Transcripts For CSPAN Scientists 20240704

Democracy. [background noises] [background noises] [background noises] [background noises] [background noises] [background noises] [background noises] good morning. Good morning. If we can get everybodys attention. Thank you. Good morning. This here it is that Senate Appropriations would please come to order we are here for a very important reason and the first is to thank all the young people who are here today for your commitment to coming in fighting for yourself and for many others. To talk about the special Diabetes Program and its critical work that supports Life Saving Research for millions of kids and people across our country and the world who are living with type one diabetes. And in particular we are here today to hear from kids living with type one diabetes about why this program matters. Ill before i started i want to welcome all of you to washington d. C. And to congress but i know many of you have traveled from all over the country to be here today. I want you to know that your voices make a huge difference in making sure that Congress Takes action to treat and eventually cure type one diabetes. The special Diabetes Program plays a crucial role in fighting this disease because it supports nih research into type one diabetes that has lead to breakthroughs in Diabetes Prevention and treatment. Given this program does so much good for so many families back home it should be no surprise that has strong bipartisan support here in congress. I was pleased orca senator alexander to reauthorize this program back in 2020 when we led the help committee together. Vice chair collins is such a tremendous leader in that effort and is a tireless champion on this issue as cochair of the diabetes caucus along with senator shaheen. I am very glad to have an vice chair collins who will lead this hearing today. I have heard from so many patients fighting this disease it can be really hard. Here in congress we need to make things easier and give people hope and show we are serious about breakthroughs to permit, treat and cure diabetes. That includes continuing to authorize this Crucial Program and to support it and hopefully reauthorize again this year. We also need to make life saving insulin affordable for everyone. Something senator collins and senator shaheen are working tirelessly on. I am going to keep pushing to grow the bipartisan momentum that we have for fighting this disease with everything we have got it i know with the incredible advocates from this years childrens congress we are going to keep making progress. We are going to keep investing in lifechanging research and eventually she worked type or in diabetes and on that note i am very proud to turn over the gavel to vice chair collins who will lead this hearing. Facts before it senator murray has to leave i want to first thank you for your leadership on this issue. And for allowing me too share the honor of chairing this important hearing. Good morning everyone. Welcome to our nations capitol. This is our 12th childrens congress and the third is since the pandemic. It is wonderful to host you and your families at the Senate Appropriations committee and again i want to especially thank our chair first sharing the honor of chairing this childrens congress. As the founding cochair of the senate diabetes caucus, i have long promoted Diabetes Research as one of my top priorities. Your advocacy for the lifechanging research to prevent, treat, and one day cure diabetes type one diabetes motivates me. All of the terrific children with type one whom i have met over the years. Many i have watched grow up. Children like Aiden Sweeney who i first met at age four. And he turned 21 this year. Ruby whitmore a young teen who is my summer neighbor. Nicole is the main teacher who has lived with diabetes for more than 35 years and she is married to my nephew. And so many more including our main delegate i will be testifying shortly. You inspire me. You inspire all of us. More than 160 delegates have traveled to washington from every state in the union and five foreign countries. In fact this morning i met someone from the United Kingdom who is here as well. You are all here to share your personal stories with members of congress. You will tell us what its like to live with type one diabetes. And why it is critical for congress to fund the research necessary to discover better treatment, more effective technology, and one day a cure. Your personal stories really matter. They motivate senators and representatives to get involved in the cause. And i want to tell you my personal story about how i got involved. One of the very first meetings i had as a brandnew senator in 1997 with who had children with type one. I will never forget this 10yearold boy looking up at me and saying senator collins, i wish i could just take one day off from having diabetes. Christmas or my birthday. And of course he never can. That is why i started the Bipartisan Senate diabetes caucus that very year. Since then federal funding for Diabetes Research has almost quadrupled. The federal government now invest more than one point to billion dollars for Diabetes Research each year. Funding, as a chair at mention, the special Diabetes Program in particular has contributed to phenomenal discovery, including several advancements in spieth last convened. For example Research Conducted by the funded trial net program demonstrated for the first time that early preventative treatment with the drug targeting the immune system can delay the onset of clinical t1 d for some atrisk individuals. The fda also approved the first cell therapy to treat individuals with type one. Stp supported Clinical Trial data that contributed to that advancement. Technology has also advance. I remember the very first childrens congress that id shared, we did not have continuous glucose monitors back then or artificial pancreas system. People had big, bulky pumps with them. They were checking their blood sugar. They were taking injections. We have come a long way. Another important components of the special Diabetes Program supports the prevention and Treatment Services or American Indians and alaska natives who experience type two diabetes at nearly three times the National Average. Without an extension both programs are at risk of expiring at the end of this fiscal year. That is september 30. So we simply must pass legislation to reauthorize stp it has strong bipartisan support, 60 senators signed a letter that senator shaheen and i offered to Senate Leaders advocating for this program. So please ask your senators and your representatives to support the extension of this vital program. And there is encouraging news. Just last month the Senate Health lip legislation labor and Pension Committee on which the chair and i both serve overwhelmingly approved the reauthorization act that i introduced with senator shaheen. Our bill on both components of the special Diabetes Program through december 2025. Plan here is the good news. Our bill contains a 20 million annual increase per program. That would be the first increase in 20 years. So lets get that done. Finally, let me touch on another pressing issue which the chair mention. That is insulin affordability. I know many of you it will educating members about this today. As some of you have experienced firsthand, the cost of insulin has soared in recent years. This life saving treatment has become unaffordable for far too many individuals with diabetes. So we need comprehensive legislation to reform the whole insulin market. And we need to put a monthly cap on the cost. That is split legislation senator shaheen and i have introduced would do. Let me just close by saying it is so inspiring to look out and see the wave of blue in town today. When i was coming into work this morning i met a whole and on your hope for a cure are contagious. And together i am confident we will continue our progress and achieve that goal. Thank you. I now have a brief statement from the cochair of the diabetes caucus, jane shaheen of New Hampshire. She has a constituent is going be testifying before us today. Here is what senator shaheen said. I welcome all of the witnesses and more than 160 advocates that have traveled to washington d. C. To participate in todays 12th annual childrens congress. Your relentless efforts to find a cure for type one and for all of those living with the disease, including my granddaughter are an inspiration. In the particular i want to welcome elyse and her family from New Hampshire whom i had the pleasure of meeting and our states. Elyse is among the very best theres no better advocate for those living with type one. I urge my colleagues to listen to each witness closely truly hear their stories and finally act on legislation to improve the lives of those living with type one. That means increasing investments to research to find the cure such as a special Diabetes Program reauthorization act authored by senator collins and myself. But also it means passing legislation to comprehensively and permanently solve insulin affordability. Namely our bipartisan which senator collins and i authored. And it weird to refer to myself in third person. I am reading senator shaheen statement. Until the day, so we finally have a cure, no patient should be forced to risk rationing their daily insulin. Thank you again for coming today to share your story. I wish you a productive and memorable childrens congress and hope to see you again ndc very soon. Thank you, senator shaheen for that statement. Well, thank you all for being here. Are there any of our members who want to make a very brief statement before we turn our we all set . Our rates. We will introduce our witnesses. Our first witness today is dr. Griffin rogers the director of the National Institute of diabetes and digestive and kidney diseases at the National Institutes of health. He is no stranger to our committee. He is a familiar face to the childrens congress. He assumed his current position in 2007 and has testified before us at each and every childrens congress. I admire him so much and i am delighted to welcome him back. Next we will hear from doctor erin the president and ceo. He is the first person with type one diabetes to lead a jd rf. We had the pleasure of having doctor kowalski testify is part of the 2019 childrens congress that was the last one we had before the pandemic. And i am delighted to welcome him back prior to his appointment as president he served as jd rf chief mission officer. That means he oversaw significant advances in Diabetes Research. Now, our next witness comes to us from a very different background. Song writing and music production. I am pleased to welcome Jimmy Jim Harris to testify before our committee. Jimmy jam is an awardwinning music producer who has been inducted into the rock n roll hall of fame. His son max was diagnosed with type one diabetes at two years old. Jimmy jam is here to advocate on behalf of max who is now a thriving young adult in the sitting right over there. And to inspire other kids and teens living with diabetes. And with due respect to those three wonderful witnesses we are then going to hear from the stars of the show. We are going to hear from two delegates. First maria practice on this. Maria, there i did it from maine, maria is 10 years old and was diagnosed with type one diabetes when she was seven. She is proud to be a type when diabetes advocate and this helped increase awareness of her school. We will also then hear from elyse from New Hampshire. Elyse does not remember life without diabetes she was diagnosed at just over a year old. But she has not let type one diabetes hold her back. She is extremely active teenager. She is an extraordinary athletes. Playing soccer, basketball, and lacrosse. Outside of school and sports elyse is passionate about educating those around her about life with t when d. Thank you all for joining us well start with doctor rogers. Thank you doctor rogers. Lets thank you so much. Chair murray, pfister collins, senator shaheen, members of the committee thank you for this invitation to testify and for your support of type one Diabetes Research. Research supported to the special Diabetes Program has ushered in a new era of type one diabetes management and continues to improve the lives of People Living with this disease. I like to recognize my fellow witnesses, all of you. Everyone here today are true champions and advancing Diabetes Research. Nih Clinical Research studies would not be possible without the participation and support of people like you and those you represent across this country. Thank you. This year we celebrate the silver anniversary for 25 years stp supported research has sought ways to prevent cure type one diabetes and its complications. This enduring investment has enabled us to take on challenges beyond what we could support with nih regular appropriations and to perform critical trials unlikely to be done by the private sector. There is much progress to report since i last testified here in person four years ago. In november of 22 the fda approved the first early prevented treatment that can delay clinical diagnosis of type one diabetes for at least three years. That is three years without having to take insulin or check your blood glucose. Three years towards preventing or delaying diabetes complications. He Research Underlying this landmark approval stem from Clinical Trials conducted by supported type one diabetes trial method. That trial was made possible by decades of nih supported research that builds a paradigm shifting understanding of how type one diabetes progresses from normal glucose levels to clinical disease. That knowledge also help identify potential therapies and made prevention trials possible. Continues to new approaches with trials ongoing others ready to launch. There is also been significant progress on ways to ease the burden of daily glucose management. When i first testified about type one diabetes, 16 years ago the goal was clear. Good and artificial pancreas device into the hands of those who need it. Now we have six artificial pancreas devices on the market. Five of these had stp support in two of those devices supported both the development and the Clinical Trials. Underscoring the value of longterm research support. Importantly some these devices are approved for children as young as to which can be lifechanging for them and for their families. Looking into the future supported the development of the next generation of artificial pancreas including fully Automated Systems were the goal of a biotic pancreas that requires minimal user input and can automate insulin doses along with it was approved just this may. Another Research Focus is ensuring new devices benefit all your concluding groups that are understudied by industry. Finally we continue to search for a biological cure type one diabetes. The high party for people with the disease and their families is understand insulin producing beta cells are lost and how they can be protected and replaced. Scientists are getting new insight into how beta cells develop finding ways to make replacements in the lab. There also devising ways to protect from the bodys immune attack. You might be interested to know stp funded Research Also provides benefits beyond type one diabetes. Blood glucose Management Technologies benefit those with type two diabetes as does research on complications that affects organs like the heart and the eyes. These broad benefits will expand such as Artificial Intelligence and Machine Learning. Apply to the data being generated by supported studies. The incredible progress made possible made possible by the values as a longterm investment in health. But we must continue to build on our remarkable progress. We look forward to achieving our ultimate goal preventing and curing type one diabetes. Thank you and i will be pleased to answer questions and comments when time is available thank you. Thank you very much. [applause] doctor kowalski. Chair murray, vice chair collins, sunder shaheen and members of the committee. And cute for welcoming all of our amazing 2023 childrens Congress Delegates it. Their guardians and our special guests. Also thank you for allowing me too testify before you today. I am honored to be here and be joined by doctor rogers and three of our incredible advocates to highlight the important progress advanced by the special Diabetes Program and our hopes for the future. I am chief executive officer. I am a trained scientist ive been fortunate to work for jd rf for the past 19 years. Four of which in my current role print like every delegate here are too many people across the world my family and i are impacted by type one. My familys experience dates to 1977 will my brother steve out of the blue was diagnosed at just the age of three. That i was diagnosed a few years later when i was 13. Traveling daytoday was difficult. Very, very difficult then and still impacts every aspect of our lives today. We have good news to share because of your steadfast leadership senator collins and shaheen the strong bipartisan support in congress, special Diabetes Program has fundamentally changed what it means to live with type one diabetes. It has put new lifechanging therapies in our hands and brought us closer to cures. Stp Sister Program the special Diabetes Program for indians is yielding similar significant results. We must keep this momentum going to capitalize on the progress to date and ultimately realize cures. We have on the market the therapy doctor rogers pointed out first so therapy who are unable to maintain the hypoglycemia problems. This therapy allows some patients to live without external insulin for several years. Stp supported clinical trance consortium played a major role in this pivotal step forward to identify cures. Most delegates you see are wearing ap systems now which is an amazing thing for me too see. Stp funding the trials that led to the approvals of the systems that i many of the kids here use making diabetes much more manageable and i cannot wait to see whats coming next. Continued support would enable several longterm Oriented Research programs and Clinical Trial networks to continue their important work. Plus it will enable researchers to explore new opportunities. For example inhibitors are not yet approved for people type one. We need to develop strategies to ensure these drugs can be safely used by people with type one which could reduce the costly and devastating impacts of heart and kidney disease. It is indeed improving and creating pope living with this disease. Our future is bright. Senators collins and shaheen we are tremendously grateful for your leadership. Committee members we are greatly appreciative of your support. Many of you are among the 60 senators who signed a letter led by et cetera shaheen and collins recognize the importance of stp and its renewal. Thank you. I urge you also to all vote in favor s1855 which extent stp funding through december of 2025. The Program Expires this september so please act swiftly. Assuming its part having invested over two and half billion dollars in research to date. I must also mention until we have cures people with diabetes need access to affordable insulin. We are making progress but we must do more. Urges congress to pass the bipartisan insulin act of 2023 which will establish a 35 per month cap met cap for commercial insurance and includes other provisions that make insulin more affordable for everyone here regardless of their insurance status. We need your continued support. Thank you again for allowing me too testify and im happy to answer any questions. Thank you very much. Mr. Harris welcome. Talk, how about that okay. Thank you chair murray vice chair Collins Center sheet members of the committee. My name is jimmy jam im a songwriter, producer musician and recording artist today im honored to be testified not as a member of the music community, but as a parent whose family has been impacted by type one diabetes for the past two decades. My son max was just two years old when his first diagnosed with type one diabetes. At the time i thought i knew what t1 d was but i did not really understand what it meant. Type one diabetes does not affect you until it really affects you. Once it does you are completely immersed in it. Our lives quickly revolved around maxs diabetes. Late nights working on music for me quickly became working on waking my son up to test and manages blood sugar levels. Now max is now in his 20s and we are glad that instead of this constant finger pokes to test him, he now uses a continuous glucose monitor or cgm it. Those lifechanging devices never wouldve come to market as quickly as they did or perhaps even at all without Research Funded by the special Diabetes Program. And jd rf funding extensive involvement. But even with the great new technologies to help control t1 d, we can never take maxs levels for granted. That is a thing with diabetes the second you think you have it down, Something Else to changes in the number is too high or too low. Congress needs to renew the stp though researchers can discover new breakthroughs to help families with type one diabetes. Through maxs eyes ive also seen the crisis facing millions of americans. Insulin affordability. I remember when max was young we were on a family trip to new york. In the chaos of a packing forgot to pack his insulin. I did not think it would be a big deal because we had insurance. Then our insurance would not cover it we had already used our refill. So we ended up having to pay at that point in time a couple hundred dollars outofpocket just to get his lifesaving insulin. That we were fortunate we could afford the cost. Even as a child max realize the problem. I will never forget how he asked me that day, what about the people who cant afford that . There are so many people across the country you cannot afford their incident over the years the cost has only gotten higher. People like max need insulin to survive. I have heard heartbreaking stories of families forced to ration insulin because it is too expensive. Congress should make sure no family has to make these impossible choices to keep their child alive. Aside from my roles as father and musician by muscle chairman emeritus of the Recording Academy that is the Organization Behind the grammy awards. Like the members of this committee i noticed like to sit in a contentious meeting our differences are too great. Ive also learned if i Start Playing music i can look around and see the commonalities up everyones head moving at the same time in the same way. We all may have our differences but there are things we can all agree upon. Music is one of those things. Type one diabetes should be one of those things we can all agree upon too. It is a nonpartisan should all agree that should be research to improve the lives of those with diabetes we all should agree insulin should be affordable to all who need it. Thank you for the opportunity to join you today and im happy to answer any of your questions. Thank you. [applause] thank you very much as you can tell from looking at all of the delegates in front of you, we are a Diverse Group of people. Some of us are in preschool intd some about to go to college. Some love math and others prefer other classes at school. What brings us together is that we all live with type one diabetes. We know what it feels like to live the highs and lows literally. My family and i are the first generation americans and know that with hard work we can do anything. Every delegate knows this and thats why we are here. My dream and my families hope is to cure type one diabetes. Together with your help, we can do it. The special fund research. We dont have one today but someday we will and research is important to make it happen. Its going to be amazing when they cure diabetes. Theres so much to look forward to. I wont have to wear my devices and that brings unwanted attention from my classmates when they make noises. One day i want to have to eat food to treat a low after i brush my teeth which is just as annoying as any device i have to wear. [laughter] one day i will be able to spend more time doing things i love like face time my family and play outside with my friends. Until they cure this disease i would like if everyone could afford the supplies they need to live, all the medicine and tools i need to stay alive our expensive but they are necessary and they work. I hope you can find a way to make that happen. When i grow up i want to become a pediatrician so i can help other people including kids with diabetes. It would be even better if by the time im a pediatrician, kids dont get type one diabetes anymore. The only way that will happen is if you keep funding research. Thank you very much for letting me share my hopes and thank you, senator collins and all the members of the committee for all that youre doing to help us. [applause] members of the committee, thank you for inviting me to speak with you today about my life with type one diabetes. Im 15yearsold from New Hampshire. I was diagnosed with type one diabetes when i was 18 months old. Many of my fellow delegates can remember a time without diabetes. I cannot. This is the only life ive ever known. However my life with diabetes today is drastically different than it was when i was diagnosed. Back then we didnt have the same tools we have today, continuous glucose monitors like the one im wearing today were not adopted by the community. With Artificial Pancreas Technology not available. Thanks to brilliant researchers, Clinical Trial participants, advocates, jd rf and the overwhelming support of senators like you the tools i have today are vastly superior. In fact i currently use an insulin pump that has an algorithm called control iq that gives me more when i needed and decreases the ground to help prevent dangerously low blood sugars. The special Diabetes Program funded the Clinical Trial for this algorithm. The Clinical Trial led to its fda approval and my life is so much better because of it. I can sleep better at night and so can my parents because of the funded research. I am not alone. I can guarantee many fellow delegates utilize this for other systems like it and they were all helped in one way or another. Thank you for your support of this critical program. Today im proud to say i live as close to a normal life as possible. Im active as i play soccer and basketball and im able to spend time with my family wearing the oldest of five and the most recent camping trip. In a few years i hope to go to college, become an athlete and study psychology so i can become a child life specialist. As normal as i look on the outside, type one diabetes is always on the back of my mind. It affects every decision i make every day. When im playing soccer i need to ensure my blood sugar is in the right range. If its too high i can become fatigue but if too low i can pass out. If it sounds like a lot to keep track of your right, it is. Many americans with diabetes have one more thing to keep track of, whether they can even afford their insulin. Im incredibly lucky to say that im able to access the insulin i made. It makes me disappointed there are people just like me who have trouble affording their insulin and have to make terrible decisions like whether to buy groceries or insulin which are both things we cannot live without. I hope that the members of the senate and the rest of congress can Work Together to solve this problem. The Community Needs your help. One day soon i hope to live free from type one diabetes. You play a Critical Role making that a reality. Please continue to fight for me and the 163 kids here today and the millions more in america affected by this disease. Thank you for listening to my story and thank you for your support. Im happy to answer any questions. [applause] thank you very much. Now we will do a round of five minutes per senator for questions, though im sure we could go on longer than that. Let me start with maria. First of all, thank you for that inspiring testimony. I know that you and your family moved to maine from iraq and said you were diagnosed here with type one diabetes. I want to ask you whether you think that having type one led to your decision to become a pediatrician when you grow up. It did lead to me wanting to become a pediatrician, because i know that kids and adults with type one diabetes will understand the pain and struggle that they go through and i would like to help kids better understand that. Thank you. Doctor rogers, i appreciate your strong leadership and all that you have done for the community with type one diabetes and the special Diabetes Program for indians and native alaskans. I want you to look ahead and answer two questions for me. One, what would happen to those Research Efforts if Congress Fails to expand the special Diabetes Program if it just went away on september 30th and 2nd, since i dont think we are going to allow that to happen, i would like you to give us a sense of what exciting developments are on the horizon. Thank you for that question, senator collins. I think if there were to be a circumstance in which the funds would lapse of course they would continue to fund existing studies but we certainly wouldnt be able to do it at the pace that we are able to do it now. Clearly in order to recruit people for Clinical Trials, we really follow the philosophy that we dont want to subject individuals into their families to these trials if we are not sure we can conclude them. That would be an important aspect. So youre saying the special Diabetes Program allows you to achieve breakthroughs much more quickly. Absolutely. In terms of the second question, looking towards the future, what we like to see with these. You heard about the use of drugs that are currently approved for type two diabetes. These drugs have not only the ability to lower blood sugar and reduce weight in many instances but also have a protective effect on the heart and the kidneys which the complications are what are driving a lot of the cost associated with it so we look forward to continuing and making sure that they are safe and effective. Thank you. Im going to do a second round leader so im going to yield to senator tester. First of all it is great to have everybody here. These folks know how to lobby. Let me tell you that. I came to school in seventh grade and my best buddy wasnt there and i wondered why. He came back to school and he had been diagnosed with diabetes. That was 1969 and you know what he paid for the vial of insulin, 2. 3. That three vial today 203. The Delivery System has changed and we talked about that, but ive watched him for the last 54 years go through life and it hasnt been easy. Watching him and the challenges hes had to deal with every day because he has diabetes and has made me personally very angry because life is more complicated for him than it is for me. My question is for you, doctor rogers. Congratulations on 25 years. The glucose monitoring, the artificial pancreas, the Delivery System where you dont have to prick your finger and give your sells a shot in the leg every day. All that stuff is admirable, and i will preface my question by saying if the money senator collins put up im going to support it because its important research. Its critical in this area. But my question you talked about a biological cure. The goal is not to have to have an artificial pancreas, not to have far beyond my ability to understand as a farmer just having it so kids and adults can go through and live a normal life and not have to deal with some of the challenges that are out there that diabetes creates. So my question is how close are we . Weve been at this for 25 years, 2. 5 million. Its real money. These folks are real people, these are real kids and they are the reason we are in this position. Tell me what weve got to do to get a biological cure. Thank you for your question, senator. It is supporting and has supported a group of scientists called the Search Network and they try to very much understand and move towards a goal that you set forth to try to take stem cells either from a persons skin or some other place, transform it into data producing insulin and get the cells back into the patient, which would be a true biological cure. The problem is of course that of those same cells would be subjected to the immune response, which caused the type one diabetes in the first place. An alternate way would be to develop the cells and to somehow encapsulate it to override the effect, and that is being actively studied as well. But at the same time, we have a group of investigators looking at prevention, may be better to prevent the disease than to actually cure it. And what we know is that individuals have a genetic predisposition towards diabetes, and for some reason, there is a trigger that turns on their immune system like insulin cells and if we are able to determine what that is, be it food, virus or bacteria, we may be able to prevent that unwanted autoimmune disease. So we have a program called a teddy that is actively studying that and we hope to report to you with a result of the studies. These are kids that were first brought into the study when they were born and we study them until they were 15 years of age. Thats about to come to a conclusion and we have a lot of samples that have been collected. This is the first instance in which we are going to be using Artificial Intelligence and Machine Learning with certain patterns of what is likely to be the trigger and more than likely more than one thats earning turningthat on. So it is pertinent to explore multiple pathways as well, but that is certainly to look things i can tell you. Thank you, doctor anna senator collins. Thank you. Senator kennedy. Thanks to all of the witnesses. Thank you for giving so much. Have you ever heard the expression yada yada . What does that mean . On and on and on. Yeah. Weve had so much about affordable insulin. Not from people like you, but from us. Weve been nibbling around the edges for years. Doctor rogers, thank you for giving so much. Let me ask a question, do you have Health Insurance . Fortunately is a Government Employee i do. And its pretty good, isnt it . Now who do you think needs affordable insulin . Who do you think needs capping the price of insulin at 30 or so more, you or an uninsured person . To me, senator . You. As you ask the question i think the person who is less able to afford it would probably benefit more. 30 Million People who are uninsured in this country and some of them are diabetic. Senator shaheen and senator collins have a great bill. Senator warnock and i have a bill also its called the affordable insulin now act and we are working closely with senator collins and senator shaheen. Our bill would cover everybody whether you have Health Insurance or you are uninsured because a lot of people become uninsured. Now i know our Health Insurance companies, and god bless them, they are trying to work with us through lower the cost of insulin and they have these programs they call them patient assistance programs, so if you are uninsured and cant afford your insulin, they will work with you. Have you ever tried to apply for one of those programs . Any of you . First, the application process, the fine print to apply, theres so much you could hide a dead body there, nobody would find it. Number two, they send the medicine to your doctor, not to you. So if youve got a job or dont have a job youve got to go to the expense of driving all the way to your Doctors Office and probably have to pay your doctor to get the medication. The programs only cover one or two forms of insulin. A year in you go in and then it is 567. 23 and use a my god ive got to go sell blood plasma to be able to afford it. We need to stop nibbling around the edges. We need to be smart enough to figure this out. At the cost i think it could be done for 250 million a year and im not talking about taking out a reverse mortgage and borrowing more money. Im talking about finding it in our budget. Let me ask a quick question you probably dont know the answer. But if i started counting to billion right now, right this moment in 2023 and i counted one number of second and i counted all day and night and i counted in the shower and between bites at breakfast how long do you think it would take me to count to a billion . A very long time. [laughter] right. I told you you were smart. It would take me 32 years. It would be 2055. I wouldnt make it. You know how big the federal budget is . Thats just 1 billion. The federal budget is 6 trillion every year and we cant find 250 million . To cap the price of insulin . Lets do it right. No more yada yada. [applause] thank you. Senator baldwin. Thank you. I want to start by congratulating and welcoming my constituent. Welcome to the nations capital, and i want to thank you for your role in the jd rf 2023 childrens congress and for your continued advocacy on behalf of of wisconsinites with diabetes. Your advocacy helps drive the work of congress, and i want to thank you for using your voices for this important cause. This is for doctor rogers. The Diabetes Research center in milwaukee wisconsin is focused on early identification and prevention of type one diabetes. Thanks to funding from the National Institute of diabetes and digestive and kidney diseases the center develops [inaudible] blood tests that can detect inflammation associated with type one diabetes up to seven years before the diseases onset. This test is already helping researchers better understand how patients are responding to new therapeutic interventions and strengthens our understanding of the development of type one diabetes. So doctor rogers, can you describe how the research that focuses on the development of type one diabetes leads to progress in preventing juvenile diabetes . Thank you, senator. Thats outstanding work thats being done by investigators in your state. I have to say the special Diabetes Program i mentioned in my introduction over the years of discontinuous funding is really changed the way we think about diabetes in the various stages. Its not that you have it or you dont. We know that it progresses through several stages. One actually develops clinical disease associated with abnormal blood sugar levels, and its in people with extremely high risk, they have antibodies but before their blood sugar gets out of whack, it is critically important because that leads to the development of studies such as was reported by senator collins and has been mentioned that works in the immune system to actually stop the immune system from damaging those insulin producing cells so having ways of defining these much earlier is critically important for prevention, and we continue to work with investigators throughout the country to try to come up with more precise, easy and more accurate way of detecting that just for that purpose. Thank you. Also, doctor rogers, thanks to the special Diabetes Program, people with type one diabetes are living longer than ever but theres much more that we can do to improve the lives of those with type one to make sure that we are working to reduce complications. This is especially important for children living with type one diabetes including the wisconsinites who i welcomed earlier. Doctor rogers, what are some of the understudied complications of type one diabetes that you hope will be examined in the future, and what are the gaps or the things we havent studied enough and how will this research improve the lives of many in this audience . Two aspects of that. I will answer in two ways. There are understudied groups of individuals with type one diabetes that unfortunately the industry is into studying that , and this is where it fills in the gap. Those understudied individuals include those who are pregnant, those who have frequent episodes of low blood glucose or this condition that was mentioned, impairment, impaired hypo glycemia, their blood sugar gets very low, older adults and very young adults are understudied. Those with lower education levels also tend to be. Now with respect to completions of the disease, something that we really need to focus on because this is where a lot of the funding for diabetes comes in, people with Heart Disease, and it looks like people with type one diabetes might have a different form of Heart Disease in terms of its manifestations, diabetic foot ulcers is something that is very much understood. Weve begun a Consortium Study because once people get this, they may not be aware of the mortality associated is close to people with certain types of cancers and so those are two areas. Weve learned a lot in terms of diabetic eye disease and other manifestations. If i had to pick two complications that is where we would want to focus and we have had the studies already developed in that regard. Senator highsmith. I want to thank everyone for being here today. This means so much and i hope you always remember this day for your effort into trying to make your situation and your life better doctor rogers my question is for you and its more state specific. Mississippi is a state i represent, a very large state but pretty low population for such a large state. A lot of rural areas into so many times we have so many patients that go undiagnosed and the chronic disease complications just skyrocket. With the specialists are few and far between and at the patients usually have to travel a long way for their appointment. We have seen however the communities seem to face such a greater challenge. I have more family members that suffer from diabetes everyone in mississippi is very aware because we do have one of the highest rates. But during your time as the director of the National Institute of diabetes and digestive and kidney disease, how have researchers focused on the rural populations and research in their studies . Because this is a great concern in my state. Thank you, senator, for that question. There is a lot of activity in mississippi. Ive visited there multiple times to actually speak and youre right we have been following and working with the centers for Disease Control who as you know follow the incidence and prevalence of certain diseases like diabetes not only at a state level but even at a sort of county level to try to understand what are some of the factors that are contributing to that prevalence and changing and the prevalence of the disease. We are also learning, for example, that in a study that we worked with the cdc called a search what it is now telling us of course everything has an acronym so its an acronym i wont go into at the moment but we are searching for diabetes in youth and adolescence and we are finding that not only are we seeing an increase in the number of kids with type one but areas totally unexpected we are also seeing type two diabetes, for example in kids as young as ten, 11 or 12. And what we know about type two diabetes and these kids is that it doesnt respond at the same way that drugs that are commonly available respond in adults with the disease. A second, its much more aggressive. This is type two diabetes, not type one. It seems to be associated with the development of the complication much, much earlier than what we see in adults that typically takes years of the disease, so these are studies that are being actively pursued both at the state and county level to try to understand this and using new sophisticated gps to target these we have some investigators coming up with ideas that will be subject to testing so we are very much focused on the disparities that exist and that is something that is very important to me. Can you tell me how we as congress can help address some of those issues, is it anything specific because of the lack of quality of healthcare in so many rural areas . Is there anything specifically we can do . Certainly your support for this program and other programs are certainly critically important. We want to make sure we continue to have investigators in the pipeline to continue investigative inquiries to be right there to answer questions that they pose, so ensuring that we can not only maintain pivotal Clinical Trials and diabetes and other areas but obviously funding the next generation of investigators both to treat patients appropriately but also to uncover ideas that we were not even aware of yet to make sure they are there to help us move forward and your ongoing support for those efforts is very much valuable. I think all of you for being here and for your efforts and i do have one young man 17yearsold from mississippi. He has the pump and its changed his life. I just want that opportunity for every child that suffers from this. I want them to have every opportunity we can provide us with thank you for doing the research and thank you for your diligence. [applause] thank you all for being here and maybe one question for both of you what would you think is something most people dont understand something they just dont understand unless no one else would understand that . You cant just say i dont feel like doing this today and a lot of people get confused with type two diabetes which is frustrating because its not something we ever wanted to live with. We were given it and its really frustrating especially as children here. A lot of adults dont want to give time to listen to us. You keep telling your story, okay . I feel that kids in my school at least think i dont need my pump on all the time and come and poke at it and touch it. When the nurse comes up to my classroom, they always crowd around me when my blood sugar is going up or down. Keep explaining to them. They want to know and im sure most people want to help but understanding is the most important thing and educating them is something you can do and no one else can do. Never give up or be ashamed. Its what we all can do working together. I want to recognize mr. Chris ward from charlestown west virginia. Hes here today and i want to thank him. Let me say to all the family thank you for the support you give your loved ones and what you do every day because people dont understand and there is not a family in america thats not been affected one way or another or doesnt have someone in their immediate family, extended or close relation. To all of you, you are the hope of america. You are sitting here today i as our hope. Many of you will be sitting where we are setting learning how you can make life better and improve the quality of life and that is what we are trying to do. We want to make sure you have the greatest opportunity that anybody in any generation has ever had. We can only do that if youre healthy and we want to make sure you have that opportunity but i want you to understand you have to live to grow to be a loving, caring adult. You have a lot to show people how they can live a better life and as you grow and become responsible for that, youre going to be sharing the greatest gift that you have, and that is the knowledge of knowing the challenge that some people have the sum dont understand. They just dont. And you being here today sharing that with us makes a difference of what we do. Theres not a person here republican or democrat, you hear a lot about politics. You have united congress. You made us all understand its not about politics. Its about each individual having the opportunity for quality of life. Thats what your here accomplishing today and i hope you understand making the effort to come here today makes a big difference and what we do and how we do our job and how important it is we do it as quickly as humanly possible. We had a piece of legislation called the Inflation Reduction Act that put a cap at 30. We try to cap all across the board, everybody. No one would pay more than 35. We are achieving it a little bit at the time. We got medicare first and now weve got some companies knowing that they are making excessive profits, coming down to 35 we want to make sure we have a piece of legislation that does it and i want to thank the chairwoman, my good friend from maine, and also my good friend from washington, the state of washington for what they have done in leading this cause and the charge. And i would say one final thing, doctor rogers on the teddy program thats a very important program. My state has the largest percentage of adult diabetes in the country. Over 16 of the population has when the National Average is about 10 . Can you tell me how that affects families and what we can do and how its working, ive always said you cant teach an old dog new tricks but you can teach a young pup tricks that can help gold dogs and thats what weve got to do. These kids basically to educate the population that doesnt know how effective it is. Certainly one of these studies i want to emphasize your point that this is something that families are very much involved. The study identifies kids from birth they come in periodically several times a year then maybe three times a year or a quarter bringing all types of samples with very detailed record of when they had a cold or whether they received the vaccine and the like so it is quite laborintensive, but the product of that study is going to inform us greatly in terms of what those triggers are so in the environmental determinant we are going to learn quite a bit from that and i would say within the next few years, so really stay tuned. And what we learn about that might give clues for other autoimmune diseases. Thats why this has benefits beyond the intended purpose. So, stick with it and again we appreciate all of your support as im sure the population in your state. Let me say this to all of you thank you. You are in the greatest country in the world the United States of america and its not the divided states. Today you helped unite us more than you know. God bless each and every one of you thank you for being here. [applause] thank you so much, Ranking Member collins. I want to tell you how much i appreciate your efforts on this important issue. Im proud to support the work that humana senator shaheen are doing and proud to work alongside senator kennedy and others. I want to tell you all how important it is that you continue to tell your story. So, maria, the people from my home state, tory, violet, where are you . This makes such a difference. You are changing hearts and minds. For me it was one of my dear friends. She had two children diagnosed with type one diabetes. Her telling her story gave me a window into the sacrifices and struggles you make. To all of the mothers out there thank you for your vigilance and the dads too. We appreciate what youre doing to make sure that each and every one of these kids can live a happy and healthy and fulfilled life. Please continue to do what you do so we can make sure that we do our job. Doctor rogers, your research is needed. Its important so we can continue to make the right decisions here in this body, in this chamber. Unfortunately, in alabama, diabetes continues to grow. Approximately 568,000 alabamians suffer with diabetes. That is 12 of the population in my home state. Its estimated that probably 35,000 of these diagnoses have just recently happened. So, my question for you is this continual increase must be stopped. What are we seeing in the research into the development that tells us where this is coming from, what are the triggers, what do we need to know as we sit here today . Thank you for your question, senator. What is driving the increase in the type one diabetes in individuals who historically havent had the sort of genetic predisposition seems to be something in the environment and again i think that we are going to learn as i mentioned earlier from the study what are some of those environmental triggers. We are also seeing an answer to an earlier question diabetes occurring at a much younger age. Type two diabetes. This may be the increase that you were referring to in the state of alabama in young individuals as well. Some of that is the effect of lifestyle choices in terms of getting less physical activity, sort of being involved mostly behind the screen on a video screen or Television Screen or some other but those devices down. Not being as active as you may remember. Food choices for example. Those seem to be contributing to being overweight, and that in itself acts as, it makes the insulin that is in our body not work as well as it should. A condition called insulin resistance. So i think there are multiple factors that are driving at, but it certainly is related to a change in the environment. One final thing that i will say and certainly its true in alabama and others may be aware that alabama has one of the highest frequencies of gestational diabetes in any state in the country and research that weve funded indicates that a mother who develops gestational diabetes not only is at a higher risk for ultimately developing diabetes themselves, but the infant who is in that environment is also at a subsequent high risk. You can imagine if that individual is a girl, ultimately when she becomes a mother, she may also pass that down at a younger and younger age, so that is certainly a contributing factor as well and we are trying to break that cycle through some very innovative Research Efforts at the moment. Thank you. I see my time is expired but i want to tell all of you you inspire me. Please keep telling your story. Keep being vigilant. We have work to do up here and we are certainly committed to doing it. [applause] senator. Thank you, madam chair. And to those who are gathered here whether you are the parents, the friends, thank you for your advocacy on behalf of yourselves and others. Over the years ive had so many different visits from Young Alaskans who would come to me and theyve got their little stories and pictures showing them over the years as they have dealt with their diabetes and also what they have done as individuals who are brave enough and willing to make the long trip to washington, d. C. To come and tell their story, so i joined my colleagues appear to encourage you to do more of the same. Somewhere out there is samantha. I look forward to visiting with you, but it is an effort, and i know that as young kids, you just want to be like everybody else and everybody else doesnt have an insulin pump. Everybody else doesnt have to pick their finger. Everybody else doesnt have to do what you were going through. Everybody elses moms and dads and caregivers dont worry what is happening to them and their blood sugar levels but this is why again share your story and make sure that others understand not only what youre going through but why its so important that we find the cure and treatment. So thank you for what you continue to do. I want to direct my question here to doctor rogers and many of us have asked the same question along the lines of senator tester, id played to smith. About some of the environmental exposures that may contribute to the risk of developing type one diabetes. In my state of course we are very rural in alaska. We have in the overall population a rate of 7. 5 that have diabetes and a higher rate at 8. 5 of the population so it is significant for us. I was in the north slope which is the furthest area north [inaudible] there might be occasional potatoes, but theres no fruit. So how do you get your vegetables and fruit . You might get them frozen and if youre lucky. You might get your fruit and heavy fructose syrup, but the reality is the diet is a consideration for us and a huge concern. So, as you are looking at not only the access in rural areas to healthcare that can provide prescreening and for the treatment, i am worried about areas where we simply, where we are literally food deserts when it comes to those Healthy Foods and as many in the rural villages have transitioned to the commercial processed foods. It has resulted in escalating rises of diabetes, so i am assuming, doctor rogers as you are looking at this in your study, this part of your review is also under careful consideration. Absolutely, senator. That is an area that i think we are going to learn from some general principles that will eliminate a lot of the origins of this condition particularly type one diabetes. But i think the factors that you just outlined particularly food islands were areas and the type may be pushing up the numbers of individuals at risk. Even of course the food is very important in terms of maintaining a relatively constant level throughout the day. The role has been trying to develop the science bases to allow you to inform your policy decisions. One of the things we are doing and i will say quickly as we have an effort called time sensitive studies in which when theres going to likely be a change in policy for example, the development of systems or new food Delivery Systems were orsomething like that, in an effort to diminish the amount of overweight, obesity, perhaps making food better available, and we want to see whether it really does have an impact try to get these investigators to get funding for the studies so they can get a baseline information very quickly. And then as policies are enabled or established, one could then study six months, a year, two years later to test the hypothesis on the effectiveness of such. So something to sort of keep in mind to try to take a multifaceted approach to our research and again as i mentioned earlier its an area of enormous disparities and i think weve got to keep our eye on. Madam chair, i want to thank you anna senator shaheen and all those that have been working so aggressively on this and senator kennedy articulated very well that the efforts that we are making to reduce the cost of insulin to make it affordable it may sound like a lot of money i think when we evaluate and consider the cost to our overall healthcare system, when not properly diagnosed were screened early enough, not given the treatment necessary, those are the costs that are out of sight and are something that we have to address. So im with him on his yada yada kind of the same thing, lets do more than just talk about it. Lets make sure the access is there until we can find a treatment. Thank you for your leadership on this. [applause] senator peters, thank you for your patience and your graciousness. Thank you, madam chair. And all i can say is ive never been to a Committee Hearing like this. I havent been around all that long but long enough to know this doesnt normally happen here in washington to see so many people all these folks in front of me. Thank you for coming to washington to make sure your voice is heard and your activism it inspires me to see this and also shows our democracy is alive and well so thank you for being here. Doctor rogers, first i want to say im thankful to jdr enough for its partnership with the Diabetes Institute and the university of michigan in my home state which is improving Health Outcomes for people with type one diabetes by developing a comprehensive understanding of metabolism and adolescents and young adults as well as people with longstanding type one diabetes. The institute was started by the family in michigan which the father and two of his three sons were diagnosed with type one diabetes. Elizabeth became relentless in her pursuit. The center for excellence at the institute has been identifying new ways to control diabetes and to prevent the devastating consequences allowing them to provide better care as well as Health Outcomes for people with type one diabetes. Specifically the state Research Takes cuttingedge approaches to identifying predictive markers in therapeutic targets for type one diabetes complications. The center of excellence also studies relationships among metabolic profiles, brain function and stress and allowins to identify new ways to minimize the Mental Health burdens associated with type one diabetes. So, my question for you is how does the institute at the university rely on special Diabetes Programs fundings and what what the institute be able to accomplish if we increased this funding . Thank you, senator. I can say that its been supporting Research Infrastructure at the university of michigan for quite some time. In fact one of the original Diabetes Research Centers Going back to 1977 was at the university of michigan, and i think it had substantial funding from that time moving forward, so it is doing great work. In terms of type one diabetes its doing extremely cuttingedge research i mentioned earlier about the involvement in developing the first drug that is fda approved that can delay the onset by at least three years. One of the major sites is at the university of michigan and the university of michigan is also very actively involved in a supported Diabetes Consortium that aims to study wound healing. They also have a center for Diabetes Translation Research that if we were to develop the evidence then to put that into practice to get that implemented so there are many areas that the university should be very proud of. Having additional funding will allow for some very bright ideas which im sure there are many more at that center and others to move forward and this support will allow them to sort of get to some of the things on the wish list moving forward much more rapidly. Good to hear. As youve talked about in some of your previous testimony, diabetes impacts folks of all age groups and we have to be thinking about it very broadly about all the impact it has, so i want to ask a quick question related to medicare for older adults. Medicare will not cover nutrition, Therapy Services for individuals and you talked about the importance of nutrition and your testimony. Medical Nutrition Therapy isnt just a Critical Service for people with diabetes it can also have the potential to help 88 million americans with prediabetes so thats why i introduced with senator ouppercaseletter who is here the act with my colleagues on the committee to extend that coverage, Medicare Coverage for medical nutrition Therapy Services with risk factors for developing type two diabetes. Real quickly, doctor rogers do you believe that this coverage is essential and will bring down cost in the long run . I cant discuss or speculate in terms of the funding of another agency. What i can say is that we have worked with Diabetes Prevention programs on a landmark study in which we were able to show either a medication or intensive Lifestyle Changes the people that have prediabetes and that Lifestyle Changes include changes to their nutrition and at least 30 minutes of exercise five times a week greatly reduced ones risk of going from type two diabetes to diabetes by some 57 . The study ultimately led to coverage for people over 65 because weve included a substantial number of individuals that could be looked at separately and ultimately their staff made a calculation that providing this is a benefit for people on medicare was costeffective even as early as two years. So, one component of that is nutrition but i cant begin to speculate more of that. In closing i would say again thank you for being here. Its clear from what youve been hearing from colleagues on the committee, we are all committed to attacking this insidious disease. Weve got to Stay Together. We focused on it but i have a hopeful message with all of you sitting here in front of me with your bright Smiling Faces i think we are probably living in one of the most exciting times in Human History in terms of scientific advances we are looking at things like Artificial Intelligence, things like synthetic biology. Weve got all sorts of new technologies that are coming on board that will literally revolutionize our world in very exciting ways. And im confident as long as we Stay Together and lock arms and speak with one voice, we will defeat this and have the ability to treat people with diabetes and we will succeed. Thank you very much. [applause] im proud to be a cosponsor of your medical Nutrition Therapy bill. I think its a great idea. Im just going to ask very quickly a couple of closing questions because we have a vote and i know you need to get onto the rest of your program. Ive wanted to ask a question of you from the perspective of being a parent of a son with type one who was diagnosed at such an early age, at age two. And i would ask you what advice do you have two other parents, and id like you to focus particularly on the black community because black teens have the largest increase in prevalence of type one diabetes. I would say that starting off, its absolutely a devastating to find out the news, it is absolutely devastating. The thing that we really tried to do is make sure that we found a support system of people we could talk to to try to gain some knowledge. Thats one of the things that is great about today is the awareness, people being aware of it and aware of the need for funding and all those things is important. But as a parent, i know the things we learned early on is that its a moving target trying to keep your numbers correct, trying to keep up with the advances in technology that are happening and all those kind of things. The thing i would say to parents is dont beat yourself up about it. We actually had a nurse that was helping us that trained us how to manage the disease is back in the old days when it was still the finger pokes into the syringe is and all that. She came to help us one night and teaching people she called and said he went low. I think having that real world experience helped her as someone who was then teaching other parents. Even the parents i talked to over the last couple of days, that is the thing i try to always say to them is just its a moving target. Its not always going to be right, but you figured out and you deal with it. Its one of those things as soon as you think youve got it figured out, something changes because the thing about particularly the young people here today is they are growing. So their bodies are going to change, their attitudes are going to change and all those things. The parental support is very important. I think across all communities. I know we talk about insulin affordability. I know that is a big piece of this also but if you have the tools to manage the disease in the right way. And i also struck by one of the things thats happening where i think a cure is the destination and we all agree upon that as a destination. Sometimes we disagree even if we know where the destination is, we disagree on how we are going to get there. What ive been encouraged in this room is that the destination of finding the cure has been the most important thing that we all agree upon. But i also have to say that i love the fact that we are also talking about i guess the road to get to the cure to make sure that its an affordable and smooth road as smooth as it can possibly be. So i would just say that i am here to support, and my son was honored a few years back and said that he vows he will be here until we get to that destination of the cure and what im encouraged about with all these young people years when they look back and ten years from now or however many years down the road they have kids and they have their families, they are not going to have to have these conversations with their kids. Its going to be whats diabetes, ive never heard of that before. Thats going to be the nice thing. So senator collins, i want to thank you for having me here today and allowing us all to speak and allowing all these young people to be here because this is the future and when diabetes is secured, each and everybody in this room is going to be part of making that happen. Thank you. Well said. [applause] i know senator shaheen wanted to be here today. So on her behalf, i am going to ask you a question and that is you live a very active life. You play all these sports. Can you tell us how important it is that the technology that you use allows you to play those sports and have a very active life . Its definitely a challenge but the technology that we have helps so much. There is a setting called activity and i put that on two hours before any training or practice or game and two hours after and it more closely monitors my blood sugars so i dont go low. So far its helped me so much and i was also funded by the special Diabetes Program, so im grateful for that. But its important to continue that because playing sports you can go dangerously low. Thank you for that great answer. And my final question is going to be for the president of jv rf. We have worked so closely with you on the insulin question and youve provided us with expertise and drafting the act which would reform the market to remove all of the pro verse incentives that contribute to the high prices, plus to put it a 35dollar cap on a monthly copay. I think that is so important. It would also have an important protection so you dont have to go through prior approvals and all of this that we hear about so often. As weve talked about today that some of the manufacturers have lowered their price to 35. I do think that is in response to our legislation. Im glad theyve done it, but i think that is our legislation that caused them to do it. So just to get you on the record, do you believe that its important that we still pass federal legislation like the insulin act that senator shaheen and i have introduced . Senator collins, thank you anna senator shaheen for your leadership on this topic. Its the number one topic when i travel around the country and im sure every parent in this room under a year that its still a problem. We are fully aligned in a and supportive of the insulin act. No one in the country should go for a lack of food or rent or car payment or insulin which sustains their life. So, we commend your work and we will look forward to seeing the insulin act passed. Thank you so much. I want to thank everyone for being here today. I have frequently said that every time i chair the childrens congress, which ive done many times, i leave with a sense of renewed commitment. You inspire me and us all that you inspired all of the members that are here today. You can make the difference when you go see your members of congress and urge them to support the insulin act and to separate the reauthorization of the special Diabetes Program that has been so successful in speeding up the new technology that is making your lives better. Ultimately, we want a cure and that is what we are all working towards. So thank you for coming from all over the country to be with us today and a special thanks to maria for coming with her mother to be with us today. With that, the hearing is, ive got to gavel to make it official. The hearing is now adjourned. [applause] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] host house on friday past the annual bill on the pentagon policies and pay levels. The Defense Authorization bill long considered a bipartisan