tv Key Capitol Hill Hearings CSPAN May 27, 2016 6:00am-8:01am EDT
he has been a giant and public interest. michael jacobson is head of the center for science in the public interest where he has done health advocacy, nutrition, newsletter, thousands of subscribers to it, he engaged in multiple dcd fights, taken on coke and kellogg and the rest of them. he drives them absolutely crazy. that is a pretty short ride for a number of them if you think about it. he does it through education,
legislation, litigation, agitation. the agitators, center posts in the washing machine that get the dirt out, we need more agitators and michael jacobson is one of the best in the country. michael jacobson. [applause] >> thanks very much. congratulations to ralph nader for organizing this nice party. i came to washington volunteered with ralph nader. my first day on the job i sat around with ralph, what are we going to do with this concept? is that a good enough imitation? one of the people sitting there
was jim turner who just that week was publishing a book about food and drug administration and various failures and inadequacy. so ralph said why don't you write a book about food attitudes? i came out of grad school studying viruses, i knew nothing about writing books, no idea what a food attitude was. i said marco -- i would be glad to do it. how do i write a book about food attitudes? everyone on staff was writing a book that year so i scurried to the library. how do you write a book? i put my nose to the grind stone and wrote that book which was
novel, and food attitudes. from the 1930s, the authors had to prove every food additive was dangerous. and an intellectually honest book, my conclusion was food attitudes like sodium nitrate and artificial flavorings were not nearly as big a problem as the foods themselves, the sugar and the fat and salt, my grandmother unlike jim's grandmother would say this arrives in the foods. i met two other scientists working with ralph, and you will
hear how rich talk this afternoon. we decided to start our own organization, the center for science and public interest. no money, and somehow it worked out. he had free rent from the church, jim and i lived in group houses and managed okay but gradually wrote books and pamphlets and grants that kept us going. the previous speaker karen mentioned the idea of using mass media and the media was so different then from now. phil donahue who might be on this program later in the week was just an angel in inviting public interest people onto the show and letting them advertise
their products, memberships, newsletters and we had posters back then on food attitudes and nutrition and we would be on a show and sell thousands and thousands of posters and newspaper columnists talking about the issue and saying get this pamphlet for $1.50 or whatever and we would sell thousands and thousands. mccarthy, another speaker in the series wrote a column about one of the things we wrote and we had orders for publication sitting outside our front door. we lived on that sort of thing. a giveaway, little newsletter for nutritionists that are
somewhat progressive. after a year we decided we couldn't afford to give it away for free anymore so we started charging and gradually build that into a real powerhouse of a newsletter, the largest circulation newsletter in the country. that has been the basis of our existence. we have been so fortunate because we are lousy grant getters but we write a pretty good newsletter so subscribers and some of the subscribers donate extra money. that is the backbone of financial support, it is very satisfying, under our control rather than having to beg the foundation all the time. if any of you are here we would love to have your money also and you have a free newsletter
subscription if you donate. so we have 700,000 subscribers and income of $15 million a year much of which goes to the post office with the printer but as i was thinking you saw ralph's slide of executive salaries, $15 million is what the president of coca-cola got last year. that was after a 40% pay cut. he was taking $25 million but is down to $15 million and the president of pepsi makes a cool $26 million. getting back to the substance. nutrition is more important than the food additives though they are significant and very interesting, we kept working on those ever since. back then, the mantra of the
nutrition establishment, department of agriculture, american diabetic association, food industry and others was a very convenient, self-serving, all food is good food, just eat a variety of foods and you will be okay. when i began looking into this and really knew almost nothing about nutrition began looking into it and that clearly wasn't the case. there was a shift going on from some professors, the american heart association a little bit, recognizing the saturated fat in cholesterol and salt and other things in food were major causes of heart disease, stroke, high blood pressure, diabetes, there was controversy, but the whole conversation was shifted as
shifted in many other fields in the concert series from deficiencies of micronutrients to excess of certain nutrients in our food. that is what we have been working on ever since to improve the quality of the american diet partly by educating the public which i think is essential but more by focusing on the kind of garbage companies were producing and government was defending. i remember one debate i had, we use to give out the memorial award to the biggest junk food producer of the year and we give it out at the convention of the institute of food technologists, the people who create all this junk. i am outside the convention, the
award was a beat up old garbage can. i had the garbage can, in pr is interviewing me and i am saying all processed food is junk food as only a committed young man can say with such fervor. web right after doing the interview someone from general foods rushes up to the npr reporter and says this is not true, the reporter gives him the microphone and says tell us about the foods, general foods is marketing and he says we are working on one right now and i think that made it very easy to win the debate. a couple years later i had the idea that too much salt was harmful because there is a lot of evidence in the 1970s.
in 1977 i said bonnie, let's write a petition to the food and drug administration about salt, that the government should limit sodium levels and put warning notices on warning canisters. back then salt, now salt considered generally recognized as safe companies could use as much as they want. bonnie and i at georgetown wrote the petition. working on salt ever since. and researchers, discovering week we could cut sodium from salt and other food additives.
and $20 billion or so every year in medical costs, an issue of enormous importance and meanwhile salt is generally recognized as safe. one of those issues, all americans know it is safe. and we are working at it, petitioned the fda in 1978. we lost in 1983. and went on to other things like the nutrition facts label. sodium would be listed on the label. and sodium levels to choose less. and as much sodium in 2005 as
they were in 1978 when we started this campaign. we went back to court, the court got a petition for the fda again which we did in 2005. and waited for a response, got the institute of medicine to do a study that said the report said the food industry said it would reduce sodium levels voluntarily, government urged voluntary reduction since 1969 and for the past 40 years there was no progress whatsoever and the fda should set formal limits. that was 2011. the fda immediately said we are not going to set limits because the food industry wouldn't let us but would set voluntary
targets so 2011 we have been waiting for voluntary targets so we finally sued the fda again to respond to our petition last october. we expect a response in ten days so keep your eye on that and we think the fda will probably announce proposed voluntary targets, not mandatory and go through a long phase but the first time the sba -- the fda has taken any real action to lower sodium levels and hopefully the food industry will go along with them. that is typical. these big things every food company uses salt, every restaurant has salty foods. these issues take a long long time. tremendous industry resistance
was one of the things that happened quickly in the scheme of things is trans fat. in 1990 there was almost no evidence the trance that was harmful, and careful research showed that it raised the bad cholesterol in food and lowered the good cholesterol. it was the first human study by the department of agriculture. trans fat comes from partially hydrogenated oil which like salt is generally recognized, that is an interesting issue that went on, we petitioned fda in 1994, went through the usual public meetings and hearings and debates and lawsuits and in 2006 the fda required trans fat on labels which spurred a lot of companies to remove it. the fda banned partially
hydrogenated oil and trans fat with a deadline of 2018. 90% of trans fats. [applause] >> thank you. 90% of trans fat is out of the food supply, more than 7 billion pounds of partially hydrogenated oil has been removed and everybody from food manufacturers, feed developers, farmers, everybody deserves credit for that enormous change in the food supply and the next one is sugar. should say trance that was causing upwards of 50,000 deaths per year, premature deaths per year. the label said trans fat making it difficult to deal with. harder to get the victim to be spokespersons. sugar is another big one, soda
pop is killing 25,000 americans each year. it is something the battle lines have been drawn, soda consumption is down by 27% since 1998 when we first really started working on this. enormous change, and the president of pepsi, $25 million a year, pepsi sales have declined by 50% since 1998. i would pay her a lot of money to drive sables - sales down further. we will see what happens. my time is running out. i want to mention a couple challenges, we are not eating more fruits and vegetables despite all the farmers markets, propaganda, it is ridiculous. we need to develop these campaigns to improve consumption
of fruits and vegetables which are protective of health and more probably the citizens movements, this food area needs to do what it is doing in many other areas, keep the pressure on industry. they will respond to public pressure whether it is over the web, newspapers or shopping dollars at supermarkets and they deserve applause for doing the right thing and so that is a challenge, environmental and health workers rights and other issues. we need to use diverse strategies from creative publicity to lawsuits to legislation. the greatest strength of the citizens movement is facts and
credibility and persistence. got to keep this basically forever because opponents will come back like the ocean, building sand castles, the ocean will continue to come back and remove what you have done but it is gratifying to work on public interest issues because you can have an impact, you are protecting the public. not only is it gratifying to do that but it is also a lot of fun. thank you very much, i really appreciate it. [applause] >> thank you, mike. our next speaker is james love, director of ecology international and that is a fancy phrase for saying making
pharmaceuticals among other intellectual property subject affordable to people. if anybody thinks citizen action may be important but doesn't have much drama listen to the story. he is in alaska in his early 20s and producing these policy papers on the oil industry comes to our attention and my colleague says who is putting this out? it is brilliant. some high school grad moved from seattle to alaska. he was so brilliant he was admitted to the kennedy school at harvard university skipping four years of undergraduate and then he went to get a phd in economics from princeton but always too busy seeing how he could save lives. here is the key story i want to relate quickly. the price of the cocktail drugs
from us drug companies, $10,000 per patient per year, pay or die and they died. jamie love went all over the world, he met with who people, ministers of health, aggregations of patients, advocates for patients, he was in the air half the time, and john richard, and a singular dynamo that connected with the drug company in india and showed the drug companies here that were backed by the clinton administration that that drug cocktail can be brought down to $300 a year per patient in africa. [applause] >> and continued to go down.
it was a huge drama. he never got any press coverage to speak of. never got any awards, didn't matter to him. he was driven, the combination of powerful knowledge, being at the right place at the right time everywhere in the world, heading for geneva tonight. needless to say he was helped by groups like backed up which stands for age coalition unleashed power. they demonstrated it, a glorious announcement running for president, in tennessee. they demonstrated everywhere to begin changing the attitude toward ignoring necessary research and price controls that were necessary to avoid pay or die monstrosity system of healthcare. anyone who wants drama i introduce to you the very modest
james love. [applause] >> thank you very much. i want to thank ralph for inviting me to this event. i am going to talk today about this issue of pharmaceutical drugs, the way the things ralph talked about that i was involved in early on in this debate and the current way to play, people are interested in changing the relationship between people and medicine around the world. all the technology, get it to work here. ralph talked about some of the early issues.
i was asked by ralph nader in 1991 to look at the pricing of the drug for cancer which is a breast cancer drug, it was a drug infected at the nih license to bristol-myers squibb which was a pharmaceutical company. there was a clause in the agreement that said the drug should be priced at a reasonable price so congressman wyden at the time was interested. i started working on this drug and that led to looking at the federal government and funding all cancer drugs that were put on the market since 1955 and other types of drugs for hiv and severe illnesses and other rare diseases. as a result of this work that i was doing on drug pricing in the
united states like these issues, i began to become more aware of the role of international agreements and international discussions about what the us could do and what was happening in foreign countries and in 1994 i was invited to argentina and brazil by people who picked up my name as someone working on these issues and i became aware for the first time of the extent to which the united states or the state department and the trade-off and the whole apparatus of foreign-policy putting pressure on developing countries to extend and put in place monopolies on pharmaceutical drugs and a lot of developing countries excluded pharmaceutical drugs from the patent system and you could get expensive drugs from india and argentina at that point and
brazil. and putting pads in place but also going way beyond that. at argentina the first time the united states was putting pressure, congre would not pass a patent law the united states government wanted. the world trade agreement agreed to put into effect a system of patents on pharmaceutical drugs by the transition period. the battle is already over. argentina and other countries, which create a monopoly on pharmaceutical drugs. and roughly 10 years before were required to one of the wto.
the congress wouldn't pass this law. and in argentina. the president of argentina to invoke executive fiat. a short period of time, the idea that the president could dictate laws for executive orders and things like that was considered to be a step backwards in the dictatorship and a way democracy which was fairly new. i was struck at getting the equation of looking at democracy on the one hand and, they are jumping into the price of drugs.
process. when i work on this issue, i do a lot of work, i am not going to go through everything we have been working on. to understand the nature of the power that is involved in trying to deal with the issue of access -- what ralph talked about history with hiv drugs, 9000 people a day dying for lack of access to aids treatment drugs, and somewhere from 10 to 15,000 people in sub-saharan africa receiving hiv drugs many of them white people from south africa. today there are 10 million people in treatment in developing worlds as a result of efforts that my colleagues worked on but the people ralph talked about and other
nongovernment organizations. doctors without borders, all these different organizations in south africa, drug study group in thailand and a wide range of groups that want to involve this thing and it is a big success story. at the root of these disputes just understand as i mentioned the power that is involved for several years. my wife took a drug for women who are about 1/5 breast cancer patients with a certain kind of cancer that is useful. that drug was generating $500 million, $500 million a month for the swiss company developing
initially by us subsidiary, and developing the drug at first, pushed by an academic at ucla. it is not even the biggest selling drug nowadays, they generate more cash than that. what political problem, $500 a month, almost entirely the superhigh profit margin. dealing with these issues the profits are so large, costs almost nothing. my wife has taken a drug that cost $150,000 a year. it probably cost instead of $5000 a week at cost 3000, trying to remember, between the sticker price and negotiated price, $5 a week to make this. that is the kind of margin we
are talking about. every time somebody tries to fix things. whenever there is an effort at reform, i will skip the slide, i am confused on the slides. i will talk a little bit about this. the prices too high for a drug. for example. a drug for prostate cancer invented at ucla on grants from the u.s. army licensing the japanese company tells us cost $129,000 per year in the united states and other countries in europe, high income including switzerland, norway or countries with higher income than we have or sweden, the price is less than half. and some it is a quarter even though this is a drug invented in us dollars. when we try, there are rights in
this drug and we tried to change the price of this drug, what people say, it will hurt the willingness of company to collaborate with the nih. every effort to reform abuses in the pharmaceutical. every single effort whether it is africa which is around the area for drug companies in terms of sales or a big-ticket item like prostate cancer drug in the united states. every single time every drug, every disease the answer is always if you do anything to move the price of the drug down you undermine r&d and because people care about -- they know somebody that doesn't have a drug that will address that and recognize the value of having a pipeline they feel powerless to address this issue and they accept anything and you are at a negotiation when you are asked about whether or not what price
you are willing to pay to keep your wife alive, keep your son alive, keep your husband alive, keep yourself alive for your neighbor alive and often that is a big number. people are poor often price out of that system, routinely 80% of the world population is completely priced out of the market for new cancer drugs, a long time before it is widely available in developing companies. almost no women, to keep my wife alive in the past six years. that is a system we accept because people think it is necessary so the important thing we are working on that is forward-looking is to change the dilemma we are in, situation of powerless and to d-link the cost of pharmaceutical drugs from
financing of r&d. you grant a monopoly on the life-saving drug, then you sit around and people are consistently shocked when a for profit drug company charges a really high price on the drug you will die if you don't get. every month they are surprised this happens. year in and year out a likely surprise. there should be a learning curve that goes along with this, it is predictable but when you grant a monopoly some profitmaking and maximizing, a high price if the drug is effective and important medically. the idea is to get rid of the monopoly altogether. make every drug a generic drug from day one. you cannot regulate monopolies in public interest in this case.
they have too much money, too much power, they have gamed the system from one or another. we don't regulate them, they regulate us. that is what is going on now with monopoly. if you get rid of the monopoly you have to replace it with something that also provides robust funding for r&d so what element of this would be to have the trade agreements which are ramming patents, patent extensions, intellectual property protections and 1 million other things and trade agreements which raise the price of drugs. instead of that the idea is to have the trade agreements focus on national obligations to fund r&d, things like the and i chase -- nih does to put into place measures, different measures like innovation and direct funding like the nih does, but focus on funding r&d rather than
high prices, not make ip are the focus of the trade agreement but make r&d the focus. another step is to reinvent the idea of incentives the company would do, give the money and design the money in such a way the system works in an efficient way and efficient set of rewards, senator sanders introduced several bills to work with. in the hiv, i have time for this one example, we are up to $14 billion a year. over the past 30 years, we have one new hiv drug. $14 billion to pay for one more drug per year. these are drugs you can buy for less than 1% of the us price by fda approved suppliers outside
the united states. we are throwing money at these guys. what senator sanders proposed, $3 billion a year is a reward for people who develop new chemical entities for hiv drugs, a very big reward system. and you eliminate the monopoly. what you are looking at is $10 billion a year free and upper resources which is based on what we are currently doing but a lower number of hiv patients, some african countries do because prices are high, sometimes patients are not tested, the authority doesn't want the obligation to pay for the expensive treatments, lower rates of utilization of drugs, we can do it for cancer.
the good part is basically have 45 seconds so i won't be able to go through much of my talk here, but we are committed to this. recently the ceo of one of the largest firms in the world, glaxosmithkline, has endorsed the idea we look forward to finding ways to implement the linkage. a number of countries proposed developing countries proposed at a fraction of their budget, and satisfied to reward the developers of new drugs and they get their drugs as generics, they don't pay $3000 a week for a cancer drug, but $5000 and extend treatment to people. but they do recognize the importance of innovation, it is a different way of financing, changing business model, how the business model for telecommunications was radically transformed by the way internet
pricing is done. so you're not yelling at somebody to hang up the phone every time they talk to the mother of their friend or something like that because the clock is running, not a friend to send an email message or look at a webpage because it is so expensive because on the margin that is free even though you pay to have the service, that is what we are looking at with drugs. we want the price of a drug to be almost free on the margin like aspirin. the first copy out the door, it is a change in the business model, it will make the world a better place, the most transformative thing, access to care, thank you for the opportunity. [applause]
>> now we know. wait a minute. >> getting the republicans running the cooling system to turn it off. [applause] >> it is a little cold. thank you for saying that. now you know why james love got the award for civic courage. his book knowledge economy internationals budget is equivalent to less than one day's compensation package. less than one day's compensation package up there. our speaker, congealed, ralph
hodgkins. a finishing sophomore majoring in physics, came up to me and said can i go to washington this summer and work on problems affecting people with disabilities. i said of course and he was a paraplegic in a motorcycle accident, sliding soft sand, soft curved type motorcycle after his freshman year. he was in on the ground floor at the movement, one of the greatest success movements in american history. those who are of older age remember we didn't even see a student with a physical disability in school. out of sight out of mind. there are no ramps. they didn't want to take the students upstairs, they were
segregated. the americans with disabilities act, buildings have been renovated, buildings have been retroactive, there is still a lot to do. the special olympics, racing down connecticut avenue with four people in wheelchairs joyously talking to one another, rules and hospitals and that is right. on the ground floor, part of the demonstrations, the brilliant inventor of much more durable resilient wheelchairs. he and a few others broke the wheelchair monopoly, jennings corporation out of london that was selling high-priced, unreliable, flimsy wheelchairs. he has designed these wheelchairs, he does not patent any of his inventions for anybody to use.
he goes all by himself to places like central america and central asia teaching many people, mostly women, how to build wheelchairs from local materials that are strong, durable and inexpensive. if you don't have a wheelchair it is almost a death sentence and every year his network manufactures 15,000. you also see a demonstration of something ralph -- ralf hotchkiss expresses in his incredible redefinition of people with disabilities which is why he wanted to call his group whirlwind wheelchair. i give you ralf hotchkiss. [applause]
>> think about this. put your feet in the stirrups of a wheelchair in the third world. there you are. because your spine has been snapped by impact with the hood of a car. somehow you survived the impact and made it home after limited medical care where you are. without a clue how to stay alive in your village and on your farm. you hear of some who are alive with your injury but none are nearby. you badly need to know how they managed to stay alive. you have no way to move beyond your caught. the few wheelchairs in your country were designed long ago for hospital use. these designs rarely last long.
most are discarded, resting in a large pile behind national hospital. your family begs to help but what can they do? who will feed your children to the monsoon? if you are like most, you will plead to get out and find solutions but pressure sores and infections will beat you back and within a year friends will say she died of a broken back. 50 years ago today i swapped -- i snapped my spine in illinois. wheelchairs were plentiful in the us but were far from optimal since the early 1950s, a single company had monopolized the us
industry. they did what monopolies do best, raising prices on their products. my first wheelchair came from this company and with that i left the hospital. after only half a block i got a crack in the sidewalk and destroyed the front caster. the company declared the chair beyond repair. what kind of chair do people need in the developing world? we have cars, we have buses with lifts, we have ramps. third world -- it will take what it can give it. whatever you do, cobblestones every single day coming down
rocks. over muddy terrain, fighting to get in and out of your house. and american chair just does not work. it is much tougher than what the gringos get by with. [applause] a few years later while working in washington dc i was asked to repair the many breakdowns of the wheelchair as an attorney at the security exchange commission. he told me the manufacturer of both our chairs, subsidiaries were dumping chairs overseas, keeping competition out of the
us. i responded the price of the company's newest chair, the sports model, was $750 in today's money in england, the same chair lifted for 2007 $50 in the us in 1973. when activists in the us disability rights movement tried to import the low-priced chairs to the us there owners were refused. the security exchange commission attorney pulled me in that refusing these purchases was an illegal restriction of international trade and should be challenged. that attorney was evan kim, a republican who later became the head of the equal employment opportunity commission under president bush the first. following kemp's advice i went
to the london showroom of jennings and ordered ten chairs asking that be sent to washington dc. jennings refused saying, quote, our parent company does not allow us to ship to the western hemisphere. jack anderson reported this violation and president carter's attorney general opened an antitrust investigation. that investigation moved very slowly until 1977, when ralph nader, and the disability rights and to challenged bill in a public forum shortly after the doj filed an antitrust law. in 1979 a settlement was reached, perhaps prodded by the likelihood of a new
administration that would be very friendly to monopolies. the settlement was a classic consent degree in which the monopolist swore they had never broken the law and promised never to do it again. competition in the us wheelchair industry, prices fell but dependability improved. some american wheelchair writers found better wheelchairs, very little of this improvement trickled down to the poor 80% of the world. the cost of imported wheelchairs were far too high for developing countries where people with disabilities are the poorest of the poorest of the poor. what is needed is a locally-based industry where wheelchairs can be bought anywhere and can be repaired anywhere else. the new american chairs made of
exotic carbon fiber cannot be repaired in poor countries. steel can be repaired almost anywhere. this is why the vast majorities of bicycles have been made of steel for over 100 years. they also have a personal interest in improving wheelchair, steel wheelchairs, as wheelchairs cannot be used to travel safely outside the wealthy world. reporter john hotsinbarry wrote that a wheelchair anywhere on this planet travels with a large case of spare parts and needs a large amount of npr to bail him out when things break down but a traveler with a classic steel bicycle can get parts replaced or repaired or custom-made by the blacksmiths and bike shops
in every corner of the globe. with more dependable mobility in mind, i searched the us and europe throughout the 1970s looking for inventors who want to bring a steel wheelchair to the state-of-the-art in the 1890s. i found very little help. most westerners were working on high-tech materials with wheelchairs, they were not working on providing basic mobility that can help a farmer. in nicaragua i realized i could get help in the poorest parts of the world. there i met four young riders all sharing one chair. there wheelchair was a us hospital model that broke down frequently. their shared wheelchair. each time the wheelchair broke,
my clicker. they would help -- marco boy. thank you. thanks a lot. let's see. there wheelchair was a us hospital model that broke frequently. each time the chair broke they would help from a nearby blacksmith would redesign it and fix it so it would not fail again. what it would take to make my own chair much better. as we developed together early chairs, skilled writers and builders in the philippines and
mexico showed us how to toughen our welding fixtures without making them anywhere near as heavy and expensive as the american equivalent but much as we like to write our chairs, they were hard to sell. medical personnel were leery of our hand-painted rustic sky all as themselves had the money. disabled survivors of the nicaraguan civil war, dozens of these survivors held a marathon writing wheelchairs across nicaragua to show that they were ready and willing to be part of the new nicaragua. they did not expect the only woman entering the race, the first prototype of her new chair, would be the mall. [applause]
>> within a week a dozen new chairs were sold and nicaraguan wheelchairs shops have continued to sell chairs for the 35 years since then. the nicaraguan wheelchair project got training and support from usaid and the us peace corps. this help was cut off by the new reagan administration. wheelchair network is here and in nicaragua, has always been tied to the growth of the international disability rights movement. since everyone has equal opportunity to gain a
disability. the movement opens lines of communication that are otherwise not allowed. the national disability in south africa was the first and only multiregional group during apartheid allowed to lobby the african legislature. innovations have come from young and old. there we go. paul silva of the us peace corps. this is an ongoing nicaraguan activist group of disabled people. most of them riders of locally made chairs and some of those chairs very old. and some inventions come from people very young and very old.
he rearranged his pattern after he was 8 years old and we still take advantage of his great ideas. the greatly improved stability of our chair, notice it is wrong on the chair, a 50% longer wheelbase for the typical chair and the chair that is 16 inches shorter because my feet are behind the front. gives a great stability. the biggest injury cause of wheelchair writers falling forward on the chair, you hit a bump and you fall forward. if you take the ratio of track lengths to the height of the typical american wheelchair and
apply to a chevrolet it is 3 stories tall. hit a curb with that car and it falls on its face and you can break your femur in the process. our training at san francisco state university includes welding, sewing, destructive testing and over the edge learning how to do over the edge wheelchair riding. our new shop in berkeley, california is the most wheelchair accessible shop yet. feed that from long-term users is critical. to keep on -- it is critical to keep on improving our chairs. in nicaragua, has written and abused this chair since 1985 and
always proud to show me -- this is hard. [applause] >> the best and the brightest. they put us to shame. he is always proud to show me he has broken something new. mistakes happen. our original parking brake had an open handle to make it easier to grab. recently some of our shops are the shops we work with and they are all independent and they switch to this more professional looking rubber handle but when this quadriplegic fell in nicaragua felt he couldn't work