[inaudible conversations] thank you all for being here in the Senate Committee on health education, labor and pensions. We will come to order. This morning we will be considering the nomination of doctor Monica Bertagnolli to serve as the National Institutes of health director. Let me begin by welcoming doctor bertagnolli to the committee. We look forward to hearing from you and we thank you for being here today. I see you brought along a fellow from wyoming and we welcome senator barrasso as well. The nih with a budget of more than 47 billion is the largest funder of medical research in the world. This research has led to new treatments and Prescription Drugs that are significantly improved the lives of americans and people throughout the entire world and i think all of us every single american should be very proud of those accomplishments. Having said that, let me say a few words about my concerns. I dont have to tell any american that the Healthcare System in our country is broken and it is failing. We spent almost twice as much per capita on healthcare as any other industrialized nation yet we have 85 Million People who are uninsured or underinsured. We dont have enough doctors, nurses, dentists, Mental Health specialists. Our Life Expectancy is lower than other major countries and is actually in decline today and very relevant to the hearing that we are conducting right now. We spend as a nation the highest prices, we pay the highest prices in the world for Prescription Drugs in some cases ten times more than the people in other nations. While the largest Drug Companies made over 112 billion in profits last year and paid their ceos exorbitant compensation packages, one out of four americans cannot afford to pay for the medicine they need and thousands of families face financial ruin as they pay prices that they cannot afford for the Prescription Drugs that keep them alive. Think about it for one second millions go to the doctor, the doctor writes a prescription and they cannot afford to fill the prescription. How insane is that . But its not just the high cost of Prescription Drugs impacting individuals. In the largest hospital in my state in vermont and i dont think that its different elsewhere, the high cost of Prescription Drugs account for 20 of the overall budget for the hospital and that drives costs up as well. Prescription drugs impact hospital costs big time. In other words, the outrageously high cost of Prescription Drugs in america is a crisis and it must be addressed. Adding insult to injury not only has the federal government not effectively regulated the price, but the taxpayers of this country have over the years provided hundreds of billions of dollars in research and development into new Prescription Drugs that have provided financial benefits to some of the most profitable pharmaceutical companies in the world. In America Today the median cost of new cancer drugs has gone up more than 300 over the past decade even though 85 of the initial foundational Cancer Research is funded by the u. S. Taxpayer. We are putting money rightfully so into research to deal with cancer and yet we pay outrageously high prices. In june the committee released the report that found that the average price of new treatments that the nih scientists helped event over the past 20 years is 111,000. In virtually all cases american taxpayers are paying far more than people in other countries for the exact same medicine that the nih and taxpayers helped develop. Here are just a few examples from this report. They charged over 165,000 for expanding while the exact same chart can be purchased in japan for just 20,000. This is a drug developed by american taxpayer dollars. Johnson johnson charges americans with hiv 56,000. While the same treatment can be purchased in the uk for just 10,000. A product developed by u. S. Tax dollars. Gilead charges americans with nonhodgkins lymphoma 424,000 on the exact same therapy purchased in japan for just 212,000 and the list goes on and on and on. We pay for the research. The Drug Companies develop the drugs, make billions in charge the highest prices in the world for the product. One last example. After receiving 12 billion from the federal government, theyve quadrupled the price of the Covid Vaccine that was literally coinvented by nih scientists 128 for the exact same medicine, same vaccine will be available in europe for as little as 26. Anybody here think that makes sense . We develop the research, we pay for it, the highest prices in the world, doesnt make sense to me. In my view at this very difficult moment for American Health care and we are in a crisis situation we need an nih director who is prepared to take on the pharmaceutical industry and use every tool at his or her disposal to lower the outrageous cost of the Prescription Drugs. The 1800 well paid lobbyists from the pharmaceutical industry all over this place may not be happy about that but that is precisely what the American People want. The status quo is not working. We need fundamental changes from the way they address the crisis of the Prescription Drugs. We need nih directors who had to reinstate and expand the reasonable pricing clause to make sure the Companies Set reasonable prices for the drugs developed. A whole lot of things the end of the nih alone are their agencies there agenciesthe administratioe active as well. At the media describes what goes on in congress as we are a divided nation. But i will tell you this whether you are a conservative republican, progressive, democrat or independent, you know what we all agree on is the American People want to the congress to deal with the outrageously high cost of Prescription Drugs. Senator cassidy. Thank you, chair sanders. The Committee Considers the nomination of doctor Monica Bertagnolli to be the director of the National Institutes of health. Thanks for being here. Thanks for taking on this job and going through the committee that i know must be stressful but again very pleased to have you. You have an incredibly impressive resume and i say that is at the physician who was formerly an academic but has no resume that compares with yours and its reflected by the support you have in the scientific community. Theres no question regarding scientific qualifications but there are people that will ask questions regarding the overall ability to lead in the next phase and this is what my remaining remarks will be about. Everybody knows the role in strengthening americas Biomedical Research into supporting Public Health especially during the crisis. Unfortunately it became a lightning rod for partisan debates during the pandemic and that eroded the trust between the nih and the public. First and foremost you will be tasked to rebuild the relationship with congress and the public being a leader that represents the interest of all americans and not just of the scientific community. This means making the agency more transparent and accountable to congress while advancing cutting edge science effectively communicating to the American People and rebuilding trust between Public Health officials and the Biomedical Research community. The director must also protect and strengthen the valuable Publicprivate Partnerships that make up our Biomedical Research enterprise. And sometimes that Publicprivate Partnership is underestimated but clearly the private and the Public Partnership has been what has made the United States a leader in innovative drugs. Last month i issued a request for information on the stakeholders on modernizing the nih and this would include buying small. I look forward to hearing about your vision and how you shall achieve. During the meeting we spoke about the bioethical issues including field tissue and Stem Cell Research and the use of hormones and other transition, gender transition interventions on children, like on children. Frankly at times you avoided getting into specifics citing a lack of expertise. But as the director, you will have to have this expertise. And you will need to be prepared to weigh in on topics that are not in your Research Specialty but across the entire enterprise making policy decisions that will shape the direction of the Biomedical Research. While you consult with experts and take input from your directors you are ultimately the person who decides. I would point out that this hearing is apparently happening today. It wasnt going to otherwise because the publicly acknowledged deal Biden Administration cut to implement partisan drug pricing policies in exchange for advancing your nomination. Biden Administration Officials told us in the hearing earlier this year policy is similar to those in the deal that have been reported could risk future partnerships between the government and the private sector. By the way, future partnerships critical to generating the cure important for cancers and alzheimers into the next pandemic. Partnerships and the foundation of the Biomedical Research enterprise which by the way leads the world in developing these cures. Its concerning that the administration would jeopardize the longterm success of this enterprise for the shortterm goal of advancing your nomination. Last week i asked President Biden into the secretary for a full accounting of any deals cut with members of congress relative to advancing the nomination. At 5 43 last night i received a letter that presided no information and intentionally ignored the request it was supposedly responding to. The administration wasnt forthcoming about any deals with members of Congress Even though some of the details have been reported in the press. Senators expected a vote on the confirmation should be aware of any such deal prior to the nomination. We speak about the breakdown of trust and its rhetoric which is true but not related driving the process by the administration on something that we should know about but we are not being told. We sent the acting director a letter about the funding that resulted in the death of two adolescents. We didnt get the response until september 15th. I have concerns given the administrations history of failing to respond to congressional oversight requests particularly for members of the committee that are responsible for that oversight. So rebuilding the relationship with congress will require a strong director who can overcome partisan divisions, overcome the administration stonewalling of a request from members of the committee for that information pertinent to the work of this committee and work with both republicans and democrats to improve trust in our federal health institutions. That means being open and responsive to this committee which would directly oversee the work as nih director if you were confirmed. I look forward to hearing how you shall fulfill these parts of the job and move the nih forward. Thank you and with that i yield. I would now like to welcome our nominee doctor Monica Bertagnolli has served as the director of the National CancerInstitute Since october, 2022. Prior to that role, she was a surgeon at Brigham Williams hospital and professor of surgery in the field of surgical oncology at Harvard Medical School she served as president and director. I think her for being here today and turn over to senator john barrasso. Thanks so much mr. Chairman and im pleased to welcome to the senate the committee Monica Bertagnolli who was a physician and wyoming native. President biden nominated her to be the director of the National Institutes of health and its certainly not everyday that one of wyomings very own is nominated for such a high position in the nation. Doctor bertagnolli has devoted her entire life to medicine and medical research. She earned a bachelors degree in engineering from princeton university, graduated from the university of Utah Medical School and completed her surgical Residency Training at brigham and Womens Hospital in boston. She then went on to be a Research Fellow at tumor immunology at the Cancer Institute in boston and later served as the chief of surgical oncology for over a decade. Shes continued caring for patients at brigham and Womens Hospital while being a renowned Cancer Researcher and also served as a professor in surgical oncology at Harvard Medical School. She strained not only the next generation of doctors but also Cancer Researchers. This makes her a perfect fit to serve as the current director of the National Cancer institute. While many may know she is a wellrespected physician and researcher that she is, wyoming knows her as part of a multigeneration ranching family and im proud to say that she has never forgotten where she came from. As i traveled and met with folks across wyoming and the Mountain West ive heard of her great work not only as a doctor but also on the ranch so that includes the ranch neighbors. If you want to somebody you talk to their ranching neighbors. They speak of her grid, endurance and determination. Her commitment to the land and livestock speaks volumes about her character and courage. She understands the needs of rural health and frontier medicine. She has used her background medical as well as the values that she learned growing up to improve healthcare for all americans. She served as an advisor to the Cancer Institute in Salt Lake City utah which is a designated Cancer Institute for wyoming. She also advised them on how to reach patients in rural areas and focused on reducing burdens on patients by using local Cancer Treatment clinics. One is in the Sweetwater Regional Cancer Center in her hometown of rock springs wyoming. Her firsthand experience in accessing healthcare in Rural America gives her a perspective that is often lacking in washington. She has annexed intensive track record of cultivating Publicprivate Partnerships to push medical innovation forward. I know this background will serve her well as the director of the National Institutes of health. I have tremendous appreciation and admiration and respect for doctor bertagnolli and with that being said mr. Chairman i do have serious concerns about the way this administration has handled the covid pandemic as politicized agencies such as the nih attacked innovation to the inflation reduction act. I think its important that this position be filled with someone with a critical and open mind ready to tackle the important challenges ahead and for all these reasons, i support the nomination of doctor bertagnolli to serve as the director of the National Institutes of health. Thank you mr. Chairman. Thank you, senator. Do you have to be italian to be from wyoming . [laughter] in a bipartisan way. The stage is yours. Turn the microphone on, please. Chairman sanders, Ranking Member cassidy and members of the committee, thank you for considering my nomination to be the director of the National Institutes of health. Its an honor to appear before you today to share my vision for the nih. I want to thank President Biden for trusting me with this nomination and a senator barrasso for the very kind introduction. I also want to thank my husband and my two children for their unwavering support and unqualified love. I grew up on a ranch in southwestern wyoming. My early inspiration