[inaudible conversations] thank you all for being here in the Senate Committee on health, education, labor and pensions will come to order. N, this morning we will be considering the nomination of dr. Monica bertagnolli to serve as director of the u. S. National institutes of health. And let me begin by welcoming dr. Bertagnolli to our committee. Committee. We look forward to hearing t frm you, and we thank you for being here today and i see you brought along a fellow wyoming or i hate. 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 have 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. But 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 sailing. We spend f almost twice as much per capita on health care 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 pay 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 of people get sick, they go to the doctor called doctorhe writes out a prescription. They cannot afford to fill the prescription the doctors right. How insane is that . But its not just the high cost of prescription drugs impacting individuals. In the largest hospital in my state of vermont, i dont think its terribly different elsewhere, the high cost of prescription drugs account for 20 of the overall budget for the hospital, and that drives insurance costs up as well. Prescription drugs impacting hospital costs big timee period 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 meddling as the the federal government not effectively regulated the price of prescription drugs, 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 enormous benefits, financial benefits, to some of the most profitable pharmaceutical companies in the country. For example, in America Today the median cost of new cancer drugs has gone up by more than 300 over the past decade, even though 85 of the initial foundational Cancer Research is funded by the u. S. Taxpayer. Weey are putting money rightfuly so into research to deal with cancer, and yet we pay outrageous prices. In c june of this committee released a report that found that the average price of new treatments that nihth scientists helped invent over the past 20 years is 111,000. In virtually all cases, american taxpayers are paying far more than peoplee in other countries for the exact same medicine that the nih and taxpayers helped develop. Here are just a few examples from this report. With Prostate Cancer over 165,000 for expanding what exact same drug 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 exact executive e purchased in uk for just 10,000. Product developed by u. S. Tax dollars. Gilead charges americans with nonhodgkins lymphoma 424,000 what exact andrc 30 can be purchased in japan for just 212,000. And the list goes on and on and on. We pay for the research. Drug companies to help the drugs, make billions then they charges charge as the highest prices in for the product. One last example. After receiving 12 billion from the federalal government, moder, has quadrupled the price of the covid vaccine, a vaccine of literally coinvented by nhi kiska 128. While the exact same medicine, same vaccine be available in europe for as little as 26. Really . Anybody here think that vaguely make sense . We develop the research, we pay for, we pay the highest prices and world. People can afford it. Doesnt w make sense to me. In my view at this very difficult moment for american healthcare, and we are in a crisis situation, we need an nih director who is prepared to take on the greed of the pharmaceutical industry and use every tool at his or her disposal to substantially lower the outrageous cost of prescription drugs. The 1800 wellpaid lobbyists from the pharmaceutical industry are all over this place, may not be happy about that thought, but that is precisely what the American People want. The status quo is not working. We need fundamental changes in the way the nih addresses the crisis of prescription drugs. We need d nih director who is prepared to reinstate and spent reasonable pricing clause to make sure thehe pharmaceutical Companies Set reasonable prices for new prescription drugs developed with taxpayers, et cetera, et cetera. A whole lot of thingss thelo nih can do. Will nih alone solve the problem . Of course the period of the agencies and administration have got to be active as well. You know, the media describes what goes on in congress with a very divided nation. While we are. But i will tell you this, whether you are a conservative republican got a progressive, a democrat when independent do you know wee on every poll tells us that, as is the American People want focus to do with outrageously high costs of prescription drugs. That is what weve got t do. Senator cassidy your recognize reopening remarks were thank you, chair sanders. Today the Committee Considers nomination of dr. Monica bertagnolli to be the next recognize as it of health. Dr. Bertagnolli, pennsylvania. Thanks for taking on this job and going through this committee which i know must be stressful, but again very pleased to have you. You have an incredibly impressive resume and i say that as a physician performing was an academic but as a resident that compares with yours. And its reflected by the support you from the scientific community. There are some questions regarding scientific qualifications, but their people double as questions regarding your overall ability to lead the nih in the next days, and this is what my remaining much will be about. Everybodyow knows nih role in strengthening americas Biomedical Research and supportingto Public Health especially during a crisis. Unfortunately, it became a lightning rod for partisan debates during the covid19de pandemic, and that eroded the trust between the nih and the public. First and foremost, you will be cast to rebuild the relationship with congress and the public. The leaders represents the interests of all americans and not just of the scientific community. This means making agency more transparent and accountable while also advancing cutting edge science. Effectively communicating to the American People and rebuilding trust with copy between Public Health officials and the Biomedical Research community. An extract was also protect and strengthen the valuable Publicprivate Partnerships that make up our Biomedical Research enterprise, and sometimes the 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 from stakeholders on modernizing nih, and this would include my i look forward to hearing from you about your vision for agency and how you shall achieve. Now during our meeting we spoke about bioethical issues including field tissue and embryonice Stem Cell Research ad the use of hormones and other transition, gender transition interventions of children. Frankly, a times you avoided getting to the specifics citing a lack of expertise. But as the director you have to have thisr, expertise. You will need to be prepared to weigh in on topics that are not in your research specialty, but across the entire enterprise. Making the policy decisions that will shape the direction of Biomedical Research. While you consult with experts and take input from your institute directors, you are ultimately the person who decides. I point out that this hearing is apparently happening today was not going to otherwise because of the Public Technology deal the Biden Administration cut with chair sanders to implement artisan drug pricing policies in exchange for dancing your nomination. The Biden Administration officials told us in a hearing earlier this year that policy similar to those in the deal that have been reported could risk of future partnerships between the government and the private sector. By the way, future partnerships critical to generating the cures important for cancer and alzheimers and for the next pandemic. Partnerships that are the foundation of the Biomedical Research enterprise which by the way leads the world in developing these cures. Its concerning the administration would jeopardize the longterm success of this enterprise for the short term goal of advancing your nomination. Last week i asked President Biden secretary becerra for full accounting of any deals cut with members of congress wanted to advancing your nomination. At 5 43 plastic, kind of the problem, at 543 time a class that i proceed basically a form letter basically a form letter that resided to information and intentionally ignored the request was supposed to responding to. The administration was not forthcoming about any deals with members of Congress Even though some of those details have been reported in the press. Now standard is expected to vote under confirmation should be aware of any such deal prior to the nomination. Thats not you hear its the process. And we speak about the breakdown of trust. Its like rhetoric inflammatory rhetoric which is true, true true not related. Is driving a process by the administration on something that we should know about but we are not being told. Another example, in june senator tuberville and i sent the acting nih director of that about nih funding cut nih funded projects that resulted in the death of two adolescence. We didnt get a response to that letter until september 15, week after the Biden Administration struck the deal to move your nomination. I believe you when you say that youre committed to transparency and rebuilding the nihs relationship with congress. I appreciate that commitment body have concerns given the administrations history i failed to respond to congressional oversight requests, particularly for members of this committee who are responsible for that oversight. So rebuilding nihs relationship with congress will require a strong director who can overcome partisan divisions, overcome the administrations delivered stonewalling of requests to members of this 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 will directly oversee your work as an agent director, if youre confirm. Ir i look forward to hearing how you shall fulfill these parts of the job and move the nih forward. I thank you and with that i yield. Thank you, senator cassidy. I now would like to welcome our nominee, dr. Monica bertagnolli fso district of National CancerInstitute Since october 2022. Prior to the role doctor bertinelli was a surgeon at brigham and Womens Hospital and professor of surgery at the field of surgical oncology at harvard medical school. Dr. Bertagnolli is a longtime member of the American Society of clinical oncology wishes service both president and a member of the board of directors. I thanked her for being here today and after over two store John Barrasso to introduce her. Takes a much mr. Chairman and a pleased to welcome to the senate and to the committee dr. Monica bertagnolli was a fellow physician and the wyoming native. President biden is nominator to be the director of the National Institutes of health. It certainly not every day that one of wyomings their own is nominated for such a high position in our nation. Dr. Bertagnolli has devoted her entire life to medicine and medical research. She earned a bachelors degree in engineering from princeton university, graduated from university of utahs medical school and later surgical Residency Training at brigham and Womens Hospital in boston. She went on to be Research Fellow in tumor immunology at the Cancer Institute in boston, she later served as the chief of surgical oncology for over a decade. Shes continued caring for patients at brigham andor Womens Hospital while being every now and Cancer Researcher. She is also serve as a professor in surgical oncology at harvard medical school. She strained that only the next generation of doctors but also Cancer Researchers. And thises makes her a perfect t to serve as our current director of the National Cancer institute. While many may know that she is a wellrespected physician and researcher that she is, wyoming no, sir as part of a multigeneration ranging family. And a proud to say that she has never forgotten where she came from. As i have traveled and met with folks across wyoming and the mountain west, ive heard of her great work not only as a doctor the ranch. So that includes the rage and neighbors. If you want to know somebody you talk to their neighbors and arranging neighbors. They speak of her grid, her endurance and her determination. Her commitment to the land and livestock speaks volumes about her character and her courage. She understands the needs of rural health and frontier medicine. She has used her background, medical as well s as the values she learned growing up, to improve healthcare allamericans shee serves as an advisor to the huntsman Cancer Institute in Salt Lake City utah which is a designated Cancer Institute wyoming. She also advised huntsman on how to reach patients in rural areas. She focused on reducing burdens on patients by using local Cancer Treatment clinics. One is in Sweetwater Regional Cancer Center in her hometown of rock springs wyoming. Our firsthand experience in accessing health care in Rural America gets her a perspective that is often lacking in washington pick she has an extensive track record of cultivating privatePublic Partnerships to push medical innovation forward. This back when will serve her well as the director of the National Institutes of health. I have immenseha appreciation ad admiration and respect for dr. 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 Government Agencies such as the nih has attacked Health Innovation through the inflation reduction act. I think its important that this position be filled with someone with a critical and an open mind ready to tackle the important challenges ahead, and for all these reasons, mr. Chairman, i support the nomination of doctor Monica Bertagnolli to Service Director dinesh institutes of health. Thank you, mr. Chairman. Thank you, senator barrasso. To be italian to be for my only question what im saying . [laughing] well, in a bipartisan way mike enzi, republican. If there a former congressman, tito who was also from rock springs, wyoming, so it helps. [laughing] okay. With that introduction, dr. Bertagnolli, the stage is yours. Welcome. Turn the mic back on, please. There we go. Chairman desantis got Ranking Member cassidy, and members of the committee, thank you for considering my nomination to be director of dinesh institutes of health. T before you today to share my vision for the nih. I want to thank