[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
FROM MOLECULES TO MINDS: THE FUTURE OF NEUROSCIENCE RESEARCH AND
DEVELOPMENT
=======================================================================
HEARING
before the
SUBCOMMITTEE ON DOMESTIC POLICY
of the
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 29, 2010
__________
Serial No. 111-159
__________
Printed for the use of the Committee on Oversight and Government Reform
Available via the World Wide Web: http://www.fdsys.gov
http://www.oversight.house.gov
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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
EDOLPHUS TOWNS, New York, Chairman
PAUL E. KANJORSKI, Pennsylvania DARRELL E. ISSA, California
CAROLYN B. MALONEY, New York DAN BURTON, Indiana
ELIJAH E. CUMMINGS, Maryland JOHN L. MICA, Florida
DENNIS J. KUCINICH, Ohio JOHN J. DUNCAN, Jr., Tennessee
JOHN F. TIERNEY, Massachusetts MICHAEL R. TURNER, Ohio
WM. LACY CLAY, Missouri LYNN A. WESTMORELAND, Georgia
DIANE E. WATSON, California PATRICK T. McHENRY, North Carolina
STEPHEN F. LYNCH, Massachusetts BRIAN P. BILBRAY, California
JIM COOPER, Tennessee JIM JORDAN, Ohio
GERALD E. CONNOLLY, Virginia JEFF FLAKE, Arizona
MIKE QUIGLEY, Illinois JEFF FORTENBERRY, Nebraska
MARCY KAPTUR, Ohio JASON CHAFFETZ, Utah
ELEANOR HOLMES NORTON, District of AARON SCHOCK, Illinois
Columbia BLAINE LUETKEMEYER, Missouri
PATRICK J. KENNEDY, Rhode Island ANH ``JOSEPH'' CAO, Louisiana
DANNY K. DAVIS, Illinois BILL SHUSTER, Pennsylvania
CHRIS VAN HOLLEN, Maryland
HENRY CUELLAR, Texas
PAUL W. HODES, New Hampshire
CHRISTOPHER S. MURPHY, Connecticut
PETER WELCH, Vermont
BILL FOSTER, Illinois
JACKIE SPEIER, California
STEVE DRIEHAUS, Ohio
JUDY CHU, California
Ron Stroman, Staff Director
Michael McCarthy, Deputy Staff Director
Carla Hultberg, Chief Clerk
Larry Brady, Minority Staff Director
Subcommittee on Domestic Policy
DENNIS J. KUCINICH, Ohio, Chairman
ELIJAH E. CUMMINGS, Maryland JIM JORDAN, Ohio
JOHN F. TIERNEY, Massachusetts DAN BURTON, Indiana
DIANE E. WATSON, California MICHAEL R. TURNER, Ohio
JIM COOPER, Tennessee JEFF FORTENBERRY, Nebraska
PATRICK J. KENNEDY, Rhode Island AARON SCHOCK, Illinois
PETER WELCH, Vermont ------ ------
BILL FOSTER, Illinois
MARCY KAPTUR, Ohio
Jaron R. Bourke, Staff Director
C O N T E N T S
----------
Page
Hearing held on September 29, 2010............................... 1
Statement of:
Akil, Huda, Ph.D., co-director and research professor, the
Molecular & Behavioral Neuroscience Institute, University
of Michigan; William Z. Potter, M.D., Ph.D., former vice
president of transactional neuroscience, Merck Research
Laboratories; Tim Coetzee, Ph.D., executive director, Fast
Forward, LLC; Kevin Kit Parker, Ph.D., associate professor
of applied science and biomedical engineering, Harvard
University; and John Morrison, Ph.D., dean, basic sciences
and the Graduate School of Biological Sciences, Mount Sinai
Medical Center............................................. 84
Akil, Huda, Ph.D......................................... 84
Coetzee, Tim, Ph.D....................................... 102
Morrison, John, Ph.D..................................... 126
Parker, Kevin Kit, Ph.D.................................. 113
Potter, William Z., Ph.D................................. 93
Insel, Thomas R., M.D., Director, National Institute of
Mental Health; Walter J. Koroshetz, M.D., Deputy Director,
National Institute for Neurological Disorders and Stroke;
Joel Kupersmith, M.D., Chief Research and Development
Officer, Veterans Health Administration, U.S. Department of
Veterans Affairs; and Terry Rauch, Ph.D., Director, Defense
Medical Research and Development Program, Office of the
Assistant Secretary of Defense for Health Affairs,
Department of Defense...................................... 10
Insel, Thomas R., M.D.................................... 10
Koroshetz, Walter J., M.D................................ 22
Kupersmith, Joel, M.D.................................... 41
Rauch, Terry, Ph.D....................................... 55
Letters, statements, etc., submitted for the record by:
Akil, Huda, Ph.D., co-director and research professor, the
Molecular & Behavioral Neuroscience Institute, University
of Michigan, prepared statement of......................... 87
Coetzee, Tim, Ph.D., executive director, Fast Forward, LLC,
prepared statement of...................................... 104
Insel, Thomas R., M.D., Director, National Institute of
Mental Health, prepared statement of....................... 14
Koroshetz, Walter J., M.D., Deputy Director, National
Institute for Neurological Disorders and Stroke, prepared
statement of............................................... 26
Kucinich, Hon. Dennis J., a Representative in Congress from
the State of Ohio, prepared statement of................... 4
Kupersmith, Joel, M.D., Chief Research and Development
Officer, Veterans Health Administration, U.S. Department of
Veterans Affairs, prepared statement of.................... 43
Morrison, John, Ph.D., dean, basic sciences and the Graduate
School of Biological Sciences, Mount Sinai Medical Center,
prepared statement of...................................... 128
Parker, Kevin Kit, Ph.D., associate professor of applied
science and biomedical engineering, Harvard University,
prepared statement of...................................... 116
Potter, William Z., M.D., Ph.D., former vice president of
transactional neuroscience, Merck Research Laboratories,
prepared statement of...................................... 95
Rauch, Terry, Ph.D., Director, Defense Medical Research and
Development Program, Office of the Assistant Secretary of
Defense for Health Affairs, Department of Defense, prepared
statement of............................................... 57
FROM MOLECULES TO MINDS: THE FUTURE OF NEUROSCIENCE RESEARCH AND
DEVELOPMENT
----------
WEDNESDAY, SEPTEMBER 29, 2010
House of Representatives,
Subcommittee on Domestic Policy,
Committee on Oversight and Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 2 p.m. in room
2203, Rayburn House Office Building, Hon. Dennis Kucinich
(chairman of the subcommittee) presiding.
Present: Representatives Kucinich, Kennedy, Foster, and
Jordan.
Also present: Representatives Thompson and Jones.
Staff present: Claire Coleman, counsel; Justin Baker,
clerk/policy analyst; and Molly Boyl, minority professional
staff member.
Mr. Kucinich. Good afternoon. The Domestic Policy
Subcommittee of the Oversight and Government Reform Committee
will now come to order.
This hearing will explore efforts to expand knowledge and
treatments to help individuals afflicted with neurological and
mental health disorders. Without objection, the Chair and
ranking minority member will have 5 minutes to make opening
statements, prior to opening statements not to exceed 3 minutes
by any other Member who seeks recognition.
Without objection, Members and witnesses may have 5
legislative days to submit a written statement or extraneous
materials for the record. And without objection, for the
purposes of participation in today's hearing, we welcome
Congressman Mike Thompson to the subcommittee.
Today's hearing will address the critical needs for better
treatment for neurologic and psychiatric disorders, and how the
neuroscience community can best facilitate research to advance
and accelerate discovery of treatments and cures. Every year,
the more than 1,000 disorders of the brain and nervous system
result in more hospitalizations than any other disease group,
even more than heart disease and cancer. Neurological illnesses
affect more than 50 million Americans annually at costs
exceeding $460 billion.
Neuropsychiatric illnesses, like schizophrenia, mood
disorders and autism are the leading cause of disability in
North America and Europe. In the United States, the cost in
lost earnings due to psychiatric disease is estimated
conservatively to be $200 billion per year. The toll of brain-
related disorders is enormous for individuals and for families.
Veterans returning from wars in Iraq and Afghanistan have been
particularly hard hit by neurologic disorders. Traumatic brain
injury, defined as a disruption in brain function as caused by
head injury, has become known as one of the signature wounds of
the wars in Iraq and Afghanistan, because of the insurgents'
heavy use of explosive devices and armor which has better
protected soldiers' lives from life-threatening injuries. That
is despite the fact that we have better-protected soldiers.
A disproportionately high number of returning military
personnel also struggle with psychological health issues like
post-traumatic stress disorder, clinical depression, anxiety
disorder, sleep disturbances and substance abuse. The
psychological toll of these wars has been particularly harsh
because of long exposure to combat-related stress over multiple
rotations. Unlike the physical wounds of war that maim or
disfigure, these conditions remain invisible to other service
members, to family members and to society in general.
But emblematic of the great tragedy of war, especially this
war, the toll these invisible wounds take on lives is great.
Treatments to reverse or delay these injuries and disorders are
critical and would benefit both the military and civilian
populations alike, as approximately 1.7 million civilians
sustain a traumatic brain injury as a result of car accidents,
falls or other blows to the head every year.
The field of neuroscience, which is the study of the
nervous system, has made significant advances in the last
decade, providing new insights into the functioning of the
brain and underlying disease mechanisms. Yet many questions
remain, spanning the most fundamental, such as how to keep our
brains healthy to the specific challenges of finding diagnostic
tools for diseases like Alzheimer's or schizophrenia and
determining ways to effectively treat TBI and PTSD.
The Federal Government has a vast array of research
initiatives devoted to advances in neuroscience, and our
ability to treat brain injuries and mental health disorders
affecting both military and civilian populations. Many of these
Federal initiatives involve extensive coordination with
civilian and non-governmental sectors, including multi-
disciplinary, multi-sector research programs and centers. We
will hear about these efforts today.
Likewise, private foundations have played an increasingly
important role in expediting the drug development process by
bridging the gap between promising scientific discoveries and
entrepreneurial expertise and funding needed to move them
forward. The role of Government and private foundations has
become especially critical to progress, because unfortunately,
despite their immense profits, the pharmaceutical industry has
been cutting back the research and development of central
nervous system medications due to the high cost and high risk.
As we will hear today, this could have a devastating impact on
the drug development pipeline for neurologic disorders.
Without collaboration across all sectors--Government,
industry and non-profit--neuroscience breakthroughs will stall
and much-needed treatments for all Americans, especially for
our men and women in uniform, who have endured injuries in
service to their country, will not materialize. I hope this
hearing will raise awareness about the critical role
neuroscience has in developing treatments to reverse or delay
some of the impacts of neurologic or psychiatric disorders that
millions of Americans are afflicted with, and will stimulate
creative thinking about how to best advance discoveries and
treatments for the broad spectrum of devastating brain-related
injuries and disorders that continue to impose a heavy burden
on individuals and society today.
Before I recognize our ranking member, Mr. Jordan, I want
to say that the reason why this hearing came about is because
Representative Kennedy, who has throughout a great period of
time communicated to me his concern that we delve into this
subject in a methodical way, that we contact all sectors, and
we try to find ways of creating benefits for people through
either recognizing the synergies that exist, or where there may
be insufficient numbers, helping to make sure that resources at
some point will be available to help facilitate greater
coordination.
Representative Patrick Kennedy has been a tireless advocate
for innovative, cross-disciplinary, collaborative biomedical
research and has provided unwavering support to those with
psychiatric disorders as well as returning veterans suffering
from signature war injuries affecting the nervous system. So
Pat, I want to thank you, not just on behalf of this committee,
but on behalf of Members of Congress for your assistance in
this vital area. You have made so many contributions to this
Congress, but I think that as life goes on, this is going to be
an area where you are leaving an enduring mark for your wisdom,
your compassion and your sharing of your own experience with
all of us. You are a person of great integrity and courage. I
am honored to have served with you.
At this point, I would recognize the ranking member, Mr.
Jordan.
[The prepared statement of Hon. Dennis J. Kucinich
follows:]
[GRAPHIC] [TIFF OMITTED] T5562.001
[GRAPHIC] [TIFF OMITTED] T5562.002
Mr. Jordan. Thank you, Mr. Chairman. Let me too thank you
for having this important hearing and for the work that
Congressman Kennedy has done on this subject.
I have a meeting I have to get to in a few minutes, so in
the interest of time I will ask the chairman if I can just
submit my opening statement for the record.
Mr. Kucinich. Without objection, so ordered.
Mr. Jordan. Thank you.
Mr. Kucinich. Thank you, Mr. Jordan, for your presence.
Mr. Kennedy, the Chair recognizes Mr. Kennedy.
Mr. Kennedy. Thank you, Mr. Chairman. I really appreciate
those very generous and kind remarks. And of course, Ranking
Member Jordan, thank you for your being here to help kick this
important hearing off.
And to my other colleagues, Mike Thompson, whose work in
this area but also whose service today is highlighted because
of his service to our country as a veteran in our military and
that perspective that he brings and his work in this area. It
is so appreciated. And Mr. Foster, thank you very much both for
your being here and your efforts.
I want to thank you, Mr. Chairman, for putting this hearing
together, and also your staff, who have been so instrumental.
Jaron Bourke and Claire Coleman, who have been helpful, and
Justin Baker, and all those who have been so critical in
putting this event together. And my own staff, I want to thank
Dan Murphy and Laurel Havis and my whole office for the work
that they did in putting up with my aggravation at trying to
get all this pulled together. They have just been the best and
I want to thank them tremendously for this.
I have Chris Cann, who does all my veterans events in Rhode
Island, I want to acknowledge he has put together a veterans
diversion program for those ending up in our criminal justice
system because of their wounds on this war, which are at ever-
higher rates. We are doing that on October 25th in Rhode
Island. I thank Chris for his work on that. And I want to thank
John Sack for all the efforts that he put in as well.
Mr. Chairman, I also want to acknowledge some real other
heroes here in this audience, not the least of which has been
the former Secretary of Veterans Affairs, former U.S. Senator,
but most important to all of us, an American hero in the true
sense of the word, and that is Max Cleland.
[Applause.]
Mr. Kennedy. We have an amazing lineup of people who have
come to testify today. I want to thank all of them for being
here, and say we are really at a point today when we are going
to examine where we are today in neuroscience. And most
importantly, what the stage is for us to set for us to really
move forward much faster, more effectively and certainly to
deliver the answers to neurological disorders and disability.
Now more than ever, because of how it affects our American
heroes, our Nation's veterans, the signature wounds of this
war, brain injury and PTSD. We have the biggest burden of
illness amongst the civilian population, but the civilian
population today is going to be looking to the fact that our
heroes are going to be the catalyst to bring us to one mind on
brain research. No more divisiveness; let's unify, let's get
behind our veterans. When they win it, we all win it, as is
always the case with our Nation's heroes, and in this case
especially.
So we have a bunch of great testimony today. We will learn
from those in the civilian sector how they can be helpful in
their research to help our veterans, which should be our No. 1
priority.
So thank you, Mr. Chairman. I appreciate the opportunity to
have an opening statement. I look forward to the questions.
Mr. Kucinich. Thank you. The Chair recognizes Mr. Foster.
Mr. Foster. I yield back.
Mr. Kucinich. The Chair recognizes Mr. Thompson.
Mr. Thompson. Thank you, Chairman Kucinich. Thank you for
having the hearing and thanks to you and Representative Kennedy
for inviting me to provide testimony today. My thanks to
everyone who is here who recognizes this as not only a huge
problem, but one that we can really get ahead of the curve on.
Mental illness impacts us all a great deal. The chairman
pointed out the financial cost. While staggering, I think those
dollar costs really pale in comparison to the heartbreak and
the pain that families go through because of mental illness.
With one in six of our adults in the country with diagnosable
mental illness, it is really hard to find a family that isn't
somehow touched by mental illness. As Patrick Kennedy said, our
veterans are certainly a cause that we call can rally around. I
am pleased to be able to say something on their behalf, and
honored to be in the same hearing room with Senator Cleland,
who is in fact a true hero.
We see more of our military personnel returning from Iraq
and Afghanistan not with physical injuries, although they are a
huge issue, important issue as well, but with mental injuries
including PTSD, anxiety disorder or depression. So the call for
research and support for a cure for brain illness grows louder
and louder each time one of these veterans returns home.
Reports indicate that 19 percent of Iraq war veterans and 11
percent of Afghanistan veterans suffer from mental illness.
The brain has been called the last frontier for medicine.
And the time for that to end, I believe, is right now. It is
time to bring together all of the different groups, including
the Federal Government, the Congress, private industry,
academia, everyone who has an interest in brain illness, to
fully explore and to tackle this problem once and for all.
Every year in my congressional district, they hold the
single largest fundraiser for mental health. It is called the
Staglin Music Festival for Mental Health. And the proceeds from
this fundraiser, the annual fundraiser, has now reached over
$94 million. It is used to find research, to find better
treatments and cures for schizophrenia, bipolar disorder and
depression.
Another great hero who is with us today is Garen Staglin,
in the front row. I don't know where his wonderful wife, Shari,
is, if she is here or not. But the two of them work tirelessly
for mental health and to raise the money to provide research
funding for mental health. Their work to find a cure and to
improve treatment for brain illness is inspired, and it is
driven by a very personal story. In 1990, their son was
diagnosed with schizophrenia. It was heartbreaking, it was a
scary time for them and for their son.
But they took that heartbreak and they turned it into a
benefit for everyone who cares about the advancement of mental
health. In 1995, they started the International Mental Health
Research Organization, which raises money for mental health
research, collaborates and affiliates with organizations, and
works to build awareness of scientific achievements in the
field of mental health research.
The Staglins are very fond of saying the rewards are much
greater if you run toward the problem, not away from it. We are
fortunate that both Garen and Shari are running toward the
problem of mental health and not away from it. The rewards, as
I mentioned, have been great. So I want to make sure we
recognize that they are making an immediate difference in the
lives of millions of people. And I am really proud that you are
here, Garen, and of the work that you are doing.
I too would like to join the chairman in recognizing our
friend and colleague, Congressman Kennedy, for his work on
mental health issues. He has been tireless, the entire 12 years
that I have been in Congress, I don't know anyone who has
worked any harder on any single subject than Patrick has worked
on this. He has done so much good for so many people.
It really saddens me that you are leaving Congress, because
so many people are going to lose, in Congress, a great
advocate. I know you will always been working on this stuff,
but he is just a tireless fighter. So I want to pledge to you,
Patrick, that I will keep doing everything you tell me to do to
make sure that we can get ahead of this. Everything you tell me
to do in regard to working on mental illness.
Mr. Kennedy. Good thing you made that distinction.
[Laughter.]
Mr. Thompson. Everyone that has said it is right on, now is
the time, and the emphasis on our veterans, I think it just
punctuates the need to really double down and get this done. I
thank you very much and I yield back and thank you for letting
me testify.
Mr. Kucinich. I thank the gentleman. Any other Members who
appear will be given 5 legislative days to be able to make an
opening statement.
Mr. Kennedy. Mr. Chairman, Congressman Walter Jones has
arrived.
Mr. Kucinich. Congressman Jones, do you have a statement
that you want to make?
Mr. Jones. Yes, Mr. Chairman.
Mr. Kucinich. Without objection, come on up here, have a
seat. This is Congressman Walter Jones from North Carolina,
Republican Member. Have a seat.
Mr. Jones. Thank you, Mr. Chairman. Nothing like being
late. Thank you.
I have Camp LeJeune Marine Base in my district. We have had
a number of suicides of Marines who have been frequently
deployed. We are having more problems with families staying
together. I want to thank Patrick Kennedy for taking the lead
on this and asking me to join you, Mr. Chairman, and the other
Members here.
My biggest concern is that at some point in time in the
very near future, we are not going to be able to do what we
should do for those who are suffering from PTSD and TBI. So I
wanted to be here today to listen, to learn and to also be very
proactive with my friends.
Thank you.
Mr. Kucinich. I thank the gentleman. Members who appear
once the testimony begins will be given five legislative days
to submit statements for the record.
Before I begin introducing our panel of witnesses, I
apologize for being a few minutes late, but I ran right into
the room and focused on my script and getting the hearing off
and running. Had I noticed Max Cleland in the room, I would
have spoken as some of my colleagues have to his exemplary
service to our country in so many ways.
When I came into Congress, Max was one of the first people
I consulted with on that other side of the Capitol. And I have
to say, Max, you honor us by your presence in this room. I am
so grateful that you continue to serve in other capacities. You
know how I feel about you and when I saw you, I thought, wow,
Cleland is in the audience. So thank you.
Our first panel: Dr. Thomas R. Insel, M.D., is the Director
of the National Institute of Mental Health. His tenure at NIMH
has been distinguished by groundbreaking findings in the areas
of practical clinical trials, autism research and the role of
genetics in mental illnesses. Prior to his appointment as NIMH
Director in fall 2002, Dr. Insel was professor of psychiatry at
Emory University.
Next, Dr. Walter J. Koroshetz, who is Deputy Director of
the National Institute for Neurological Disorders and Stroke.
Before joining NINDS, Dr. Koroshetz served as vice chair of the
neurology service and director of stroke and neurointensive
care services at Massachusetts General Hospital. He is also
professor of neurology at Harvard Medical.
Joel Kupersmith, M.D., Dr. Kupersmith is Chief Research and
Development Officer for the Veterans Health Administration,
U.S. Department of Veterans Affairs. Prior to joining VA, Dr.
Kupersmith was dean of the School of Medicine and Graduate
School of Biomedical Sciences and vice president for clinical
affairs at Tech University.
Finally, Terry Rauch, Ph.D., currently serves as the
Director of the Defense Medical Research and Development
Program within the Office of the Assistant Secretary of Defense
for Health Affairs. He has responsibility for the defense
health program R&D portfolio. He has over 30 years of
experience in many facets of the military health system and has
held numerous senior level positions in the Army and the Office
of the Secretary of Defense.
I want to thank each and every one of the distinguished
panelists for their presence here today. It is a policy of the
Committee on Oversight and Government Reform to swear in our
witnesses before they testify. I would now ask that each of the
witnesses rise, raise your right hands.
[Witnesses sworn.]
Mr. Kucinich. Thank you very much.
Let the record reflect that each of the witnesses answered
in the affirmative. I would now ask that each witness give a
brief summary of your testimony, keep the summary under 5
minutes in duration if you can. Your complete written statement
will be in the hearing record.
I don't know if you can see the clock there, there is a,
you have an even better view, but we have a little box there
with colored lights. Let's begin with Dr. Insel. And thank you
for being here, sir. Please start.
STATEMENTS OF THOMAS R. INSEL, M.D., DIRECTOR, NATIONAL
INSTITUTE OF MENTAL HEALTH; WALTER J. KOROSHETZ, M.D., DEPUTY
DIRECTOR, NATIONAL INSTITUTE FOR NEUROLOGICAL DISORDERS AND
STROKE; JOEL KUPERSMITH, M.D., CHIEF RESEARCH AND DEVELOPMENT
OFFICER, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF
VETERANS AFFAIRS; AND TERRY RAUCH, PH.D., DIRECTOR, DEFENSE
MEDICAL RESEARCH AND DEVELOPMENT PROGRAM, OFFICE OF THE
ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, DEPARTMENT
OF DEFENSE
STATEMENT OF THOMAS R. INSEL, M.D.
Dr. Insel. Thank you, Mr. Chairman. I really appreciate the
committee's interest in this issue, and I also want to thank
Congressman Kennedy for what has been a very long period of
passionate leadership. We are going to miss you tremendously as
you move to your next post. I can only hope that you will come
work for us at some point.
Mr. Kennedy. I thought I already was. [Laughter.]
What do you think all those appropriations were over there?
Mr. Kucinich. Regular order. Go ahead.
Dr. Insel. The National Institute of Mental Health is part
of the National Institute of Health, part of the Department of
Health and Human Services. And Dr. Koroshetz and I will talk
about this perspective on these disorders and the urgent needs
we have from the NIH side both for NINDS and NIMH. I think
rather than go into the details of my testimony, which you have
in front of you, I would like to just take you through pictures
that may be more helpful for you to expand on some of the
things, Chairman Kucinich, you already mentioned in your
opening statements.
So if I can have the next slide, let me talk a little bit
about what it is when we talk about this burden of illness that
people refer to. When we think about this in numerical terms,
we use something called the disability adjusted life years, an
unfortunate term, that has to do with how many years are lost
to disability. You can see from this graph, I hope, from the
World Health Organization, numbers put together in 2008, that
neuropsychiatric illnesses broadly represent almost 30 percent
of all the disability form all medical causes for non-
communicable diseases. So that ranks them well above heart
disease, cancer and many of the things that many of us often
think about as the big killers.
Part of the reason why the disability rate is so high is
that some of these actually become chronic diseases, and they
begin early, and as was already mentioned, common. So the high
prevalence also drives these kinds of numbers.
In the next slide, you'll see that if you break this down,
the next slide, please, I am sorry, we skipped one. Can we go
back one? That the actual disorders within this category
include depression, alcohol, Alzheimer's disease and many
others, with depression being really the No. 1 driver for the
sources of disability.
It is really a powerful statement that so much of medical
disability is driven by this one group of illnesses, all of
which occur quite early in life. We tend to think of these as
the chronic disorders of young people. But it is not just that
they are chronic. They are also, not only that they cause
morbidity, they also are a source or mortality.
You will see in the next slide that suicide, which 90
percent of the time involves a mental illness, accounts for
over 34,000 deaths each year in this country, which is an
extraordinary number when you put this in context. As you will
see in the next bullet, that is almost double the number of
homicides. And at this point, based on the numbers released
about a week ago from the National Safety Transportation Board,
more than the number of deaths from traffic fatalities, which
is just extraordinary.
Now, we have a whole criminal justice system to deal with
the homicides and a whole transportation safety system to deal
with traffic fatalities. One might ask, what do we have by
comparison to handle this growing issue of suicides in America.
It is not only suicides that are driving mortality, but lots of
other sources of medical illness.
You can see in the next bullet that in fact, in the United
States, the life expectancy today for someone with a serious
mental illness is about 56 years, which according to what I
looked at on Google about a week ago is about the life
expectancy today in Bangladesh. So this is not where we want to
be in 2010.
It was already mentioned before about the economic costs
involved here. In the next slide, you will have a picture of
that. Maybe this will be difficult for you to see, but the last
column over shows that, if you will hit the next bullet, that
it is about $57\1/2\ billion in health care costs that go to
mental illnesses, which is just about what we are spending each
year for cancer in the United States. What is dramatic about
that are two things: first, that is a huge increase from where
we were a decade ago, so these are really now driving upwards
relative to many other medical sources. And maybe second, even
more importantly, this barely captures the real costs,
economically. Because most of the costs of mental illnesses are
outside of the health care system.
Next bullet, you will see, the costs of lost earnings, of
welfare, next, incarceration, homelessness, school and home
care, all the places where most care or failure of care from
mental illnesses really play out. Next, so we estimate that the
actual total comes to about $1,000 per American per year that
we are spending, the way we do this now, to provide what is
obviously mediocre help to people with these very disabling and
chronic illnesses.
Next, if that is the bad news, I need to tell you that we
are not just facing huge challenges, but really unprecedented
opportunities. And I wanted to take just a couple of minutes,
if I can, to flesh those out. There are two that I will speak
of very quickly. The first has to do with the recognition in
the next bullet that these are indeed brain disorders, they are
not brain disorders in the way stroke or Alzheimer's might be,
but they are disorders of brain circuits. We have been able now
to define those with the help of genetics and with the help of
new technologies.
We also now recognize, in the next bullet, that these are
developmental disorders. I mentioned that they start early in
childhood most of the time, at a time when the brain is still
developing. But this gives us a real opportunity for thinking
about how to intervene. We will see in the next slide that we
have a whole range of technologies that have been developed
over the last 5 to 10 years that are real game-changers here.
For the first time, we can study brain circuits with the kind
of precision that we can only dream about 15 to 20 years ago.
And that has made this a tractable problem, where we should
expect to see tremendous progress over the next decade.
You will see in the next slide, and we will just run
through these very quickly, that we have already begun to
describe the circuit basis of most of the major disorders. This
is depression. Next is obsessive compulsive disorder. Next,
PTSD, one that we are going to talk much more about this
afternoon.
But in each case, we have begun to identify the major nodes
in the brain, the importance of the pre-frontal cortex, which
is really the kind of great last frontier for neuroscience. It
has begun to open up real opportunities for new therapeutics.
Let me finish up by saying that this is an enormous
challenge. I don't want to give you for a moment the sense that
we have mastered this problem. I would like to say that we know
about 2 percent of what we need to know. But we need to do this
in a way that as Congressman Kennedy said will be collaborative
and will be a joint effort.
There is an old African proverb that says if you need to go
fast, go alone, if you need to go far, go together. And we will
need to do both.
So I will show you in the next couple of slides how we are
thinking about that. In the next slide, you will see, let's go
ahead and run through this. We have a number of projects with
the VA, with a total of about nearly 100 grants across 23
States with about $41 million in investments that we are now
doing. And just keep hitting the bullets, because we don't have
time to go through much of this. But I want to make sure you
understand that this is by no means a siloed effort. We are not
balkanized any longer. There is a lot of effort going on, both
intellectually and practically, to make sure that we are
working very closely together.
And finally, in the last slide, let me just say that
probably the largest effort that we have mounted at the NIMH in
the past 18 months has been the Army Stars initiative, which we
are doing very closely with the Department of Defense. This
really responds to the increase in suicide, which you have
heard a little bit about already, the increase has gone to 160
in 2009, and 239 if you include reserve forces as well. In a
recent publication, Vice Chief of Staff Pete Corelli mentioned
that from his perspective, it appears that we may be losing
more soldiers to suicide and to high risk behaviors than we are
to combat. This has to be the highest priority.
We have now entered in with them a very large study. We
call it a Framingham-like study, because it is really looking
at the entire Army and trying to understand risk and resilience
for the forces, and providing information back as quickly as we
can to promote resilience and to reduce risk.
So if we can just put up the last slide. I want to thank
you for your leadership in this area, Mr. Chairman, and I look
forward to having a chance to discuss any of this much further
with you.
[The prepared statement of Dr. Insel follows:]
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Mr. Kucinich. Thank you very much.
Dr. Koroshetz, please.
STATEMENT OF WALTER J. KOROSHETZ, M.D.
Dr. Koroshetz. Thank you very much, Chairman. I am going to
talk a little bit maybe deeper in the weeds than Tom went. But
I think a lot of the things are very complementary. I am going
to talk about what we are doing to try to understand how the
brain works and how we are working together, actually stressing
the collaborative piece on developing treatments for brain
disorders.
Next slide. So our problem is that we have a lot of
disorders. There are, some people count 600 neurological
disorders that our institute is trying to attack. But the
message here is that we have to go one by one to get a drug.
But to make real progress, we need basic science discoveries
that are going to cut across multiple, as opposed, because one-
by-one is going to take such a long time.
Next slide. So this slide basically gets away from the
numbers and just reminds you of the real tragedy that occurs
when you lose part of your nervous system function. It really
defines what is a human being and what makes us different from
the next person. And so there is real personal tragedy behind
all of these diseases, unfortunately.
For people who are interested, I refer you to the Web site.
We actually did a very kind of in-depth, bare bones, look at
how the NINDS works, where we need to improve. We got experts
from the extramural community, different Government agencies,
industry, academia, disease organization leaders, to look at
it. We brought them in, we bared ourselves, showed them how the
Institute works. We got very good recommendations to move
forward.
And out of this, you can see the details on the Web site,
but the mission is reaffirmed, which is to reduce the burden of
neurological disorders through research. We think there are two
main pillars on which this is going to stand. Firstly, we need
to understand how the normal brain and nervous system develop.
Much of what we think happens in repair when there is a brain
injury is just beginning that developmental program all over
again. So the more we learn about how the brain develops, we
think the more we are going to know about how to effect repair
once it is injured.
We need to know what goes wrong in diseases, and then we
need to be able to translate this knowledge from basic and
clinical discoveries into better ways to prevent and treat
neurologic disorders. There are a number of other points here
which you could read more about, but I am going to hit some of
them as we go along.
Next slide, please. This point has come up already in the
chairman's statements and hopefully will come up again. It is
the fact that when push comes to shove, if you have a
neurological disease, you need a particular treatment, a
particular drug, a particular type of treatment that is going
to help you. And it has to be specific. We eventually have to
go from our basic knowledge to a very specific treatment.
If we don't do that, if we don't take advantage of our
preeminence in biological sciences to translate to really what
are commercial products at the end, the patients see no
benefit, needless to say the economy sees no benefit from the
Government's investment. And it has been said, major pharma is
now shunning neurological disorders as unacceptable, risky
investments. They have very high development costs. They have a
high failure rate when they go into the clinic. And the more
and more we know about the diseases, we get smaller and smaller
markets for them to make profits on. So we have to try and
solve this problem.
And the word that is used around NIH now is the word de-
risk. So what NIH sees is that their role currently is to try
to take basic knowledge, try and actually develop molecules
that will be treatments and bring them as far along the
pipeline as we can until the risk is so low that industry will
pick them up. That is kind of the general idea.
The big problem, well, there are a lot of problems, but one
of the big problems that we have hit is that if the sad but
true statement that if you are a mouse and have disease X,
don't worry about it, we can fix you. But if you are a human
with disease X, you had better worry, because we don't have
something.
So we have been able to do really well for the mice. The
problem is, when we go from the mouse to the human, we are
missing something. We need a bridge. And we talk about
biomarkers, and maybe this will come up later. A biomarker in
my mind is a way to bridge what we know from the animal disease
to the human disease, so that we know when we go into the
human, we hit this biomarker, it is going to give a high chance
of success. If we just go into the human and treat the brain as
a black box, then there is a lot of guesswork, a lot of things
can go wrong.
That is the idea of this bridging biomarker. So there is a
big emphasis now. You will hear about it particularly with
regard to Alzheimer's disease, and this big ADNI project that
is a public-private partnership to develop biomarkers for
Alzheimer's disease drug development.
Next slide. NINDS does not work alone. We have so many
disorders, we need everybody working together. We basically
work very closely with tremendous numbers of really innovative
neuroscientists that, most belong to the Society for
Neuroscience, the professionals in neurology, surgical,
psychiatry, emergency medicine. Many different professional
societies. And these private organizations, these organizations
that are disease related that have real motivation and
dedication and persistence to galvanize communities are
essential for us to carry out our mission and perform
tremendous, really tremendous research now.
Next slide. Now, this is a really busy slide. And this is
basically a slide of how we conceive of the pipeline going
from, on the left, the basic science R01 investigative grants,
which are the mainstream of the NIH investment, to really make
the most of the innovation in the American scientist pool, to
bring out new basic knowledge. And that is really the critical
thing that everything is based upon.
But once you have that knowledge, someone who is interested
in this other area has to go in and try to pick out from that
knowledge something that is going to be a useful treatment.
Then there are a number of steps one has to go through until
you get to the proof of principle, and the animal model, show
it working, and go into the human. So this is not rocket
science, but it is a process. It is well known to the
pharmaceutical companies and now NIH is really getting
interested in how we can move this further to the left, taking
the risk out of drug development.
What I have listed here is a number of the programs that
NINDS has in this arena. The ones in green are ones that we do
with many institutes at NIH. The ones in blue are ones that we
generally have disease organizations as our partners. And the
ones in red are the ones we usually have industry as our
partners.
And just a couple of points, just yesterday we announced
that we will be working on a public-private partnership much
like Alzheimer's disease, develop biomarkers for Parkinson's
disease drug development. We have a network that we are going
to set up that will be nimble, be able to move from disease to
disease, to test the best therapies available coming out of
neuroscience and biomarker informed trials. The NIH blueprint,
important to know about the blueprint, it is all the institutes
at NIH, they come together and they decide what they can do
together as a group. Here they put together this
neurotherapeutic grant challenge, which is trying to really
fill the pipeline with really creative agents that can help
many different neuroscience diseases, not just NINDS diseases
or NIMH diseases, any neuroscience disease.
Next slide. In terms of brain injury research, we have been
working really hard with our DOD and VA collaborators to try
and make a dent in trying to do something that will improve the
recovery of our soldiers and protect them potentially in the
future.
So NINDS is a leading funding agency and has been for
traumatic brain injury research. TBI is the leading killer of
young adults. One of the couple of things we have done recently
is we have set up, and I am the co-director of this, with Dr.
Armstrong at the Uniformed Services University across the
street, a center for TBI research. This is investigators at
Walter Reed, National Navy Medical Center, Uniformed Services
University and NIH. It is about 56 investigators working with a
fairly good budget, trying to make a dent in many different
areas of traumatic brain injury research. It is an intramural
program at NIH and USU.
We have a common data elements project that has been done
with a Federal interagency group that has members from almost
any Federal agency that works in the area of TBI. What they
have been working on most recently is standard ways of
collecting data, so that no matter who is doing the study, what
agency is funding it, they are collecting the same type of
data, so this data can be combined and mined, and the value of
the data goes up substantially.
We also are working on projects with DARPA. They have an
amazing prosthetic arm. I don't know if anybody has seen it,
but if you haven't, it is really worth it. Tremendous new
prosthetic arm for upper extremity amputees. And we are funding
projects so that soldiers will be able to control this from
brain activity.
The NIH also participates in DOD grant review. We are
working now with Uniformed Services and some of the other DOD
groups to develop an MRI scanner that will just do brains, but
can be small enough to be taken far afield into the military.
Finally, we do again have another phase three trial on
progesterone ongoing in acute TBI. We are working with a
military site to bring them into San Antonio TBI Level I trauma
center.
Next slide. I am going to end really where the beginning
is, and that is kind of in the basic science. I just want to
tell this one story. There are lots of stories like this and
the details change. But this is an example of how really basic
science that you had no idea was going to be helpful to brain
diseases, turns out that it really is.
So basically, these little pictures here are microbes. They
are not even real bacteria, that is how primitive they are. But
they have these channels in their membranes that when light is
shined upon the membrane, the channels open. And really
innovative scientists have been able to take this gene from
these microbes, put it into viruses, transfect brain cells. Now
the brain cells have these channels.
And they can go in with laser lights and with amazing
temporal and spatial accuracy, they can then shine the light,
the channels will open. Some of them will shut the cells off,
depending on what channels, some will turn the cells on. And
for the first time, with this technology, you can actually
activate circuits in the brain, as opposed to what we did
before, which was sent electricity in with a wire and nobody
knew where the electrons went. This is really specific, really
tremendous.
It has only been out a couple of years, you can see from
these papers, that there is real disease-related work that has
come from this stuff that started with microbes. So for
instance, they have been able to show that when someone has a
spinal cord injury, they lose their ability to breathe. They
can now put these channels into mice with a spinal cord injury,
activate the breathing circuits and the mice start breathing
again.
So just a great example, lots of stories like this where
the basic science, you can't tell where the advances are coming
from. But a tool that comes out of this that you didn't have
before and really allows a lot of breakthroughs.
Next slide. And that is basically what I wanted to say, it
is short but I hope it was interesting and I would be happy to
answer any questions. Thanks.
[The prepared statement of Dr. Koroshetz follows:]
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Mr. Kucinich. Thank you very much.
Dr. Kupersmith, you may proceed.
STATEMENT OF JOEL KUPERSMITH, M.D.
Dr. Kupersmith. I want to also thank the committee for
inviting us, for having this hearing. I want to thank Dr. Insel
and Dr. Koroshetz for their slide shows, which also act as a
basis for what we have to say.
VA is one of the largest medical programs in the country,
one of the largest research programs. And it includes close
academic affiliations with major universities and medical
schools.
We have over 3,400 researchers working on 2,300 projects
and supported by approximately $1.9 billion in funding from all
sources. We are widely supported by the Department of Defense
and National Institutes of Health grants, our pharmacy
coordinating center that is part of our nationwide clinical
trials program, recently won the Baldridge Award, and has
worked closely with NIH and DOD on projects.
Our collaborations with relative partners are extensive and
essential to our advancement of research.
Our cutting-edge neuroscience research has extended from
seminal studies on how memory is organized to the only
evidence-based treatment for PTSD to Nobel Prize work on
neuropeptides to a variety of genomic advances. I will
highlight some of our findings and some of our research on
PTSD, traumatic brain injury, spinal cord injuries and our work
on the DEKA DARPA arm that was just mentioned.
We are a leader in PTSD research, currently supporting over
10 studies and spearheading the national dissemination of two
evidence-based psychotherapies that we have proven to be most
effective for PTSD, cognitive processing therapy and prolonged
exposure therapy. We are also undertaking three large studies
in the long-term assessment of PTSD and associated health
conditions in Vietnam veterans. We have other studies which
include genetic assessment of PTSD, genetic assessment of
resilience to PTSD, treatment for sleep-related disturbances
and strategies to engage veterans in early PTSD treatment.
Our research directly affects our PTSD guidelines and our
guidelines are developed jointly with the Department of
Defense. We have increased our research funding in traumatic
brain injury, and at the beginning of fiscal year 2010, started
three research centers dedicated to detecting and treating TBI.
These include one that is going to specialize in PTSD and TBI
and how to distinguish one in basic science, and one that is
going to deal with other aspects of TBI.
VA is at the cutting edge of methods for detecting mild TBI
through the use of biomarkers imaging and eye tracking
assessments and is investigating, as I said, the links between
TBI and PTSD and how to improve diagnosis of each.
We are also studying repetitive brain injuries combined
with aging to determine whether these injuries can lead to
neurodegenerative diseases. And there are some initial findings
in that.
We have also and have always invested substantially in
spinal cord injury research and recently started a spinal cord
injury consortium to better address the needs of veterans with
these conditions. One project involves combination therapy
using bioscaffolds to implant stem cells with growth factors to
repair and restore function. This approach, as Dr. Koroshetz
intimated, is successful in rodents so far. But we are testing
it in non-human primates. And it does hold promise to restore
spinal cord function over the long haul.
Another group of studies we are doing is on functional
electrical stimulation that applies low-level currents to
nerves of spinal cord injured patients to stimulate muscle
activity for movement of limbs, as well as for bladder
function.
Now, our work on the new generation prosthetic arm, I
think, is an example of mutual beneficial results of
collaboration. This is the arm that Dr. Koroshetz mentioned. It
was developed by DARPA. We are doing the clinical trials and
optimization of it. And we have completed studies in 22 male
and female veterans and military personnel and others.
We are testing the prototype, which has flexible socket
design and innovative control features. And one of the
important developments that has also been mentioned is that we
will add the addition of brain computer interface technology.
This is a group that is working at the Providence VA with a
number of associated medical schools funded by us and also
funded by the National Institute of Health. Right now, the DEKA
arm is controlled by sensors that are in the feet. So it can
only be used while sitting or standing, not while walking. But
with this brain computer interface, we will enable individuals
to walk and to command this prosthesis through thoughts in the
brain.
Time does not permit me to discuss other VA neuroscience
studies, but these are included in my written statement and I
am happy to answer your questions. Thank you.
[The prepared statement of Dr. Kupersmith follows:]
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Mr. Kucinich. Dr. Rauch, you may proceed.
STATEMENT OF TERRY M. RAUCH, PH.D.
Mr. Rauch. Mr. Chairman, before I give my statement, I
would like to thank Mr. Kennedy for his hard work in this area.
This old retired soldier very much appreciates your effort in
this critical area.
Mr. Chairman, members of the committee, thank you for the
opportunity to discuss Department of Defense research efforts
to advance our understanding of neurological and psychological
trauma. We greatly appreciate the committee's support of our
efforts to discover and develop diagnostic treatment and
prevention strategies to help the many brave men and women who
have been afflicted with these debilitating disorders.
Mr. Chairman, without a doubt, the devastating nature of
neurological and psychological trauma is one of the most
difficult challenges we face with respect to research and
development and translation of discoveries in clinical care.
The central nervous system allows us to interact with the world
around us. Therefore, any neurological or psychological injury
can be devastating, not only to the service member but also to
the family members as well.
Psychological trauma in many cases has proven responsive to
various therapies, but it remains a difficult challenge to
identify and effectively treat. Recovery from psychological
trauma is often complicated by co-occurring physical injury,
depression, substance abuse and the threat of suicide. Even
mild cases of neurological and psychological trauma can have
devastating effects on lives, careers and families.
The Department of Defense has developed a comprehensive
research and development program for the study of neurotrauma
and psychological health. The programs focus on basic
mechanisms of disease and applied and clinical research that
address prevention, diagnosis, treatment and rehab. This
research and development is conducted by investigators within
DOD, within the VA, within NIH and within leading academic
institutions and also in industry partners.
Psychological trauma has posed a significant threat to
service members. During Operations Iraqi Freedom, now Operation
New Dawn, and Enduring Freedom, an estimated 20 to 40 percent
of service members experienced behavioral health problems post-
deployment, most often PTSD, depression, and interpersonal
conflicts. Studies have also shown evidence of increased strain
on families.
Our highest priority in neurotrauma research is the
diagnosis of TBI, specifically mild TBI. While moderate and
severe TBI are relatively straightforward, to diagnose mild TBI
can be difficult to assess, particularly if the service member
has an injury that wasn't witnessed. Our goal in diagnostics
has been to identify the unique biological effects of TBI and
to leverage that knowledge to identify or develop more
effective, objective diagnostic tools that will determine the
presence and severity of brain injury.
To meet this challenge, we have funded research on more
than 60 different technologies over the past 4 years. These
include blood biomarkers of TBI, identifying unique electrical
paterns of the brain, indicative of injury and the severity of
that injury, and more valid and reliable neurocognitive
diagnositc tests.
With regard to treatment and rehab research on neurotrauma,
we currently sponsor more than 70 projbects investigating drug
and drug combinations, nutritional compounds with therapeutic
potential, cell and gene therapies used in regenerative
medicine, deep brain stimulation and rehab methods and devices.
We sponsor a significant amount of work to better
understand neurobiological basis of PTSD. Significant research
is underway to discover objective techniques to distinguish
between PTSD and TBI. These efforts are focused on neuroimaging
techniques, as well as biomarkers specific to PTSD and mild
TBI.
We have also invested significantly in research to identify
the most promising drugs to treat various PTSD symptoms and to
use in combination with different psychtherapies.
Last, suicide is a significant public health problem. It
has been identified as the third leading cause of death of
young people and the eleventh overall leading cause of death in
the U.S. population. Until recently, military suicide rates
have been significantly lower than general population rates.
However, in 2004, military suicide rates began to climb, and
today, exceed the age-adjusted civilian rate.
In order to better understand the factors related to
suicide, the DOD and NIH are invoolved in an ongoing
collaboration, as my colleagues described before, to conduct
the largest scale study of suicide in the military. The project
is the largest epidemiologic study of mental health,
psychological resilience, suicide risk, suicide-related
behaviors and suicide deaths in the U.S. Army.
Drug, including prescription drugs and alcohol abuse, is a
significant health problem in the military. Almost 30 percent
of the Army's suicide deaths from 2003 to 2009 and more than 45
percent of the non-fatal suicide behavior from 2005 to 2009
involved the use of drugs or alcohol. Increased prescription
use among the military has led to heightened concern with
overdoses. We have sponsored a significant amount of substance
abuse research that includes epidemiologic studies as well as
studies investigating prevention and treatment interventions.
Further epidemiologic research is needed to accurately
characterize drug use and mis-use to include risk factors and
to identify potential barriers to treatment-seeking behavior.
Mr. Chairman, the Department of Defense continues to
perform and manage exceptional medical research and development
for the population that demands and deserves the finest care
available. I am proud to be here today to represent the men and
women who conduct these programs. And I thank them for their
service. I thank you, Mr. Chairman, for the opportunity to be
with you today and I look forward to your questions.
[The prepared statement of Mr. Rauch follows:]
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Mr. Kucinich. Thank you very much, Mr. Rauch.
We have a vote on. We are going to go for another 5
minutes. What I would like to do is, in deference to Mr.
Kennedy, I am going to give him the first question here. After
he concludes with his questions, we are going to go vote. Then
we will come back here at 4 p.m., because five votes will take
up about an hour.
So Mr. Kennedy, why don't you start.
Mr. Kennedy. Thank you, Mr. Chairman.
First, I appreciate your contributions to this hearing
enormously, and the testimony submitted and the points that you
have made, and the questions that we will get into over the
course of time when we come back I think will really bring some
more illumination to all that and will be very useful.
But I want to take this opportunity in response to Dr.
Rauch's point, first thank him for his service to our country
in the military.
To hit one point home that I believe needs to get hit home
hard, and that is, there is no difference between psychological
and neurological. And if you want to know there is the highest
suicide rates now against military, they are not supposed to
have problems. But when we have a military that is talking
about their problems in terms of 30 percent of the suicides are
caused by alcohol, alcohol is caused by their combat wound.
That 30 percent isn't alcohol, that 30 percent is a result of
their combat wound.
And the last word about drug-seeking behaviors, no, self-
medicating because they got a combat wound. Physical. We have a
dual track, one, objective diagnostic tools for TBI as like a
separate track from objective diagnostic tools from what you
said, behavioral. It is not behavioral. It is physiological. Do
you want to know why there is a stigma? Because the military
refuses to talk about this as a combat wound, PTSD, physical
changes in the brain as a result of prolonged exposure to
cortisol.
We still have the leading medical experts coming up here
and testifying, in spite of the report that was just released
last week, which I would like to submit for the record, if it
is all right with the chairman.
Mr. Kucinich. Without objection.
Mr. Kennedy. I think you were right, Dr. Rauch, about it
being neurotrauma. But that doesn't apply to TBI, it applies to
PTSD and TBI. I only can't hit this point home enough, because
if we don't get to the stigma of mental illness, we are never
going to get to the science. This notion that there is a dual
track between the psychological versus the neurological, no
way, wait a second. Let me just say, psychological is
neurological. That is what we just learned on the board from
the Director of the National Institutes of Mental Health. It is
neurological. Stop calling it psychological. Stop calling it
mental health and you will have less veterans feeling
stigmatized by it, because we are the biggest stigmatizers,
with that nomenclature.
When you have, and it is a fact, more veterans killing
themselves in active service than are being killed in combat,
there should be a wake-up as to what we are doing. The last
commission report just released, no mention of the
physiological impact of the trauma of war impacting suicide.
All that we heard was psychological, behavioral, mental health.
We re-stigmatized it.
That suicide commission was an utter disaster, in my
opinion. Because all it ended up doing was laying on top to
these veterans that somehow they have something that happens to
them after war. No. This happened to them while they were
serving, it is a combat wound. It is not alcoholic, it is not
drug-seeking. It is a combat wound that ends up manifesting
itself in these symptoms that then ultimately ends up as a
suicide. And if we refer to it as alcohol-seeking behavior,
drug-seeking behavior, something else, we do injustice to the
fact that these veterans are stigmatized by their behavior
because it is a result of their neurological changes that their
service incurred on their brains.
And we can talk all day about science. But if we don't get
this issue of stigma out on the table, we are never going to
get anywhere, as far as I am concerned, Mr. Chairman. Thank you
for allowing me the time.
Mr. Kucinich. Thank you very much, Mr. Kennedy. We are
going to recess until 4 p.m., at which time I will come back
and I have questions for the panelists. Then we will go to the
next panel after that.
I appreciate your patience and we will come back, and if
the other members, Mr. Jones, Mr. Foster, if you are able to
make it back, we would be very grateful.
Thank you, Mr. Kennedy. We are recessed until 4.
[Recess.]
Mr. Kucinich. Thank you very much for your patience. We are
going to resume the hearing.
Dr. Koroshetz had to leave due to a previously scheduled
engagement, so we excused him from the panel of witnesses
during the break.
We are going to resume with questions. Mr. Jones, we will
go to you and then when all Members have had a chance to ask
questions during the first round, I will ask mine.
Mr. Jones. Mr. Chairman, thank you for holding the hearing,
and Mr. Kennedy, thank you for your leadership on this issue
regarding mental health, but also the mental health of our
soldiers and our families.
I want to very briefly, again, I talked about Camp LeJeune.
A year ago, Dr. Kernan Manion, a psychiatrist, was released
from his contract at Camp LeJeune. Because of that I asked for
an investigation. And the IG is investigating his situation,
but also from that situation, it has kind of expanded. Tom
Bagosy was a sergeant, Marine sergeant that had been overseas
twice. He was in the mental health counseling at Camp LeJeune,
it was PTSD. Three months ago, he left the clinic at Camp
LeJeune, and on McHugh Boulevard, he stopped his car and
committed suicide at 11:30 a.m.
I want to ask you experts a little bit from the
neurosciences to this point. Do you believe that the military
mental health system could be helped if there was a national
committee set up to evaluate military mental health, to make
recommendations to the Department of Defense and to the
Congress? The reason I bring this up is I have been very
impressed with you. You are professionals, you are experts into
an area that I am not.
But as a layman who has a military base in his district,
and seeing the pain and the hurt that I have seen over the last
few years, last story, and I would appreciate your answer about
what can we do to strengthen military health. Can you imagine
being able to speak at an elementary school at Camp LeJeune,
Johnson Elementary School, National Reading Day, we are home
because of the Easter break, I am reading Dr. Seuss to 12 kids
sitting on the floor. And as I take questions at the end of, I
say, you can ask me anything. The questions went, have you seen
the President, do you have a wife, do you have a dog, those
kinds of things. The last child, these are 6-year-old children,
the last child, I said, this is my last question. He looked up
at me and he said, my daddy's not dead yet. My daddy's not dead
yet. Out of the mouth of a 6-year-old child.
Now I want to come back to what would be my only question
of you. Are we at a point that the Congress needs to say to the
President, whomever he is or maybe 1 day she, we need to put
together a mental health commission of experts like yourself at
the table to help our military develop a strong mental health
program, whether we be at war or we be at peace? Does this have
any validity?
Because what I am hearing, I know the hyperbaric oxygen
treatment, we finally got it down at Camp LeJeune. They don't
have the staff yet. But it seems like we are doing everything
we can to deal with the mental health of our military,
particularly those at war. But yet, it just seems like there
are so many different aspects of it that somebody has to kind
of bring it together and have it focus.
Does it make sense to have a commission to recommend to the
military, to the Congress, to the President, of what we need to
do to make the mental health program in our military stronger
and better for the families?
Mr. Rauch. Sir, I will start off. I think we need to work
hard to leverage our existing collaborations right now that we
have. They are very strong and they are very robust, with the
VA and NIH. I have tried in my statement to focus on some
examples. In my written statement, I have more examples.
But I think from my professional point of view, as a
psychologist, I think the place to start is to work hard to
leverage the existing relationships and collaborations that we
have thus far with NIH and the VA on this issue of family
studies, specific to the military.
Mr. Kennedy. Walter, could I interject here?
Mr. Jones. Yes, sir.
Mr. Kennedy. Do we have standard data points for TBI so
that we can collaborate, so that a scientist from Rhode Island
can talk to a scientist in his district on neuroscience?
Because apparently in the second testimony that we heard, we
don't, from Dr. Koroshetz's statement there is no standard TBI
data input. So how can you talk about collaboration?
Mr. Rauch. Sir, that is a good point. Remember that when we
talk about traumatic brain injury, we are talking about a
pretty broad spectrum. So that can range from mild, in
concussion, to severe and penetrating and everything in
between. There are a lot of differences in there. So it is a
very, very broad spectrum.
I will turn it over to my colleagues, if they have a
different view of the range of TBI.
Mr. Kennedy. I think the whole purpose here, as Walter is
saying, is that we are all in it together. Civilian research
can benefit veteran research.
Mr. Rauch. Absolutely.
Mr. Kennedy. But if we don't have common data points and
there are TBIs every night of the week from car accidents, and
we can't collect anything that is useful to the veteran in
terms of recovery, response, function, how can we be saying we
are in it to win it for the vets? Tom, you have the blueprint
at the NIH for a collaboration.
Dr. Insel. Right. The blueprint has developed these
programs for collaboration. As Walter Koroshetz mentioned,
there is a real interest in what they are calling common data
elements, which the neurology institute is putting out for all
investigators to use for each of the disorders that they
support. So that I think will be an important resource.
But if I may, could I go back to your original question? I
think the perspective that you are describing is just very
different from the personal experience I have had as a civilian
representing a Government agency dealing with the leadership of
the Pentagon. I have to say this, as clearly as I can, that the
level of commitment to reducing suicide, to ensuring that
resilience is supported, and to changing culture is greater
amongst the leadership in the Pentagon than anything I have
ever seen in the civilian sector.
These people really believe that this is their highest
priority right now. They are very concerned about this issue. I
have never seen that level of concern from anyone in the
civilian sector, where in fact the suicide rate continues to
take 34,000 lives a year.
So I think, I understand your wish to be helpful. But I do
think that it underestimates what is already happening from an
administration that really wants to make a difference here and
is looking for answers quickly, and is trying out things
quickly to try to bring this rate down and to try to make life
better for soldiers in active duty.
Mr. Jones. Mr. Chairman, can I speak just very quick and I
will finish?
Mr. Kucinich. Go ahead.
Mr. Jones. I have great respect for the military. I didn't
serve, but I have great respect. But this hyperbaric oxygen
treatment that has been studied for years and years and years
by the military, that is why they put a chamber down at Camp
LeJeune, they are going to continue to study, I found out,
talked to two people the other day, one was awarded the Medal
of Honor in Vietnam for this country. He was so distraught
about his grandson who had been severely injured, TBI, that he
paid for him to go to the hyperbaric oxygen program at LSU.
I called him. He said, my son is just remarkably recovered.
He can function now. He is not on drugs. So your point, I don't
disagree with you. But this still, I am not saying it is the
only treatment. You are the scientists. I am not. But I have
talked to three different individuals, including a General
Manny down at Florida, do you know him? Yes, you are smiling,
so you do know who I am talking about. He was under the
treatment at Walter Reed for months and months and months, saw
no improvement. His wife talked to the doctor at Walter Reed
and she went to I think it was George Washington Med School.
The doctor actually gave a prescription for him to be in the
hyperbaric treatment program there.
This man has been in my office. He has been elected a State
judge. He is functioning 110 percent. But if he would have
stayed in the military, they would have kept him probably
drugged for quite a bit of his life with no real improvement.
So that is my concern. I don't fault anybody in the military. I
think they do a magnificent job. But when you talk about
working together, when you are talking about bringing people
together, I just wonder if, as Patrick was saying, is there a
formula that we can have for the military to know what is
available without having people trying to duplicate other
studies?
I just don't know, and that is the reason I wanted to sit
here today. With that, I yield back.
Mr. Kennedy. Well, Walter, you hit the nail, there isn't,
to answer your question. Because there aren't common data
points on TBI, which is the signature wound in the war, to help
us instruct on whether those are injuries that affect and
increase suicide rates. Just as of September 24th, I appreciate
Tom standing up for his compatriots who are working hard, but
Walter Reed Amy Hospital's chief of psychiatry, Colonel John
Bradley, said shoddy training and coordination has left us a
failure on taking on suicides in the military. From his own
words.
So I appreciate your standing up for him. But when don't
have the lead expert on mental health and suicides different
psychological from neurological, after your testimony saying it
is all neurological, you have a big problem here.
Mr. Kucinich. I am going to ask the gentleman to hold some
of that for the next round of questions. I have some questions,
then we are going to have one more round, which the gentleman
may lead off again.
Dr. Insel, I want to talk to you about the nature of
stress. Stress produces chemicals which affect the brain, isn't
that right?
Dr. Insel. Correct.
Mr. Kucinich. Can an abundance of stress in certain
individuals bring about organic brain changes?
Dr. Insel. We know that some of the stress hormones alter
the way in which cells are born and cells die within the brain.
So there is every reason to think that stress does have direct
effects on the health of the brain. You will be able to hear a
lot more about this from Dr. Akil, who is in the next panel,
who is really one of the world's experts on this.
Mr. Kucinich. Is there an area of the brain where frequent
stress breaks down inhibition toward suicide?
Dr. Insel. A lot of the research is focused on the effect
of stress on an area called the hippocampus, which is certainly
very important for higher cortical function, for memory, for
the way in which memories get encoded in the brain. But the
relationship of stress to brain anatomy or brain morphology and
suicide remains now a very vague one. There are a lot of gaps
in our understanding of how these things connect.
Mr. Kucinich. I ask this question because, if it is not
site-specific, then the work of someone like Karl Pribram, his
holonomic theory, comes into play. I am sure you are familiar
with his theories.
Dr. Insel. The places where stress is likely to have the
greatest impact is where the receptors for hormones like
cortisol, are found in the brain. And they are not everywhere.
There are areas that are highly enriched. Those are places that
we look, and in fact, those are the places where we see
changes.
But again, there is a gap here between our understanding of
the cellular effects of stress and our understanding of what
causes suicide. It is a very complicated area when you try to
predict, for instance, who is likely to take their own life. We
know some of the factors from a population, but within an
individual person, we are not very good yet at being able to
have high levels of prediction.
Mr. Kucinich. I heard you in response to an observation by
my friend from North Carolina indicate work that is being done
in the Department of Defense on matters relating to suicide.
You did say that, correct?
Dr. Insel. This is a joint project between NIMH and DOD.
Mr. Kucinich. What is ironic about that, if I may, is that
the stressor in this case is war. There is a ``duh'' factor
about this. The latest book about President Obama and the
Afghanistan war indicates the tension between the
administration and the Pentagon, and the difficulty that the
administration was having in having the Pentagon produce a plan
to exit the war.
I think that my friend from North Carolina would agree, you
can study the nature of suicide all you want. But if you have
increased suicide that is coming from people who are in combat
under horrendous conditions where there are all kinds of
atrocities being committed, how smart do you have to be to
figure this out?
So I appreciate that you are studying it. But it would be
more productive, I think, if a group of scientists would come
forward and have the opportunity to do some real tests on how
stress breaks down people and how it puts them in that soft
circumference of suicidal ideation, which then may lead to
people acting and taking their own life. So you can't really
speak to that, because that is not your area of decisionmaking.
But no matter how caring the people in the Pentagon are
about the troops, as long as you are sending people into this
mix-master of war, you are going to end up with suicides.
Again, I don't think you have to be a neurophysiologist to
understand this. I don't think you have to be a cognitive
psychologist or cognitive neuroscientist to understand this. We
put these young people into an impossible situation, they are
killing themselves. I don't deserve a Ph.D. for that
observation.
Now, is it true, Dr. Insel, that certain approaches to
neuroscience necessarily depend on a mechanistic view of human
beings?
Dr. Insel. I am not sure I understand your question.
Mr. Kucinich. Well, like Skinner, Skinnerian approach,
stimulus-response. Behaviorism, if you induce certain stimuli,
you get a certain effect. Are you a student of that particular
type of neuroscience?
Dr. Insel. That actually falls into a category of what
would be called behavioral science. That really has to do with
predicting behavior based on stimulus and response. One of the
things that is perhaps most conspicuous about that is that it
leaves out the brain. So neuroscientists tend to think more
about the mechanisms by which behavior gets regulated, and they
tend to be a little more complicated than just the simple----
Mr. Kucinich. Complicated. That is a good word. Tell me
about it.
Dr. Insel. The complications of how we predict behavior.
Again, I need a little help here in terms of what it is you are
looking for.
Mr. Kucinich. When you talk about neuroscience, you could
take an almost linear view. I am interested as compared with
cognitive neuroscience, which encompasses the possibilities of
quantum physics interfacing with neuroscience, where you
actually create the potential of change that cannot necessarily
be explained by the more linear progression of a more
mechanical approach. Does that not register with you at all? If
it doesn't, I will withdraw the question.
Dr. Insel. Well, I am not sure I heard the question. But if
the question is, does neuroscience provide a basis for
approaching that complexity and trying to understand that
complexity, I think the answer is yes. I think we have the
tools now, many of which come from very different fields, such
as higher math or from physics, from dealing with large amounts
of information that we are able to actually begin to make sense
of the complexity of how the brain works with models that
become predictive.
We have a long way to go, but I would say that we have come
a very long way from a simple Skinnerian model of stimulus and
response.
Mr. Kucinich. That is good to hear. Every component of the
philosophy of science carries with it part of the headlong
momentum of some of the early thinking within those
disciplines. So I just wondered where a Skinnerian view fits
in.
Dr. Insel. In the testimony that I gave, Mr. Chairman, I
used the term disruptive innovations. From my perspective, this
last decade has been a series of truly disruptive innovations,
as we have begun to understand, to go back to Congressman
Kennedy's point, that the brain really is the gateway to
understanding the mind. I don't believe that we had fully
appreciated that in previous decades.
Mr. Kucinich. I want to conclude by saying that, it may
have been in, I don't think it was in your testimony, but maybe
your colleague who just had to leave, spoke of the light
shining on microbial membranes that opened up new channels. Is
that what you are talking about?
Dr. Insel. That is a technique that has been used to be
able to study circuitry in the brain in a very precise way.
Mr. Kucinich. I think you understand the comparison I am
making, and that is that if you use light as a metaphor here,
shining itself on certain membranes, opening up new channels,
it is a metaphor for the possibilities of neuroscience to go
into areas which would make the work that you are working out
right now seem primitive in years to come, with all due
respect. I am a fan of neuroscience's capabilities. So I
appreciate your presence here.
Dr. Insel. Thank you. If I may, just as a final comment
about this, I think it needs to be said, we are in the middle
of a revolution. In 20 to 30 years we will look back on this
period to realize how little we knew. But the tools are there
to transform the way we think about the brain. As someone said
in the opening comments, this is really the last great frontier
of science. For the first time, I think we have the discovery
tools that we have needed to really explore and to colonize
that frontier in a different way.
Mr. Kucinich. Just one other question occurs to me. I don't
know if you are able to answer this. But the phenomenon of
fear, the emotion of fear. I have seen some studies that
suggest that it originates in the limbic system, is that right?
Dr. Insel. We use the term mediated.
Mr. Kucinich. Mediated by the limbic system.
Dr. Insel. Yes.
Mr. Kucinich. And is that really, on an evolutionary
standpoint, part of what some might call part of the reptilian
brain, the flight or fight syndrome?
Dr. Insel. Sir, those are models that we have kind of given
up a few years ago.
Mr. Kucinich. Well, I am talking about the archaeology of
your discipline.
Dr. Insel. The core, ancient part of the brain which feeds
into those kinds of flight or fight impulses.
Mr. Kucinich. Since you work with, since people in the
neuroscience discipline work with the Department of Defense, is
anyone doing any studies about the potential of transformation
beyond fear, which often puts people into this fight or flight,
which is a precursor for, inevitably, on a macrocosmic level,
the precursor of war? Does anybody ever think about that?
Dr. Insel. I am not sure that we are where you are on this
idea. There is a tremendous amount of research right now on the
fundamental neurobiology of fear and fear responses. And
particularly what we call extinction, the ability to overcome
fear.
But the relationship of that to war is a place where I
think most neuroscientists haven't gone.
Mr. Kucinich. Thank you.
Mr. Kennedy, second round.
Mr. Kennedy. Thank you.
I think the most significant issue is how to do the
research, so we make the most of what we know. It is not what
we know, it is how much we don't know that we know. And that
gets back to the common data points for TBI. But we can't do
the data mining or find out what is working or what isn't, if
there isn't common language and nomenclature.
You have a blueprint at NIMH. Does that blueprint include
DOD and VA? And if not, why not? And to Dr. Kupersmith, do you
have, along with the DOD and Terry, the ability to have a
common program, computer program to input these data points or
not?
Dr. Insel. Just very quickly, we do have a blueprint, which
is a consortium of I think 15 institutes and centers at NIH for
some common projects. It is a fairly limited effort, it is
identifying areas of common need and pushing ahead on a few of
those. It does not involve DOD, VA or many of the other
institutes at NIH, even. So it is truly a kind of homegrown
project.
It has not in any way inhibited many of the institutes, my
own included, NIMH, from these very large collaborations. As I
said, the biggest project we are doing is the collaboration
with DOD. And it has really become our signature project for
2010, and probably will be for the next few years. So the
blueprint is not part of that. But it almost doesn't need to
be. We have a lot going on just out of the institute itself.
Mr. Kennedy. We don't have a program that allows for all
this data to be put in so the scientists in one area of the
country can find out what the scientists in the other areas of
the country are doing, so we can work to greater effect, to
everybody's advantage. We don't have that.
Dr. Insel. We don't have a single data repository at this
point for, other than for autism. I don't think that exists for
any other area that our institute is working in.
Mr. Kennedy. Would it be useful to everybody? I know you
have these collaborations and it is helpful. But could we
dedicate funding that would leverage what the institutes do by
giving a little money to help bring them and their work
together, to help and maximize each other in a coordinated way?
Dr. Insel. We have done that in autism, and I think it has
been transformative. We have an opportunity now for virtually
every project to flow into the same data base called the
National Data Base for Autism Research. That is a model that
could be followed in a number of areas.
Mr. Kennedy. That is terrific. Dr. Kupersmith.
Dr. Kupersmith. Our computers have not merged yet with DOD,
but there is a tremendous amount of work on that. And that is a
goal, certainly, of this administration. Our computer system
evolved out of a clinical computer system sort of from the
ground up with investigators creating software, merging into a
large system. So that is clearly a goal of this administration,
it is not a research topic, per se. Although research will
benefit greatly from it. We are looking forward to being able
to do that.
Mr. Kennedy. Because if we don't know what we know, we are
just doomed to repeat the science.
Dr. Kupersmith. Absolutely. And I think that quotes Albert
Einstein, actually.
Mr. Kennedy. Well, I am often confused for him in my
intellectual passion for things. [Laughter.]
Dr. Kupersmith. There is very hard work, as many know, that
is going on, very important.
Mr. Kennedy. Thank you. And Terry, what would you say, Dr.
Rauch, about the need to get DOD to help open what Tom has in
his NIH and the VA, make it all, so everybody is helping to a
common effort, both soldiers benefiting, and civilians
benefiting from the soldier and vice versa.
Mr. Rauch. You make a very good point, sir. We are working
on it. We have a collaborative effort with VA, NIH, DOD,
Department of Education. It is called the Common Data Elements
project. And its purpose is to do exactly what you charged us
to do, and that is to standardize terminology within TBI and
the psych health portfolio. It is in development, it is in
progress. But it has started.
I think I probably need to take this for the record and
give you some more information. Your question really deserves a
more detailed answer, and I would like to provide more detail
on the Common Data Elements project for TBI and psych health.
Mr. Kennedy. Super. Thank you. That is what the hearing is
about: what can we do in Congress to help leverage what you are
already doing and what the science shows us out there already.
Mr. Kucinich. Congressman Kennedy, there is a person by the
name of George Farre who was a physicist and is a philosopher.
And he spoke to science as a structure-specific language,
constructed for the representation of what there is. So
semantics do count. Because they link through their expression
to specific structures that help either to confirm pre-existing
notions of a science or dis-confirm them.
So the point that you raised about the nomenclature is not
a small matter. It is actually quite significant, not just for
the subject of a particular type of behavior, but there are
implications, broader social implications.
Mr. Kennedy. I just want to repeat, Tom, what you said, to
go fast, go alone, but to go far, you go together. But we need
to go far together, but we need to go faster. If you can
provide us some recommendations from your point of view as to
what FDA can do, since they are integral in whatever comes up,
your researchers, together if we can it right into the field
for our soldier and our veteran. That would be very useful, if
you can give us some ideas on regulatory science. Again, this
is a process issue, as you have just said, Dr. Kupersmith. It
doesn't involve the science, but the science can't be maximized
unless you get the process right.
So if you could provide us some input on that, as you have
already in your testimony, it helps us make a better case
politically, that if we just put some dollars here, we leverage
a whole bunch. If we work as a team, we get further. And your
blueprint is a perfect, how do we institutionalize that more,
get the common data sets and standardized terminology together.
So that would be useful.
Mr. Kucinich. Thank you, Congressman Kennedy. I just have a
couple brief questions and we will go to our next panel. One of
you gentleman brought up nutrition, was it you, Mr. Rauch? In
what context did you bring that up?
Mr. Rauch. I brought that up in the context of nutritional
interventions in the whole psych health/TBI/PTSD portfolio, to
include looking at nutriceuticals. That is an area in which we
have a number of projects that we are funding.
Mr. Kucinich. John Robbins, the author, has written
extensively about the impact, adverse impact on human health of
certain types of foods. There has been plenty of research about
the adverse impact on physical and mental states in consuming
large amounts of sugar. We know it is true of large amounts of
salt. There have been studies done on prison populations whose
diets have changed and it has, a change in diet produced
changes in their emotional states, made them actually less
aggressive.
I think that the potential for neuroscience making a great
contribution is there, there is no question about it. It is
really urgent that we use whatever means we have available to
help fulfill its potential.
So I want to thank the members of the first panel for your
commitment in your respective disciplines, for your thoughtful
testimony and question answering that you provided. This is an
area which Congressman Kennedy, I think that in the next
Congress, we ought to think about doing some followup hearings.
We ought to think about----
Mr. Kennedy. I will be sitting back there, Mr. Chairman,
looking up at you.
Mr. Kucinich. You will always be welcomed. I think what you
have done is you have, through your becoming involved in this,
we have become aware there are examples of research
collaboration between and among Federal agencies. What you have
done is to remind the people in the community that it is
important to collaborate with each other. Whether it is done on
ad hoc process or on a regular basis, I think that it is and
can be productive because of the synergy that always comes from
interdisciplinary thinking.
So I would urge that an approach of interdisciplinary
thinking to continue through encouraging all the parties to
this to keep talking, if they are, and to start talking
together if they are not. I think it is a good idea to work
collaboratively with your friends in Congress who will advocate
on your behalf in the appropriate venues.
Thank you for being here, and good luck with your work, and
we are going to call the second panel.
While the second panel is getting into place, I want to
thank them and the members of the audience for your patience.
Because of the congressional voting schedule, we have had kind
of a prolonged hearing here. Your willingness to come here to
offer testimony and answer questions is much appreciated.
I am going to introduce our second panel. Dr. Huda Akil,
Ph.D., is the Gardner Quarton distinguished University
professor of neuroscience and psychiatry and the co-director of
the molecular and behavioral neuroscience institute at the
University of Michigan. Dr. Akil has made seminal contributions
to the understanding of brain biology, of emotions, including
pain, anxiety, depression and substance abuse. Dr. Akil has
received several awards for her research and is past president
of the Society for Neuroscience. Thank you, Dr. Akil, for your
presence.
William Z. Potter, M.D., and Ph.D., spent 25 years at the
National Institutes of Health focused on translational
neuroscience. While at the NIH, Dr. Potter developed a wide
reputation as an expert in psychopharmacological sciences and
championed the development of novel treatments for CNS
disorders. In 2004, Dr. Potter joined Merck Research Labs as VP
of Clinical Neuroscience and assumed the newly created position
of VP of Transactional Neuroscience in 2006, a position from
which he retired in January of this year. Thank you very much,
Doctor.
Timothy Coetzee, Ph.D., is the executive director of Fast
Forward, LLC, the National Multiple Sclerosis Society's drug
discovery and development affiliate. In this capacity, Dr.
Coetzee is responsible for the Society's strategic funding of
early stage biotechnology and pharmaceutical companies engaged
in the discovery and development of new treatments and
diagnostic tools for multiple sclerosis. Thank you, sir.
Kevin Kit Parker, Ph.D., is the Thomas D. Cabot associate
professor of applied sciences and associate professor of
biomedical engineering at the School of Engineering and Applied
Sciences at Harvard. Professor Parker is the director of the
Disease Biophysics Group and a member of the Systems Biology
Department at Harvard Medical School, Harvard Stem Cell
Institute and the Harvard-MIT Health Sciences and Technology
program.
He is also a major in the Rhode Island Army National Guard
and has completed two combat tours in Afghanistan with the 82nd
Airborne and the 10th Mountain Division. Thank you for being
here, sir.
John H. Morrison, Ph.D., is the dean of basic sciences and
the Graduate School of Biological Sciences at Mount Sinai
School of Medicine. Before becoming Dean, he served as the
Chair of neuroscience. Dr. Morrison is also professor of
neuroscience and the Willard T.C. Johnson professor of
geriatrics and adult development in neurobiology of aging.
Thank you.
This is a distinguished panel, as was the last one. It is
our policy in this Committee on Government Oversight and Reform
to swear in all witnesses before they testify. I would ask that
the witnesses stand, raise your right hands.
[Witnesses sworn.]
Mr. Kucinich. Thank you. Let the record reflect that each
of the witnesses has answered in the affirmative.
As with the members of the first panel, I would ask you to
try to keep your remarks to 5 minutes. And as with the members
of the first panel, I let them go on, because they had some
things to say that were very important.
Mr. Kennedy. In that regard, Mr. Chairman, I just want to
thank everybody who showed up today. All of you represent
different organizations, groups and have been very useful in
helping put this hearing together. I want to thank Zach Lynch
from the Neurotechnology Organization who has been very useful
in helping put together some very helpful statistics and points
for us in the hearing, and just say, we wish we could get
everybody up here. Because everybody in this audience, from
looking out on this audience, I am familiar with in this field.
But just appreciate that we understand and have incorporated a
lot of your recommendations and suggestions into the hearing.
And thank everybody for being here today.
Mr. Kucinich. Thank you.
Dr. Akil, you may begin. Thank you.
STATEMENTS OF HUDA AKIL, PH.D., CO-DIRECTOR AND RESEARCH
PROFESSOR, THE MOLECULAR & BEHAVIORAL NEUROSCIENCE INSTITUTE,
UNIVERSITY OF MICHIGAN; WILLIAM Z. POTTER, M.D., PH.D., FORMER
VICE PRESIDENT OF TRANSACTIONAL NEUROSCIENCE, MERCK RESEARCH
LABORATORIES; TIM COETZEE, PH.D., EXECUTIVE DIRECTOR, FAST
FORWARD, LLC; KEVIN KIT PARKER, PH.D., ASSOCIATE PROFESSOR OF
APPLIED SCIENCE AND BIOMEDICAL ENGINEERING, HARVARD UNIVERSITY;
AND JOHN MORRISON, PH.D., DEAN, BASIC SCIENCES AND THE GRADUATE
SCHOOL OF BIOLOGICAL SCIENCES, MOUNT SINAI MEDICAL CENTER
STATEMENT OF HUDA AKIL, PH.D.
Ms. Akil. Mr. Chairman, Mr. Kennedy, members of the
committee, thank you for this opportunity to testify here
today.
I wanted to mention that beyond my service as the past
president of the Society for Neuroscience, I am a member of the
Council of the Institute of Medicine and its forum on
neuroscience. I am also a co-chair of the steering committee of
the Biomarkers Consortium at the Foundation for NIH.
I currently hold funding from the NIH, the Office of Naval
Research and the Pritzker Foundation to conduct work on the
biology of stress, emotions, addiction and mood disorder. As an
aside, given the discussion in the earlier period, we are
studying in the Consortium the brains of people who were
depressed and committed suicide versus the brains of people who
did not and whether they were being treated or not. We are
beginning to get some insights to your question about where in
the brain the changes might happen. That is not the focus of my
testimony today, but I am happy to answer questions about it.
So as we have heard, the global burden of brain disease is
staggering. The challenge of understanding, preventing and
curing brain disorders is still very much before us. Today,
what I wanted to do is outline what I believe to be the central
grand challenge of neuroscience, one that is relevant to all
the brain disorders that we have been talking about. I would
like to suggest a couple of strategies for meeting it.
Our brain contains 100 billion cells that communicate via
500 trillion connections or synapses. The point of all this
communication is to orchestrate brain activity. Each brain cell
is a breathtaking piece of biological machinery. But a single
cell can never perceive beauty or feel sadness or solve a
mathematical problem. Through the magic of integration,
completely new capabilities emerge. When networks of brain
cells come together to form brain circuits, each of which
perform specific functions, such as vision, hunger, cognition,
emotions.
I call this neural choreography. By the time a brain
disorder is evident, it has affected not a single group of
cells, but the entire circuit. It is the disruption of the
whole network that leads to the symptoms of the illnesses that
we are concerned about. The problem is not that a ballerina has
stumbled, but that the choreography of the whole ensemble has
fallen apart.
So when we are thinking about the impact of brain injury on
movement, the exaggerated response to a threat signal in a
soldier with PTSD, the drug compulsion in an addict, the
confusion about reality in a psychotic patient, we have to
think about disrupted brain circuits, neural choreography gone
awry.
And our grand challenge is to understand the workings of a
brain circuit and learn how it controls itself. As Dr. Insel
has indicated, we know the elements of many of these circuits.
But we need to watch them perform in real life, in real time,
and discover how their choreography fails and how that causes
disease.
The idea that brain disorders are the result of faulty
brain circuits also explains why it has been so hard to uncover
genetic causes of some disorders that we know to be very
heritable, like bipolar illness. It is because the symptoms
that clinicians diagnose are manifestations of a disrupted
brain circuit and there are countless ways to screw that up. So
different families can suffer from completely different genetic
problems and still share the same medical diagnosis. It is like
any given dancer in the troop can fail and disrupt the whole
dance.
But the choreography idea also means that there are
multiple ways to repair the problem. We don't need to devise a
new treatment for each family. We need to learn how to retune
the circuits, the networks.
So how do we take on the neural choreography challenge? My
inspiration for tackling it comes from the brain itself, the
creation of well-orchestrated networks of scientists who work
together to achieve what can never be achieved separately. This
effort needs to be grounded in some hard-earned realities. In
the words of President Kennedy, we need to be idealists without
illusions. Understanding the brain and mind is hard. And we
need help, not only from each other, but from our colleagues in
math, physics, chemistry and engineering. We also need to
engage our friends in the social sciences, since our brains are
constantly being remodeled by our social environment.
But the knowledge that can emerge from such networks can be
transformative, and the discoveries unimaginable. I have
suggested in my written testimony three types of integration:
horizontal integration, where a large number of investigators
with the same general expertise focus on a given slice of a
problem, for example, validating biomarkers over disrupted
brain circuits, say in PTSD. Vertical integration among
different scientists who are focusing on a scientific question
or disorder and trying to solve it from molecule to mind and
back. Neural choreography is right in the middle of that path.
And finally, two-dimensional integration that represents
special large-scale projects that combine vertical and
horizontal efforts. The goal would be to advance our
fundamental knowledge of neural circuitry and relate the
discoveries not to one disease but to several disorders.
But whatever the model, rather than being entirely
investigator-driven or agency-driven, I believe that this
process needs to arise from a partnership between the
scientific community and the Federal agencies, to get buy-in
and to define the specific approaches that would be most
fruitful.
So in summary, understanding the brain and healing it when
it is sick may well be the most difficult challenge that
humanity has ever undertaken. We need to give this amazing
organ its due by bringing together every tool we have at our
disposal and working together to probe its mysteries. Thank
you.
[The prepared statement of Ms. Akil follows:]
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Mr. Kucinich. Thank you.
Dr. Potter.
STATEMENT OF WILLIAM Z. POTTER, PH.D.
Dr. Potter. Mr. Chairman, Mr. Kennedy and members of the
committee, I am speaking from the perspective of a retired
officer in the Public Health Service and a practicing
psychiatrist. I served in intramural programs of the National
Institute of Mental Health for 25 years, and I have just
retired from the pharmaceutical industry, where for the last 15
years, I worked with a couple of big companies, Eli Lilly and
Merck, which had big investments in CNS drugs.
Despite the sensational advances in neuroscience during
this period, and the explosion of sophisticated technologies
you have been hearing about, we have not delivered truly novel
drugs for diseases of the brain. Arguably, the current
generation of psychiatric medications for treating
schizophrenia, depression and severe anxiety are no more
effective than the first generation of medications discovered
over 50 years ago, and those by accident.
The assumption back in the 1980's at all levels of
Government and industry was that scientific explosion would
rapidly lead to more scientific treatments. But that was overly
optimistic. If anything, the opposite has been the case. It has
become much more difficult to develop the novel targets that
were identified, and to bring a single new entity to market now
costs on average $1.8 billion, which is actually a pretty
conservative estimate of the real costs.
The new drugs, and this is for all drugs, new drugs for
brain diseases emerge at even a lower rate and prove more
expensive to develop and carry extremely high risks.
So what went wrong with our predictions from the 1980's?
And as Dr. Insel has pointed out, we have a new revolution to
incorporate into our future thinking.
So what went wrong was the assumptions were too simple, as
Dr. Akil has currently addressed. So the complexity at both the
genetic and physiological level was much greater than we ever
anticipated, and we did not have the maps or navigational tools
to go through all this data and pick out the right targets.
So what we are up against is this wall of what we call
target validation, what are the right things to make drugs for.
Instead of a few drug targets, we have hundreds now that we
need to sort through. And it requires us to sort through a
single one that we think might be valid, which takes us over 13
to 14 years and get it through regulatory review and to the
market, if you are in the business of the industry. For the
central nervous system area, at best, 1 in 20 of the things we
that into this expensive and long development actually deliver.
So obviously, with that sort of numbers, it is not possible
for the pharmaceutical industry to survive by investing in the
CNS field, without a huge paradigm shift. Given long
development times under the current laws, most drugs will have
10 years or less of patent protection by the time you have been
through this. And ironically, the ``me-too'' drugs, which are
easier to develop, are actually the ones that enjoy the longer
patent protection. So the incentive structure actually rewards
coming up with ``me-too'' drugs, and says, don't waste your
money on coming up with novel, better drugs. But this is
basically why many companies have reduced their investment.
So in one area we have an exception, fortunately, and that
is around the field of Alzheimer's. And there, both the NIH,
clinical scientists, patient advocacy groups, philanthropies,
FDA and industry joined together under this remarkable effort
sponsored by the National Institute of Aging called the
Alzheimer's Disease Neuroimaging Initiative.
In keeping with some of what Mr. Kennedy has already
discussed, the findings become available on computer, available
all in the public domain, as soon as the data is gathered and
processed. This ADNI model has taken hold worldwide and is
currently trying to be implemented in the European Union,
Japan, Australia and Korea. Fundamentally, their governments
have said, this area of translational medicine and the tools
and the data sharing necessary to support it are national
priorities.
We use this term translational medicine to cover all the
science and technology to help us translate the basic science
that Dr. Akil was talking about into something that might be
useful for patients. But to realize the promise of these
scientific advances, we have to invest a great deal more in the
tools of translational medicine, an area which sort of falls in
the middle and gets less support than the basic science at one
end, or the large clinical trials of the drug companies at
others.
So the right balance of resources across the domains of
basic research, translational medicine, clinical trials, has
yet to be achieved. We need to expand this open source model,
which Mr. Kennedy has already been referring to. So the first
major recommendation of what can we do better is get more open
sharing of all relevant clinical data on the characterization
of the disease state and drug response. Obviously you need to
protect individual privacy.
And the second big push would be to put the research tools
and compounds held by both commercial entities and universities
and private and funded investigators into the public domain,
into what we call pre-competitive space, get that out there as
quickly as possible. And to make that possible, we probably do
need innovative approaches to the intellectual property issues
which currently impede this sharing of technology and data.
I will stop there, but I can go into much greater detail of
how this might work.
[The prepared statement of Dr. Potter follows:]
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Mr. Kucinich. Your entire statement will be in the record,
Dr. Potter.
Dr. Potter. I would like to mention one thing. We do have
an initiative, which Dr. Akil has already referred to, the
Foundation of the National Institutes of Health, where we are
beginning to try to bring us all together to work in this pre-
competitive manner. I want to emphasize that the funding and
infrastructure and degree of support to really do it at a
proper national scale is simply not great enough.
Mr. Kucinich. Thank you.
Dr. Coetzee.
STATEMENT OF TIM COETZEE, PH.D.
Mr. Coetzee. Thank you, Mr. Chairman and Mr. Kennedy, for
inviting us to speak here. I am honored to be here with these
distinguished panelists.
My name is Timothy Coetzee. I am the President of Fast
Forward, the venture philanthropy arm of the National Multiple
Sclerosis Society.
I am here today on behalf of the estimated 400,000
Americans and the many thousands of veterans who live with MS
every day. Together, we ask you to help us advance MS research
and really neurological research across the board for all of
our colleagues who are affected by neurological disease. We
need your help in providing resources and policies to expand
collaboration and networks between Government, patient
advocates, private foundations and the pharmaceutical and
biotechnology industries, and of course, academic
investigators.
While my remarks focus on MS, really they can be applied
across the board. Multiple sclerosis is a chronic,
unpredictable, often disabling disease of the central nervous
system. It interrupts the flow of information from the brain to
the body and stops people from moving.
MS is the most common neurological disease leading to
disability in young adults. But despite many decades of
research, its cause remains unclear and there is indeed no
cure. While we are grateful for the availability of a number of
FDA approved disease modifying therapies, we still need more
and better cost-effective therapies. Finding these new
therapies hinges on the research and the kinds of collaborative
efforts that we are talking about today amongst all the
stakeholders.
It has been our experience that research discoveries can
happen in a lot of different ways, as you have heard today.
Some require lots of careful years of shepherding, while a lot
can happen overnight. Whether it is a molecule or a tool, they
all need a number of steps to be taken in order to translate
those discoveries into actual applications that can be used in
people with MS, as well as other neurological diseases. This
involves collaborators, commercial development, access to
clinical trial participants and a lot of money.
We were created as an organization by the National MS
Society specifically to drive commercial development for MS
therapies. We have made a commitment to ensure that potential
new therapies actually make it into the clinic and are
developed and are able to be used for people with all forms of
MS.
We have found that all too often, promising drug treatments
languish because companies lack the funding, focus to conduct
pivotal research that will break through barriers and move a
compound through the development pipeline and ultimately into
clinical trials. We fill the gap that is often called the
valley of death by creating a collaborative environment between
scientists, clinicians, academic researchers and of course,
commercial visionaries. By creating these vital networks, Fast
Forward increases the focus on MS and speeds the process of
bringing drugs to market.
Today we join with our patient advocacy colleagues in
calling for more investments and policies to sustain innovation
in neuroscience research and development. In our view,
expanding and sustaining innovation in neuroscience R&D really
requires three critical elements. As you have heard today, we
need to sustain a large and vibrant medical research community
in the United States. Medical innovation doesn't happen in
isolation, it happens amongst a community of scientists and
physicians actively involved in understanding knowledge and
disease about biology and human disease. It is vital that we
continue to expand our commitment to the National Institutes of
Health and work also funded through the Department of Defense
and the Veterans Administration.
Second, we also believe that we have to create an
environment conducive to the formation of what we call fluid
networks of scientists engaged in translational research. We
know that research and innovation happens faster when
scientists work together across networks, fields, institutions,
and borders, for that matter. Coordination by the Government
agencies, private foundations and patient advocates is critical
to ensuring these networks.
And last, we believe that Government, foundations and
patient advocates have to use their influence and financial
resources to connect people together across sectors. We know
from our own experience that young companies and innovators
work smarter and faster when you have experts in the private
sector working with experts in the academic sector. We need to
do more of this, so that all the stakeholders can enhance
neuroscience R&D.
In conclusion, Mr. Chairman, the United States has a long
history of being a leader and driver of neuroscience research
and development. Unfortunately, we do find ourselves in the
environment where economic challenges are beginning to threaten
this leadership. As patient advocates, we urge action to ensure
that there is greater coordination amongst the stakeholders.
Every day, Americans receive the diagnosis that they have a
neurological disease. These individuals do not have the luxury
of time. They need our help to create a research and
development environment where they can have access to the best
treatments to stop their disease and restore lost function.
Thank you for helping us move closer to that world and thank
you for your time.
[The prepared statement of Mr. Coetzee follows:]
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Mr. Kucinich. Thank you very much.
Dr. Parker.
STATEMENT OF KEVIN KIT PARKER, PH.D.
Mr. Parker. Chairman Kucinich, Congressman Kennedy, thanks
a lot for inviting me here.
I am going to tell you the story of TBI through a rather
uncommon lens, because I am a soldier and a scientist. I am
going to start last year, last March in the Tangi Valley in
Afghanistan. You will see it up there. We ran a patrol and the
lead vehicle, we had been fighting since off and on since about
8 a.m., we hit an IED. We flipped over the MRAP and there you
see us running up to check the soldiers.
About 30 seconds after this photograph was taken, an RPG
hit that cliff right above our heads, when we were trying to
pull the wounded soldiers out of there. And then the day got a
lot worse.
That just kind of illustrates the situation you were
talking about, combat stress. There is a lot to that, and we
could talk more about that later. But this kind of illustrates
what is happening out there in the battlefield. This is the
ignition event for TBI, and it is the ignition event for those
neurodegenerative diseases that can result on down the road.
So if you will move to the next slide, please. I want to
just teach you a little bit about TBI, and I can only teach you
a little bit, because I am not a neuroscientist. I was doing
the heart when someone started to kill my friends with IEDs,
and I figured I had better get a piece of this fight.
So if you take a look, you imagine that the whole patient,
the soldier, the behavior, those functional behaviors that can
arise from neurodegenerative diseases, that is a meter link
scale. What happens when that IED goes off? The brain, listed
up there at the top of that scale gets slammed forward into
that skull because that shock wave couples into the body. And
it starts a cascade of injuries that goes from the centimeter
scale of this brain through the neural networks that allow you
to recognize a friend, speak to a loved one, count your change
at the Burger King. It disrupts the neurons, breaks the
synapses, all the way down to the nanometer scale at the
bottom, where you see endocrine bonding, cellular matrix, this
is where mechanical forces get transduced into physiological
signals called mechanical transduction pathways. In this case,
it is a pathophysiological signal, because we are activitating
signal pathways that we don't necessarily want to activate.
This is the temporal scale of TBI. I am going to look
mostly on this time line to the right of the blast, what we
call right of the boom. You can assume that prior to the blast,
we assume we get stable neural structures, stable vascular
structures and a stable gene expression. There is a big
asterisk next to that, because these guys are in combat, they
are facing physical danger, moral jeopardy. There is a lot of
stress hormones there. We don't know exactly how they might be
impacting all those structures.
Once that boom happens, things start happening on a
nanometer scale. Proteins undergo conformational changes that
turn on those signaling pathways that cause excitotoxicity that
cause these neurons to have their membranes torn, to activate
signaling pathways in mild cases of TBI that you might not see
for some time. You can't diagnose them currently.
If you follow that time line going all the way across to
the right, spanning out through the rest of the epidemiological
life span of that soldier, you are going to see a variety of
problems emerge. They might not emerge right away, but
eventually they might. And when they do emerge, every time they
emerge, if it is 20, 30 years on down the road, that is one
more victory for the opponents that we are facing on the
battlefield. When they take another soldier down with
Parkinson's disease or Alzheimer's or dementia on down the
road, they are still winning that fight.
We talk about counterinsurgency as a long war. Taking care
of these casualties is the longer war. What we need to do is
develop a cohesive plan to address this longer war. It is
interagency, just like we have on the battlefield right now.
But interagency, just like you heard from the first panel, is
the only way we are going to solve this problem.
I want to make a couple of recommendations before I close
here. When you start taking a look at putting people onto this
problem, I think as an outsider coming in, there is a need to
evangelize the scientific community about TBI. We talk about
job retraining for people that have been in textiles, that have
been in the automotive industry that need a new job, we need
retraining for scientists who want to come into this field, who
want to make that jump, it is very difficult for them.
So this might be as simple as running courses at the Marine
Biological Lab at Woods Hole, MA, or Cold Spring Harbor Labs in
New York. It could be as simple as that. It could be something
more complex, where NINDS, VA, DOD and NIMH get together and
start talking about that kind of job retraining. That is
literally what it is.
We need funding mechanisms for a long, sustained
interdisciplinary effort. Earlier you heard about the
prosthetics programs being run out at DARPA. The program
manager for that is Geoffrey Ling, who is the only
neurointensive care doc in the Army. He is also the program
manager for my DARPA funding, the TBI program called PREVENT,
Prevent an Explosive, Violent Neurological Trauma. You have one
guy doing this thing all by himself over there at DARPA.
But these kind of interdisciplinary fights, where you need
people that understand shock physics, cell and tissue
mechanics, molecular biology, neural biology, psychiatry, that
is very complex. And you probably won't find an instance in
American or scientific history where all those scientists have
been represented in the same room at one time. About the only
people that can pull that together is DARPA.
But DARPA does short-term funding. They come in, they
impact a field and they move on and let another agency pick it
up. We need a longer term, more sustained effort at bringing
these people together for a long time.
I think that two things need to happen in terms of
establishing goals for this field. One is, I am not going to
surrender that turf that you see just to the right of boom.
Right now, if you get a mild TBI on the battlefield, you might
get treated, you might get evaluated, you might get pushed back
into the fight. And one of the soldiers that was in that
photograph I showed you earlier in that photograph has been
blown up 10 times between tours in Iraq and Afghanistan. What
is going to happen when he goes home 1 day and he suddenly
can't remember his son's name? That is a victory for the enemy.
I am not going to surrender that turf to the enemy. If you
take a look, just to the right of boom, when I run up there and
I take care of that soldier, when I pull open that MRAP door to
see if he is OK, the treatment for that TBI needs to start
right now. So one of the goals that we need to have for this
interdisciplinary research program is to develop a technique or
a means of treating prophylactically the neurodegenerative
diseases that might not emerge until 20 or 30 years on down the
road.
The second thing we need, and this is something that was
mentioned previously, is we need a Framingham heart study on
TBI. It might be PTSD, too. But the DOD and the VA keep great
medical records. I live in Massachusetts. The Framingham heart
study run by Boston University has revealed all kinds of great
things about heart disease that scientists like me, who
traditionally work in the cardiac field--now I split my time
between TBI and the heart--have used to guide our scientific
studies. We currently don't have that data base. We need that
data base.
A Framingham heart study, and short-term goals, so that
over entire timeframe of the disease, and that is what TBI is,
it is a disease, we need opportunities, we need funding, we
need organization and we need leadership to do that.
In conclusion, I would like to thank you again for the
opportunity to testify.
[The prepared statement of Mr. Parker follows:]
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Mr. Kennedy. We need your leadership. Kevin, awesome. Thank
you for your service, every which way.
Mr. Kucinich. Dr. Morrison.
STATEMENT OF JOHN MORRISON, PH.D.
Mr. Morrison. I would also like to thank the chairman and
Mr. Kennedy for the opportunity to be here today to discuss the
potential and promise of neuroscience.
I am here today on behalf of the Society for Neuroscience,
which is a non-profit membership organization of more than
40,000 basic scientists and clinicians from around the world
who study the brain and central nervous system. Our members
work across the entire research spectrum to advance basic
understanding of brain function and to translate basic science
discoveries into treatment strategies for more than 1,000 brain
illnesses.
Exciting achievements in scientific discovery have fueled
tremendous progress over the last decades, positioning the
neuroscience community for transformational progress, thanks to
new tools and technologies that enable us to study the brain as
never before. You have heard about some of those today.
Today I would just like to offer two brief examples of
emerging discoveries that hold promise for research and the
American people. First, neuroscientists are making great
strides in understanding the brain circuits involved in PTSD
and how these circuits are altered by stress. We know now of a
number of altered brain chemicals and systems associated with
PTSD and the part of the brain that links learning and memory
to emotion is smaller in people with PTSD. As Mr. Kennedy
pointed out earlier, PTSD is circuit-based, specific circuits
are malfunctioning.
Neuroscientists are also making tremendous progress in
understanding the neurobiology of aging. We know that a part of
brain cells called spines in the prefrontal cortex are depleted
as we age, and this leads to cognitive decline. These basic
research findings have already provided scientists and
clinicians with new therapeutic targets to prevent the loss of
spines and retain cognitive health. These same observations
will help form a new approach to therapeutics for Alzheimer's
disease.
The importance of neuroscience research is reflected, and
you have heard about this already today, in the fact that brain
and nervous system disorders result in more hospitalizations
than any other group, affecting more than 50 million Americans
a year at costs exceeding $460 billion.
A strong investment in basic science innovation is also
critical to our national economy. It creates thousands of high-
wage jobs at a critical time.
Biomedical research must be seen as one primary solution
for diseases and disorders that already cost society hundreds
of billions of dollars a year, several of which increasingly
threaten our social fabric, including my area of expertise,
Alzheimer's disease. Two years ago, the bipartisan Alzheimer's
Study Group, co-chaired by Newt Gingrich and Bob Kerry, painted
a very troubling picture of the social impact of Alzheimer's
disease, if we don't do more to delay or prevent progression of
the disease.
The outlook for Alzheimer's is not morally sustainable for
those millions who we know will suffer terribly or for their
families. Nor is it economically sustainable for our Nation.
The situation is repeated for a thousand other brain disorders.
At a time of economic challenge for our Nation, the economic
question is not, how can we afford to invest in research,
rather, it is how can we afford not to invest in research that
has the potential to save many times the dollars invested.
The issue discussed today remind us that scientists and
medical practitioners must be much more engaged in a two-way
dialog if we are to ensure that discoveries translate into
treatments and clinical observations are integrated into
research development. We have seen this referred to several
times today.
Neuroscience research that benefits one condition or
disorder has broad potential applications for many conditions,
making it critical that we encourage more collaboration that
crosses traditional scientific boundaries. One of the most
critical collaborations is across what has traditionally been
thought of as two largely independent enterprises: basic
science and clinical research. In fact, we must recognize that
both endeavors are necessary components of a continuum that
leads to translation. We must encourage and facilitate
scientists and clinicians to work together as a team to
translate scientific knowledge and discoveries into specific
personalized approaches to diagnosis, treatment and prevention
of disease.
One example of the importance of practical scientific
application and translation is our increased understanding of
synaptic plasticity, which is in essence the brain's ability to
modify neural circuits to better cope with new circumstances.
This incredible capacity for adaptation is a fundamental
property of the synapse and our understanding of it emerged
from basic science. Yet it is already having a revolutionary
impact on therapeutic strategies for multiple brain disorders.
In closing, we live on the forefront of an era of
breathtaking potential to advance biological knowledge and
human health. Our future success will depend in large measure
on sustaining the strong investment in basic neuroscience
discovery as well as team-oriented, collaborative approaches
between the basic researchers and the clinical researcher.
I look forward to the road ahead in this exciting field and
what our success stories will mean to the American people.
[The prepared statement of Mr. Morrison follows:]
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Mr. Kucinich. Thank you very much.
We have another series of votes. Mr. Kennedy and I have
conferred and we are each going to take 3 minutes for questions
or comments, and then we are going to adjourn this.
But I would just say that there will be followup questions
that myself and others will submit to you, and we will ask for
your thoughtful consideration on the questions members of the
committee submit.
Mr. Kennedy, you are recognized for 3 minutes, and then I
will wrap it up.
Mr. Kennedy. Thank you very much, Mr. Chairman.
As we are speaking today, a Rhode Islander in Fort Hood
committed suicide, as we were conducting this hearing. He is
from Middletown, Rhode Island, in my district. He committed
suicide and murdered his wife. He leaves behind two children,
one six and one is two. Dr. Parker, Kit Parker, who could very
well have served alongside of this Rhode Islander in his
service as a Rhode Island Guard, pointed out most poignantly,
these are combat deaths. And they are part of the enemy's
strategy. Whether they are killed in action or they are killed
over here because of their wounds of that action that they saw,
it is a death as a result of this war. And if we don't take it
as such, we are not going to approach it as such. Because we
will think of it as something else, other than part of our war
effort.
So the urgency that you gave us, Kit, in terms of fighting
this fight as if it were fighting the enemy, because this is
the enemy's fight that they are taking to us, we have to take
it back to them. And that kind of call to action that you gave
us, so poignant, so powerful, serves to act as a catalyst for
all of the things that Dr. Potter was saying about the need for
a national priority to be put on this, that is going to return
the science in short order on the emergency level that it is
demanded, because we are not turning it around fast enough.
So for everybody here, that open source need for sharing of
science, because we are all in it together, and the need for us
to do it fast and furious for the benefit of the people who
will come to benefit from this, and to bring it to a national
scale is so welcome. I thank you all for that. That image, Tim,
of the valley of death, the valley of death in translational
research, from moving that research in the lab to the bedside
to benefit people, that is the valley of death. That is the
word you used, it is a valley of death. Every day longer we
leave these veterans in that valley, we are shirking our
responsibility to go in and set them free.
Thank you for your comments. Dr. Potter, if you could keep
submitting for us the kinds of regulatory science reform you
think would be necessary at the FDA to give Dr. Hamburg her
support along with what we ask the NIH and other directors to
talk about, so that when they come up with something, we can
move it right into practice. If you could just close by
commenting a little bit about where that is just such a lacking
part of our FDA. No offense to them, they need the support from
us.
Mr. Kucinich. What we will do is ask if you will respond in
a letter on that.
Mr. Morrison. Certainly.
Mr. Kucinich. If I may, I am going to try to make sure that
we can get to vote here.
I want to thank Pat Kennedy again for being instrumental in
creating this hearing.
Dr. Morrison, can high levels of stress impair synaptic
plasticity?
Mr. Morrison. Absolutely. Well, let me qualify that.
Absolutely in animal models, there is no question about it.
Mr. Kucinich. Dr. Akil, you said something that I thought
was, everything you said, all the witnesses, is very important.
But you said our brains are modeled by the social environment.
That parallels the studies of David Bohm, the quantum
physicist, who said that the world is a hologram of the brain,
which is a hologram of the world. He was really looking at the
holonomic theories of Karl Pribram. They got together and
addressed the issue of the brain in a more global way, which is
what your testimony, I assume, is advocating. When you talk
about the choreography of the brain, you are speaking of the
brain in a much broader sense, instead of things that are site-
specific, you are looking at the brain in terms of its
vastness?
Dr. Akil. Yes. I think the idea is that things are
integrated both in space and in time in the brain. That is how
new functions emerge that we cannot comprehend by looking too
molecularly. And the brain is the place where nature and
nurture meet. So the social environment is just as important as
the genes that we are born with.
Mr. Kucinich. The work, then, of let's say a Maslow becomes
relevant?
Dr. Akil. Right.
Mr. Kucinich. The work of Carl Rogers becomes relevant.
Dr. Akil. Exactly, yes.
Mr. Kucinich. I would just like conclude by saying one
other thing. That is, we have spent time talking about
soldiers, and Dr. Parker, thank you for bringing this very
specific study of the impact of war, the physical impact of war
and the long-term impact of war. We also need to look at post-
9/11 America, when you talk about the social environment, the
brain being modeled by social environment. We have an America
that has been filled with fear and violence, whether it is
vicarious through the media. That has to have an effect, it
just does. I would like that to be a subject of perhaps another
hearing in which maybe we can ask some of you to come.
We have 2 minutes to vote, Representative Kennedy.
Thank you for your dedication. As Chair, I can promise you
that our subcommittee is going to stay in touch with each and
every one of you. I think the work that you are doing is
important to the future of the world. Thank you.
[Whereupon, at 5:35 p.m., the subcommittee was adjourned.]