tv Politics and Public Policy Today CSPAN January 11, 2016 3:26pm-5:27pm EST
factors. >> and in someone, doctor, experiments with opiates, are they on a path for permanently damage their neurological functions? and over what time does it happen, ma'am? there i would have to yield to somebody else about neurological function. once somebody starts to using opioids the chance they will develop a dependence increases but it's not a guarantee. so it is important at that point to intervene as quickly as possible. the shorter the drug-using career, the better the prognosis. >> dr. caopiano -- thank you very much -- dr. campopiano, if i may, you mentioned during your briefing to our committee several different factors in one's life. could you paint for us on the committee, and for the parents that are listening, is there a profile that you could paint for
us such that moms and dads and aunts and uncles and grandparents and look at families and say these kids, adults have more of a tendency to become addicted to drugs and alcohol or not? >> i don't want to say there's a profile but certainly a family history of substance use disorder, whether it's alcoholism, which is so common, it's still the most common form of substance use disorder, can predispose subsequent generations. early experiment agent with things as such as cigarettes can be a suggestion that an individual is acting on some maybe buy logic or genetic impulse to alter one's state of mind. beyond that, it's kind of it could happen to anybody. >> is there any genetic mapping that's taking place, maybe
dr. compton you want to dig into, such that it helps folks make sure that they know that they have a higher or lower t tendency to have this problem in life, sir? >> we have not unravelled again n again ngenetic disorders. some tobacco addiction. we haven't solved that when it comes to opioid addiction disspite a great amount of effort. there's ongoing studies to try to unravel this now. >> dr. campopiano, if i may come back to you, you mentioned in your opening remashremarks, iss dealing with incentives. for folks who you treat, so desperate need for our help, what are some insent stivs to help them along the path to recovery? >> it's so highly individual -- >> give us a few examples. >> well, for example, you would
think that losing everything would be an incentive, but it's not necessarily. you can lose jobs. you can lose your home. you can lose the trust of your friends and family and still not be able to change your behavior. >> what i'm looking for really is the support that these individuals need from their families and friends. >> right. >> and it's so heartbreaking, so destructive to our families in maine and throughout the country, give us some hope. what these families and friends and the support groups can help these addicted individuals with when it comes to incentives. give us a few examples, please. >> the desire to be the parent, the son, the daughter, that you set out to be at one point in life. the hope that that can be
created for you within your family again. the knowledge that people aren't going to up on you or throw you away. >> there is -- there's so much -- if i may, mr. chair -- that has been discussed here today about post detox meds that help folks get back on their live. but what if somebody is noncompliant? how do you -- how you engage someone like that such that they see there's an incentive for themselves to be compliant, how do you do that? dr. peirce? there actually i think families can do a lot to encourage individuals with an opioid addiction. because i think one of the things they can do is they can insist that the patient go to treatment. they can refuse to give the support that a family could give. we call that enabling. >> tough love? >> yeah, tough love.
if you give money to somebody who has an active addiction you're more likely to feed the addiction than treatment. understanding about the availability of treatment, the insistence that treatment is necessary, if someone leaves treatment they need to return, and continued monitoring. and in the context of that, all of that love and care can go toward promoting health instead of promoting estrangement and poor health. >> my time is up. thank you all very, very much. >> thank you. recognizing my colleague, elizabeth esty from connecticut and john sarbanes from delaware who have to be on the short floorly. excuse me, maryland. >> thank you so much. i'm going to quick yield 30 seconds to john sarbanes. we both have a bill on the floor in ten minutes. >> thank you you for yielding. quickly, i represent baltimore city, you've alluded to it a number of times. it's an important place for research and progress on this. i'd ask that you submit
potentially in writing, if that's an opportunity we have through the process here. i'm very interested in this idea that we treat this as an epidemic. you alluded to cholera epidemic. how we have responded to them, what common elements there may be there, i think that can be instructive to us going forward. i won't take the answer now. if you could submit that, that would be wonderful. i yield back my time. >> thank you very much. i wanted to thank the three of you. i want to thank our co-chairs of the task force and all of my colleagues in connecticut. we've seen a dramatic increase be we had over 30 deaths -- 300 deaths, a small state in 2014. my district is the epicenter. i started working on the prescription drug side in 2009 as a representative. it's of grave concern. a couple of questions to lay out and hopefully get as much response as i can on the record,
and then follow up. dr. compton, you and i talked beforehand, can you talk a little bit about what we can do to right size opioid prescription policies? i look at my kids who got 30 pills when they had wisdom teeth extracted which was the same amount when my brother-in-law had his hip shattered he got. obviously that makes no sense and we need ability so right size prescriptions. is there research being done on alternative pain management? is there research being done on less addictive -- the drug companies doing research on less addictive nonopioid or opioid but less addictive opioid prescriptions that we might be able to use for pain management? and and for dr. peirce, talk
about how we can better d disseminate best practices. it's not being used everywhere. we want to get the information into the hands of our communities, our states and the people we represent to save their lives and to be the parents they want to be, to be the chrn thildren they want to have a bright forward. look forward to your responses. >> as you mentioned, figuring out how to make sure that the number of pills prescribed or the number people need is a key gree ingredient in all medical care. it's true of opiates, having them leftover in medicine cabinets can provide a diversion to misuse and abuse and addiction at that point. so you raised a number of questions. one is, there are medical conditions for which there is pretty clear evidence that opioids are generally not used. third molar extraction, which is the medical term for wisdom
teeth extraction, responds extremely well to nonsteroidal anti-inflammatory medication, i bu profin. a bu profin and similar may provide reduction of inflammation whereas an opioid treats the pain. some people can't tolerate a bu profin. there may be a clinical reason to rely on opioid. in many health conditions we have very few studies to help guide that decision. and so the boundary between when nonopioids and opioids should be used is not clear-cut as we'd like to be. that's an area where ongoing research is needed. alternative pain management, and a until of studies going on, nih has a number of studies looking at alternative approaches. even chronic pain, mindfulness training, similar can be
helpful. how about physical therapy? other forms of nonmedication treatments for chronic or acute pain? when we think of nonopioids, of course, this is a very large market. there are a lot of people with pain. whether that's short term or long-term pain. it's potential, lucrative pharmaceutical market and there a number of companies looking for new products in this area. that's just a quick version. but i certainly agree with you the idea of right sizing the prescriptions is key. i wish i had a clear answer for every clinical condition and we don't. we're working on trying to make that better. >> to speak to the question of how we can increase evidence-based care, from the policy side, i think you can inform people of the evidence-based care that's available. you can expect it. you can benchmark treatment. you can say, i need to see that what your drug use rates are. i need to see how you treat your patients. and you can help reduce stigma in seeking treatment.
it is so difficult, part of the reason that methadone clinics look like what you saw from dr. campopiano is because people don't want them in their neighborhood because they think they're terrible people. we need to reduce that in order to increase effective treatment. >> thank you very much. thank you very much. my time is out. >> i yield five minutes to the gentleman from pennsylvania. >> i want to thank our co-chairs for organizing this task force to begin with and to doing all of work and the staff on putting this together. i thank witnesses for coming in today to help educate us and the american people about what we're looking at here. a couple of questions. dr. compton, you used the term idu, injection drug users, and i want a point of clarification here. from what i understand, heroin is not necessarily an injectable -- it is injectable, but there's also snorting going on, smoking going on. i'm wondering if you can educate
me a little bit about what percent of heroin out there is bei bei being snorted versus smoked versus injected. >> i don't precisely know the percentage for each route. i will go back and see if i can find a specific answer to that. we know that all of those routes are commonly used. it typical that they -- that an addict may progress from the noninjection routes towards injection. injection, of course, more efficient as a drug delivery system, because it gets into your body quicker and more completely than either taken by mouth or snorted or smoked. but all of those routes of administration can be used. and typically, when people start out they may start out with snorting or taking it by mouth, as their first way of using
almost all of the substances. >> but in your field when you talk about idu, talking about a drug that can be injected but is delivered through other mechanisms as well? >> injection drug use means that specifically. but typically people who use drugs by injection also use the or routes of administration. >> are you satisfied with the current prescription guidelines for opioids? >> you know, we have anecdotes. i was talking with a parent, their son had shoulder surgery and they gave them a 45-day supply. and the mother didn't think that was appropriate. and she asked for less. this is being looked at. can we expect there would be changes in guide lines? >> first off, you have to remember that guidelines are just that, they are not rules, they are not regulations, they
are advice to physicians or prescribers who will then interpret them based on their clinical situation. i certainly agree with you that we see that opioids are overprescribed in very many settings. finding ways to teach clinicians about smarter ways to approach patients and get them down to the minimum that's needed remember than the maximum that they may require. >> dr. campopiano, you -- this quote, i don't have any of those people in my practice, when you talked to your colleagues, i guess i'm looking for some protocols perhaps that might exist within on the counselor side of things and informing physicians. under the 42 cfr part ii privacy regulation, confidentiality of drug and alcohol abuse records from drug treatment facilities required to be kept private from primary care physicians. this can lead to a situation
where the primary care physician doesn't know what's going on. are there protocols in place, for example, where somebody comes in for counseling and counselor knows that they should ask the patient whether they'd like this to be communicated to their pcp? >> well, there's two approaches to that situation. one is that particularly when you're prescribing medication-assisted treatment, the treatment provider has an obligation to coordinate care for the safety of that person who could be treated with drugs that would interact with the opiates or be dangerous with the opiates if they're prescribing methadone or buprenorphine to treat the person's opiate use disorder. the other treating physician should know. and the treating -- the physician or other prescriber who is treating the person's opiate use disorder does need to coordinate care. they must have the individual's
agreement to do that. there's a matching responsibility on the part of urgent care, emergency rooms, prime mar care doctors to ask about and identify substance use disorder, and the protocol for that is screening brief intervention referral to treatment modality that both nida and samhsa have advocated for. >> you mentioned 1400 certified programs. as these programs are certified, is there any effectiveness requirement that has to be demonstrated? how do we measure effectiveness of any one of these 1,400 programs? >> the regulations don't specifically require that we ask about outcomes. we're looking into developing a process that would tie certification and recertification to patient
outcomes. the regulations were put in place at a time when the technological infrastructure and the understanding of what the outcomes could be was limited. >> is there a consistency among certified programs, looking at the medical side, the counseling side, would you expect to go to any one of these 1,400 certify programs in the country and see the same model? >> i would. and the reason i can say that -- >> dr. peirce is shaking her head. >> i would at the basis of it, because these programs are accredited by private, nonprofit organizations in addition to being certified by the federal government. so while we at samhsa don't have the staff to go and visit every individual program, they are required to be accredited by nonprofit organizations every three years. >> my time's expired. >> i'm sorry. >> thank you. >> thank you. and i'd like to recognize my
colleague, representative nor cross from new jersey. >> thank you. certainly appreciate the chair's putting this together because we're talking about today is the disease of addiction. it's complex. it long term. and it's certainly not one size fits all when we look at this, one of our former colleagues, patrick kennedy, i have to compliment him, about bringing the disease of addiction out of the closet so we we can have this discussion in the form like we have here today. heroin and the opium epidemic originally was thought to be urban issue, it was them, we didn't have to worry about it. lo and behold, it's in the suburbs and all of the kids with great families are now ending up if a very difficult situation. and creating havoc for families. new jersey, we did the mobile methadone clinics, we did the needle exchange, we were one of
11 states to do narcan and have over 1,000 saves already with the nasal. because as we were debating, i was serving state legislature, are we enabling them? what are you doing? making it easy. we're trying to save lives. so they have that moment in clarity, maybe it's one time, maybe it's five times but if you're that kid and their parents you want to make sure that they have that opportunity. but i want to bring all of this back because treatment in jails, we're spending plenty of money. we're spending it on jails instead of treatment for the nonviolent offender. but what i want to ask you, and i haven't heard it yet, this is a life-long issue. it doesn't go away luke a broken arm. what do you consider a recovery? is it six months, six years, 60 griers? i'm not hearing any of that discussion what we're considering a win. would each of you comment on
that? >> there's been some interesting work looking at when can you say somebody has a high likelihood of remaining abstinent for future years? a long-term study out of chicago illinois done by chris scott and mike dennis, they followed personsed amen stirring public treatment system and followed them for ten year. they found after three years or so of abstinence that the chances of remaining clean and sober for the next year are markedly increased but it has to be quite a number of years for accumulation of stability in their life to say somebody that is likely to remain in recovery long term. even then, i can't give you a guarantee. so that's why we say -- >> exactly the point i want to make. there are no guarantees. please. >> if i could comment as well. i'm think recovery is function. the ability to function at your
predrug use level or close to it as a member of society, as an employed person, as a parent, as a responsible adult child able to take care of your older parents, to fulfill social roles. and to not be defined by the illness of addiction is recovering. and how long it takes and what shape it takes is very individual. and what resources somebody needs to get there is going to depend on how far they got from their previous level of social function, whether or not they have a criminal record now. and whether or not they're closed from seeking employment in certain fields or fields in which they trained originally. but being able to be an employed, housed, dignified person who can fulfill your
roles in your family, i think, are what makes recovery. >> would you consider them at risk for the rest of their lives? >> i think kind of from the point of view of a physician, yeah. it's sort of like if you had cancer once, i'm going to consider you to be high risk for relapse. we may say you got five years and you're cured but i'm going to keep a close eye on you. that is just kind of 0 the medical thinking that i would apply. >> thank you. dr. peirce? >> one of the things i want to say, it's important to recognize whatever recovery is for a given person, people can live well in recovery. they can live a long, happy, fulfilled life in recovery. and the fact that we have such a stigma associated with a history of opioid or other drug addiction and recovery makes that a problem. someone needs to be aibl to say, i'm in recovery and things are doing great. or have the access to i'm in
recovery and things are starting to feel like they're slipping, what do i need to do to get better? how can i get back on track? the importance is thinking of themselves living well in recovery. >> bringing it out of the closet. i yield back. >> i recognize the gentlelady from virginia, mrs. comstock, for five minutes. >> thank you. and i want to thank my colleagues for this important hearing. i know we all share our concern about this growing epidemic we're seeing throughout our districts. my district is in northern virginia and starts around the cia and stretches out to the west virginia border, and we first started seeing this problem in winchester in the western part of the district now it's moving east and we're seeing it throughout. we have several task forces working on this. but one of the things that has been really most difficult
thing -- so many of the things, i can't say who's most difficult to see -- one of the things trauly heartbreaking to see in our hospitals and neonatal addi. and very difficult treatments and things to get those babies okay. you know, when they have that situation. so i know there was a little bit of a mention of how to treat somebody who's pregnant if you can get them, what are some of the best practices. we have several pieces of legislation in that area to look at best practices and what we can do both for the mother as well as for the baby if any of you might have some thoughts on that. >> there are two key issues to me. one is what can we do to prevent that, as much as possible. so how do we minimize exposure to opioids for those that are taking them medically or extra
medically. and get pregnant women into treatment when it's identified. but the other issue is when -- and it is to improve the treatment for the newborns. but then the second is not to think that it ends right there. because there may be long term issues for the family that need attention. so what are the supports for the infant as it grows and develops in that household. those are some of the long term issues that need to be attended to as well. >> the -- i think the important thing and sometimes challenging thing is that pregnant women with opioid use disorder need to be on medication assisted treatment. at this point in time we don't have evidence for safety of the use of drugs in pregnancy. but some are deemed safe and
effective. what sometimes happens is that women are encouraged to seek treatment while they're pregnant and then encouraged to get off of medication assisted treatment after they have given birth. and what happens is they relapse. and just because the baby is on the outside of their body doesn't mean that baby is in better shape to endure parental relapse than during the pregnancy. so, you know, watching out that we don't have policies and procedures in place that make it more difficult for women who are parenting to receive medication assisted treatment. pairing services for the infant and the parent, mother or father, making sure that medication assisted treatment is delivered in a child friendly way. which can be difficult because we tend to be very cautious when we're dispensing controlled substances for a person to
ingest that our tendency is not to want children in that environment. but if that person is a parent, they need to be there and they need to be there safely. really and truly encouraging breast-feeding among opioid dependent women who are stable on medication assisted treatment can improve the bonding and the parenting and the -- in the parent/child relationship. and can -- >> there's no problem there for the baby -- with the breast milk? >> well, the medication is generally in the breast milk to a tiny extent and this may actually help mitigate the withdrawal for the infant. >> oh, okay. >> but the mom has to be stable. she can't be using any other drugs and care has to be taken if she season on medications for other medical conditions or psychiatric conditions when the decision to breast-feed is made. but it should be encouraged in women who are stable in medication assisted treatment. >> okay.
thank you. . chairman, i yield back. thank you for the work you're doing in this area. i appreciate you being here today. >> thank you, i now recognize the gentleman from pennsylvania for five minutes, mr. costello. >> thank you. i want to thank congresswoman kuster for chairing this important task force. used to be a county official. usually what i would read about as it relates to the heroin epidemic, related to policy making from the law enforcement side or the treatment and recovery side. and what i would like to ask you for your feedback on, and i ask this with a constituent company in my district, eaglet corporation who is in the process of r&d and product development on what is termed
abuse deterrent oxycodone products. what you suggestions, recommendations are and observations are with respect to preventing certain instances of on opioid abuse by designing the drugs which many do have a medical value. but designing them in such a way to strip it of its euphoric effect so we're not introducing certain patients to potential abuse on the back end because they never experienced the euphoric effect on the front end. and with that i'd like to have it be open ended for all three of you to comment as you find appropriate. >> certainly the development of abuse deterrent formulations is an -- could be helpful in
reducing the progression from oral -- certainly by taking it from mouth to either taking it by nose or injecting a drug. but it won't necessarily eliminate the euphoria or the pleasure or the reenforcement that people get from the oral form. that's wum of -- one of the shortcomings of most of the current technologies that means we need to keep looking at analgesics, pain killers, that are effective but don't produce at all the intoxication or reward or reenforcement. that's different from making sure it isn't dissolvable and can't be injected. it has to do with a more fundamental nature of how our brains worm. >> i will say from the clinical side that this is something that we deal with in the medicati medicatimedication assisted treatment program. there are many treatments out there for pain because our patients still have pain, even though they're on methadone. and we use a lot of nonopioid or
capa opioid receptor medications that are more helpful and do not run the risk of abuse. when people have very limited acute pain, they might need opioids even on methadone. then we monitor that very closely. we coordinate with the proscribing provider. there are lots of ways to manage that even for somebody who has an addiction. >> i think the other piece and the technology is very exciting. i'm sure there will be a place for it. i think the other piece is that how providers are educated and prepared to help patients deal with pain and i'm speaking more from the point of view of treating people with opioid use disorder who unfortunately had
painful medical conditions. a broken bone, a cancer diagnosis. and did not want to take additional opiates. they felt it would compromise their recovery. it was difficult to find providers who were willing to work with people on what the role of pain was in their illness, other ways to cope with it. instead of just kind of throwing a prescription at it. and it generally felt to me who was supposed to be treating their addiction, not their pain, to help them deal with how do you accommodate you-- with this problem in terms of how you function or how you live your life or what can you really expect from say an ibuprofen or tylenol or pain relief. and how can we make that work for you? >> when you spoke about the technology being exciting or the potential for the technology to be exciting, could you just expound upon that a bit more?
>> maybe i'm just a science geek, but i think that the idea that you could have a drug that should it fall into the wrong hands would not be abusable is an exciting reality of where we're at with technology. and it's a plus. >> right. >> it probably is not going to be the only solution. it needs to be part of the solution. >> yeah, i'm not a science geek but i find it exciting too. particularly when you read about the number of stories of those who have been caught up in this absolutely terrible circumstance. the abuse and the consequences of abuse. and would never have been there but for being injured, having pain in the first place, and having it be in a downward cycle there. so i share that you. i look forward to learning more about the technology and hope -- i think we all hope that we'll continue to progress in a way
that will enable those opportunities so we can avoid some of the abuse that does occur. i yield back. thank you. >> i thank the gentleman. i want to recognize the gentleman from maine for five minutes. >> thank you, i appreciate it very much. i'd like to further explore some of the shumss that we -- issues that we talked about a short time ago. if we may, folks. we're all in the belief i'm sure that governments one of the -- one of the primary jobs of government is to show compassion who truly need our help. let's say you have a terrific young adult that's doing well and is learning a trade in a community college. and is living at home and for some reason, somehow gets wrapped up with maybe the wrong people. the wrong people or gets mixed up with opiates or alcohol or
what have you. and now the parent is in one heck of a mess along with the child. what do you do? how do you not enable that child? so let's say the child goes through treatment. of course we all know that dealing with individuals that really need help, they first have to recognize they need help, right? and then after that make sure they go through the process to get the help and then once they get out of the detox situation make sure they have ongoing treatment, which is based on discussion today and all the knowledge in this area. but what if the individual falls back, you have told us here today that the probability of that happening is quite high. so let's say you're a guardian. and you take your daughter, your son or your -- the person you're responsible for helping out to lunch, three times a week. just to make sure they have something good in their belly to last them over. they show up at lunch or knock on the car window clearly high.
now, we have talked all about this treatment using drugs and so forth. so on. but what about the support system? remember now, this individual may now be getting assistance for housing and heat and food and clothing and may have a small cash allowance that enables that individual to have the freedom to purchase whatever he or she wants. how do you make sure those individuals continue to stay in the path of recovery? so they don't slip back and how does that support group that's so important for these individuals to fully recover so they're productive and they have the dignity of being on their own and independent, how do you help them? what support group, dr. campopiano, is available out there or how do you help these people? how do you help the support group to help these people? >> well, there's the well known
12 step recovery movement. >> yeah. >> that has helped more people than i think we can possibly know. that can't be overemphasized and is fully compatible with principle if that person should need medication in addition to recovery support from peers. that said, a more formal peer recovery support model is -- has been demonstrated to be effective. where you have somebody who's been there and you can call them up and say, this is what, you know, i did when that happened. >> do you think that our government programs that are designed to help these folks that we just love so much and we want so badly to help, do you think they are designed to make sure that the individuals have
incentives to follow a path of healthy behavior? >> that question might be a little bit broad, but i think so. >> good. >> the challenge that i think is that we collectively live in a society that doesn't really do that. so if you have a program where for a few hours a day or a few hours a week, you get support and everybody courage -- encouragement and you go out in the world -- >> let me give you an example, because we're down to the short period of time here, mr. chair. but you treat people, folks, on a -- on a private practice basis. let's say one of your patients comes in that has been following the regimen of treatment but comes in high or misses an appointment or two. what is ingrained in our programs to hold that individual
accountable to get that individual back on track? >> i think that it's on the confrontation of the behavior. if as the treatment provider or the health care provider, if you are unprepared to deal with it, you feel it's easier, less scary to kind of ignore it or send them away, let them come back when they pull themselves together, pretend it never happened, you're doing a disservice. >> it seems like -- i'm guessing and i know dr. campopiano, you want to hop in here, but we need more focus on the programs to provide to make sure the providers hold the folks accountable for healthy behavior. >> i agree with you. i think we have models like dr. peirce focused on the stepped care models that show you can
enforce rules in a consistent way that's not punitive, but is expectable and predictable and does set limits on behaviors. but it does require monitoring for infractions of the rules so you have to do appropriate intermittent drug testing to catch people when something is gone wrong, but also observing their behavior. these are models that are typically well done by drug courts at times and by others that combine an opportunity for a close monitoring and enforcement along with the compassion and services that people need. >> thank you very much. i appreciate it. >> thank you. mr. charge. >> i thank the gentleman from maine. indto yield two minutes to the gentle lady from new hampshire. >> thank you so much to everyone who participated. to our colleagues and the panel. distinguished guests, this is a challenging topic and a challenging problem for communities all across the country.
the rapid rise of heroin related deaths is truly challenging. what we need to do is educate ourselves as legislators and educate the communities so that people begin to understand the elements of prevention, treatment and then life long recovery. and the resources that are needed in our communities. this testimony has demonstrated the challenges that we face, treating patients who suffer from substance use disorders, but also areas of promise. i think there is hope. today i had a conversation -- i was an adoption attorney for 25 years. one of my patients -- one of my clients many, many years ago had a truly remarkable and very challenging circumstance. i was able to be a part of her life at a time when she took control of her life. but she called me today. she not only has been in recovery for eight years, but she is opening a center for
women to be able to live in recovery in a safe space and to get the resources and the support that they need. i'm very enthused and buoyed by that story and by many, many others of the people that i have met. people themselves who have been in recovery for a long time and are now coming to the floor to address this challenge. what we have learned is that this epidemic has struck across gender, racial, socioeconomic lines and partisan likes. it's not a partisan issue and it's our duty as representatives to take action for the american people. so i look forward to working with my colleagues on the task force to combat the heroin epidemic. to introduce legislation and build upon these ideas and to share ideas for best practices, how we can encourage more
treatment with scientifically based, sound performance guidelines. how we can deal with these issues around prescription medication and making sure that our prescription drug monitoring is robust. the bill that congressman guinta and i, the stop abuse act, does include a provision for state -- interstate compliance with prescription drug monitor because we're in a small state and surrounded by the other new england states. we have learned from hospitals and physicians and treatment providers that people are shopping across state lines if you will. but on a number of fronts we can work together, work with law enforcement, with health care providers and start to begin to bend the curve as you said, dr. compton. those were dramatic and staggering slides. i hope we'll get a chance to get those up and share those with our constituents and with folks across the country so that people understand the urgency, but they also understand that
there are steps we can take and we will be taking in the next six months to really make a difference in people's lives. so i thank you for being with us. thank you, i yield back. >> thank you, the gentle lady from new hampshire. i would like to yield myself two minutes as well. first, i want to thank dr. compton and dr. campopiano and dr. peirce to iorm us as members and those interested in this epidemic. i would like to thank the cochair of the bipartisan task force to combat the heroin epidemic, congresswoman kuster and the members of the task force now 50 members of congress. this is a clearly growing concern across the nation. more and more members are understanding the concern, not just from what we're accomplishing here in washington, but from their constituents as well. i think we have learned a whole host of new ways that we can help the prescription side of
this particular issue and as we continue to look at legislation and how we can help at a federal level, to integrate what we're trying to do with the stop abuse act we may call upon you to help us in that challenge. i also see one of the key significant components is eliminating the stigmatism. i have gone through this many my life because i have a family member with mental illness, and the stigma is just as bad as with substance abuse and it's something we have to continue to inform and make people aware that this is a disease and that if there's something we can attack and that we can help. i also i hope that this year we can pass the stop abuse act. there are several components of the act that i think would dramatically and immediately help those who are looking for a way to assist themselves or their family members and a way out of the deep dive that they're in. and we also do have to inform
those in our districts and around the nation of how pervasive this epidemic is. and if you think about it whether it's from a national perspective or a new hampshire perspective. heroin abuse in the united states has reached unprecedented levels. it's increased 63% over the last decade. when you see something of that significance, an increase that quickly, you would consider that a national epidemic. new hampshire alone we have doubled from 2004 to 2013 the number of estate based inpatient individuals to 1,500. we have had thousands of overdoses in the last year and we have had 400 deaths related to drug overdose. i'm interested and i know that the chair kuster was also interested in not just solving the this crisis, but also in anticipating and planning for the next one. so we can be proactive in shave
saving as many lives as we can. so i thank you very much for the time that you have given us today. we will be announcing our next hearing in the coming weeks. and we look forward to working with each and every one in come batting this heroin epidemic. with that, our time has expired for the afternoon. thank you for being here and we are now closed.
former defense secretaries from the obama, clinton and carter administrations will talk about u.s./china relations and some of the major challenges ahead. that forum live at 5:00 here on c-span 3. as president obama prepares for his state of the union address on tuesday, he released this video on twitter.
>> i'm working on my state of the union address. it's my last one. and as i'm writing, i keep thinking about the road that we have travelled together these past seven years. that's what makes america great. our capacity to change for the better. our ability to come together as one american family and pull ourselves closer to the america we believe in. it's hard to see sometimes in the day to day noise of washington but it who we are and it is what i want to focus on in this state of the union address. >> and c-span's coverage starts at 8:00 p.m. with betty coed and congressional reporter james arkin, looking back at the history and tradition of the president's annual message and what to expect in this year's address. then at 9:00, our live coverage of the president's speech followed by the republican response by south carolina governor nikki haley. plus, your reaction by phone, facebook, tweets and e-mail as
well as those from members of congress. on c-span, c-span radio and c-span.org. we'll re-air our state of the union coverage and the republican response starting at 11:00 p.m. eastern/8:00 p.m. pacific. also live after the speech we'll hear from members of congress in the hall with their reactions. journalist and former director of voice of america, david ensor discusses the state of u.s. international broadcasting and how washington can win the so called information war against russia, the islamic state and others. the university of south carolina hosted the event last week. >> we are honored and pleased to have someone also known to almost everyone in this room. which is someone known to
eryone in this room. david ensor. former director of the voice of america. he's had an extraordinary career at npr, out at abc news before voi. since voi he's beened a harvard where he developed a report which you see on the harvard website. he's going to bring us a summary of it today. so david, the floor is yours. >> thank you very much. okay, the question is will the mike be loud enough? if anyone doesn't hear me, if anyone doesn't hear me please let me know because i will speak louder. i can do that. i used to do it for a living. it's nice to be here today and thank you very much for coming out. my print colleagues used to complain about a newspaper
headline writers who would exaggerate the contents of their articles and create an attention grabbing headline. i'm afraid the title of this talk may frankly be in that category. it's the headline given to an article i recently published based on this paper. it makes a promise of more wisdom than i probably -- i think than any one of us in the room, and certainly more than i have. but at least maybe it helped to convince you to come here today so it achieved its purpose. also the headline writer chose the term information war. my friend admiral, dean of the fletcher school says he thinks the war of ideas is as flawed as a concept as the war on drugs. in practice, he said we need a marketplace of ideas that presents positive alternatives and not just the negative side of islam. he's right of course.
i don't have all the answers as to how washington can win the information war or prevail in the marketplace of ideas, but i would like today to try to offer you some thoughts on the road forward from the perspective of someone who was as was mentioned honored to have led the voice of america for four year, to have worked in public diplomacy in afghanistan for 16 months before that in the embassy. who served the nation as a broadcast journalist for 30 years before that. for starters, we need to face facts. we will not do well enough in this arena until we take it more seriously. it's clear from our recent history in iraq, afghanistan and elsewhere that america cannot prevail globally with hard power alone, but the nation's capacity to participate in the global contest of ideas has been allowed to decline in recent years. veep as the information -- even as the information challenges we face grow and change. in a world where vladimir putin
weaponizes information and where terrorists recruit on the internet, the united states has no one in overall charge of its information efforts. it has cut the budget for diplomacy and spending in real terms on exporting honest journalism. as most here know, when the u.s. information agency was disbanded at the end of the cold war, public diplomacy efforts were moved to the state department across the street. and international broadcasting was put under the bipartisan board. let's start with the advocacy side, the public diplomacy side of that equation first. since 1999 when this happened, it has suffered quite frankly from weak budgets and excessive leadership turnover. understandably perhaps unfortunately, public diplomacy tends not to be valued at the department as highly as conventional diplomacy. frankly in the digital age i think thatay of thinking is out of date.
in recent weeks both president obama and hillary clinton the democratic candidate and former secretary of state have called for american digital technology companies to help the government prevent terrorists from using social media and the internet to propagandize and recruit. and now there's a whole post snowden debate about what's the proper place for our country on the scale between security and privacy. that's a big complex topic and not the subject of my talk today, but i simply mention it, this front burner issue, to underscore the nation's need for full-time sustained leadership in the area of information. there's a countermessaging aspect of this too. the state department has a $5.8 million effort to counter isis recruiting online. the work's critically important, but frankly the effort is much too small. so it may be just as well that
in the upcoming defense authorization bill, the pentagon is given permission to launch a bigger effort of its own. going forward however, maintaining civilian control and high level coordination will be key as will strong partnerships with our allies in the region. and in fact, i believe the actual efforts on website chat rooms and social media should only be done by arab partners in the region and not by washington. of course there's much more to public diplomacy than countering isis on the internet. one of the most effective efforts in afghanistan when i served in the embassy was our effort to strengthen the afghan media. it was highly successful. we and others including the british government did a lot to make the media sector in afghanistan vibe rant, strong,
meaningful for the country. but that sector along with the others faces some new challenges as the taliban takes back territory and as investment from overseas is reduced. it's going to need some continued support. we can't just leave it. one of the most powerful ways though to project american values and help our friends around the world is to export the first amendment by broadcasting truthful journalism. and because the united states is one of the relatively few nations around the world where there is no state broadcaster on the air, few americans realize that the voice of america is actually one of the most influential media organizations on the planet. because in november this past november, voa parent agency, the broadcasting board of governors, issued the report on global audiences. in the past four years, the audience has grown 40%.
to almost 188 million people a week. they listen to, watch, or read voa on everything from short wave radio to satellite television, from smartphone apps to facebook and twitter. and this robust growth has come despite budget cuts in real terms. it is also come despite basic problems with the governance structure over voa and sister entities. the idea behind the creation of a bbc was laudable to create a firewall, protecting the independence of the journalism from interference by policymakers. but ask yourself this question. how can nine busy people run a large, complex collection of companies as a part-time activity? the bbg has had difficulty, sometimes, playing an effective decision making role. it's not helped that the white house and the senate have often
left seats unfilled for long periods of time. fortunately, chairman b -- chairman jeff kjell and the current board understand the structural problem and what to do with it. they rightly want to get ott of the business of running international broadcasting month to month. the bbg's recent appointment of a full-time executive officer for u.s. international media is an excellent first step in my view. because what's needed is a full-time professional boss. but john lansing the seasoned media manager who's in that role now now needs legislation giving him clear authority over all budgets and all personnel. unfortunately, there is a bill currently before the house of representatives which unless amended could make things worse. the current draft of hr 2323 would create yet another board
and yet another ceo to oversee three of voa's sister entities, radio free europe, radio free asia and the middle east broadcasting network. so now there would be two separate and competing u.s. civilian broadcasting efforts. there would be a needless duplication of oversight and management layers. it would also exasperate an will be unhealthy rivalry over funding and market roles between the radio frees and voice of america. furthermore, the bill has language ordering the voa which has always been a full service broadcaster to cover only news relating to the united states or to u.s. policies. that would be a poison pill. it would be a recipe for declining audiences and impact. instead of confrontation and divorce, as is proposed in hr 2323, what we need is a model of
collaboration between voa and the sister organizations. we need more projects like the russian language tv show current time, which was created after the seizure of crimea. the show has anchors in washington and prague. it's coproduced by rfe and voa and seen on 25 stations in nine countries. almost 2 million russians inside the federation are able to download it, to stream it off the internet or see it on satellite television. neither are rfe or voa could have done this project alone. it takes collaboration. i would urge those of you who are interested to take a look at the bill and let your representatives and senators know what you think. i understand that there's an argument being made in recent days by some radio free alumni
that somehow it might not be acceptable or even legal for a federal ceo to oversee the grantees. the point is this. john lansing is not an administration federal appointee. he was chosen by a bipartisan board. he's protected by a political firewall that the bbg represents. and i think accountability to a full-time professional with oversight of the whole effort would be good for everybody. and good for our country. let me turn for a few minutes the to a key question in the fast changing media world. what should voa and sister entities be? in a cacophony of voices where half truths and spin and information are, is journalism done with objectivity and balance still the answer or is it time to advocate for government policies as some of the newer state broadcasters are already doing?
this is not a new debate. it's been revisited many times since voa's founding as alan hal's excellent history tells us. but once again, in recent years, a number of influential voices have called for voa to be a full throated advocate for american policy rather than a journalistic enterprise. for this research paper that i have been working on for the last few months at harvard, i took a look at the two models in the marketplace. comparing voa and the bbc world service with newer challenges that advocate and spin for their governments. i looked at some data on russia's rt, china's ccb and that the coverage by al jazeera arabic of the events in places like egypt and how that played out for them. if the goal is to seek to influence public in strategic places around the world then i would say the evidence is pretty
clear. influence is a difficult thing to measure. but rest assured without measurable audience you will not have it. rt for example claims a worldwide reach of 700 million people. but that claim is deliberately misleading. the russians are using potential audience reach as their metric. in other words, every single person who sits underneath a satellite which has the rt signal on it or who has a cable menu hundreds of cable stations available to them counts in the 700 million. no one in the business uses that metric. it is meaningless. what we professionals measure is actual audience. thus, the voa audience estimate of 188 million is paced on careful polling by the gallup
organization and others as is the bbc that it has a worldwide audience of 300 million people per week. after the shooting down of the malaysian jet over ukraine, the media reported on the mounting efldz -- evidence that the weapon used was russian made and could have been fired from a town held by russian backed rebels. rt in the early days cranked out a new theory on who could have been responsible for practically every news cycle. maybe it was the ukrainians trying to shoot down president putin's plane, maybe it was a cia conspiracy. if the goal was confusion, rt's approach may have been partially successful. but if the goal was credibility with lots of people, not so much. while rt has not put up backed up audience estimates there are some numbers out there. in the u.k. for example, in may 2013 when the ukraine story was hot, rt was 175th out of 278 channels in the united kingdom. i had about 120,000 viewers.
as rt's coverage became increasingly one sided and shrill, that number dropped. a year later it was 90,000. less than 0.2% of the u.k. viewing population. in the united states, rt claimed a solid audience, but it does not make public data from the nielsen company or elsewhere to back that claim up. a nielsen press official told one reporter that the american audience is too small to be measured. china's cc tv with the budget in the multiple billions of dollars has poured money into broadcasting in africa. yet, the results also appear to so far to have been relatively disappointing. for example, data gathered for the bbg from kenya in 2013 showed 52% of kenyans watching a local challenge called citizen tv. 17% watching cnn. 7% watching the bbc and just 2%
watching cc tv in that market. at that time. in egypt, when al jazeera arabic moved to heavily biased content in favor of the muslim brotherhood, it lost a substantial share of the audience, very, very rapidly. to some newer egyptian channels but also to bbc arabic. i'm not sure that we americans would be much good at propaganda anyway but after looking at the numbers i'm convinced of this. honesty on the air is not only the right thing to do. it's also the best business strategy for the voice of america and the other broadcasters that are funded by the united states government. now, of course, that means telling the truth. even about us. coverage of the abu ghraib scandal, the snowden revelations, the protests in ferguson, missouri, about police kills of african-americans that coverage was and had to be thorough, complete.
each time the voa reporters explain how this country deals with its challenges, their journalism amounts to a civics lesson. that's more powerful in my view than any propaganda ever could be. after four years at the helm of voa i have a lot of specific suggestions about how to build impact in audiences and in specific markets. from what we called denied areas like russia, china, iran, to more mature markets like ibdznese ya, latin america to key growth areas. but i would rather get to questions and discussions so i think i'm going to say that those -- the points that i have to make on the markets and what can be done on them in my view can be found on the website of harvard's school of government. briefly let me say, we can do
much more to influence our world for the better but we'll need to set up a clear leadership structure and we'll need to more adequately fund broadcasting and public diplomacy. back in 1961, president john f. kennedy recruited the famed journalist edward r. murrow to run u.s. iaa. perhaps president obama or his successor should hire an information adviser who is similarly experienced. in the age of rt, and isis online recruiting in our digital age, it's time for our country to more effectively engage in the marketplace of ideas. we should not delay. thank you. >> thank you, david, and as he said he's welcoming your questions and comments. i see one hand, arnold siteland. >> good afternoon.
my name is arnold siteland and i teach journalism in china. you mentioned russia. you mentioned isis and you mentioned the middle east, afghanistan. you haven't said anything about china. i wonder if you can assess the impact of china in the so-called information war, especially with the recent discussion by president si of inserting the factory of sovereignty into the intersnet. >> well, china has taken the subject of soft power very seriously. there are, you know, reported reportedly -- reportedly having signed a budget of over $700 billion to various kinds of projects and what we'd call public diplomacy and broadcasting. i don't know if you have seen
the building -- the headquarters of cc tv but it's one of the more extraordinary pieces of architecture and clearly not cheap. there are scores of confucius institutes that have been set up around the world. so china takes the subject very seriously. they read jonai of harvard who coined the term soft power and they read him and quote him back in corporations about the subject matter. what -- the problem for them is that, at least in my view, you know, you've got my resume. you know where i'm coming from. it -- the truth is more powerful than propaganda will ever be. if you look at for example i was talking about kenya the market, the numbers for cctv in kenya. looking at some of the coverage and talking to people who have looked at much more of it, you
know, the chinese were telling their african employees who worked on the station, you can't mention the name of countries that have relations with taiwan. you know? countries in africa. they can't even be mentioned on the air. or when you're doing a story about ivory poaching, you mustn't mention the demand side. the chinese demand side. so you end up with journalism that isn't -- it's desiccated. i want isn't truthful. and as long as they don't face up to the fact that that doesn't really sell all that well, they're going to have a problem. we don't have to spend $7 billion to compete with them because our project is a better one. but with that said, it worries me the size of the budgets. the -- you know, some of my -- some of my colleague, who at abc and at cnn, very good people, are now working for cctv.
they can afford the best. they have terrific production values, as in zi sets. no money is spared in distribution, satellites and so forth. it's a formidable effort by china and they have the long view. so, you know, they are a competitor that i respect. that has certain strengths. i just wish we would become a bit more of a competitor too because we have even more strengths in my view. but we've got to get serious about it, which is the point i'm trying to make in the speech. we used to be pretty good at this. the world is changing really rapidly right now. in ways in which human beings communicate with each other is changing daily. we need to be on this, so on this, and we're not in my view. >> hi. i'm wondering if you could comment on the seeming dichotomy between putting more money in to
social media when that is the easiest format for countries around the world to close off. usually a great firewall or a smaller firewall. and so you can never reach the, you know, designed audience. what's the dichotomy between that and -- what's the other half? >> well, you know -- broadcasting, satellite, things more difficult to block. in other words, you can shut twitter off or facebook with a flip of a switch in any country in the world if they desire. >> yeah, it's not as simple as that. andy mendez is sitting in the foreground here and he works hard on this. the bbg spends -- i don't know the exact number, but i'm sure andre does, but it's millions, multiple millions.
10 or 12. 17. $17 million, on internet circumvention efforts of various kinds. it funds an hourly effort if not more, by certain companies to set up work arounds so that young chinese people and others around the world can still get freely on to the internet, despite the great firewall and the efforts to shut things down and censor things in china and other countries is that enough, no, it's not enough. but it means that -- for example, like voa, their new numbers not too long ago and the number of people in china who reach voa materials weekly, you know, is -- i think it's well over 2 million now. okay. it's a huge country, you might say that's not many, but it's not an insignificant audience. but if we work at it, probably with a little more robust funding and clearness of
leadership and direction we could do a lot more than that. you know, 2 million people in china, that's worth -- that's an audience worth reaching so i wouldn't say that it's not worth the money. to be on -- to be trying to reach people in china and other countries on the internet or social media. with that said, doing that alone is clearly not a public diplomacy strategy. i mean, i'm a big believer in some of the more traditional levers that we have all used. when don bishop and i were in afghanistan, we greatly increased the number of fulbright scholarships. i mean, that brings people to our country. you know, who are going to have an experience that they'll take back with them and it changes people forever. i think many people in the room
here know examples of how much difference that makes. how many world leaders, national leaders have had that kind of exchange experience or studied at one of our universities. programs encouraging that sort of thing are deep and powerful. we need to do those as well. if the point of your question is we shouldn't put all our eggs in the social media basket, i totally agree with you. on the other hand, we should be in the basket big time. >> thank you. i have been a reporter since 1968. first of all, congratulations on your career, great career. secondly, can i echo what -- tribute to max kacus, who died and he worked to improve things, very sad. my question is like a song from the sound of music, how do you solve a problem like the donald? the image that we project now is donald trump and ted cruz and this man might well become
president. how do you do public diplomacy with those who -- >> thanks for the temptation to get into politics. i'm going to forego the pleasure, however. i mean, i'm worried about the tone of the debate that we are hearing thus far. and the way it resonates overseas as i know many people in the room realize, you know, which can be quite negative. but we'll have to buckle up our seat belts because it's going to get bumpier before we have a president elected. i think that's just the kind of thing you have to keep emphasizing to foreign audiences as well as domestic ones. that in the heat of the campaign a lot of things get said. what matters is what's done. what the next president will actually do. that's what matters. that's more heat than light in the american presidential campaign many times.
but you're kind of -- you're asking me to go rather beyond where i want to go here today, to be honest. thanks for asking. should by pointing to people? >> ken moscow, retired fso. a very coherent and very persuasive presentation. thank you. you started by sounding like we needed a gentler, kinder information effort that is not a war of ideas but a marketplace. but i recall the war of ideas coming out of the white house because we had these gentle arts and educational programs which didn't have a policy content. there was no point, no goal there. that we needed something harder, something more muscular. i wonder if we're going to move to something which you seem to suggest that we don't need to spend more money on it, because the see ones, the efforts that come out of the pentagon, the
new sources this would be closed down, or this is something that's also worthy? is this something you're arguing against? >> what i'm trying to say is -- in my opinion, all of that other stuff you just mentioned, the gray programs if you will, that's all part of the information policy for a country. i mean, our country has white, gray and black programs in the area of information. and what we don't have is someone in overall charge of it, who thinks about how these things relate to each other. we should. we should have -- this is a serious matter. it should be handled at a high matter. there should be people doing it full-time. that's my main point. the other point it's underresourced. all of it is underresourced, including public diplomacy efforts, including honest journalism and also including the various kind of messages that others are involved in. we're not taking the subject
seriously enough. pretty simple point, but that's what i strongly believe. >> hi, david. jim bullock. >> nice to see you. >> going back to the idea of having one person in charge. you said overseas, you know, you have violent extremists recruiting in various countries and it would be best to leave organizations in the countries to take the lead on countering the extremism message. i get back to the question here in the united states. we have massive recruiting among somalis in minneapolis, et cetera, and yet we were all raised in -- we can't violate this firewall. do you see -- do you see a role for this one person in charge going across into domestic messaging out of the white house or wherever? is that doable or how would you
square that circle? i'm aware of an exchange student right now who is actually being harassed. who we are field officers would send people back, but what happens to the young muslim student who comes to the united states and in fact has a bad experience? are we failing to message the american people about what really needs to be done? that's a tough question. but i'll give it to you. >> yeah. well, on the first half, i can -- don't think i can help much on the second half. that's are very regrettable and there needs to be work on various fronts by the leadership to try to minimize the number of times that happens. most of the people who come have a good experience, but it's terrible when someone doesn't. on the first point of smith monthen on the celebration, a couple of years ago congress amended smith mont to reflect reality.
the internet had made an ass of the law, let's be honest. for example, on voice of america, thou shalt not broadcast to the united states, period. full stop. but all you had to do was go on a website and click and you had a live stream of our somali service in minnesota, right? by the way a lot of people in minnesota were listening to that somali service and what's wrong with that, one thought? congress thought so too. so in a recognition of reality and a very sensible move, they amended smith mont to say if asked you can offer the broadcasts. set up a system under which that can be done. you're beginning to be able to hear the voa somali in minnesota and voa creole in florida and other broadcasts that are not designed for u.s. domestic consumption and not $1 is spent to -- for coverage aimed at this country.
yeah. well, i guess i would say this. this is the kind of reason we need information leadership. we need to think this through. yes, i think there are some concept of national barriers is getting weaker all the time. and we need to face that reality. technology's moving ahead. an and many of the platforms we now broadcast on, talk op, communicate on, are global in nature. they don't respect borders. so, our strategy should reflect that reality. and the amendment is probably, i think you're implying, i think you're right, probably just one step of a number that ought to be made to make it easier to address the global audience. the somalis in minnesota are somali, too, as well as americans, and they can be influential on people who might be recruited. so, it's really a global problem. needs a global solution. very much agree with that underlying sentiment i get from
your question. >> yes, thank you very much. my name is is greta morris, i'm retired public diplomacy officer. you've mentioned a couple of times the need for overall and very strong and capable leadership of the u.s. information effort. and of course mentioned edward r. murrow, and i'm just wondering what you see as the ideal profile for a director of that, a leader of that effort. and secondly, should that be a whole of government effort or are we talking about someone at the state department or nsc or perhaps over all the various entities that are a part of this information effort. >> i appreciate your question. i feel a little uncomfortable.
it might be presumptuous of me to put my own architecture up there and say, this is what it should be. i think better heads than mine can figure this out. i would say one thing. i think that the next president needs an information policy adviser who's in all the meetings. and then maybe it's a question of just having the right structure. i talked about structure over at the bbg. i very strongly believe that one full-time boss is what the broadcasting entities need. i know that many on the other, from the others, from the grantees, are nervous about that. afraid they'll sort of be corralled into a federal space where they feel they don't belong. i would just say that i don't think that would be a problem. and i think the challenges our country faces abroad are so large now. in the information area. that we really don't have the
luxury of having lots of people running off in all different directions. we need a clearly, well-led effort. and i think the radio frees can contribute a lot from where they are and should do so, but under a full time professional boss who kind of makes it all work in a cohesive way. i mentioned the current time show, you know, it took leadership from folks at the bbg to help get to where they could do that and shows better than either network could have produced and has a larger audience. it's not perfect. it's not enough. those kinds of efforts are only possible if you have one board, one ceo, unified structure and everybody pulls in the same direction. a i strongly believe that's what's need on the broadcast side. i'm less expert on the state department diplomacy side, although i did serve in the
embassy as a public diplomacy officer and very proud to have done so. i have some views on what works and what doesn't in that area. if you look at what the budget was when usia handed it over to the state department, it's smaller now. and that's, you know, many years later when the dollar isn't worth what it was. why is that the case? it should the nobody the case. if anythinging public diplomacy is getting more important, not less. so, i think the leadership of the state department needs to look closely at this and really should put a higher priority on it and we should have an undersecretary who stays for a while. we have one now who wants to stay and that's wonderful. there have been too much turnover in the job i think, i'll say that. yeah. >> thank you for your comments. monty mcghee, i work with the state department, but i'm not here speaking on behalf, i'm speaking for myself. i really enjoyed both of your pieces.
the fp as well as the more in depth part of the piece. i wanted to go back to a point that was made earlier, but address anytime a little bit of a different way. this idea of new media versus traditional media. you focus a lot on the idea of a shrinking budget and the need to invest more. what i'm interested to know is given the fact that much of the next againration or much of the world the way we see it, whether it be in africa or latin america, is under an age where traditional media would be to look for their news and information. and new media, social media platforms are where many people get their information. now, so, can you help me understand how reinvesting more into traditional media is actually where our dollars should go as opposed to accounting for where the current and future information will be
sought? >> if you took from my remarks that i think traditional media is where we should put our eggs, then i didn't explain it properly. i do not believe that. i believe that each market -- people used to ask me, what's your overall strategy at voa? i would say, i've got 45, which one do you want to talk about? 45 language services. in each one there's a different situation. in north korea, yeah, short wave radio is probably the best thing. there may be a little bit of medium wave along the border and so forth. at night, you can get people that way, but basically, there's not much more that's going to work in north korea. but in russia, where putin has thrown international broadcasters off of their partnerships with tv and radio stations around federation, clearly, an internet strategy aimed at mostly young people is our best and main way of reaching people in the russian federation. that said, as i said, there's television, radio, music
partners, getting things on to youtube, getting clips out of shows on youtube every day that are interesting, that are stimulating, thought provoking. you need a strategy that's different for each market. in latin america, while i was director, when i arrived, we had about 3 million listeners or viewers in latin america. we now have over 30 million. because we, i don't claim credit for this, my predecessors thought this up, but i helped enact it. we went to a new strategy. we recognized that latin america has most markets, mature media. they're doing the news. they don't want us to do it for them. however, if you go to tvs tech owe mexico and you say, that's a great evening news show you have there. we notice you don't cover the country to your north though very much. why is that? could we help you with that? maybe have somebody perhaps mexican born, who went to an american journalism school and now works at voa who will cover whatever suspect within reason
you want covered out of washington or elsewhere. maybe on your evening news every night for three or four minutes. people jump at that. so, that's a mature market strategy that is paying dividends in latin america, indonesia, ukraine, believe it or not, and many other markets. it depends where you're looking. in northern nigeria, the housing service. very, very strong service. has for years had a solid audience in the millions. short wave radio broadcasts. that audience is dying off, and the use of short wave radio is dropping quite rapidly at the moment. so, what has the service done? launched a mobile app in house. with news and sports and various other sort of lifestyle features, stuff about america. that click on your phone.
the app figures out what kind of phone you have. if it's primitive, it will give you a simpler product. if it's more sophisticated, it will give you more. the last figures i saw, we're losing something like 3 million in short wave viewers and gaining about 2.5 million or so on mobile app. so you've got to move to the place where the market's going and where the young people are going because they're going to be the audience to longer. and voa is doing that, with proper funding, with more robust funding, a lot more could and should be done. but no, i don't think we should be bias in favor traditionally. i will say this. a lot of people around this town talk about new media as the answer to everything. the biggest audience growth at voa over the last four years is old fashioned television. you know, old media. and there's a tremendous amount of growth still possible on traditional media.
>> we'll break away from the last part of this program. live now to the omni hotel here in washington for the national committee on us-china relations for former defense secretaries talking about u.s. and china policy. live coverage on c-span3. >> and chinese about america from ping-pong diplomacy to today's program, we have sought to strengthen the bilateral relationship with fostering relations and informed discussion. today's program is the first in a series of seven programs throughout the next year. two months, we will gather the former secretaries of the treasury. in two months later the former secretaries of commerce. and united states trade representatives. including our chair, carla hills, who is here with us today. later in the year, we will gather national security
advisers. and then, american business leaders who have blazed trails in china. our final program this year will gather former secretaries of state. and next year we will hold a similar program in china with many chinese leaders some of whom are alumni of our programs. to begin the celebrations today, i am joined by former -- four former secretary of defense who also happened to be four great americans. all four of them have served our country above and beyond the call of duty. and have contributed to peace in this world in ways too numerous to enumerate. if i began to list their
accomplishments, i would have no time for questions for discussions. so let me go right to questions. i will stashtd with dr. harold brown, secretary from 1977 to '81. then go to william perry, who was secretary from 1994 to '97. bill, can you hear us? >> i can. >> we couldn't hear your response. >> i can hear you fine. >> terrific. >> then, we'll go to senator william cohen, secretary from '97-2001. and finally, to senator chuck hagel, who was secretary from 2013 to less than a year ago. i and the american people cannot thank all of you enough for your service to our country. and i am honored to be here with you today. secretary brown, you were
secretary when we established diplomatic relations with china and is and a young lawyer, at the chinese are fond of saying small potato in the state department. tell us about the relationship with china in those early days when you were secretary and dealings you had with the chinese. >> the situation then between the u.s. and china were very different from what they are now or were for the tenures of the others as secretary of defense who will be speaking here today. the chinese were then very much worried about soviet possible attack on china. and looked to the u.s. as an offset, essentially, and as a way of ensuring chinese
security. moreover, they were very far from their present military capabilities. and that's quite different from the situation not only today but during the tenure of the others here. bill perry was in a somewhat different position because he was my undersecretary at that time and, in fact, went to china as a way of exploring some cooperation in terms of research and development, and even perhaps -- well it didn't happen until quite a bit later -- even some transfers. so that's a very different situation from the present. i've watched and, to some degree
participat participated, in the somewhat evolution of the strategic relationship of the military-to-military relationship. and i must says that it's become, at first, a cautious relationship. and now has turned into a peculiar combination of int interdependence and disagreement and, in fact, controversy, and even -- it wasn't approached am knitty yet but it could get there. that's, i think, to some degree, limited by the mutual dependence of the two economies. and i know i'll offend bill perry by saying this, but it's almost limited by the possession of nuclear weapons on both sides in the devil's bargain that is
mutual deterrence. that is to say, the sides are greatly inhibited from armed conflict by the possibility it would escalate to nuclear war. but of course, if it happens, it is an unimaginable catastrophe. maybe there's an intermediate step that is created by cyber warfare. but, in any event, that's going to be a big worry. the relationship is very different, both in nature and relative position of the two sides from the way it was when i was secretary of defense and when i first visited china and saw military display that largely consisted of troops mounted on bicycles. >> secretary perry, it was about
13 years later that you then became secretary of defense. talk about the relationship with china then, obviously you experienced quite a dust-up, so to speak, of the taiwan issue at that point. >> well, it's time that bill clinton was a candidate and running for president. he took a very negative position on china. and as a consequence of that, when we came in office we had no real significant mutual relationship with them. the secretary thought that was a mistake with the president to allow the close relationship. i had the opportunity with the permission of president clinton
to make a significant visit to china. this was my second visit. the first one, i think, occurred at the request of secretary brown, as he mentioned. this visit was about one week in duration and it was, i would say, interesting and useful but not really extremely productive. we had a cordial relationship, not a close relationship. and then about no more than a year after that, i guess about the time that the minister of defense of china was scheduled for a arenreturn visit to the ud states, we had an incident in the taiwan strait where chinese and of course military exercise in the strait fired missiles that landed within a few tens of
miles of taiwan. obvious will a very provocative action that occurred about the time the taiwanese were conducting presidential elections and i think intended to intimidate the taiwan people not to vote for the candidate who was seemingly promoting independence from china. both president clinton and i believed that this violated agreement that led to the shanghai concord and we felt it was a dangerous situation. i arequested, and received, permission to send two battle groups to the taiwan strait, along with a message to china th we were -- thought their actions during the exercise were not -- we could not tolerate
those and we were sending this -- sending the groups to ensure. this has the desired effect, military exercise stopped. there were no missiles fired. but of course, it strained our relationship. i had to cancel the return visit of the chinese minister a few weeks after that. i feared this was going to be the end 0 of our relationship with china during the clinton administration. it turned out a year after that, the last year of my term as secretary, we were able to get back on a positive track again. and indeed defense minister of china did make a return visit. it was friendly but not close. and in terms of subsequent relations nothing was accomplished in those meetings. we were in a tenuous relationship at that time. later on in the clinton
administration the relationship grew quite a bit more. for that period right after the taiwan strait incident they were very tense. >> thank you. secretary cohen, you followed right on, i guess, bill's stewardship. tell us how the relationship kind of evolved, our defense relationship evolve the with china during your tenure. >> as secretary perry pointed out, a year after he left office, the situation improved. i'd like to think it was because a republican was at the defense department. about but really, i owe a great deal to secretary perry. he took a tough stand, at a time when a signal needed to be sent at the time, that we wanted to see a peaceful unification of taiwan with the mainland. and so i inherited a much better
situation certainly than secretary perry had at that time. and i would like to think that my tenure during that period was -- it was closer and i think friendlier. and i had been going to china since december 1978, when i was just about to be sworn in as u.s. senator as a member of the house of representatives and delegation of four senators were sent to beijing. senator nunn, senator hart, senator glenn and myself. the three of them decided being the youngest member of the group, that i should raise the issue of human rights. [ laughter ] so that was my first experience. and i met with the then-equivalent of defense minister at that time, and i asked what the defense budget was. the answer was, we don't have one. so it was a different china at
that time than certainly my years later when i went as secretary of defense. my tenure there was positive. it was for the four years that i was therer i would say very gratifying, one of the first things i tried to do was set up a hot line between the defense department and military departments in china. it didn't take place quickly. it took ten years. that was not actually instituted until 2007. but nonetheless, it was a very positive relationship then. i should say that i have a bit of a conflict of interest because i have been going to china now for many, many years, and actually i have two offices in china. one in beijing, one in tanjen. i have made it part of my career as such to foster a about thor relationship between u.s. and china. but it also gives me an
opportunity to meet with china's officials, and to indicate to them very frankly, usually behind closed doors, what the issues are that are important to the united states and to our relationship with china. so i would say, during my period of time there with one exception and that was the sale proposed by israel to china of a sophisticated radar system. i was very much opposed to it. i was able to persuade the administration that it was worth opposing. president clinton agreed, and the sale didn't go through. but i must say, it did not make the chinese government very happy with that. it was a deal they thought they had concluded and felt that i had intervened in a very negative way. other than that, one incident, i would say the relationship was very positive and since that time it has remained so.
>> secretary hagel? very recent, obviously, post pivot, post rebalance. tell us about the relationship that you had as secretary with the chinese and the experiences that you had with them. >> steve, just as my three predecessors have noted, each of us inherit a different situation. i had a different time in the relationship. and as i was listening, as i always do to my elders, on this, i will start here because i think the three of them have developed a pretty good base to work from. from the time bill cohen left office until i came to office, it was about a dozen years. and in that intervening 12 years, as everyone here knows, a tremendous amount occurred in china, started with the
development, economic development. and with that came an expe expectati expectation, i think, of a pushing out in their defense capabilities, as in, i think we've seen clearly all of their capabilities, technological capacity. and so when i became secretary of defense, i think relations were very much on the upside. now, there were some issues during the two years that i was secretary of defense, which i will mention in a moment, but i think generally what i inherited as secretary of defense was very good, very positive. that was a result, i think, of something harold brown said. we all know the common interests of our two nations that was prosperity, peace, stability, security. it was in our interests, it was
in china's interests, clearly. i also think it's important our uniformed military get a lot of credit. admiral locklear is here. those who served, admiral pruer's here -- those who served in the military, particularly the navy, who had responsibility for a specific command, did a tremendous amount in those 12 years in particular because they had more opportunities, i think, than military leaders did during my three predecessors' time to build those military-to-military relationships. and two admirals here with us tonight did really tremendous work as well as their colleagues. so i was fortunate when i became secretary, in particular, with what already had been built and was building out and what i thought was exactly the right
thing at the right time and the vision of president obama to make very clear a defined, pronounced rebalancing of our interests. and i used to say in the six long asia pacific trips i took -- as you know every trip you take is long to the pacific or anywhere in asia -- that the rebalance, what was not to crowd out china or to contain china or to in any way afflict any damage economic, security damage to china, but was to engage china as well as all of the nations in the pacific, and asia, we all know that the united states has been a pacific power for more than a century. clearly a pacific power. in fact the entire western hemisphere, north to south,
borders the pacific. our interests are very clear. china's interests are very clear. now, how we managed through those differences, like the east china sea, south china sea issue, which really developed and came to a head during the time i was there, i think, are the more defined critical examples of managing through a very difficult set of circumstances. and i think, too, what we've seen in the markets -- and i know yard probably going to get to some of this, so i'll told any particular comments on this -- the reflexion of what's happened in china's markets the last week and how that has reflected on everyone's markets consequences, reactions, and i think that should -- if we needed any other reminder -- should clearly remind us, again, of something my predecessors have all mentioned the inner
connectedness of our interests and china's interests and all of the nations of asia pacific. so sum it up, my time at the defense department was a time of really more, i think, continued engagement as our military-to-military leaders have done, as i did in the six trips i took. in fact, i took those at my initiative to do more and more of that, develop partnerships, relationships. and also, a time of more and more -- i wouldn't say conflict. i would say difference -- differences that i think are going to continue to grow out, as china expands, their economic growth which they have been on this rocket ship the last 20 years have not been able to be sustained. cannot be sustained. but we surely want to stable
china and secure china and it's in our interests. all of that was bubbling at the time i was there. but overall, i think it was a time of management of the relationship. >> just a short follow-up, before i go on to my next question, which is, the rebalance is designed to engage the chinese, is designed to strengthen our alliances with our traditional allies. there's virtually no chinese who believes that, that any time you speak with the chinese they say it's directed against china, it has kind of allowed the philippines and vietnam to poke the chinese eyes because they know americans are strengthening their alliances and we're selling coast guardships to vietnamese to kind of confront
the chinese in their near shores. so why do you think the chinese universally doesn't believe what we're saying? let me first ask chuck, then i'll ask dr. brown. >> well, i concur with your premise that chinese, these leadership -- i suspect represents most of the people -- have that feeling about the rebalance. we're going to have to work through that for obvious reasons. but i'm not particularly surprised by that. i am no china expert, no asia pacific expert. but i recall the first -- my first visit to china as a businessman in 1984. and what china was then, and i was all over the country, five different cities, in those days there was only one flight a week
from new york, jfk, into beijing. we landed there on january 1st, 1984, and got off the plane, only plane on the tarmac, walked inside, being escorted by mao-suited submachine gun carriers, welcome to beijing. 32 years later, it is a different world. about you what i saw, i was in then-canton, different city, shaping high, bay inc. >> reporter: was a great suspicion of western interests, western culture, of manipulation. and i think we've always got to remember to focus on a framework of history when dealing with countries. where did they come from? where did we come from? now, that doesn't -- that doesn't excuse, in my opinion, some of the chinese behavior that we are seeing today. but that said, i think that
that's part of the answer. i can say some other things but in the interest of time here, let me hear from my colleagues. >> dr. brown, you want to comment on this one? >> a country that for 150 years was weak and was imposed upon, naturally feels aggrieved. the chinese feel aggrieved. the united states was not prominent among the aggrievers, as a matter of fact. but we represent the aggrievers to the chinese. and of course the government of china uses this as a way of getting support, patriotic feeling. i think a reasonable way of looking at this is to say it not what china thinks or what u.s.
thinks that should count most. what should count most is how the other countries in the region feel. and they essentially look to the u.s. as a way to avoid being dominated by china. al of this is natural. it's not very helpful. and i think, from our point of view, chinese have perhaps overused their legitimate task grievances. at the same time, i think what's happened is that the chinese have looked at the u.s. as recent stumbles, both geopolitically and economically, and concluded that, indeed, the u.s. is a power on the decline and that they are a rising power and that dispositions in the
region should reflect that change. well, i think maybe they're going to find that they are not without economic difficulties as well. and i worry that, instead of making them rethink and say, okay, it's time to negotiate as equals or as the existing power and the rising power, it may actually increase their sense of grievance. that's a big worry. but things are changing and they are going to be affected by the fact that the u.s. is recovering and china may be in some difficulties. >> may i add one point to harold's point? the united states of america has seven treaty obligations in the world. o