Transcripts For CSPAN Key Capitol Hill Hearings 20140221 : c

I wanted to ask him about language department. Think the following dr. On your program can answer it. What is host what is your concern about it . Why does it interest you . Caller you can hear i have an accent. I was 27 when i came here from the soviet union. I got accepted to ucla and i was having a terrible time with the language. Ive been here many years now, but i wanted to ask him what the brain does or does not do to acquire the language faster. That was my question. I was kind of looking forward to getting his answer. Host hunh. And the fact that you were in ucla a year after leaving the soviet union, do you think it helped . Caller i remember nightmares. Like, 72 hours a day. It was a very difficult time. No social life, no nothing. It was extremely hard. That is maria in l. A. And this is jerry in cottontail, alabama. Good morning, jerry. Caller good morning. I was wanting to talk to dr. Guttmacher, too. Host he is gone, but what was your question going to be . Caller i was going to ask about an experiment at a local university. I have a friend who went through the program. ,he went through 2. 5 years ago a program in emory. She was fixing to go to hospice. She had given up. He had stage four cancer i think it was seven cancers through her body. She went through this program at emory and they implanted some type of device in her back. I dont know and what this device days, a cut off the blood supply to those cancers. And today, she is 2. 5 years out of that program cancer free. I wanted to know if that treatment system was ever going. O be made available how much longer he would be an Experimental Program and when it would become available. I try to keep up with most cancers. My wife died of cancer twoandahalf years ago. We have cancer in my family. And this treatment was so successful and so good, i was just wondering how much longer it would be before it he came available to the general public. Host think you, sir. We will try to work a question in as we go this morning. And now has to go to the National Institute of health, dr. Gary gibbons, who is the director of the heart, lung, and Blood Institute. What is the connection between the heart, lungs, and blood . Guest the thing that connects them all is the blood vessels. In our portfolio, the number one cause of death in america for both men and women is hard to see. Our portfolio also includes toding chronic diseases determine the leading causes of death in this nation. It is an important part of our portfolio and has an impact on the health of all americans. And that is why, indeed it is important to continue to invest in Biomedical Research so that then we can reduce the morbidity of these chronic diseases. Host what are chronic diseases . Guest diseases like Heart Disease that promote ongoing disability. For example, Heart Failure makes it difficult to walk from exercise, creates chronic shortness of breath and has a negative impact on their quality of life. Part of what we are trying to do is to develop preventive strategies that can keep the heart healthy so that it does not fail to act as it should as a pump and to keep people healthier, so they live longer and more productive lives. Causes, andre the how many causes are there of Heart Disease . Guest the major problem with Heart Disease is the clogging of the blood vessels that feed the heart. As you are probably aware, the Research Done with the heart study that we funded identified oneweek all risk factors for the development of those clogged arteries. It relates to things like high blood cholesterol, high Blood Pressure, cigarette smoking. And these risk factors injure the blood vessels that feed the heart, clogging the arteries come and up writing the heart of od flow and oxygen clogging the arteries, depriving the heart of blood flow and oxygen. When this happens, we call that a heart attack. They can cause death immediately, or can injure the heart in a way that predisposes the feeling of the heart failing of the heart. Host is that recoverable . Guest that is part of the good news. Due to the research that the nih has funded, we have learned so much more about what causes the clogging of the arteries and that has lead to interventions that can actually prevent and even reverse the clotting process. Some of the drugs that maybe some of your audience is aware of, the staten drugs, they actually lower the bad cholesterol, the ldl cholesterol. In studies done by the nih and others they have been shown to prevent heart attacks and in that way, it is reducing the burden of this disease. Host dr. Gary gibbons is our guest, the director of the heart, lung, and Blood Institute, one of the larger institute at nih. Annual budget of about 3 billion, about 917 federal employees. How long have you been with nih, dr. Gibbons . Guest im still a relative newbie. Ive been here about 18 months. It has been a privilege. Host prior to that, what are you doing . Guest i was a professor at a Research Institute in georgia. And a graduate of harvard ino at brigham hospital baltimore. We hear eat fish for your heart from exercise for your heart. What is common sense advice . Those are good pieces of common sense advice. All three work. Our nih research forms the basis of all of those recommendations. For example, we funded a study that developed the dash dietary plan. It is rich in fruits and vegetables, whole grains, fish, poultry, and that diet has been shown to lower Blood Pressure. Indeed, it lowers Blood Pressure almost as well as the pills you can take. We recognize that eating healthy reduces those risk factors i talked about before that drive the development of the clogging of the arteries that leads to. Eart attacks a healthy diet is critical. We also know that smoking stopping smoking is critical to prevent heart attack. Clearly, moving more, eating healthier, all good things for your heart. Host can we still enjoy a good steak . Guest as your grandmother probably told you, all things in moderation. It is important to recognize that having a diet in which proteins are really low in fat is a critical aspect of the healthy lifestyle. Is also, what were learning what is the connection between diet and Heart Disease . Intriguing Research Suggests that fruits and vegetables are also changing our whole bodies metabolism. Your bodys metabolism is influenced by bacteria and microbes that live with in your gut and when you eat certain dietary foods, youre actually feeding the bacteria in your gut that are helping to digest the food. A diet rich in fruits and vegetables and low in red meat actually preis predisposes you to the kinds of microbes that are beneficial in helping us digest food in ways beneficial to unclogging the arteries. That is the linkage between those healthy dietary habits and the pathways and processes that protect your heart. Host dr. Gibbons, do you eat red meat at all anymore . Guest i must admit, on occasion. I do try to practice what i preach, however, so it is just on occasion. Part, my diet is fruits and vegetables, wholegrain, lean fish, and poultry. Host another heart cure that we have had heard about over the years is red wine. Guest i dont know if i would call it a cure, but we have learned that there are chemicals in both fruits and vegetables come as you know in chemicals in both fruits and vegetables. As you know, one is made from fruit. These chemicals are called phytochemicals. And they are broken down by the bacteria that cohabitate with us and coexist with us in our gut. Gives wineerial that its color is broken down to a chemical that actually changes how our bodys immune system works and affects our metabolism that probably does contribute to the beneficial effects. But i should caution, all things in moderation. Host cardiovascular disease by the numbers in 2010, 700 88,000 deaths. 788,000 it is the leading cause of death in the state. The death rate increased, cardiovascular death, from 1920 until it peaked in 1968. And in 2010, the rate was below the alltime low in 1900. How did we peaked and then go down from 1968 . Really a great testimony for the importance of investing in Biomedical Research. I think it is one of the great obiries in which the nh 1949 to study in determine what the determinants of Heart Disease and heart attacks were. That was a death sentence in that timeframe. It unlocked and really discovered these risk factors that i talked about. And that you mentioned. Cigarette smoking, high Blood Pressure, high cholesterol, diabetes as determinants of the statistics that you talked about. Similarly, researchers began to identify the pathways that created things like high cholesterol and high Blood Pressure. Moreover, as part of a partnership between the ,overnment and private sector and identification of the pathways, the drug targets that could change cholesterol and let pressure, Blood Pressure, this development of lowerceuticals that could Blood Pressure. The nih funded Clinical Trials to show that if you lower Blood Pressure and ldl cholesterol, you can save lives. It took a lot to bend those curves and change the statistics that you described. It is a testimony to how important it is to continually invest in Biomedical Research in ways that turn science into enhancements that are helpful to the nation. Host boring file clerk tweet into you, doctor, our youth experiencing more Heart Disease than in the past . What is the cause of this question mark is a diet, stress, or both . Guest we are concerned about the youth in america. Heart disease is something that is thought of as something that happens only to the elderly, and certainly it is quite prevalent. But one of the concerns we have is with the growing obesity epidemic. And the fact that our children are increasingly overweight and obese. We now recognize related to cardiovascular disease starts very early. And indeed, the earliest signs of a begin in childhood. Being overweight and obese as a child puts that individual on a trajectory so that by the time they reach middle age, they are at an increased risk for developing Heart Disease. One of the possibilities is that despite those trends and advances that you described earlier, you we could have a that actually may have Heart Disease at an earlier age than the current term duration. That would be the current generation. That would be sad. The key thing is that this is preventable. The important thing is that we as families get together and make sure that our children are more physically active and that they maintain a normal body weight. Host richard from franklin texas, you are on with dr. Gary gibbons, director of the heart, lung, and Blood Institute. Caller all right. Ive been waiting a little bit. I had two questions. One for the previous guest, and he is gone, but i will make it comment and a question to the current guest. From the statement made by the previous dr. What was his name . Guttmacher, yeah. He made all the statements about the great things that the nih is doing. I would like to make this comment. If you get on any website, you can see that we rate number 27 around the world in longevity. If we have such a Great Program here at 31 billion a year, what are these other countries spending and why are they living longer . Host thank you. Lets get an answer from dr. Gibbons. Guest the caller raises a good question. Its important to recognize that america still remains the preeminent leader in Biomedical Research. And the Research Results that we describe actually do go around the world. This is new knowledge that is put into action by citizens throughout the world in advancing science and advancing medicine. What the caller also points out is that it is important to translate discovery science, the new knowledge we generate into. Hanges in health indeed, some of that relates to the Health Behaviors and we must adopt, as weve been describing. Much of it is at the level of the individual. We talk about stopping smoking and exercising more, and eating a heart healthy diet. I might point out that many of the dietary elements i mentioned, the dash diet, high in fruits and vegetables, lean , is probablyish different from the typical american diet. And we know that americans to the glee eat higher fat food, typically eat higher fat food, calorie dense food. And some of those statistics relate to the fact that we, as americans, are still not adhering to the most heart healthy diet as the leading cause of death and disability. Host from smith, arkansas. Caller good morning. 2008 andeart attack in they did a thing called eeoc. Are you familiar with it . Guest i have some familiarity with it. Host what is that . Caller it is a procedure where they put the balloons on your leg and on your body, and you are tied up to the computer. Goes up to ais a maximum of 200 pounds of pressure and it pushes the blood on the heartbeat. In the middle of the heartbeat when it momentarily stops, it balloons up. It puts pressure. I had the bottom of my heart, due to diabetes, the little vessels were stopped up. Anyway, its been 5. 5 years. Testcently ran a stress and there was virtually no change in the stress test that i had at the end of that 35 day program and my current status. I was rather impressed with it. Host thank you. A response for the caller . Guest i think it is always important to consult your care provider in these cases. There are many things we dont know about the colors disease. Is when you have a heart attack, there are several critical things that are important, that we note works through critical trial data. That is, if you had a heart attack and your smoking, stop smoking and you reduce the likelihood of having a repeat heart attack. We know that it is critical that you be on a medicine, a class of them, thatcall lowers the allele cholesterol. That is critically important. And depending on how much damage is done, other therapies are important to institute after a heart attack, particularly if there is damage to the heart to pump blood. There are clear guidelines that have been developed that are based on evidence and Clinical Trial work that shows what really benefits patients after a heart attack. We encourage them we encourage patients to follow those legal guidelines. Host do you recommend to your patience and aspirin a day question mark guest and aspirin a day . Guest yes, that is one of those things that been shown that has been shown to be beneficial. As one of the medications that a person after heart attack should be on. Host the last 20 to 30 years when it comes to heart and lung diseases, cardiovascular diseases, how has our world changed . Guest i have enough gray hairs to recognize that when i was in training how we treated patients coming in for a heart attack is dramatically different than the way it is today. There have been a number of advances in our ability to diagnose disease, prevent disease, intervene in the , andxt of a heart attack literally open up an artery that is clogged in the midst of a heart attack. That has been shown to be beneficial. The advent of the things you and wiresing balloons to keep a blood vessel open. These are incredible advances in the last couple of decades. And more important, we are excited about the opportunities in the future, the advances in our knowledge that have led to their. , new drugs two therapeutics new drugs that are helping us fight disease. And Biomedical Research is advancing our knowledge even further. We are now recognizing that there may be other molecules and other cholesterols and fats in the blood that could be problematic. Weve learned about new pathways. Sk9 and itled pc advances our understanding of the genetic basis of disease and that is leading to new development of therapeutic targets that are being tested. We still have some Unfinished Business in further reducing Heart Disease. I think research will lead to results. There is a promising future. History of your long working with hearts and heart medication, has the socalled zipper club been reduced dramatically, the openheart surgery folks . Guest well, certainly, there are probably fewer members of that club every year. That relates to a number of changes. Is, how cardiothoracic surgeons approach Heart Disease is changing. There are advances and robotices that use tools that are less interested in terms of the effect on the chest wall. Some of these that i have we are getting nonsurgical approaches to open longertermies with effectiveness, using stints and other strategies. Those advances are influencing our ability to what we call e the heart. T on with dr. You are given. Dr. Gibbons. Caller thank you. I have been ignorant of the nih. I have had a person not, door frequently. I disregarded the person and now i change my mind. Im going to contact them. Host why is nih knocking on your door . Caller they evidently want to do research. After listening to your program, im so impressed. How did i get put into their database . Host can you give us at least a generic explanation of your situation, why they would contact you . Caller i dont know if it is my records from my Doctors Office sent to a database. I dont know. Host host dr. Gibbons, any response for her without knowing her situation . Its a little difficult to comment without knowing the details, but i suspect its highly unlikely that the National Institutes of health solicited a person mo didnt voluntarily come to seek engagement in a Clinical Research study. Tiply Experimental Program<\/a> and when it would become available. I try to keep up with most cancers. My wife died of cancer twoandahalf years ago. We have cancer in my family. And this treatment was so successful and so good, i was just wondering how much longer it would be before it he came available to the general public. Host think you, sir. We will try to work a question in as we go this morning. And now has to go to the National Institute<\/a> of health, dr. Gary gibbons, who is the director of the heart, lung, and Blood Institute<\/a>. What is the connection between the heart, lungs, and blood . Guest the thing that connects them all is the blood vessels. In our portfolio, the number one cause of death in america for both men and women is hard to see. Our portfolio also includes toding chronic diseases determine the leading causes of death in this nation. It is an important part of our portfolio and has an impact on the health of all americans. And that is why, indeed it is important to continue to invest in Biomedical Research<\/a> so that then we can reduce the morbidity of these chronic diseases. Host what are chronic diseases . Guest diseases like Heart Disease<\/a> that promote ongoing disability. For example, Heart Failure<\/a> makes it difficult to walk from exercise, creates chronic shortness of breath and has a negative impact on their quality of life. Part of what we are trying to do is to develop preventive strategies that can keep the heart healthy so that it does not fail to act as it should as a pump and to keep people healthier, so they live longer and more productive lives. Causes, andre the how many causes are there of Heart Disease<\/a> . Guest the major problem with Heart Disease<\/a> is the clogging of the blood vessels that feed the heart. As you are probably aware, the Research Done<\/a> with the heart study that we funded identified oneweek all risk factors for the development of those clogged arteries. It relates to things like high blood cholesterol, high Blood Pressure<\/a>, cigarette smoking. And these risk factors injure the blood vessels that feed the heart, clogging the arteries come and up writing the heart of od flow and oxygen clogging the arteries, depriving the heart of blood flow and oxygen. When this happens, we call that a heart attack. They can cause death immediately, or can injure the heart in a way that predisposes the feeling of the heart failing of the heart. Host is that recoverable . Guest that is part of the good news. Due to the research that the nih has funded, we have learned so much more about what causes the clogging of the arteries and that has lead to interventions that can actually prevent and even reverse the clotting process. Some of the drugs that maybe some of your audience is aware of, the staten drugs, they actually lower the bad cholesterol, the ldl cholesterol. In studies done by the nih and others they have been shown to prevent heart attacks and in that way, it is reducing the burden of this disease. Host dr. Gary gibbons is our guest, the director of the heart, lung, and Blood Institute<\/a>, one of the larger institute at nih. Annual budget of about 3 billion, about 917 federal employees. How long have you been with nih, dr. Gibbons . Guest im still a relative newbie. Ive been here about 18 months. It has been a privilege. Host prior to that, what are you doing . Guest i was a professor at a Research Institute<\/a> in georgia. And a graduate of harvard ino at brigham hospital baltimore. We hear eat fish for your heart from exercise for your heart. What is common sense advice . Those are good pieces of common sense advice. All three work. Our nih research forms the basis of all of those recommendations. For example, we funded a study that developed the dash dietary plan. It is rich in fruits and vegetables, whole grains, fish, poultry, and that diet has been shown to lower Blood Pressure<\/a>. Indeed, it lowers Blood Pressure<\/a> almost as well as the pills you can take. We recognize that eating healthy reduces those risk factors i talked about before that drive the development of the clogging of the arteries that leads to. Eart attacks a healthy diet is critical. We also know that smoking stopping smoking is critical to prevent heart attack. Clearly, moving more, eating healthier, all good things for your heart. Host can we still enjoy a good steak . Guest as your grandmother probably told you, all things in moderation. It is important to recognize that having a diet in which proteins are really low in fat is a critical aspect of the healthy lifestyle. Is also, what were learning what is the connection between diet and Heart Disease<\/a> . Intriguing Research Suggests<\/a> that fruits and vegetables are also changing our whole bodies metabolism. Your bodys metabolism is influenced by bacteria and microbes that live with in your gut and when you eat certain dietary foods, youre actually feeding the bacteria in your gut that are helping to digest the food. A diet rich in fruits and vegetables and low in red meat actually preis predisposes you to the kinds of microbes that are beneficial in helping us digest food in ways beneficial to unclogging the arteries. That is the linkage between those healthy dietary habits and the pathways and processes that protect your heart. Host dr. Gibbons, do you eat red meat at all anymore . Guest i must admit, on occasion. I do try to practice what i preach, however, so it is just on occasion. Part, my diet is fruits and vegetables, wholegrain, lean fish, and poultry. Host another heart cure that we have had heard about over the years is red wine. Guest i dont know if i would call it a cure, but we have learned that there are chemicals in both fruits and vegetables come as you know in chemicals in both fruits and vegetables. As you know, one is made from fruit. These chemicals are called phytochemicals. And they are broken down by the bacteria that cohabitate with us and coexist with us in our gut. Gives wineerial that its color is broken down to a chemical that actually changes how our bodys immune system works and affects our metabolism that probably does contribute to the beneficial effects. But i should caution, all things in moderation. Host cardiovascular disease by the numbers in 2010, 700 88,000 deaths. 788,000 it is the leading cause of death in the state. The death rate increased, cardiovascular death, from 1920 until it peaked in 1968. And in 2010, the rate was below the alltime low in 1900. How did we peaked and then go down from 1968 . Really a great testimony for the importance of investing in Biomedical Research<\/a>. I think it is one of the great obiries in which the nh 1949 to study in determine what the determinants of Heart Disease<\/a> and heart attacks were. That was a death sentence in that timeframe. It unlocked and really discovered these risk factors that i talked about. And that you mentioned. Cigarette smoking, high Blood Pressure<\/a>, high cholesterol, diabetes as determinants of the statistics that you talked about. Similarly, researchers began to identify the pathways that created things like high cholesterol and high Blood Pressure<\/a>. Moreover, as part of a partnership between the ,overnment and private sector and identification of the pathways, the drug targets that could change cholesterol and let pressure, Blood Pressure<\/a>, this development of lowerceuticals that could Blood Pressure<\/a>. The nih funded Clinical Trials<\/a> to show that if you lower Blood Pressure<\/a> and ldl cholesterol, you can save lives. It took a lot to bend those curves and change the statistics that you described. It is a testimony to how important it is to continually invest in Biomedical Research<\/a> in ways that turn science into enhancements that are helpful to the nation. Host boring file clerk tweet into you, doctor, our youth experiencing more Heart Disease<\/a> than in the past . What is the cause of this question mark is a diet, stress, or both . Guest we are concerned about the youth in america. Heart disease is something that is thought of as something that happens only to the elderly, and certainly it is quite prevalent. But one of the concerns we have is with the growing obesity epidemic. And the fact that our children are increasingly overweight and obese. We now recognize related to cardiovascular disease starts very early. And indeed, the earliest signs of a begin in childhood. Being overweight and obese as a child puts that individual on a trajectory so that by the time they reach middle age, they are at an increased risk for developing Heart Disease<\/a>. One of the possibilities is that despite those trends and advances that you described earlier, you we could have a that actually may have Heart Disease<\/a> at an earlier age than the current term duration. That would be the current generation. That would be sad. The key thing is that this is preventable. The important thing is that we as families get together and make sure that our children are more physically active and that they maintain a normal body weight. Host richard from franklin texas, you are on with dr. Gary gibbons, director of the heart, lung, and Blood Institute<\/a>. Caller all right. Ive been waiting a little bit. I had two questions. One for the previous guest, and he is gone, but i will make it comment and a question to the current guest. From the statement made by the previous dr. What was his name . Guttmacher, yeah. He made all the statements about the great things that the nih is doing. I would like to make this comment. If you get on any website, you can see that we rate number 27 around the world in longevity. If we have such a Great Program<\/a> here at 31 billion a year, what are these other countries spending and why are they living longer . Host thank you. Lets get an answer from dr. Gibbons. Guest the caller raises a good question. Its important to recognize that america still remains the preeminent leader in Biomedical Research<\/a>. And the Research Results<\/a> that we describe actually do go around the world. This is new knowledge that is put into action by citizens throughout the world in advancing science and advancing medicine. What the caller also points out is that it is important to translate discovery science, the new knowledge we generate into. Hanges in health indeed, some of that relates to the Health Behaviors<\/a> and we must adopt, as weve been describing. Much of it is at the level of the individual. We talk about stopping smoking and exercising more, and eating a heart healthy diet. I might point out that many of the dietary elements i mentioned, the dash diet, high in fruits and vegetables, lean , is probablyish different from the typical american diet. And we know that americans to the glee eat higher fat food, typically eat higher fat food, calorie dense food. And some of those statistics relate to the fact that we, as americans, are still not adhering to the most heart healthy diet as the leading cause of death and disability. Host from smith, arkansas. Caller good morning. 2008 andeart attack in they did a thing called eeoc. Are you familiar with it . Guest i have some familiarity with it. Host what is that . Caller it is a procedure where they put the balloons on your leg and on your body, and you are tied up to the computer. Goes up to ais a maximum of 200 pounds of pressure and it pushes the blood on the heartbeat. In the middle of the heartbeat when it momentarily stops, it balloons up. It puts pressure. I had the bottom of my heart, due to diabetes, the little vessels were stopped up. Anyway, its been 5. 5 years. Testcently ran a stress and there was virtually no change in the stress test that i had at the end of that 35 day program and my current status. I was rather impressed with it. Host thank you. A response for the caller . Guest i think it is always important to consult your care provider in these cases. There are many things we dont know about the colors disease. Is when you have a heart attack, there are several critical things that are important, that we note works through critical trial data. That is, if you had a heart attack and your smoking, stop smoking and you reduce the likelihood of having a repeat heart attack. We know that it is critical that you be on a medicine, a class of them, thatcall lowers the allele cholesterol. That is critically important. And depending on how much damage is done, other therapies are important to institute after a heart attack, particularly if there is damage to the heart to pump blood. There are clear guidelines that have been developed that are based on evidence and Clinical Trial<\/a> work that shows what really benefits patients after a heart attack. We encourage them we encourage patients to follow those legal guidelines. Host do you recommend to your patience and aspirin a day question mark guest and aspirin a day . Guest yes, that is one of those things that been shown that has been shown to be beneficial. As one of the medications that a person after heart attack should be on. Host the last 20 to 30 years when it comes to heart and lung diseases, cardiovascular diseases, how has our world changed . Guest i have enough gray hairs to recognize that when i was in training how we treated patients coming in for a heart attack is dramatically different than the way it is today. There have been a number of advances in our ability to diagnose disease, prevent disease, intervene in the , andxt of a heart attack literally open up an artery that is clogged in the midst of a heart attack. That has been shown to be beneficial. The advent of the things you and wiresing balloons to keep a blood vessel open. These are incredible advances in the last couple of decades. And more important, we are excited about the opportunities in the future, the advances in our knowledge that have led to their. , new drugs two therapeutics new drugs that are helping us fight disease. And Biomedical Research<\/a> is advancing our knowledge even further. We are now recognizing that there may be other molecules and other cholesterols and fats in the blood that could be problematic. Weve learned about new pathways. Sk9 and itled pc advances our understanding of the genetic basis of disease and that is leading to new development of therapeutic targets that are being tested. We still have some Unfinished Business<\/a> in further reducing Heart Disease<\/a>. I think research will lead to results. There is a promising future. History of your long working with hearts and heart medication, has the socalled zipper club been reduced dramatically, the openheart surgery folks . Guest well, certainly, there are probably fewer members of that club every year. That relates to a number of changes. Is, how cardiothoracic surgeons approach Heart Disease<\/a> is changing. There are advances and robotices that use tools that are less interested in terms of the effect on the chest wall. Some of these that i have we are getting nonsurgical approaches to open longertermies with effectiveness, using stints and other strategies. Those advances are influencing our ability to what we call e the heart. T on with dr. You are given. Dr. Gibbons. Caller thank you. I have been ignorant of the nih. I have had a person not, door frequently. I disregarded the person and now i change my mind. Im going to contact them. Host why is nih knocking on your door . Caller they evidently want to do research. After listening to your program, im so impressed. How did i get put into their database . Host can you give us at least a generic explanation of your situation, why they would contact you . Caller i dont know if it is my records from my Doctors Office<\/a> sent to a database. I dont know. Host host dr. Gibbons, any response for her without knowing her situation . Its a little difficult to comment without knowing the details, but i suspect its highly unlikely that the National Institute<\/a>s of health solicited a person mo didnt voluntarily come to seek engagement in a Clinical Research<\/a> study. Tiply Funds Research<\/a> ins to do they solicited individuals to participate. But its always a voluntary done under the oversight of what are called ensure that theres informed consent involved. There are close safeguards on privacy issues. Sharing ofnot a information. That would enable someone to trace someone down for research. Are a lot of safeguards that would prevent that from happening. Dr. Gibbons, do you currently have patients at. I. H. . Guest im sorry, i didnt get that last question. Currently at heart lung and Blood Institute<\/a> patients . Have guest there is a program at. I. H. On the bethesda, maryland campus in which we have the Largest Research<\/a> hospital in world. Which patients come from all world. E its an integral program in which patients are undergoing Research Studies<\/a> in the clinical center. Host from virginia, good you. Ng to caller hi, how are you doing. About researchon biomedical. I have a chronic illness and i and since thent problems. Ll kinds of im diabetic. Im certain to have trouble with and starting to cough up blood, and blow out blood and nose. Out of any and the stress of it is really great diet,ave a vitamins every day. But i do not have a doctor or insurance right now and im wondering if youre having these bloodms like coughing up and stuff, is there any kind of, to say, Research Thing<\/a> that yall could get me into . Guest well, certainly those symptoms are of concern. You toould encourage seek a Health Care Provider<\/a> to really try to diagnose whats going on there. Those are clearly symptoms that and they do need to be checked out. So. Courage you to do those could be of substantial significance, and its more important to find out whats going on and get the appropriate thatment, as opposed to being a research matter. So, again, i encourage you to clinical care. Host dr. Gibbons, when it comes to the issue of asthma, how much is hereditary, how much of that is environmental . What kind of research is being done right now . Pointingll, as you are out, asthma is one of our most common chronic conditions, it the most chronic condition for children, it causes millions of lost school days each year for children and work days for adults. So this is a critical problem, expecting tens of millions of americans. And its one in which its a classic example of both genes and environment playing a role. Al of the emergence 1,000of what may be a genome in which well know all the genetic codes of a given it all offers a lot of promise for personalizing precision medicine. Were starting to unlock what of asthma and identifying new pathways that preventingful in. His chronic disorder were starting to identify pathways, and the environment get overreved up and cause problems like asthma. For newa lot of promise therapeutics that can target these pathways and be more treating this disease. This is a condition that is particularly problematic in populations, africanamerican children, latino children, particularly high disproportionate burden of this, with high room visits and hospitalization. So this is a top provide or toy we can takee how Research Results<\/a> and have public impact. Host dr. Gary gibbons is the director of the national heart, one ofd Blood Institute<\/a>, 27 institutes at the National Institute<\/a>s of health. For your time. Guest thank you. Host one more Institute Director<\/a> coming up and thats dr. Stephen katz, National Institute<\/a> of arthritis and and skineletal diseases. Hell be joining us in just a to takes we continue your calls. Anthony in virginia, if youd make a comment, go ahead we have no guest at this point. A comment tove make wed like to hear from you. You. R thank id like to make a comment to dr. Gibbons that im very grateful for his organization and what they do for the country, i think its very honorable. Is thation or comment the chairman of the world health who, has recently stated that 85 of the Worlds Health<\/a> problems derive from smoking cigarettes. Understand that 1400 fromcans die per day smoking cigarettes. I was just wondering, why is such a monster being sold in the United States<\/a> and the world, and why is it legal . Thats anthony in stewart, virginia. Mark yet in north carolina, hi. Caller hi. I have heard that theres a lot drugstroversy over statin and particularly for women. And i was going to ask the doctor about that. Host where did you hear that there was controversy over statins . Caller well, you hear it, you everywhere, you know. Doctor see it on lots of it. S on tv, you read about so thats where ive heard about it. Host thank you for sharing that. Maureen in beaver dam, kentucky, maureen, we dont have any guest us yet, but what kind of comment would you like to make regarding. I. H. . Caller well, with dr. Gibbons disease, i lost several members of my family recently, and out of eight siblings, seven of us have had heart surgery and high cholesterol and so forth, and high Blood Pressure<\/a>. Wondering why the study of the use of marijuana has not allowed, and im disabled from multiple car wrecks, glaucoma, neurological disorders, and the studies and ive looked at all marijuana the use of would benefit my health and could be more myself and i was wondering why theyre not use of that and allowing that. Tried it on your own, regardless of what the says . Of kentucky caller yes, i have. You . Does it help caller yes. Ad all of the drugs, 14 drugs day, have more affect on my than what the marijuana would have. Medications for over 20 years. An effect on my knowing whether one part of the body, just because this is bad for you, well, they need to look hemp and marijuana that morea lot less effect and benefits for people like me. Host all right. Kentucky, beaver dam, thank you. One more Institute Director<\/a>, we want to introduce you to at. Morning and thats dr. Stephen katz, national anditute of arthritis musculoskeletal disease and skin diseases, thats a mouthful, dr. Katz. What is it that your institute on . Entrates guest well, i should say that i nihns, just to be short, and we greatly appreciate featuring the. In i. H. On your program so that will learneople about the things we do here at n. I. H. Betweenon feature arthritis musculoskeletal and skin diseases is the connective tissue. Youve much these components is made of primarily of connective other cells of course. So even though you dont think likenes and skin as a organ, they are alike in that uponhave a basic structure which other molecules build. In the case of bones, its which makes up our bones. Array ofa broad diseases, maybe common and chronic diseases, many diseases that have a propensity for occurring in women and more so than men and majority. And we feature our research on joints, andes, skin. That is a wide array of mission. Ility and host dr. Katz, could you give us some disease names that be familiar with . Guest are of course. Sayhe first of all i should that the diseases that we cover touch virtually every family not country but in the world. So osteoporosis, for example, thinning of bones that leads to fractures. Osteo excuse me. Osteoporosis is one. Another thatl be well be talking about. Osteoarthritis is another that causes degenerative arthritis. Millions andn millions of people in the area diseases. Mune diseases like rheumatoid art lupus. Nd is sorry about this. Host no problem. Lupus is another one. Were going to put the numbers up. Area of skin the diseases, psoriasis, for example, and dermatitis, among others. Host these are the numbers if youd like to participate in our conversation with dr. Stephen katz. Well begin taking your calls in just a minute. Comes to ahen it disease like arthritis or osteoporosis, number one, are inherited . Are they reversible . Heard fromyouve others that many of these diseasesare complex that are contributed to by both the genes and environment. We know, for example, that osteoporosis, when i was in school, we learned that bones just eroded as you age, but thats not true. Very dynamic organ. Now there are drugs that can reverse some of the effects of osteoporosis to make bones stronger, to make them less susceptible to fracture. That advanced with regard to osteoarthritis. We do know some of the risk factors, but were not that advanced. Psoriasis, for example or rule toy arthritis, which are know amune diseases, we lot about the diseases, we know treatment. The we are learning more about early diagnosis, because Early Intervention<\/a> becomes very, very important in terms of stopping isity of these diseases and most of these are chronic of which are very painful. In the case of skin diseases, many of them are very itchy. Host dr. Katz youve been working at n. I. H. For quite a while. A lot of the diseases you deal with involve drugs. Betweenhe interaction n. I. H. And the Drug Companies<\/a> and the research . Whats the dynamic . Well, you have partnerships with pharmaceutical companies. Give threee to examples. The first example is something that weve been doing for about or 13 years which is the osteoarthritis initiative. Initiativethritis was instituted by our institute the National Institute<\/a> of aging, as well as other i. H. , and of the n. Four pharmaceutical companies. That partnership was to identify progression of degeneration who wereints in people susceptible to degeneration of the joints. Because Drug Companies<\/a> cant take 20o studies that or 25 years to develop the drug. So what were looking for are bio markers. Biomarkers can be markers of disease or they can be markers of disease progression. Thats the type of partnership the we have in osteoarthritis initiative. With that resource thats available to the whole world, the whole world is using that resource to try to identify of thehanges and trends joint space thinning, so that one doesnt get bone on bone causes the osteoarthritis. The area of bone quality, we theres a which many of your listeners that predictsut ofewhat the possibility developing fractures. Its good, but its not so good. We need better markers. So in collaboration with the wendation for the n. I. H. , and other institutes at the n. I. H. Have just recently launched the bone quality initiative, because its not only the density of bone that counts, of bone thatity counts in terms of predisposition to fractures. Most recent of the partnerships is one that francis featured in december in the washington journal as well as the National Press<\/a> club recently and that is the medicineing partnership, which is a partnership between four n. I. H. Institutes and 10 pharmaceutical companies. To advance really the understanding of targets that may be used for the pharmaceuticals. So in our case there are actually three components to this. Component is to target hear abouthat youll from jeff rogers when you speak with him. The other is on alzheimers disease, by the doctor from the National Institute<\/a> of aging is othersd with, and the are Rheumatoid Arthritis<\/a>, lupus and other auto immune diseases we at the nims are particularly involved with. This is a partnership where and theutical companies n. I. H. Contribute equally to iselop information that called precompetitive information, that is nobody is get advantage of this except its going to move the field forward. So that things that we couldnt do individually can be done in with openp information so that the whole world will know about it and be to developlize that intellectual property and develop certain pharmaceuticals accelerated manner. Called what is otherwise the a. M. P. Initiative. The n. I. H. See any financial return from the successful experiment and research . Guest so, in the precompetitive are no intellectual developed. That are if something is developed from this knowledge, it depends on where its developed. Developed within the n. I. H. Campus here, by one of our there areors, yes, royalties that come through not only the individual investigator by also to the n. I. H. In general. In these investigators community that we support and as youve heard we support many hundreds of thousands of investigators throughout the country and the world, if the discovery is made by them, then the intellectual property goes them as well as to their academic host center, as well as the pharmaceutical companies. Whate not, and ill repeat Francis Collins<\/a> said a few weeks ago, or a few months ago, were in the business of making pills. Were in the business of developingknowledge, new discoveries that will lead identification of ins dents host dr. Stephen katz its our guest. Barbara from missouri, you are up. T caller good morning. I want to ask questions about patient participation in your toearch, and what i want if, are you really there to help the person who would participate . And the other question is how do become a participant as a patient . Host thank you for that question. Cover ae at the niams broad slot of information. Very, very basic research to translational to theh to translation patient, and to translation to the public in terms of prevention. When there are certain studies that normal individuals participate in, that will be of no benefit to them, but they them. Articipate in the arthritis initiative is one where we have asked people to participate. They can be treated for their as at the oh arthritis, but is that of the to the study. There are other studies where we ask patients to participate when we are developing new interventions, and when we ask them to participate they may from those studies, they may not benefit from those studies. If theres studies where some patients get the intervention placebo,patients get a its blinded, so that we dont gets what so the evaluation can be much more critical. How do you participate in clinical studies at the n. I. H. , good question. Terrific website that no matter what disease or what problem youre looking to research, you dont even have to well,ow to sell it very because theres a spelling correction on it, its called trials. Gov, probably one of the most used websites in all of medicine. To do is put that disease name in or the problems name in at the Clinical Trials<\/a>. Gov and youll find out what studies are being done in disease. Icular host art from clearwater, kansas, youre on with katz. Ephen caller yes, good morning, for this thank cspan Great Program<\/a> this morning. Had a littleo i of i got remission on the symptoms was on a drug last august that. Ing very well on but among the areas of research do . You guest it is amongst the diseases that we do here. Who was on the program earlier this Program Leads<\/a> the National Institute<\/a> of diseases and strokes. And that condition aegis. Nder that but important for patients to know, that may be associated a skin disease. And those two are auto immune comeses that somehow together to target the molecules that attack the thymus, also be ak the skin, and it can problem for a small percentage of patients. But theres a Clear Association<\/a> diseases and two researchport a lot of in that. Host an individual tweets in to dont carbon ated beverages block absorption of vitamins . Ls and kids who drink cola five times as likely to break bone . That theyret know five times as likely to break bones. But the premise is correct, that inhibit absorption of minerals. Concerned about children as well. Theres a very recent study showing that if you take young that is, Young Children<\/a> age 8 to 12, 8 to 13, and if they actually break a wrist from standing position, then they densityeal low bone that is concerning. Itiously if they break during some football accident or some other accident, it may not with anyated osteoporosis. Again do believe that, talking about osteoporosis, that it is important to build up your bone bank early on in life, after the age of 20, 25, the breakdown of bone is a little greater than the buildup of bone. Made up of lots of different cells, but at age 25, degenerating start more than it builds up. Host whats the best way to bank . Up your bone guest well, one of the best ways to build up your bone bank diet iske sure your right, make sure you have a proper level of calcium and vitamin d. Your nutritional intake is proper. Builds uping that exercise,rly is particularly exercise like running. Example, fromfor in space, that, one of the major problems that astronauts have had in the past losing massive amounts of because ofscle, conditions. Ngravity so exercise and diet are very important elements. Thatct, there are studies show that Young Children<\/a> who can box, for example, five times a day or six times a those whored to dont, eventually will have a density. T higher bone if you take tennis players, their tennis arm has a higher, much higher bone melts density than the arm thats not the major arm for playing tennis. Youre ambidextrous. But those are proof that that type of exercise does help build bones. Host caller from virginia, holding, youre on with dr. Stephen katz. Morning, dr. Katz. I recently had an experience hospitalizedho was and in intensive care for two days. Doctors couldnt figure out what he had. But he finally, through an appointment with a got thelogist, diagnosis of a rare disease, still disease i. Wonder if you have any insight about that disease, or any contact point that might be helpful in helping him get over this. He seems to be doing much better, hes taking prednisone a rheumatologist, so maybe this is not anything au can add here, but its rare disease and i thought maybe it. Had some insight about guest thank you for the question. You are doing all the right things for your son. Sounds like hes moving in the right direction. One of the other i haventlities that talked about that all of us at dissemination the of knowledge. And i would encourage you to go nims ebsite, will findgov, and you that we have information on onset stills disease, and youll learn a little more in lay language about the disease, the prognosis. We are learning more about it fromse were learning actually Rare Diseases<\/a>, were learning a lot about more common diseases. Stills disease is one of the Rare Diseases<\/a> that is telling us more commonout the forms of arthritis. Host i want to read a couple of average american has tweeted in. Philosophical. This is the first one, doctor. How can a patient in a research guarantee that they get the experimental treatment and placebo . , followed by this tweet, how many control patients need to effective new treatment can be approved for mainstream use . Questions. Llent so the first, in answer to the first question, there are phases of studies. So, for example, in a phase one not beenere a drug has a ghostanyone, its finding study so that everyone getting the drug starting at a lower dose to a higher dose. At most studies are done in double blind fashion so that whoher the physician or ever is doing the study is blinded to the fact as to gettingthe patient is the active ingredient or the placebo. The importance of that is that some molecules that are thought be good, and thats why the study is done, may actually not only not work, but they may be bad. And the only way to find that objectivedo really studies. A doubleot possible in blind study to pick and choose what you want to happen. Are some surgical studies that are done as crossover put in forre if you one group and you are not, you no success out of that, you cross over to the other group and then you obviously know youre in. Palisades, pacific california, good morning. Caller good morning, hi, dr. Katz. Hi name is holly, im 58 years old. Was young i had severe legse spasms, and in my like charlie horses, and my neck. And throughout the years i developed couplen casts for a years. But when i turned 40 my osteoporosis became very, very developed i had surgery in 2000 that was successful. And i was literally hunched over the and on a walker. Years ago my upper neck disintegrated and dr. Patrick constructiveone and to hold my spinal cord. But the question is ive also renauds. Kin disease, is there a connection between the arthritis, the muscular diseases . Im just curious if there is a connection linking all of those, and i have been dieing a having auto immune a. A. N. Guest holly, are you the only member of your family who has conditions . Atler my grandmother died 73, and they said that her spine had also disintegrated when she in conjunction with also had colitis. Host well get the answer from dr. Katz. Guest so im a dermatologist and an immune olds, i know a lot diseases, auto immune diseases and skin diseases. But i do know about connections between these diseases and others. There is really no connection as reauds know between and as at the oh arthritis of the neck. The osteoporosis that you have, we know that in theres a muchs greater predisposition for one of thend thats big risk factors for developing history. Is family has anyone in your family had a of 55. E before the age if they have, maybe you want to test earlier on which the bones endocrinologists have identified people of an early osteoporosis. There are very good interventions which will stop the degeneration or deterioration of bone density. Host dr. Katz, how is your time divided between being an administrator, researcher and a physician . I probably spend 150 of my time being an administrator. Probably 40 of my time being im just kidding. Spent probably 75 of my time being an administrator. My time with my laboratory, and i spent about 5 to 10 of my time seeing patients. Have been following patients autocertain types of immune skin diseases for the past 40 plus years. N. I. H. Hem here at the host in the last 20, 25 years, forhave treatments arthritis, fibromyalgia, how ore they changed and advanced . Guest so if you start with arthritis, particularly in the arthritis,umatoid theres a sea change, and that about from very fundamental studies of actually mice that dying. They had whats called and they had a certain molecule that we now know which is far less important in cancer than inflammatory diseases. The start of the anticnf,t of the which has changed the lives of withons of people Rheumatoid Arthritis<\/a> and other diseases. Because of the development of these anticnf and other thebodies that work against inflammatory molecules. In the area of fibromyalgia, which is very important disease primarily in women, much more so in women than in men, our advances have not been as great because we have not underlyingo identify pathologic factors. But we do have constant that. Ment in weve done genetic studies as well as in the area of weve done, supported many behavioral therapy treatments to see if we can lessen the devastation of some of the pain that people have, andnic pain, sleeplessness have. Symptoms that they host dr. Stephen katz, director of the arthritis and skinloskeletal and diseases institute, one of 27 at the National Institute<\/a>s of health. We have the ability to write the script of our own life. We are in the driving seat of our own future. Our biggest decisions are made by us. America creates the sense of possibility. An of that, you can become activist, Community Organizers<\/a> are. Organizer. You are living off of the cap list explosion of wealth that you did not create. Nobody said, america is the most terrible place. But there are a couple of assertions that you have to take on faith that are astonishing. Americas idea that great invention was wealth creation. What about the theft of the entire continent . That was a theft. [applause] 90 of the residents who lived here were murdered. That was a part of it too. They debate what is so great about america tonight at 8 00 eastern on cspan. , new Jersey Governor Chris Christie<\/a> held a town meeting. They asked why he privatize the hurricane recovery program. My name is tom. That, you are right theres not enough money to make everyone whole. I would like to know the reason why you privatize the grant programs. Paid over 100 million to run different programs. Let me stop you. I will answer question. What is your suggestion on how i should have done it . Should i have hired thousands of new Government Employees<\/a> to administer the programs . I heard you say that you have 60,000 employees to manage. New york data it differently. They did not privatize it. That is not correct. By the way, new york is significantly, by a measure of threefold behind us in the distribution of money to victims. Significantly behind us. You cannot just say one fact that you like, that supports year position. You say, new york did not do it that way. If you talk to people in new york, like i have, who have not gotten anywhere near the aid. We are trying to do this in a way that its it out there to people as quickly and efficiently as possible. Dont take my word for it. I wont. I know you wont. The secretary of urban development and Obama Administration<\/a> has said that this money is gone out faster than in any major disaster in history. Thank you. Can we get back to my question . Why was hgi fired . Them 50ou pay million, and why did you privatize the programs . You didnt have to do that. I disagree with you. You say not to privatize it the alternative is. I am answering the question. Hiredternative is to have thousands of additional Government Employees<\/a> to be able to administer this. Who was going to administer this . It is a rhetorical question. Someone had to administer the programs. Placee a new company and run the Program Going<\/a> forward. If we reach a point where we believe that theres another company who can do the job better, then we will make that change. Think make a change if i there is an option that is better. If what you are hoping for is that every decision that is made, regarding billions of dollars is going to be made ,erfectly the first time, then your expectations are not where they need to be. The fact is that we do not have the number of employees, thankfully for you and your tax rates, on staff in the State Government<\/a> that could run an additional 20 billion were the programs. Be runningwe would your government and efficiently from daytoday. The 33 enough to run billion dollar government that you are ready pay for. I have not going to bring on more people. You have to pay Health Benefits<\/a> for and benjamin of its for, or the long haul, to run a program that by its nature, is a temporary program. That is why you bring and private contractors to run it. Not something that will be longterm, but something that will be temporary. That is why we did it. And that is why we chose to do it that way. And the results we have delivered is significantly better, in terms of the amount of money put out, then what youre seeing on the other side. Part of the town hall meeting held last night by chris christie. You can watch the entire event tonight at 10 00 p. M. Eastern or any time online at cspan. Org. On the next washington journal, james and david of the Heritage Foundation<\/a> discussed president obamas proposal to raise the minimum wage. Of theily Miller Washington<\/a> times on gun ownership in america. Then a discussion on wildlife trafficking and u. S. Strategies. Your phone calls. Facebook comments, and tweets. All that is on the washington at 7 00 a. M. On eastern on cspan. Yesterday Senior Executives<\/a> from the Retail Industry<\/a> discussed problems with transportation of the structure at an event held by the u. S. Chamber of commerce. This is close to one hour. Go behind the curtain. We are going to transition a little bit this afternoon. Morningd a lot this about the primary areas of the economy. Raw materials grade the manufacturing that turns it into products well need. Howit is time to talk about we get product into the hands of the people we needed, and how transportation helps the liver the services we need in the economy. The retail segment of the economy is massive. Matthew shaye, the president of the National Retail<\/a> federation, 4 workers. 1 in that is our story and we are sticking to it. The best thing i learned about matt, in addition to one asked of his favorite retailer, he said, i love them equally like children. He said that his children, and the president of shopping. I present to you the president of shopping, and matthew shaye. Shopping, matthew shaye. It is a pleasure to be here. I am matthew shaye, the president and ceo of the National Retail<\/a> federation. Were happy to be part of the discussion. It is the largest association representing the Retail Industry<\/a>. We spent everyone from the largest Discount Stores<\/a> to the smallest momandpop stores. From discount and department stores, chain restaurants, supermarkets, wholesale loves, luxury clubs , luxury. ,nd also sales of goods online those offered by online retailers. Theyre members of hours. They are companies that depend upon our nations and infrastructure to receive the goods that come to them from overseas into the country, and into a distribution center, or are manufactured in the United States<\/a> and shipped to places around the country am a either eventses or two consumer places. 4 jobs. Ate 1 in of therate a big part gdp. It is a big business. It it touches americans lives everything with a. That is why the intersection of infrastructure and read hill retail are so important. That is not just the car industry, both for consumers. Where one of the nations larger shippers. We spend billions of dollars moving products across highways. And to give you an idea of scale of what we move on and youll basis, we developed a product that tracks the level of container shipments that come into the country. Were 16 million containers that came into United States<\/a> and were turnaround and delivered via other means to Distribution Centers<\/a> and to the endusers. Increasea nearly 2. 5 over 2012. We expect we will see another increase again in 2014. Those containers get unloaded, they move across the nations infrastructure somehow to the enduser and to the final trip to the customer. Not just the imported merchandise, but it is something we manufacture and distribute in the country that is so important. A safe and efficient means of transportation is critical to our bottom line. To the extent that there are delays or inefficiencies in the supply chain, that adds up to additional costs for retailers, and ultimately, for consumers in the world in which we live today. We have an on demand level of expectation. A commitment that retailers and their partners want to make. And we will talk about that in a minute. A commitment we cannot fulfill unless the infrastructure needs are being met in a responsible way to ensure that we can take advantage of all of the opportunities that exist to grow 21stconomy by leveraging century infrastructure systems. That kind of sufficient efficient system is never more important than at the holidays. We know, given the kind of issues that occurred over the holiday, and with whether in particular. You cannot blame the weather exclusively. We know that the inadequacies of the system exist on a more permanent basis. We are aware that the weather this year has started to create problems in the past few weeks. Inknow that the numbers, terms of the delays that are going to occur in new york and new jersey, offloading container ships, and take move the cargo out of port have an impact. We heard about that during a luncheon presentation. We all expect some rough spots in january and february of this year. That highlights the need to create the most effective, efficient infrastructure we can. Ofse will be all the needs their resources. Have a conversation with an appropriate group of stakeholders to help us explore that. Perspective, what we would like to see is an adult discussion here in washington and row commitment to leadership in terms of thinking about longterm solutions here, not just continued shortterm lurching from crisis to crisis and temporary solution to temporary solution. Background, let me introduce our panel. I know you have their complete biographies, so i will not going to great detail. What from your left across the table, larry is the Senior Vice President<\/a> of director supply chain operations at a department store. Then the ceo it the airports , north international america. And the president of ups freight. And he has a brown suit on. It is perfect. Welcome to our panelists. Thank you all for being here today. Let me start with a question that you can each take a minute and address. We will start with larry. Is, what is your perspective on the role that infrastructure place in u. S. Competitiveness . , there is no question listening to all the speakers infrastructure forms the veins and arteries of the nation and country. All of us in the northeast have had to deal with punishing cold in january. We had nonstop snowstorms and i storms in february. It has been imperative that we set up contingency plans and emergency plans, and executing those plans is somewhat surprising to see. And infrastructure that is so robust and critical can also be so exposed overnight. Clearly, it is not a question of maintaining the infrastructure. It is a question of growing the infrastructure to make certain that the nation remains as efficient as possible. Also, globally is as competitive as possible. Shortt, my view and my 3. 5 weeks on the job here, with the airport industry, i have learned one thing. I knew this before. How important a strong infrastructure is for strong economy. Great deal time traveling around the world to third world countries and other countries where, in many cases, infrastructure is in a lot better shape than ours. In order for our commerce to be well received here and internationally, we up to have a strong of the structure at home. He the airports are gateways. Citiesorize them as within cities that have all the responsibilities and more regulatory requirements than the cities in which theyre in. They are also economic generators. Infrastructure is important for rails, roads, airlines and airports, and by see. Gateways forare people coming into United States<\/a> to spend money here. There gateways for people to leave the United States<\/a>. The longer we wait to fix the infrastructure, the bigger problem we have is how expensive it gets to fix. On top of that, it is the employment issue. Infrastructure employs people. Stillosition where we have high unemployment, well have to look to create jobs. In the airport business, we employ 1. 3 million people. Airport ised every United States<\/a>, we would be the second largest private sector employee in the United States<\/a>. That is a lot of folks. In terms of our effect on the gdp, we are seven percent of the total workforce in the United States<\/a>. And we are a percent of the nations ddp. When you add that up and see what infrastructure means, it is a huge issue for us grade us. Youre in a global business. Is your perspective on the impact on our overall competitiveness. First of all, i guess to describe our network i will use medical terminology. The connective tissue of the economy. Transportation, telecom, and energy. Our system is the envy of the world. If you think about the rawsportation side, a gets goods to factories. A gets workers to jobs. Ultimately, it gets consumers to the stores. If you think about all those they are all positive and great contributors to the economy. If you go back to the 19th 50s 1950s, 19 and then you take them for it and see the lack of investment that penalizes us, and some of the stories with Mother Nature<\/a> spending some. In the past couple months. The stories are in a positive. Icenta where one inch of shuts down a city that is a vital city in our system. The effects on the economy are going to be huge because of that. As a transportation company, five minutes of delay per driver million inuals 105 additional cost to us. You can imagine how Something Like<\/a> that impacts us, especially where we have a system that is interconnected with buildings and facilities. Do is throw off a part of the chain and a conscript the rest of the chain. Having said that, i think, for the most part, certainly, we are still be envy of the world. We have got a lot of work to do to maintain that. If you look on the railroad side, especially, that sets us apart. There are a lot of countries out there that are trying to do what is happening with the american railroads. They have a long way to go. I am on the National Freight<\/a> advisory council. Part of our task has been to develop recommendations. I think that is important. Greg was here. Craig was here. I am sure he hit hard on the port side of things. All of it is interconnected, at some point. Regardless of how free is moving, it is going to use another mode as it finishes getting to the consumer. Our plan is to be comprehensive. It was less comprehensive at the beginning. It has to be well connected now. We have a lot of work to do to make that happen. You couldmaybe take some time and get into some detail on why structure and investment is so important to detail and how that would affect your ability to for failure commitment to customers. And winsorms aside aside, when a customer comes she expects to see the merchandise that she is looking for. To see the merchandise they would like to order is in stock. All of us have a responsibility to make sure the merchandise is where it is supposed to be, on time, when a customer needs it. About inon, in talking the structure, is to make sure that the customer is going to be satisfied. It is imperative that we support that. We are all customers. We, as service providers, and sure that everyone is satisfied. You are a major strategic harder for many retailers in this country and around the world, for that matter grade can you talk about those relationships a little bit and the nature of the relationships, and how you Work Together<\/a> so you can get things done you need to get done . We started in 1907. The history of our company was a telegraph wiring where he would take messages. We did that for 10 years in seattle. Really, we got into the space in 1917 when the three Big Department<\/a> stores in seattle turnover their Delivery Network<\/a> to us. That was the first opportunity for us. That was to not just be a transactional player, but to partner up with a company to take care of more than delivering on time. Produce, and get involved as a partner to increase their margins. That is still the concept today. If you look at it, we certainly do a lot of business with huge retailers, whether they are in the ecommerce side or another side. We know we have a lot to offer their. Re. Were also enablers for some new ideas out there. In a response to some of the major ecommerce players out there, some of the brick and mortars have used the concept of using a brickandmortar stores as supply hubs for product, rather than shipping from washington dc somewhere to a besumers home, they may helping to manage and trim inventory out of stores by shipping from the store to homes. Pickosition is not to winners and losers. Our position is to enable people to compete effectively. That is what we do. Youre going to see a lot more of this. This is something that is going to get figured out grade we would like to be part of that process. Printing thatd is coming out that has a lot of possibilities. Necessarily going to be the company that is going to tell you what to do. We will give you the equipment. We will enable you with the tools. And there will be a lot of entrepreneurial people out there. Sure, i from now, i am dont think there will be drones delivering, and i do think there is going to be some groundbreaking ideas and transportation that we will be investing in to support our customers that choose to go down those roads. The phenomenon of omnichannel retailing has been one that has become the conversation of the day in the industry. Dont really care whether they get it in the store or online, or get shipped to their house, or they pick it up. They are agnostic. They just want what they want when they want to. They are less concerned about how i got there. Macys has been a real later in that area, in particular. They have been using existing stores as an extension of the distribution center. If it is not there, you label all the other inventory not used. We saw a lot of driving activity that had implications for shipping partners and customers. If i could add one thing. A few years ago you saw some major retailers tear apart the supply chain. Ome of it was when fuel hit people were looking at sourcing in total transportation costs. Youve got to think about the primary Business Model<\/a> for retailer was grow revenue faster than expenses. With the recession, what happened was that people started to challenge be challenged on the cost side. You had to bring expense down at the same rate. That required all new way of thinking. Worth birth to some of the involvement. That has grown. Almost one quarter of the business is 3pl controlled. People are coming in with a static supply chain saying, try this. One of the things that took more was a move from frequent flow of goods to less frequent. Eightd of sending it packages, you would move that to the palate and sent to ballots. Pallets,f selling two you might send one truck. You meet a lot of product at once. Sometimes, you get stuck with a lot of product. Again, this idea of using brickandmortar to satisfy the ecommerce side kind of take some of the risk out of the model. Let me ask you, heal them the youngratulations, have been on the job, congratulations. They compared the gordie at two an airport in a third world country. It is an opportunity to have an important discussion. What is your perspective . How do you address that issue . Hardees thick about the commitment of the airports inncil international supporting that extension of Infrastructure Investment<\/a> that we need. I heard that statement. I felt bad for the airport director. It was not a good day for that person. The condition of the airport is not really her fault. The comments could not have happened at a better time. As i said before, airports or gateways for commerce. Jfk, major airport in new jersey , all the infrastructure changes, the multibilliondollar issues cost a lot of money. They do not just happen overnight. They dont just decide to build a runway and then that afternoon decide to start constructing. Whos talk to anyone trying to get runways put into increased travel at airports, it takes months to begin the planning process, and multiple years to get through the regulatory process, even to begin the process of putting together runways. Then there is the cost. Who is going to pay for this . That gets into the issue of how airports are funded. There is the aeronautical review. Aeronautical, non which comes retail. When you do traveling, you see that theyre shopping centers. When i go to national, i make my left hand turn and see brooks brothers. Thats a member of my old organization. In terms of revenue, bringing retail in is most important. Year we did 2 billion. . 5 billion was from retail. We see that is a growing trend. These projectsce to build an airport renewed terminals, wenew had to treat passengers like customers. When they come, they want to buy things. A retailers not going to be in a place where they are not going to sell. If you see retailers in an airport, theyre there for a reason. They have a good market to sell. Challenge iss how did they get into an airport they want to sell and . In . It is a different process than getting into a mall. It will continue to grow, as we grow airports. Then dont grow airports, it will get stagnant. Retailers will not want to be there. You want to build a supported by multiple means. Retail is important part. Theres the shipping end of it. Airports make lots of money. They want to continue to make lots of money in the shipping business. It is about product coming and going. They are big part of the economy. The retail side of that is very intriguing. All the new airports ive seen around the world that are built from scratch, all have enormous retail components, if youve been to shanghai or hong kong. They all have retail components. They are only growing. That highlights an opportunity, and may be a challenge. For all of you, how would you assess the greatest challenge that we face when it comes to infrastructure . Is it funding . Is a Public Awareness<\/a> . What are your thoughts . There are a couple of issues. From the supply chain side, you mentioned that congestion of the docs. That is a continuing problem. Theres been congestion. We have had truckers abandon the line for the length of time it has taken to get to move up in the line. We have seen the Port Authority<\/a> dismissed the trailers because of the congestion. One of the issues is getting the containers off of the port. Theres a fleet of tractortrailers. We have been seeing a shortage of experienced tractortrailer drivers. Part of that issue is being masturbated by the Service Requirements<\/a> put in last summer. Ist is going to happen there were going to have a shortage of drivers. Theyre going to be more trucks on the road. We dont want to add more tractortrailers to the road. From a supply chain standpoint, those are two of the major issues we need to look at. From an infrastructure standpoint, clearly, must properly maintain roads and bridges. Extrato miles miles. That translates to extra repair the vehicle. That is extra expense for extra payload. Getting seasonal merchandise out so the customer , thatw seasonal products specific shirt or genes at the store always carries, if you dont have that merchandise in the store, clearly youre looking at lost sales. That is a drain on margin. We want to have a match of supply chain and infrastructure. We want to Work Together<\/a> to fix these problems. Jack, what is your perspective . A long list. If you have to start , theres a huge contingent issue here in it was contentious on its own. Now it is tied together with other revenue. Simplest way to do this that would make an impact is increase the fuel tax, and index it to inflation. Some may want to argue about that, about the faults in them. Maybe i would agree with some of those. But maybe theres a better measure. That better measure is probably going to be five years away, six years ago i six years away. I dont know of a better solution than that right now. If you look at the highways and talk about the infrastructure side, not just on the highways, in a lot of different modes of transport, that is one part of it here in the other part is, how can we more effectively manage the flow of traffic and the opportunities. Even though we are trucking company, we have been the biggest customer of the railroads for 35 years dell because we recognize the advantages. Our growth is grown in perfect relationship. There greatly improved. They needed to be in order for us to use them. I think we are part of the reason they are greatly improved because we have so high standards on the service side. That is part of it. Larrys point on they jabbers drivers id, typically , the the economy is not acted the way we hoped it would. When it does, it will expose this issue in a big way. Ours. Sue is not just ownerimary issue is the operator, the person who is the backbone of the network cannot afford the equipment. ,hey used to be that they could after they put their trade in, they would finance 40,000 for a tractor. Now they get less for it. It does not have the emissions requirements. Fund thehave to tractor for 120,000 dollars. That barrier to entry is huge. Companies are taking a burden on, which is ok. Budget divers are seeing more barriers to come in. You are seeing less people enter the market. That is going to be a huge deal Going Forward<\/a>. It is Going Forward<\/a> at the same time that the infrastructure is getting worse. The services requiring more vehicles on the highway, not less. Figure got a strategy to how to get more vehicles on. We had new regulations they came in. We look at productivity. Many people of been involved in have opinions on the vehicles. The twin trailers that provide more capacity, and moose moore freight in expedited form. We think that would be a contributor. More freight in expedited forms. We think that would be a contributor. Kevin, do you want to elaborate . In 2012, they put out a survey, a Capital Needs<\/a> survey. They found out that between the 20132017, our airports are going to need 72 billion in Capital Improvements<\/a> just to stay equal. Standards,hington 72 billion is a lot of money. Whered you get that money . Revenue,eronautical comes from two sources. One is a passenger facility charge. When you travel on an airplane, . 50 peror always airport you are in. 4. 50. A passthrough charge. That money goes the airports so they can do Capital Improvements<\/a>. People applynts for. Projects,o do major they putting in a 10,000 foot runway. Those projects are backed by bonds. Now, 14 years later, it is earned about half of the potential. It needs to be driven up. Part of our goal moving forward in 2015 is to get the number up where we can use it. It is a user fee. It is being charged to be believes airports. We view it as a user fee. Others have called attacks. Tax . These are not small projects. They are built to last many years. There built to reject what economy will look like in 20 years. An example is what is looking at happening in dallas. There is an intermodal connection. That is between airport in downtown washington. That is taking years. High, pfc,t have a it is used as collateral. A good flow, you pay a lower rate on your bonds. Funding, theet airports begin to crumble. What ive learned, and it is common sense, is at an airport is for sharing in terms of constructing a new facility. Think about the industries that floors with it. Steele, trucks, anything that goes into the making of an airport. The airports become big hubs of which affectvity, the airport itself and the Community Around<\/a> it. If the airport is healthy, the community is healthy with it. Let me ask larry and jack a question. We talked about this earlier. This move more into economy that consumers had this expectation that they can pull up the phone, order it, and get it the next day, or the same day, not by drone, but they can get it and get it quickly, we created the set of expectations among consumers. Retailers want to for fill the ulfill thens fo expectations. Strong asy is not as some may suggest. Our unemployment numbers still far too high. That worsen the situation during the holiday season. The only way to get customers out and get them to shop was to have promotions. One of those was to wait to the last minute to get the best possible deal. Between consumer confidence, lastminute decisions, can you talk about, from your perspective, how that is representative of where were going in the future . How the relationships get structured between retailers and ups, for example. And what sorts of investments we could make that might diminish the burden here . We were discussing after cant make back valentines day when it is affected by snow and ice. When thoseake back factors inhibit shopping. You are face of the situation of creativity and value. It with the retailer is selling has value, hopefully, the customer will come back. Not in the case of valentines day. But in the case of holidays. I think the customer will still see value. Value is what is causing the recovery. In certain situations, you move on and decide that you have no choice but to make sure customers are where what you have. Story aboutl the january being over. I will address what i think the core of it is. That is peak season. We have been doing this for a lot of years. It is not often that something happens that is outside of our window of likely happenings. This year was certainly that. Wascalendar for peak season compressed into less days this year. Weather had a big impact. Without making excuses, what happened in dallas was probably the start of it. People there to deal with the ice storms and then they lock down the city. That was difficult. But that is our problem. We have to get through it. Ecommerce, with that, maybe when you are buying it brickandmortar you were doing it two weeks beforehand. ,he trend toward ecommerce especially with Free Shipping<\/a> and guarantees, you can still get it there for christmas. He a kind of her words procrastinators out there it kind of rewards procrastinators out there. We expected to grow every year. And we did. But 10 days during december were higher than our previous record revenue. And there was no accounting for that. Next year there will be. We are a company that is very engineering vision focused. We have torn apart every day and moment of this peak season to be prepared for next peak season. Our Capital Expenditures<\/a> have been modified toward an issue like this. Inres going to be more regards to planning Delivery Technology<\/a> to create more efficiencies in the system that will help us. Go other impact is when we december, a during lot of times we count on third parties to contract from the rail line to one of our hubs, or a local short home of haul move. This is the most difficult time we had it having thirdparty drivers delivering our goods. We are not alone in that. Anybody we talked to in business in december, had a heckuva time finding drivers in december. Again, that is our problem. We put a good team together. Obviously, we did let some people down. We are not used to that. We expect that will happen in the future. Is that the highest in volume youve seen before . Correct. Unbelievable. And you said customers do this more often. And observation of how an airport fits in. When i take out my iphone and walk through macys and decide it cant get it there at the store, but i do know my iphone and it can get the liver the next day. Wants it whener they won it, and if they can get it they wanted the next day. It doesnt get there by truck and gets there by an airplane. From, 90 iness i came of the things came in from containership. Described,what matt and somebody want something tomorrow, if you are going to buy shoes and what them tomorrow, that is going to end up on a plane. That to get to the airport. That freight is additional revenue. Youre going to see people shipping product quickly. This is not to diminish the importance of any other mode of transportation. But because of todays environment and consumer, youre going to see people paying more money to get it there tomorrow rather than waiting one week for it to be there. We are going to see two levels of customer. When the wanted immediately. It ne that wants immediately. And one that wants it for free. We are becoming impatient society. We are going to have to satisfy both of those unequal levels. We identified a lot of entional challenges potential challenges. We need help from our policymakers in washington. We are getting close to wrapping up our session. Maybe we can finish with a discussion about congress and policymakers, what they can do to help. We identified funding is a big issue. Other than funding, what can we be asking the congress to do . Restrictions on drivers . What are the places can we go . One of the things we are going to be doing is educating members of congress on one airport is. I did my first tour of Dulles Airport<\/a> the other day. Ive been through their 1000 times as a passenger, but ive never been underneath to see how it works. St ofey saw the co maintaining it, they wouldve a better appreciation for what theyre funding. When it comes down to giving up the big high, between rail, road, and airports, we are talking about a lot of money. I would venture to say that most members of congress have not dipped their toe into how it really works. One of the things we will be doing is taking members of congress under the terminal and tell them why we need the funding we need. And we will show them how we are employing people. If you are representing seven percent of the working population of the United States<\/a>, you would think they would want to know how they can keep it flowing. If i am an elected official, i want to support things that are reasonably priced but, longterm, infrastructure projects, and the people are employed doing it. That is how it all works together. It is not going to be easy. It has to be done. Are there things we can do other than ask for money . We have to revisit a couple of issues. We opted discuss the weight of the trailers have to discuss the weight of the trailers. That is something we need to consider. Talking about natural gas. We looked into the potential of using natural gas. It requires a major investment. Youris major equipment by servicers. There are restrictions and natural gas vehicles versus legal bugles. There is no practical, longterm, refueling capabilities. Local. F it seems to be said, the advantages of natural gas are clear. It is something we should continue to look into. It will prove to be less expensive to maintain and more ecologically friendly. Lastly, a couple of the speakers said that we have to make certain that, however we fund isse programs, whether it from a fee, the fees must go to infrastructure and onto other projects, not to building anything. But to rebuild and establish infrastructure and keep it strong. For an industry that is been deregulated twice, we feel it were pretty regulated. I will give you some examples. 1 we were talking about natural gas. There is a push to move in that direction. It is the right thing to do. It is responsible, in regards to effects on the environment. Ok, we wantay, companies to be more , soronmentally responsible our response would be, ok, how do you help us there . The fueling side of it is a big part of that. Our concern is were going to make the investment, we just want to make sure that the government is supportive of us making that investment and will be continually supportive critic we want to buy tractors that are more spent of that support that you will. But weak attacks at the same rate if we are spending more. The government is asking us to participate more. We are willing to that. But we are being taxed more for doing it. Fuelame amount of diesel versus natural gas, diesel fuel generate more power. You have to use more natural gas. , youring to natural gas tax at a higher rate than you would be with diesel. You want us to be involved, help us do that. Check. Ot, give us a just take some of the barriers to entry out of the way. It is the same thing with the csa. Ays and they worked with us very well. They are satisfied that there is constructive feedback going on. If youre going to institute hours of service, do something that will let us be more productive, so were not carry the burden. Day, imd of the talking about larry, myself, and everyone else. Theyre going to call time. We will give you the last word. Ok. Every citizen uses all the modes of transportation discussed today. We all complain when we are stuck in traffic, when it takes , i1. 5 hours to drive to work complain, as a citizen. Finance thewant to roads, rails, and airports, we could do a better education job about how these are longterm projects that will effectively fix some of the problems that everybody complains about. At the same time, fixing good part of our economy. It is about reconstructing a great system that was constructed by eisenhower. The chinese copied it. To fix it, and our airports, and railroads, and everything else. It is crucial to everyone appear to ever on the panel. We are grateful you organize and invited us to be here. Thank ourn our panelists. Tonight on cspan, conservative author Dinesh Dsouza<\/a> and bill ayers debate what is so great about america. Lectures aboutor the history of corruption in the state. The the National Annual<\/a> Governors Association<\/a> winter meeting in washington. The all new cspan. Org website is now mobile friendly. That means you can access our of americanoverage history er","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia801307.us.archive.org\/15\/items\/CSPAN_20140221_230000_Key_Capitol_Hill_Hearings\/CSPAN_20140221_230000_Key_Capitol_Hill_Hearings.thumbs\/CSPAN_20140221_230000_Key_Capitol_Hill_Hearings_000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240620T12:35:10+00:00"}