trust your open mindedness. i think we can solve the problem of unemployment and housing. my friends, during this term, the devising of the open plan and the points i mentioned before, these are on the agenda of the tent government. everyone should believe that all the points i mentioned can be dealt with quickly. we need to get rid of the- bureaucracy that limits people and our human sources. our youths will make the destiny of this country. they should get rid of these
restrictions so that they can fly to the peak of progress. people have the capacity to do great things. it is you and me who need to be determined and take action. foreign policy is the fourth issue. we will still continue with active foreign policy in this term and with the blessing of god, with more power and fresh plans and more effective plans, we will have an active role in all spheres. joint human values, we will emphasize these values and invite everyone to peace, fraternity and tranquillity. we will resist bullying powers.
we will try to correct a discriminatory mechanisms in the world. the people of iran still are bearing the flags of injustice. -- the flag of injustice. we should play an active role internationally. some governments should feel responsible for their words and deeds. interferences, occupations, and cultural-economic disturbances, environmental disturbances that arise from their policies, they need to be corrected and they need to be accountable for this. the people of iran are for constructive dialogue. we're for logic. the pillar of the foreign policy is interaction, constructive,
with all peoples and nations based on justice, mutual respect, and spent -- friendship. however, we will not risk the violation of law and interference and abuse of international mechanisms and discrimination. we will not remain silent. we want equal and friendly relations but this respect, interference, insult, we will not tolerate these. you just heard that some of those countries announced that they recognize the election but they will not extend their congratulations. what is this attitude mean? the message is that they just want democracy at the service of
their own interests. they do not respect the rights of other nations. they recognize themselves as the pioneers of democracy. our people oppose this very same approach and attitude. that is what our people are resisting. no way in and i ran is waiting for anyone's congratulations -- no one in iran is ready for anyone's congratulations. the people of iran do not care about the frowning foreheads. they do not care whether there are smiles and congratulations. [chanting]
>> my friends, with the blessing of god, and with the guidelines of the islamic revolutionary leader, and with the firm result of the abomination, we're starting a new age of the islamic revolution and a new chapter of developments for humanity. we need to realize our status in this historical juncture and we need to fulfill our divine duties. this is our great mission and we should come to believe that i ran can stand on the peaks of progress. iran is able to reach those summits and we should have our eyes cast upon the heavenly
aspirations. we should leave aside shortsightedness. we should believe that we can. we should believe in the government of justice and it is around the corner. the pure some of the holy provident islam, mamati, we can feel his presence. we can feel his reappearance is a round the corner. let's be leave in the bombing -- the dawning of justice.
[reciting poetry] i think all the representatives of the people. i respect my brother and the respected head of the iranian judiciary and the government council and the ambassadors for participating in this ceremony. there are different from different walks of life. -- there are different people from different walks of life and god bless. >> the u.s. senate continues debate the section on the
nomination of judge sonia sotomayor to be a justice on the supreme court. the final confirmation vote will likely happen before the senate adjourns for august recess this week. the chamber also take up legislation that gives $2 billion for the cash for clunkers of trade in program and a bill that promotes tourism to the u.s. for foreign visitors. a break this afternoon between 2:00 p.m. and 5:00 p.m. for a caucus meeting on health care legislation, you can follow that live on c-span 2. all this month, and revisit that there's an festivals' we covered this year on c-span 2's book tv. this weekend, panels from the key west literary seminar and the annapolis book festival. go to booktv.org. the phenomenon of facebook. that is part of the book tv
weekend. >> sunday, frank which reflects some 15 years of political columns for the new york times." a look at the future of the internet from 1985. "q &a" by sunday night on c- span. >> a hearing on autism research. there are several parents of children with autism. a senate appropriations subcommittee met earlier today. this is 2 hours 15 minutes. [no audio] >> a subcommittee will come to order. today's hearing is on autism. it regards research, treatment,
and interventions. the centers for disease control and prevention estimates that one out of every 150 children will be diagnosed with autism. among boys, the rate is higher, won in '94. we do not know what causes this. most researchers agree there is a genetic component. every discovery raises more questions autism does not seem to have one cause but many. we still don't know what the treasury -- triggering mechanisms are. experts think that environmental factors could be applied. we don't know what they are exactly or whether they take effect during a child's first few months or years or maybe during gestation period we know a little bit more about interventions. some behavioral interventions seem to help early but we are nowhere near a church at all. the number of people with autism
continues to grow as the rate of incidences grow. this subcommittee has taken a strong interest in autism in recent years. we held a hearing on autism two years ago in april of 2007. the fiscal year 2010 appropriations bill which was approved by the full committee last week includes a range of activities related to autism. it includes outreach, education, medical research, and the inter- agency coordinating committee. the bill also includes $14 billion for a new program to help students with intellectual disabilities make the transition to college and paying for post- secondary education. we have an outstanding panel of witnesses to help us examine what is in today from many perspectives. another problem that does not receive enough attention to date, have to address the needs of the growing population of adults with autism.
let me thank all the witnesses for coming today. another senator is on his way and i will leave the record open for his introductory statement. we have two panels. the first, is dr. thomas insel, the director of the nih. mr. joshua cobbs is on the next panel. david miller, va., and christina halverson from iowa. we have covered all the aspects we wanted to cover on autism with these two panels. we will first opened up with dr. thomas insel, the director of the national institute of mental health. he is not a stranger to this
subcommittee. dr. insel, welcome. your statements will be made a part of their record in their entirety. we ask you to go ahead and proceed, as you so desire. >> thank you, mr. chairman. it is a real pleasure and honor to be here with the other panelists. i know this a very busy time for you and your colleagues. we greatly appreciate you taking time in the middle of the summer before recess to hear about the latest research and challenges with autism. i will try to review the
progress. the testimony will be submitted for the record so rather to than just reading that, i will take you very quickly 33 questions. what do we know at this point? what do we need? and what are we doing? we will summarize those quickly. to get you on track, let's make sure we are on the same page in what we're talking about. autism by definition starts by age three. we are talking about three different kinds of symptoms that characterize autism, reduced social behavior, abnormal language, and repetitive, restricted behavior's that often are called stereotopies. these are the definitions that many children with autism come in with, there are other features. i have listed a few of them here. some 20%-30% will have an associated seizure disorder that can be a part of the autism
syndrome. intellectual disability of various sorts. we have many families that are concerned about gastrointestinal problems of many different kinds. about 10% of children who have an autism label have faces or of appearances. recall that does more thick. -- we call that dysmorphic. many of them have regression. everyone may regress to some degree, there are children that seem to develop quite well for the first 18 months and will clearly you lose language and function. the result of understanding these complicated features and the fact that this is such at heterogeneous syndrome is that we increasingly talk about autism -- not about autism but autisms. we are prisoners of our own language here by thinking of it as a single syndrome.
the term that has now been most widely accepted and you will hear about this morning is called the autism spectrum. all that means is that we are talking about a range within this syndrome from those children who have limited functioning and often have no language whatsoever and i have severe intellectual disability and show no interest in social interaction, have many motor abnormalities, they are the ones that often have these dysmorphic facial features. there are children also will grow up to the highly successful. they may have social awkward as. -- of awkwardness. maybe more men interested in numbers than people but they could be tremendously useful and successful and make huge contributions as engineers, computer scientists, in areas
that may not tap into their social awkwardness but allow them to use what they do best which is to be able to think about the mechanical, numerical, and less social aspects of the world. all of those people, whether you call a classic autism or asper% from, that within the spectrum. as you hear the debate as to what is available and what the treatment and causes are, you have to remember that we're talking about a tremendous range within the spectrum. let's dive into what we know and what we have learned the last couple of years that will be important force in thinking about this as we go forward. i think there is wide recognition that there is a developmental brain disorder. we do not know yet where in the brain or what in the brain or when in the brain things go off track. the most recent research suggests that what we're talking about is not a specific legion
in a particular area. it may be more likely what we call late synaptic disorder. it may be a problem of bringing connection. that may be very diffuse and it is possible that the reason you see problems in language and problems and social interaction is that those are functions that require the greatest number of synapses. if you are not able to process information as quickly as you need to or if you process information in a way that is too quick and is not filtered, you will see deficits. if your connections are not working, you can see deficits in those functions. probably the greatest degree of progress has been in genetics. that is true of almost every area of medicine in the last three or four years. there has been an explosion of information from genomics. that is not necessarily delivered jurors that we were looking for, yet. it has helped us understand more about the heterogenaiety of
these disorders. we would have said that it would be important because a small% of children have recognized syndromes. rett syndrome, single gene mutations were 50% of the children have a diagnosis of autism as well in the last two years, we have discovered a range of rare but apparently highly significant mutations. these are in the form of structural lesions with in the genome that seem to contribute. two years ago, i might have said 5% of any population of children with autism would have one of the syndromes, i think now we can say that number will be considerably higher, perhaps more than 10%. we do not have names for all of these but we have, in the last
couple of years, and it is changing, there may be rare mutations that could explain another 2% of this disorder. there's clearly a genetic factor at work that does not explain all of autism. we still need to learn a lot about how genes and environment interact. there'll be lots more research on that in the near future. that is clearly an important area of progress. we know and we spoke about this two years ago, as you said your opening remarks, behavioral interventions are helpful and they are especially helpful when they are started early. you will hear more about this from other panelists. i want to flag this because the issue here is to make sure the best behavioral interventions are available to the people who need them. we're not just talking about children but also children in transition to adulthood and adults themselves. these to work but they are not always available and they are not always paid for. this may not be paid for through
insurance. we need to have a conversation later this morning about how that will happen. i would also recommend, you can ask dr. dawson, the impact of intervention and some of her work which is setting a new bar as to how far these interventions will go if they are done early. finally, the issue you brought up in your opening remarks, it is one of great concern to you specifically, is the increasing prevalence. the centers for disease control and prevention now reports, from 2007, a rate of about one in 150 children. these are in a year-old being given a diagnosis on the autism spectrum. i do not think that number is at great variance with numbers we have seen elsewhere. it is also true that that is a about a tenfold increase over the numbers coming from the cdc
from the 1992-1993 preiod. that is of great interest to many of us. i want to caution you that a change in prevalence is not unique to autism. we have seen a 40 fold increase in the prevalence of pediatric bipolar disorder in the same time period. we have seen a greater increase in attention deficit and hyperactivity in the last few decades in children. this kind of change is not unique to autism. it is certainly one that deserves our attention and we have to remember the difference between prevalence, which can be affected by entertainment, the change and diagnosis, a number of other features, and the difference in the incidents. we do not have good evidence right now that there is a true increase in the rate of new cases. that is an area that requires more research. if that is what we know, what do we need? part of what we need is to fill
in gaps of what we don't know. certainly, understanding more about risk, the risc architecture of the whole spectrum will be critical. james r. porter, environmental factors are important, and mostg important would be andenes will be important, environmental factors are important. we want to know about molecular targets. there peace will come from there and they already have begun to emerge. we want to understand the heterogenaiety earlier. brain disorders, behaviors is one of the last features to change. that is true for alzheimer's disease. that is true for parkinson's disease. it is true for huntington's disease. it would be important to move upstream by having a bio-marker to detect risk and the disorder
much earlier. we want web information -- interventions that are more affected. that is effective for many children but they are expensive, extensive, they take a long time to work and it is not where we want to be at the end of the day. we want to offer much more than the behavioral interventions. we want to know which treatments will work best for which people. you will hear a lot over the next year about personalized medicine. we are hoping that the new nih director will be confirmed by the full senate this week. should that be the case, i think you'll hear from him that there will be a high priority put on personal madison. -- personal and medicine. -- personal medicine. as you mentioned, we have a whole wave of children with autism who will soon be adults with autism. how we make sure they have
access to services, that we take care of this transition to independence and the covers for different kinds of care they need deserves urgent attention from this committee and from others who make policy. finally, let's talk about what we are doing. this can be summed up quickly through the work of the interagency autism coordinating committee. we have a new strategic plan. this was released in january of this year. it provides a whole range of activities, short-term and long- term, that we hope to be able to invest in so that we can get some of the answers of what we need. we have an extraordinary opportunity now. when he came up with this plan in january, we heard that this was a great road map but we don't know there is any gas in the car. soon thereafter, with the american recovery investment act was the opportunity to make new
investments to jump-start the strategic plan. it particularly focused on the short term objectives. we hope within the next six weeks, to be able to announce publicly a large number of grants that have been funded through the american recovery and reinvestment act. this includes the special rfa from by the institutes to support new autism research to the tune of about $60 million but also a larchmont -- number of challenge grants and opportunity awards. there will be announced before september 30 of this year. we have also tried to jump start much of this progress by creating a national database for autism research which will the -- will be a meeting ground for scientists around the world to be able to share data and to share the tools that are necessary to accelerate progress
in this area. in the strategic plan, there are six questions that guide of the research and will help us think about what the most important issues are. iacc , which was in the combating autism act of 1966, composes federal members and these questions came out of a rich discussion about what it is that families and people themselves on the autism spectrum are looking for. we have taken each of these two part. we have come up with a summary of what we know and what we need for these six questions. we have objectives that are being addressed, long-term and short-term got through the recovery act and other sources of funding through the nih. i will finish with this vision statement. this is from the strategic plan which talks about what we're trying to do as we move forward.
that is to inspire research that will profoundly improve the health and well-being of every person on the spectrum across the life span. i cannot emphasize enough the importance of attention to adults and soon to become adults with autism. this plan will not only provide the road map for research but also set the standard for public-private cooperation and for engaging the broad community who will be so invested in trying to make sure that we expedite research progress. with that, i will make one final comment -- i know you have been thanked for many things you have done for autism and four n i h and for many other issues you deal with but i would like to send personal thank-you for giving us ellen murphy will join hhs very soon. i understand this was a lot to offer and a lot to give up.
for those of us hhs , is a terrific gift. we are delighted that you sought to to share -- you saw to it to share her expertise of ellen murray. >> i am pleased to join you at this hearing. many people share their thoughts about what we can do to deal with the johns of autism. we have had hearings but it is important for us to continue and stay up-to-date and join forces with the victims and their families to make sure that we try and don't make sure the victims and their families, we don't let them down. we want to support the cause and i thank you for being here. >> thank you. >> thank you for your leadership.
i am looking at the list of the people on the committee. our interest is obviously in research and finding causes which will hopefully lead to prevention and cure. also, we are interested in early intervention and and you get to these kids early. do you have an of expertise on this panel to look at that aspect also? what are the most effective early intervention programs that we can find and work on? >> the iacc, we bring in the expertise. one thing we do is to update the plan and we do that by bringing in the experts in the areas we're concerned with. we have heard about both ends of the spectrum. the early detection and early intervention, we like to use the word pre-emption when we can. that is one of the places that need a big push. the other end of the spectrum is adults on the spectrum who need
a lot more in a way of interventions. >> which treatments or interventions will help? this interagency group is actively out there looking at different interventions and try to find out which ones work best and are you also promoting different types of -- are you instigating different types of early interventions to see which ones work the best? >> let me go to the process quickly. the first thing we did was to do a portfolio analysis. this was unprecedented. we asked, not only an ihl and
cdc and the department of education and all the federal players, including the department of defense, but also the private groups which are substantial players for autism and are putting in significant amounts of research dollars. for the first time, everybody has shared their information about every grant they fund and how much people are putting into it. we are able to use that to map onto the six questions and see what is missing. one of the places where we look like we're underfunded or under invested across the six questions is this area of interventions. how do we tell them? the first thing we do is bring in experts on an annual basis to tell us what the needs are and the opportunities for it what can we do? what is really hot right now in terms of techniques or things that are going on in other areas in medicine? the meeting this year will be on september 30 and october 1. we did a previous one which would have been in january,
2008, if i have that right. we used four days to hear from a broad panel of experts. i might add that it is not only your typical academic grantee that we hear from but we are bringing in family members who may have had a very interesting experience that we -- that they think we should hear about. we are bringing in clinicians', as well. we are trying to throw a broad net to make sure we are getting all the best ideas onto the table before we decide what we want to recommend for nih and cdc's and the dod to be looking at for funding. but >> we talk about applied behavior therapy which seems to be successful? how early an age can you start that and do we know what age you
can start that? >> i will duck the question. the world expert on that is sitting behind me and you will talk to her in a few minutes, dr. dawson. she has just completed what is the landmark study on just that question. i would love to steal the thunder but because she is a friend and i don't want to alienate her, it would be better for you to hear from her directly about her data. >> you will hear a lot of talk today as i hear about this issue of vaccines and awesome. can you summarize the state of the signs regarding that issue? >> i can tell you what we know scientifically. there is no question from the community that there are environmental factors at work. some aspect of the environment will be interacting with genetics to make children and
even unborn children vulnerable. it may be that these are prenatal environmental factors. the only factor that has been explored in great detail would be vaccines. part of that has to do with v increasing number of vaccines -- with the increasing number of vaccines which has gone up the last 30 years or so. i made a slide so you can see what that looks like. there has been a striking increase from 1900 to about 2009. there are more vaccines in the recommended schedule. there are more injections and perhaps even more injections per visit better possible currently. it is also important for you to realize that while the number of vaccines have increased, the quality of vaccines has changed in the same time.
if you go back to your first chart, i have a bit different chart that shows in the 1983 the maximum number of vaccine doses administered before age 2 was 8. into that tonight, it is a minimum of 21, maximum of 29, and from everything i can ascertain, it is closer to 29. we have gone from eight in 1983
to 29 this year before the age of 2. most pediatricians do that. how would you find a group of kids that do not get those? >> i want to remind you it is not comparing the ages. you look at the number of antigens present in 1983 versus what is present in the vaccines that a child would receive in 2008, and there is the striking decrease. these are not the same formulations, the same kinds of vaccines. when we talk about it today, there is a profound reduction in the number of protein and antigens. >> some of these vaccines were not around the bend. we have influenza, and some of these were not even around -- hepatitis a -- they were not
around in 1983. >> the vaccines have been changed. they are not the same vaccines in many cases. they may have the same names, but the formulation has been greatly refined. this is how you get this kind of changes. >> i get confused because i want to focus on the number of vaccines and the fact they are put together before the age of 2, just the total number has gone up, and i do not know of any studies that would compare a cohort of children from 0 to 2 that did not get these shots and the incidence of autism's and those that did receive 29 vaccines and did come down with
autism. >> we have had a discussion about this issue about could we mount a study of vaccinated versus one vaccinated children. we do not have the expertise on that committee, so we have decided to consult and other federal advisory committee that reports to the secretary to get their expertise because they have it. we met about a month ago. before meeting with them we sent them the question, saying, has there been such a study, the kind you described, and it's not, can we do such a study? their first response was it has not been done. they did not think it was feasible to do it. they also did not think it was ethical. they had concerns about the ethics of randomizing a group of children to not receive a
vaccine because they were particularly concerned about the risk involved in not vaccinating a large number of children, and it would need a large number of children for such a study. >> we cannot tell that, but i know of people now with children who are not letting their children get those numbers of vaccines. some of these are highly educated, professional people, and they have decided they are not -- or that are going to stretch them out and they're not going to give them before the age of 2, maybe before the age of five or six. a lot of pediatricians will not treat a child if in fact they are not getting these immunizations. they will tell the parents if you do not agree to the vaccination schedule, you cannot be a patient of mine. a lot of people are not having their kids back senate.
i do not know the ramifications of that. i know that is happening. the problem is is that we do not know if 29 vaccinations, immunizations by the age of 2 have it and the fact. >> let me show you the conversation we had on this committee, because you can imagine this is a topic that has come up, a highly charged topic, the community is highly charged, and we have heard of people who are convinced, that it is a problem, and i must say there are both ends of the spectrum here. we hear from families who have had a child with autism and wonder about what they should do with their next child, and that is a question on the table because they do not know what to listen to. the group of people who feel there is an issue here and we
should be concerned because there is a relationship between vaccines and autism punta the numbers you point to, a large increase, and they say there have been 16 studies. those are all epidemiological studies and cannot rule out the possibility that there is a signal there that hasn't been missed. on the other side, the other end of the spectrum, which heard from other people, scientist and family members, who say enough already. if there is an environmental factor at play here that we have spent a lot of money and time doing these 16 studies and nothing has shown up on this question, maybe we do not need to turn back rock over a 17th time, let's look at something that is more likely to shed light on what could be an important factor increasing prevalence or increasing their risk for autism.
that is what we are hearing, and we're trying to balance both of those points of view and try to make sure is information available for people who are most concerned about what they should do their next child. >> that is true and that is why i say both the research on the causes and triggers but also interventions come early interventions, now we help people right now that are having a tough time getting with children of their own right now. we have to focus on this early interventions. we will get to that in the next panel. >> thank you. i want to join you in welc oming dr insel to the hearings, and we have had efforts in the past to develop a body of information that will help us identify better ways of dealing
with autism, what are the causes, are there other causes, what a possible changes in the environment or nutrition, health care, generally, that we can turn to for help, and looking to deal with to the challenges and difficulties that autism brings to our society. i can recall in mississippi joining with families there to help raise money, have the benefit events, go on television, and by people to attend and contribute and the like, and some of the experiences i had then, observing the children who were victims of optimism and talking with families, getting to know about it, made a big impact on me and how challenging the situation is. my heart goes out to those families who are dealing with it, and i want to be here today
to support the effort to identify how government can be more helpful, what are the other possible causes for optimism, what are the things we can do, and to continue to work and not give up. a lot of people had invested a lot of time and effort and research and dollars, personal energies, to cope with this situation, and i am curious to know from you, is there hope? have we discovered things, and we learn things over the last several years that we have been a part in this joint effort, and give us any hope that we're making progress? >> absolutely. there is always hope, but even more than that, there is rapid progress, and i think this next period of time is going to be even more extraordinary because we are ramping up the investments very rapidly.
in 2008, our budget for autism research at nih went up 25% over 2007. in 2009, it will go up much more than that because we are seeing this recovery act effort. we have put money specifically into a autism request application for the act. the only disease specific request in the recovery act from n.i.h. for this year. we have lots of other things going, but this is the one that does have a disease name on it, because we realized there is an urgent need and equally important there is a tremendous opportunity right now for progress. we have the tools we need that we can start to move quickly, so we want to do that over the next two years. >> think you very much for your efforts and being involved in the -- as the director of the
institute for mental health. we appreciate you being here to help us understand the challenges we have had. >> thank you. >> wheelock -- we would like to call our second panel. if you have time to stay, we would appreciate that. if you can stay for our second panel, i would appreciate that. >> i will be happy to stay and i want to hear the panelists because all of us need to hear some of the personal experiences. >> why don't you stay up right where you are. let's call our second panel, dr. geraldine dawson, mr. joshua cobbs, nicole akins boyd, david miller, and dana halverson.
thank you for being here. some of you have come a great distance. again, your statements will be made a part of the record in their entirety. if you could summarize, five minutes or so, i would appreciate it very much. dr. geraldine dawson, the chief science officer for artisan speaks. she was a professor at the university of washington, the founding director of the university's autism said. she received her ph.d. from the university of washington. please proceed, and if you could summarize it we would be appreciated. -- appreciative. >> good morning. i want to thank you for inviting me. i am very honored to appear before this subcommittee. i want to thank the committee
members and you for your leadership in providing full funding for the combating what is an act. also for your most recent fiscal year 2010 appropriations bill. this year more children will be diagnosed with autism than with aids, i'd be this, and cancer combined. autism research is significantly underfunded despite greater public and congressional awareness. for example, leukemia affects one in 25,000 people, but receives research funding for $310 million annually. he entered -- pediatric aids funding, $255 million a year. autism affects one in 150 individuals, and at nih funding is estimated for 2009 to beat
$122 million. and you have heard most scientists agree it is caused by both genetic risk factors and environmental factors. we discovered some of the risk jeans, but we still know very little about the role of the environment and how it interacts with these genes. we understand it is not one disease, but many different diseases, that has many different causes, and each costs will likely only to explain a minority of cases, so piece by piece, we must discover each of these causes so that the effective treatment and prevention will be possible. to identify the causes and will be necessary to invest in large scale population based studies that broadly examined genetic factors and environmental triggers, such as the n.i.h. national children's study. it will be important to invest in large scale databases and repositories such as a national
database for autism research, the autism genetic research exchange, and the autism tissue program. recent studies suggest autism may be fundamentally a problem of the synapse, as you heard from dr. insel, the connection between brain cells. some of the best tests in the world are working hard at understanding how genetic mutations can change the way in which neurons communicate, and they are developing strategies that might to restore the function of the synapse. while this work is offering real hope, a piece of discovery is simply to smoke -- to slow in large part because of lack of adequate funding. we can screen for autism at 18 months of age, and autism speaks this funding several trials that are evaluating interventions for at-risk infants who are as young as 12
months of age. the hope is by detecting autism early we will be able to reduce its severity or even prevent the syndrome from developing. however, the impact of this work will not be felt less pediatricians are using the available screening methods and parents have access to trained professionals who can deliver these interventions. that is why it is critical we continue to study dissemination methods, invest in training professionals and caretakers, and support the early mandated insurance coverage for behavioral interventions which are cost effective in the long run. while behavioral interventions are effective for some individuals, most individuals suffer without relief with a wide range of medical conditions, sleep disorder it's, and epilepsy. few trials have been conducted
that address these conditions, and no cost effective studies have been done to determine which treatments are most effective. parents are left to sort through confusing and often inaccurate information about the various treatment options and claims. clinicians are often at a loss in helping parents to make evidence-based treatment decisions. this gap in research must be addressed. very little research has been conducted that addresses the issues that adults with autism face despite the fact that adult care accounts for the bulk of the $35 billion that is spent annually in united states. unlike other health conditions, which have limited information about what the visit -- autism health care utilization, barriers that access, disparities, our cost effectiveness models. over the past two years your subcommittee and you have been responding to the challenge of
autism with resources, and this is beginning a meaningful fight against this challenging disorder. more is needed. to better understand the disorder, to diagnose it, and to better treat this individuals who at it. i want to end by thanking you for your time, couldn't, and your leadership, and i am happy to entertain any questions you may have. >> thank you, and before we go on, i want to recognize my good friend and colleague from pennsylvania, with whom i have shared the gavel with over 20 years, but senator specter is a member of the judiciary committee. i guess you are on the floor now, and i will yield to senator specter. >> thank you for yielding. we're taking up the confirmation
of judge sotomayor forked supreme court, and i am due on the floor shortly. i wanted to thank you, mr. chairman, and the ranking member for scheduling this hearing on this very important subject, and i think the witnesses for coming in. autism is a heartbreaking ailment, and of the many issues we have to face, among the toughest, talking to parents who have children who suffer from autism, and there is a real question of doing more. senator harkin and i have worked hard on funding for the national institutes of health, and for a decade we were able to raise funding up to $30 billion at that time when senator harkin and i have transferred the
gavel, and regrettably that is not enough. i note that funding for optimism was slightly under $2 million in 2000, up to $141 billion, and the cdc's funding has increased to a little over $22 million. we have been successful in getting it to the stimulus package. it is my projection that some of that will be going to autism. these funding levels were set by n.i.h. in order to avoid what we call politicization. our job is to get the money, but not to distribute its, and i think there should be a bigger
share for autism, but we are pushing to make that happen. on a comprehensive health care reform, we are trying to get $10 billion at it as a base to start with $40 -- $40 billion, to give us the opportunity to work on this very important element. i wanted to express those views today and the staff will be there -- your default testimony, which will have a chance to review its, i appreciate your coming in, and you have our assurances that we will do everything we can on this important malady. >> thank you. we will go to mr. copps. -- cobbs. you are from iowa. >> i am from the sioux city area. >> you are the father of nine-
year old boy with autism. your wife, tina is with you, and two children. you were here at our last hearing, a couple of years ago? >> i was. >> and you were involved with a project with a young boy. i am interested in with what has happened. welcome to the committee. >> fate you for having me. good morning. my name is joshua cobbs, a parent of a child with autism. i spent over seven years trying to better the lives of individuals with autism through insurance and regulation reforms.
the last time here i spoke about the service is my son received using telehealth technology. these services were provided to my home in iowa st. in national research project. we are one of 15 families that participated in this demonstration across the nation. in the model, after a phase of on-site face-to-face training, crucial to build a 30 relationship, which were linked to professionals by a system that enabled life training, consultation, and support in our home when we needed it. to this model we received professional support in teaching our some language, life skills, and over all improving the quality of life. one of the main components of the pit -- the participation was a reduction in our family stress. through training and education we had a better understanding of
our chop's condition and the things we could do to bring to bear to improve his life. not only did it iimprove his life, but it is impacted my family as well. our family showed a dramatic reduction in stress. i will never forget the call from my wife saying you'll never guess what our son dead. he went potty on the big boy potting. this moment was a monumental moment for the entire family. while many consider this a milestone, it becomes a super milestone when your child has autism and has the additional burden of society reduction -- rejection. we were given the right teaching skills and able to achieve what was previously undetectable. our experience was chronicled by a two-part series.
we have copies of the footage that we would like to share with committee and it can be viewed on a website. i cannot stress enough that the needs of a person with optimism do not conveniently conform to professional appointment powers. we were able to access this help when we needed it and it made all the difference. just having the support in my home allowed natural interaction for my son and allow professionals to see behaviors at it -- as the occurred. as the chairperson of the council, i have the opportunity to speak with many family members within the community to learn their needs. from my perspective and my experience, these families are in need of services desperately. as parents search for appropriate health services, they're confronted with an array of technologies and individuals claiming expertise in treatment. there are no safeguards in place
to protect vulnerable parents and children. for example, from anywhere in the world anyone with a personal computer uppecan offer video services termed as advice. any individual can claim qualifications in helping children with autism. not only our families entering the burden, but they also have the financial burden of paying for the treatment with no assurance to the quality of care provided. when organizations can distance themselves into the cloud that is the internet, which can families expect for recourse to failed expectations? the reality of standards settings is evidence -- is evident. while the method and system is cost effective, without proper reimbursement model they remain in unattainable for many parents who are struggling financial to
find care for their children. there are millions of dollars being placed in their rural telehealth networks. additionally, the current wave of state whilwide health insurae requirements do not have requirements for reimbursements. families and children are not granted access to prove it and effected care. this committee has recognized the need to assess best practice, professional criteria and standards and to make recommendations concerning national standards which advances and encourages telehealth technology. i urge this momentum continues. in closing, you may be wondering how my son is doing today.
he is 9 years old and my family is still using this technology. we are addressing the havers as food selectivity, expressive language. it is important that my son's growth continues. we continue to use telehealth. my daughter has now become a therapist using strategies that we learned in the program with my son. at this point in his life, he continues in the role of student and teacher to us all. his future is bright. thank you for your time and opportunity to share our story and the story of thousands of families here today. thank you. >> thank you. we turn to nicole akins boyd, vice chairman of the mississippi
autism task force, the mother of two children. her second child developed autism 22 months of age. she was appointed to the department of education special education advisory committee in mississippi to. she attended mississippi state. welcome to the committee. >> i want to thank this committee on the behalf of many mississippi citizens. and the like -- late fall of 2005, our family was living in texas while my husband completed his college appeared might invest child developed request of autism. overnight he digressed from using words and sentences in two languages with fine and gross
motor coronations about his development appears to someone who lost almost all of this skill sets. it was as though a tornado had hit our lives. at age 25 months, my son began a rigorous program filled with behavioral and occupational therapy that has continued after our move to mississippi. we can see progress and we are cautiously optimistic about the future -- his future. he is a horrible and his skills have improved. his medical -- he is verbal and his skills have improved. simple viruses will turn this high functioning child to a low functioning child within just a matter of hours. today he will attend his kindergarten open house in
oxford, mississippi. he will attend a regular education class and will have some assistance. as -- as the class starts kindergarten, schools will look very quick -- very different. 20 years ago he would have been the only child in his class with autism or his whole school district. his kindergarten class of around 200 students will have six children diagnosed with autism spectrum. all are high functioning. that is roughly one in 34. in mississippi, according to the surveys we did, we know that children typically did not get diagnosed until much later than 5, so that number will go higher. this is a high number of compared to what we see in national statistics, but you will see this number replicated in kindergartens throughout this
country in various places. we know the rate of autism goes up up to something -- up to 70% every year. -- up to 17% every year. we know there has got to be contributing factors that are the rest of this increase. better diagnosis does not completely explain the explosion we are seeing in america. what often times we see, adversarial relationships develop between pediatricians and families who believe the autism was caused by vaccines. we seek relationships adversarial when parents do not accept the advice of physicians. we reached an impasse, and help
the child is hard to come by. the autism society currently estimates the lifetime cost of caring for a child with artisan is up to $5 million. taking those numbers we are looking at facing almost a $90 billion annual cost for optimism. the question we have to ask this committee, is can we afford not to raise the money if these are the numbers we are looking at? thi am glad you're sitting besie me. that combating artisautism fiels to move quicker. we've got to see the committee look at all aspects and possible causes 2 artisan -- to autism.
we need to look at populations of children to find out what of the pictures we see of these children's parents, the family members, what are the health indicators we see, and it has got to be done quicker than we usually operate at government bureaucracy levels. the the thing i would be remiss in representing the parents, but i feel i would be remiss if i did not back to your question, which have to look at the causation with vaccines. dr. healy he testified before this committee anytime, he does not have any financial interest, has noted there is a dearth of research and looking at the vaccine-autism
connection. there are good studies that have yet to be done. i know this committee and the senate does not like to tell the n.i.h. how to spend the dollars. on behalf of parents across america, ask that you look at this, particularly when you are confirming a new nih director. i want to give you autism. -- i want to give you optimism. in this classroom, five of these children have been blessed to receive intensive behavioral therapy. their families -- one of the situation is they have taken to jobs to afford this therapy. that is not often the case in mississippi, and that is a rarity. with recipients, the average annual income is less than $35,000 a year, and yet this private therapy runs over
$50,000 a year. it is impossible for many of the constituents back home to afford the therapy that they know will make fairchild better. on behalf of those -- to make their child that appeared on behalf of these citizens, i ask you to find ways to make this therapy available for all children. even at the age of five, they already require less classroom supports than they would have. you can see the financial bright spots down the road of investing in early intensive behavioral therapy. the question i will leave you with is, if we know that we are looking at a $90 billion annual health-care costs and we are looking -- and i put the information that i turned into you -- and we are looking at initial investments of around
$32,000 a year and over that chop'ild's life, we can see returns of $2.5 million of savings for children who get this, the question is, can we afford not to make that investment? >> a very profound statement. thank you. we will now turn to david miller, a resident of fairfax county virginia, serves on the board of directors of northern virginia community college, where he co-founded a consortium on autism. he received his master's at northeastern, and has a law degree at george mason university. he retired from the armed forces. he is the father of two artistic boys who are identical trip --
twins. >> thank you very much for holding this hearing. as the chairman indicated, i am a board member of a committee college. what are the second largest community college in the nation. our committee is comprised of areas that have the highest incidence of autism in the country. a person also tells me he is the president of the largest community college in mississippi. we have community college presence here that i would like to introduce the committee to. the first is willie duncan. he is the chairman of taft
college and is the chairman of our consortiums. the second person, dr. wayne burton, president of north shore community college in massachusetts. we have steve rose, the chairman of passaic county community college. also dr. chjeff ross, the chairman of one of most important post secondary programs in the country. the summary of the results these last 13 years with respect to students with disabilities is astounding. wheat at this level aspire to have programs as effected as the taft program. this hearing has poignancy to me today because i am the father
of boys who are autistic. their sister is the youngest of these triplets. thankfully she is a healthy seven-year-old princess. i know you're back there somewhere. my comments are those of a parent who is concerned about long-term ability amount children -- of my children to live independently and develop a career track that will allow them to develop -- to support them financially and overcome challenges that i have never faced. i am not an educator, a therapist, nor am i will versed in the nuances of autism as my wife is to meet the challenges not only during the day, but in the evening in terms of the nocturnal at tennessee's of
autistic children. she is an accomplished woman. she should be seated. i would like -- people talk about takeaways. when this hearing, when you go on to activities, the takeaways i could get for my testimony are these -- my kids are here to stay. what you are doing with respect to research is excellent. we need to have funds invested in screening and diagnosis. we need to do that. my kids are here and all the panelists that have autistic kids are here. the second thing that i find more as i talk to advocates and opponents is, what is the game plan, the end result? what are we working for? most of these kids are below of 17, but more and more are
entering middle school, high school. at some point they are going to be adults. why are we going to do with these kids? that is a critical question and we need to keep that objective in mind. we at the community college level are seeing our first beginnings of autistic kids on our campuses. you're chairman gets it. we have had a number of discussions and he has called this a tsunami. he said we need to do with this. a bill based on his author rush -- of the ship authorizes grants and support model programs that promote the successful transition assistance with disabilities at the higher education level. there is no amount authorized, and i have a letter sent from
senator kennedy where he requests $35 million for 2010 to fund these programs. the reason for this funding request is that the vast majority of these students are currently at community college and will attend these schools because we have open admission policies. they graduate from secondary school and they come on our campuses. we have no programs to deal with these children. they come on our campuses, they enroll in normal course is, there are soon put on probation and then dismissed and that is it. they have no further contacts with respect to job training programs or workshops. they have no further educational opportunities. that is it. what happens to these kids after that? that is what senator kennedy is focused on. schools like kirkwood will tell
you these are expensive programs. they run roughly $30,000 a school. they are limited by law to approximately $3,000 as far as tuition. they do not have access to further funding. with a reduction of funding, they do not have the resources to develop programs, to assist these students. one thing and i realized i am overtime, these are economically development funds. these funds will be focused by colleges in life skills training and vocational training. again, we appreciate the fact you have seen fit to put $15 million to the program and hope and conference you will walk away at least with that minimum amount of money. fake you very much.
-- thank you very much. >> thank you. we will continue with dana halverson. we usually did not say beat, iowa. i should have looked at that before i said it's. that little clip could be misinterpreted. she lives on a farm in iowa, way up in northwest iowa, and her seven-year-old daughter was diagnosed when she was 15 months old. she has a degree in veterinary technology from the university of minnesota. welcome. >> she was diagnosed at age 3, regressed at 15 months.
>> go ahead. >> thank you, mr. chairman. for this opportunity to encourage more thought on autism. i am a wife and mother of an iowa farm family. my days are filled with joyce, blessings, and challenges. i have one daughter who has a heavy metal toxicity. her diagnosis at over age three was autism and mental retardation. although given of this label, the term fails to describe the nature of her disordered. after her diagnosis i discovered the margins of her condition. we confirmed multiple medical diagnoses including food allergies, growth hormone deficiency, metabolic this function, and the current dysfunction, and pituitary
dysfunction, and heavy metal toxicity. we have been able to help run by traveling over the country and working with many practitioners, spending thousands of dollars on tests and clinical visits, most of which are not covered by insurance. her health the appearance belies the death of her medical problems. people expect her to be able to respond to them and share with them. she has, and long way but still has difficulties. i know of children who ever covered with a proper therapy for their conditions. my daughter is on that path. i only hope that everything we are doing will be enough so that someday she can live a normal life. once we learned of her issues, and sought out professionals for
pretreatment, she began to improve. the symptoms we see in her and other children are not psychiatric. artisan is a narrow biological disorder, a set of disorders with behavioral characteristics. we call it the a-word. because these problems exist in our children and cause symptoms labeled autism, i have been involved with meetings with researchers for eight years. discussing the rit causes and treatment issues. because no action has been taken, thousands of more children have suffered damage. very soon the burden of their care will not fall only to the parents and families, to tax payers in general as the large wave of some of the oldest
children cannot work and must collect disability checks. professionals estimate lifetime care will cost millions of dollars. i want to set the record straight. you cannot address autism without addressing some other a- words. he should be alarmed that we have a generation with one in nine children suffering with asthma, and one in 1150 with autism. opposing the right questions is essential to up to any constructive answers. agencies charged with protecting the health of our sherwin server with conflicts of interest. the need to be held accountable. it is difficult for me to sit
here and tell you you have been lied to, that we have all been lied to. mercury levels exceeding safe levels were in her vaccines and in jackson's a while i was pregnant and after her birth. the industry safety data sheet identifies the chemicals as follows -- the mercury component has caused nervous system defects in experimental animals, including retardation and motor corp. impairment. he did not need to take my word for these facts trade a doctor who is the assistant director of the national toxicology program is with me today. he has shared his view of the
dangers thimerisol has. this to create vaccines could to approve vaccines with dollars from the products being used to insure them from legal liability. who is at the table? that is your job as elected officials and few are doing it. we need transparency, and once and for all, as you suggested earlier, a ballot unbiased study vaccinated verses and vaccinated populations. congress has hearings about grown men voluntarily injecting
themselves with steroids. we know that some children are injured by vaccines. their access to compensation is barred by many legal obstacles. the compensation system needs reform. although i do not have time to describe this, take a look at the statute of limitations among other problems facing these problems. heavy metals and other substances should not be injected into people, especially babies and young children and other individuals susceptible to vaccine injury. ct encompasses more concerns than just mercury. mercury is so talks this -- is so toxic it is the grow in the room.
the mayors all continues to be used in vaccine including -- in food -- including flu shots. thimerisol is damaging at nano levels. it is in front of us but we pretend not to secret those in power have not acted on those facts to protect the children of this nation, but instead have protected industry and government. my hope is for action. can we afford to risk losing another generation? thank you for listening and allowing me to share my concerns. as i return to my iowa farm i will reflect upon what my daughter and family have lost. and many other mothers and fathers whose hopes and dreams have been crushed with this
chronic illness. we continue to hope for action. our children and our future depend on you. >> thank you very much. we have heard the whole gamut of everything that we're confronted with. dr. dawson, since you are first on the left, i will start with you. you mentioned no comparative studies have been done to evaluate treatments for optimism. this is something we have to focus on. we have to do the research. as it was pointed out, we are in the here and now. families are struggling and we are facing this whole generation of what is going to happen with them as adults. we have to focus on what are the most effective treatments we have now. this committee provided over 01 billion dollars in the recent recovery act for comparative
effectiveness studies, $1.1 billion to be exact. we did not say exactly where to put them up, but you know if any of those dollars will be spent on autism? autism was included as one of the conditions that was to be studied. have you been watching or had any involvement in trying to see that some of these effectiveness studies are done on early intervention programs? >> yes, i am aware of the focus by the agency for healthcare on comparative effectiveness, and we have submitted recommendations and terms of the kinds of questions we feel need to be asked. it is so critical that parents have a sense of whether one thing is effected, more than
another treatment. the other aspect of comparative effectiveness work has to do with method of service delivery, so what we know now is when the children receive care they often receive its by a set of professionals who individually or with the child. the parent and self has to act as the keys coordinator. there are other models how to effectively work with a child with autism, which involves 18 which has different financial aspects that go to court needing care. we feel this kind of model is much more effective. that is an example of comparative studies that need to be done, to look at different models of service delivery to find what is ultimately more cost effective. the other question has to do with this issue of personalized
medicine. what kinds of treatments work for which kinds of individuals? we know autism is not going to be a one size fits all kind of treatment approach. we need to understand the effectiveness of understanding underlying markers, whether looking at medical conditions, as one of the parents talked about, or genetic conditions, metabolic conditions, and how these can direct treatment approaches. we are at an early stage in understanding the question of which treatments are best for which individuals. until we do that, parents could to the internet, they seek out answers themselves, and often are acting on non evidence based decisions. >> that brings me to mr. copbbs.
i got interested in using telehealth for a variety of things. i come from our rural state. . . >> there are some programs for older kids, but correct me if i am wrong, -- you can jump in on this, too, but i think there is some pretty good evidence that the earlier you get to these kids and provide them with
supportive services, intervention by trained people that know what they are doing, that they really do get over a lot of these problems that they have had. you earlier you -- the earlier you get to them, the more effective if it is. we put some money in this project of looking at telehealth and how you can get to a group of professionals are leon and with high-speed internet, it is like you are in the doctor's office. tommy and little bit about -- you have been in this experimental program for about three years? >> since last time we continued the study, so we can test the
longevity and show that the program can grow with the child threw out the life span. >> have you talked with other people? have you talk to others about this? have you talked to them about this and what interest is there in this? >> that is a great question. just this morning, we were talking. it is the light bulb that goes on for parents. for instance, if noah is having a great behavior day and it is in home, we can build on that. or if he is having a bad day, it is not because we are in an abstract physician's office. it is because he is in his own home and there was something
that triggered his behavior. we can get immediate results when the behavior is happening, both good and bad. >> that is the other thing that got me thinking about this. a lot of times, kids with autism, they don't act upper in the doctor's office and then when you get home, they do. >> in our case, it might be the exact opposite. the environment of the doctor's office might have too much stimulus in the area so you will get the reverse effect. all of the sudden, we have a behavior taking place. we may have to leave that environment without properly getting the care. it is a great at junked peace to
a dovetail program. -- atdjunct piece to a dovetailed program. >> is this something that hopefully the $1 billion -- does anyone know that? have reflected these early intervention type programs? >> not with respect to the tele- health program that i am aware of. >> we just completed a study recently. the recovery act has given us the opportunity to open up the doors for additional work and we do have some exciting proposals on just this topic for autism specifically that we are hoping to be able to fund. we cannot say more until we -- i think there is a chance to see
some real progress in this arena. it is not only for the child. this is for the family. that is where the big implications will be. >> i am assuming you are not on this tele-health? >> no. we really hit all aspects. we found out about the bio medical site first. i feel they have been essential in robin's progress. however, i know that a lot of other families agree with me that if your children have these by a medical issues, you will have better results if you are using the aba. >> how would you feel as a parent if you had access in your own home with your child 24/7 so
that anything that happens, you would have access to train specialists? >> my daughter responded so well to buy medical intervention, behavior's did not become much of the issue. for me, the medical care that she needs i can only obtain in our doctors' offices and other than supplements that we use. if i am taking her in, as an example, monthly since the beginning of the year, she has been undergoing a six-hour infusion in the doctor's office. that has to be done for us. it is a drive no matter what. >> i have taken 10 minutes of time so i yield my time. >> thank you. i appreciate you calling the hearing.
i am committed to try to tailor the programs of support, research that are needed, that will help make positive contributions to solve the problems that all of you face personally or professionally. i am wondering if something you have in mind to suggest about financial support and willingness for government to maybe find out ways to be more supportive, tangible benefits of some kind. insurance programs that maybe if the government can help support in terms of cost of premiums or disperse sharing for responsibility. it seems to me that we have a lot of organic medical disabilities and frailties that come within the gambit of insurance. this challenge is just not been
helped with. i wondered if you have any thoughts along those lines. >> i would like to comment first on this notion of early intervention and tell you about the study that the doctor was referring to. this was the study that i was the principal investigator. children began the intervention below the 30 months of age. it was the first randomized clinical trial that has been conducted with toddlers who were at risk for optimism. they were randomized into either standard care into the community or an intensive early behavioral intervention not only working with the child directly but also working with the family said that intervention occurred throughout daily activities with the child. the intervention when over a
two-year period. all the assessments were done blind without respect to the knowledge that the child received early intervention. at the beginning, both groups of toddlers had iq's in data mentally retarded range. after the treatment group, the average iq increase to the extent that they were no longer in the mentally retarded range. they had developed language. their diagnoses or less severe. many went from autism to pervasive developmental disorder. remember, this was only two years so the children were only four. we know these are affected. this study is in the journal of pediatrics and will come of sen.
" we don't have is two things that limit access. one is financial support for families. it is absolutely essential that we get mandated insurance coverage for these. it is going to save money, help families, and allow individuals to take advantage of some of the programs we have heard about. the community colleges and so forth. the second piece is training for professionals and parents. many of the interventions that we are developing because we are now working with infants and toddlers are actually teaching the parents to administer the interventions. we need programs such as tele- medicine, or we are developing web-based programs to train parents and professionals around the world.
we are working in india and africa and other developing countries to train professionals. this combination of insurance coverage and trained professionals is going to be absolutely key. then we are going to get kids on the right trajectory and then we have to look step-by-step to see how we can support children with autism to be the most productive citizens they can. >> thank you very much for that helpful analysis of some of the options we should consider. i wanted to call on you next. >> the task force looked at this extensively in mississippi because of our financial situation of many of our parents. publicly, there were intervention programs that do not cover services. it needs to now include behavioral services because many of the sturgeon are being
identified very early. i can anecdotally speak to the success of that. i met a precious toddler named catalina. her mother recognized autism signs it at eight months. the child is 4 years old now and it is absolutely amazing. you would never recognize that she was a child in the spectrum. i anecdotally i saw that working. the other program that has to be looked at is medicaid. the states have the option to give a specific waiver. i encourage you to look at that and not give states that option because it is one of the things that could reach out to these families who don't have the finances to do that. the other thing that dr. dawson mentioned is private insurance. there are virtually no policies in our state that cover autism
therapies. there are none. in fact, it does not only cover behavioral therapy, but senators, it only covers 20 visit of any type of speech, o.t., or wetp.t. that is combined speech and ot. you concealing many of these children on not getting the assistance they need because the visit our kind of costly. those are the kinds of things that we looked at the gaps that needed to be filled. >> we ought to introduce a bill to modernize our laws on medicaid and reimbursement. >> how do people afford to do this? >> they can't.
>> frankly, they can't. i do not have the exact figures, but we have been working quite a bit to get coverage. b -- it is a foxhole by foxhole case. these families have to do without. again, it is being done on a state-by-state basis. how you can do some sort of insurance pre-emption would be the ideal way to go. this is an educational issue, not a health issue, some have said. if you have seen my two sons, it is a combination of the 2. >> the other factor that did not get brought up, the financial
stress that what it leads to within families. the divorce rates conservative estimates, and we see this anecdotally, a minimum of around 80%. there are some estimates -- there was a speaker from california last week, her divorce rates were around 90%. these are absolutely incredible numbers. in mississippi, we lost to parents this year who could no longer handle the stressors of having a child in the spectrum and one of them was a dear friend of ours. that is not unique to mississippi. that is that things that we see all around the country. >> i would just like to go ahead and piggyback on that statement. the government needs to move rapidly to go ahead and advance
grade technologies and the insurance portion. it is easy to go ahead and pass a bill here and there but in order to make a change, we need the standards and the reimbursement model for applied behavioral analysis and other therapies. applied behavioral analysis is recommended by the surgeon general yet private insurance companies typically do not reverse that for families with autism. >> we do have a unique opportunity with health-care reform to address this issue. the house bill does include coverage for behavioral intervention for autism as well as aba. i think it is critical that with this opportunity that we are looking at in terms of health care reform, that we include this, and the payoff in
terms of the financial payoff down the road is going to be tremendous. it is going to help with this tsunami and the impact on families will be tremendous. it is an opportunity that we must not miss. [inaudible] >> we are going to introduce something together. [laughter] we will find out the details a little later on it. >> if i could also add, we do have a services group made up of family members as well as somebody from cms has been leading this charge along with the president of the autism society of america.
together, they have been listening to families about these issues trying to come up with some recommendations. if we could be helpful as you pulled together some of these ideas, i love that group would love to have an audience >. >> somebody mentioned about how you go on the internet and get all kinds of misinformation. mr. cox, you have been on this tele-held for three years now, but you are dealing with trained professionals that you work with. when you mentioned standards, is that when you are talking about, setting up those kinds of standards? >> absolutely. when we started our treatment program, it was comprehensive that for started with face-to- face interaction. unfortunately, families can pop
up any internet search and tight end tel-e health treatment -- tyep ipe in tele-health treatme. it is very disconcerting. you can query pretty much anything with autism and related disorders and you will get a myriad of different treatments scattered amongst whether somebody to repair your car or somebody to pay your house. it is so sporadic. parents do not have a consistent place to make sure they will receive quality of care. i am encouraged that you have folks meeting and talking about new treatments. until we get a set of parameters of standards, so when parents to go and get treatment
-- especially over innovative technologies. they have the assurance that they are going to get a trained, quality professional and there are actually some standards that they could rely on, and right now, those are not there. >> i just wanted to mention a program that i think is a wonderful example of a public- private partnership that is beginning to address this issue of standards, which is the autism treatment network. this is built on the cystic fibrosis dicmodel. they were in the same situation. there were not getting quality of care or standards about how a child should be treated. the way this model works, there are 15 hospitals that care for children with autism that have come together to both look at quality of care, models of care,
as well as it develops standards that can be practiced standards published in journals that physicians can then use to guide assessment, assessment of medical conditions, behavioral interventions, and so forth. there is a mechanism that this is beginning to be addressed but this is in the early stages. >> is your group working on standards, that interagency group? who does this? who is charged with the responsibility of coming up with standards that have to be met so we don't have people out there that really don't know what they are doing who are trying to treat people? >> it is not unique to autism. we have built standards around by a medical interventions that are essentially overseen by the fda. in the broad intervention arena
with it would be a part of that, there is not an agency or a licensing body that oversees this in quite the same way. there is a gap as we look at this. the question is, in this healthcare reform discussion, when you are talking about treatments that may not be given in a doctor's office or maybe in the 15 hospitals but requires trained families to administer care tenor 15 hours a week, how does that get reimbursed? how do we set standards to the degree of care and the level of care that is needed to be reimbursed? >> you asked me that question or is it just rhetorical proof [laughter] -- or is it just rhetorical? [laughter] >> i am a psychiatrist.
[laughter] >> how do i feel doctor? [laughter] >> and that is true. again, obviously, we have a whole range of interest here. everything from research and into the causes. obviously, a lot of talk about vaccines, you covered that in your testimony. we had a couple of questions about the number of vaccines and how we set up that kind of a steady. somebody talked about the kind of a steady but i just don't know how you would do it.
if you wanted to determine that, i do not know how you would go about doing that. >> one of the reasons i wanted to bring that up, senator, is that there are so many families right now, and this greatly concerns me, because i am a vaccine proponent. i think it is one of the greatest public health achievements that we have ever had. i am a huge proponent of it. what i am concerned about, there are so many families right now that are not vaccinating their children, and we do vaccinate our children, but there are so many that are not vaccinating right now because what they perceive as a huge risk. i am concerned that the nih and the cdc with the failure to actually look of this and give good, valid studies to some
people that may have some interest one way or the other into this that they are doing more harm to lower the immunization rates than anybody is yelling out be concerned about vaccines. there are some many people of their choosing not to vaccinate their children. i do not think that population is going to be as difficult as scientists believe that it is. in the autism community, we see that going on right now, and that concerns many of us that field that vaccines are very important. we hear families all the time come up to us and say we are not going to vaccinate our kids. having a husband as a medical professional, i worked as an attorney and public health, that
greatly concerns me because many of these families do not have any of the possible health characteristics that some of us who did have children with vaccine reactions had that could have been red flags. now that we know that, they could be possibly study. i think the scientific community can find these people to do this. [no audio] >> i was just going to mention i don't know how many people who work are thinking needed to be included in a study like this. there is a physician and i believe the chicago area that have a practice of about 35,000 patients, and many of them choose not to vaccinate and their autism rate is next to nothing. there are populations of people
who have that documentation. i agree, i do not think it is going to be that hard to find. the homage people can argue on that. -- the amish people can argue on that. >> i don't know about that. >> let me be just very clear on this point because i am representing what we know about the scientific evidence so far. it is really on a credible. -- it is really unequivocal. this problem has been looked at over and over again, 16 large scale studies that have addressed this question. whether you read those studies or listen to the institute of medicine -- >> studies on the drug or the
total number of vaccines? >> the possibility of a connection between vaccination with particular formulations or without and the prevalence of autism, whether this is a risk factor. studies have consistently found no evidence of a connection. we heard that from the institute of medicine that looked at this whole broad spectrum of studies. there is not even possibility -- >> you told me when i mentioned getting a study done of the number of vaccines in the first two years of life now compared to what it was 22 years ago, can we compare what would be instances of optimism among a cohort of children that received 29 vaccines in two years compared to a cohort of kids that got five or six or seven or
eight, what they did in 1980, compared to 2009. you tell me that there are no studies that have done that. >> if you are asking the question if the prevalence of autism has increased with the number of vaccines increase, is there a relationship? we know they have both gone up. >> but what we don't know is, is there any relationship between the number of vaccines that are given. in 1980, it was 89. -- eight or nine. what we don't know is is there any relationship between the number of vaccines, 29 in two years, and the higher instances of autism.
we don't know that, do we? >> the way to do such a steady would clearly -- we would have to do a randomized control design to look very carefully at those who were vaccinated in a different way. that is where i said we get into the ethical problems mostly because of the scientific evidence. i cannot stress this enough. . .
>> what is the impact on rubella? a whole series of preventable illnesses for which we know the cause. for which we know that vaccines can prevent them. do we believe want to ask parents to put their children at risk for those children for which have community so that we could investigate for the 17th time a potential relationship. >> senator, this is where there are many people in the medical community, and i mentioned that this issue feels as if it has not been appropriately evaluated. particularly looking at some populations of the community, looking at whether there are immunological -- >> mitochondrial. >> thank you.
many issues involved with that that are missing from the study is right now. i think it is imperative that we look at those particular studies. i understand the ethical reasoning behind asking parents to do this, but we already have families that are not doing this anyways. we need to look at whether or not your children developed measles. quite frankly, senator, measles and autism? >> if you had a choice? i had all those diseases what i was a kid. i had everything like that. [laughter] >> [inaudible] >> i do not think i had that one. >> it is important to recognize that many of us that were exposed to those illnesses and
to do well, they are also fatal. i grew up as a physician watching people die from meningitis, watching them die with the ramifications of the fact we were not preventing all of the diseases at that point in time. i would love to go back to those days. i could tell you to think that we are able to finally succeed, but to go backwards and and by that to come back, i think that we are better than that. science tells us that we are better than that. >> i know that we are better off in that regard, but i would like to see whether or not -- i still have questions. i have spoken to a lot of professionals about this, as to whether or not you need all of those vaccination's early in life or if they should be stretched out longer. >> i just have to point out,
also, vaccines do not always work all the time. my son is a walking example. the chickens that -- chicken pox vaccine was brand new when he was 2-years old. my doctor said that i should get it for him. i had it as a kid, not a big problem but i missed a couple of weeks of school. six months after being immunized, my son developed a full-blown case anyways. that was my first clue that i was not going to necessarily choose to immunize my daughter or future of children -- or future children. i was pregnant at the time that my son developed chicken pox six months after his vaccine. if i had not had lifelong immunity, my baby could have
been at risk. so, there's more to consider. more than just a blanket statement of the vaccine automatically protecting. it does not always work that way. >> in many ways i agree, we have answered some questions definitively. it does not appear that there is accounting for a large increase in what we have seen, it does not appear to account for the increase in prevalence. i think that there are important questions that remain to be addressed that have not been by the large studies conducted so far. in particular i think it is important to understand the role of underlying genetic susceptibility and whether they
might lead to an adverse response to a single vaccine or a set given over a short period time. we know that the era of personalized message and is beginning to infuse the practice of treating infectious disease, but our understanding of underlying variation genetics has not been studied in the context of responses to vaccinations. so, autism seeks focus and our funding in this area is on understanding the medical and genetic vulnerabilities. we know that they can affect responses to vaccines in developing seizure disorder and so forth. whether these might account for, again, a minority of cases, is arguable. the other thing that i would like to put out or suggest, i
agree with the doctor that there randomized study in which we ask parents to forgo getting vaccines is not ethical feasible. we have two ongoing studies. one is a study that follows a cohort of that risk infants. babies or infants with a higher chance of developing autism because of the siblings. we know that some parents are choosing to vaccinate, others are not. it is important that we leverage those studies. the other study is the national
institutes of health children's study. the cohort of 100,000 children being followed from conception to adulthood. keep in mind, 600 individuals are going to develop and autism spectrum based on the current estimates. one of the weaknesses in the current design is overseeing the advisory expert in advising the children's study on how to leverage and inform autism. one of the weaknesses in design is that they are not collecting medical records. they are not collecting information that would and for how parents are vaccinating their children. again, with many parents choosing not to vaccinate their children, this is another opportunity, with the collection of medical records, that we could leverage an ongoing study.
i would like to say that our position on autism speech is one that is evidence based. as to whether a vaccine plays a role or not, we believe that by addressing the questions of parents, we will increase confidence in the program, ultimately leading prayer -- leading parents to be more likely to vaccinate their children, which will be critically important for public health. >> i did not know this. i have been a big supporter, and i have used my position to make sure that we continue funding. i think it is a vital study, one of the most vital we have ever done. you are telling me that all of the money that we put into that, what is this, 20 years?
that they are not keeping medical records? >> true, they have questionnaire data, but not the funding to go about and actually obtain medical records and extract the information that they need. this not only affects our ability to address questions about vaccines, but it also addresses our ability, the effect is of a mother having the flu, infection during pregnancy, specific medications, and the kinds of prenatal events. these all only being obtained through a questionnaire rather than medical records. so, our advice to the study, but one key component, and a reason for that doing it, is strictly financial. they just do not have the funds.
>> i want to make sure that you do not go away with the idea that they do not have medical records. they are not able to maintain the original records with of the budget. i have looked at the possibility of getting supplementary funding that would allow them to obtain the records from the physician of referral. the doctor is right about that. i know that we are running out of time, but i think that it should be said by someone who your, there will be a time in the future when we will have a much better understanding of the environmental causes of autism. one concern that people have is that if we get stuck by looking at one thing over and over again, we may miss an opportunity. where the doctor and i agree is that the evidence makes it clear, whenever the story is with vaccine, it does not
explain much about what we know about autism. we may never be able to fully eliminate a very rare disease that might be in play, saying that this is not the main story. the question for us is where we should be looking. that is truly important. we need to be focusing on it very quickly and moving into a very quickly. these studies are agnostic, looking broadly at the prenatal factors, including the postnatal factors, and we will see a pattern emerge. so far, we do not have that. >> i wrote that down in the committee records. i will have to find out about
that. so, again, we have got three things. one, the research that needs to be ongoing that we are putting a lot of money into. it is to find the causes and what is happening. we know that families in the next several years are still going to have children with autism. we have to think about what we do on the early intervention and how is structured -- it is structured. we have a whole group of young people with autism out there that will be adults soon. what is happening to them? how do you operate these programs for independent living
and things like that? a big task, one that we are trying to address in multiple ways. that is what this committee is how he tried to do. we have some good ideas from this morning, i wish i had a sick -- simple answer. does anyone else have anything they would like to get across before we leave? >> thank you for your leadership. i would just encourage you all to continue to talk more about independent researchers. i really take issue with the statements that all of the evidence says that this is not a connection. if you do not look, you will not find it.
i would really encourage you all to talk with the doctors, like those seated behind me. i could name a whole bunch of scientists that you could glean a lot of information from. >> i believe in open inquiry, i do not believe in clotheslines or closed doors. again, if something has been looked at scientifically and the vast majority of the community looking at it says that there is no correlation, you have got to move on to something else. again, i am always for open inquiry. any less things? -- last things? >> i would like to thank you again for allowing us to tell our story. >> there are so many families out there that are just at their
wits' end on how to take care of their recently diagnosed kids. they cannot go to an office every day. you are an example of what happens when you have someone where the child is acting up and a professional with good standards could say that this is how you should take care of that action. of course, the problem is that we do not get reimbursed for that. there were probably the reimbursement and the hospital. >> there has been a complete public and private insurance rates down. >> hopefully we will look at that in reform and the issuer reimbursement. i almost put that in has preventative.
thank you all very much. to me, this has been a great day. we will continue to work at this issue that just the devils assault. thank you for your leadership. believe me, we will continue to pursue open inquiry. there are questions out there that have answers. we will pursue them. and you all very much. we stand adjourned. -- thank you all very much. we stand adjourned. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009]
>> the senate continues to debate the nomination of judge sonia sotomayor to serve on the supreme court. a final confirmation that will likely happen before the senate adjourns for august recess this week. there also offering money for the cash for clunkers program. the senate is live right now on c-span 2. come to -- coming later today, health care legislation debate. later, the defense department is an update on operations in afghanistan in preparations for elections there. >> all this month, revisit the fairs and festivals we have covered this year on books tv.
go to the web site for the fall schedule. >> now, a look at the health- care debate from the business perspective with the president of a business roundtable who was a guest this morning on "washington journal." we're joined now with senator john castellani on the business roundtable. let me give you a chance to explain. guest: it is an association of the chief executive officers of the largest companies in the u.s. collectively, they have more than $4 trillion in annual revenues. it is the ceos of the big companies that you can think of. we're there to advocate for public policy. host: that was mentioned today in "the financial times" where it says on the headline that
obama was urged to make the case for freedom. -- to make the case fo free trade. the letter which is signed by the president of the u.s. chamber of commerce and several other entities -- it was signed by all these entities. why bring it up now? guest: it is essential. 95% of the world's population lives outside the u.s. and we need excess of we will have the kind of economic growth we want. we want to be able to sell our products and services around the world. this has been a time where we have been very quiet on trade
and anin gear shooting trade while the rest of the world has been busy. some took the 5 million americans depend on the international markets and their good-paying jobs. host: the president has said he would give a speech but he has not yet. why? guest: we don't know what the president's motivation is. but in this letter and the conversations with the administration, we're trying to point out that re-entering those markets, continuing to expand them, and opening them, it is essential to economic growth and job creation. the president has been focused on other issues, but this is an important part of the economy. it should not be ignored. host: are there specific trade pacts? >> their three, one with
colombia, panama, and another -- there are three. the u.s. products related to, and panama -- to colombia and panama have substantial tariffs are levied on them. korea is more complicated. it is larger. there are lots of issues. but it is being able to invest their to sell products and services so that we can grow our economy here. host: on the domestic front, healthcare is a big deal. does the business roundtable have a position? guest: first of all, these companies provide health insurance for 35 million americans. we want to stay in the business. frankly, the cost of health care for companies is just and
sustainable and the way it is growing at three or four times inflation. we need to make high-quality and available for everybody. we need to bend the cost curve. we want to continue to provide health care for workers and their families. we need to get costs under control and everyone into the system, so we support health care reform. we have some issues, some things we favor in the bills the house is considering now. things present us with problems. we're working very closely with the finance committee negotiators trying to craft a bill in the senate. we work closely with everyone. we are at the table, talking with the administration. we want this to succeed in the right way. host: give me something that you support and something that you
oppose. guest: one of the things that gets lost is that the health care delivery system as we have it now in this country is not the system. it is a mechanism that focuses on treatment of disease or conditions when people enter a health facility. it needs to be expanded and modernized be more holistic and innovative. it needs to focus on wellness and prevention as well as treatment so that we can prevent a lot of conditions people now go to hospitals and doctors with. we need to do this by good management of lifestyles, weight management. that, thankfully, it is and just about everyone's proposal. that is very important if we will get high quality health care to everyone affordably. host: what about the public
option? guest: that presents us with some problems. we need everyone in the system, but we need a system that allows us to innovate. things i talk about and things that senator patrick leahy talked about with regard to information technology. government does not innovate. we are concerned it will inhibit innovation. the second concern is really in the way it is structured. right now when the government through medicare reimburses doctors and hospitals, they do not reimburse them for the full costs, so the shift those costs to employers. the way it is structured -- it is another big it entry into the market that shifts costs and is a more expensive for us. host: let's hear from viewers.
the first caller is from fort worth, texas, on the line for democrats. caller: good morning. i hope that you'll bear with me. i have had a little through the surgery. this gentleman has some point i would agree with and some i would not. my father [inaudible] -- my career was military. i love the special forces. what i see today is to be able to afford my people a decent insurance, my god, it is getting where you cannot afford it. let's get rid of this free trade. [inaudible]
this is breaking is. all i hear from you is about this trade. but your jobs, still in five states there are over 500 people laid off. guest: your first point, about health care reform, that is key. those who are uninsured because they cannot afford it, those who think they are invincible and do not want to pay for it, and those who move from job to job. we think that the key there is a reforming the insurance market. as a large employer we can choose between 10 and 12 plants, but you as an individual -- of course, you have some tri-care coverage, but individuals only usually have one choice.
as far as fur trade is concerned, we want access to markets -- as far as fair trade is concerned. we want access to the country's december that others do. we have 20 million jobs that depend on multinational companies. all in total 55 million workers depend on companies that can sell products and services around the world. these are very good-paying jobs, paying about 25% more than those which are not engaging around the world. host: on the independent line we have cecilia from michigan. caller: hi, i wonder why they are not emphasizing that businesses will not be able to afford to keep paying for insurance for employees. they emphasize that if you have
insurance now you could lose a policy you enjoy, but they're not talking about the fact that if you have insurance now you could lose your coverage altogether because of the expense involved to the companies. guest: very good point, and that is why the business roundtable and ceos are so focused on health care reform. we are really in and unsustainable position. health-care costs have been going up up to four times inflation. we're competing against companies that do not bear that cost. this is an economic imperative. we want to keep doing reforms in the system and the quality and on wellness and prevention that bring