Transcripts For CSPAN2 Today In Washington 20100429

for reasons we will explore this afternoon antibiotics in turn become less effective making infections far more hazardous to health. this is not an exaggeration or hyperbole or even the stuff of some hypothetical computer model. this is not propaganda which we hear a lot about in these committees sessions when people are campaigning to the november election and not looking at the issues we have to deal with. two many americans already succumbing to inability to treat infections in the numbers are staggering. today will learn about the impact of antibiotic resistance on health from to the nation's leading experts on infectious diseases, dr. tom friedman, director of cdc, dr. fauci, director of national institute of allergy infectious diseases and in time age. as we do i hope we can appreciate the severity of the problem we face and to gather worked for public-private plan of attack. i don't know 22 and obviously research is their default and most of for an answer to a problem like this. but is going to take a strong multifaceted in a coordinated strategy to get the job done. i think we have to think about things that haven't been on the agenda for a while because the pressure some special interests, the impact of using antibiotics and without medical need when applied to large numbers. is this resulting in more drug-resistant antibiotics. what will it take to get the pharmaceutical companies to do more work in this area of the and i met with the group yesterday hutto may they need this and that and the other thing but don't want to work on antibiotics because it's not profitable enough. well, let's look at that problem. let's look at whatever is going to take to keep our eye on the objectives. we cannot afford a to live in a world where antibiotics don't work anymore. and i think the numbers are just so staggering. 90,000 americans die each year of deadly hospital acquired infections which are anomaly caused by antibiotic resistant bacteria, or 18,000 including healthy young people die annually from mrsa. we have seen soldiers the deadly enemies and directly to return home with the epidemic have deadly antibiotic resistant bacteria and any more hearing so we can say these words -- say these words correctly. [laughter] because these are and factions that we want to stop with antibiotics. thank you very much mr. chairman and al gore to testimony. >> thank you chairman waxman. the gentleman from kentucky, mr. winfield. >> mr. chairman, thank you very much. we look for to this very important hearing and certainly appreciate our to witnesses for being here today. i would however like to reiterate the importance and necessity in my view of holding hearings regarding the implementations of this massive and far reaching change to our health delivery system. as chairman waxman noted about hospital infection, according to the center for disease control 2 million people acquire bacterial infections in hospitals each year and of that around 90,000 people die because of these infections. according to the information given to may 70 percent of the hospital acquired infections are caused by bacteria that are resistant to at least one of the drugs most commonly used to treat them. i also do believe that we must explore incentives and other options to encourage pharmaceutical companies to continue their research coming up with new medicines to deal with this problem. i look for to testimony of our witnesses today and i yield back the balance of my time. >> thank you. the gentlewoman from the virgin islands, miss christiansen. >> thank you chairman pallone and dr. fauci and dr. freeman for being here. good to see you again. the hard facts and data about the prevalence of antibiotic resistant bacteria is nothing short of astounding. because of repeated and widespread improper antibiotic use almost every type of bacteria has become stronger and less responsive to treatment. between five and 10 percent of all hospital patients as roughly 2 million people that will develop infection and 90,000 patients die. this trend is related to the fact that more than 7 percent of bacteria cause these are resistant to release one antibiotics this most commonly used to treat them. will the full economic impact is difficult to determine the estimated costs for summer and vicinity of 5 billion every year. was so disturbing is because of this basing prospect of the times in health care we're only able to offer a hand to hold. not only by antibiotics price out of reach but we may see cases where there are none that are affected in a given direction and that's unacceptable. as a physician i know the pressures we are always under and prescribing antibiotics. committed a point not to use them until i thought there indicated for my patients or my family. i think gw hard for that. as i see the resistance forces out of the bar. the only way is a national is a huge developing a vaccine as they did which had a good results as far as development of antibiotics and by the cdc campaign directed at writers including hospitals and the public. none are easy but have to become a party because this country in the world cannot revert to the dark is a madison. thank you speeeighteen -- chairman pallone for all of this hearing. i look for to your testimony and the discussion. >> thank you. gentleman from pennsylvania, mr. pitts. >> thank you mr. chairman. antimicrobrials drugs have saved countless lives over the last half century. and enhance the quality of life for many more people. unfortunately we are observing a growing amount of bacterial resistance to antibiotics and infectious diseases are increasingly difficult to treat as a result. there are multiple reasons for our micros becoming drug-resistant including in a proper use by physicians and inadequate diagnostics, hospital use and agricultural use. i was pleased to see that in the majority's memo for this hearing they noted that quote, bob the national institute of allergy and infectious diseases and knowledge there is debate about the public health impact of an antimicrobrials use in animal agriculture. particularly in animal feed. because i believe that the legitimate and judicious use of a antibiotics in animal agriculture has been unfairly attacked and demonized in recent years. fda puts these drugs through a rigorous approval process with many new or antibiotics having been extensively reviewed specifically to assess in the rest to humans as a result of drug resistance. with treatment, prevention, control and growth promotion, feed, efficiency or all fda approved uses before antibiotics. fda also conducts post approval monitoring and multiple public and private surveillance systems. .. the gentleman from texas, mr. burgess. >> thank you mr. chairman and due to the high-octane high octane witnesses we have i'm going to wave an opening statement and submit part-time for questions. >> without objection, so ordered and did you have a statement? let me say, all the statements will be submitted for the record thank you. the gentleman from-- the gentlewoman from illinois, ms. schakowsky. >> i will put my full statement and the record but i do have a couple of comments. in my home state, the illinois illinois department of health has stated that in its four-year incidence of mrsa has increased 57% over 10,000 cases. and as we are going to hear from the cdc and the national institute of allergy and infectious diseases, antibiotics become less effective as humans are increasingly and often unnecessarily exposed to them. this can happen when they are overprescribed but it also happens through other types of exposures. for this reason, i find the rampant use of antibiotics for non-therapeutic purposes and livestock populations alarming. many factory farms give cows, chickens and pigs antibiotics in their daily feed. that they are not treating any diseases. they are promoting growth in compensating for bad sanitation. when antibiotics are used in livestock populations it gets into our food system and to our water supply, using highly potent medications for this type of use continues to contribute to the increasing prevalence of antibiotic resistant infections. i applaud my good friend representative louise slaughter for introducing the preservation of antibiotics for medical treatment act which would take needed steps to protect the effectiveness of antibiotics on a-- i am a co-sponsor this legislation and i look forward to dr. frieden and dr. fauci's testimony on this issue. i hope you will attest this as well and i've will yield that. >> thank you. the gentlewoman from tennessee, ms. blackburn. >> thank you and dr. frieden and dr. fauci thank you for being with us today. i will have to say this is a hearing i have waited a long time for us to have. ifrs wrote you mr. chairman in october 07 with my concerns about mrsa and the fact that we needed to look into this. i find it astounding when you look at the 2005 stats, that there are more people that die from mrsa caused infections than those that die from aids, parkinson's, emphysema or homicide each year. and i do think that this is something that has to be addressed. i was surprised as they looked at the issue first in 07, to find out from our tennessee department of health that there is not a national standard on a way to report mrsa issues, and that is of concern to me. do something i want to address with both of you as we move through the hearing. i do have a full statement that i want to submit for the record, but i thank you for the hearing and look forward to our witness is. >> the full statement will be entered into the record. thank you. are vice chair, ms. caps, the gentleman from california. >> thank you chairman pallone. i will be very brief but i want to thank you for holding the hearing and thank you are witnesses for coming in their testimony. i have to give a special thanks to dr. fauci they gave a stirring commencement speech for someone named amy fisher who is now my medical health specialist on my staff so you must have said just the right thing when she graduated from emory. thank you very much. this issue in antibiotic resistance is of extreme importance to the health and economic well-being of all americans. resistant strains of bacteria are harder to treat, often requiring longer and more difficult courses of treatment and the longer an individual must been fighting an illness the greater the loss of valuable time at work and at home with family but there is also an economic consequence to the nation as a whole. these infections cost the health care more expensive treatments in nearly $5 billion in annual costs associated with hospital-acquired infections. for many years we have taken for granted that when we are sick we can go to her doctor, take a weeks worth of medicine and be well again. now he must face the fact that we needed more comprehensive approach to treating back ariel infections. perhaps most concerning is that there are broad range of potential causes for the antibiotic resistance in the specs us today. individual levels like when and what medicines a doctor prescribes and how well a patient adheres to treatment combined with health care associated infections, agricultural antibiotic use in the lack of new antibiotic treatment. all of these have contributed to the current state of antibiotic resistance. i look forward to hearing are witnesses thoughts on how we can employ evidence-based strategies to combat antibiotic resistance and the multiple factors that contribute to it in a coordinated approach. thank you for being here and i yield back. >> thank you. next, the gentleman from utah, mr. matheson. >> thank you mr. chairman. i have a full statement but i want to make one brief comment. i just want to point out that on this important issue i have once again were introduced in this congress h.r. 2400, the strategies to address antimicrobial resistant act with the star act. i believe this is a comprehensive piece of legislation to strengthen our country's response to pathogens that are increasingly becoming resistant to antibiotics. senator sherrod round and orrin hatch will be introducing a companion bill in the senate in the coming weeks. i encourage this hearing and others to move forward and i hope these legislations can be contributing to this bait-- debate and with that i yield back. >> thankthank you. the gentleman from ohio, mr. space. >> thank you mr. chairman holding this hearing and i would like to tanker the witnesses for their attendance today. we have all as a nation taken granted that the antibiotics were there. as a parent, i have thought much about the consequences if they hadn't been there, and it is a little unnerving now to see that in combating some forms of bacteria, we can now say antibiotics are less effective, and in the words of chairman waxman, this would be a very frightening world if it were a world without antibiotics, ring true. we are pleased to cdc and fda and other agencies have begun to take basic steps to combat the problem. i think public awareness is a big part of it and i think this congress and other agencies have an obligation to advance research of the issue. my only hope is that, if this congress, this term decides to take legislative action that we do so with a sense of moderation to the extent that that can be done. concern always is that we may be overreaching so we don't want to see that. researching and developing a solution to this problem is very important, but it assuring access to antibiotics for all americans is equally important during the process and without, mr. mr. chairman i yield back. >> thank you. the gentlewoman from florida, ms. castor. >> thank you mr. chairman for holding this evidence hearing on human resistance to antibiotic drugs. welcome to eyewitnesses. this is a critical and rather frightening issue that we must work to resolve. particularly the findings of the recently released agency for health care research and quality report are alarming. postoperative let infections increased by a person, urinary tract infections increased by 3.6%. they are more statistic like that in the number should be going down, not. i thought it was also disturbing the reports aren't blacks, hispanics and native americans patients were less likely than whites to receive preventative antibiotics before surgery in a timely manner so we still have those disparities in health care and all these infections caused nearly 100,000 deaths each year and account for up $26 billion a year in additional costs. many of these infections are resistant to some of the strongest antibiotics causing some patients to be in the hospital for weeks or months. in florida, drug-resistant mrsa infections are going, and are infecting healthy adults and children. the number of cases in florida from outpatient facilities increased more than four times in a three-year period from 2003 to 2005. drug-resistant gram-negative infections, different the mercer also on the rise. these infections are primarily in hospitals or long-term care settings. they the high death rate and are resistant to antibiotics, usually known as the last line of defense. according to the cdc, the antimicrobial resistance problem is a major public health crisis. researchers that i've heard from have highlighted to me that lack of resources coming from nih for this particular issue. there is a lack of resources to detect monitoring a global resistance and public health laboratories. florida like other states does not have the technical ability to categorize this quickly so gentleman you have your work cut out for you and we need your help in tackling this crisis. i look forward to your testimony. thank you mr. chairman. >> thank you. i think everyone has had a chance to give an opening statements will now turn to our panel. we have our two witnesses today. i want to welcome you. let me introduce on my left, dr. thomas said to his director for the centers for the centers for disease control and prevention and to my right is dr. anthony fauci who is director of the national institute of allergy and infectious diseases. thank you are being with us today. sorry again you had to wait. we have five-minute opening statements that are made part of the record and you can submit additional statements or comments after we meet and also follow up with written questions. start with dr. frieden. >> thank you very much chairman pallone, chairman emeritus dingell, ranking member shimkus and members of the subcommittee for your interest in holding this hearing. as an infectious disease physician myself and having worked at the tuberculosis control officer, health commissioner for more than 20 years i have seen the growing problem of drug resistance and also the potential to prevent and reverse drug-resistant with effective public health action. i appreciate the opportunity to speak with you today about the public health threat of antibiotic resistance in the world the cdc plays in preventing, detecting and better understanding and responding to the problem. i would like to show several slides to illustrate the problem. the first one shows the increase in drug resistance in different organisms. staphylococcus aureus, resistance to penicillin that emerges almost immediately after penicillin became available early on. tiny doses of penicillin were able to cure severe infections with staff aureus. this resistant organisms first emerged in the hospital and then after a decade or so in the community. that same pattern has existed with mrsa, which first emerged in hospitals in the late 70s or early '80s and over the past decade we have seen increasingly in the community. antibiotic resistance is an increasing public health problem. assistance occurs wherever antibiotics are used. many bacteria become resistant to more than one type of antibiotic and doctors and nurses are faced with treating infections with antibiotic cases that are sometimes nonexistent. as resistance increases, but the risk of death and health care costs increase. addressing each antibiotic resistant pathogens requires a balanced portfolio. a multifaceted approach that would reduce inappropriate use of antibiotics, prevent the spread of resistant organisms and develop new antibiotics for the future. dr. fauci will speak about the need to continue and accelerate our efforts to develop new antibiotics but unless we improve our monitoring and use of antibiotics to effective public health action we will steadily lose the ability to use both current and future drugs. the nt e shows or approach to combating antimicrobial resistance. it starts with surveillance, understanding what is happening. surveillance is key to assessing and monitoring the scope, magnitude and attitude in terms of antibiotic resistance. surveillance data can drive and direct prevention efforts and determine treatment recommendations, guided drug development and evaluate whether our prevention efforts are working. we need to detect and respond, including two more effective laboratory facilities and hospitals, state and local health departments and throughout the federal system. we need to develop and implement prevention strategies. an example of this, the cdc working with the veterans administration hospital in pittsburgh documented a 60% decline in mrsa infections. that same approach was rolled out to the va system nationally and then to many other health systems nationally. although drug resistance is a growing problem, we have had some good news in that it has been a documented decline in mrsa nationally by about half and methicillin susceptible infections in hospitals by about 70%, according to the hospitals we tracked over time in the national health care safety network. finally to rigorously evaluate the impact, to see what is working and what is not. in my written statement i highlighted several high-priority antibiotic infections and prevention strategies and my next slide outline some of them. mrsa, gram-negative rods,. they are becoming increasingly resistant around the world, tuberculosis where infections increase the risk of death and in the cost of treatment. generally we work to improve antibiotic use, but is located rapid and accurate diagnoses, improved treatment of infections we have seen significant progress in reducing inappropriate antibiotic use when preachers and, infection control and wherever possible create and distribute vaccines. for example to prevent pneumococcal infections. a vaccine which has prevented about 10,000 deaths and saved more than $300 million in direct medical costs each year over the past decade. we speak of the pre-antibiotic and antibiotic eras but if we don't improve our response to the public health problem of antibiotic resistance we may enter a post-antibiotic world in which we will have few or no clinical interventions for some infections. we are working closely with our colleagues across hhs on this important issue and we very much appreciate the committee's interest and welcome your questions. >> thank you dr. frieden. dr. fauci. >> mr. chairman, ranking member shimkus, mr. dingell and members of the committee thank you for calling this hearing and thank you for giving me the opportunity to discuss with you for a couple of minutes here to roll the biomedical research endeavor and a comprehensive strategy to address antimicrobial resistance. as swn o the sde on the screen as pointed out so well by dr. frieden, the strategy to address antimicrobial resistance include surveillance, infection control and the promotion by various means of the rational use of antimicrobials. an important component of that strategy is the biomedical research endeavor, fundamentally to understand the mechanisms of resistance and to do the basic and clinical research to develop the countermeasures that are needed against microbial resistance. on the next slide is a picture of a journal in which we have published their research agenda of the national institute of allergy and infectious diseases, which have three major pillars to it. basic fundamental research, clinical research and transnational research leading to product development. on the next slide i want to very briefly address the issue of basic research. fundamental to the basic research approach is the study of the microbe itself. we have been enormous leaf bud at an advantage over the last decade by the striking if not stunning advances in the ability to sequence the genome of microbes. just to give you an example, in 1996, when the first microbe come become opelousas influenza was sequenced it took a year and a million dollars. in the year 2000, you can sequence a bacteria for about $50,000 it would take about four days. today you can sequence a bacteria for 1 dollar it takes just several hours. we have the capability right now to do sequence e., math sequencing of microbes as they evolve into their resistant form. this gives us the opportunity of what we are pursuing very aggressively in our research to determine the mudd it-- molecular resistance and to use that to target both diagnostic vaccines, but importantly, to target new pipelines of antimicrobials. in addition, we study the host pathogen interaction, namely how the microbe virus or bacteria interacts with the host and with the body's immune responses in the form of immunological response. on the next slide, we also do clinical research activities. as dr. frieden as pointed out, we focus on some of the problematic organisms. in this case obviously one that was mentioned several times already this afternoon, methicillin resistant staph aureus. in addition the escape organisms which are also prone to resistance are on our top priority. what do we do with clinical trials besides testing new drugs? we determined under certain circumstances if treatment is even needed, such as in some of the infections that turn out actually to be viral infections in which the use of antibiotics might not be appropriate. we also need to know how much antibiotics we should use and for how long. the appropriate duration of therapy for different types of infections are still not fully worked out. importantly, we are looking for new uses for older drugs. drugs that have fallen into the-- because the more modern antibiotics might be brought back into the ballgame to treat multiple drug-resistant microbes. on the next slide, it is a scheme that goes from left to right. i think this is a very important slide that i would like to spend a minute on because it is a scheme of what happens when you develop products for antimicrobials, in this case those that are resistant. on the far left is what the nih, niaid in particular does best and as more intensively and that is the fundamental research to develop the concept to ultimately on the far right-hand side of the slide, to develop countermeasures. these could be diagnostic which are critical in the antimicrobial resistance because you want to know if you are dealing with a resistant micro. the other is a vaccine which somebody mentioned to prevent some of the infections in the first place and finally the development of new antimicrobial drugs. i should go from left to right, industry plays more and more of a role and as we have seen, the incentive for industry to get involved in the development of new antimicrobials is not very great and i heard several of you mentioned in your opening statements that we need to address some of the incentives we might partner with them and getting them involved in a very important public health problem that they don't have as an economic incentive, something that is really a great drive on their part to get involved in this is something that we generally use when we deal with emerging microbes for which there are no countermeasures and i believe this is something we should address when they are dealing with the addressing of older microbes that have developed resistance. finally, to just go back to my first slide, to reiterate that there are multiple strategies and multiple components of strategies to develop the issue of antimicrobial resistance and in conclusion i want to say that we will continue to pursue the biomedical research approach as an important part of a comprehensive strategy. thank you mr. chairman and i would be happy to answer questions. >> thank you doctor and now we will have questions for five minutes or in some cases aid of some people wave their opening statements and i will start with myself for five minutes. i guess i am really addressing this to both of you because both of you agree that resistance occurs wherever antimicrobial is used whether it be in the community, on the farm or in health care. i don't have time for all of you so i'm going to concentrate on resistance in the community and hope that my colleagues will talk about farm use or use in health care settings. let me just focus on the community. you both describe described way so much antibiotics are prescribed in the community and when we say using the community i mean outside of the hospital. dr. fauci's testimony described the fact that physicians often prescribe antibiotics to patients who have viral infections and not bacterial infections simply because patients come to expect or demand treatment with antibiotics, even when they can't-- so my question is how concerned should we be about these practices or i guess to put it bluntly, our doctors using antibiotics inappropriately and too frequently and if that is true, what can we do about it? either one. >> dr. frieden. >> thank you. the centers for disease control has a survey called the ambulatory medical care survey. this is one of our main instruments for determining what doctors practices are and allows us to check over time what happens in clinical encounters. since we have this nationwide-- in the surveys we have seen an improvement in that there has been a smaller proportion of patients who come in with for example upper respiratory infection, who leave with an antibiotic, which they shouldn't leave with. it still remains too common a practice in the challenges educating physicians and having them with a monitoring system in place to give feedback to clinicians. one of the things we-- will greatly facilitate that work is electronic health records to remind doctors that the system a good use of antibiotics or contracting give feedback on the behavior of individual clinicians are so we need to both have the monitoring. we need to intervene by educating better and we need to put into the process of health care automatic ways of telling doctors are helping doctors to make the right decisions. >> i have to say it is hard for me to relate to these questions because i never want to go to the doctrine when i ago i try to avoid having them give me anything but i know it is a common practice. >> actually i agree completely with dr. frieden and also it is an issue of getting better sensitive point of care type of diagnostics where you can really underscore and confirm because sometimes when a physician is talking to a family member and they say you have got to put my child or my husband or whatever on antibiotics because they know that either have an infection or are going to get one. if you can and often show immediately that person does not have a bacterial infection i think you will go a long way to convince the person that the decision that physicians make it is the appropriate decision. >> what is the get smart campaign that the cdc has been working on, dr. frieden? do you want to talk about that and i guess you haven't recommended that it continue in the budget so do you want to say why? what it is and why do you are not recommending that we fund it again? >> the get smart campaign is an educational intervention that works with reducing unnecessary or use of antibiotics. we are faced with significant budget constraints. we are not able to continue or expand all the programs which we would like to continue or expand and we are committed to maintaining and strengthening work to reduce antimicrobial resistance in every way we can within our budgetary limitations. >> the reason you have not recommended continuing it is not because it isn't a good thing but it is not that important compared to other priorities? is that fair to say? >> we believe the program is effective but we are not able to include it in the current budget request. >> so, the answer is yes? i want you to reflect that you said yes, not me. the gentleman from illinois, mr. shimkus. >> thank you mr. chairman. i'm trying to get my hands around this i think conjecture that is making the claim that antibiotic use in animals is translated in changing the resistance in humans, which in one of the testimonies kind is said that casually. their assumptions made on the other side. is there any peer review, cdc study that shows a direct correlation to support that assumption? >> it is clear that any antimicrobial use will result in the emergence resistance and spread of antimicrobial resistant organisms, so the use of antibiotics in the farm animals will generate the development and spread and persistence of antimicrobial resistance among the farm animals. your question relates to whether there is evidence that that resistance has spread to humans. we do know that there are many interconnections between human and animal health. there is experience from several countries in europe, where prescriptions of an antibiotic that is related to vancomycin was shown to be associated with an increase in the vancomycin resistance among humans. that was experienced in the european union countries. that antibiotic was burnt-- band and resistance levels then declined. there is no scientific doubt about the theoretical possibility of transfer of parts of viruses, transposed into other ways you could spread antibiotic resistance from animals to people. there also are many outbreaks. >> i only have a limited amount of time but the question is do you have peer-reviewed scientific research that shows this connection? , the cdc? >> what i said is there is peer-reviewed research in europe. in the united states it has not been to my knowledge documented. >> my point is this and i use this across the board and on this committee, that running on emotions is running on emotions. running on science and fact, peer-reviewed replication is critical if we are going to move public policy and we don't seem to want to do that here in washington. but, do you know the danish study? have you followed the danish example of banning antibiotic use in livestock? >> i'm not familiar with a specific study. >> not a study. they actually banned antibiotic use in livestock and what they found us a couple of things. antibiotic resistance even though it was banned increased in humans. issue one. issue two was antibiotic use increased in the use of animals because it was then used therapeutically, so then the other question that has to be asked is, would we rather have in the livestock consumption industry antibiotic use for healthy animals or would we rather be using antibiotic use treating sick animals that eventually going to the food chain? these are all part of the debate, and i just wonder-- want to caution people to make this jump on this without scientific research, peer-reviewed studies that makes a direct correlation and again i think i've friends would want to do this. one of the issues of this is the industry, how do we get industry to develop that? we have done that with different types of drugs and chairman waxman has been good and how do you get industry to market in areas where we want to do it? able to you one thing that we don't do is we don't add an additional 27 billion-dollar tax if you are trying to incentivize to create lifesaving antibiotics, which we just did in health reform bill. and i'm concerned that if we go and take antibiotic use out of livestock, if you believe in economics 101, supply and demand, you reduce another supply avenue for selling antibiotics. then you limit the ability of a return on investment on those companies producing it to begin with. so, this is an important hearing and there is a lot more scientific aspects to this but i would just plead that we make sure any action we do is not raised upon emotion but they we to peer-reviewed science and with that mr. chairman i yield back my time. >> thank you or cochairmen waxman. >> thank you mr. chairman. i am trying to understand the science. it seems to me from what i've understood that when you use an antibiotic over and over and over again inappropriately and by inappropriately i mean not to deal with a bacterial infection but for other reasons, whether it is used on an animal or on people, it increases the chance of resistance to the antibiotic. is that a correct statement of the science? >> yes, it is. i mean that is just the nature of how organisms are involved. you put any pressure on them, they will select the survival and survival is resistant. it is a natural phenomena of the interaction of a microbe with the pressure you put on the micro. that is the scientific reality. >> so to avoid antibacterial resistance, microbes, we should be sure that we are using the antibiotics where it is necessary and not using it where it doesn't have a therapeutic purpose? does that make sense? you both answered yes. >> there is no disagreement about the use of antibiotics to treat infections nor is there disagreement about the theoretical risk of promotional resistance to the widespread use of antibiotics. >> i don't know of anybody who would argue that we shouldn't give an antibiotic to an animal that has an infection, because it is for a legitimate therapeutic purpose. i haven't heard anybody argue we should give an antibiotic to a person who is a bacterial infection if that antibiotic and stopped at bacterial infection, but if you give it to large numbers of animals for don therapeutic purposes, let's say as a preventive, if you give it to kids who may have a virus and not affect serial infection, aren't we running a greater risk of resistance? >> yes. are basic principle is to promote judicious use of antibiotics. the institute of medicine is has called for the phasing out. >> is this from science worm europe or is the science that is accepted here in the united states? >> public health authorities including the institute of medicine have called for a phasing out the abuses to promote growth. there is no disagreement as you note about use for treatment or evidence-based prevention of infection. >> dr. fauci i think you particularly raised the question is that we don't have companies making new products. we need new breakthroughs, antimicrobials, and it appears to be market failure. now, i don't accept the idea that if we used it in a more widespread way that that would encourage the drug companies to make more antimicrobials. it sounds to me like we are running a risk of making more bacteria resistant diseases might make them more money but i'm not even sure then it is the product won't work after a wild. we have had market failures in the past and you and i were in this room many years ago when we first heard about the aids epidemic and we were trying to deal with it. there was a small patient population we didn't know what resources we had to treat them. in this room we had many hearings on people with rare diseases that didn't offer profit potential for companies to put efforts into drugs for people with a small number of people infected by the diseases. disease is. we came up with the orphan drug act. we tried to give other incentives for research and development. we have a patent law. we have renewal of time that is lost in the fda to help the producers. do you have any other ideas on how we can correct what appears to be a market failure? is it just because it is not profitable to produce these antimicrobials because they were too few seldom used and not widespread enough? >> certainly mr. waxman, that is one of the major reasons why pharmaceutical companies, who do great things come are driven by the profit origin and what they have to answer to their board and if a company has a choice of making a major investments to develop a new product, a new drug, it is several hundred millions of dollars, an average of $700 million which includes a risk that they taken the development of the product. if they are going to make a choice of making a product that a lot of people are going to take every day for the rest of their lives, they lipid lowering agent or whatever you have, they are going to lean towards that rather than make a new product that a relatively small proportion of the population will use maybe 10 days to two weeks out of the year and then because it happens naturally, that after a period of time there is going to be resistance against that antimicrobial soap from the interactions i have had with industry, we need to work with them in partnership to figure out what incentives we can do. we at the nih, i show that's like, we are fundamentally doing clinical research but what we are doing now is we are offering some of our research resources, our animal model capabilities, the agent repositories and even our clinical trials capabilities to lessen the risk of an investment on industry, to give them more of an incentive to get involved and i'm sure there are other types of financial incentives that could be worked out in an appropriate way but i really do think we need to push the envelope a bit and getting rid of some of the disincentives for getting them in both. >> one last question. i assume this was a problem even before the health insurance bill was passed last month. >> yes sir. it is probably a bigger problem now though. >> i yield back. >> thank you chairman waxman. the gentleman from texas, mr. burgess. >> i am struggling to keep from taking the bait. let me depart for just a moment because we only show profitability-- penicillin is clearly a wonderful discovery and for alexander fleming appropriately ignited by the king or the queen, properly honored with a statue erected by the bullfighters in spain that really it was an american manufacturing company, i believe it was spicer during the second world war that changed the penicillin from a parlor trick that inhibited bacterial growth on in ag replayed to a clinical utility for hundreds of thousands of people because of the ability to create a lot of it in the manufacturing process they developed during the second world war. you argue it is truly a profit motive. they would accept those doses of antibiotics loan cap the price hike, but they went with mass production and as a consequence soldiers during d-day were spared life and limb because they had readily available abundant, cheap penicillin which you alluded to on your slide welch-- worked well until they figured out they could chew up the ring and survive nicely with their cell wall intact despite the penicillin. it is not always the profit motive. i am telling you stuff that you know better than i. this was a seminal event in american medicine that fundamentally change the way subsequently all of us were trained to practice and the generations that followed. it truly was a life altering event. but, let's think for just a minute. dr. fauci, the new molecular entity for broad spectrum antibiotics that have been introduced by the fda in the last 10 years, do we have an idea of how many new drugs have been produced? broad spectrum antibiotics? >> new antibiotics, very few, handfuls. >> i have a list of 10, does that sound right? >> that sounds right. >> my staff has got me about 25 pages of antibacterials that been approved for new indications and you reference that on your slide, new chores for old drugs that we might find but, these older drugs, not necessarily helping resistance, they are just an antibiotic that was found to have an indication for something else. so the problem is that there are only two-- 10 truly new antibiotics produced in the last decade, and i have another document attracts $92 million of federal research at your institute dr. fauci in fiscal year 09 alone on antibiotic research. does that sound like a fair figure? [inaudible] about 200 plus. >> my numbers were low. so taxpayers are popping a lot into the pipeline, and we are getting out of at the other end approximately the average of one new antibiotic a year? am i making the correct. >> well, i would ask the question, do we have a problem with the pipeline, so where in the pipeline is the problem? is that the dollars we are pumping and? isn't the resource we are putting into it? is that the fda? where's the problem in the pipeline? >> mr. burgess the problem in the pipeline is right in the middle of that arrow that i showed in one of my slides and that is that the pharmaceutical companies, is much as we can do research and we can sequence. i mention that for a reason. we can sequence a thousand microbes very reasonable price really quickly. we can pinpoint all of the different targets that could serve as a target for the development of a drug. there is not an overwhelming incentive on the part of companies to get involved in developing a new antimicrobial, and that is the reason why and the answer to the question of was-- mr. waxman i emphasize that there are a lot of issues that go into why we don't have a lot more drugs for the amount of fundamental research money that we put in, but one that is really paramount is to get the companies involved and incentivized into wanting to make them. i don't have the complete answer for that. we are trying to the things that i mentioned in response to mr. waxman's question that we need to do better than that. >> i really don't want to cut you off because they know your position in the scientific world and mind, but i need to ask you this. market incentives, are those always dollars or are there changes we could make in the regulatory level that would help the environment? >> the fda right now is putting a considerable effort in pushing what is referred to now is regulatory science. in other words, to get them involved in developing biomarkers, two clinical trial designs that would facilitate the development of any product including a product geared against a resistant microbe, so there is something we could do at the regulatory level in the fda is trying very hard to push that agenda. >> i am going to ask mr. shimkus this question because i can't help myself. can we put a 27 billion-dollar new tax on to the industry under the health bill so is that likely to have a positive or negative effect on the pipeline problem that we have? we will go to the next question. [laughter] does your institute track how much research is invested and translated into applications of approval at the fda? what kind of data does the national institute of infectious disease have that could be shared with the subcommittee? >> when you say information, everything we do is transparent. you get any information you want but i think you were asking. >> the application for approval, the application to go over to the food and drug administration and the approval that come out of the other and? >> as a product. >> as a product. >> that is the question that is difficult if not impossible for me to answer because we don't control the concept of products. we do fundamental research that might develop a concept that could be pushed to the preclinical but if we were to solely be responsible from soup to nuts i could give you an exact answer, but we are not. we have to punted to the pharmaceutical companies. that is the point. >> it seems the slide that one of you showed with a methicillin-resistant staph aureus and the community acquired, i think a huge problem in dormitories and public shelters, seems like the market is being created and none of the companies are interested in being the first one to cross the finish line with the a silver bullet for mrsa. where's the paul ehrlich of our generation? >> i would think personally a company would be very interested in getting in it. they balance the risk for the benefit and say mention there is there is a considerable risk for a company to put several hundred of millions of dollars to develop a product and what i would be proposing is that somehow we and the federal government help alleviate that risk by doing some of the things that i mentioned we can do but we are not the only player in this. >> a quick question on hospital-acquired infections. might epidemiologist that i rely upon a lot back in dallas is bob haley, and he told me early on that in order to take something you have to be able to measure it and in the church to measure if you can't have people frightened to report data to you or you will never have the accurate data to measure. is that a valid observation and? >> we have already 28 states reporting mandatorily and half of all hospitals in the country. >> which brings me to the point, what is the best approach here? i've always felt that at the 28 states that report, find the best practice or sets a floor perhaps at the federal level, let you guys deal with the, identify the aggregate data so you are not getting into privacy issues so that you then have the data to study as opposed to what we seem to see here in the committee sometimes looks very punitive and as somebody who has practiced medicine for years if you make a punitive, doctors we will find a way to obscure things for you so you don't pin it on us. i'm oversimplifying but that had tried to peer concept is one that we need to have breaks, cms needs to embrace and i would just encourage you to continue to work along that line and i think that is where the ultimate answer for this problem lies. >> thank you mr. chairman for your indulgence and i wheeled back. >> chairman dingell. >> thank you mr. chairman. gentlemen, welcome to the committee. i am curious, has there ever been a definitive study on the impact on microbes and other similar creatures to define what the impact on them might be in terms of resistance to antibiotics by reason of using these antibiotics in animal feed and for other similar uses? >> there are clear studies that show the use of antibiotics in animal feed increases resistance among animals. >> among animals are amongst bacteria? >> resistance of the bacteria that are resident in animals, within the animal. >> would such a study be useful? i mean as opposed to bits and pieces. >> there is an increasing body of evidence that looks at where antibiotic resistance emerges and how it spreads. and additional if they wish of that understand the spread from animals to community, i think is something that is many groups are working on. there is not right now definitive evidence. there is a clear understanding that the more judiciously we use antibiotic, the longer we will be able to continue to use them effectively. >> now, has any work been done to define what is efficient use of antibiotics in animal feed? in other words, how much is necessary, how much is too much, how much it doesn't work, how much we could do without and what would be the benefits of the different steps? has there been any study of this kind? >> as the director for the center i would have to defer to my colleagues at the fda on those questioned. >> let's see, the fda in the room. who has authority to do this kind of research or fix this level of tolerance or content or the time at which these antibiotics are fed or insert into animal feed? >> i would imagine the most appropriate venue to do that would be the department of agriculture. i mean, that's an obvious question of great importance. >> do they have the authority? >> i don't know if i could answer that definitively. i cannot imagine they don't have the authority to do a study if they would want to do it. >> i would imagine they don't have the authority and they don't use it if they do. now, let me go into some of the questions. cdc's overall budget would see a 5% cut, and the antimicrobial resistance program would see a cut of more than 50%. gentlemen, do you think these cuts would negatively impact the work you're doing related to antibiotic resistance, especially support for state and local surveillance, prevention and control efforts? >> mr. dingell, we're committed to doing as much as we can with the resources we have available. >> that's not the answer to my question. is that level of cut going to hurt what you're doing? >> it will be difficult to continue current programs at that level. >> would you submit for the record the level of your requests for financial support for these programs in the budget? and also, submit the amount that you have been given for the last three years and for the coming three years. >> we will provide that information. >> all right. now, you've addressed this slightly, but i'd like a little more on it. as much as it appears to to be much debate over what is the practice of adding antibiotics to agricultural feeds is such to promote drug resistance. what does current science and surveillance tell us on this point? is there a trick to link, and what is at? >> i think we know that theoretically there is a risk. there is literature we have reviewed outlined the problem that clearly emerged in europe. i'm not aware of evidence in this country that has document the spread from animals to humans, feed animals to humans. we have of of course seeing spread from animals to humans in a wide right of infection. we know the more antibiotics are in the environment, given to animals and people, the higher the selective -- >> let me try, sir, to try to reduce the. i'm getting the impression from what you two gentlemen are telling us here that we really don't know what the nexus between the feed is and, rather, the feed with antibiotics added, and when there's a point of danger, and what is the level of danger, and what research is going on. what, do you make on that statement? >> from the question, mr. dingell, and the questions were from the other members, there is no doubt in anyone's mind that if you give antibiotics to any auditcome in animal an and you do it private, that resistance to microbes will it all. i think the question that mr. shimkus brought up and others, is that what is the evidence that, if you give it to an animal from feed and resistance develops and microbes, and that animal, that that resistant microbe will then spread to a human ear and i think -- >> welcome it might spread to other microbes are might spread to humans. but rather come to the conclusion, don't have much information on it. now, let me, doctor, get to this because my time is limited here. food and drug administration withdrew its approval for the use of thorough when the loan antibiotics, that if and poultry. are there any preliminary, any surveillance reports that would indicate the impact of fda's decision? yes or no? >> i would have to get you back on that. >> would you submit that for the record? >> absolutely. >> now, dr. fauci, in addition to the work that your agency is come engaged in with the smaller manufacturers, what additional steps can or should be taken to incentivize participation of industry, both large and small manufacturers in developing new effective therapies for these drug resistance, infections? >> there are several things that could be done, mr. dingell. one is to make available to the company some of the assets and capabilities that we have in the government, including in my own institute, and that's a very is assays, repositories, animal model and clinical trial capabilities. and then also to reach out and partner with them on the risk for the advanced development, something that they generally do themselves. and if we can diminish somewhat the risk they take him i think there will be much more of an incentive for us to get involved. >> is this question raised at any point in the government regulatory structure when you address the questions of whether or not or how much antibiotics should be used in animal feed? and if so, who has authority to do that? >> welcome we surly, that's not something that we as a research -- >> here is my question. if we are putting too much in animal feed, not using it wisely and don't have any particular constraints on its use, we're obviously increasing a risk if a risk there is. is that right? clearly the answer to that is yes. >> well, i'm not sure what -- >> would you say there's no risk in this? >> so -- >> so we're agreed, doctor, my time is limited and i'm trying to get this through here. so who has the responsibility for defining the level of risk and defining what ought to be done to protect the american public and the world against runaway infectious cause by antibiotics that no longer work and -- on drug-resistant bacteria? anybody have this authority or not? >> yes, both the fda and -- >> they do? >> yeah. >> okay. the drug act was written in 1983 to encourage hamas to go companies to develop drugs for diseases that have a small market. this was done through a series of incentives. fda a, the 2007 reauthorization of the fda user fee programs include provisions intended to strengthen the antibiotic pipeline through the orphan drug program. how effective has the orphan drug program been in your research and evolved work related to drug-resistant bacteria, and what cooperation has it induced on the part of manufactures, feed manufacturers, antibiotic producers or farm organizations? certainly the orphan drug program has incentivize the development of drugs of various types. >> now, you have said that this has incentivize. what particular incentive hasn't produced -- has it produced to do research work related to the drug-resistant bacteria? >> the basic research that we do feeds into a company wanting to develop a drug for a quote orphan disease, a disease that is a relatively rare disease. >> do you make it available to them automatically? is made available to them by food and drug? isn't made available to them by the department of agriculture, or sort of we hope they learn about in some way so they can do something about it? who is in charge of that? >> mr. chairman, it has to be the last question that he can answer this and then we will move on. okay. >> when we provide the assets that we have, we essentially make it available for anyone who needs it, who has a reasonable project. >> so that they think they need they come by and see you. >> they do expect or if there is no incentive for them to come by, they don't come by, am i right speaker is correct. >> mr. chairman, this is a very interesting subject. i think we have to have more to learn more here. i don't want our two very fine panel members to think that i have in any way been trying to demean them. i think that we need a great deal more knowledge on this before i feel comfortable on the subject. >> thank you. the gentleman from missouri, mr. blonde your. >> thank you, mr. chairman. i agree with chairman emeritus. this is a good hint that i may take a different attack on the same topic though several questions came to minus chairman dingell asked his question. and one would be do we know the food chain, the animal food chain doesn't get less safe if you don't put certain antibiotics in the food and in the system? how do we know that? i mean, there's a veterinary guideline on these antibiotics, so how do we know it doesn't have just the opposite effect? >> mr. blunt, if you don't mind, i'd like to finish the answer to a question which might be to what you were are saying. the issue is if you give antibiotics to anybody, and animal, human, or whatever, you will unequivocally ultimately induce the occurrence of a resistant microbe. the real question -- >> but isn't it true that antibiotic to animals, you don't have much of a chain of lifespan here in animals. now, i agree with you. if you and i took an antibiotic for 30 years, or three years, it might make a difference but we both know that that is not the processing system for animals. let's not go there that you're going to convince in the animal. the individual animal itself an antibiotic reaction because they've had antibiotics for a long time. because the process just doesn't go that are. >> with all due respect, you can develop -- i can have an upper respiratory tract infection and i could take an antibiotic that is suboptimal and what not the right antibiotic, and in 10 days or less i could have a resistant microbe. >> so does that mean you shouldn't take any antibiotic? >> no, no. i'm not saying that. >> actually i think you're answering my friends mr. dingell's question instead of mind. >> no. >> are the american veterinary guidelines on antibiotics to animals? >> that is not my area of expertise of antibiotics. >> then what is -- why wouldn't that be something you would look at as you look at this, get smart, know when antibiotics work on the farm program, why would you look at the veterinary medical association's guidelines on judicious use of antibiotics? if it's not your area of expertise. >> that is more of a cdc issued than -- it is, i'm not trying -- >> i would be glad to have them answer the question. >> thank you. the basic question is we know that there's no disagreement about certain things. we should start with those. first, we know that no one disagrees with the need to treat infections in humans and animals that are responsive to those infections. second, there are evidence-based preventives antibiotics that are sometimes needed in the treatment of outbreaks or other similar situations. third, there is a clear theoretical risk of -- there is a known fact that you will, the more antibiotics you get, the more resistance you will have. the theoretical risk is whether those resistant organisms that emerge in animals, will cause humanisease. and on that there is some evidence as i've indicated several times that occurred in europe, and there is less evidence in this country. >> dr. frieden, aren't their animal antibiotic guidelines -- am i wrong? isn't the relative processing life of most food animals pretty short? so the more you give in a short period of time, i would think the veterinary medicine guidelines would have more impact of their than the more you would give over a longer period of time. i mean, the processing time are the production time for animal agriculture is relatively short, and there are guidelines or the safety of animals. and then i guess another question would be, are you sure you don't make the food chain less safe by not getting the proper amounts of additives, including antibiotics to animal feed, for instance? the question mr. dingell asked appropriately several times. >> to question, two key points to make. unfortunately, for humans mike rhodes divide very rapidly. and as dr. fauci indicated, even in the course of ten-day antibiotic course, you could have emergency of resistance by a variety of molecular mechanisms. so even relatively short durations of treatment may in fact lead to widespread emergence of drug-resistant. second, antibiotics are not an essential nutrient. they may increase -- they do increase growth, but they're not an essential nutrient. and there are certain ways to keep the food supply safe without using an a biotic to promote growth. >> i believe mr. dingell asked if the u.s., ask you, does usda have the authority to look at animal antibiotics, and i believe you said you didn't know, or what was your answer to that? >> we suggest that i cannot imagine they don't have the authority to do that. there would be no reason why prohibit them. >> do you have the authority to look at animal antibiotics? >> i have the authority but not the mandate. that's not what the mandate of my institute is to look at animal antibiotics and agricultural issues. >> not the mandate what you think you do have the authority but you don't have the mandate? >> it depends on what you mean by a story. if someone comes in with a grant and wants to do that, it's likely he would get referred to a different agency. >> but you believe usda does have the authority? >> i do believe that but i don't know for sure. >> thank you, mr. chairman. >> dr. fauci, mr. shimkus and i are of the opinion that you want to answer a question that you couldn't. so what you just answer the question. [laughter] >> just -- is this an extension of my time? >> that there is no doubt that if you give an ally on next to an animal, a cow, of all, what ever. if you give them antibiotics them in that animal there's unquestionably going to be the evolution of antimicrobial resistance in that annual. the critical question that mr. shimkus was getting at and that dr. frieden answered with regard to european study is that the question that people are struggling with is that if you develop the antibiotic resistant microbe in an animal whose getting antibiotics as part of the feed, is that a danger to the health of humans by transferring of that microbe to the humans? and there are some data that says that that is the case, that european data, to my knowledge and to dr. frieden's knowledge, i don't think any of those days have been done in the united states. so that's still something that people argue about whether there is any significance to that. >> okay. thank you. gentlewoman from the virgin islands, ms. christianson. >> thank you, mr. chairman. dr. fauci, as you talk about your institute that supports basic research, how much of that research is done at universities and how many of the universities involved in the basic research are minority serving institutions? do you have any -- that's the question to begin with. >> about 90%, 89 to 90% of all of the research funding that we do goes out to universities on the outside. we funded by grants and contracts virtually all of the primary institutions, whether not they have grants and antimicrobial resistance, i would have to get back you on that, but we readily fund primarily minority institutions in our portfolio. >> okay. i have another question. last week at our spring with the minority health form, were you receive the award last year, we had a discussion of the lack of a participation in clinical trials and the need for diversity. and the translational research that is being done in this area, isn't diverse enough? given the different environment, i would assume there are different exposures, maybe different communities, and maybe possibly even different responses to antibiotics? do you feel that in the translational research area that you have a good representation of minorities and women? >> it really varies. if you look at the clinical trials that we do, for example, with hiv aids, because of the disproportionate disparity of infection among african-americans and to a lesser extent hispanics, we are over representative relative to the population, but adequately represent with regard to the burden of disease. that's for a specific disease. it really varies. there some clinical trials were, as hard as we try, because of either the location of whether come up with a trial takes place, or quite frankly, of some of the mistrust that the minority committee has. >> we're going to really make an effort to those two organizations and others to work on that. thank you. mr. frieden, you mention in your testimony that tend states make up the network for aip, are the states that have diverse populations of information that you get is selected other countries demographics of? >> yes, it is. they are and it is that however this is an area we feel we need to continue to develop to ensure we have adequate representation. >> thank you. and you talked about helping states respond to outbreaks and cdc has been very helpful to the virgin islands in assisting and investigating some of our outbreaks. as far as the nhs in an nar income are the territories included in that? >> i would have to get back to you. >> okay. and if you find they are not, could you see what you can do to make sure that we are, if appropriate? >> absolutely. >> thank you. this question is a little different. because there's a certain consents i've had, but in the patient protectioprotection and affordable care act, which we've heard a lot about this afternoon, there are provisions that, where hospital acquired infections occur, the hospitals will not be reimbursed and i so would not be reimbursed for the care that is provided, and there are a lot of antimicrobial products on the market that are used to clean surfaces in the hospitals, and some questions have been raised and brought about whether they are effective. and i think it's very important if we're going to penalize hospitals and providers to know that these antimicrobials that are being used in the facilities are effective. do you have any information on whether that would suggest that they are not? and do you think that it would be worthwhile for the oversight subcommittee or this subcommittee to take a look at that question? given the importance of it going forward with the new legislation. >> this is a complex issue speed is asking both of you that question. >> that the new legislation does is require reporting of hospital associated infections, and this we presume will be done to the national safety health care network. this is something that we believe is an essential first step in recognizing and addressing infections. for some infections like methicillin, environmentally may be very important. it may be challenging because they can be hard on the equipment to do it regularly. but this is an area where we work with others, hospital systems, to identify effective strategy to prevent the spread of infection or to stop outbreaks once they have occurred. >> tranforty do have any comments? thank you, mr. chairman. i yield back with my time. >> thank you. the gentlewoman from illinois, ms. schakowsky. >> i want to get back to the antibiotics in animals. both of you in your opening statements talked about, and the reason we're here, public health problems increasing magnitude. serious public health count post by anti-my poll numbers is that both of you i don't this is a service problem. we know most of the antibiotics used in united states argues for animals come and most of that is used for non-therapeutic use. mainly for growth of animals. you know, we're dancing around is because there is a lot of opposition. this is a highly charged political issue. and there are many forces who think that, you know, stay out of the farm. leave that alone. and i know that. but i'm trying to understand why we don't have an answer to that question. if all of this use of antibiotics is going on right now in what people are eating, and we are facing a serious health threat in this country, explain to me why it has not been any research done in the united states, that you can site. why we don't have an answer to this question, and why, even if we don't have an answer to this question, why non-therapeutic use of antibiotics is so lucky dog? is potentially that has this kind of negative effect dangerous effects, it feels to me that there is this threat out there, so many threats that we can't totally control but here's one if we know about it, as a potential threat, i mean, how much money are we spending in the defense department and homeland security to defend against potential threats? this is a potential threat, at least don't you think now to find out if this is a real threat? will both of you please answer? >> i think there is no doubt as i've said before that there's a potential risk of spread. there's also no doubt that this is not the only way that resistance gets into the community. we see a widespread abuse -- >> why don't we try and find out whether or not this is a source of the problem? and are there any plans to do that? i am a cosponsor of congresswoman slaughter's bill. what you're saying is not responsive. >> there are several ways to study this. what we can do is look in more detail what is currently happening, what are the potential additional ways to get more information on it. >> the simplest way to find out, because antibiotics are used in feed for the reasons that you mentioned. we both spoke of the theoretical risk, the real unanswered question, definitively un-answered is what is the risk. >> that's correct. that's what i've asked. >> you're asking a very appropriate question, is that how do we get the answer to that. it would seem since there is widespread use of antibiotics and a non-therapeutic, not prophylactic feed for animals, that the only way you can answer the question that you're opposing is to stop doing it and see if antimicrobial resistance -- >> yes, that's right and are there no forms on which they are not using the -- so is there not some sort -- are you telling me that science cannot determine whether or not this is a risk to human beings? >> no, i think you can determine it by stopping the use of it and seeing if the antimicrobial resistance goes down. >> there's no laboratory way? there's no possible way to find out? i just don't -- >> no, i understand your question and i understand your dilemma. if the question is, if an animal is given antibiotic in feed, will there be resistance? and i can tell you, we could do that stay but i can say what the answer is that it's going to be yes. the question is, does that resistance, does that resistant microbe get out into the community and spread into the community? that is not a very easy thing to get the answer to, unless you stop it completely and measure for years what happens -- >> no. really? >> yes. >> no. if we're going to test whether or not the fact of resistant bacteria in an animal, then can transfer to a human being, and -- i mean, you can't possibly do without stopping? >> there are at least several other ways to do that. one way is to look for the markers of resistance and see whether there's a specific way that resistance has emerged on animals is found in people in the community. i can just take a little more information. i mention several times the european experience with the drug which is related to a very effective drug which has been used to treat severe infections in animals and people. it's the last line of defense for many organisms that it's very important to preserve it for use their pete oakley. it was used for growth promotion in 1970s. and it was finally phased out and banned by the european union in 1997. it was found that community carriage of michael meissen strength of one particular micro, which is a highly resistant organism was quite common before the ban, and after the band gradually to decline. that's why we can say that there is strong evidence from europe that suggest that there is spread between feed animals and people in that environment, and that restricting the use in that environment for that antibiotic resulted in a reduction in the amount of resistant organisms in the community. that type of study we would have to look more comprehensively to see what's been done in this country and what could be done by different means to? i certainly think that we ought to do that, given the amount of antibiotics that we are feeding to animals, and, therefore, eating ourselves, given that we have this problem. it's shocking to me that this kind of work doesn't seem to even be on the table. thank you. >> thank you. the general woman from california, ms. capps? >> thank you. as this has been an interesting hearing, thank you very much that add a couple of questions for you, dr. fauci, and if i have time, dr. frieden. in today's hearing, we're getting what can be perceived i believe by the public as mixed messages. on the one hand, there's overuse of antibiotics. on the other hand, we do need greater production of antibiotics as antidotes to antibiotic resistant strains of bacteria. new antibiotics. and, of course, the need, underneath it all for provider and consumer education plays a role in all of this. how do you reconcile this message for the public? how do you reconcile these messages, and how our cdc and nih working to comprehensive strategy to combat antibiotic resistance by educating consumers? >> an excellent question, ms. capps. there are two fundamental issues. you're asking questions if concerned about antibiotic resistance, why we try to make more antibiotics that antibiotics are -- >> i understand that it is a mixed message. >> but i'm going to try to explain that. we can get away from the mixed messages by compartmentalizing it. you try as best as you can to prevent the emergence of resistance by the public health measures that dr. frieden spoke about. unfortunately, we are in a position where there are resistant microbes out there that we are up to the last line of defense with one, and that the most, to antibiotics that are useful. so there is a clear need to fill -- to feed into the pipeline for new antimicrobial's. so i look at it as not a mixed message. we need to do two things simultaneously. we need to put the lid on the evolution and the development of antimicrobials resistant and then we've got to have a pipeline of drugs to take them. so the messages we've got to get more antibiotics but we got to prevent further evolution of resistant. >> do you have a public message that you're putting out for the public on ways to not go and keep asking your doctor for something for a sore throat and so forth, that kind of thing? is that they don't? >> yes. >> okay. i will assume that is happening. now, from the other side because i want to get at the concern that has been raised, you know, i appreciate the history of the story of development of penicillin, but pharmacology, pharmaceutical companies are very much working from more of a profit motive today that perhaps they were when some of these initial antibiotics came onto the market just because they were on the way to be developed. dr. fauci, can you elaborate on the pathway that you illustrate in your slides from basic research to private development? i would like to know how you're collaborating with private industry in this area. which you noted isn't necessarily the first area of private industry would like to invest. in other words, you really want, you know, some antibiotics to fight these resistant, and other resistant diseases. how can we incentivize them to do this? >> i can give you a concrete real-time, real-life example of how we have done that with one particular finding. since we involve fundamentally in pursuing and supporting basic research for concept development. we have funded a group of investigators from several of our centers, and they have found a small molecule which has the capability of inhibiting essentially any virus that has a lipid component to its envelope, or its outer coating. potentially a really, really important advance. they have -- >> you have done this? >> we funded them at a university. they made the discovery. so how we are partnering with industry and biotech is that we are providing the resource we agents, the animal models, the capabilities to do a phase one clinical trial for those investigators in hooking them up with biotech companies and then ultimately pharma in order to take what was just a concept into something that might actually be a product. and win, i hope this comes to fruition, of a product, and if and when it does, we're going to provide the clinical trial capabilities to test it in people to see if it works. so we are really forming a partnership that goes right from the investigator who makes the original observation and develops the concept up through and including the translation of that through biotech and industry. >> and genetic commitment from biotech and industry, because they see the kind of research that you're incentivizing at university level. so they are committed already that -- >> we hope they are committed and stay in the game. if we make him and that's the point i was making an answer to several questions, if we can facilitate that difficult process from concept to product but anyway we can, by making our assets available, other things beyond our control, such as financial incentives, and cetera, it makes that transition from concept to product much easier. we play an important but not an exclusive role in that. there are other components that have to come in to do that. >> thank you very much. that's helpful. i have a question for you, dr. frieden, but i'm out of time so we will wait for the next day. thank you very much. i yield back. >> thank you. the general woman from florida, ms. kaptur. >> thank you, mr. chairman. i'm interested in whether or not you are able to achieve the enough data to track what is obviously a major public health issue, one that has deadly consequences for so many. when i look at the estimates, we have estimates in the number of antibiotic resistant infections, and it we have estimates in number of health care associated infections. the cdc's most recent data is that in the u.s., every year it's about 2 million hospital related infections, and about 90,000 americans die from it. and in the other one include in our material in america there are 90 -- annually about 94,000 cases of mrsa every year with 18,000 -- 18,000 deaths from mrsa. doctors, do these figures sound about right for you? is it fair for me to conclude that over 100,000 americans die each year to antibiotic resistance? >> large numbers, i think the estimate you gave was 90,000 which is an estimate that has been used before. as i indicated in my opening statement, there has been progress with mrsa where we have seen a decrease of about 50% in serious infections in hospitals that participate in the national health care safety network. >> so how is the data collected for you to compile these numbers and estimates the? >> we have two major methods. the one that is more widespread is the national health care safety network. this builds on the more than a decade of experience working with hospitals, working with infection control practitioners, standardizing definitions, encouraging reporting. and now we have 28 states which mandate reporting. 21 of infrastructure to report and about half of all hospitals in the united states currently including many hospitals in states that don't require the reporting publicly yet. that reporting respect to see expand nationally over the next couple of years. >> why would states not mandate that? and why would hospitals not? >> it's a recent phenomenon, so five, 10 years ago no state-mandated. again, a few states it's been gradually spreading. it is concerning to hospitals. they're worried about reporting coming from reputation risk, and the approach has been to make clear that reporting is a good thing because it helps us to identify problems and address them. >> with the estimate you have now, knowing that some is not reported in some states don't mandate it, do you extrapolate? >> yes. these are extrapolated from both in age as an and also network called which allows us to monitor and about resistant to a series of core infections and a representative sample. across the country should have become every portable? >> certain strains of antibiotic resistant organisms are mandatory reportable. there are some that are so, that reporting probably wouldn't be worth the burden, and sampling may be more effective. that for many organisms, reporting mandatory reporting is something that's recommended by the council of state and territory epidemiologist, and is done in most or all states. >> it sounds like we can do a lot better. what are you working on are what recommendations do you have to improve reporting so that we're able to track with adequate data? >> thank you. all excellent questions that one of the things we have done is to try do the electronic health record to extract information which then is validated by human beings, what would allow us to ensure us infections are reported reliably, rss the completeness of reporting. one of the things that is essential to make that happen is in electronic laboratory reported so when a laboratory gets a result, it ends up in the medical record. it is a reportable condition. it ends up with the authority to which it should be reported. we also fundamentally need to make better use of the information so that we implement the programs that we know work. and there are programs window can drastically reduce central line associate infections, and other hospital associated infections, and that we continue to generate knowledge so we can better prevent problems that we don't yet have good tools to prevent such as community associated methicillin resistant. >> doctor, you want to comment on data tracking? well, i want to say in my district back home, we have a researcher that is working on the antibiotic resistance, and he -- this is a doctor at the university of south florida. and his research is mrsa based, and he is particularly looking at the design and develop in a nano particle-based technology for drug delivery. but in his comments to me and his answer to the hearing, he was right on point with what you are saying of what happens from the basic research level and then turning that into some kind of new antibiotic so that it's a real issue, and along with the lack of funding at nih, cdc and d.o.d. it is practically non-existent. we simply cannot get the product companies to take any interest. thank you very much. >> thank you. gentlemen, mr. shimkus want to ask additional questions or and and if anybody else does, i will allow it because i don't want to have another round but i know there's a great deal of interest here. so recognize the gentleman from illinois and. >> thank you. and we've talked about the cdc, nih, fda, and then through this hearing i remembered that the copper industry had been working with the department of defense to test copper as an antimicrobial -- killer. anti--- antimicrobial killer. and so epa is just certified -- of environment protection agency approve the registration by the copper give him an association for copper and capper allies to make public health claims as being antimicrobial. these claims acknowledge the fact that copper is in italy cable of killing back to. have you guys to any look at that? and should you? is that something that cdc or nih, or is this the problem -- the federal government is huge and we're doing different things. >> well, let me answer in a way. it may not be the direct and you're asking for but there are a lot of elements that can have any microbial activity. the question is to get it into a drug that would not be toxic. that's the -- >> this is making a claim that copper being used on surfaces kills microbes. this is what -- and i think we've had federal dollars in research and d.o.d. through the department of defense. all i would say is, think, you know, -- >> do want to get back to his? >> that's out there that the epa has said they can make that claim. >> why don't you ask him, why didn't you get back to his? >> will do. >> ms. capps, did you want to ask your additional questions? [inaudible] >> i don't want to keep you because you've already wait most of the afternoon anyway. but my question, kind of ties in with before and i can come up with another and we might have as well. i was just concerned, curious, if because according to the national antimicrobial resistant monitoring system of data, and that is a mouthful, at least 80% of meat and poultry products are tainted with some kind of antibiotic resistant bacteria. at least that's a study that has been out there. can i use that as a basis of fact? >> i'm not coming with that specific statistic. >> okay. maybe it's -- will make the assumption, since this is a national antimicrobial resistance monitoring system data, and they did state that at least 80% of meat and poultry products are tainted with antibiotic resistant bacteria. tainted, i don't know what level. my question was, what bacteria are we testing for in our food? are we doing any kind of antibiotic resistant pathogens like staff are like mrsa, methicillin resistant? is it possible to test or any markers or any facet that this might be in food products? >> these are all relatively easily tested for in small quantities, if you want to test large portion of the food, there are obviously logistical and financial implications. this really is the territory of the fda. >> i understand it, but just in the science point of view, you don't have to agree to the study if this is something you're not the money with. >> i just don't know the specifics. >> we can take that off the table. but supposing something like that is true, there is the science to be able to pick up the markers or test within food products. and again, i'm not suggesting we should because i understand this belongs to another department, but there is a concern about the spread of mrsa and whether or not it is their and there is a possibly the some research and another department like food and drug administration could do this. >> it's scientifically possible, but it's a logistic issue. the fda is very difficult for fda to test broadly and the only have the capability and the logistic capability, a very small fraction. >> exactly. thank you for a much. and that completes my questions. >> doctor burgess, do i dare ask if you have another question? [laughter] speck of course you can. i would just like to hear from one or both of you, what are some of the things you see over the horizon just very quickly that this committee should be aware of its tranforty reference a couple of things with genomics and being able to sequence of things very rapidly. we didn't get into the diagnostic, the diagnostics part of this, haven't talked about the vaccine part of this, but just very briefly what's over the horizon that you guys see on a daily basis that we wouldn't be aware of? >> i think in terms of practice the first thing is to scale up the proven means of reducing hospital associated infections and reducing inappropriate antibiotic use. this is something which we have made progress in, but we could make a lot more progress. >> and i have to say because there's been a lot of discussion of antibiotics in animal feed and use for both promotion feed efficiency, that we do not consider used to promote growth. an example of judicious use of antibiotics. i think the directions we're going our first apply to things we know well to reduce infections. and i think of a lot farther to go there, and second to continue to generate knowledge on how we can reduce infections through programs such as hospital associate programs, electronic health records, reminder systems come a control systems that will support doctors in restricting use of antibiotics. and s. dr. fauci mention, point of care diagnostics which are very important in helping a dr. no right there, the kid doesn't strep throat you don't have to treat him for strep throat? >> okay. we obviously may ask additional written questions, we will try to get them to you in the next 10 days or so, which is the normal routine. but members are free to, you know, send more written questions or comments to. so i just want you to be aware of that. but i do thank you. i mean, this is a very good hitting. and obviously members are very concerned about the issue and work that you're doing is really crucial. so thank you very much for your participation. and without objection the meeting of the subcommittee is adjourned. >> thank you. >> thank you very much. [inaudible conversations] [inaudible conversations] >> wanted to have the security that gave them exposure to the housing market. and that's what they got. >> the senate with goldman sachs executives went nearly 11 hours. see the key moments, see every moment. it's washington your way at the c-span the library. every program since 1987, free, online. >> now a senate hearing on expanding small business access to internet broadband. witnesses include federal communications commission chairman julius genachowski. mary landrieu of louisiana chairs the small business and entrepreneurship committee. this is just over two hours. >> good morning, everyone and welcome to the small business hearing. connecting main street to the world. we are excited about the two panels that we have this morning, and anxious to hear the testimony and also looking forward to the questions. we should have a good attendance on our side this morning as we can see the room is packed, because there's a tremendous amount of interest in how small businesses, both in urban areas, suburban areas, and in rural and sometimes underserved areas can benefit from the new technologies and new partnerships that are emerging on this issue. so i am pleased to be in the senate hearing on small business and entrepreneurship today in our newly renovated space and hopefully you all will enjoy the benefits of that today. i like to begin by thanking our witnesses. we have a distinguished verse panel, which i will introduce in a minute. but what i want to say is that i understanunderstand our witnesses have at a full congressional dance card in recent months. you testified individually before a variety of committees, but this is the first time that all of your representative agencies have shared one committee panel to discuss broadband. federal coordination will be key as each of you have unique resources, expertise and authority. for our business panel it's critical that we hear from providers to small businesses so that we can make informed legislative decisions. many have traveled from across the country to be here. suffer from louisiana, one especially want to read a recognize them. i also encourage any business or business association not able to testify today to submit a written statement for the record. we will build a full committee report on this subject and the record will be open for the next two weeks. in the same way that our interstate system connected america by reducing travel time, facilitating commerce, broadband has minimized the barriers that separate small businesses from geographically consumers. one country that's been able to do this in my home state, just for an example, his louisiana network foundation. i companies to buy to louisiana tech graduates. i the opportunity to tour such a company last year. and one of my visits to the state. it has to build a technology that allows live streaming video over the internet without using large amounts of bandwidth. in partnership with louisiana tech, they punted as for various sporting events throughout the country and around the world. a midsize rural town in north louisiana, this business is developing because of access to this new highway. it's a great example of how public and private sector can join to form meaningful partnerships in providing and utilizing advanced technology. nft also shows that broadband technology can create high-paying jobs come use only associate with other more famous high-tech corridors, of course in california, massachusetts, are right here in northern virginia. but broadband has not impacted small high-tech businesses. this technology has changed traditional business models that all small business owners once relied on. as such, it is particularly important that small businesses have access to broadband technology so they can compete on a global level. this committee has long understood that small business come in all shapes and all sizes. and occupy a wide range of different industries. with this in mind, we do not want to disconnect mainstream. we also want to connect every street. every side alley and every country road so that all small businesses, whether they are a traditional farming interest or internet startup, out in these less populated areas, have the same technological opportunities. so while we must expand access to these services at the same time, we must ensure broadband is affordable for these entrepreneurs. according to reports from the fcc, businesses with 25 or employees or less, take two times more employees for broadband than those with more than 25 employees. we want to explore this fact today. education is the key. we need to provide small business with the tools they need to understand the benefits of broadband and the challenges associated. we need is show small businesses how to utilize this technology to make their businesses more efficient, to gain access to new markets, and ultimately reduce operating costs so that small businesses can be the engines that they are or the best engines that they can be, as they lead our country out of this recession. our committee has received data on the importance of the small broadband providers will offer service to rural and other underserved and conserve areas, innovative small businesses are key to finding cost-effective ways to serve rural and underserved communities. i understand that today our committee will hear about small business participation and network buildup projects funded under the recovery act. just last night i understand there was an additional $1.2 billion announced in grants throughout the country, adding to the 1.2 that were previously issued. expanding broadband access and adoption is not just the fcc's job. we all have a role to play. that is what i believe it's important to hear from each of the federal agencies today. chairman genachowski, we're here to work together to ensure our national broadband plan offers robust competition among all broadband providers as a means to travel broadband service at higher speeds and lower prices. there's a lot of work to be done. in this spirit, the subcommittee, the staff of our committee and other subcommittees, has been active in conducting outreach to various broadband providers interested in further connecting their communities. my staff is great broadband guide to help small businesses. we are directing this guide to be distributed today. i'm very proud of the work that the committee on the small business committee has done in this regard. it can be said, and also, access to our website. we have made hard copies available, and there will be accessed through the website. i'm also pleased that a number of small business recommendations from this committee have been made to the national plan. many of these provisions are included in the broadband bill that i plan to introduce in the coming weeks. i hope my call is on the small business committee will join me, both ranking member of snow and former chair of this committee, senator kerry have done a tremendous amount of work on this in the past and i want to acknowledge both of their leadership in this regard. and finally, through the broadband data improvement act of 2008, which i cosponsored along with the american recovery reinvestment act, many federal agencies were given a renewed focus on broadband and small business issues. first, the federal communicate should commission and the sba's office of advocacy were tasked with collecting better data on broadband and small business broadband usage. second, rural utilities service as a national telecommute haitian and invert communication were directed to set up broadband grant guidelines that would encourage small businesses participation, especially participation from socially and economically disadvantaged small businesses. unfortunately, my state of louisiana ranked towards the bottom of technology penetration. i'd like to work to see that changed, and am aggressively working towards that end. third, in these set of bills the federal communications commission was given the challenging task of crafting our national broadband plan. at 360 pages and 17 chapters, mr. chairman, you and your team have provided us with a blueprint of how to move forward. so i want to just in closing to thank you all again. i will be introducing the panel is in just a minute, but at this time i would like to turn it over to ranking member olympia stowe for her comments, and again, thank her for really her extraordinary leadership in this area, both as a former chair of this committee and a member of the commerce committee. senator snowe? >> thank you, chairman do. for holding this hearing. and championing the critical federal efforts that are necessary to enhance affordable high speed internet service through small businesses, and appreciate you can think this hearing today. . . puno had to ctia. they also can provide a unique point of view in the small advertising marketing and consulting firm spirit actually they're both the same islamist pro football hall of fame and the other is in the frozen foods hall of fame. so i think all of our witnesses for taking the time to discuss an issue that has wide-ranging impact bike to join in the entire system of commerce. there currently to her clan initiatives, the sec national broadband plan and the economic recovery act broadband wireless spending program, boso which will have far-reaching implications for small businesses across the country. i look forward to discussing the ecstasy of these measures and eager to explore other ways the federal government can encourage wireless and wireless companies to compete fairly in a property product remarkable balancing the fact we must avoid creating undue burden through this government regulation. as a member of the commerce committee, with whom i for the senate kerry i'm pleased to join them in a critical legislation, i have heard countless stories from entrepreneurs in my home state of maine across the country, that abuse the internet to transform the way they do business. just last week in fact i was contacted by an owner of a small business, who depends on broadband connection is thematically basic business access. his business is located in rural maine. in his own words and i quote, my knees were broadband are standing for with the limited access and marketed name is putting extra semi-business. in my industry, claims really have time to do with waves of technical problems and would move to my competition the moment our ability to deliver is compromise, and quote. those such as this entrepreneur and his family into the main way of life, he now faces the gutwrenching reality of possibly relocating his business to new york or los angeles, not because he wants to come about because he have to do to the lack to the lack of processing capacity i find this deeply disconcerting coming at regrettably millions of americans and small firms are facing a similar unlevel technological plainfield and neither did not have access to, cannot afford the very technology that is created such opportunities to so many others. the internet is not only a tool for increasing efficiency and productivity, it's necessary for competitiveness and job creation capacity for businesses large and small. unfortunately however, it remains an untapped resource for approximately 93 million americans who do not use broadband today. the sec estimates 14 million american households lacked access broadband. most lived in rural communities throughout the most to gain from broadband availability which provide better access to jobs and education. so i applaud chairman genachowski for the fec's national broadband plan we had here in the commerce committee, a very important issue to eliminate the digital divide that exists within these areas. this morning i certainly hope to explore with the panelists to ensure that the recommendations in this plan will achieve everything is so desperately requires this rural small businesses. with unemployment remained stagnant in nearly 10% or nation undergoing what appears to be a jobless economic recovery, it is paramount that we leave no stone fostering and not to binaural environment in which small businesses can hire new technology and best in the future to preserve and create new jobs. as congress considers the dimension of issues that can help small businesses to start hiring again and i'll repeat it as last week in the chair and i agree on this is that we need to pass long-overdue small-business job creation legislation. and i hope there will will be considered in that legislation this proposal but i've also recommended, is to increase the small business development center funding by $50 million. i think that that money can be used for training and outreach of small businesses and broadband applications, which is so imperative that we're going to make sure that small businesses are on par in trying to not only access this technology, but also in terms of how to use it. we must ensure small entrepreneurs of every tool at their disposal including accessible and expose of old broadband. a recent brookings report concluded by big capital expenditures have created nearly half a million jobs in 2009. the availability of broadband undoubtedly contributes to business expansion in employment growth. the brookings report estimates a $5 billion increase in property investment will successfully increase broadband penetration by 7% and resulting 2.4 million new jobs to route the economy. a stunningly the united states, which has long been the world leader in technological innovation ranked fifth, 15 clubland brought him as adoption, 14th and broadband icing and 28 and broadband fees. not very impressive to a country that invented the internet. there is a significant impact these four rankings have and that is not technological innovation leadership to broadband, the internet and information technology are catalyst spurring innovation. without greater availability and adoption are competitiveness will be significantly hindered good recovery act has done many things, including camino, providing grants to so many projects that are underway certainly in my state including the three ring binder project both increase broadband access at the interested in hearing from the administrator today on how this is working and making sure the money is disseminated fairly among small businesses in rural communities. i mustn't be good to you today from fpa on his plans administrated recently penned a joint event with chairman genachowski to partner with the sec and the national broadband plan. it is my hope and expectation that the fda will be anything but a silent partner because our nation nearly 80 million small business in the county agency to stand up loudly and aggressively in the seminal issue. the broadband plan recommends that the sba engage its resource partners for small business development and women's business centers and training and supporting small-business broadband use and application. i support these basic recommendations, but the sba must leverage the entirety of its resources and fully utilized all the core programs so that we can maximize their technological potential to enhance rural broadband deployment. some item chair again, thank you premature host in this critical hearing today. >> thank you, senator snowe. senator kerry. >> man in chair, thank you very much. first of all, let me congratulate you on the many innovations that you brought to the committee, not the least of which is granted to us that we'll get to sit at and i notice all these little green bottles around here. we've moved south and not valid springwater from arkansas. >> as close as i could. >> when i was chair we at poland springs, ranking member. >> and we're probably moving to count was, louisiana very soon. >> sledges want to stay close to the ranking member. we need her. seriously, i really do congratulate you. i thank you for a terrific energy and terrific focus to the chair and we all appreciate it. and i really strongly support your effort to focus on ensuring that small businesses are able to the best connected in the world and it is shocking that this year, 2010, after all the promises of 2004 and beyond, we are still strikingly disconnected in the united states. you can go other places all over the world. in fact, coming inherent to constitution avenue is one of the most disconnected places in the world. i think your phone calls dropped about three times per 500 yards. we've got to get this connect it. we've got to get this going here. you got to go to other countries and sit in the field and download the fastest way possible, complicated and long, you know, communications and your headquarters and elsewhere. here in our country we can do it and i believe personally that the stimulus grants are working. i support the national broadband plan. i think chairman genachowski has brought some strong leadership to that effort, but we have a long way to go and i just want to focus very quickly as the senator from maine did on massachusetts for a moment. i want to put a chart appear. this is a map of western massachusetts and those broad red slots that are rural areas that are either unsaved completely for underserved. there's a small line going up through pittsfield after north adams, williamsburg, so forth, where we have the highway connection, but we got 123 towns there that are completely disconnected and those folks left behind, which is that the governor, local leaders, state legislators and business leaders constructed a broadband to the supplication that i think is the best in this class called mass broadband 123 and it's named after the 123 towns that remain disconnected or poorly connected to the internet. i'd ask unanimous consent to insert in the record to one to three document that outlines the benefits of small businesses. >> without objection. >> madam chair, thousands of my constituents have written and supported that. a major share a couple observations. arnold linker right, my computer is my enemy. it can take me an hour to do something that should take 10 minutes on a high-speed connection. lorus trevino from nashville massachusetts writes, is completely insane that we're using dial-up internet herein are held in the united states in 2010. she goes on to say them at a disadvantage compared to my colleagues who have high-speed internet at home and my work is less efficient. lisa kirchner writes, i run a small graphic design business for my home in peru, massachusetts. i presently have dial-up internet access because i don't have access to broadband. it's not been usual for a photo upload to take hours and of course they can't talk on the phone to my customers while in connect to the internet. the mass broadband 123 proposal will build an open broadband back onto which private providers can connect to my columns on small businesses to speeds that they only dream about today. and that means that you don't have to be an employee was actually working. you could be at home and work. you could be in a remote location and be working and that also means that just because you live in western massachusetts it doesn't deprive you of the opportunity to reach customers in western europe or elsewhere. the national broadband plan has laid out a comprehensive strategy and i appreciate it particularly from my role as chair of the communications technology subcommittee on the commerce committee and we are working with the chair and others to really get this out as fast as possible. the fcc strategy, which i support, will combine the modernization of telephone universal service fund with no competition, wireless policies and enhance consumer access information that will generate two investments and is going to drive innovation and job creation at the same time. also, we just embarked on an ambitious health care reform effort. and as we do so, how providers including small practices in remote rural areas and elsewhere, we've got to remember it's a vital piece of the disc health i.t. without high-speed internet, it's also impossible to download and transfer patient files for provider to provider. and as we explore new ways to use technology to reach underserved communities, initiatives such as consultations via web video in distance learning for professional development on all of these things just don't work without adequate internet. the broadband plan calls for releasing more spectrum in order to encourage wireless broadband competition. making more information about their service accessible to consumers and it also protects an open internet, which many of us believe is very important. it's a just modernizing the universal service fund that is investing in a wireless network the police and firefighters can access and rely to safeguard vital medications during emergency situations. and all of these will result in investments in rural broadband that's going to ensure that radio collapses that occur in the wake of 9/11 and hurricane katrina are not repeated again. so i support all those initiatives and madam chair, i really appreciate this hearing. it's a very, very important -- you know, we always talk about how small businesses in the engine of our economy. you also hear every political speech about how 90% of america's businesses small business, but it rarely get to the focused attention it deserves. >> thank you, senator kerry. as former chair of this committee. we are very focused and i think all republicans and democrats could not get capital into the hands of small business, but we also want to give them access to a high-speed internet, both of which are critical to listing them forward and moving our country forward. we have three members of going to recognize likely. if you could limit your opening statements to one minute, submit the rest to your records starting with you senator wicker. >> thank you and i appreciate being limited in a moment of weakness i really don't recall. i agreed to appear off the hill at 1030 at clock. my staff assures me that i actually agree to this, so i'm going to a future out of this meeting. let me say it's good to a penal number one here, i particularly appreciate my two former colleagues, steve largent and gordon's mythically to come here today and be on the panel. perhaps i'll give it to come back in time for their testimony. but clearly, madam chair, the national broadband plan as a broad analysis of the marketplace. not every proposal is a unanimously agreed to, but i recognize the plan is flexible and a roadmap that provides many options to ensure important goals, two of which are relevant to our discussion today. first he must ensure that intranets with indications industries competitive in the global marketplace and second broadband access and homemaker are small and rural businesses competitive, locally, racially and national. i hope today we get into discussions of the level of government intervention that might be in certain areas and while we do that, we need to make sure that it's accomplished with the light touch clear recognition that private investment is essential. we'll also discuss the universal service fund, very important to the chairs state of louisiana into my state of mississippi as well as other rural areas and worse we will get into the discussion of spectrum. we need to make sure we efficiently and effectively use this finite resource. the success of small businesses is essential for economic growth in my state of mississippi small businesses make up a majority of our state's employers, that is their quality and affordable access to the internet to help them compete in the market. i asked that my opening statement be included in its entirety. >> thank you and a senator for being so cooperative in my lap without objection. the reason were having to do is simply as two panels, 10 witnesses this morning and it's really a very full hearing. senator hagan. >> thank you on madam chairman. i want to thank you and the testimony of the witnesses. in north carolina, we do have a lot of rural counties. eighty-five more counties are rural. one of the issues i care over and over again is the lack of high-speed broadband that these farmers can use. there's a farmer and camden county who provides many potatoes too late to make any potato ships. one of the issues is he has to report daily were the hardest. and he doesn't have high-speed. yes to literally go from as far back to his home where he only has dial-up in order to provide that information on a daily basis. think of the amount of time and energy he waste because he doesn't have broadband. so when he does desperately and i look forward to the testimony. >> thank you, senator hagan. senator vitter. >> thank you, madam chairman. and i'll provide mine for the record. i just want to welcome everyone and look forward to the statements. i want to welcome to folks [inaudible] city of lafayette is doing amazing work in terms of bringing tremendous broadband capabilities to that community and regulations on that work commentary, and look for tree continuing to date. and secondly, i'm also excited representatives century link is here and has one small louisiana company certainly not small anymore into 37 states with greater access through that network, so i welcomed them and i look forward to the discussion. >> thank you. in her statement will be submitted into the record. let's begin our panel this morning and let me give a brief introduction. chairman genachowski from the federal communications commission has two decades of experience in public service on the private sector. prior to his appointment he spent more than 10 years working in the industry as in executives and notch up anywhere. we thank you for your leadership, mr. chairman. larry strickling from the department of commerce. mr. strickling is a technology policy expert, excuse me come with one in two decades of experience. he was also chief of the comment kerry a hero for the fcc. jonathan adelstein joins us today from the u.s. department of agriculture preview the 17th administrator of the usda's rural utilities service. he previously served as commissioner of the federal communication. we thank you as well. suzanne huval from the fda serves as chief counsel for advocacy. of course that is still vacant. we're working hard to get it filled and we hope to get that done soon. in the absence of the administrator, she's here to testify on behalf of the small business administration. and lastly we have shone greene also with the sba was special adviser spirit cardinals could not be here with us today so we are very grateful to have mr. greene. let's begin with their opening statements of mr. chairman if we can begin with you, i'm pleased that this administration has made a broadband policy for this nation a priority. there've been billions of dollars invested so far in a tremendous amount of interest and thank you for being with us this morning. [inaudible] [inaudible] >> and if i may although over a shorter opening statement that focuses on broadband and small businesses. sorry, i apologize if i wasn't heard. broadband can indication is rapidly becoming an essential platform, it's not our most essential platform for job creation and economic growth in the 21st century, necessary for the global competitiveness in the u.s. it enjoyed direct to do the fcc to achieve universal broad and and to tackle important issues such as entrepreneurial activity investment job creation and economic growth. now small businesses really are our nation's understandable driver of job creation and economic growth. and the evidence is clear that broadband con activity and associated on line tools can be powerful for yours and small businesses, reaching new market, increasing productivity. together wired and wireless broadband can bring small businesses new revenue for new customers and lower operating costs by using business tools available in the internet class. that's a formula for more profit, more investment, more economic growth and more jobs on main street. the president has said quote, we need to expand broadband lines across america so that a small business in a rural town can connect him to be with anywhere in the world. i couldn't agree more. rocket attack transformative economic affect both in rural and urban areas. consider blue valley sheet in nebraska, which has used this online marketing tool to reach new customers out side creating new jobs. consider a bakery here and 14th street d.c., which is expanded from one place that broadband has been in the sports announces revenue and growth of its business. empowering him to reach his customers quote where they are online and on mobile, while keeping its costs in check. a farmer in theory, pennsylvania, he told me that all his life he thought computers have have no relevance at all to his business, except that now he realizes that without computers, without smart phones, without high-speed access you can't be a farmer in the 21st century. the fcc is work on the broadband plan not only confirmed by opportunity's for small businesses for broadband, it reveals several significant challenges to seeding them. first, to many small businesses operate the regions of our country but so do not have access to high-speed broadband infrastructure at all. second, in areas with high speed, dvd, too many small businesses find too few marketplace choices, a lack of adequate speed or prices that are too high. today small businesses pay an average of three times more per employee than large businesses for broadband service. third, small businesses to often don't have sufficient understanding of broadband, what we call digital literacy. the result of that in most rural counties in america, fewer than half of small businesses have broadband access. and overall, fewer than a quarter of small businesses, even today, and used e-commerce tools to grow and expand their businesses. the fcc's broadband plan recommends taking concrete action to tackle those challenges. to improve availability, particularly in rural areas and plans for the generation transformation, shifting support from plain old telephone service to broadband communication. a recommends that to make available sufficient spectrum so that we can lead the world in mobile and so we can benefit small businesses productivity, which relies increasingly on mobile communications. to boost marketplace and affordability to small businesses to plan recommends perrotta competition in broadband, including removing barriers and increasing trend antsy about speed of service while broadband consumers including small businesses, to improve digital literacy that he calls for increased training and outreach to small businesses. i'm pleased to say that this effort officially kicked off earlier this month when sba administrator karen mills and i announced the public-private partnership to provide broadband tools, training and support of the small businesses. and as you mentioned the plan includes a number of recommendations working with the fca to enhance resources so they can provide training and outreach to small businesses as quickly as possible. i'm pleased by our collaboration at the fcc, the commerce department particularly with the fbi, administrator strickling with the u.s. administrator adelstein interagency coordination is vital when it comes to this horizontal technology and i look forward to continuing to work well together. in implementing our efforts at the fcc, focal point of their opposite medications business opportunities led by director tom reid. although central to support and encourage the development of small and diverse businesses in the telecommunications industry taking advantage of broadband. but the fcc removed with urgency to implement the national broadband plan. we released about 10 days ago in implementation plan unprecedented and it broke and transparency with target dates for over 60 commission actions over the next year to implement what the country needs to do to lead the world in broadband. supporting small businesses and entrepreneurs must be a national priority of paramount importance. i am at small businesses with broadband encouraging digital literacy, we cannot ensure that broadband fills its promise as a transformative tool for spawn businesses and america's economy. thank you and i look forward to your questions. >> thank you very much. mr. strickling. >> chairwoman landor, ranking member snow and members of the committee thank you for the opportunity to testify today about ntia suffers to expand small business internet access. as you pointed out we testified in many previous committees. i think this is the seven-time administrator adelstein and i have appeared. it's always bad as a duet and today we welcome three new members to debate him up for it to the continued discussion. what about you focus on in my testimony this morning is what particularly ntia has accomplished since the passage of the recovery act to expand broadband availability and adoption and specifically how we can keep small business and the sufferer. as a recovery act directed ntia to direct administrator program totaling $4.7 billion with four purposes to build broadband infrastructure, to increase broadband adoption, to expand the computer systems and expand the map. we've now completed the first round of funding and i'm pleased to report that as of today and tia has awarded 100 or b6 recovery act against totaling approximately $1.3 billion. this includes 54 grams for mapping, totaling about $100 billion in 82 projects for broadband, totaling more than 1.2 billion. in total they will let 25,000 miles of new or upgraded broadband networks, will directly collect institutions and within schools, libraries, hospitals, community colleges, government facilities. for investing more than 1000 new upgraded computer centers accounting for more than 10,000 new or improved public computer workstations. i provided a map is learning to read be too that shows the geographical distribution of our route one grants. we were able to work grants in over 30 states, although some of our words and packed more than one state could nonetheless come as we head into her second round of funding we are very cognizant of our obligation under the eye to award at least one created each day the extent practical. small businesses have been direct beneficiaries of the screens appeared at the 20 worst to private businesses round one, even to small businesses, one of which is a socially and economically disadvantaged business. these grids deliver $73 million moreover nearly 40% of the tv to broadband grants awarded in round one include social and economic disadvantage businesses is business partners. hundreds of thousands of small businesses will benefit from these programs through increased high-speed internet availability for themselves and their consumers. let me give you just a few examples. in puerto rico, critical hub networks faced socially and economically business will make a wireless that makes every unit for polity and offer speeds of over 100 megabits per second to more than 1500 schools and local internet service providers. in maine, we awarded $25 million to a small business to build a fiber-optic network extending to the most rural and disadvantaged areas of the state, which will improve the overall level of facilities in the state and enable last mile service providers to offer services to homes and businesses about the state. and one of our multistate projects clinician economic government agency is using our public community senator grant of almost $4 million to create or expand the team computer centers in 10 states in partnership with latino serving economic development organizations. they will focus not just on delivering computer literacy training to hispanic communities, but also to deliver specific educational programs or latino mike or entrepreneurs interested in starting or growing their own businesses. those are just some of the examples of types of products refunded in round one and while we're pleased with the response of small businesses in round one, we doubled our efforts in round two to encourage and facilitate participation by small businesses and on to viewers. as a key element, we developed an online tool called broadband match or as we call it e. harmony for broadband, which allows interested parties to register online. more than 1400 entities signed up for broadband natch including many small businesses and. and they've closed for the second on a funny last month, more than four and up to two organizations and individuals for profiles on broadband match at either submit an application or worm fault is a key partner on iran to application. traditionally conducted workshops for phoning around to rows including six pre-workshop events focused specifically on the issues of small businesses attempting to participate in our program. and i set out in our round two rows will be giving extra consideration to an application that includes an ftp either for the document or a partner. we saw the effects of these experts on iran to application pool. those are just him and when the process of reviewing them, but we received a total of nearly 900 applications requesting $11 billion in grants. 21% of its applicants are small businesses, 24% of the applicants are either socially disadvantaged and economically disadvantaged businesses or have partnered with an and their application with 14% in round one weird deadline to award wrong to grant to september 30, 2010. as another recovery act does not provide authority or funding for administration or oversight of our projects beyond that date, yet to realize the benefits of our programming to avoid waste and fraud, it's critical that we monitor and oversee the screens while there've been put into operation. for this reason, the president's fiscal year 2011 budget includes authority and funding are ncaa to administer and monitor these projects and i urge members of this committee to support expeditious funding for oversight beyond the september to ensure these projects deliver the benefit that promise and protect the investment taxpayers have made for these projects. thank you and for the opportunity to testify and i will look forward to your questions. >> thank you very much. mr. adelstein. through that thank you, chair of landrieu and for your leadership on broadband issues. i appreciate that sentiment to make sure in a second to none in terms of broadband connections. senator snowe, ranking member so it's been great to work with your review as we appreciate your work on schools and libraries both of them are the commerce committee and former chair sure. senator hagan, thank you for your leadership as well. which is in asheville, north carolina. i think the president called me shortly after and talked about the needs of north carolina for broadband service and were committed to serving the area. we certainly are quite to be here and it's great to have a broader ban to testify with you especially honor to be with chairman of the fcc, chairman genachowski who's done such an outstanding job of leading the commission both in terms of the national broadband plan on so many other fronts. and of course my friend larry strickling has been announced in a partner in the same as broadband effort and it's great to partner also with our friends from the fbi and were looking forward to working with them and share john's or the person hearing the committee. it's good to see you here. we're committed to the obama administration is referred to getting broadband. secretary vilsack is pathetic top of his agenda, one of the pillars he sees as a critical making sure that broadband is everywhere and we appreciate your guidance as we implement this major undertaking. broadband connectivity cannot let small businesses to thrive, rural businesses, farmers, ranchers needed to expand and compete in the global economy. studies have clearly shown that rural growth increase of broadband availability. that is no set of work for entrepreneurs; our broadband program. nearly all of our borrowers under the federal broadband loan program have been small businesses. 35% are startups we've been doing this for many years. at the same is true under the recovery act. small businesses that put a big part of both of our two notices of funding availability for the program. under the first know that a large number of applications of minority firms, indian tribes and data of alaska native hawaiian organizations. a november u.s. awarded over 1 billion for 60 broadband projects that connect over half a million households in the nearly 100,000 rural businesses and anchor situation such as schools, libraries and community facilities. these expand 31 date and includes 17 tribal lands and rural communities. it was also a portrait diverse group of providers from very small public medications companies, wireless provider, were electric and telephone cooperatives to cable providers. to build a world that works and create urgently needed jobs in rural america. bugs were worked to small disadvantaged businesses and indian tribes in these projects also feature very quiet a bag of technologies from dsl but an too wireless. in fact, 37% of our awardees have a wireless component. the experience we gain is what will be in this committee and others haven't found another unproven and the second round of funding. the u.s. is offering a 75% correct, 25% on combination could defend his or her up on components. we eliminated the category for remote projects. with that offered's flexibility to increase the plan for 100% of rural areas and those of low and medium might come and high unemployment. which directly connects the helmet is used as an community anchor institutions. they will continue to finance the mobile projects for borrowers and grantees. it also allows satellite providers to compete for a land of 100 million to provide service to rural customers that remain unsurpassed for all of their funds have been obligated. awardees boatswain applicants can apply for technical assistance grants for the development of the usda approved broadband plan. awardees under e.u. council can apply for funds to buy broadband connectivity to rural libraries that were in her facilities program could expect to not grammars for these programs very shortly. we continue to focus on world and other areas for terms of eligibility. run the process of routing applications for the second move forward. we have received about 76 applications for nearly 11.2 billion running, that's over five times the amount available. about 60% of the applications are companies identify themselves as small businesses, disadvantaged firms, nearly 76% of applications was that of a for-profit corporation and run for% were by public entities and we had 21 applicants that were indian tribes. we believe our six years of experience and provide intelligent indications that usda will help us prepare to deliver broadband and encourage the development of locally on businesses. our goals are to modernize the nation's infrastructure, create or save jobs and work towards rural economic development. we certainly welcome input from members of this committee is reprint this next one of applications. as a mantra brca2 and our partners throughout the obama administration jamaica for both broadband services wanted the available throughout america. thank you for inviting me in a welcome any questions you might have. >> thank you very much. ms. white hall. >> chair lander, ranking member snow, senator hagan, good morning and thank you for the opportunity to appear before you today. and susan walthall, acting chief for advocacy at u.s. small business administration. in the interest of time will summarize my prepared testimony and asked that the full statement be included in the record. congress established the efficacy in 1976 to represent the views of small businesses before small businesses and congress has advocacy as an independent office come of the views expressed in this testimony do not reflect the position of the administration or the da. on a personal note, chair lander, i was able to spend several months in new orleans immediately after hurricane katrina through my work at the sba. that experience reinforced to me that importance of broadband can indication to small businesses and communities. the office about because he has been and continues to be active on a number of small-business broadband issues. on behalf of small businesses via feld, letters on the guidelines for the broadband technologies opportunities program in the broadband initiatives program. the fcc's role in the national bullock broadband strategy. in the senate are numerous, letters included in appendix i to my written testimony. we are pleased to work with and cia on the recovery act, the top program and be part of the efforts to include small and socially and economically distant and its businesses. we were happy to you that several businesses chose to partner put sdbs. in addition, with advocate for increased access to spectrum by small businesses through the fcc's designated entity program, special access reform and competitive regulatory approach to the u.s. telecommute acacia and industry. today i will highlight two key areas. first my looks from the challenge and state by small-business providers. second i will discuss a study that diathesis conduct and on broadband and small business directed by this committee. my office were closely with small broadband providers understand the unique barriers they face. we recently visited the offices of operations of natural gas, a small cable operator figures come in rural maryland. we saw firsthand the difficulties matcher cast is facing and could service area separated by and accessible terrain. it helps us understand what a true, mom-and-pop broadband provider looks like and why they are so important to many of our communities. two problems for small-business providers are special access and the acquisition of spectrum. small carriers have continuously reported increased rates for special like this. the current price of special access specifically demonstrates a lack of competition in the market. incumbents are able to raise prices without losing customers. the combination of high prices and few alternatives creates a difficult burden for the small-business providers. advocacy is committed to working with the fcc to ensure that small entities are able to acquires doctrine. the 2006 revision to these rules has encumbered small business participation in fcc's r. term option. to consider amending its designated entity roles, allowing small companies to compete in spectrum auctions but the use of bidding credit. the broadband data improvement that the 2008 directed advocacy to conduct a study to ally with broadband availability for small businesses. i want to thank senators landrieu, snowe and carry for spearheading this study. the study due in the fall will provide valuable information on broadband options currently available to small businesses. it will provide a baseline against which the success of the broadband grand and programs can be evaluated. results will geographically highly small businesses that are underserved areas and determine just how limited their service choices are and how this affects the price of broadband. the study will match service availability with small businesses location, allowing small service providers to enter the market and offer innovative projects in this region. broadband allows small businesses throughout the u.s. to access customers, fostering greater small-business contribution to economic growth and job creation. we are ready to work with everyone here to make universal broadband a reality. thank you for allowing me to present these views. i will be happy to answer any questions. >> thank you or imagine it's good to know not only we have the small business administration advocating on behalf of small business that the actual office about 60 they can get a more independent u.s. love and i know the small businesses in our country appreciate that. mr. greene. >> thank you chair landrieu, ranking member snowe provided me to this important hearing. broadband technology brings extraordinary opportunities to america's small businesses regardless of industry size or geographical location. there are two critical factors to consider when it comes to broadband and small business. first, this is the benefit for broad and in an accessible and affordable and secondly better tools and training targeted to small businesses would help maximize broadband potential. the immediate challenge is relatively simple. access to affordable broadband service is not yet available to all small-business owners, especially those located in unserved and underserved parts of the country. when they give you some concrete examples of how small businesses are taking advantage of the internet as a sales and marketing platform. take ricky collins or granny d and internet entrepreneur selling her home a children's clothing from louisiana. after her friends and family taught her how to use ebay, she made the leap into creating hope business in her own website and is now generating orders in japan, canada, england and italy. or northern outdoors and adventure are running by watercraft in maine. northern outdoors recognized a long time ago how to use potential of the internet to bring new customers to their business. not a market there crips or a customized website for new search engine automation and keyword buying of google. yesterday with twitter and facebook to get new customers and take bookings online as well. finally open table provides one more example of the importance of broadband for small businesses. in this case, serving as a platform for an innovative high-growth business to use the internet to serve other small businesses as customers. open table allows consumers to book restaurant reservations in real-time via the internet. in turn can be used in a, restaurants use open table software as the reservation management system, getting updates on reservations real-time, far more efficiently than answer lots of phone calls and booking everything on paper. the company is initially funded by small-business investment company that public last year and now employs over 300 people. but despite such success stories, more work still needs to be done. for instance, with a small business gets access to affordable broadband, challenge lies in adopting the technology and leveraging to its fullest potential, which leads me to the second key area, small businesses need better tools and training to maximize broadband potential. this is where sba and its partners can play a key role. that's where the sba and its resource partners are focusing on increasing visual literacy. we want to broaden the knowledge base of small businesses to take advantage of such areas as e-commerce online marketing, social media, on demand software and much more. i'll get one recent example. be our partnership with score, we have a cadre of 12,000 volunteers who are executives at counsel entrepreneurs and small-business owners. earlier this month, score announced a partnership with technology companies that will develop training materials to inform, educate and support small businesses interested in using broadband. this core leadership team is working to develop these train the trainers material from a party brought on board another one of sba's key resource partners, are 110 women's business centers. sba will continue working with all of our resource partners on similar efforts, including the possibility of delivering additional training for a network of small business development centers. as today's hearing clearly shows, broadband access adoption and utilization play critical role in supporting the strongest engine of our economy, small businesses. sba and her partners cannot small-business owners in the knowledge and skills they need to harness the strength of this powerful new technology. if we can account for stock, we know small businesses will grow and create even more good american jobs that will lead us towards economic recovery. thank you for leadership in this crucial area and for holding this important hearing today. i'm happy to take any of your questions. >> thank you are a much mr. greene and we do have a series of questions we will ask you now. i want to say this will probably go for another 15 minutes, maybe 20 and then we'll start with the second panel to give them notice, but i have quite a few and i know that senator snowe does as well. i like to call your attention, all of you, to this is one of my favorite charts. we use it often in this committee because we like to put a picture with the statement. when we talk about opportunities for growth for small businesses and mr. greene, you hit on this in thank you for highlighting a small company in louisiana that is not because of access to high-speed internet able to sell objects not just in the surrounding northwestern part of louisiana or arkansas or texas, which would eat in a previous time 20 years ago her only market possibility. but today, she can sell those products in china and other places that she mentioned. this is how few small businesses in america export. 1%, mr. chairman of our businesses in america, small businesses are exporting. when the bulk of the market of the world lies outside of the territory of the united states of america. but to export, not only do they need ships and trains and trucks and sport, they need communication and they need fast communication to do that. that's in large measure what this hearing is about, not just exports, but also -- but it is interesting when you think about to look to see this jobless recovery, where the jobs may come from, here's a big space and i want you all to address that, large businesses are exporting 42%. they of course have opportunities as well. but this is going to be the lifeblood for firms in maine and firms in louisiana, but again they just don't need the highway going to their business. they made the super fast highway now come in the interstate. i mean, not just the interstate but of high-speed rock band. let me ask you again, mr. chairman, i read a summer of your broadband report which was issued i think the first one in our nations history, most comprehensive 12 years months ago. can you hit the highlights of how this plan will open a part sure to these for small business, not just to export to other places in the world, but to give them the capacity to grow the jobs we desperately and urgently need in this country today. >> first i would say this is a perfect visualization of one of the huge opportunities if we get brought in policy and strategy right in the country good and you look at it not just as an opportunity, it's a necessity. the strategies that we recommend pursuing flow for the challenges we see for investment. one, many small businesses in areas where they just don't have access to broadband at all. there are digital literacy institute where they don't understand the full benefits of what can be accomplished on broadband and third affordability issues. as other number of steps were taking, some are processed will disproportionately benefit small businesses. some are small-business targets such as a transforming our service fund to make sure that wired and wireless broadband medications as extended everywhere, so i small-business that is in a small town getting by as the opportunity to connect to high-speed broadband and whether they meet company or a clothing company, selling products to the next day, to the next country. making sure that mobile broadband is truly available everywhere in the country. we're challenges as a country to achieve that, tackling the training and tools issue. and this is where think interagency coordination will become particularly important, the resources at the sba or something refocused on in the planet together with sba kicked off the program to mentor and small businesses good segue to tackle competition issues that many small businesses -- on the panel as well are keeping prices too high and choices too few for small businesses to broadband. >> okay, i'm going to ask each of you, starting with you, mr. strickling, to see what comes to your mind as the number one strength or one of the important strength of the plan and also which you potentially see as a weakness, relative to small-business being helped by the broadband plan, just off the top of your head, what do you think one of the strength of the national plan is in that regard and what are the shortfalls come either shortfalls or weakness this? >> are right. i think the chairman gave a very thorough listening of the opportunities on the recommendations of the plan. in terms of reaching small-business, i think first and foremost probably the most important single issue is the reform of the universal service program because that i think will provide a lasting mechanism to ensure that these facilities get buildout tool regions of the country. the recovery has provided us nearly $5 billion to get started on this effort and then the ruf has received an additional 2.5 billion to do it. but to succeed long-term were going to need universal service reform, so i would say that's probably the top one in terms of having an impact on small business here at i have no shortfalls to identify from the plan. i think it's a very thorough and complete effort on the part of the fcc's and they should be very proud of the work they've done. >> thank you. mr. adelstein. >> i also think it's an outstanding plan. a lot of us are when it appeared what's important is that the haeckel, 100 megabits per second for every home, for example, are small businesses will need to be in with. other countries like korea have that in every household. this country family under this administration has taken leadership and then we're going to do that, too. when a leading other countries around the world make sure that their people have access to very high bandwidth and are stoned. and i think the big challenge is not a weakness, but there's a lot of issues in front of the commission in dealing with competition policy, universal service policy and flushing them out of something the commission under the feeble leadership is very able to do. there's a great deal of work ahead here we set a brilliant blueprint and now for the rubber meets the road in a deep trance that into you policy. in my chair, it's are small-business providers that provide this access in the rural areas and so we've got to make sure it's a level playing field for the small-business providers. >> mr. greene. >> a think clearly from sba's perspective a critical component of the plan that the fcc got it right is in addition to getting the access, the importance of the training, digital literacy to reach out to the small businesses to train them in how to take advantage. the fcc's focus on that i think is critical and from our perspective our ability to leverage our foot could be a all our resource partners to help train the small businesses is spot on. beyond that, the administration as a whole and sba as well is looking to say how do we use the report as a starting point to develop were broadly if respect is on additional ways that we can also serve our respective missions within the context of the broadband plan. >> i'm going to recognize senator snowe and it will come back for second on the questions questions because there's a few more that i want to us. senator snowe and i review the budget for the sbs proposed at the administration both recommending while we are proud that the administration supported a more robust budget, which weaken considerably because of past budget, we both are recommending somewhere between $50,000,100,000,000 in addition, but it reminds me when i think about when you say the footprint, think about a pair of shoes, without shoelaces. you can't run very fast and then. and so when i think about the footprint of the sba, and over spending a little bit of money purchasing those places necessary to get that footprint really moving when it comes to broadband. and yes we have small-business centers out there. with minority business owners, we escort chapters, with the banks themselves. 5000 banks that get technical assistance with 5000 committed events in this country, not to mention credit unions, it under. that's where small businesses go to get capital. we need to think about that footprint in getting access to high-speed internet and technology, closing the digital divide. senator snowe. >> thank you, madam chairman. in thank you all for being here today. i think it's critical to have the collaboration that is represented here today among all the agencies. i think along with the fcc has been spearheading the whole effort to create a national plan for broadband deployment, without a doubt, this is the way it's going to

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