Transcripts For CSPAN3 Sports Brain Injuries And Aging 20141106

Of democracy. Its absolutely for the mental for our type of democracy and its the engine of Economic Prosperity for economic growth. Thats why we invest so much in Higher Education and provide that opportunity for everyone. In the state of maryland, our goal is that 55 of all students have a college degree. You dont have that in other parts in the world. But other parts of the world are beginning to emulate the american model and beginning to catch up. We have to retain our supremacy in education and science and technology. Thats the only way that well win the future in the 21st century. President wallace loh, want to thank you very much and those at the university of maryland for joining us for this conversation about Higher Education. Appreciate your time. Thank you. It was a pleasure. On American History tv in primetime, three medal of honor recipients discuss their service in world war ii, vietnam and afghanistan. Hosted by the u. S. Naval institute at annapolis, maryland. It begins at 8 00 p. M. Eastern. Tom brokaw reflects on his career in the 1989 fall of the berlin wall in a talk of newseum here in washington, d. C. Friday night on book tv in primetime, ronald ross bottom talks about his book when paris went dark about that si occupied paris. No good men among the living and account of the war in afghanistan is told through the lives of three afghans. Walter isaacson on his new book, the innovators. They created the personal computer and the internet. That starts at 8 00 p. M. Eastern on cspan2. Next a hearing on brain injuries with former nfl tight end, ben utech. He talked about memory gaps caused by numerous concussions he experienced while playing sports. The committee examined the link between sports injuries impacting the brain and whether they lead to ageing diseases like alzheimers. This is an hour and 25 minutes. Good afternoon. Today were going to have to be little creative because we are going to have a series of votes at 2 30. So what ill do is recess the committee and well go over and vote until the very last vote and well cast the vote at the very beginning of the last vote and then race back over here so that we can continue the hearing. Theres also some breaking news. Just an hour ago, the nfl agreed to eliminate the 675 million cap on concussionrelated claims available to thousands of players as part of a major lawsuit. And so, without objection, i will enter the nfls statement in the record. And part of what were going to discuss today is traumatic brain injuries, a bump, a blow, a jolt to the head or penetrating head injury that disrupts the normal function of the brain, more mild tbis, more commonly referred to as concussions have been the center of an increasing discussion within the Sports Community in recent years as a growing number of current and former athletes say that they are suffering from memory loss and other impairments caused by repeated blows to the head. And, of course, we are seeing the tbis that are coming home from overseas with our men and women in uniform and the performance of their duties as well. The centers for Disease Control and prevention have looked at 1. 6 to 3. 8 million sports and recreationrelated tbis and they say that they occur in the u. S. Each year. Such head injuries are not limited, obviously, just to one sport. They occur in a wide range of sports and most recently we were reminded that of the story the New York Times with the graphic pictures of the games going on in brazil right now in which one of the soccer players was completely knocked out. Over the last few years, much has been done to increase awareness of the risks posed by sportsrelated concussions. And thanks to a number of partnerships and initiatives, research is underway to help us better understand the cause and the longterm impact of concussions and what we can do to prevent them. And these initiatives involve a number of organizations. So while were making progress, its important to note that much more research is needed. And to see all of the links to other things, such as alzheimers. And so today were going to hear from two former professional athletes who had their careers cut short due to concussions and now theyre going to wonder about their function in the future. Were going to take testimony from two prominent medical researchers who will discuss the latest research. And im going to give that privilege of introduction to senator warren after i turn to our great Ranking Member, senator collins. Thank you very much, mr. Chairman. I very much appreciate your calling this important hearing so that we can better explore the relationship between traumatic brain injury and diseases associated with ageing as much as alzheimers, par kinsons and lou gehrigs disease, also known as als. Traumatic brain injury or tbi affects 5 million americans at an annual cost of more than 76 billion. As the senate cochair of the alzheimers task force, im particularly interested in the Research Conducted over the past three decades that is linked moderate and severe traumatic brain injury to a greater risk of developing alzheimers disease and other forms of dementia. One troubling study sited by the Alzheimers Association found that older individuals with a history of mod rale traumatic brain injury are more than twice as likely to develop alzheimers than our seniors with no history of brain injury. Those with a history of severe traumatic brain injury were found in this study to have a 4. 5 times greater risk. Finding a way to prevent and effectively treat alzheimers disease is among my highest priorities as a senator and has been a focus of this committees work. In many ways, alzheimers is the defining disease of the baby boom generation. If we are to prevent it from becoming the defining disease of the next generation, we must strengthen our commitment to research leading to a better understanding of this devastating disease. While researchers still have a great deal to learn about how head injuries affect an individuals risk of developing neurological diseases like alzheimers later in life, there is increasing evidence of a relationship. Women, even more than men, may be more likely to experience longterm symptoms, such as cognitive and visual impairments after sustaining a severe head injury. We know that currently almost two thirds of americans living with alzheimers are women. There are many Important Research projects being conducted on tbi and the link to neurological diseases. For example, the National Institutes Football League have embarked upon a 60 million 4year Public Private partnership to advance research that may lead to the improvement of tbi diagnoses through better Imaging Technologies and also improve treatment for those who have sustained serious head injuries. Indeed while those who have participated in Contact Sports are served in the military may face a particular risk for tbirelated health conditions, the leading cause of tbi among seniors is false. According to the cdc, individuals over age 65, had the highest rates of tbirelated hospitalizations and death. More research is required to establish definitively the link between head injuries and neurological diseases. But it is clear that this Important Research could lead to a better understanding of such devastating diseases as alzheimers, par kensons and als. This Critical Research could also benefit our veterans and troupes on the ground. Far too many of whom have experienced tbi and its painful lasting effects. Again, mr. Chairman, thank you for holding this hearing. We have a great panel of witnesses and i look forward to getting their insights and learning more about the Current Research on this topic. Thank you, senator collins. I want to especially recognize kevin turner. Kevin was a star fullback at the university of alabama. He played eight seasons with the new England Patriots and the Philadelphia Eagles in the 1990s. Since being diagnosed in 2010 with als, lou gehrigs disease, kevin has worked tirelessly to raise awareness about the disease and its possible connection to traumatic brain injuries. And so, kevin, we thank you very much for being with us here today. [ applause ]. Senator warren, if you will introduce two of our panel. I will do that. Thank you very much, mr. Chairman. And Ranking Member collins for having this hearing today. I am pleased to have the opportunity to introduce dr. Roberts stern, and chris newinski, cocorrect directors of the Boston University for the study of traumatic enreceive lop thi. Dr. Stern is a professor of neurosurgery at Boston University school of medicine and he is the director of the clinical core of the Boston University alzheimers disease sender. He received his undergraduate degree from Wesleyan University and his masters and doctoral degrees in Clinical Psychology from the university of rhode island. T before joining the Boston University school of medicine, he served on the faculty of Brown Medical School and the university of North Carolina school of medicine. Dr. Sterns research has led to more than 250 peerreviewed publications and has helped us to better understand the iskts of trauma and ageing on the human brain. Now, hes here today with mr. New win ski who is the cofounder and executive director of the sports legacy institute. This is a Nonprofit Organization thats focussed on addressing the issue of brain trauma through education, through policy and through research. He received his undergraduate degree from Harvard University where he played defensive tackle for the football team. And after college, mr. New win ski became a professional wrestler and his own experience in that sport with head trauma led him to cofound the sports legacy institute. He currently serves as an adviser on the Nfl Players Association mackie white Traumatic Brain Injury Committee and the ivy league multisport concussion committee. Chris has received numerous accolades, including the United States Sports Academy distinguished Service Award for his work advocating for improving Safety Standards in sports. I am very pleased that dr. Stern and mr. Fowinski are here with us today. I know that will add enormously to our discussions. Thank you, both. Thank you, mr. Chairman. And its my pleasure to enter deuce ben utecht who is a former nfl tight end for the Cincinnati Bengals and the Indianapolis Colts. And if i recall, you were on one of those teams that went into the playoffs and perhaps you can tell us the rest of that story. And dr. Jacob van landing ham is the director of neuro biological research at tallahassee Memorial Hospital and he is a professor at Florida State universitys college of medicine. So what well see, well start with you, mr. Nowinski and just go right down the list, what your written statement is entered into the record. So if you would just share with us for a few minutes and then well get into questions. Mr. Nowinski . Thank you if that are wonderful introduction, senator warren. Chairman nelson, Ranking Member collins and committee. Thank you for inviting me to speak today. Its a Nonprofit Organization dedicating to solving the sports concussion crysy through advocacy, policy and research. But i have a personal relationship with concussion. Tremendous concerns that i have increased my risk of developing into degenerative brain disease in the future. Its my hope that this hearing raises awareness of the urgent need for funding for research on traumatic brain injuries as well as the tremendous opportunities we have for the prevention of their longterm consequences. I never had a Second Thought about concussions or brain injuries until i was 24 years old. After playing Contact Sports in high school and then at harvard, i became a pro wrestler, known as a superstar with wwe. And i got to travel the world playing a bad guy or heel, known as Chris Harvard who creatively insult the fans intelligence and scheet to win. This is a character i played. I rarely cheat anymore. It was a performance to entertain our fans and it was a lot of fun. But in a match i was kicked in the head by my opponent and my world immediately changed. My head became throbbing, everything got foggy and most importantly i forgot the script. I couldnt remember how we were supposed to finish the match and that was terrifying. After the match, i was stopped by our athletic trainer, who asked if i was all right. I lied and i said, im fine. Even though the headache was killing me. The symptoms then expanded beyond daily headaches to include depression and sleepwalking and would not go away. I lied about my symptoms for five weeks thinking i was doing the right thing. I meant dr. Robert can who helped me understand that all the dings and bell ringers i had been getting over the years were actually concussions. So think that at 24 i was learning for the first time how fragile my brain was and how critical rest was after concussion and that i am now at higher risk for developing a degenerative brain disease. My ignorance cost me my career, cost me at least five years of my health with terrible post concussion syndrome and i dont know what its going to cost me in the future. But cte, chronic traumatic enreceive lop thi is what i fear most. It was named punchdrunk and largely ignored. We realize it affects weve known it affects boxers but now we know it affects other athletes, military veterans and members of the general public. We cant diagnose it in living people, we dont know how many people have it but early evidence indicates its not insignificant. At the brain bank, collaboration with the Boston University and Va Boston Health Care System led by dr. An mckee, 58 of the 62 brains of former nfl studied have been found positive for this disease. Athletes as young as 17. Dr. Mckee connected to motor neuroron disease. And want to mention having my friend kevin turner here in the room who courageously is taking on this issue. Ill defer the rest of my science to my colleague, dr. Stern. The we need answers quickly. We dont know how big this problem is. But it may be massive with 1. 7 million tbis a year, 3. 8 million ks and we have to recognize Contact Sports are constantly evolving and still dont know what the full life effects are of exposing children to repetitive brain trauma because the sports theyre playing now arent the ones we were then. And Football Players didnt hit each other in the head. Soccer wasnt as popular so dont know what the effects of headers are. Few women were playing Contact Sports so dont know these answers but it is a Public Health crisis so while we work to independently fund more work and applaud the state laws that have changed how we play sport, its not enough. We dont know, you know, one of the things i do wrestlers on concussions which is fun. Before they get into the ring they have to listen to me. We think we can train adults. We dont know if we can train children. The reality we dont know we have kids playing Contact Sports who dont recognize whether they have a concussion who will never have a doctor on the sidelines, that means with all the changes weve made cte will continue to be a problem for athletes and most certainly for our military veterans. A in initiative we announced today that we hope will help prevent this, we teamed up with the santa clara institute of sport, law and ethics on a campaign to educate parents and coaches on the risk of headers in soccer in high school joined by Womens National team players, former National Team players, brandi chastain, joy fawcett who won the 99 world cup along with dr. Cantu to say the reality is we dont need these headers to happen. The current guideline is ten, may start earlier but it shouldnt happen so to conclude, we must not underestimate the longterm impact of brain injuries. With 1 in 4 girls and 1 in 16 girls playing Contact Sports in america were putting a lot of children at risk and owe them greater investment into finding ways to effectively i minimize the consequences of this inevitable brain trauma. Thank you. Thank you, mr. Nowinski. Mr. Utecht. Well, first of all, thank you very much for this opportunity. It is truly a privilege to be here before you to speak about something that is impacting my life in ways that are very scary and unknowns that as a husband and father have put me in a situation where i dont know what my future is going to look like. As a river kid from a small town in minnesota, hastings, minnesota, i dont know how it happened but i found my way into the nfl. Six years i had an opportunity to play in the super bowl championship of 2006 with the Indianapolis Colts where i went on to play two years with the Cincinnati Bengals and now a husband and a father of three beautiful girls, so thankfully i dont have any Football Players in the family right now, but the new perspective of a father has really become a part of my life. Right now ive just taken the National Sports position for the American Academy of neurology which is the largest associations of neurologists in the world, 27,000 now make up the academy, the leaders in neurology in the world along with the national their national foundation, the american brain foundation, whose goal is to cure brain disease through exactly what chris talked about the importance of raising money for research. I hope i never forget the night of february 4th, 2007. It was an amazing night in miami, florida, as we stepped on to the dolphins stadium on to the biggest stage in the world. I dont even know how to put it into words to describe it to you, over 100 Million People tuned in to watch the Indianapolis Colts face off against the chicago bears. Ill never forget two weeks prior all our pro kicker Adam Vinatieri telling the team, dont you dare blink at kickoff, now adam has already won three super bowls so has quite the experience but there i am on the field standing in between future hall of fame quarterback Peyton Manning and future hall of fame coach tony dungy and i remember adams words dont you dare blink at kickoff so there adam is walking off the step, the whistle blows, his hand drops and he releases the players and he places his foot on the ball and i have never in my life seen so many flashing lights. I mean, it would rival the experience of neil armstrong. It truly felt like i was dancing with the stars. It was the greatest experience of my life. We won the game, 2917 and forever i will be able to wear this ring on my finger in remembrance of that game. It was a dream come true. Two years later, that dream was shatter shattered when i woke up face down on a Training Camp field in georgetown, kentucky, being strapped to a board and put on to an ambulance because of my fifth documented concussion. For the first time in my life, my brain became a priority. And the reason why it became a priority is because at 29 years old i started to have memory problems. And it took losing my mind to care about my mind. My memories began to fade away. One story i shared going home to minneapolis and spending time with friends of our, my wife and i sitting around a table and matt brought my friend brought up his wedding and i said, well, why wasnt i able to get there and i got the strangest look from him. And the table got quiet and his wife brought over their photo album from their wedding and page after page there i was as a groomsmen in his wedding and sang a song at his wedding and have no memory of that experience. Its completely gone. Then there are Behavioral Changes. There is hearing my 5yearold daughter tell our Family Practice doctor that at times shes afraid of me. As a father, it puts the idea of the effects of traumatic brain injury on a completely different level. I cant help now but throw myself into a new target, neurology. To tackle a new opponent, brain disease and particularly traumatic brain injuries and concussions. I have been impassioned through advocacy to fight for lives being ripped apart, alzheimers, parkinsons, epilepsy, chronic traumatic encephalopathy. We need a National Revival of funding to go into these issues so we can find the answers. You as senators can really become our new coaches. You can help decide the game strategy, put in the countless hours of work and research and create policies that can change this nation, connecting people to their most valuable asset, their mind. Its not just education and awareness but its changing the nature of a person. Its getting them to truly care so that they can take the education and awareness and implement it because theyre passionate about who they are, which comes from their brains. I will not stop in the pursuit of finding cures for brain disease and creating an emotional connection between the world and neurology because neurolo neurology, our neurologists are who cradle the miracle of make us who we are, our brains. Its time for us to realize how special our brains really are. And i have a number of policies id love to share with you in question and answer time. Thank you. Thank you, mr. Utecht. Dr. Vanlandingham. Thank you, mr. Nelson and thanks to the committee for giving me the opportunity to speak today about traumatic brain injury. I am a researcher. In 1995 i had my own personal experience with brain injury. I was not playing football. I was actually assaulted. I was down in gainesville and there was a vague grant who assaulted me and i had three hemorrhages in my brain. I spent two weeks in intensive care and 18 months with amnesia. I was one of the lucky ones, i got my memory back. Most people who experience what a lot of us have experienced arent that lucky. I went on to do a degree, ph. D. In neuroscience and focus on research. Most of my clinical and basic research over the last 17 years has been focused on traumatic brain injury. Recently ive put the last five years more focus into concussions and mild traumatic brain injury. To give you a little background, after what causes a concussion is the brain sort of slings forward, is accelerated and its going to hit against the inner skull on the frontal part of the brain and then its going to be kicked back the other way and its going to go through this sort of acceleration deceleration rattling inside the skull. A lot of people think the brain is only damaged by hitting the inner part of the skull. But actually the brain is sort of like jello and it stretches the accelerating portion goes faster than the back porras and it stretches the brain in between and thats that stretching that causes a sort of breakdown in metabolism in the brain and it makes it where the brains functions are slower, electricity doesnt run in the brain quite as well as it used to. When weve had a concussion, often we will be able to get to the right answer, were just delayed. Our thought processes are delayed in getting to that correct answer. So i think its important that we also note that not only are we having concussions in athletics, we mentioned the military earlier and mentioned the elderly and the falls epidemic in the egg derly and falls in children. We dont want to forget the pediatric population and by midnight tonight nearly 30 children in this country will die from a traumatic brain injury. And a lot of folks, you know, will continue, a lot of these kids to have problems for the remainder of their life so its very important we put the focus across the age span, across the life span, if you will. If we think about pediatric traumatic brain injury well notice that they often take a lot longer to get better after a concussion. What may take an adult like myself seven to ten days to get better, it may take them seven to ten months. They get behind in school. They dont graduate with their fellow schoolmates, a lot of issues with pediatric brains theyre different and need to be respected as different when coming up with treatment compared to the adult. Same goes for the elderly. So when we think about sports we always go to the nfl and professional sports. I believe that we have an even worse problem if you will in High School Athletics because its still an immature brain, the brain is not fully developed. If you do not have a fully developed brain and it is injured it has a harder time recovering. That means if weve got a High School Player playing football whos 240 pound, estimate big, hits with a tremendous amount of force and engaging and having head contact with an immature brain and that makes it that much worse. So after you have a concussion, most everybody thinks if you get rest you just get better. About 20 of people dont get better and end up with post concussion syndrome and how that ruined chris career t takes months to years to get over post concussion syndrome. Well, we also see when we have postconcussion syndrome, a lot of sleep difficulties. If i had a dime for every person i knew that had a head injury that had sleep problems and the sleep problems we never recognize that, we never put efforts into trying to improve sleep patterns and thats such a huge part of getting better, getting the appropriate sleep at night so that brain can repair. Unfortunately concussions are notorious for being difficult to diagnose and treat. Each injury may have a different constellation of findings and these findings can be very subtle. Well, injury may be subtle and unique, the common factor is that when folks are injured and theyre athletes or theyre in the military, they dont want to actually tell the truth. They want to sort of intentionally mask it. The same thing goes with an elderly patient. An elderly patient doesnt want to lose their independence. Theyre not engaged in wanting to give up driving or whatever it may be. The World Health Organization has stated that as the life span increases were going to see that tbi will surpass many other diseases as the major cause of death and difficulty. Id like to say that tbi transcends generations and populations from the infant to the elderly. A concussion is compounding. If you have one concussion, youre more likely to have two and so on and so forth. In my professional opinion, we are dealing with two Major Research and development issues, two. First, because concussions are compounding, we need to develop new acute pharmaceutical treatments. We treat Everything Else with drugs, why dont we put a focus on developing a drug for this condition . If we can give an acute treatment after a concussion, we can reset the brain, cure it at that point and then its not a compounding issue. Youre not more likely to get a second concussion and so on and so forth. The other thing that were up against and i know dr. Stern will speak more to is the issue of chronic traumatic encephalopathy. Alzheimers disease like pathologies. They are being seen down in the spinal cord and leading to lou gehrigs disease or anterior lateral sclerosis. We need to put a precedence on developing drugs that can stop this pathology. So we need to stop concussions in the beginning, prevent it from being compounding and then we need to put a focus on new drugs that can stop or halt the progression of the pathologies associated with traumatic encephalopathy. Our company is developing an acute treatment for concussion. We will design it as a field deliverable. It will be a nasal inhalant to get more of the drug to the brain and a medic, an ambulance technician, an athletic trainer can give it immediately and we can stop the pathological consequences in their tracks. We also hope to be developing two new neurosteroid drugs this summer which will be focused on alzheimers disease and lou gehrigs disease. Id like to thank you one against for the time youve given me to speak. Thank you. Thank you, dr. Vanlandingham. And we have to deal with issues up here like the cuts in funding to nih and having to restore those, so were very sensitive to what you say. Dr. Stern. Good afternoon, mr. Chairman. Turn your mike on. Good afternoon. Mr. Chairman, Ranking Member collins and distinguished members of the committee, it is a great honor to appear before you today. My name is dr. Robert stern. Im a professor of neurology, neurosurgery and anatomy and neurobiology at Boston University school of medicine. Im also the director of the clinical core of the Boston University alzheimers disease center, 1 of 29 centers funded by the National Institute on aging. For the past 24 25 years i have been conducting Neuroscience Research into issues pertaining to the aging brain. In particular, alzheimers disease. Since 2008 my research has focused on the longterm consequences of repetitive brain trauma in athletes. In particular ive been studying the chronic traumatic encephalopathy or cte. Cte is a progressive brain disease that can lead to dramatic changes in mood, behavior and cognition. Eventually leading to dementia. It is similar to alzheimers disease, but it is a unique disease. Easily distinguished through postmortem neuropathological examination. Originally called punch drunk or dementia pugilistica in the early 1900s when believed to occur only in boxers cte has been found in individuals from age 17 to 98. Including youth, college and professional contact sport athletes such as football, hockey, soccer and rugby players. Research suggests that in some individuals, repetitive impacts to the head trigger a cascade of events leading to a progressive destruction of brain tissue. These changes in the brain can begin years or even decades after the last trauma or after the end of athletic involvement and can lead to memory loss, poor judgment, impulse control problems, aggression, rage, depression, suicidality, Movement Problems and, yes, dementia. Ive had the great privilege and honor to interview the family members of a approximately 100 deceased former athletes who were diagnosed with cte after death by my colleague dr. Mckee and her team. From these interviews, ive begun to learn about the clinical course and presentation of this disease but more importantly ive learned about the tremendous pain and suffering the family members experienced while their loved ones life was destroyed by cte. Ive also been privileged to meet over 70 former nfl players who have come to boston to participate in my nih funded detect study. I hear their stories, i speak with their family members and i listen to their fears that they have cte or that their fellow former Football Players have or will get the disease. They have all witnessed firsthand the tragic downward spiral of cte. The sadly seems to have become an expected consequence of playing the game they loved. The goal of the detect study is to develop objective biological tests or bio markers to diagnose cte during life. Just as a separate note, right now today in the next half hour, the first nfl player, former nfl player in our study is going to undergo a very exciting new p. E. T. Scan that is designed to detect the abnormal deposition of the tao protein found in this disease in a human being while theyre alive. Thats happening this afternoon. This will hopefully improve our ability to diagnose cte and that, indeed, the ability to diagnose cte during life is the next critical step. It will lead to the ability to answer important questions about this disease such as how common is it . What are its risk factors . How can it be prevented . How can we treat it . In other words, at this point we actually know very little about this disease. One thing we do know is that concussions are just the tip of the iceberg. Youve been hearing today a lot about concussions, weve been hearing a lot about concussions in sport and in the military, but the thing i am most concerned about what we refer to as subconcussive blows or hits to the head that rattle the brain and likely do the same type of thing that dr. Vanlandingham has mentioned to those neurons, but without causing the same symptoms of concussion. And those can happen many, many more times than anyone ever expects, a thousand to 1500 times in a typical football lineman. Perhaps a thousand times during heading in a season in soccer. Thats what scares me. In order to tackle the complex issue of cte, we must expand upon current approaches to conducting research in neu neurodegenerative disease. We must break down the traditional silos of individual research labs, institutions and disciplines and begin to conduct mul Multidisciplinary Collaborative Research across research centers, bringing together the very best scientists, novel methodologies and state of the art technology. I fear that we have a major Public Health crisis looming. We must act now. Alas, as youve been hearing this requires tremendous financial support. And all as all of you know all too well current nih funding is, indeed, tragically low. I want to express my gratitude toward this committee for leading the recent effort in increasing nih funding for alzheimers disease research. However, we must now have additional funding to support research focusing on cte and because of their similarities new discovers about cte will inform and expand our knowledge of other neurodegenerative diseases like alzheimers. Parkinsons and lou gehrigs disease. Many of our most cherished gapes in our country such as football, hockey and soccer often involve repetitive blows to the head potentially leading to a progressive brain disease. We must learn as much as possible as quickly as possible in order to determine who may be at increased risk for cte and to develop methods of preventing and treating the symptoms of cte. I want to close by thanking the committee for your interest in addressing this important issue and for your commitment toward improving the health and wellbeing of older americans. Thank you. Thank you, dr. Stern. Senator collins. Thank you, mr. Chairman. First i want to thank all four of our witnesses for truly exceptional testimony. Mr. Utecht, your statement was so moving and so riveting, you mentioned during the course of your comments that when you were strapped to that stretcher, that that was your fifth documented concussion. What happened after the previous four . Were you treated each time . Did you try to conceal that you had had a concussion such as mr. Nowinski mentioned . Tell us what happened. Sure. Thank you for those questions. A number of answers. Very ever concealed that ive had a concussion . Yes, i have. Theres tremendous pressure in professional sports to want to continue to play not only you dont want to let down your teammates who become your family. You dont want to let down your coaches who you work countless hours with to put together a successful plan, and an injury can remove you from that plan and you dont want that to have an effect on the team and so, yes, i was put in a position where i wanted to play and that pressure kept me from being honest and i regret that. Each concussion got worse. As the doctors have talked about today, my third concussion was simply a player jumping over me in pursuit of a tackle as his foot lightly braised my helmet and i was knocked out unconscious for 20 seconds. I watched the film and i see myself get up and run off to the sideline and i have no memory of that. It was the first time i had ever experienced amnesia and midway through the First Quarter against the broncos in 2007 and i dont remember anything from that game until we went in at halftime. And that really became once the time that i began experiencing shortterm memory issues which led into my final concussion that was an eightmonth rehabilitation process. Each team at that time was set up differently. For the Indianapolis Colts they did have a neurosurgeon who was our one of our team doctors who treated the players that had concussions. In cincinnati it was a neurorow psychologist who treated players with concussions. And so i think thats one of the things weve really wanted to change making sure players are seeing a neurologist who are those that are the experts that can diagnose and manage concussions properly. Mr. Nowinski, the comments weve just heard reminds me of when i first learned about the link between traumatic brain injury and neurodegenerative diseases and it was when i met with a neurologist from maine, dr. Bruce sixby who had a patient come to him who was a veteran and he was being treated for posttraumatic stress syndrome at the v. A. In maine, and the doctor, the neurologist asked him if he had ever had a concussion and it turned out that hed had several concussions and traumatic brain injuries while he was in iraq, and he had been misdiagnosed as having posttraumatic stress when, in fact, he had a tbi and it turned out that the tbi was causing him or caused him to have a form of epilepsy which the neurologist then treated him for so my question to you is, is it your experience that patients with neurodegenerative diseases often have a difficult time in getting a proper diagnosis . I thank you, senator collins for that question. It is a great question and the answer is there is no question that former athletes are having a very hard time getting the right diagnosis because cte is so new that were not have been not been training for it in medical school and its been widely ignored in continuing education and so i mean interestingly when you go through our brain bank records most everybody who eventually, dr. Mead diagnoses with cte was originally diagnosed with alzheimers or some other similar disease but almost until the last couple of years none of them were getting cte as a diagnosis, meaning that they were probably being mistreated and so, you know, as dr. Stern alluded to how just horrible this disease is for the individual and encephalopathy their families, its important that we at least do a better job of trying to treat them while they are alive so that they can live a better life because and thats something that i hope for myself because, you know, im 35 now and the average onset of symptoms is usually for these people in their 40s and so theres not that much time left for me and certainly ticking clocks for a lot of people. Thank you. Dr. Stern, i was struck when i heard you talk about the new imaging and you mentioned that individuals with cte have the tao protein and i know from my work on alzheimers that theres the tau protein is present in the brains of people with alzheimers also so are we talking about the same protein and is there a link here . Its a wonderful question and its one of the things that is so exciting about working in this disease because there is a definite link but yet theyre completely distinct. The difference is that in alzheimers disease, there are two proteins that start accumulating in an abnormal fashion and its an abnormal form, one called tau and one is called amyloid and in cte, we dont see the amyloid and when we do see it, its not in the same kind of plaques that we see in alzheimers disease. And so cte is very specifically a tau disease and the type of formation of the tau and the places in the brain where the tau starts to accumulate is quite distinct from what we see in alzheimers disease. And so to answer the question, we have to understand that we cant right now diagnose these neurodegenerative diseases accurately while people are living. Including alzheimers disease. Weve been studying alzheimers disease since 1905 when it was first discovered and yet we still cant truly diagnose it during life. But fortunately were getting very, very close. In large part to the help that this committee has give ton support research. But we still cant do it. With cte weve only been studying it really in depth for the last five, six years, but what were able to do and what were doing with my research right now is exploiting what we have learned with alzheimers disease to learn about cte so studying the tau now with a method that was originally developed for alzheimers disease and other neurodegenerative diseases we can quickly come to answers about cte. Thank you. Well, is there secret that we need to be aware of with regard to helping you in the experimentation on living patients . Yeah, money, money, money. Thats what it comes down to. But it isnt just the responsibility of the federal government. This needs to be a partnership of the federal government, foundations and the private sector. These types of Research Studies and to answer the questions the right way costs tremendous amounts of money and in order to get to some answers quickly, we must have the adequate resources to do so. So, yes, indeed, we need continued assistance in increasing the budgets, not just reducing the cuts but increasing the budgets at the National Institutes of health for Neurodegenerative Disease Research in general but i would hope for and ask you to start a special line of research for the for supporting chronic traumatic encephalopathy so we can understand the distinction between this disease that may affect countless people in the future and diseases that have already been receiving funding like alzheimers disease. Senator blumenthal. Thank you, mr. Chairman. And thank you for having this very important and enlightening hearing and thank you to the members of the panel for contributing so importantly to our discussion and each of you has really been extraordinarily insightful in your own way based in part on the experience and the research that you bring to this table and just to add to the chairmans question, money, money, money is often very important but its also how the money is spent. Yes. And also what can be done to prevent cte. One of the areas is education. Yes. The Korey Stringer institute at the university of connecticut has released as you know a list of nine recommendations for lessening the incidence and reducing the longterm effects of traumatic brain injuries and the experience of the states in adopting those recommendations is very, very mixed. Connecticut has implemented only four. Most other states have implemented fewer of them. So there is a lot of work to be done here in educating parents, trainers, but also Public Officials as to what can be done. You know, one of the areas of injury that was unknown to me concerns horse back riding which is, in fact, the leading cause of sportsrelated traumatic brain injuries out of all the recreational sports. Think of it. Horse back riding is the leading cause of sportsrelated traumatic brain injuries . Why . Because a lot of young riders are wearing helmets made of velvet with no real protection. Think of a Football Player wearing a velvet helmet. Nothing more. And so, in fact, i am planning to introduce a measure which im naming for a young woman, Kristin Odonnell from darrien, connecticut thrown from a horse while riding, suffered a traumatic brain injury and died the next day. She wore one of these traditional velvet hunt caps and it was sold alongside safety certified helmets but her parents had no idea that they were buying a velvet decorative helmet rather than a real protective gear. So the bill that i will introduce, Kristin Odonnell he quest triian safety helmet act would require helmets produced and sold to meet minimum Safety Standards. I dont want to go too much into the details because i have limited amount of time, but i want to thank you for the support in terms of the factual background that youve provided for this kind of measure which i think can be replicated in other sports areas, as well, and im sure that well be talking about them in the near future. Id like to ask mr. Nowinski, youre now 35. Your injury occurred when you were 24. How are you feeling now . Well, thank you for asking, senator blumenthal. Its up and down. I mean these days i still get way more headaches than id like to. The last two days were tough. Today right now i feel pretty good but, you know, as part of dr. Sterns legend study i did my annual phone call, longitudinal study testing my cognition. Im happy where i am but im always wary of where im going. The kick in the head that caused your injury was in a sense a routine part of the sport, correct. Well, it was an accident. Were not supposed to actually do that. Just so you know. But accidents in that sport sure. Frequently occur. In fact, theyre sort of part of the routine because, well, you say it in your own words, but when youre in a contact sport of that kind, particularly where the routine, so to speak, is to actually do damage, at least fake damage to another person, its easy to make a mistake just like if youre throwing a fake punch, if you do it in the wrong way youre going to hit the person. The real punch. With a real punch. So and this must have happened to you repeatedly before that one as you say in your testimony. You suffered repeated blows to the head and, of course, sports and so forth. And in your experience, are people in that sport call it a sport for the moment, wwe wrestling or similar kinds of sports aware of this repeated impact and effect of the routine blows that are struck . Actually, yes, wwe has become actually a close partner in the last few years with sli. We actually honored them with our annual impact award last year because they have become a real leader on this issue. And you actually participate in some of the educational sections. Right, i got i go back and train the whole roster and then when they hire new wrestler, i come down and train them on concussions before they get into the ring and made a 1. 2 million unrestricted gift to support our research at Boston University so its been very rewarding to see that culture change so quickly so that the people and many of them my friends are still wroteling there are in a much safer place and have protections in place that will hopefully minimize the risk of longterm damage. And in terms of the contact sport area generally and any of the other folks on the panel should feel free to comment, as well, how is the Insurance Coverage for that sport and others so far as you know relating to this kind of injury, which as you have just said very dramatically and compellingly is not just a one month or a one year Recovery Period but it can be literally a lifetime. Yeah, you know, its difficult for me to speak to all Insurance Programs because i know theres been a lot of changes encephalopathy very recently in many sports to provide for more medical care long term. But i think you make a good point its just extraordinarily expensive to deal with these consequences long term so i can pass that down the panel but it is a significant issue. Thank you. Ill comment real quick. We have hmos in the state of florida that will not even reimburse for a concussion diagnosis. And even in tallahassee area, the largest hmo. We have to get reimbursement and come up with other things like claim theres memory impairment and we get reimbursed based on that code but there is still not a specific code or multiple hmos will reimburse this in the civilian word. Is it true in medicare, as well . So in medicare, people are definitely supported for dementiarelated conditions and assessments, but often what were seeing with this disease of chronic traumatic encephalopathy is that it doesnt present exactly the same way as alzheimers disease and other dementias, there could just be really dramatic Behavioral Changes or mood changes without the memory problem initially. And in those cases, they might be treated as having a psychiatric disease or illness and so the funding is quite different in those cases and much more limited. Senator, before i return to you, i want to get an understanding of how could concussions have an effect upon lou gehrigs disease, als, that our special guest was is afflicted with . So, again, just want to underscore that its not necessarily concussions, its the overall repetitive brain trauma including all those subconcussive hits that dont result in someone at all being knocked out or having changes in silts, its the little hits over and over again that may start this cascade of changes in the brain cells that lead to the deposition of this abnormal tau that leads to the destruction of the brain as people live longer. What weve seen is that in some cases, the abnormal tau and another preteen called tdp43 is not just in the brain of an individual with a history of repetitive trauma but in the spinal cord and in those cases it leads to the same types of alterations in motor functioning, in strength and weakness as one would see in runofthemill als. And so its not that it leads to the same type of als that might be caused by another underlying factor, it results in the same type of motor neuron disease caused by repetitive brain trauma is what we currently think. Senator, please continue. Thank you. You know, mr. Chairman, youre very, very gracious. Im over my time, out of my time and im going to yield to some of my colleagues in light of the vote we have coming up. Sport warren. Thank you very much. Research at places like Boston University that focus on traumatic brain injuries has revealed that athletes and veterans with chronic traumatic encephalopathy or cte exhibit structural changes to their brains that are similar to the patterns of brains for people with alzheimers disease and that the patients exhibit similar symptoms and i know weve been talking some about this. But i want to ask the question a little bit differently. We dont know the root causes of these conditions because not everyone with a history of head trauma develops cte and not everyone who develops altitude disease as they age. But we also currently lack effective diagnostic tools or treatments for either disease so the question id like to ask for dr. Stern and dr. Vanlandingham is how can you use what you learn about traumatic brain injuries to inform the study of other agerelated neurodegenerative diseases. Dr. Stern. Senator warren, thank you for that question. That is the question that led me to get involved in the study of chronic traumatic encephalopathy. As an alzheimers researcher, i was never really interested in traumatic brain injury except one day i happened to be giving a lecture that it was a risk factor for dementia and chris nowinskis roommate was in the audience and we connected and led me to find out about what was a burgeoning topic of this chronic traumatic encephalopathy. And the reason why i got excited about it was just for that reason that it is a close enough cousin to alzheimers and other diseases that had been studied that it could we could exploit what we find out about one to learn about the other. And so with chronic traumatic encephalopathy, we know the necessary variable for developing this disease. The necessary variable is repetitive brain trauma like you articulately said that is not the sufficient variable. Not everybody who hits their head will develop this disease but we know that everyone who has this disease has had a history of repetitive brain trauma. By that nature, were able to then look at a group of people at high risk, very high risk for developing this disease and study themle longitudinally and use new diagnostic tests to be able to detect when the disease might start and then follow them till death and have my colleague dr. Mckee and others examine him. Thats a very unique thing. In alzheimers disease we dont have that ability. We dont know who is at very high risk for getting it until later on when we might be able to do now a special kind of p. E. T. Scan that can detect the amount of amyloid this their brain. Well, now we can use both sides of this picture to inform the other and make us get to answers so necessary in a much faster fashion. Dr. Vanlandingham, did you want to add anything to that. Well, just reiterate a little bit no one brain is the same. One of the most common questions i get from parents, well, when should i make my son or my daughter stop playing this sport . How many concussions and, you know, im like, well, everybody is different. You know, youd like to say after three theyre predisposed to cte so its a very complicated answer but i agree with dr. Stern that it is a special population that can be measured for in the years to come and youll get closer to the right answer. Id like to add one more comment to the lou gehrigs disease issue. I do a lot of Preclinical Research with animals and we can give concussions even one single concussion to an animal and we find the tau protein in the cerebral spinal fluid and that not only bathes the brain but bathes the spinal cord so could be an issue of transferal from the brain thats been damaged of these pathological proteins down into the spinal canal and some level of fusion but we dont know yet but its definitely bathing the spinal cord after a brain injury. Your comments, both of you, dr. Stern, and dr. Vanlandingham remind me that the wonderful thing about science is discoveries dont occur in isolation. That what we learn by studying one disease can pay dividends in shedding light on other diseases. The director of the National Institute of mental health, dr. Tom ensel told the help Committee Last year we are on the cusp of a revolution in Brain Research because of the incredible tools that are now available that hadnt been there before. And yet at this critical moment were cutting back on nih funding. Year after year adjusted for biomedical inflation nihs budget has shrunk to the point that we are now investing less in Research Within nih than we were in 2001. So let me ask the question this way, if we could double the budgets of your centers, what could you do and how much faster could you do it . S. Ill go first. You have to show us the as per ra piration. We wouldnt just double the speed at which we could answer important questions, it would be an exponential increase. One of the things thats been happening across the nation has been the loss of young investigators and senior investigators. Young investigators because there are no jobs for them, because of nih cuts, there are no jobs for young postdoctoral fellows or new researchers. Senior investigators who have been working for decades are having to close their labs because for the First Time Ever they have no funding. Because of that, we cant have continuity in research. We cant have the numbers of people to be able to focus on a particular question at any given time. So thats one of the starting point, why wed be able to have much faster answers is because if we had more money wed be able to have a real meaningful staff to answer the questions. But wed also be able to do much more with technology and thats whats so wonderful about doing this type of research in 2014. While senator warren was out i was mentioning just right now this moment were putting one of our former nfl players in a p. E. T. Scanner to be able to look at tau protein in their brain. Its the first time were doing it. Its very exciting. By being able to have support for that, to double our budget, to able to continue that research not to close it down, wed be able to be diagnose cte during life, very, very accurately, within the next five years. Thats amazing. Dr. Vanlandingham. So ill start by saying that i work for two different Nonprofit Companies for a for Profit Company and im a professor at an Academic Institute so theres various thoughts that go through my mind to answer this question. I think if we had funds from the federal government, lets say, that would sponsor private companies that would be easier for private companies to get investors, it would improve the value to the investor by having federal government support. Now, thats a little out there. Big pharmaceutical companies dont do r d anymore. Smaller companies are now the ones that have to go out there and either raise the money or fight for the grants just to be able to get this to a point where it can go into Clinical Trials. Professors in Academic Institutes have wonderful ideas but they never hardly ever try to commercialize them because they do not have the means in which to do that. Your question on how much money doubling the budget and for 20 million in a year i could in a phase two Clinical Trial for concussion, first drug if i had 20 million today in a year i could have it in a phase two Clinical Trial. I appreciate it. You know, we talk a lot on this committee, for example, about alzheimers and the Alzheimers Association says that as our nation continues to age, alzheimers disease is projected to cost our nation 1. 2 trillion a year by 2050. Over and over we understand the importance of research and ultimately the importance not just for peoples lives but the importance in terms of how much money we have to spend to care for people. And so i just want to make it again clear, we cannot stand by and do nothing. We must increase our federal investment in medical research, not slash it. This is our only chance, to bring costs in the future under control and to give people a better quality of life so thank you very much for your work. Thank you so much for being here to raise awareness around this issue and thank you, mr. Chairman, for letting us go over. Amen to your comments about research, senator. I am going to try to squeeze us in before we have to go to vote and the vote will be called momentarily but we dont have to go right at that time and i will wait till the last possible minute so let me see if i can handle quickly a number of questions that are still left. Dr. Stern, how does a tbi differ in a military combat injury versus a sports injury . The brain does not know whats hitting it. However, theres something new thats been occurring in the last 12 years in the military theaters of iraq and afghanistan and that is these roadside blast injuries that occur to our military servicemen and women. And these blasts injuries are not a direct hit to the brain or to the head, but through the blast waves, and often what happens during that type of injury, the person not only has the effect of the blast on their brain and those brain cells but the person is also thrown and hits their head within their vehicle on the ground, et cetera. Thats a different type of injury. S that is a double dose on an individual thats already been exposed perhaps to similar injuries but just like the stories you hear of our Football Players and other athletes who want to hide their injuries to be able to help their team be strong, our military personnel do the same all too often. And so what we need to do is to be able to make sure that we reduce the repetitive nature of those types of injuries. The type of injury that one gets, lets say, in a football stadium is not necessarily going to be that same type of, you know, blast followed by hitting, but it is still going to be some kind of impact to those brain cells, like was described earlier, the stretching, the shearing of those neurons that lead to this metabolic crisis within the nerve cells. It doesnt matter how the hit happens, that same type of change is going to occur leading to the same type of acute symptoms. I want to ask mr. Nowinski and mr. Utecht, you have any observations about player suicide . Well, clearly its a concern. Whether its in wrestling or whether its in the nfl, thats thats at last thing you would ever want to see occur. I think at this point theres just not enough information to be able to say that they are connected and i think thats one more thing that funding into research would really be able to help us to provide is more context between a relationship with depression and traumatic brain injury but at this point its not there yet and so when we look at some of these players who have come to that point, its really hard to be able to i think make that connection yet today between traumatic brain injury and suicide. Thank you for the question, chairman nelson. You know, suicide is extraordinarily complicated but there are some things we do know, one is that acute concussion, acute traumatic brain injury does increase your risk of suicide or Suicidal Ideation within the next year from studies and have a lot of brains in our brain banks from teenagers who have taken their lives within some 36 hours, some within a year while still suffering postconcussion symptoms so theres something going on there and with the longterm cases and people committing suicide with cte, you know, its hard to know if the their suicide was linked to anxiety or depression issues that the disease brought on. Certainly whats consistent in a lot of cases it has alienated them interest their families and are unable to work and become isolated and you sometimes wonder if the guilt and the destruction of their life had some role to play in the conscious decision to take their lives but i think it shows how much it does affect family. If i could add something to that talking about the science of it, suicide is a very complex, very tragic occurrence. But what we do know is that the parts of the brain that are affected in chronic traumatic encephalopathy can, indeed, lead to changes in emotion and to changes in impulse control. Those are two of the big things that are affected by this disease. The emigdula, the home of emotional regulation and the bottom parts of the frontal locations where we control our impulses, where we stop our inappropriate behavior and if you have an individual who has this, you know, rage and sadness and emotional discontrol and then they have the inability to stop an impulse, that may lead to that very tragic recipe that could eventually turn to suicide. Are women more subject to this type of injury than men . The data would say, yes, in sports like yes. In sports like soccer and basketball where the roles are very similar, women do suffer more concussions. The theory is it is likely biomechanical. They have thinner, less muscular necks. It takes less impact to make the head move quickly. But since women havent been playing organized sports as long, we dont know what the o results are. We dont have a positive case here at the cte. So were not sure what we will see there. But it is concerning. So if you are the teams coach or the doctor, whats your best way to make an assessment as to whether or not your player should be able to continue . I would say first you do a memory and attention test there on the side lines. And now days we know that a lot of issues after a concussion are related to bl impairment because of inner ear damage because of the concussion. That a quality test for bl as well as sort of quick thinking, memory attention things opt sideline is probably the most common thing today. And does that get into that impact, the immediate post concussion assessment and cognitive testing . Yes, sir. The impact test is the most common cognitive assessment for side lines not really sideline testing but for athletic testing. It is used most commonly as a baseline test before a season. Then after someone is injured, it is used for a performance but not used on the sideline. It takes too long. The environment is not appropriate and whats very important know is that many of the symptoms. Concussion are not immediate. They may not occur for hours or perhaps until the next day. And so if youre a coach, trying to make a decision, first of all, have adequate medical staff on hand, whether that be athletic trainers or team doctors, who are well trained in concussion assessment. And those medical professionals should take it very seriously. And be independent of the coaching decision. So theyre not pushed in any way, shape or form to send someone back to play before theyre ready. One of the things to note on the impact, too, is we are finding that athletes are now failing the impact test on purpose so that their baseline is now lower to start out with. So that if in fact the concussion occurs, they dont have to get back to what truly is their normal baseline. But one that has been fabricated because of choices theyve made during the testtaking. So this is about changing the nature of this injury as well. And really getting people to care about their brains so that they dont make choices like that. And in this case, you mean, that that enables them to get back out on the field. Correct. It takes it takes their baseline and lowers it. So that their results dont have to come back to what is their normal baseline. I see. They wouldnt take that impact until the day after. Correct. Youre doing sort of a quick and dirty on the side lines, to decide whether they can go back in immediately or not. Then you are holding thep out and doing that, you know, check towards baseline the day after. And every seven days until they return to normal. All right. There have been a number of athletic organizations getting involved in the business of donating millions of dollars to research. Some through nih. How can the public be sure that these donations do not bias the outcome of the research . Owe can speak to the nih donation by the Football League. Nih gave 50,000 to the Organization Associated with the National Institute of health to accept money from the private sector to then be used for Peer Reviewed research. So there is this firewall between accepting the money, and then the review that is done through nih. Not through fnih. And so, the goal of the nfl giving that money so it didnt have any conflict of interest, there wasnt any playing favorites. It was there to truly support research so it could be Peer Reviewed and funded just like any other nih research. So in that case, i strongly support it. Okay. Now, final question. A reseptember medical journal said emergency room visit for these sports related tbis increased by the 2 over a tenyear period. Youre a parent. You have a child. They want to play sports. If its a contact sport, do you let them play . Right down. Mr. Newinski. After doing this for a long ill keep you short because we have to vote. We have sports with repetitive brain trama after high school i dont have kids yet, but i would say, don let them get hit in the head hundreds of times before high school. I would have to agree with mr. Newinski. There is a high school in texas that has gone to flag football up through high school. You see players in the nfl that dpt play in college. They become pro bowl players in the nfl. So can you in fact remove Contact Sports until high school and still teach fundamentals . Still teach even correctly how to attack, removing contact . I believe that you can. Doctor . I agree. I just still have my concerns as large and fast as High School Players have gotten today that there is still a major issue. But at least reremoved anybody under the age of 15 or 16 from being engaged. Sir . I think weve had a tremendous knee jerk response in our society to limited research that has led to a lot of perhaps scary stories that are passed along. And thats before we have adequate science. However, we also have to think rationally and make rational decisions. I think people are now understanding that hitting your head over and over again is not necessarily a good thing for you. So i would agree with everyone else that at the very least, Contact Sports with repetitive hits to the head should be limited to as late as possible. We especially bant to thank our special guest, ken. We want to thank all of you, mr. Chairman, and most illuminating. Senator . I apologize for interrupting. But im wuondering whether the record could be kept pope this has been a phenomenally good panel. I have questions to submit. The record will be kept open for five days. Thank you. Meeting is adjourned. On American History tv in prime type, discussing service in world war ii, vietnam and afghanistan, hosted by the u. S. Naval institute at the u. S. Naf yl academy in annapolis, maryland. At 9 40 eastern, tom brokaw reflects on his career in the 198 the fall of the berlin wall and talk to the museum here in washington, d. C. Friday night on book tv and prime time, ronald rockbottom talks about nazi occupied paris in 1902. Then an account of the war in afghanistan as told through the lives of throw afghans. And Walter Isaacson on his new book about the entrepreneurs and creators of the internet. Next, house energy and commerce hearing with the heads of nih and fda as well as neuro surgeons and drug developers. They testified on medical cures and innovation. And challenges of conducting research with tightening budgets. This event took plis place at the farm and home center in lancaster, pennsylvania. Ace at farm and home center in lancaster, pennsylvania