Transcripts For CSPAN3 Politics And Public Policy Today 20160314

The opportunity to strike a new grand bargain that leverages more efficient donor action to parallel changes and u. N. Agency so that collectively we are more strategic and more effective and more efficient and more nimble. We will also have the opportunity and the obligation to grapple headon with the sharp decline and adherence to basic humanitarian doctrine and the fact that the greatest impediment to reaching people in need in chronic conflicts today is the willful denial of humanitarian access by all parties. Second, in september, president obama will host a summit on refugees on the margins of the u. N. General assembly. Theres no question that the global refugee crisis putting the host countries to the test and it is also putting people to the test. Most refugees face futures without education or jobs or the hope of normalcy, often for a generation. Unfortunately, the debate on the global refugee crisis has sparked has been more about rhetoric. Some of it hateful than about solutions and the summit provides an opportunity to change that by challenging the world to commit to solutions to sustained humanitarian funding to the settlement and other legal channels and to enabling refugees to secure the protection, education and livelihoods they need for their families. Finally, let me come back to u. S. Aid. I am proud of where the agency is today, and i know that what the United States needs regardless of administration or party, and it was an effective, agile and impactful u. S. Aid and one thats ready to handle whatever the future brings. So i end where i began and leave you with the hope perhaps more easily offered by an administrator near the beginning and the end of her term. Its kind of interesting, that we can strike our own grand bargain. Weve shown a development is an endeavor backed by bipartisan commitment and we have shown that u. S. Aid can deliver. I have told members of congress with whom i have met that i will be transparent and accountable, a pledge made easier by the hard work and vigor that the men and women of u. S. Aid bring every day. Ive also said that i will not be shy about coming to congress to ask for what we need. We met with the former u. S. Aid administrations who span four administrators and Political Parties and each of whom maintains the same commitment to the agency that they held while . Office. Im looking at one of them as i say, i know they would agree, when i say that all of us across party lines and from one administration to the next must pledge to keep building a stronger u. S. Aid and one that delivers accountability and impact and earns flexibility and exchange. An agency with the agility and support it needs and the agency we need and the world deserves. It we meet these three challenges and we made the choice to invest in the future and not just the right now and we cannot show an air of progress. If we persist through the inevitable setbacks and shocks of the countrys transformation and well have capable and responsible partners. As we come together as a Global Community to say we can do better and do it and well have systems worthy of the complex and changing world. The men and women of u. S. Aid with whom i am proud to serve are proud to lead and with you by our side. Thank you very much. [ applause ] can you hear me . Three techsavvy people. I will start off. Gail, thank you very much for that address. Thank you very much, george. I want to pick up on a theme that you started talking about before we all came out here. And that both senators talked about because the venue bier here in this audience, i really want to put an exclamation point on the issue of a bipartisan nature of foreign assistance, and you talked about it, and i think at this stark political period were in. Its really striking how over the past 15 years theres been a common support and backing for the range of initiatives that have been undertaken and in addition to what you say i look at the signature aspects of the Millennium Challenge Corporation and the transparency, the ownership and the evaluation, accountability, and this administration really largely under your leadership took those themes and concepts and took them from one agency and spread them across the whole foreign assistance program. You mention electrify africa which the Republican Congress enacted and youve got the foreign assistance accountability and Transparency Act which is past the house and is hopefully poised to pass the senate and tonight the Senate Foreign relations takes up the legislation that would enact into law this administrations feed the future program. And all of your consultations during you, you say you never had to make the argument with foreign assistance. Why do we have this strong support for foreign assistance and how can we tie that into what you call for which is a grand bargain of Greater Transparency and accountability in exchange for more flexibility and agility for the agency . Well, i will say i find it really striking and its one of the things about this job that is quite pleasurable that literally in no meeting did i say developments are really important and theres this agency called and i think theres room in pursuit of development for everybody regardless of what your point of entry is. Some people are behind it given that its an expression of our values. Some because it makes economic good sense and some because its a National Security impairment. I think we have also been able to show mcc from the beginning. I think u. S. Aid is doing an extraordinary job at this now, and agencies across the board that it works. You can show the actual results of good investments. I think its greater awareness that it matters and were seeing evidence of what happens when the world is not making the investments and development that you need to make. So i think theres a basis for the bipartisan support that is rooted in a lot of fact and a lot of evidence. Any administration serving in washington needs a strong u. S. Aid and the Administration Needs a strong u. S. Aid. To have a strong u. S. Aid it is the steward of taxpayers money. Im aware of that every day. I think all of us are as we figure out who we are and how we do it. In order for it to be as nimble and agile as it needs to be in a world changing as quickly as this one is, i think earning the flexibility that will allow us to be nimble and agile is something we should all strive for and i think there is a willingness to do that and there is a willingness on the part of u. S. Aid to see results and one of the great things about evaluations, sometimes they show you can do things really well and they say keep doing it. Sometimes they show that one of your assumptions was wrong and you need to take a midcourse correction and thats what happens, and sometimes they show that it sounded like a good idea, but maybe it didnt work. Stop. That builds confidence. So it is my hope that we have the confidence and the recognition and the need to over time provide this agency the flexibility it needs to be the agency they think we need. Thank you. That was a great talk. Thank you all very much for being here. I want to tug on the threads of the things that you talked about in your address. You mentioned private capital and systemic Public Private partnerships and rules of law. Theres a lot. Music to my ears. I think one of the things that is clear to anybody who cares about the transformation of the developing world is the understanding that and entrepreneurship are the things that, first of all, give peoples lives meaning and secondly allow them to propel themselves and theyre changing their lives themselves and that requires, that obviously requires the kind of systems in place that permit that, and i know that theres been a huge change in focus at a. I. D. From the old days and think about handing out money as a metric and the handing out food is a metric and youre so much more than that now, and perhaps you can talk a little bit about this transformation and think about whether a. I. D. Is optimally configured and is it an organization that can propel the centrality of this Public Private partnership and this emphasis on markets and on entrepreneurship into the next generation and really change the way that the way that business is done overseas . Yes and no. Yes in the sense that i think aid has proven over many years to adapt very well. To work on increasing public capital flows which is basically what part of the mission is, whether its entrepreneurs, whether it is larger businesses and whether its domestic investment or Foreign Investment is now pretty much in the dna of the agency and i find, with all of the Mission Directors i meet in almost every regional bureau. Its something that missions do. It is something that the leaders do to provide initial capital to entrepreneurs and innovators and to get those things started and i think and some of it has to do with the partnerships themselves and when i said this notion of what is a systemic publicprivate partnership. There are extraordinary partnerships across the agency and all over the world that bring local partners and u. S. Aedz. The question is in some of these can we look at the kind of scale that might come from looking systemically at water. Systemically at some of the areas that we work where i think we have the potential to take it to the next level. To optimize the ability of the agency and there are things that we could or should do over the coming years to give it greater capability to do that . Absolutely yes. Absolutely yes. Can i just follow up and ask you, the one thing that i think is probably confusing more from the outside and less for us in a long time, Washington People is how a. I. D. As it shifts into this area and m. C. C. And opec and all of the other organizations that are focused on not dissimilar things and how do you Work Together. There is a lot of work that we do in global health, for example, that is helping provide the Health Services build the capacity for Health Services that is not predominantly a private capital exercise. You know, its interesting and i was able to work on this a lot when i was at the nsc about how do we bring together the compliment that exists among multiple agencies and power africa is one of the best examples of that and what we have been able to do and aid is privileged to be the coordinator of this, but weve got every agency in the government that has a capability in this area. We all came together and what does each agency have to contribute and how do we bring those together rather than having multiple agencies doing a little bit on energy, poverty here and a little bit on regulatory policy there. I think weve found some ways to bring that complimentarity together and we work with mcc very often on a kind of bilateral basis when they are developing compacts in certain countries and empower africa, again, weve been able to bring mcc which may have a major compact and u. S. Aid which provides coordination and a great deal of assistance and transaction advisers and opec that has been able to provide Risk Insurance and other tools and the department of energy which has got expertise. Its about bringing the complimentarity together and i think theres one other thing. The president ial policy directive on Global Development that we did in the first term. On the surface it sounds like thats just a piece of paper and it sounds obvious. What i did through the course of a ninemonth study that preceded it and the promulgation and the agencies acting on it was, i think, brought together agencies in a way that is noncompetitive and complimentary and its working and im gooding head nods. Gail, you talked about local ownership which has been a Key Initiative and focus to the administration of aid across the programs and you also reference domestic resource mobilization and both of them are aimed at building up the local capacity of government and nongovernmental institutions and give us the rational for local ownership and the role that domestic resource mobilization can play in that. And ownership is a prerequisite for the entire enterprise. Now youve got varying degrees of local ownership in the political sense and i think one of the great things were seeing, i mentioned feed the future, for example. We were able to build that on a commitment that was made by African Leaders to increase spending on agriculture and everybody, all countries having a plan. Local ownership in another sense means working with local partners and in that, i think its extremely important because we kind of get a twofer out of that. We are able to contribute and help the Development Process and work with partners that themselves are developing as our partners and building capacity. And it is early days in a lot of cases and we have found, for example, that a subject that sounds like it would not be the most exciting for a major conference or event, how can we have Effective Tax Administration administrations and its one of the issues that comes up a great deal. It comes up along the financing for Development Agreement where a lot of countries are saying we need to figure out ways to develop Revenue Streams that will enable us to fund our budgets including health and education that for a long time have been financed with foreign aid. Its not a major amount of assistance on the part of the United States to help build that capacity. Its often Technical Assistance and other means, but were seeing in health increased expenditure by many, many governments on health. Were seeing a lot of government again and look at what they need to do to mobilize their own Revenue Streams. Were looking at a lot of local financing and the local banks and finance institutions to support entrepreneurs and i think the trend line weve seen over the years in assistance becoming a lesser share of the total. I think domestic resource, the domestic resource share will grow significantly and i think we would be wise to do as much as we can to do that and where a lot of the emphasis, and enhancing government revenues and the tax system to helping generate and mobilize private capital also. Absolutely. Absolutely. And we have been able to mobilize private capital and a percentage of that is domestic private capital which is the other piece of this which and thats critically important and i think its Domestic Companies and including small entrepreneurs and its the Small Businesses that make them grow makes a huge difference. Thank you. I wouldnt be doing my job if i didnt ask you a hard question. Okay. But we are going to after i bogart the microphone for another minute, we are going to open things up to folks so in the time we have remaining, think of your very, very clever and penetrating questions and well turn to the audience. Gail, i want to ask you, you mentioned something which gave me more fodder here. You mentioned attending the world humanitarian summit in istanbul and they had the biggest and most independent newspaper and theyre vying with reg i want and a couple of other countries to have the most journalists in prison than any other country and i know theyre a nato partner and they are suffering from the inflow of refugees, but you talked about that and theres we talked about egypt and egypt is one of the largest amounts of assistance and we tried to use that in ways that are productive for us and the egyptians and theyre more than 10,000 Political Prisoners in egypt and there are a lot of political backsliding as well as not a lot of economic reform thats happening that is really necessary to the current governors success and you can go on here. And i know this is a tough one and a lot of it rests on policy decision and help us understand how you are able to operate in this environment and how you would address people who look at this and say what the hell are we doing giving money to people. Youre right. All of those are cases that this is a matter of our Foreign Policy, but ill tell you how ive thought about ittttt a lot of this has come from being able to spend time with the agencies in that its different from some of the other environments and thats to think about im always thinking in buckets, but let me tell you about three. Q bucket buckets and one bucket is the work that u. S. Aid does and thats the development and were in cases where the conditions are aligned, where youve got a very, very good chance of achieving sustained gains across the board and thats a huge portion of what we do. A second bucket is the crisis prevention response and mitigation and those are the places where through things like resilience and other work that we do, we are trying to prevent, obviously, but then manage crises as they occur and do a great deal of response, but the third is those places where we work where as a matter of Foreign Policy and National Security we have a presence and we have a need to impact the Development Agenda in some positive manner, but where, quite frankly, it is much harder and the conditions are not always aligned and it may not always be a priority it is in some other environments and the security conditions were often extremely tough for our people to move around and in those cases i would be dishonest if i said it isnt much harder to achieve progress and there i think weve got records in some cases where we have been able to achieve gains that are slowly and it is slower in those environments oftentimes to build up the progress and some cases where its proven much more difficult. Our job in aid in those environments is to do two things. One is to identify those areas where you can make the gains where regardless of the sick stances i think we would all agree there critically important, that in egypt or in pakistan or in any of these countries have stable economies and satisfied people and Everything Else that goes with it. The other is to take what we learn from those situations and share it with the rest of the government and i think were able to provide insights that are often quite helpful, but i do think weve got to reckon with the fact that i dont think this is something thats going to change and its something that will, and going on into the future and its hard and i would say that i think people have a good job in identifying those areas where we could have some impact and doing the kind of evaluating looking at things that enables us to say quite frankly in internal policy discussions and other deliberations this is working and how this isnt and what does it mean when we move forward. Its hard. No question, but it is very difficult. Thanks for being frank about it. Goodness, you are ready. There is a microphone. Go ahead, pick the first person. This young lady had her hand up first. Introduce yourself and be very brief. Rachels on world, congressional quarter lely. You spoke about the need to build resiliency in a world where there are crises happening all of the time and oftentimes from unexpected places. And where the crises are demanding so much political attention and you also have limitations on the budget, for example, i know in the zika debates on capitol hill, theres been a big push from lawmakers to use some of the funding left over from ebola and allocate that to the zika crisis. You know, i think the trick is weve got to walk and chew gum at the same time. I mean, thats why i have the Global Security agenda and thats what the president launched a year before we were dealing with an ebola epidemic and the simple premise of that is that we need to do the very long, hard, but doable work of building the capacity of countries to prevent, detect and respond so the kind of Health Outbreaks that we are seeing increasing number business of. Its every six months and theres a new acronym or a new virus out there. On the resilience front, it means even as we respond, and i think there are two things, even as we respond, there are ways to respond in an emergency where you can keep a malnourished child alive or you can keep that child alive by building his or her nutritional base back stronger even as you help survive a crisis. The second way and this is something that the agency is doing phenomenal work on this and its something i want to give much more visibility to. And its again, layering in what are the coping mechanisms for people in communities and countries so that when they face shocks like the shocks were seeing around the world they are more ready to withstand them. Some of it his done through nutrition and some of it is done through productive safety programs that enable poor farmers to Work Together, to harvest water and protect their livestock and have systems in place so that again, if there is a drought or a conflict they arent forced into a situation where they have to sell and lose their livestock for the duration. Again, its not easy. Everything would be easier with lots more money. I think the agency does a superb job as i say of walking and chewing gum at the same time, but part of the challenge im talking about is we cant just do one or the other, and i think we all know that we are going to respond to crises whenever they occur. So what the agency has taken onboard and i think will expand and i think we need to expand quite frankly, globally is the ability to keep building that base not only through our longterm development enterprise, but through building in these layers of resilience because we know well see shocks of the nature were seeing now with greater regularity over the coming decade. Thank you, gail. Im john from the hunger project and i wanted to ask you about how you see as an administrator leveraging the expertise of the different sectoral Groups Health education, watch drg into more integrated strategies . I think its a smart thing to do. And i think its something we do pretty well and were at a staff meeting this morning where some of the assistance administrators was talking about doing one of the regular meetings with many of the groups represented here today on a particular region and to get everybodys insight and thoughts and whats working and whats not. So i think that needs to be in most cases there is something of a regular order and i think its something well, there you have it. Gentlemen up front, mr. Ambassador. The microphone is coming. Just a moment. Im ambassador of nepal. Thank you very much for enlightening us in addressing the developmental challenges in our part of the world. I would like to really congratulate you for mentioning local ownership in development, but how about ensuring the use of the country system in providing it and at the same time i would like to learn about your idea of untying it. Yeah. Everybody wants it untied. The state department. Okay. Look, part of ownership is country ownership and one of the things weve learned around the world is when the country takes ownership, but the leadership, whether its the uppermost level or the local level is willing to put a few things into the mix. Political capital, and a commitment to transparency and fairness that we get gains that last for a very, very long time and so that is, i think thats one of the most important ingredients for longterm success. So thats key. User friendly systems, we are also trying to be more user friendly, and i will say that over the years, theres been a lot of layering of new systems and new ideas and new procedures and i will not put this on the career men and women of u. S. Aid as much as i would put it on the rotating leadership and new teams come in and weve all got brilliant ideas, and so i think, you know, its a constant struggle and a constant pursuit of the agency to try to figure out how we can manage our systems in such a way that we are able to satisfy the congress and the american taxpayers and also avoid burdening our partners with undue levels of systems. And thats a constant challenge and something we continue to work on. Its one of the reasons i mention this notion of flexibility because i think theres a lot that could be done over time to streamline the systems of a. I. D. And be totally responsible to taxpayers in the congress and also be much more user friendly and thats why i mentioned that one and remind me. Tight aid. Yes. There are all sorts of issues about yeah. [ laughter ] you know, its very interesting when you become a public official as opposed to when i was think tank. Danny and i dont have to be so careful what we say. No, no. Look, i actually think conditions that are tied to aid or who aid is tied to, all of these kinds of things i think have a lot to do with transparency, accountability and evidence, and i think the more we do and the better we do and its true for a. I. D. And true for every donor and its true for people who receive assistance from any donor whether its a government or ngo. The more transparent we are, the more accountable we are and the more evidence and data that we bring to the mix that shows is up or down what the impact is i think the greater chance over time that there will be greater flexibility with assistance. So i see an ngo colleague of mine nodding his head and i think thats true not just for bilateral donors and its got to be that mix to ultimately unlock the ties. I wish we had more time. But we dont. But we dont. We dont. Gail, we appreciate your taking the time to talk, and i think youve got a crowd of people here who understand development, understand the challenges that u. S. Aid are confronting and wish you well and danny, thank you for joining me today. [ laughter ] thank you. Youre welcome. [ applause ] and im going to say one thank you again. You clapped prematurely, but you can clap again, if you want. I also want to thank all of our staff. This kind of an important conversation doesnt come together easily even though it looks easy. So for all of your people at aid and your folks at brookings and mine and the senators staffs thank you very much, and to all of our guests. I wanted to make sure we said a warm thank you and i know you want to say a word. I just want to say this is a great job and its great to come to work every morning and to try to make the world a better place and its a better job because of the number of people who care not only about development, but about this institution and whether youve got critical things to say and things we could do better and things that wooe doing well, it makes a huge difference to the work that we do every day and the work that i do is that there are so many people who care about the mission and for the agency and for that caring, it really makes a big difference. [ applause ] and staying on capitol hill, needing to look into head trauma and concussions in sports. Well hear from medical, military, ath lettic and research experts. Live coverage in under half an hour at 2 00 eastern time here on cspan3 and then later this afternoon a live road to the white house coverage from the Campaign Rally for Ohio Governor john kasich ahead of the primary there tomorrow and hell be joined by former president ial candidate mitt romney and ohio senator rob portman. Live coverage here on cspan3 tonight at 6 00 eastern. Campaign 2016 continues on tuesday with primaries taking place in missouri, illinois and swing states, ohio, North Carolina and florida. Live coverage of the Election Results and candidate speeches and viewer reaction begins at 7 00 p. M. Eastern and taking you on the road to the white house on cspan, cspan radio and cspan. Org. Texas congressman louie gomert debated a republican latina activist about immigration. It was in national harbor, maryland. The 20minute discussion was moderated by a former staffer of president reagans. And now we have a counterpoint, two takes on immigration. Please welcome our moderator, Vice President of external relations at the heritage foundation. Good morning all. We have a wonderful discussion this morning on a topic that is important to each of us in this room. In fact, each of us in this country. Our first presenter is kate brian. Kate is a communication strategist and writer living in washington, d. C. She holds her bachelors degree from Franciscan University in steubenville, ohio, but she also attended and received a Political Communications masters degree from the Dublin Institute in ireland. She previously worked at the american principles project and at live action. She also worked in the senate in dublin, ireland and she worked as Research Director for two leading prolife groups in ireland. Shes appeared on numerous television and radio programs and she should be welcome here today. Please welcome kate brian. [ applause ] good morning. In 2016 there is one republican voice that we should be focused on when discussing immigration. This man has consistently dominated republican politics and continues to do so. This man is loved by many, despised by others. This man has captivated Television Audiences and is well known for his great hair. This man has addressed immigration in a powerful way, and i truly believe that he is the man that we here at cpac should look to when discussing this contentious and important issue. This man, of course, is Ronald Reagan. [ cheering ] we are gathered here today under reagans famous words, our time is now. These werent words of encouragement. These were meant as a challenge to us as conservatives that our time to lead is now. It is truly our time to lead on the issue of immigration. With the political rhetoric on immigration, it seems as though there are only two sides to this issue. Youre either for obamas amnesty or youre for selfdeportation. However, there is a third way. A truly conservative approach to immigration that Ronald Reagan himself supported. An approach to immigration that is based on the rule of law, but also respects the proper role of immigrants within the makeup of our society. Its an approach in which principles form policy. We currently kr 11 Million People living in the shadows of our country. We have a southern border that is not fully secured and there are parts that are completely lawless. A circumstance that human traffickers, drug cartel and terrorists are surely taking advantage of. Our nation is facing a great Immigration Crisis that is putting our National Security at risk. It begins first and foremost with guaranteeing the National Security of the territory and securing our borders. Doublelayer fencing along with manpower and technology would work to stop and deter illegal entry. We should also mandate e verify to make sure that only legal immigrants are employed and fully implement a biometric entryexit tracking system to make sure all legal immigrants leave the country by the time their visa expires. The truly conservative approach to imgraition does not end here. It also recognizes that immigration has been good for our country and for our economy and that the market is better equipped than the government to regulate our nations migration flows. Now i, just like all of you understand the plight of the middle class. We are dealing with rising prices and stagnant wages and we are struggling to provide for our families, but these problems are not due to immigration. Rather, our challenges are a result of flawed Monetary Policy overregulation, overtaxation and a culture built by elites at berkeley, harvard and even right here in washington, d. C. The truth is even in this slow growing economy America Needs Foreign Workers not just to do the jobs that americans dont want, but to do the jobs that are necessary to create other good paying jobs for americans. Contrary to popular rhetoric, immigrants are not taking jobs away from america americans, theyre actually creating jobs for americans and if we truly care about our middle class and we should work to facilitate the legal flow of Foreign Workers rather than creating obstacles to it. Take the current guest worker programs. These programs are now highly regulated and do not reflect the needs of our markets. What our country needs is an Effective Guest Worker Program and this is a uniquely conservative proposal that is so conservative that president obama, democrats in congress, big labor and all of the leftist immigration advocates vehemently oppose it. Under this program, an American Company that cannot find American Workers and i repeat, cannot find American Workers, can bring Foreign Workers into the country legally to temporarily work here. Once their work here is done they will be sent home and may reenter if and when they are needed again. This is the concept of circular migration that is consistent with the free market principles that we as conservatives consistently defend. The majority of Law Enforcement experts agree that its unrealistic to deport 11 Million People or that theyre going to leave voluntarily especially when youve been here for decades and their families are part of our communities and many have children who are american which is why we need to see the face of each immigrant and deal with their situation accordingly. We should grant legal status, not amnesty to some, but not all who have acknowledged that they broke the law and paid for the appropriate penalties for their offenses. This does not mean amnesty nor does it mean granting them a special path to citizenship. If someone want tos become a citizen they will have to follow the current process established by law just like everyone else. America as a long tradition of immigration. President eisenhower opened our doors to cuban refugees. President nixon and president ford did for the same for the vietnamese after the vietnam war and they did the same for the irish. Many of us here today are the fruits of these immigration stories. The story of immigration is americas story. My ancestors traveled here from ireland during the potato famine. They suffered greatly under british rule and it was only because conditions were so bad that they had the courage to make the difficult journey to america. Immigrants today are facing many of the same conditions, often fleeing violence, starvation and brutal tyranny. Being american is not determined by blood, heritage or faith, but rather by embracing our shared history and common democratic and constitutional principles. Ronald reagan himself once told a story of a letter that he received from a man just before he left office. Reagan said i dont know why this man chose to write this letter to me, but im glad he did. He wrote that you can go to france, but you cant become a frenchman. You can go live in germany or italy, but you cant become german or italian. He went through turkey, greece, japan and other countries, but he said anyone from any corner of the world can come to live in the United States and become an american. [ applause ] amen. Our nation has always had the unique ability to embrace people from all corners of the world and make them fully american and anyone who doibts that immigrants can assimilate and become full members of American Society truly doubt america. America is not a nation of nativists and were a nation of patriots. Nativism is not a part of the conservative philosophy nor is it a part of americas founding, but patriotism is. As conservatives, we talk every single day about the dignity of the human person and we fight for the protection of life from conception to natural death and we stand on the founding principles of our great nation including the belief that every great man is created equal under the eyes of god and every human individual has the right to life, liberty and the pursuit of happiness. They are conservative and stand with us on these principles and look at the march for life and the march for marriage where huge numbers of the Hispanic Community turn out consistently every single year. Its time for us to remember our history and embrace Ronald Reagans optimistic vision of america as the shining city on the hill where he described in his farewell address as a tall, proud city built on being ross, stronger than oceans, wind swept, god blessed and teaming with people of all kinds, living in harmony and peace, a city with freeports that hummeded with commerce and creativity and if there had to be city walls, the walls had doors and the doors were open to anyone with the will and the heart to get here. While we are in the midst of a very passionate debate about immigration, we must always remember who we are as conservatives and remain steadfast and consistent in the founding principles of our great nation. The time for us as conservatives to lead on immigration is now. God bless america. [ applause ] thank you, kate brian. Our counterpoint now will be brought to us by one of our heroes, congressman Louie Gohmert. Congressman gohmert was first sworn in as a member of the house of representatives in january 2005. He represents the First District of texas which encompasses over 12 counties. He boldly stands on americas founding principles and is constantly coming up with big, innovative ideas solidly baseded on constitutional fundamentals. Congressman gohmert is chairman of the Natural Resources subcommittee on oversight and investigations and the vice chair of the judiciary subcommittee on crime, terrorism and homeland security. Prior to being selected to serve in congress louie was elected to three terms as district judge in smith county, texas. He was later appointed by Texas Governor rick perry to complete a term as chief justice of the 12th court of appeals. He received his undergraduate degree from texas a m university and his law degree from baylor. He is also a veteran having served his country as captain in the United States army. Please welcome congressman Louie Gohmert [ applause ] all right. It is great to be here with you. Im glad to be invited to cpac. For a while there for a number people who like might want a new speaker or might talk about radical islam. So im thrilled. Theres new leadership in cpac and theyve even allowed a guy like me to come speak. So its awesome. It is great to be with you guys. Now, i know that a lot of people like to paint a rosy picture. And im an optimist. My sister says youre the optimist among us four kids. Well, i like to paint a rosy picture. So many remember the line from forrest gump you know, life is like a box of chocolates. You know . Well, i would submit to you, when you wake up and see the real world, its really more like a jar of jalapenos. Because what you do today can bite you in the bottom tomorrow. So youve got to always be cog na cognizant of that. When we talk about immigration, you know, i did pretty well in school, but im still always learning things. Sometimes im surprised that i remain a little naive. But i have learned, when you hear the word comprehensive, in washington thats a code. Comprehensive means theres a whole lot of stuff we want to pass that nobody would vote for if they see what it is, so we need a really long bill to hide that in so we can get it passed. Thats what comprehensive means. You want to do it right, you dont have comprehensive bills. You have bills that are short enough for everybody to read. Now ive spent a lot of time on our nations border. Ive spent a lot of time not just going on the little trips that the dog and pony show and the power point proposals and programs they have for you as a member of congress when you show up. I dont like those. I like to show up and just go out in the middle of the night eventually though they do know who you are and they get word. But dana was telling me yesterday, boy, when we went out with you in the middle of the night, you knew the dirt roads, you knew well, thats the way to go see the border. And when youre out there in the middle of the night with border control, men with into supervisors around, they really open up to you. One of them told me, you know what the drug cartels and the gangs call us in mexico . Homeland security said what . He said logistics. Yall seen the commercial for u. P. S. , you get us your package, were your logistics. We get that package anywhere you want to go. Well it applies. In case you werent aware, as ive learned the hard way, every mile of our border, whole border, is under some drug cartels control. You dont cross that border unless you have permission of the drug cartel. So when somebody comes across, normally theyve had to pay the gangs to bring them in. Thats why one of the border paroleman had said late one night, we were out there talking, he said, i speak better spanish, being hispanic, that some of the men and women coming across. And i dont let them get away with some of the things that others do. They have their list of questions theyre supposed to ask people that come across. One of them is, why did you come across to america . And he said, you know, over90 of the time the answer is, to escape Gang Violence. He said when they tell me that, i let them know in spanish, you may fool some grin ggoe with th answer, but you and i both know you fooled some gang. He said 90 of the time theyll say but you are a he right, but we were told to say were evading Gang Violence by coming. They know. Ive a seem them in the middle of the night when a group comes in look at their identification stuff and start trading and pass them around. Then they ask, heres mine. Really . You guys are passing all this stuff around. And im still i still get messages from our border parolemen all hours of the day and night. What theyre telling me now is that the drug cartels are very smart. They send a group across and they know when two or three groups come across. Thats going to take up all the resources because the Obama Administration has lessened the number of Border Patrol that are actually out there stand something at our borders. So when a grop comes across, they have to move in, especially if they throw in some kids. Of course all our hearts break when you see a poor little kid thats been drug across mexico from central america, other places. So weve got compassion. But wouldnt it be more compassionate to say youre not coming across mexico, youre not dragging your daughter that may end as a slave to sex cartel. Were not going to allow that to happen. Dont even bother to come because we have secured our border. Wouldnt that be better . Wouldnt that be more compassionate . How about the millions of people in the world were told want to come to america and want to do it the right wayed. And all of those who have come the right way. Isnt it more fair to say, wait a minute. Youre not coming in unless you come legally, and if you come illegally, i mean i guess were all subject to how we grew up. But we had a Community Swimming pool at del wood park, little town i grew up in. Every year they called it splash day. People would line up, the pool was opening. Mr. Ellis was in charge and he believed in the rule of law, and if somebody tried to cut the line, he wouldnt make them get back where they were before they cut. He would make them go to the very back of the line and it cut out all the line jumping because people knew it wouldnt pay off. Now weve had testimony before our committee, judiciary committee, immigration committee. Weve had people telling us look. These people are coming for more opportunity. Theyre trying to get away from bad circumstances and get opportunity. Why would you deny them . Well, nobody wants to deny people opportunity. But i would ask why did they leave where they came from . Well, theyre coming for more opportunity. No, no, no. Why dont they have that opportunity where they were . Well, theres corruption, theres they dont follow it the law there. Exactly. Where they come from, they dont follow the rule of law. They dont apply it across the board. So think about it, they want to come to this country, and once here say now that were here, we want you to be like the corrupt country we came from, we want you to ignore your laws and that would make us like the country they came from. We cant do that. We owe this country more than that. And one of the things that has been forgotten in this country, when we talk about voting rights. Absolutely every american ought to have those rights. And dont think for a minute that if somebody says, no, no, were going to let people come in legally no path to citizenship. No right to vote. Well, thats already happening. People that have come in illegally, theyre jumping on the bandwagon to get citizenship. If you think for a moment that people that are given amnesty of any kind of legal permit of any kind are going to be kept from voting, youre sadly mistaken because as soon as you get an amnesty, people will come right behind it and say, how dare you. Youre being like those slave traders that say slaves were only threefifths of a person. Of all those were all democrats and republicans dont believe in that. Anyway, thats where it will go. Theyll get the right to vote. And we have got to train up people to understand, there are voting rights, but there are voting responsibilities, and unless youre educated as to what it takes to keep this little experiment in the democratic republic, we wont keep it. People cannot come in and get citizenship until they understand what it takes to maintain the greatest country, the greatest government in the history of the world. Thats what needs to be done. Folks, were in trouble. This country is in trouble. And what happens from here will determine whether we get another 20, 30, 100, 200 years. We have got to get this right, or people will rise up in the future and they wont call us blessed. They will curse our names. We have got to get this right. We got to stand for the rule of law. Weve got to stand up and say were not giving special privileges to anybody. And if we can do that, we can say with lincoln that this nation, under god, can have a new birth of freedom again. We can do it again. So that government of the people, by the people, and for the people will not perish from the earth. Thank you, god bless you. You can find nmore from the conference, cspan. Org. Now live to a hearing of the house energy and Commerce Committee looking into head trauma and concussions in sports. Well hear from medical, military, athletic and research experts. Fred upton and frank palone chair the committee and the Ranking Member. A good afternoon. Want to welcome all of our panelists here. This is a forum, not a earning ho hearing. We will have members arriving throughout this, this forum here. It has a different approach so no ones going to be sitting in the panel, raising their right hand and swearing to tell the whole truth. Were scientists so we assume thats all youll say anyways. Joined by my colleague, Ranking Member, any other members here yet . Let me start off with a little brief Opening Statement to set the tone. I want to thank you all for being here for todays roundtable called evaluating state concussion repercussions. There is a new and provocative movie some of you may have seen called concussions getting a lot of attention. We have mounting evidence regarding the prevalence of concussions in sports and military and the broader population, and we know most concussions dont even occur in sports an military. From parents and patients to athletes and Service Members, people are worried. They hear more and more about the dangers, potential longterm effects. They want to know if they or their Family Members are at risk. Of course thats not always been the case. Less than two decades ago concussions were barely a blip on the National Radar screen whether you fell off a ladder, got hit by a pitch, it was a bump on the said or they just said you got your bell rung, saw some stars and a no big deal type of injury. I remember when i played football years ago, you got knocked out, they waved ammonia under your nose, and you got up and walked away. Now the public is concerned and looking for answers. Where do you draw the line between that booboo and going to the er and is it safe to play Contact Sports. Is my memory loss due to six years of high school and College Football or Something Else . Is it somehow tied to training or that car accident that took place ten years ago . It is a good thing we are asking these questions. Unfortunately as we sit here today we do not yet have all the answers and therein lies the challenge. The public wants answers that science is not ready to provide, so we deal with the challenges of misapprehension and fear of what we dont understand. The need to get greater clarity regarding the science of concussions and traumatic brain injury is of utmost importance. In 2010 it contributed to the deaths of 50,000 people and accounted for 2. 5 million misdemean emergency room visits. Nearly 4 40 of all documented brain injury injuries are due to falls. 10 to assaults. Those 65 and older had the largettlarg largest rate of tbi related death. Today we begin a new chapter in the dialogue on concussions, not to relit past actions. We are about to begin a conversation focused on solutions not problems. We are joined today by some of the most prominent experts in this field. This is a wonderful opportunity for members to sit back and listen and learn from these individual and their decades of collective experience. Theyre here to help educate members and the public about the state of the science on concussions. What do we know, what are the gaps, how do we address those gaps to achieve a meaningful short and longterm solution. We are also here today to make one thing clear. It is not just a sports or military issue. This is a Public Health issue. Every year millions of americans not playing sports and not serving in the military suffer concussions. They can happen to anyone, any time, anywhere. Some will recover with no noticeable effects, others will have debilitating symptoms. Why the difference . We want to know. Thats why we are here today and to ensure we are on the right path, to provide the public the answers they deserve. We will begin with a brief presentation from dr. Baldwin from the cdc who will provide a previous introduction of concussions and general overview about what we know about these injuries and their prevalence in society and information to provide a baseline for this information. Then put forward a broad series of discussion questions to our participants focus on, one, prominent misconceptions or underappreciated facts about concussions. Two, knowledge gaps on our understanding of concussions. Three, specific objectives that will lead to meaningful progress and minimizing the rifx for csk conclusions, and obstacles to achieving those. These questions are intended to guide participation and provide us an opportunity to listen and learn. Members are welcome to ask questions. It is not going to be formal like a hearing but just let us know if you have a question. Well keep track of that. Assuming we have time, well have more question and answer with the panelists at the end to cover any outstanding areas of interests. Id like to thank it the Ranking Member for her support on this. Thanks a lot, mr. Chairman, for this roundtable. Sometimes it seems like the format is a little unwieldy, but as chairman upton will tell you, we did a lot of these when we worked on our 21st century kearse initiative and it was a way to get a lot of information packed into one afternoon. Id also like to thank the Panel Experts who have come today to talk to us about the importance of head trauma. Understand being the impacts to the head and how to diagnose and treat injury that results from such trauma is critical to various segments of our society, from military to sports leagues, to parents of young athlete all around the country. Given the quality of the panelists today and the diversity of opinions, i believe we have the opportunity for a lively discussion. I hope todays event, as has been communicated to us at the staff level, is the beginning of a series of discussions and hearings on this topic. I think targeted and structured discussions on this matter would be useful as we start to think about what congresss role is. As we move forward the hearing process will provide us with important organizational a tools and structure. I dont think the most important thing is that people be under oath, but i think it does help to have testimony in the record. Ten years ago, not much attention was paid to concussions, as you said. As we learned more and more about the potential short and longterm effects of concussive and subconcussive hits, our constituents have many questions and concerns, particularly about their childrens involvement in Contact Sports. Young athletes may be particularly at risk of lasting brain damage due to repetitive hits, even when those hits dont rise to the level of a concussion. Studies have shown that Young Athletes who do not sustain concussions but did experience repetitive hits to the head exhibited neurological impairment over the course of a single athletic season. Additionally, according to a recently released study by the mayo clinic in december of last year, about onethird of men who played amateur Contact Sports in their youth displayed evidence of cte pathology. Onethird. That number is surprising and it is deeply concerning. It shows that you dont have to have played professional football or hockey to suffer longterm brain damage from Contact Sports. While we still have not established a prevalence rate for cte, the study strongly suggests that the disease is more prevalent than we originally thought, and frankly, not just with those diseases but also with girls soccer and other diseases affecting both girls and boys. Now i understand that as in any such scientific endeavor, there may be disagreement and uncertainty regarding what we know or what policy actions we should take against the backdrop of that knowledge. But uncertainty does not excuse inaction. Im interesting in hearing from our panelists today in terms of what arctions we should take right now, and then how we need to move forward in our continuing investigation. Now im going to say, as the congresswoman for the World Champion denver broncos, you know i had to say it, and somebody whose family has been lifelong season ticket owners, and also somebody who graduated from a Division Hockey 1 school and now represents one, the university of denver, we love playing and watching Contact Sports. We appreciate the fitness and the other benefits of the activities. But at the same time, the head injuries associated with some of these activities appear to have consequences that are long term, irreversible or even deadly. Therefore, if there are ways to make these activities safer, not just for our kids, but also for professi professional athletes, we need to be sure theyre being implemented. In other words, mr. Chairman, we want it all. We want to enjoy the thrill being a fan or participants but with as much information as possible inform the players of the health risks and minimize the Health Risks Associated with Contact Sports. Thank you very much for recognizing me. I know we have a lot to discuss and many voices to hear from. Im glad that were kicking off thissest. I yield back. So to speak. Thats right. I notice the kickoff lifes been moved back. Fred upton, chairman of the full committee, you are recognized. Thank you. I have a long statement. But im not going to read it because i want to get to the business of the day. I appreciate everyone being here. I think that weve learned a lot. We have a lot more to learn. But primarily this is to listen. This is why the format is a little bit different here than normal and it is i understand my friend mr. Palone has a letter for me. This is not the first step and i know that were all truly very interested in this. I intend to make sure that that happens. I want to quickly say that i visited with my Trauma Center in kalamazoo, michigan a couple weeks ago, in february, at bronson hospital. One of the quotes that we took down was what we have this is what we have identified as simple concussions are not quite as simple as they seem to be. That underscores what we are facing. We want a to learn more, we want to listen, and i yield back. Thank you. Thank you. I just want to thank all of our participants for joining us today. Concussions are a critical Public Health issue affecting millions of people each year, and we have indications that the effects of major brain trauma even that occurred during ones youth can be long term life threatening. These were once known as subconsuccessive hits. Recent studies show athletes demonstrate evidence of significant brain damage of hits to the head even when they do not suffer concussions. For example the group of a work of researchers out of Purdue University found significant structural changes to the brains of High School Football players even among those who do not have concussion dying nis. Whats particularly troubling is that these changes persisted even two months later somethinging lasting damage. Many other studies have documented an association between subconcussive hits and significant changes in brain chemistry decrease brain functioning, Behavioral Changes and the release of biochemical markers linked to brain damage. Researchers have also repeatedly found evidence of the linkage between head impacts and the degenerative brain disease known as cte. Cte is devastating memory loss associated with depression and eventually dementia. Dr. Ann mckey is here today from boston university. She and her colleagues from the university have been conducting groundbreaking research into understanding and defining cte. Theyve examined the brain tissue of dozens of deceased former nfl players as well as the individuals playing football at the lee jcollegiate and even school levels. Theyve discovered the presence in athletes as young as 25 and in many adults who played football since they were kids and they have confirmed cte is a unique disease with a unique signature and that work has culminated in a broad Scientific Consensus that finding the characteristics of cte. It is unfortunate that the doctors work has been questioned by those who have a invested interest in maintaining the status quo. I understand the unwillingness to acknowledge the linkage between Contact Sports and brain damage. It is what we call an Inconvenient Truth that some of our Great National past times, sports that we love and that our Children Play every day, may cause significant and lasting brain damage. But it is time to accept the mounding evidence that there is a linkage between head impacts and brain damage and it is time to do something about it. While Research Still needs to be done in order to answer all the questions, this should not be an excuse for inaction. We examine not only the state of the science but also look into how we can apply what we know right now to protect our servicemen and women, our athletes and our kids. As we explore the state of the science at our round table, i hope our discussion doesnt cause confusion or serve the Scientific Consensus around repetitive head trauma and the dangers it imposes. Lisa mchale is here. Not only director of family relations for ot Concussion Legacy Foundation which does truly critical work in advance being the science of concussions and cte, but shes also the wife of former tampa bay buccaneer tom mckey who had cte. It is valuable to hear about lisas experience with cte. Her experience and others like hers can inform research and the path forward to address this disease. So let me say, chairman upton, let me conclude my remarks by suggesting respectfully you mentioned it already while this roundtable is a valuable start to our work, we should see it as that a start. We need to hold hearings on the subject given the gravity of this topic and the number of lives it affects and an informal process i dont think is sufficient. You mentioned, chairman, that im sending you a letter before i even mentioned it. Asking that we jointly expand the committees exploration of the causes, effects, treatment and preventions of concussions. I mentioned in the letter proposal for a series of four Committee Hearings that would give concussions a and sports related head trauma the attention they deserve as critical Public Health issues and hope we can Work Together in moving forward and planning future hearings. Thank you again to all of our participants and thank you, chairman upton and chairman murphy, and my colleague for putting this together. This forum is only the beginning and i think we can Work Together to find best ways to address this significant Public Health issue. Thanks again. Thank you. I want to mention some of the members that are here then. Joe pitts of pennsylvania is also the chairman of the health subcommittee. Dr. Michael burgess is also on ot subcommittee on manufacturing. And Richard Hudson of North Carolina. Paul tonkwa of new york. Gene green. Frank palone. Now let me try and i wont read your full bios. It is clear when i said before some totally experienced in the decades, i think it is actually in the centuries. Let me run through some of these things. These wont be in any particular order. Captain and dr. Mike colson, physician and director of excellence for science and technology health. Dr. Grand baldwin, Unintentional Injury prevention at the National Center for injury prevention and ccdc. Brian henlein. Clinical professor of neurology at Indiana University school skf medicine, Newark School of medicine. Good luck in the march madness, indiana. Youre in the same general brackets of pitt. He helped throw the game in the bull rings this early. Dr. Jeff manly, professor of neurosurgery at the university of california san francisco. Dr. Michael mccray, clinical neuropsychologist, professor of neurosurgery and director of Brain Injury Research at the Medical College of wisconsin. And a Research Psychologist at Uva Medical Center in milwaukee, wisconsin. I believe wisconsin played pitt in the first round. Just so you know. Well see how it goes. David dr. David seefrt is a virginia commonwealth university. Chief of physical medicine and Rehabilitation Services for bcu. Dr. Micky, university of pittsburgh Medical Center director of upmc Sports Medicine concussion program. Gerard gioia, Childrens National division chief of neuropsychology and director of the safe concussion outcome recovery and education Score Program at Childrens National health system. Colonel dennis hecht. Consultant recently retired from the military where he directed the dod combat concussive Care Research program from 2008 to 2014, currently consulting the ncaa and one mind to advance research in brain health and transition to progress to improve clinical practice. Ann mckey, welcome. Professor of neurology and pathology, alzheimers disease center. Thank you all. The format is going to be a discussion. Let me do this. I recognize that many of you here as scientists may know each other by papers youve read, maybe some of you have met and discussed things before. We want this to be an open discussion. So im going to throw out an initial question here just to be a tossup. If it is something that you know. Want to comment on, please do. Recognize were limited. We have a hard stop time later on. If it is an area you can add more to, add more. If its something you disagree with because part of this is there are differences in the science. Thats okay. We want to hear this. As members have comments and questions well try to keep members questions just to keep the discussion going forward, we wont be giving speeches today other than that. Let me do the first tossup here. Basically first were going to have the cdc speak. Dr. Baldwin will set this up so people have baseline information. Great, thank you very much. I want to thank chairman upton and representatives murphy and other members of this committee for your commitment to address concussions as a pressing Public Health issue. Id like to thank at Congressional Brain Injury Task force who have been champions of tbi for years. We want to share the latest data on the burden to americans. In the press release announcing this roundtable, the chairman noted that there is a lot that we actually dont know about head trauma. How it affects different subsets of the population, the short and lo longterm effects and other critical details. He is right. Thats why i also want to highlight the proposed cdc national concussion surveillance efforts system and our efforts to help fill these data gaps. Its in our minds one of the paths forward. So no one ever wants to hear or even imagine that a Family Member or friend has suffered a traumatic brain injury. Unfortunately, these serious injuries which are caused by a bump, blow or jolt to the head, are far too common. Tbis can occur in various ways ranging from a car crash, a fall in a bathtub or on the stairs, kol colliding with another player in a soccer game, an assault or Suicide Attempt or in the battlefield in a military conflict pmt severity of a tbi may range from mild to severe. The greater the severity the injury, the greater the likelihood of long term and life changing disability or even death. Most who suffer a concussion recover within a week or two, but for some concussion symptoms can last for several weeks, months or even longer. The prospect of a full recovery is threatened if you return to play, school or work too soon, or, frankly, sustain another concussion. Tbis are a leading cause of injury related death and disability in the United States but they all have one thing in common theyre preventable. In one year alone there were at least 2. 5 Million Emergency Department visits, hospitalizations or deaths related to a tbi in the u. S. Either alone or in combination with other injuries. Broken down that means in our two hours together today there will be about 500 tbi related Emergency Department visits, 64 tbi related are hospitalizations, and 11 tbi related deaths. This may be a significant underestimate of the burden. A recent study from the Childrens Hospital of philadelphia found that among their pediatric population, almost 90 are presenting in urgent care facilities or primary care settings. These are outside of the scope of our current data catch abilities. Tbis are costly. One survey shows they result in costs of 141 billion annually. There were about 451,000 sports and recreation related are tbi visits made to the Emergency Departments across the United States in 2012. Approximately 70 of these, or 325,000, were reported among the youngest americans, those zero to 19 years old. The leading causes of sports and recreational related are concussions, include bicycling, football, basketball, playground activities and soccer. In 2013 the institute of medicine made important recommendations, including to cdc about the need to better understand and address the problem. One recommendation calls upon cdc to establish and oversee a National Surveillance system to accurately determine the incidence of sports related concussions among youth 5 to 21 years old. Generating these data is difficult because of limitations in current methods. Our current systems do not capture concussions that occur outside of organized sports or those that are not seen in an Emergency Department. They also do not document use of protective equipment, the position played, like offense or defensive lineman in football, and surface used for the field of play. Finally, there is no record of concussion history or a persons so after doing an environmental scan and consulting with experts, including a few of the people on the panel today, cdc is proposing a new random digit dial National Household survey that will surveil all causes of concussion and all ages across the life span. It is no more onerous to keep this broad scope and of course there are some economies of scale that we are realizing, too. A parent or caregiver will report on concussions they and a randomly selected child, if there are any in the home, experienced in the last 12 months regardless of cause. Using a symptom based checklist, potential concussive events will be categorized as possible, probable, or more definitive depending upon. Symptoms experienced and their tell poral association with the event. For example, someone with headaches, plurd visiblurred vi sensitivity to light will be considered possible to have had a concussion. Or, those who were knocked out or lot of consciousness would be more categorized as having had a concussion definitively. If implemented, well be able to provide state level estimates of concussion, deliver a comprehensive picture of Health Care Utilization following a conclusion, understand differences and return to play, return to learn and return to work protocols, and have a national estimate for tbi related disability for the first time. Well also know lifetime tbi prevalence. To know what were facing and if our prevention efforts are working we absolutely need these data. Weve developed a survey and are about to pilot test it and we are ready to take the Surveillance System to National Scale if the 5 million requested within the fy 2017 president s budget are appropriated to cdc. So as we look towards the future cdc is ready to do our part. We plan to continue to improve data related to tbi to better understand the problem, understand better the relationship between tbi severity and outcomes from infancy through old ladies and gentlemen and improve implementation of essential and evidence based partnerships are essential to achieving our goals and the diversity of partners and perspectives assembled here are so critical to meeting our shared interest in reducing the burden of tbi. Again, thank you for the invitation today and i look forward to todays discussion. Thank you. Were going to open this up and ask a question. I saw this post in the metro. This is a picture of its just a fishing boat. An advertisement for the florida keys. The caption says more fights than a capital penguins game. Isnt that interesting. Where is the sport involved here . If this is what were looking for and concussions involved with that. You dont have to be a player to have a concussion. Remember this picture where all the fans are cowering. That one man put his arm out and prevented a young boy who was there looking that was his own son . That prevented his son from getting injured. So we prevent concussions, too. But in the course of this, other than sports, let me throw this out what are the most underappreciated facts about concussions. I want to ask you, are there some underappreciated facts or misconceptions we need to know about right at the onset . If other scientists want to Say Something, we will call on you. Sure, thanks very much. Pleasure to start off here and open the conversation. Misperceptions, i think there are many. I think there are, unfortunately, fueled by lack of knowledge. And i think its important to think about concussion as part of the spectrum of traumatic brain injury. I think this was mentioned injure that traumatic brain injury goes from the mild to the severe, and its not as though there are distinguishing cutoffs between those and that progression of the stage. So it is a type of traumatic brain injury. The other misconception which im not sure everybody agrees with used to be said with a concussion if you looked in the brain, you would not see anything. Thats not true. I think with modern evidence and the ability to use with microscopes into the brain at the time of a concussion in an animal, there is a Symphony Orchestra of changes that are occurring in the concussive event. So i think it the biology of concussion, it is not well known but i think that we will learn a lot more over time. So is its not a purely functional abnormality. There is a lot going on in if the brain during these during a concussion. The other one which was already mentioned which was 20 years ago people would take a sniff of ammonia, go back out and play. Now it is recognized pretty widely that thats not the case. So thanks to the cdc work, the work of multiple other groups like the academy of neurologys guidelines committee, put out guidelines for return to sports. I think those have been taken up by coaches around the country. And i think thats really been important. One thing im not sure about is the idea that we dont know enough to counsel parents. We do know that it is this repetitive concussion that gets the kids in trouble, that is initial concussion is oftentimes it can be bad, for sure, because there is this spectrum of head injury. But the kids thattive tivi hav heard about that run into trouble. First concussion theyre bad a couple days. Second one a couple weeks. Third one a couple months. So i think getting that out is very important. It is a very tough thing for the parents and kids, especially when there is this huge allegiance to the identity of the person in sports to give up and take themselves out of contention there. But i think those are the few things i throw out to begin with. [ no audio ] im sorry. My daughter was playing baseball in High School Senior year and she was hit by the baseball directly in the head. She suffered a concussion. Basically they said, you know, we dont want you to play again because if it happens again, youre going to have a serious problem. She went to college. She is a freshman in college now and a couple times well, at least once had a fainting fainted when she was in college. But she doesnt play any sports anymore because of what they said. Now i mean in some ways it is fortunate because she had the concussion, now weve been told dont play sports i mean dont play Contact Sports. You can jog she jogs but dont play Contact Sports. But if she had one of these subconcussive hits, as you talked about the spectrum, my concern is you dont necessarily know about it. So im lucky now because she knows shes not supposed to do anything more. But if you had one of these things, how would you even know . In other words, you talk about this spectrum, but it seems like were hearing more and more at least im hearing as a parent more and more that anything can cause damage. Like shes told not to play at all. I wouldnt want her to have a second or third concussion. But if you could just tell me about that. The spectrum and the subconcussive. How does that relate to this spectrum that you mentioned . Sure. So i think that the terminology is a little bit at risk here. It depends on how you think of it. Concussion was initially people thought of it as someone lost consciousness. Now that kind of went by the wayside. Now it is a change thats really recognized at the time of injury, there is a change in neurological function. And that is without loss of consciousness. But i think if you move back even more, there are changes in neurologic function that no one would recognize unless they were tested. So the ability to actually test the person is one of the limiting factors. So in these subconcussive events, i would think this i those folks. Maybe some of the other folks could comment on that. I have nothing but the ultimate respect for everybody on the panel. But there are some of us who have taken care of concussions for 25 years, ive taken care of 20,000 people with brain injury. I provide the care for an nhl team on concussions. The sky is not falling. You should return to activity within a day or two of a concussion. Not Contact Sports. Being in a dark room resting, staying at home is not the treatment for injury. In any level, including concussions. Ive had six in my life. I was a terrible athlete. All right . I wasnt stopped. But there really isnt science that supports people shouldnt play sports after a concussion. It is really bad for our youth, it is bad for our professional athletes, it is bad for everyone involved to spread that believe. We need way more research. Im involved with all of these folks in a lot of research. But really, there is no science that says dont play sports after a concussion. What about a series of concussions . Can you talk about that . Sure. You get one concussion. First of all, it needs to be identified. It is extremely easy to identify an acute condition cushion that just occurred. Anybody in this room could do it. It is very hard to use a survey to assess it even a week or two afterwards. Months afterwards . Just about impossible. I run tbi care for the va system and help set that up and in doing the research in the va for that. Its really hard to do after the fact. You have one. Its assessed. You make a diagnosis. That person gets back to activity a day or two. All right . Doesnt play sports, but gets back to activity. Gets back to school. Theyre at risk to get another concussion for the first several weeks, months, years even. But were all at risk to fall down and to be in front of a bus. Youre the much higher risk to get fat, to get Heart Disease, to get psychological problems if you dont go back tim, i just wanted from my own experience. She was hit in the face. She was told not to go to school. I know, its wrong. Its wrong. For the next six weeks. Only reason we graduated was because they let her do things after. She should have been activated quicker. I was definiteshe was defini the to do contacts sports again and if it happened a second time psh. I know. We need to stop that. How many of you think after a persons had initial concussion, whatever its causes, that they should return to activity fairly quickly . Half a single concussion . Multiples. Dr. Collins, ive been to your clinic. You pointed out to me that used to be you stayed in the dark, didnt do anything for long periods of time. Youve done a lot of research in this area. Any comment in terms of what that is a myth that we need to dispel . I agree wholeheartedly with those comments. The sky isnt falling. We made tremendous progress in terms of treatment of this injury. Were starting to identify different subtypes of concussion and matching certain treatments to these different clinical profiles. Though we need much more Prospective Research to understand the timing and dosing of treatments, we collectively met recently in pittsburgh and agree that concussion is a treatable injury. With all respect, i agree with the comments regarding your daughter. I think that what we dont want to do is the pendulum has swung from here to here very rapidly as weve all alluded to. The truth is probably in between somewhere in terms of the fact its worse than what we thought it was, but it is not as bad as what it is being made out to be. Advances weve made in treatment with significant. I would suggest its never been safer to have a concussion than it is right now because of the advances that have been made from a treatment perspective. Were starting to learn that active approaches at management and treatment are much more efficacious than sitting in a dark room. I treat a lot of problems from that philosophy of putting kids in a dark room in terms of chronic anxiety, chronic migraine, ive seen kids who are suicidal. Extensibilitve suicidal yie aal. We need to get them back to sports. Can we hear some other . You had a question on this part . My question is going to be a little different. So you want dr. Mccray . I want to make a more i guess general background commentary and say that this is probably a familiar story in medical research. Concussion has gone, as many people in this room know, has gone truly from total on security, 10 or 20 years ago, to now in a sports setting and to a large extent in the military sector dominating the national narrative. And the unfortunate position were in currently i think is weve reached that awkward stage of maturity, call it adolesce e adolescence, that weve made enormous strides over the last 20 years that puts us in a position to have this discussion today. But at the same time, the topic has been elevated in to the public spotlight such that all the stakeholders, including sports parents, assume we already know the answers to all the critical questions and they want those answers now. And theres perhaps no more unenviable position for a scientist to be in than to have to catch up with the public narrative. I think weve made Great Strides in changing how we take care of athletes on the sideline and during the ensuing days. As micky pointed out with treatment regimens, rate of exertion, the expression we often use in our program is that concussion, particularly in a sporting environment, used to be managed on a switch. The day you were symptom free, or as aour data pointed out several years ago, several days prior to being sim top free the switch was flipped and you returned to fullcontact activity, whatever the sport might be. Weve learned a lot over the years about the natural time course of recovery clinically and we now manage athletes on a dial. As david pointed out. We dont flip the switch the day theyre symptom free. We introduce norisk activity under a period with no exposure to contact. We allow to athlete to go through stages of rehabilitation, being a la mate, reach a point where they are completely sim tonfree and return to activity when they are safe to do so from a clinical recovery standpoint. We have data from the recent care study caring our outcomes and reduction of repeat injuries in the same concussion. In 2014 and 2015 to 1999 the first ncaa concussion study. In our early studies more than 90 of our sameseason repeat concussions occurred within the first ten days of the first concussion. In the Current Study there is a 0 incidence of repeat concussion in the first ten days and the average interval for those small number of sameseason repeat concussions is 75 days instead of five days. So the work by a lot of people in the room here has had a direct translational impact on how we take care of athletes and military Service Members and people in our level 1 Trauma Centers to protect them from the risks. As walter pointed out, were just scratching the service. We know very little about the underlying neuro biology of this injury. As odd as it sounds, we know a lot about how long it takes for the individual to tell us that theyre completely symptom free or recovered but we know very little about how long it takes for the brain to recover. Ultimately wed like to know the answers to those critical questions about underlying path of physiology and recovery at a brain level to make prevention based decisions about return to activity. Doctor . I just want to what dr. Mccray is referring to is basically the Research Knowledge weve currently acquired, mostly with males, adolescent and young adults, not as applied to girls, not as applied to younger children. So we are making some leaps of faith in terms of how we apply this to younger kids that weve got to have better evidence to know. I mean i think the simple answer or simple question that is often asked by any parent is when should i allow my child to do, x, y, z risk activity. We dont have those answers yet. At the same time, we also know that we want kids to be active, we know of all the benefits that have already been discussed about sports on so many levels. And so the application of our knowledge to kids, granted, we have to be more cautious. No doubt about that. But some of it may or may not be appropriate. And it appears that girls do have both different risks and different trajectories of recovery that we have to better understand because there may be a different biological, a different psychological, a different biomechanical response to forces that have to be understood. The same goes with younger children as well. So there is the perception that we, one, know a hot more about there injury than we do. But i can tell you that the knowledge is at its lowest with younger kids. Dr. Manley. Thank you very much. Id first like to bring this conversation back to some of your comments, representative murphy, which is that tbi affects more than just athletes. This is really as highlighted in your brief here the tip of the pyramid and that we look at the athletes, we look at the military personnel. But as our colleague from the cdc just pointed out there is at least 2. 5 Million People a year coming into Emergency Rooms with concussion and with more moderate and severe traumatic brain injury. The other issue is that there is at least two million to three Million People that never seek out medical care. Even when those patients get to the Emergency Department we have studies that show that over half of them are missed. In our ongoing nih funded study, were asking patients at two weeks were you referred for followup. These were people actually diagnosed in an Emergency Department at 11 of the best Trauma Centers in the country. We found less than half of those patients are actually referred for followup. There is a very low bar in terms of following up with things that we know. Other misconception is that weve treated concussion and brain injury as an event and not a process. Because we look at it as an event, even as doctors, ive taken care of traumatic brain injury for years. We dont typically follow those patients up like if you had diabetes, Heart Disease or cancer. I think now that we look at this more like a disease process and with studies like track tbi and some of the others that are funded were asking questions that we never asked before even in the medical community and we are finding that not just subconcussive blows but even a single concussion can alter it the course of someones life. Applaud the committee for bringing this to the forefront. 5 Million People suffer from the aftereffects ever traumatic brain injury and we really need to do more for this. I just want to point out that i know there is a lot of misconception about cte and concussion. The movie was called concussion. It was about cte. But in all our experience weve never seen cte after a single concussion. Cte is associated with duration of exposure to repetitive head impacts. Cumulative exposure to lowlevel head injury. So concussions have never correlated with cte. We have seen multiple studies, no correlation with the number of concussions. But we do see very consistently the years of play, the years that an individual is exposed, say playing football, or boxing. That does seem to be associated with the risk for cte. The longer you play at the higher level that you play, the greater the risk. Thank you, mr. Chairman. I was a surgeon heart surgeon before i was in congress. So my question is going to be just to about primary prevention, so to speak, education. And i have four kids all the way from age 23 to age 12. They all play hockey, all play soccer. And i pernsonally played high school in football. I played hockey. You alluded to it a little bit. My question is, a lot of research may be done in adults, but the question is, theres obviously development things going on in youth that may have a different impact on this. People with people say the plains still developing significantly into your 20s. The question question i have is, what do people think we should be doing in our Elementary Schools and grade schools really early . And i know, with currently available nvs, without shocking people and make parents afraid for their kids to play, and that said, what is the potential differences of how these things impact youth versus how they impact adults . And should we do things maybe differently in youth and adults. Who wants to respond to that . Dr. Gioia . Im sure theres a number of folks interested in commenting. Im on the Advisory Board for usa football. The question was, what age do we introduce different types of the game to different individuals . And again, depends in part, your biomechanics, physical maturity, psychological maturity. All of those factors. Do we teach the way american hockey has gone to this developmental model and sports are looking at that as a model system for matching the person, their developmental age, and the game and its particular skills. Can we teach, you know, or do we modify checking . Do we modify tackling and blocking . Do we modify force events in that developmental level cannot sustain it in and i think its a very important question. We really need to wrap some research around those questions. I think, at this point, though, we can certainly reduce that risk. And by reducing the amount of contact that goes on in these sports, but still teach the game appropriately, so youre not putting somebody into a competitive situation totally unprepared, is really our challenge. Its not a simple answer. Certainly some of the work thats been done with the heads up Football Program is showing reduction in general injuries as well as concussion. We can do more, though. We dont know that answer as to what age do we start these things at . But i think it goes beyond that. Look at physical ed Nation School and understand how do we build neck strength, what we think may be the important kinds of preventative buy lodiologic f factors. How do we think of introduction of sports at aims somebody is psychologically ready for. For some reason i loved Contact Sports. I have a son, thats not his thing. We need to understand what you are prepared for. Again, goeses for boys and girls. Our bodies are built differently, we need to take that into account as well for different sports. We need some studies done early on developmental biomechanics as it relates to different sports types. Ill briefly comment. I also coached hockey, youth hockey, and theres a transition in usa hockey what level kid can check. Used to be fairly young, trying to teach them how to properly check without injuring people was pretty hard. When people are younger, whether its football, soccer, honestly, or another thing, we usa hockey, i think, is out front on that pretty well. Doing a good job. But its pretty important. Dr. Baldwin will Say Something first. One of cdcs most successful campaigns, heads up, about prevention recognition and management of traumatic brain injury, weve had it around over a decade now. Weve distributed over 6 million materials, trained 3 million coaches on concussion prevention and management. Weve migrated on parents, coaches, Health Care Professionals, school professionals. The next phase is focused on kids. Changing the culture of sports, and so the person that leads the initiative has Creative Ideas how to bridge into the younger population. Were going to be coming out with an app in the next few months, a game, rocket blades, going to teach kids about concussion and concussion provincial. One of the tools in the tool chest for us is raising awareness and education and certainly we have tried to do that over a decade now with some of our heads up work. I mean, awareness, awareness, awareness. Theres ten apps already to teach kids. None are going to be as good as yours. I saw an app in holland last week thats unbelievable to teach kids about concussion. Its fantastic. But without the awareness of the coaches and the parents, it doesnt matter. The kids arent going to selfreport, i dont know. So if awareness is good, unless we develop Health Care Professionals that understand how to reintegrate people back that their lives. Were go egg to have some really frustrated parents. We them all the time. Thats who comes to our center and mickeys center. People kept in a closed room, people told dont ever play sports again, people that didnt take tests for a year. Theyre more focused on the fear of this amazing organ we have and less concerned about overall wellness. I mean if the kid doesnt go to a fast food place hell do better than if he gets cared for a concussion. We need to wrap this around total health of these kids, if you really care about them, because it isnt just the concussive force. People have been getting concussions for 3. 2 million years if we look at archaeological evidence were not all demented. Cdc will be releasing early next year guidelines for pediatricians treating can we see them . Can this group see them . Yes, of course. Dr. Heck, dr. Hanlin. Two groups we know the least in concussion, its in the young and in the old. I think the old, its they were getting that way anyway, if they fall, hit their head, and actually ones that suffer the most consequence from head injury is the elderly. And they decline rapidly after that, thats another whole population. In the youth, its a mat, comes down to a matter of balance, first of all. Its not patients should not be absolutely aprayfraid of a h injury to have kids participating in sports. In terms of teamwork, in terms of exercise, personal development, response and all of 0 those kinds of things. Sports has a valuable contribution to our society. What we need to do, i think, do a better job is in the area of the coaches and the trainers. In the youth, in particular. There are no standards across the board. Across at high school level, whatever teacher draws the short straw has to coach. And we mentioned in europe, there actually are tougher standards in europe when coaching kids. You actually have to have certification, some training and some actual way that you demonstrate that youve been trained. I think work needs to go on. Raising the level, the knowledge of people responsible of those kids as their coaching them. I want to get to one other thing, i should have mentioned earlier, this fear about the once they have a concussion, that theres some black or red mark on them they should never participate in sports again. The risk of a from a repeat concussion depend on a number of factors, number one, the time of the concussion. One single event doesnt preclude you from it. It depends on the time of the ee event and the characteristic of the individual that suffered that event. Dr. Hanlin. My comments will be looking at sport as a Public Health model. And i think there are three things very important that can address the whole culture in the youth sport. One is that all 48 National Governing bodies in our country are signatories to the American Development model, and its a unique opportunity working with the usoc and all of the parent organizations to look at sport as a longterm athlete Development Process and thats currently not happening well enough. But everyone is on board and concussion would be part of than the second is, and colonel hack made mention to this, to be a coach in the country all you have to do is hold up a shingle and say, im a coach, and its distinctly different than europe why youre required several hundred hours of sport training. I was in colorado addressing this, and this is something that the ncaa has been involved with with the National Governing bodies working with our 23 sports, is that were doing sportspecific conferences and bringing in that the concept of developing coaching education. But it has to start at the youth level and thats something exceptionally important. I think theres growing momentum for that. The third is there needs to be someone to protect our kids. Thats empowering people such as athletic trainers. The athletic trainers are probably the singlemost important person that could be on siter to any sort of contact collision event. Its important even in this country, for example, in the state of california, athletic trainers are not even regulated, so anyone can hold up a shingle and say im an athletic trainer or in new york city, 35,000 members of of the School Athletic league and theres not one athletic trainer. Theyre the people that need to be empowered. We passed legislation, we defined providers as athletic trainers and team physicians. I think if we can get t signatories to the American Development model, coaches education, em bower athletic trainers, those three combines will shift the safety in youth sport than anything i know of. Thank you, mr. Chairman. Thank you for convening this group. I want to echo a fair a