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tv   Key Capitol Hill Hearings  CSPAN  May 10, 2016 5:27am-7:01am EDT

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correspondent, who covers this issue. -- a politico correspondent, who covers this issue. we talked about the drug czar being there. he made the case that this is an issue of overprescribing. a week ago, the cdc announced new guidelines for prescribing for doctors. why did the cdc do that? >> like you said, the cdc sees that as an epidemic in the health care system that often does start with doctors prescribing a patient a prescription. 15 years, since 1999, the cdc says sales of prescription opioid medications have quadrupled. corresponding with that is a quadruple in the number of overdose deaths. the cdc guidelines are trying to
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change how doctors think about prescribing opioids, encouraging them to prescribe much shorter durations of treatment. lower doses of the medications. and also in many cases, encouraging them to think about not starting a patient on opioid, if that's not necessary. other kinds of perception medications, even trying modification first to deal with pain. host: executive action from the president yesterday, the cdc making initial guidelines on overprescribing. what about on capitol hill? as the senate left, they just pass the bill dealing with opioid addiction. what would that do? sarah: that bill would direct some money the federal government already appropriated. it would do two things. it would try and help support prevention programs, once that's try and prevent drug abuse and
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from even beginning. also help support treatment programs throughout the country to help those suffering from drug abuse. host: seems like one of the big amendments was some $600 million by senator shaheen. that amendment was defeated. what without money have done, and why was it defeated? -- what would that money have done, and why was it defeated? sarah: there's not a lot of appetite in the republican congress to spend new money. so they basically took money that had already been given out and regarded it here. a lot of democrats were pushing for congress to give more money to fight the problem. and it does seem like in the next set of appropriation bills, assuming those go through, that a lot of republicans in congress are thinking about providing more money to address the opioid
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epidemic. we will see how that plays out. also when the house considers some more legislation, whether they decide to add a money component or not. host: any word whether the house will take up that senate bill? sarah: it's not clear yet that they will. the chair of the house judiciary committee, who would be the committee taking up this bill has expressed interest. he says he wants to look at the costs of the bill and whether it's the best way to address the crisis. there is a lot of momentum. a lot of advocacy groups are pushing measures forward. the house is not quite started any work at. host: viewers can follow more on the bills and the opioid problem
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sarah, thanks for being with us. sarah: sure, thank you very much. host: let's get to your calls and comments. what should be the government's role in combating opioid addiction and abuse? barbara on them s line. caller: i think the advertisements from drugs and education to the public -- this has been proven to be true just as they banned cigarette ad. we need to ban prescription drug ads. when a patient season at, they are told -- patient sees an ad, they are told to ask their doctors. congress gets money the same way they got money from tobacco companies. i'm sure drug companies will suppress any bills that would suppress any of their money they are getting. from reba inear
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california. hello there. caller: hi, my husband has been prescribed that. opioids. he has been on them for quite a few years. they tried everything else. they tried stimulators, pain pump, they tried everything. with the new california law, with workers compensation, everything has to go through a board. all the pain doctors are quitting because they have to fight the review board. all of a sudden they are his opiates he's going through withdrawals. i think there should be some kind of law to help people on work comp that are already stuck on opioids. host: are you concerned about the new guidelines the cdc has putting out about overprescribing? caller: probably. my husband is not the kind that would overdose. he is the kind that absolutely needs them because there is nothing else. they have tried everything else.
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host: moreover issue spotlight program coming up on opid addiction. the government's role in addressing the problem. let's hear from paul in new orleans. welcome. caller: thanks so much for c-span. host: you bet. caller: i'd like to point out, if the nsa can record everything will conversation and e-mail in any form of communication for the purposes of terrorism, which is quite awful, but is not killing that many people as compared to all the other forms of international criminal activity that kill us. why don't they turned those resources and tell us who is bringing in all this dope? they are certainly using faxes, e-mails, every other form of communication. you can tell me who is killing us with terrorism, but you can tell me who is bringing in the dope? host: what do you do about the legal-- the legal prescriptions?
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what about that part of the problem? that is a corporate problem. you have corporations controlling the government to be allowed to use us as guinea pigs and consumers, not citizens. we are just here to eat and consume and chew up resources. in return for whatever little value we can give in return. host: let's hear from saginaw, michigan. johnny on the democrat's line. caller: good evening. host: go ahead. comment -- when , i am astening to this patient. i've noticed a lot of times, they tried to push pain pills and other drugs for new doctors coming in.
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, they have to overprescribing-- have ay they can't controlled substance without regular medication. a lot of times i get more medication than a i need instead of a one time payment occasion that i need once a month. medicationsof the than i really need to get this other medication. ust: d want to share with what kind of medication you take? taking vicodin,
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what they call hydrocortisone. and there. it here it, they wered giving me too much of it to cover the one medication that i needed periodically. host: the question this evening, is the government's role in combating opioid abuse? part of the effort has been the senate bill. just to recap the senate passed, this bill before the went on break. grant additional money to education and treatment programs. it would expand the ability of naloxone, or narcan, the one they use in overdose situations. and it would strengthen prescription drug monitoring, which seems to be the focus of the senators for -- the centers
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for disease control. checking a couple of tweaks, we are at @cspan. "the federal government should stay out. states should legalize and tax cannabis, use the rest of the money for treatment." "i wonder what types of incentives are given to doctors to prescribe drugs." @cspan is how you send us a tweet. mike from pennsylvania on the others line. caller: hi, i want to comment how these people are saying marijuana is a gateway drug to heroin. i did not start with marijuana, i started with cigarettes and high school. because i smoke cigarettes i fell into a particular clique. in that, there were those that had various types of drugs. i started with pcp and angel dust. i have been smoking marijuana for 40 years.i've held good jobs
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, i run companies, raised a family. no problem with the marijuana. once i started buying the marijuana and going to these places where people sold it, i came across the other drugs. if marijuana was legal, i would never have been exposed to all of these other drugs that these drug dealers had to deal the marijuana. so i wanted to get the point across. everybody does not start with marijuana. legal and i could go to a store and buy it, i would not have access to all those other drugs throughout the years. host: hey mike, had you keep that from being a gateway drug? you said you have been using it for 40 years. are there times where you are tempted to use something stronger? caller: in all the years i have done all kinds of things. but it wasn't because i was smoking marijuana. i had five years in addition to methamphetamine, five years to crack cocaine. i was able to be all that. and i am still smoking marijuana and is not trading problems in my life. --creating problems in my life.
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if i did not have to go to these drug houses to buy marijuana, i would not have been subjected to the crack cocaine, heroin, the meth, etc. host: mike, thanks so much. we will hear from fred in michigan, democrat's line. governmentt is the going to do to save those that are crippled and in need of opiates? twice --have been told that i was going to die. once from a car wreck, once from people breaking into my house for drugs. my ex-girlfriend told them that andd 20 pounds of pot $20,000 and the next thing i know, i'm nearly beaten to death with a hammer and a bat. host: so you were prescribed some sort of opiate? on norco and
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oxycontin. they walked away with hundred $78 and about 15 pills. and 8th of pot. and they put it in the paper as a drug case. all these doctors are running out of this area. poor people don't have the ability to make it to a doctor. host: we've got about 10 more minutes. i did want to show you a pretty graphic look at how the problem has expanded. this is a graphic done online at -- at how the epidemic of drug overdoses deaths ripples across america. this is a map, the red and orange part is the expansion of overdose deaths per 100,000 s ince 2003. you focus in 2014, and that map has gotten pretty broad across
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the u.s. just a couple of stats from that. they say the depths from overdoses -- the deaths from overdoses are reaching similar to the hiv epidemic at its peak. times, from the new york statistics from the cdc. there is the map currently, overdose deaths from 2014, in the neighborhood of 28,000. let's get back to your calls. here is mary in greensburg on the republican line. caller: hi there. i'm a 75-year-old person with all kinds of ailments. i've been on a patch for at least 12 years. and now they are trying to take this away from me. on not selling it. i'm not giving it to anyone. i change it every three days. that's not the only problem i have. i just don't understand, if teenagers know where to go buy this stuff, why don't the cops
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and undercover people know? host: mary, how are they trying to take this? are they offering you another painkiller, or are they raising the price? caller: no, let me explain. they want me to go to a pain clinic. because i cannot take anything with aspirin, my doctor said i would lead to death. -- i would bleed to death. i can't take anything, if i have been exposed to tuberculosis, so many of these means your immune system is way down and you'll get an infection. i mean, i just don't understand it. if you want the call me a drug addict, that's fine, and i need this patch. but summary is going to sign my death certificate, because if i don't get it, i don't know what i'm going to do. host: thank you for the call. we go to lee, in medicine, alabama. -- lee in madison, alabama.
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the government's role in combating opioid abuse. caller: i'm coming from this from two sides. my dad takes a lot of opioids, mainly hydro-coding. he recently switched to a different drug. and he needs it for back pain. but for me, i started opioids due to a car wreck and became highly addicted to the point where i was buying it off the black market. i almost overdosed. i went to the hospital. luckily i was put through a program and am greatly recovering. i help as many of my friends as i can. in the past four years, i've seen four of my very good friends o.d. i'm 30. benow there needs to stricter ways of dealing with this. that takingknow
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away from people with chronic pain is the way. i think that the police need a better way of finding the people that are selling. if i'm 30 and i can find it on the back streets, i'm sure that with a little bit of effort, the police could find those that are selling. host: i appreciate your input. let's hear from new york on the republican line. my producer tells me you are a doctor? caller: yes, correct. host: welcome, go ahead with your comments. caller: yeah, i'm a physician who treats addictions and addictive disorders in my community. i have the opinion that this is completely and absolutely required of the government to intervene and manage this epidemic. all the colors -- the callers
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are indicating they almost have a deterioration and disruption in their life due to the drugs, every single one. cannotle, they all control it. they have also witnessed those that have overdosed and died. without government intervention, this is only going to grow. in the bill that is being passed has only to do with expanding the prescription monitoring program. capturinge, expanding those that are taking it the wrong way. those that need the medication will be prescribed it. there is nothing against those people. but those that are using it to sell and are treating themselves are the ones that need to be stopped. this issue has only to do with the court system. the medical society cannot intervene the way that the government could. host: doctor, appreciate you
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joining us. sounds like a very busy practice for you. one more you on the government's role in the opioid addiction. barbara from pennsylvania on the other's line. caller: good evening. i was in an accident 20 years ago. i went to five different doctors. they left, they died. in my past doctor left me 2 months ago. i am on morphine and delighted dilaudid.e and this new doctor cut me down for 2 months. and i am more and more in bed because i can't walk. host: she's cut you down on the amount of your perception? caller: yes. i have 27 days. that's it.
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i had over 30. up,sked her to look it because in pennsylvania, you have to show your license even if the nurses know you. you have to show your license, sign that you are picking them up. and if you look at the three , you'll see that they pick them up always a week and a half to 2 weeks later. i don't overdo my meds, the when i need one, i need it. host: another difficult call to make, but we appreciate you joining the conversation. we want to remind you all of the video in our issues spotlight are available at more comments on this at next up, we go to a heroine abuse summit held back in january a program that includes
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members from the national institutes on drug abuse and substance abuse and the mental health services administration. >> most important information on this first slide reminds us of the tremendous number of deaths associated with drugs of abuse in general, the painkillers, prescription opioids over 19,000 deaths in the most recent data from 2014. over 10,000 deaths from heroin., i will point out that even this surveillance data has some messiness in it. deaths look at how certificates are coded. there are an awful lot that are coded as drug overdose generally, and don't specify whether it is in opioid or even heroin. -- it is prescription opioid or even heroin. there may be even greater numbers specified in the national death data.
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is the increasing rates of prescriptions that have given so many in this country a taste for an opioid. that means their brain has been exposed to it at some point. or the communities are exposed in a way that these pills can be diverted and misused and taken nonmedically by so many around the west -- aruound the u.s.. as the number of prescriptions go up, the number of deaths increase as well. a fourfold increase in the deaths associated with these we would painkillers. that strokes like oxycodone, hydrocodone, all of these narcotic opioid pain relievers. witheason i am starting prescription opioids that is the upstream, driver of the recent heroin epidemic. that seems to be the deciding factor that exposed so many to opioids and let them towards that pathway into a heroin addiction. the brain does not distinguish
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between different types of opioids very well. the brain sees them almost all as not quite identical, but very similar. heroin as a street drug, has pretty much the same impact on the brain as oxycodone or hydrocodone. in controlled laboratory studies, people cannot even distinguish when you give them one or the other. as those rates of prescription drugs become available, we seen a corresponding increase in heroin. we believe these are related in important ways because of the availability of heroin in so many communities. as you've already heard alluded to, the number of those misusing heroin has skyrocketed in the last five years. overdose deaths have seen a corresponding increase. it's almost an exponential increase in the last few years. as an epidemiologist, it concerns me. we like to see a curve venting and eventually coming down.
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we don't know where this curve will end. it's still on the upswing. there have been increases everywhere. if i only showed you the south and west, we would have thought it doubly was a terrible scourge. but look what is going on in the midwest and northeast, somewhere between a four in sixfold increase in overdose deaths. all the different major ethnic, racial, and age groups. but particularly, non-hispanic whites of young and lh -- youing and no age seeing the sharpest -- young and middle age seeing the sharpest increases. it shows these new injection drug users tend to be younger, more equally male and female. that is a novel change. we think of most drug uses being more common in males than females. that is not so true in the new injection drug users. that's another concern with the epidemic. why do people abuse things? they abuse them because these drugs have an impact on the central reward circuitry.
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they make you feel good by rewarding and relaxing. that is a basic principle from much neuroscience, that i will go to in detail. that is the underlying feature here. these are habit-forming, not for everybody. that is a conundrum here. some people take these pills or drugs and find it extraordinarily unpleasant. but some really like it. and they are thenes at risk for doing it again and keeping on doing it. i'm very pleased that our secretary of health and human services may do this one of her keynote issues. shortly after she was confirmed and took office, she convened a small group within the department to help her address this in a proactive, consistent way. we've developed three priorities. these are not the only things we are doing in opioid epidemic, but three priorities relate to prevention. let's change how many prescription opioids are available by focusing on prescriber practices.
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let's focus on saving lights immediately with the use of no locks on in greater numbers. greater access to the lifesaving overdose treatment martin. let's focus on treatment. medicated assistant therapies as the proven treatment for opioid addiction to reduce the likelihood -- to increase the likelihood of those going on and recovering their lives. i'm going to focus on the first two. when it comes to prescribing there are guidelines for prescribing opioids that plane -- that pain clinicians use. those sources have been inconsistent. some of them are outdated. some are not without their conflict of interests. as an alternative, the cdc has undertook the development of prescription guidelines. we expect these to be released
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to assist in the proper prescribing of long-term opioids for noncancer, not end-of-life care. when it comes to the overdose, we are pleased on working with one of the pharmaceutical industries and with the fda for the recent approval of an intranasal. instead of the only fda approved formulation being an injection, there is a nasal spray. as soon as it was approved in november, it should be on the market shortly. let's get to the main issue, medications. there was a study in baltimore couple years ago that showed us that as they increased the availability of methadone, they showed a corresponding drop in heroin overdose deaths in the city.
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we see this as a population-based example how you can save lives by increasing treatment access any large population. i've already mentioned methadone. that is in opioid substitution treatment. methadone is in opioid agonist. that is a fancy way of saying that it won't work as another opioid. what do we mean by that? let's take a quick lesson in cellular chemistry. when a chemical is administered were taken, it works by fitting into a receptor. think of it like a key going into iraq. -- into a lock.when morphine or heroine agonists go, opioid into the brain, they go into the receptor and produce a lot of activity. kind of like turning a lock, and the templars move and the door opens. -- and tumblers move and the door opens.
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morphine is like a dummy key. if sills the keyhole -- it fills the keyhole, prevents other keys from getting in that locke. a full agonist like opioids -- we have and in between agent that is somewhere in between the two. is a partial agonist. but therns the lock, door only opens partway. that is a quick way to think of these classes of medication. a blocking agent is one of our tools that can be given in a long-acting form. when people take it successfully, they don't get high if they use heroin or other opioids. the same thing happens with methadone. when they take those successfully, and they might slip and use heroin or other drugs, they generally want get any high. -- won't get any high. the key is a learning experience.
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that is a short version of what history is. melinda will go into this in more detail. we have focused on extended relief medications. we focused event on medications and have been pleased to partner in the release of a long-acting naltrexone. we've finally been developing vaccines as another way of keeping drugs out of the brain. one of our new medications is a long-acting beeper northing. people will take these medications, but there is an issue. my patient has to make a decision everyday whether they want to stay clean and sober, stay in treatment, take medication, or if they want to not do that and had back into a path towards relapse. sometimes it's a conscious decisions, sometimes not so much. they need to make that decision every day.
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with a long acting injectable form, they may not need to make that decision quite as often. in particular we are interested in this idea of an implantable device. a long-acting implant that only needs to be implanted once every six months. means someone only needs to make a decision about their life and turning things around about once every six months in some fundamental way, rather than every day. patients are more likely to be compliant when they take this, certainly producing greater abstinence. that is one of the hopeful possibilities. this was submitted to the fda in september. review,er an expedited so we expect an answer from the fda and whether the data supports its actual use by clinicians within the next couple months. the next area is promising vaccine development.
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for drugs to have an impact, they have to get into the brain. they go from the blood system, across the capillaries into the brain. vaccines attached to those drugs, so they create a protein binder to those drugs. they keep them in the capillaries. they keep them in our circulatory system and not in the brain. that is the theory. there is quite a bit of preclinical research with animal models. there is now some emerging human resource -- human research that suggests this to be effective. but we have a ways to go before we have vaccines to be useful and administered on a regular basis. i remind you that our job is to support what we can do today and to always be charting a path forward tomorrow even better. is last challenge implementation. we've had these medications like methadone for about 50 years.
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had naltrexone as an oral medication for 40 years and in injectable for the last couple years. what is going on? not very many people are treated, even when you go to specialty care. this is a major gap for us. people are more veiling themselves of us. we have been pleased to try novel trials. a group at yellow university -- a group of yale university noticed they were seeing the same people with either an overdose or problems related to heroine and other opioid issues. she said, maybe we can start them on it here in the emergency permit. why don't we act as their primary care physician? they found they were much more likely to be in treatment. they were also less likely to be using drugs when they were reevaluated weeks later. this is just one center, a
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top-notch center. we don't think everyone else can do it as well. we think that is very promising and are working on testing this in a number of other centers. butevery place should, those that see a lot of opioid addicts might want to do it. saddened by the story representative custer relate about patient who died shortly after being released from prison because they cannot get into treatment.this speaks to the important of linking our kernel justice and public health effort. -- our criminal justice and public health efforts. i have issues with high attrition. people drop out of this readily. with prison, they have recidivism and problems with mental activity and drug use. but working together like the drug court models, extensive work with probation and parole, we can do a better job using the
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best pieces of both. whether that's a close provision that provision and parole can provide, the treatment that providers cna provide. even incentives for people to turn their lives around through modification. these models have been shown to work for 20 years. we don't see them in white enough usage. these combined efforts seem to be an area where theere can be improvements.even medications can be used in this setting. a study coming out of baltimore took vendors about to be released long-term with a history of heroin addiction. this was in withdrawal. -- wasn't withdrawal. they are the referred them to methadone actively, which means they actively made that referral and tried to engage them in treatment after release.
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or they started them on methadone a few weeks before release. those where methadone was started prior to release had a better outcome, less criminal activity as well as less drug use. at least over the first few months after release. this speaks to the importance of being practical and thinking through what happens. when people get out of prison, they are not usually thinking about getting treatment. there are other motivations they are paying attention to as their first goal when they are released. starting treatment on the right foot could be important. thanks very much for your attention. i will turn it over to melinda from sampson. >> if i could have congresswoman custer make the introduction. >> thank you very much doctor. welcome the current medical officer for the office of pharmacologic studies at the
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substance abuse and mental health services administration. she is a position board certified in family medicine, with additional credentialing in addiction medicine. thank you for being with us. >> it's my pleasure. before i get down to the business of my presentation, i want to thank you. sam is supporting a new round of grantssa to improve access to high-quality medication assisted treatment. and funds to overdose prevention thanks to the budget you work hard to pass. similarly, i want to thank you for setting aside the block of time to together more information about treatment options for opioid disorders. i cannot begin to fathom the number of equally critical issues you are faced with. i came away from the first for him a few weeks ago deeply impressed with the urgent need
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that i felt from the members in attendance. i am going to try to be concrete and not be too high level or reviewed too much of what dr. compton has already presented. i spent 10 years as a prescriber because i came to government. 5 years in my solo private practice. and 5 years as medical director of an opiate treatment program for western psychiatric clinic pittsburgh. i maintain my private practice over that time. i can tell you the single most therapeutic thing i did for anybody was provide respectful medical treatment.
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whether that included medication or just listening and advice in coronation of ancillary services. it almost did not matter which. obviously medication was an important part. of going to spend a lot of what i talk about todahyy on that. a word about the pictures i'm showing you. one day i asked everybody i saw if they could give me their permission to take a picture. this was for me to use these photos to teach medical students about bias and disparity in health care. this is far less than half the people i saw on that date. of the people they gave me permission, i removed the children and adults that could not fully consent. it so happens there are those i was rooting for addiction. in my private practice, you can't tell one from the other. people sat in my waiting room
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and waited their turn in between the kid with the ear infection and the old lady to refill her high blood pressure medicine. nobody could tell what anybody was therefore. you have been surprised to find out. subsequently, i saw some of the same people in my opiate treatment program. the know you in that environment such that iu was saw different behavior. i was often challenged. oh, now you see what they are really like because they are in this clinic. may be their behavior is a little more street. why do you think this is what they are really like? i think what they are really like is how they caved in my office being treated with respect, seen and a pleasant place where they got the care deserved to them as human beings. not that we did not do our damnedest to do that for people in our opiate treatment program.
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reiterate what dr. compton said, as far as your brain is concerned, and opiate is an opiate. while the problem has its origins in overprescribing and being exposed to opiates to start with, once that horse is out of the barn, and opiate disorder is a disorder. you may have different strategies you want to apply on the prevention end. but the treatment end looks the same for anybody. in addition to the difference inhere qualities of an opiate, how intense it is, how quickly it affects you -- the individual brings risk factors to bear. their biology, genetics, and social situation. this unfortunately is why we see worsening in their illness when the social burden of their disease increases. when they are functioning highly
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and getting their opiates, either by misleading a fromriber or getting pills a friend, they keep the social front intact. the consequences are usually less. unfortunately, and opiate is just as deadly weather or social side is intact whether it is not. unstable,housing is if your personal safety is at risk, if you have been subject to trauma as a result of the risk you have exposed to, then it does snowball. there is a cumulative risk that cover misys or health. -- that compromises your health physically and mentally. while the brain in opiate parsonage rising in whatever way -- brain and opiate are synergize and in whatever way--
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criminalize their behavior or medicalize their behavior. moving on from that point, i want to talk about the in central ingredient for recovery is that one be alive. no locks on is not considered a treatment for addiction. it is the antidote to opioid poisoning. it has the shocking ability to take somebody who was completely without life, no air moving in the chest, and bring that person back to alert status, not always very happy to see you, to live again. it's astonishing the effect of that drug. it's essential to any successful
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treatment that people have access to the antidote to opioid poisoning when they need it. that means making this drug available to those leaving and curse ration, people that are leaving detox or rehab. -- leaving incarceration, people that are leading to talks or rehab. they are leaving in a fresh baby state. peoplemportant that likely to be on the scene of an overdose, whether that his friends and family, or other drug users, have this drug. one of the things i did in my practice was write restrictions at the overdose prevention program. i supported developing a training offers in jail. we were not able to offer the truck at that time. some programs are not doing a training in putting this drug in
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your personal effects. so that when you leave jail or prison, you have it with you when you walk out the door. all sorts of innovations going result in lifel saved instead of lives lost. samsa's updating our toolkit to reflect the new products available. that should be publicly available later this month. another take-home point, detoxification is not treatment. is necessary to break the cycle of dependence, tolerance, and not always necessary to begin treatment. for example, you don't have to be detoxed to start methadone. if you are choosing to be detoxified because that is what is best for you, than being offered naltrexone should be
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considered an important follow-up step. it should be standard for that person not seeking and opioid agonist. detoxification is better thought of as the medical management of opiate withdrawal. it does not change the course of the disease. it does not change the risk factors for relapse or the course of the. it does increase the risk of fatal overdose, should a person relapse after detox. even unfortunately if it's followed fo -- followed by a rehab stay. medication is not a treatment by itself. it will control the disease much the same way your high blood pressure medicine control your blood pressure. but it will not change the course of the disease itself. just like if you are diagnosed with high blood pressure, your
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doctor is probably telling you to lose weight or start exercising, you have to stop smoking, yo'uve got to control your stress differently/ a whole ton of behavior change that comes with most chronic illness. high blood pressure is so common. i am sure there are some of us being treated for it now. i would think what we would want is to be treated with the medication most effective for us, and be given the opportunity to change our lifestyles. unfortunately, socially and culturally the way we have looked at medication assistant treatment is that it's framed as a treatment of left -- of last resource. -- of lapsed resource. fail rehab so many times, then gosh, you just have to go on medication. that's not how we approach high
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blood pressure. let's get you on this medication while you learn how to control your stress. that is the attitude we need to have towards medication assisted treatment. get on it to get your docs in a row. -- your ducks in a row. i would use that a lot in my office, are you ducks in a row yet? well, you still have work to do. dr. compton reviewed the point. i won't go into a lot of detail except to talk about the difficulty that we in those we interact with can we in understanding how you give an opiate to in opiate addict. that is intuitive, that where you expect it to be going. as dr. compton laid out for you, if you get on the right dose. take method of -- take methadone. it is a full agonist.
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the more you take, the more affected has.if you get on the right dose , it controls your withdrawal so you can stay engaged in treatment and function. but it also feels up your receptors -- fills up your receptors. it keeps them on an even plane so that you are not being driven to use. but also, your receptors are full. so if you relapse and use something, there is no place for them to go. there is no receptor for that to bind to to you -- to reward you for that slip up. you can go okay, that did not pan out, and move on with your recovery instead of the whole bottom out of the top. it's not just about getting the dose in the right range and saturating the receptors. a property of binding so
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tightly to the receptor that nothing else can compete with it. most of what people take on the street, if they relapse, will not be able to budge this drug. the beauty is that when it is bound to that receptor, it does not fully simulate -- fully stimulate the receptor. is working part-time. so your body goes, oh, my receptors are not so busy, i don't need as many. and it starts to downgrade. that is where it can reduce tolerance over time. that's just a cool pharmacology aspect of that drug, if you're geeky you will enjoy that aspect. the antagonist gets on that receptor, binds it, blocks it off, makes it impossible for any opiate effect for whatever reason to happen. it gets tricky because you have
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to be complete free of opiates. your system has to be cleansed for you to take that blocker. if that blocker goes into your body and rips the opiates off your receptors and blocks them off, you will wish you were dead. you will not die from your withdrawal, but you will wish you did. the process of getting on it has a couple steps you have to go through. the pathway is a little bit
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>> nate weixel covers bna for bloomberg. a packet of bills dealing with opioid and heroin abuse, why is this an issue the house is focusing so much time on? >> essentially it is because a lot of the lawmakers have a problem back home where the opioid abuse epidemic has hit their constituents and in in election season is coming home where they feel the need they have do something about it. >> legislation coming out of the committees, three separate committees, a lot of bipartisan support one of them dealing with justice department grants to states for programs. how much money is attached to this and how much would states benefit? >> it is just under $3 million over four years. it is not a lot of money because the bill mainly authorizes it. it does not appropriate. that is up to the individual committees. the committees are going to allow the states to use the money to fight addiction in various programs. >> what will be some of the others this opioid week will
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touch on? >> bills are going to touch on veterans, athletes, mothers and babies, and also the amounts of patients that doctors can prescribe opioids to. >> spending has been an issue on these measures in the house. you talked about a letter the democratic sent to speaker ryan talking about emergency funding for some of these programs and other measures. how is that faring? >> it seems like it is not going to happen because democrats in the house do not have as much tools as they have in the senate. it does mirror or the senate where they are calling for money -- $600 million in emergency landing -- to get these bills actual appropriations but house leaders have said there already is money and it has been appropriated on last year's omnibus bill and they are not willing to spend any more money on it so looks like the credits
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-- the democrats are going to have to let that one go. >> that request for spending in the senate bill back in march when the senate passed that, that fell through. so how different is the senate measure from what the house is proposing is coming week. >> aside from the fact that there is one senate will and there are upwards of 12 or 13 of the house bills, the senate bill was much more comprehensive in who was getting grants and how they were authorized. the house bill is taking it on a piecemeal approach. >> what about advocates groups, victims' groups of heroin and opioid abuse, how had they waited and what would they like to see done? >> the differences advocate -- advocacy centers around has been issues of prevention
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and the bills in the house do not really address the issues of opioid abuse prevention. they would like a provision that matches the one in the senate to be taken up the house but so far it has not been included. it could be an amendment on the floor but it is unclear as to whether it will happen. >> in a house this week, will we likely see a conference between the house and the senate on a final measure? >> these bills are supposed to be basically bunched together as an amendment to the senate bill and then thursday or friday it is probably going to go to conference. it is going to be a motion from the democrats to instruct the conference committee. >> >> nate covers policy for bloomberg bna and you can follow him on twitter. nate weixel. >> thank you.
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clinton theillary democratic presidential candidate will be in louisville, kentucky. then, senator bernie sanders democratic presidential candidate in salem, oregon. >> secretary of john kerry was critical of gop presidential candidate donald trump. secretary kerry also spoke about climate change, poverty, and countering terrorism. this was held it in boston. : thank you for the generous day.
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members of the board, faculty, and the class of 2016 -- know, the garden is as good as it gets for a commencement. all you have to do is look at the banners for the boston bruins. i know that some of you come from somewhere else. but, you are here. celticse 17 championship than her's, thanks to the second coming of the big three. , thanksionship banners
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to the second coming of the big three. this is the number one reminder that boston is be number one sports town anywhere. at the moment, for the red sox, first andappens to be the yankees are in last. tellt let anybody you our country is not moving in the right direction. i have toating class, tell you that you really do look spectacular. i want you to look around you. every race,f religion, gender, shape, size, 85 countries represented, and dozens of languages, making you the most diverse class in northeastern's history and
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donald trump's worst nightmare. [applause] john kerry: now, now, you may not know it. there is one thing that truly unites you. you will all be and really big trouble if you forget that sunday is mother's day. really big trouble, if you forget that sunday is mother's day. mom and dad, your emotions have sad, relieved, and blown away by the interval between diapers and diplomas.
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beginning of blown away, i want to congratulate you guys forgetting here in time of this in time forng here the ceremony. i heard that some of you had to get here at 8:00. it is either crazy early or crazy late, depending. why would your last night be any different than your college career? i give many student speeches and for makingthank them my job a lot tougher today. thank you. honor withis
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humility, particularly because northeastern was kind enough to degree on myorary daughter, who is in the global health program. i come here not to sugarcoat reality. that is the last thing you need. s to be told that life can be a struggle, whether grades, tuition, friends, family, illness, or the death of a loved one. no words can change those realities and no lecture can lessen the loss. you are still mourning the andgic loss of victoria & priscilla. when victoria was among those
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her by a terrorist bomb, this of thety felt the weight wounded world. this morning, we grieve and celebrate, at the same time. no betterthere is shorthand description of life. no better to word summary of the "northeastern, strong." strong." i have learned -- i have learned that resilience is the beginning of what northeastern is about and service is at the heart of the institution. it is knows to prize that the effort to keep faith is unparalleled.
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veteransern graduates above the national average. [applause] john kerry: to the soldiers, amlors, so many others, i class issay that this the rule and not the exception. thank you and thank you to all of you who have worn the nation's uniform. i am honored to address a university family that, thankfully, is utterly unafraid to look beyond the borders and into the future. it is cliche to say that you have global vision.
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northeastern really does and it is different. the president tests the limits. a bold commitment to learning and the opportunity for international study and a new campus with cutting-edge research and things like n anomanufacturing. there is technology your parents cannot pronounce and you are doing something right. think, after today, you will have a leg up on facebook's mark .uckerberg you will actually have a college degree. the northeastern successful should speak to all of us about the massive transformation taking place around the world. northeastern has gone global.
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health, medicine, and film are going global. you do not have to be great at math to understand that the economy cannot grow, if we do not sell things to the world's customers and other countries. you cannot be healthy if we do healthy, if we-- do not fight ebola and zika. many of you were in elementary school when you learned the lesson of 9/11. there are no walls be enough to stop people from tens of thousands of miles away who are determined to take their own ones in an assault civilization.
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so, i think that everything we have learned tells us that we will never come on top, if we take advice from the carnival that we who pretend can be great by looking in word and hiding behind walls in times where technology has made this unwise to even attempt. than aure demands more rose tinted version of a past that did not exist. understandsybody this, viscerally, internally, intellectually. au are about to graduate into
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complex and borderless world on careers that will take many of you to companies that are not yet founded and use a device is ideast developed based on that have not yet been conceived. that is how fast things are moving and you do not have to succumb to science fiction. you will not all be replaced by robots. the economy will have space for those with the courage to compete. northeastern has made sure that you have that, and more, because of the global vision. is criticals, this in a world where thinking globally is critical to confronting the challenges we
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face. when i was younger, we had more than our share of national trauma, including a long and bloody war in southeast asia. it is also -- there was also a time when a dividing line andeen ideology was simpler primary forces shaping the world were recognized states. we face a world that is more complicated and less hierarchical. nonstate actors play a role and ing images can circle the globe in an instant. climate change and disease do not respect behavior. sectarianal and hatreds are as prominent as they have been in centuries, for some
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that is all they need to wish the world away. even see this attitude from some who think they should be entrusted with managing international affairs. it seems that, understanding this need for the greater world should be a threshold requirement for high office. yet, the specter of isolationism hovers will stop i thought we had -- hovers. i thought we had learned the lessons of the 20th century with isolation and protectionism. the desire to turn inward and shut out the world may be seductive in an era as complicated as this. it is not responsible for the most powerful and prosperous
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nation on the planet, which also happens to be the leader of the free world. as secretary of state, let me assure you, when you consider the range of challenges the world is struggling with, most countries do not lay at wake at about america's presence. they worry about our absence. we do not see an excuse for inaction. we see a mandate to lead. the greatest challenges the world confronts can only be addressed by good, capable people working in common cause with citizens of other nations. politicians talk about american
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exceptionalism and this nation, which is, indeed, exceptional. we are not exceptional because we say we are. we are exceptional because we do exceptional things. greatness is not about bragging. it is about doing. it is about never being satisfied and testing limits of what we can achieve together. what america can accomplish with partners in the world. that is what we are trying to do on more important issues in more parts of the globe than ever before in history. ofare profoundly conscious the challenges. there are mountains beyond the mountains and one of the
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mountains is the effort to safeguard future generations from the harmful effects of climate change and i am proud to say that the united states is leading the way with many nations and, last month, i committed the united states to set an example for the nations that have pledged to curb emissions and make progress towards a low energy future. i want you to think about this. with just a few exceptions, embarrassingd coterie of naysayers in the united states, the whole world meeting on how we produce
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energy. last march was the hottest march in history and last year with the hottest year and recorded history and the last 10 years was the hottest decade and the one before that was the second hottest and the one before that was the third hottest. the facts are staggering. one of my colleagues thought it would be persuasive to walk on the floor of the senate and points to a snowball as evidence that climate change is a hoax. i told him that improved something. not what he intended. at the same time, a record $230 billion was spent in the united extremen response to
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weather events. houston, 17 inches of rain in 24 hours. that is more than last year during the entire summer. imagine if we put efforts into preparing for the worst impacts of climate change? do not believe the doubters. there are millions of jobs to be built,, businesses to be fortunes to be made with renewable energies. and, i hope that many of you .hare in this future
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in paris, we took a step with an agreement to combat climate change. wes will not guarantee that hold the temperature warming to two degrees, centigrade. what it does do is send a minds to goreative to work to find the alternative so that we can solve the problem. paris is the beginning of what we need to do to meet the challenge and we will need a energyent to renewable , with say to you certainty, this is one of the great challenges of our time. challengeand in this
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is and other mountain to scale, the efforts to eliminate poverty from the world. the reaction may be that it is not possible. it is not only possible. we are making progress to achieve it right now. belowe poverty has fallen 10% and the revolution taking place has brought hundreds of people into the middle class. news, 700 is welcome million still have to survive on less than the cost of dunkin' gapts they day, because the between the rich and the poor remains far too wide. the world's came together and we
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agreed on the agenda to reduce poverty and ensure that every boy and girl can attend school and every mother gets health and they need to survive that every available resource is used against epidemic diseases. after all, we have defied the predictions by stopping ebola. the we wouldaid have one million dead without action. africaent the troops to to build capacity and provide care to stem the spread of the epidemic. thanks to the global response and accepting responsibility, most of the affected countries are virtually ebola free.
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reason -- absolutely no reason to believe that we cannot do the same for malaria and the zika virus. if we uphold our commitments to global programs in africa, we can see the birth of an aids , an generation extraordinary accomplishment. mountain.another we have to climb what stands in alm instabilitycolu m and stability we need. there can be no peace without eliminating this scourge.
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victoria mcgrath was injured earlier. boston and northeastern need no lessons on how important it is to win the battle. i want you to know, without exaggeration, we will win and we are even winning its now. we have degraded the leadership liberatedd we have the land it once occupied and they have not taken a piece of territory and held it/year. we will not be successful, in the long run, if the world at suchs to turn away an alarming rate. take onitical that we
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violent extremism at the roots. we know that there are millions across the globe without jobs. they have smartphones and they can see with the rest of the world has and what they don't. that theu to know ignited arabwho spring was not religiously .otivated he was frustrated by his inability to sell his fruit where he wanted, that he self-immolatted -- ed.
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it was young people, like you, who was wanting it for their home and country. we need young people to know that these will not be abandoned to the clutches of the terrorists and extremists. the experts tell us that could lift the global living standards and, our mission, your mission, it would be to create jobs in eightlaces, requiring deep involvement of the private international -- a deep involvement of the private sector and international organizations. it is not about giving something for nothing. it is about building our security and preventing the
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conflicts of the future, which would see us getting involved. there used to be a famous song during world war i, "over there." t was about the distant shores where we fought. in our time, there is no "over there. " they are practically at the doorstop. we have to deliver assistance to communities and family to provoke -- and families to promote worldwide, not just because it is in keeping with our national youth those. but, because our security and prosperity demands this. we are bliss -- blessed to live
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in a country with a $17 trillion economy. yet, we just spend a penny on our foreign aid. to encourage and diversify economies and stop corruption to ensure the education of young people and that it actually teaches young what they need to know and keeps them from being radicalized. there is more that we can invest in and many more projects for my generation and yours to take on, as you take on your careers in the days ahead. i ask you to think about the careers of the distinguished americans who received honorary degrees today. span of decades, susan
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dedicated her vision and talent to the fight against brain cancer. through genius and high purpose, mccarthy has reached the pinnacle of his arts. been an aviator and a military commander. above all, an aspiring leader of women and men. none of them would be a today, if they were easily satisfied. the accomplishments came about, because they dared to always explore the limits of what they charlie --hinking of what they could do. thinking of charlie, i want to tell you about a group of people ago toe called on years test themselves under the most extreme conditions. the setting was asia.
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the time was a few months after the start of world war ii. enemy airplanes dominated and, to get the supplies to the friendly forces in china, the american aviators had to fly over the highest mountains, including the himalayas. they called it, "flying in the hump." the airplanes were untested. the pilots were given no routes. they were asked to fly higher than they were trained to, and did so over the most for bidding terrain. rbiddingost for terrain. each night, plane after plane flew off. had they not, the allied forces
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would have stood no chance. eventually, the pentagon sent to a point. the officers said some of the flyers were mentally drained after the first lap. crack after the first weeks or months. only a few were able to go on longer than their buddies. in a few years, more than 1000 pilots were lost. together these courageous airmen, none of them famous or with a reputation's, kept the supply lines open and helped to win the war. some of the pilots were better the and others to persevere but here's the point, none failed. it is all went as far as their
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own capabilities allowed. each pushed like a dedicated marathoner has to push to plumb those last reserves and find the spark of greatness within them. that is the most anyone could've asked from them. it is what history demands for the united states of america. future asks of you. you graduate with an increasing reservoir of knowledge and skills. but how you use those gifts, how far you push yourselves, whether you give your own capabilities a full chance, that is not just about education. is a question of character and a question only you can answer. kennedy was running for president in 1968, he raised what the students -- he raised the students some basic questions about dignity and
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purpose. he said what we now call our gdp was measured among other things ouritems like the size of military, the capacity of our jails, the production of our pollutionnd the emanating from our factories. it was not, he lamented, measured in new things that mattered most in our daily lives. said the gross national product does not allow for the health of our children. the quality of their education. play.y of their it does not include the beauty of our poetry, the strength of our marriages, the intelligence of our public debate, the politicians.our it measures neither which nor courage, and neither wisdom nor neither compassionate nor devotion to country, it measures everything, in short, except that which makes life worthwhile. my friends, we're under no
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illusions about the gigantic challenges before us but we should remember that compared to any other earlier generation we have tremendous advantages. a child today is more likely to be born healthy, be adequately fed, get the necessary vaccinations, were likely to attend school and live a long life. individuals and companies around the world thrive on new tech knowledge he's that have made possible incredible breakthroughs in communications, education, health care, economic growth. in a number of democracies -- the number of democracies has doubled while the number of nuclear weapons has fallen by two thirds in the last 30 years and all of this is not because of any one country or because of .hat governments do it is what happens when people have faith in their own values and their own skills. when they respect the rights and dignity of each other and when
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they believe in the possibility of progress no matter how many setbacks may stand in their way. that is not a complicated formula but it gives me a powerful sense of confidence in what together we can achieve now and in what you can achieve in the years and decades ahead. because meeting those challenges, pursuing arenas that excite your compassions, completing the mission to teach and serve and heal and give back -- that is what makes life worthwhile in the i encourage you to search for the great within while you push for the outermost horizons and remember always as you do this what "all thendela said hardest jobs seem impossible until they are done." congratulations again to all of you and thank you for letting me share the state with you.
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[applause] bus continues the to pay tribute. it made a stop to recognize six time winner for her video "when thehouse becomes a home." bus then traveled to west scranton intermediate school in eighthvania to honor to graders for their prize-winning video, "national immigration issues." they donated a portion of their winnings -- of their to a charity.
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the bus traveled to honor another. over 250 classmates, teachers, and officials joined in the ceremony for zachary. a special thank you to our partner cable comcast for helping to coordinate. you can see all of the student of videos at student announcer: a number of doctors testified this morning about dyslexia research. that is live at 10:00 eastern. the house is back at noon meet eastern to work on several measures about opioid addiction. live coverage here on c-span. announcer: coming up, democratic congressman talks about his recent editorial. agencyon the federal responsible for investigating and overseeing firearm sales.
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boot will talk about donald trump's foreign policy. you can [captions copyright national cable satellite corp. 2016]] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit] host: office primary day. republicans will vote nebraska and republicans and democrats in west virginia. look for results on c-span at 8:00 tonight, also, hillary clinton and bernie sanders will have rallies tonight. go to for more information. on capitol hill, ted cruz expected back. on facebook, marco rubio saying he does not want to be donald trump's vice presidential candidate. both the justice department and the state of north carolina are suing each other over that state's bath room law.


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