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tv   Politics and Public Policy Today  CSPAN  April 21, 2016 3:31pm-5:32pm EDT

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for the national intrepid center for excellence at walter reed and michael kol ston, center of excellence for psychological help and brain injury. and dr. amy streak, deputy director of the women's health division for post-traumatic stress veterans of foreign apairs. post-traumatic suppress and brain injury have been called signature wounds of afghan and iraq conflict. since 2001, about 5% of the over 2.7 million service members deployed in support of the wars in afghanistan and iraq and diagnosed with pts. from 2000 there are 339,000 tbi cases diagnosed with most of these being mild tbi. with the significant impacts
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that both pts an tbi made on our service members and veterans, it's vitally important we better understand through well developed medical research the causes of pts and tbi and develop appropriate measures to treat and eventually prevent. >> leading to major advancements in treatments, more work must be done on prevention. today to give us an overview of promising treatments and therapies and technologies that may be available in the near future. tell us what the subcommittee to do to help your department provide better case for servicemen and women and those
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that may service from tbi and pts. >> it's xreemgly meaningful, the work we do. i want to welcome our witnesses, thank you for your service and thank you for the focus you have on the state of research diagnosis and treatment for traumatic brain injury. i'm pleased we have witnesses here both from the dod and department of veterans affairs. >> i look forward if there are different approaches how to do this. although ptsd and tbi are recognized as a wounds from iraq and afghanistan, they are more than war injuries. we know ptsd is triggered by a traumatic event that can be combat related but the trigger event can be military sexual
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assault. we continue our efforts to rid the military of this xounk, we must provide world class treatment to the survivors. i'm particularly in learning more about caused by sexual assault. i would like to know if ptsd presents itself differently in male survivors versus female and how treatment for ptsd. and in diagnosing and treating, the interact between the two and ongoing research to improve diagnosis and treatment of these conditions. over the years our understanding of ptsd and tbi has grown substantially. furthermore, we need to ensure those who suffer from ptsd and tbi related to military service have access to a health care system able to meet their physical and mental health care needs. our service members and retirees deserve the highest quality care.
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thank you each to witnesses for the time and effort you put into this important issue. thank you. >> thank you for the compliment. it's been a pleasure working with you and your staff. captain? >> good afternoon, thank you all for the opportunity to discuss the department of defense's efforts to prevent and diagnose and treat tbi. as the director for nico at the walter reed national military center i lead a team of exceptional professionals whose mission is to improve the life of patients and families impacted by tbi and psychological issues. through the fund nico opened in 2010 on the walter reed bethesda campus followed by five of the nine satellites to be built on military installations around country. together we've created a tbi
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care network, important component of the military health systems, pathway of care as managed by the defense and brain injury center. this past year they transitioned to the walter reed national military center demand structure becoming a director within the flapship of military medicine and uniform services university of the health sciences, also on bethesda campus. this approach to our work leveraging the expertise and resources of walter reed's outpatient programs and in patient consultation service, allows us to serve our unique patient population in a seamless fashion using the portfolio available on america's academic health campus in bethesda. an important part of the continuum of care in the tbi research mission is the tbi research mission. the military care center in collaboration with partners including veterans administration and national institutes of health and uniform
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services university and other federal academic and private institutions continue to push cutting edge transitional research. one project is the congressional mandated is the study to categorize service members and family members affected by tbi and 1,000 service members affected by tbr thus far evaluated clinically. collecting over 40,000 imaging and clinical data points for study per patient. in addition to high tech research, actively engaged in research on the high touch assets, such as therapeutic arts program and k-9 assisted authority. we are also able to rapidly assess and accelerate discovery more effectively using every taxpayer dollar by putting research in the findings. a greatful to represent the men
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and women and the patients we're honored to serve. i look forward to answering questions today. thank you. >> chairman graham and members of the subcommittee, thank you for the support. i'm pleased to share d.o.d.'s efforts to foster research for ptsd and other psychological health conditions and tbi and co-morbidity and pain disorders and suicide. last year over a quarter of our service members were treated for these conditions. allow me to discuss how we support the need. we reduce barriers to care including stigma and tripled the size of mental health infrastructure and improved transition points and improved our system's ability to treat the sickest patients, we developed a comprehensive research portfolio to study. d.o.d. partners with other government agencies and private
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sector in research, the centerpiece of clash tif is the national research plan which brings the department of health and human services and department of education, improving our understanding of tbi and ptsd. there are challenges. one challenge is ascertaining why ptsd and depression and chronic pain present together. long tud nal resource efforts like the 15-year study on tbi will aid our understanding just as the framing ham study helped cardiovascular disease. ptsd treatment has a wide evidence base, supporting the use of therapy and medicines ir respective of trauma, be it developmental or sexual or from the war. health systems research is imperative and answering
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mandates from congress and 13 and 15 agency goals and d.o.d.'s cost analysis and program evaluation office and psychological health and tbi is halfway through a five-year effort to evaluate programs for effectiveness. including outcomes and fiscal granularity. cooperation with academia aids us in the effort. with your continued support, i'm confident our discoveries will bear fruit in the years ahead and look forward to answering your questions. >> members of the subcommittee, as a researcher whose work is focused on military sexual trauma and psychologist with the department of veterans affairs who works with veterans who experienced mst, i'm grateful to speak about the research related and the diagnosis and treatment of conditions with a particular focus on traumatic stress disorder and honored to be
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seatwide my colleagues representing the department of defense. experiences of sexual harassment during military service are far too common. a study indicated 1% of servicemen and 5% of servicewomen were sexually assaulted in the past year. the majority of these assaults occurred in military settings. experiences that constitute sexual harass. are more common. my own research demonstrates that experiences of sexual harass. and sexual assault are common nafg and iraq raising the possibility they may have been exposed to multiple types of severe traumatic stress. mst is an experience, not a diagnosis and service members and veterans will vary in their reactions. our men and women in uniform are
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resilient after being exposed to traumatic events but many will face long-term difficulties, strongly associated with a range of mental conditions but has a particularly strong association with ptsd. research data from veteran samples indicates that experiences of mst are a strong predictor of mst as compared to other military stressors, including exposure to combat. in my clinical experience, veterans often struggle with feelings of betrayal, either by perpetrators they believe to be comrades in arms or the military system they believe should have protected them. they may struggle to integrate the victim identity with the value on their own strength and self-sufficiency as former or current service members. others felt they had to leave military service prematurely make experience grief or anger or in their view inadequate action taken by their leadership
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to protect them from such harm. although the rates of sexual assault are lower among military men than women, an absolute numbers appearanced sexual assault in the last year. sexual trauma among men has lagged behind behind women but data suggests the mental consequences may be more significant for male veterans than female veterans. recovery is possible after mst. vha has services with counsel and care and services to assist eligible veterans in these efforts, recognizing many survivors do not disclose experiences unless asked directly. it's policy that all veterans being experienced for mst. they are offered a referral for mental health service and va care necessary to overcome the
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psychological trauma is provided free of charge. a veteran's eligibility is entirely operate from the entitlement for the same conditions. mst coordinators are available at every va medical centers to assist veterans in accessing these services. brain health and head trauma transcend impacting all americans. bob mcdonald is participating in the ground breaking two-day event focused on brain health. this first annual public/private partnership event is convening the most influential, sports, veterans and community partners for mild traumatic brain injury and post-traumatic stress disorder and serve as a show case for many of the advancement for brain health for veterans
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and american public. mr. chairman, i appreciate the opportunity to appear before you today. i'm prepared to answer any questions you or the committee may have. >> thank you all very much. i'll start and excellent -- if someone is a victim of sexual assault in the military, can they get a disability rating because of the pts? >> so, disability rating would be provided for ptsd. because military sexual trauma is the experience and not the diagnosis, it would be the diagnosis related to the experience. in this case ptsd that the disability rating would come from and i didn't they can. >> if someone has been assaulted and get ptsd, they qualify. >> that's right. they would go through the same process that a veteran who experienced ptsd related to combat, that same disability assessment process. >> kevin, what's the process we use when people return from the
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battle theater in terms of evaluating them to make sure we're catching things they may have experienced? >> yes, sir, if we're talking about traumatic brain injury, for example, it actually doesn't start after they leave the battle field. it starts on the battlefield with not necessarily symptom related evaluations and screening but event related. if a service member is involved in a ied within 50 meters of an ied blast or rollover accident, it's not up to necessarily the medical leadership to say they need to get screened. the line leadership, battle buddy will ebonsure that persons screen on the battlefield. that's when the screening does begin. if somebody falls through that crack, or not involved in a significant injury or event, when they return from the battle field there's immediate post deployment health risk assessments performed.
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a cycle of three are performed within shortly after return and 90 days later. >> how old is this system? >> excuse me? >> how old is this system? >> i deployed four years ago and it was in effect several years before that. it's been modified i think -- >> you think it's working? >> i think it's as good as it can be right now because we are basically not waiting for the patients to come to us with symptoms, we're basically asking them about symptoms that maybe others wouldn't necessarily associate with a traumatic brain injury. >> when it comes to prevention, i'm sure there are all kinds of technical things we're trying to do to protect the brain and ied attack. when it comes to pts, what kind of preventive measures are we em employing? >> with regards to the psychological health, that prevention begins long before they deploy and has to do with
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training and knowing their algorithms. you want them to have adequate brain rest as well. >> are we teaching people what to watch out for in their buddies? absolutely. from the psychological health perspective and traumatic brain injury perspective as well. there's a lot of training that goes on before they deploy. depending on how long a service member is in theater, there's mandatory screening that occurs if tler more than six months, even not involved in any sort of significant events. >> do you feel you have adequate resources to do your job? >> well, sir, we would always love to have more. but i think that especially with a drawdown in commitments overseas, we're finding that the resources aren't necessarily needed for the active returning off the battle field service
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members as much as they were three or four years ago. it's more the long term kmitd. to service members, some of whom were injured years ago, understanding it's not -- you patch them up and send them back to the real world. some suffer for years and along with our vaxt colleagues, this is a long tif term commitment and the nature of support changes. >> do you think the handoff is working? >> i think it's working better than it ever has, sir. >> do you agree with that? >> i do. >> captain, you said 25% of the force has been treated for what? >> yes, sir, so one of the things we actually do in transition, where when we do handoffs we look at whose been treated in the last year. it's at about 20% for psychological health conditions and then for other conditions such as substance use disorders, pain disorders and depression, takes it over 25%. we have a large cohort of treated people right now, sir.
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>> from a d.o.d. perspective, this is a problem? >> absolutely, it's one we devoted a lot of resources to and we have really made a number of a number of turnarounds for. >>le wi do you see any promisin therapies in the future, hyperbaric oxygen treatment? i've heard a lot about that. there's a program i think in myrtle beach. people really believe in it. there are all kinds of ideas out there. could you tell me about that treatment. >> hyperbaric oxygen treatment, we've done about seven studies on that now and none of them failed to show any effect beyond a placebo effect. we have all kinds of innovative tragedies and a level evidence based strategies for ptsd. i think in the future it's going to include biomarkers, neuroimaging and better ascertainment of the disease
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states of ptsd and tbi and the other things that run with it. >> you'll have your say and you can write us a report about it. >> thank you, mr. chairman. victims and experts have stated that the response to military sexual trauma is more similar to that of incest and other forms of sexual assault. how many survivors of mst go on to develop ptsd and for survivors who develop ptsd how do they present differently from those with ptsd stemming from other traumatic events? >> we know that experiences of sexual assault during experiences of sexual assault during military service are one of the strongest predictors of ptsd. it's the type of event associated with symptoms among both women and men, even more strongly for men than for women. the symptoms look quite similar than the symptoms of ptsd
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related to other forms of traumatic stress. although survivors of mst may report certain kinds of issues more frequently than other types of trauma survivors, so for example, issues around intimacy and sexuality, issues around interpersonal relationships and boundarie boundaries, certainly issues around trust, self-blame, those issues come up more frequently when working with sexual trauma survivors. >> in the last report 62% of the people who reported that they were sexually assaulted were retaliated against, some form of retaliation. how does the experience of not being believed or being retaliate against affect symptoms? >> it worsens it. i've done research indicating that a victim's experiences in reporting in the system and how they feel about that experience, if they feel positively about it, if they feel like they were
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believed, that's a strong predictor above and beyond the experience of how they're doing years later in terms of ptsd and depression symptoms. >> last december there was a study completed by the va researchers that was published in the american journal of preventative medicine on the link of ptsd and suicide. it found it was a significant risk factor for suicide among men and women. who implications do these implications have for screening ptsd and what kind of outreach do you encourage survivors of mst to seek care? >> we do, as i mentioned, screen every veteran for experiences of mst in the va which that study would suggest is particularly important. unlike other types of traumatic events, their risk associated with mst for suicide doesn't run fully through ptsd or depression. it exists separate from that which is why it's so important that we screen specifically for
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experiences of military sexual trauma so that those patients could be followed up in terms of suicide risk directly. >> captain? >> yes, ma'am, i'd agree with dr. street. the suicide risk is increased from sexual assault aside from ptsd. ptsd itself is not necessarily a robust risk factor for suicide. it does have a hazard ratio that suggests that it's associated with suicide but certainly sexual trauma is a really big factor. developmental trauma, especially developmental sexual trauma, stuff that i've seen as a sexual child psychiatrist is a huge risk factor and affects the brain as it develops and makes you check the horizon if you're safe all the time. >> although the problems are higher among women, there are similar numbers of men and women who have survived sexual trauma, how do men differ in their response to mst and how do v.a.
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services meet the needs of men who have survived mst and are treatments different for men and women and if so how and is there a detectible difference in male suicide rates? >> male and female survivors of mst look more similar than they do different, although men's experiences may be exacerbated in terms of symptomatology although the symptoms themselves are the same. male survivors do struggle uniquely with concerns about their masculinity, understanding what this says about their sexual orientation. a lot of self-blame, why was i targeted for this. this isn't something that men usually experience. in terms of treatments, the treatments look very similar. i think differences in terms of male and female survivors really comes in when we think about our social marketing and outreach. we're very careful to have outreach to include pictures of
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men about mst in addition to pictures of women so that men can understand that our mst treatment services are there for them as well as those for women. >> i'd say one of the things that we struggle with, the prevalence of sexual assault in women compared to men is probably about five to one. dr. street's date and nath gal breath's data and some of ron kessler's data from harvard support that. one of the things that we struggle with is getting men into care. men are less apt to engage in care for sexual assault and in fact in therapy that's something you may address way downstream. it's not an initial presenting problem. >> it's why i have a concern that the suicide rate might be higher. if male survivors won't report, they don't get any care. i met a male survivor who attempted suicide, was not successful, paralyzed himself from shooting himself in the spine and was paralyzed for the rest of his life. he couldn't face his life, his
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wife, he couldn't face anything after it. instead of seeking treatment -- he actually did but for many survivors instead of seeking treatment, they just commit suicide. >> there's no question that it's a trauma that's very hard to overcome. it's very hard for us to get granular exactly about what the problem is. there's on the order of 300 risk factors associated with suicide. certainly sexual assault is one of them. ptsd is one of them. one thing is i think with regard to v.a. care and some of the promising things, we see that veterans who have ptsd have lower suicide rates than other veterans. so i think there's some promising developments in the treatment and in the turnover from dod to v.a. >> thank you. >> for the record, senator cotton served a tour of duty in combat in iraq. is that correct? senator cotton. >> thank you, chairman graham. i can say that the system that
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captain greenhalgh described has been in effect for at least ten years, at least in the army. i want to talk briefly about the relationship between traumatic brain injury and posttraumatic stress. one does not necessarily presume or infer the other, is that correct? >> not necessarily, sir. i think certainly if someone has been exposed in a traumatic event down range that resulted in a traumatic brain injury, i think the possibility is greater that they will also have co morbid posttraumatic stress with that. i believe a history of tbi predisposes someone to be more vulnerable to psychological health issues down the road. some of that has to do with the chronic effects, if that is a service member who has chronic effects of the tbi developing some symptoms that are suggestive also of psychological health issues, there's a lot of overlap there as well.
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>> i'd say patients often present to us in an undifferentiated state. they'll present maybe with the problem with suicidability, maybe a substance abuse disorder, a pain disorder. sometimes it's hard for us to discern what the precip tent was. >> is one easier to diagnose than the other to the extent that you can separate co-morbidity? >> my background is primary care. i would say certainly we see a lot of behavioral health in the primary care setting but given that we have very strong cpgs for a lot of things that we take care of in military medicine and medicine in general, when i see a patient who has a history that sort of fits within the history of the clinical practice guideline description for a certain kind of diagnose, the tbi is certainly an easy one to try and fit into that diagnostic
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realm. >> some of it has to do with patients that present in front of us. walt is going to see a different patient population than i'll see in a psychiatric setting. one of the things that occurs to me is the science for ptsd is probably more developed than the science for tbi. ptsd is a little easier to discern. it's a little easier to discern from a child psychiatry standpoint because the prevalence of that is so high. >> the research on ptsd is a bit further along and as part of that we have existing well validated instruments for the screening and diagnosis of ptsd and i think those instruments are being developed for tbi but are not as far along, haven't undergone as rigorous tests. >> so the science for ptsd is further along than tbi simply
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because of the volume of patients that the medical world has seen with posttraumatic stress as opposed to tbi? >> i think it's a number of factors. the science of t bichlt i has been really hard to get a handle on just from the standpoint of it took -- i'll give you an example, sir. it took 20 years and $50 billion to get on top of hiv. hiv has been about a dozen genes. the brain uses about 20,000 of the 30,000 genes in the human genome, understanding the way the brain works, especially a brain that's traumatized is extremely hard. with regard to ptsd, we at least have a long history of looking at people who were traumatized and a long history of treatment interventions, so i think the science is more developed for that reason. the prevalence of both of those, the prevalence of ptsd is about
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2%. tbi slightly lower. >> we really became aware of ptsd following the vietnam war so we've had that span of history to think about the disorder, the diagnosis and the treatment of the disorder. tbi is something we've become so much more aware of due to recent conflicts in iraq and afghanistan. >> if i can add, sir, again from the primary perspective, there have been versions of ptsd it seems from conflicts centuries ago as well, the idea of shell shock and things like that. i think we've gotten a handle after the vietnam conflict. with technology and neuroimaging capability, that has been a phenomenon of our generation so i think there's a lot of potential there. against from the primary perspective having neuroimaging support certain diagnostic criteria for traumatic brain injury i think that's where there's a lot of potential for the science. but i agree, we've been describing things like ptsd for
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quite a lot longer than we have traumatic brain injury. >> one word i think i heard you use twice, maybe three times was lons t longitudinal. the route of that is long which is worrisome given the number of people who suffer from ptsd or tbi. obviously when you're conducting a study it takes many years to get results. is that something about which we should be concerned now? >> yes, sir but it's the only way that we can do it because these things don't present in silos. ptsd doesn't present in silo and tbi doesn't present in a silo. we have a lot of efforts. we have the millennial study and the stars study on suicide. we're looking at several hundred thousand patients now to get an idea of where patients are coming from. >> longitudinal doesn't mean we have to wait until the study is over to start gathering data.
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there are reports out and the next one is due next year, not to mention the constant stream of data and research that is being formulated into papers along the way. longitudinal really connotes a commitment to a long-term study on this, not to say we're not going to give you answers for 15 years. >> would it be productive to expand the data set to look at other occupations that might have similar risk factors like say professional football, professional hockey, boxing or others? >> certainly the brain trust meeting that i described that's happening today and tomorrow is doing exactly that and it's bringing in a researcher from my institution who is one of the first to identify this issue among professional football players and taking that information and applying it to the military and veteran community. for sure these partnerships in which you can identify knowledge that's been gathered in other
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places and apply it to this population i think are very promising. >> thanks, mr. chairman. dr. street, i think you've touched briefly on the transition from active duty out of service or into the reserves or care of the veteran's administration. how well do you think transition is going these days in terms of the computer compatibility, not only in records but also in transition on pharmaceutical drugs, prescriptions and so forth? maybe you can give us an overview because i think you really are in a position to comment on that issue. >> i'm happy to comment from my
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perspective although my perspective may be a bit limited so you may choose to hear from my colleagues as well. but in my perspective as a practicing clinician, that transition is going well. i think captain greenhalgh said it's going better than it ever has. i know there's a lot of attention to this issue, a lot of new initiatives and in my experience as a practicing clinician i haven't encountered problems with that. >> sir, i'd say it's dod poll si -- policy right now that we do a warm handoff. we've established coaching and in transition program where we look at people's medical data and then go in and say, hey, can we help you with your follow on appointments. i think that's been used to good effect in the last year. >> it's always been the policy. it's not always been the executed policy, and so for example on the interoperability of computer programs -- i don't
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know whether you can give us an up to date perspective on how well that's going. it's been a continuing struggle as you know. >> i don't have an update on the status of that but i'm happy to take that question for the record and we could get back to you with a more thorough answer on the updated status of that process. >> i would appreciate that and as well on the pharmaceutical drug issue, the transition there has been an issue for some time. let me shift to again the posttraumatic stress, military sexual assault trauma. is that an area where you think more research as well as clinical treatment is necessary? >> i'm a researcher, i'll always say that i think more research is necessary but i do think this is a case where understanding things that are unique about
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experiences of military sexual assault, ways in which those experiences differ from the military context and civilian context, understanding that has better implications for recovery as well as research more generally targeted to the disorder and treatment of the disorder is extremely valuable. >> and it may seem obvious, the answer may seem obvious. i think i have an idea about what the answer is but maybe you can talk a little about what the differences are in the civilian versus military sexual assault trauma. >> sure. the senator earlier referred to the fact that survivors of military sexual assault in some ways look clinically more like survivors of childhood sexual abuse than they look like survivors of adult sexual assault in the civilian world and i think there's some truth to that certainly in terms of the fact that survivors from military sexual trauma often
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talk about the experience of ongoing abuse in which they feel trapped and unable to escape because they're not able to sort of leave their position, although there have been policy improvements to make that more possible. they're also dependent often on their perpetrators for meeting their basic health needs or for this feeling that their perpetrators or those who are supposed to be watching their back and looking out for those. those differences gives the survivors sometimes a little bit of a flavor that looks more like ongoing childhood abuse. of course also we know that survivors of traumatic stress are often repeatedly traumatized over a life span, so that earlier trauma increases risk for later trauma. many women and men who are survivors of sexual trauma in the military are also survivors of childhood sexual trauma or personal trauma as well so those experiences can exacerbate each other in terms of severity of
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symptom presentation. >> thank you. my time has expired. i appreciate you taking my earlier questions. thank you all for your service. thank you. >> thank you. i think senator tilis is on the way but if you have any followup. >> one of the issues that some of us work on is rescheduling marijuana to become a schedule two drug so more research can be done and so patients that have been prescribed a medication can get access to it more regularly. one of the concerns we've had is because as a schedule one drug it therefore prohibits the v.a. from being able to prescribe it, even though that individual might have been prescribed in their state if the state has passed a law. we've heard from many veterans that marijuana can often be a very useful treatment for ptsd symptoms. have you studied that issue? do you have any insight into that issue that you would like to share? >> ma'am, i can say dod hasn't
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ascertained the answer to that question for the reason that you -- >> the schedule one. >> one thing that i have seen as a child psychiatrist is, there's risks and benefits to any intervention and with regard to marijuana one of the things that we struggle with is it can precipitate psychosis in some people, especially younger people, people of a military age, so that would be a concern that i would have as we press forward on this. >> i know that va has ongoing studies looking at the effectiveness of marijuana for the treatment of ptsd but i know that there have been issues that have come up related to the quality of the marijuana, the consistency of the marijuana, the strength of the marijuana that are unique challenges in terms of studying the effectiveness on that disorder. >> would you recommend further study so we can actually have drug companies study it? >> i'd like to see the results of the earlier studies in terms
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of addressing cost benefit analyses. if early studies lo-- >> senator sullivan? >> thank you, mr. chair. i appreciate you and the ranking member calling this hearing. it's a very important topic. i appreciate the witnesses being here. one of the things i really like about this committee, it's very bipartisan. this topic comes up a lot in a very bipartisan way. you see members who actually really, really care about this. i certainly happen to be one of them. i think most people who served in the military can recall more than one instance where a troop, a member of their squad or unit
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has succumbed to the depression and suicide, and i think it's a searing experience of course for families but for the troops and the leadership and everybody else who goes through that. so it's a topic that we need to do a better job at. i'm sure it's probably already been covered to some degree, but what authorities would you view from our perspective that you need from this committee or the congress to do more to address some of the issues of the stigma of ptsd or reducing the rates of suicide among our active duty and veteran populations? is there anything more you need from us? >> sir, i think you talk about two things that are very closely related which is reducing the rate -- reducing the stigma and
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then attacking the problem itself which is suicide. i think with regards to reducing the stigma, we've made great strides over the last decade i think at least in making it not just again a symptom driven approach, the patient coming to the medical provider looking for help with our screening efforts, certainly everybody is asked whether they're symptomatic or not. when we go through our annual health maintenance examinations, that comes up as a very prominent topic, that and tbi history, as well as a lot of the technology and the apps that are available, a lot of i.t. solutions where the service member and their family doesn't necessarily have to go to a clinician to ask the question. they can get a lot of the information they need online. i think that goes a long way towards towards destigmatizing. if they can get the answer to
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their preliminary questions in a nonclinical environment, i think that's certainly one step. >> with regard to resources, i wouldn't necessarily have anything to say about that. i would say that there's a robust relationship between suicide and depression and certainly identification and management of depression, especially in a primary care setting. it's very important strategy and one that we really want to focus on, really in public health. >> let me ask another question that relates to my first one on authorities. there's a bill and i'm having my team take a look at it and i've been looking at, i believe it might have senator peters who has put this bill forward. i don't want to butcher it here so we can make sure you get it for the record. but there's concern about claims that there's been thousands, maybe tens of thousands of
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members of the military who have received discharges that are less than honorable discharges related to ptsd or brain injury type of issues. are you familiar with this bill, or are you familiar -- and the bill would ask the military to have a presumption maybe in favor of an honorable discharge. in my military career i have not really seen that issue but i may have been missing something. are you familiar with this bill? are you familiar with the problem, and what's your advice? do you think there's thousands or even more members of the military who have been discharged with other than honorable designation because of activities of undiagnosed ptsd
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and that their discharge designation should be relooked at and do you any need authority to do that from the congress? >> on the bright side we've already had that authority and we've used it. we did a mental health review where we looked at over 200,000 boards. we did a physical disability review where we looked at a number of boards for just that problem. since 2007, patients that we were going to separate for disciplinary or lack of performance, they need to be ptsd issue issues and tbi issu to be addressed before that can be done. we used to separate 4,000 folks a year. that number is down to 300 so about 7% of what it was. there's been a lot of attention to this issue and certainly about three years ago i think we spent on the order of $10 million looking at boards and certainly as senator blumenthal has brought up in some previous
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correspondence with dod sometimes we're going all the way back. so the boards of correction for military records have looked at cases from vietnam veterans, cases even where ptsd didn't exist as a clinical diagnosis. of course it's hard to ascertain exactly what the circumstances were around something that happened a long time ago without records. >> sorry, mr. chairman, just a followup. so you already have that authority. have you seen this bill, and have you weighed in on it? it would be very useful. like i said, something that i'm very sympathetic to. i don't know what dod thinks about the bill. at the same time, it sounds like you're already -- you already have the authority to do what the bill does. i don't know if it has a presumption in favor of honorable discharge. again, i don't know the specifics. i'm sorry, i should have brought it with me. but, have you weighed in or do
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you need authority or do you think you're good to go in addressing what you're obviously saying is a problem? >> sir, i mean, i haven't seen the bill. i haven't been asked to weigh in but i echo what captain colston said. i don't think it's an issue of the type of discharge that a patient gets. i think it's a matter of ensuring that they get the correct kind of care that they need prior to discharge or even after discharge with that warm handoff to our colleagues whether it's dishonorable -- honorable i don't think is necessarily the driving point. >> mr. chairman, if i may, maybe we can submit that bill and if they had a view on it. >> yeah. it sort of is the driving point. you don't want someone to have an other than honorable discharge who may have had a medical condition that resulted in it. >> this is particularly relevant for sexual trauma survivors.
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they were often diagnosed as having a personality disorder. with that discharge they weren't entitled to v.a. benefits, so it was a huge problem for them because they have trauma, they're a survivor, they need mental healthcare and they don't have access to the v.a. anymore. we wanted those cases could be looked at again to say can we get this right. >> we'll upgrade the discharge if there's a medical reason that was missed or ptsd suffering. captain colston, the reviews you're familiar with, did y'all actually change discharge designations? >> yes, sir. several service members have had discharge determinations changed over the years, and several service members have had their benefits changed, especially the physical disability board of review. >> could you do this, could you have that group -- and i applaud your efforts -- give us the results. of the 200,000 reviews, how many discharges were upgraded and how many were restored. >> yes, sir.
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the executive agent for that was the air force and the physical disability board of reviews. >> senator king? >> thank you, mr. chairman. thank you all for your work in what is a really important area. we see it daily in maine. dr. street, one of the issues we have in our state, it's a very rural state, large, long distances. how do we deal with the unique challenges facing veterans in ptsd and other mental issues who -- it's just almost impossible to drive a whole day and drive back and to have effective treatment. talk to me about treating this problem in rural areas and particularly about the possibility of using online resources, telemedicine, those kinds of things. >> the things you suggest are exactly the kind of things that we've been working with, really figuring out how we can harness
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technology to take what we know are effective treatments but have been used in a face-to-face setting in an office situation and use technology to make those more widely available. so certainly tele helps. but increasingly we've been developing and testing online technology. for example, a colleague of mine in boston recently developed an online intervention for co morbid ptsd and alcohol abuse that's showing to be quite effective. we're also harnessing the use of mobile apps that veterans can use if they have infrequent appointments in between appointments to help manage their symptoms and improve their process of recovery. so we're hoping that use of technologies and harnesses those technologies can help address some of the issues with treatment among rural veterans. >> this is a parenthetical question and then i'll get back to the technology. do we know what works? are there proven treatments to deal with this issue?
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>> there are, and i think it's such an important message to get out there because i think it provides hope for veterans. we have well established, rigorously tested treatments for ptsd, primarily psycho therapies and the cognitive behavioral that have been shown in multiple settings in multiple populations have been effective. >> i think that's important news. >> absolutely. >> this is not a hopeless situation, that there are successful treatments. >> absolutely. >> well, i want to encourage you in the strongest possible terms to pursue these technological advances because time is not on our side. again, in many places in this country people are in very rural areas in alaska and they just don't have access to a clinic or to a group. it's very gift. dr. colston, let's talk about substance abuse as it relates to
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this issue. from my anecdotal information from my staff in maine, there's a lot of overlap. a lot of people who have ptsd end up in a substance abuse situation, either alcohol or drugs. is that true, and how do we deal with that issue? >> yes, sir, there's about a 30% overlap between ptsd and substance abuse disorders. one of the really scary things that we're facing right now is the scourge of opiate overdeaths. >> 37,000 a year. >> yes. >> do you think part of it is self-medication? >> yes, sir. no question. we've seen that with alcohol and all kinds of illicit drugs. certainly now the drugs that are out there are scary. there are drugs that you can take once and end up dead and
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that's really where the change has been. we recognize that there is an overlap between those symptoms so we have a lot of stepdown care in dod, a lot of intensive outpatient treatment where we treat both your mental health issues which ptsd runs with other things, tbi, depression, substance abuse disorders, pain. we also treat the substance abuse disorders. with regard to opiate disorders, we've got medication therapy. with regard to alcohol disorders, lots of science which supports medication assisted therapy for alcoholism or other drugs that work really well. >> so you see this as an important area, that co-morbidity is an important issue? >> absolutely. duel diagnosis work is really where our work is right now. >> dr. street, are there any v.a. rules that if you're
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suffering from ptsd and also have a drug abuse problem you can't get treatment or you're excluded, there's no oh, no barriers? >> no barriers. in fact, increasingly we're looking at treatments that can treat both of the disorders simultaneously because we know that they're so interrelated. >> final question. i know that a program was created in 2010 to help people moving out of the service into -- called in transition i think it's called. my question is, is it working and how do we know? >> we're collecting -- that's run out of my office, sir. we're collecting data on it. we ramped up the program ten fold about a year ago. >> good. >> one of the things that we're trying to do throughout the dod is get outcome measures. luckily there hasn't been in this short period that we've been running the program a suicide in any person who's been coached in the program. nonetheless, we want outcome measures with regard to things like how depressed is this patient, what kind of ptsd
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symptoms does that patient have, how much healthcare is this patient utilizing. i think as our health systems evolve and we develop registry data, the ability to get an idea of where patients are, we'll get much better answers. >> i think we should be applying the same level of resources, money and personnel, to transition out of the service that we've put into recruiting in. that's where a lot of the slippage occurs in that -- sometimes very difficult transition. that's been something i just think that's a rule of thumb. let's spend as much helping people when they come out as we spend bringing them in the in the first place. thank you very much for your testimony and for your work. >> thank you, mr. chair, thank you all for being here. first off, i understand -- i'm sorry i'm late. i had a competing -- actually, i was following senator sullivan through the current committee circuit, so i apologize for being late.
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if you've already answered these questions, i can refer back to the record. one thing i wanted to underscore i think that senator sullivan covered, it's a bill that i've supported, the fairness for vets act. i think you all got into a discussion here so i won't ask you to repeat it but underscore i think it's important and i think it provides value and i believe there's at least consensus among the department that you do as well? thank you. any problems with it? >>. [ inaudible ] >> senator cotton may have mentioned something about public private partnerships. we go to the easy one to identify which will be the nfl. based on where i come from, i could argue nascar. but what other sort of network of private partners are out there and what specifically are we doing to really bring in and collaborate, use their expertise, not reinvent the
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wheel? dr. street, maybe i should direct that to you? >> there's a two-day summit that's the focus, bringing in folks from v.a., dod, the nfl, researchers from the private sector who are familiar with those issues to garner innovative technologies from different sectors and apply them to this population. it's a good general model. >> have we gone into any of the maybe research universities that do a lot of work there and find partnership opportunities there? >> absolutely. where i hail from in boston, we have very close connections with boston university. they've done a lot of work around chronic encephalopathy. many of those hold dual appointments in the academic institution and the v.a. so we
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can harness the power of some of the best scientists in this country who are doing the work. >> senator king mentioned the transition piece. i'm on veterans affairs committee and obviously a lot of the challenges we have after a man or woman comes out, they may have undiagnosed tbi, ptsd. i'm trying to figure out how we do a better job of -- there's this handoff and sometimes if you go in transition you've got the younger soldiers that are in the back of the room with their headphones on doing their duty and then moving out there they may be in fact people who should be listening and what they're thinking about is moving on. to what extent is the dod -- it necessarily becomes a v.a. role but to what extent is the dod making sure that particularly for ones where you may have evidence to suggest that someone does have something that has not yet been effectively treated make sure that those veterans
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get vehicle tered into the care that they may need through the v.a. does that occur or is it because of the finite nature of the transition -- i'm trying to get a better sense of how we do a better job that the v.a. may not know that there's someone out there that may need help. how do you create an alert system or does it already exist to make sure there's a good handoff? >> three things. first there's a separation health assessment where we try to cover all of these issues. for patients who present with any kind of condition, we have an integrated disability evaluation system with the v.a. and in transition system to coach folks. it's an opt out system to help folks get that next appointment. for the sickest paeshlts, we go all the way to when i was at great lakes, if i had an 18-year-old with schizophrenia, one of my techs would get on a
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plane and bring him to alabama or texas. that's the level of transition support that's expected. >> do you think that we're doing that consistently? >> sir, i can say we're measuring it right now. i can certainly take that question for the record with regard to how we're doing. >> i would appreciate that. just to get some sense. i'm from north carolina. we got 1 million veterans and a lot of folks who either served at ft. bragg or luzerne that end up saying at north carolina. want to make sure we're getting them to the care that we think could help avoid other problems and complications. i work a lot with drug treatment facility down in raleigh-durham. 60% of their clients are people who now have substance abuse problems but it's not clear how they got there, what caused them. some of them are rooted in ptsd so i'm sensitive to this issue to make sure we're capturing as many as possible and getting them into an appropriate care setting. i would appreciate that. thank you, mr. chair. >> thank you.
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this has been an excellent panel. just to summarize, one in four military members are affected by what we have've been talking ab today -- trauma, ptsd, drug abuse, alcohol abuse problems. they've been treated for these problems is that correct? >> yes, sir. we do a dmdc data run. so a defense management data run for everyone that's getting out and say have you been treated. one thing i can say is we do a really good job with screening and certainly we've evolved to identify more of the illness that's out there. i think we now have probably the most treated cohort in human history so i think we're doing a good job in that regard. >> that's the whole point. somebody asked this but as i wrap up here and let other people ask additional questions, please tell us what we can do because we're trusting y'all
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guys. everybody seems to be very focused that the veterans and those serving deserve this. about 80% of the cases are unrelated to being in combat. one thing about the movie, i haven't seen it but the senator was telling me you can't look at a tbi injury on an mri. it's not like looking at a broken bone, right? >> no, sir. no neuroimaging. >> only god knows how many of this we missed in past conflicts. >> for the mild tbi, yes, sir. i'll just add this and let members wrap up. i've been to a bunch of refugee camps. i can only imagine what the people in these camps are going through. i was at one in turkey. the children, the women, victims of sexual assault. there's not a whole lot of treatment for people who have
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been through conflict, and i just think they're ticking time bombs if we don't get ahead of this. one thing i'd like the senate to understand is that when we provide aid to the refugees, it's more than just food and water and clothing. if we don't have a mental health component, i think we're making a huge mistake. anybody else? >> i have a followup question. the bill is fairness to veterans erroneously discharged from the military. that's the name of the bill. if you could take a look at that and see if that's providing you additional authority that you think you need which is obviously an issue that seems to be a pretty big issue if you're looking at 200,000 cases. i just had another question. i'm on the veterans affairs committee and i asked the questions of some of our service organizations when they were testifying recently. on the designation ptsd, there's been some discussion, we talk
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about the stigma, the posttraumatic stress disorder, so a disorder kind of comes with a little bit of, you know, implications. so some people have mentioned to me, maybe this should be referred to as posttraumatic stress injury. so if you receive this in combat and you were injured obviously it's like getting shot, nobody calls a gut wound or getting shot a disorder. they call it an injury. some veterans groups think that might be a good idea. others don't for reasons that it might have to do with benefits and how things are actually categorized in the v.a. and if you don't call it disorder you might lose a certain amount of -- do you have any thoughts on that, dr. street? any of you just on the -- just
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the title itself which does have certain implications. i just wonder what your thoughts are. >> i'm in favor of retaining the posttraumatic stress disorder title. i appreciate the concern about stigma, but i don't believe that changing the title is the way to most effectively combat the stigma. >> i'm not saying it would but, you know, it might be -- it might help. >> i think certainly just to outline my specific concerns, we've made so much progress in terms of our ability to diagnose and effectively treat the disorder and in part that's due to the fact that the symptoms of ptsd look so similar regardless of the source of traumatic stress exposure, be that something associated with military service or something from the civilian sector. i'm concerned that changing the name would introduce confusion that might negatively impact functioning. i agree that the issue of stigma is a concern and needs to be addressed. i'm just not sure that this is
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the most effective way to do it. >> there is a good point to the use of that term inasmuch the normal course of being exposed to trauma is toward health. a vast majority of people who are exposed do get healthy. sebastian younger wrote a very beautiful article about some of his exposes and the subsequent course and some of the things that we've seen in the military. it's tough in the military life, especially when you're coming out of combat, especially during with austere environments. going back to where general correlli was five years ago when he used the term pts as opposed to ptsd there's arguments on both sides. i agree with dr. street that we've got to call it a disorder because we've got to get people services, support and make diagnosis to get paid in the medical record. >> thank you. >> yes, sir? >> this is really just to
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reinforce what the chair said. one of the things that i'm really intent on is challenging you all to tell us where past congressional decisions at the time may have made sense, may not have made sense, they just had the votes or times have changed, but the sorts of things that we place on you, particularly in dealing with this, you know, well intentioned policies that do not add value, they add cost or constraint, we need your feedback so that we're not only adding some new good ideas that maybe take the edge off of some of the old ones that are still in place but really help us do reforms. you got a changing environment. your understanding of ptsd, how to treat it, transition, how to keep track of our vets and take care of them change over time and i really want a committee where they come in here and tell
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us you need to change this -- or call my office or the chair's office and give us an opportunity to look at some of the things that you're currently doing that are no longer value added and could deploy resources to a better and higher use in your professional opinion. >> i move that all outside statements of the record received in advance of the hearing should be included in the official record. without objection, the hearing is adjourned. well done. thank you.
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president obama delivers his last speech at the white house correspond ent's dinner a week from saturday. coming up this saturday, c-span takes a look at some of his previous speeches from past dinners. >> no one is prouder to put this birth certificate matter to rest than the donald. and that's because he can finally get back to focusing on the issues that matter, like did we fake the moon landing. what really happened in roswell. and where are biggie and tupac. all kidding aside, obviously we all know about your credentials
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and breadth of experience. for example, seriously, just recently in an episode of "celebrity apprentice," at the steak house, the men's cooking team did not impress the judges from omaha steaks and there was a lot of blame to go around, but you, mr. trump, realized that the real problem was a lack of leadership, so ultimately you didn't blame little john or meatloaf. you fired gary busey. these are the kind of decisions that would keep me up at night. c-span's look at the president's past speeches from the white house correspondent's dinner is saturday night on c-span at 10:00 eastern. madam secretary, we proudly
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give 72 of our delegate votes to the next president of the united states. ♪ up next on c-span 3, a house hearing on law enforcement access to encrypted data on smartphones and other devices. an fbi official said law enforcement agencies need access to enscripted data to investigate crimes. in a later panel, a senior vice-president with apple explained why his company does
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not want to allow what he calls a back door into people's phones. this hearing is three hours 15 minutes. >> we have multiple hearings going on today and tomorrow we have a hearing as well so you will see people coming and going, so especially for our witnesses so you don't think that it's chaos, we have members trying to juggle a lot of things at the same time. it is chaos, okay, i stand corrected. we're meeting today to consider the deceptively complex question, should the government have the ability to law flee access encrypted technology. this is at the center of a heated debate when the fbi obtained a court order to compel apple to unlock an iphone used by one of the san bernardino terrorists. this isn't a new question. strong encryption has existed for decades and motivated
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individuals have had access to -- the government has repeatedly tried to limit the use of or obtain access to enscript data. in the 90s it sparked fears. in response, the nsa developed a clipper chip that would enable enscripted communications but would also provide the government with the key to access those communications if necessary. this so-called back door sparked intense debate between the government and the technology community about the benefits and risks of government access to encrypted technology. one of the principle arguments was that such a back door would create a vulnerability. this concern was validated when a critical flaw was developed in the chip's design. one of our witnesses today identified that vulnerability
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which made the government's back door more akin to a front door. as a partial solution congress passed the communications assistance for law enforcement act called ka leah. ka leah addressed the government's concern that rapidly involving technologies were curtailing their ability to conduct surveillance in executing authority or authorized surveillance. however, the law included notable caveats which limited the government's response to encrypted technology. after the government relaxed controls in 2000, the wars entered a period of relative quiet. what has changed in recent years? part of it is the rapid expansion of technology. this debate is about the widespread availability of encryption by default. encryption has existed for decades.
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it took effort and sophistication to employ its benefits or good or evil. law enforcement was still able to gain access to the majority of the digital evidence they discovered in their investigations. now the inkrepgs of electronic data at norm, the default. this is a natural response to escalating concerns both from government and consumers about the security of digital information. the decision by companies like apple and the messaging application whatsapp to provide default encryption means more than a billion people, including some living in countries with repressive governments have the ability to secure data. that is the crux of the recent debate. access to secure technologies is available to anyone and everyone. at the same time however as more
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of our lives become dependent on the internet and information technolo technology, while many of the arguments may echo those of decades past, the circumstances have changed and so too must the discussion. we can no longer be a battle between two sides, a choice between black and white. we take that approach to only outcome is that we all lose. this is about public safety and ethics and requires a very thoughtful approach. that is why we're here today to begin moving the conversation from apple versus the fbi or right versus wrong to construction tif dialogue that recognizes this is a complex issue that affects everyone and therefore we are all in this together. we have two very strong panels. i expect each will make strong arguments about the benefits of strong encryption and the challenges it presents for law enforcement. i encourage my colleagues to learn from these experts to better understand the multiple
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perspectives, layers and complexities of the issue. it's time to begin a new chapter in this battle. this process will not be easy. if it happen now, we may reach a time when it's too late and success becomes impossible. so for everyone calling on congress to address this issue, here we are. i can only hope moving forward you'll be willing to join us at the table. i now recognize the ranking member from colorado, ms. degette, for five minutes. >> thank you, mr. chairman, and thank you for holding this important hearing. issues surrounding encryption and particularly the disagreements between law enforcement and the tech community gained significant public attention during the san bernardino case but i'm not interested in relitigating that today. as you said, mr. chairman, the conversation needs to be broader than that one case. let me state unequivocally that i like you, and the rest of us hear today, recognize and
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appreciate the benefits of strong encryption in today's digital world. it keep ours communications secure, critical infrastructure safe and bank accounts from being drained. it also provides each one of us with significant privacy protections, while encryption does provide valuable protections, it can be used to obscure the communications and plots of criminals and terrorists. and increasingly great risk it's our task to find the proper balance between those competing interests. we need to ask both industry and law enforcement hard questions today. last month the president said, for example, "we want strong encryption because part of us preventing terrorism or preventing people from disrupting the financial system is that hackers -- state or nonstate -- can't get in there and mess around." but if we make systems that are inpenetrable or warrant proof, how do we stop criminals and
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terrorists? if you can't crack these systems, president obama said, then everybody is walking around with a swiss bank account in their pocket. i've heard the tech community's concern tha some policies being proposed -- like creating a back door for law enforcement -- will undermine the encryption that everybody needs to keep them safe and as they remind us, a back door for good guys ultimately becomes a front door for criminals. the tech community has been particularly vocal about the negative consequences of proposals to address the encryption challenge. i think many of these arguments are valid. but i've only heard what we should not do. not what we should do collectively to address this challenge. i think the discussion needs to include a dialogue about how to move forward. i can't believe this problem is intractable. now the same thing seems to be true from where i sit for law
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enforcement which raises legitimate concerns but doesn't seem to be focused on workable solutions. i don't promote forcing industry to build back doors or other circumventions that experts will tell us will undermine security or privacy for all of us. at the same time, i'm not comfortable with impenetrable warrant-proof spaces where criminals or terrorists can operate without fear law enforcement could discover their plots. so what i want to hear today is from both law enforcement and industry about possible solutions going forward. for example, if we conclude that expansive warrant-proof spaces are not acceptable in society than what are the policy options. what happens if encryption is the reason law enforcement can't solve or prevent a crime? if the holder or transmitter of the data or device can't or won't help law enforcement, what then? what are suitable options?
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last week, for example, the "washington post" reported that if government relied on gray hat hackers to circumvent the san bernardino iphone. well, thank goodness ion't think so. i don't think relying on a third party is a good model. this recent san bernardino case suggests that when the government needs to enhance its capabilities when it comes to exploring ways to work around the challenges posed by encryption, i intend to ask both panels what additional resources and capabilitys the government needs to keep pace with technology is, while providing government with more tools or capability require additional discussions regarding due process and the protection of civil liberties, enhancing the government's technical capability is one potential solution that does not mandate back doors. finally the public, the tech community and government are all
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in this together. in that spirit i want to thank our witnesses for coming today. i hope -- i'm happy that we have people from law enforcement, academia and industry and i'm really happy apple came to testify today. your voice is particularly important because other players like facebook and what's app declined our invitation to be a part of this panel. now, the tech community has told congress we need to solve this problem and we agree but i have to tell you it's hard to solve a problem when the key players won't show up for the discussion. i'm here also to tell you as a long time member of this subcommittee relying on congress to on its own pass legislation in a very complex situation like this is a blunt instrument at best. i think would be in everybody's best interest to come to the table and help us work on a solution. thanks again for holding this hearing, i no we won't trivi
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trivialize these concerns, i look forward to working with everybody to come up with a reasonable solution and i yield back. >> ygentlelady yields back. i recognize the chairman of the full committee, mr. upton. >> thank you, mr. chairman. while much of this recent debate is focused on the fbi and al, this issue is much bigger than any one entity, device, application or piece of technology. at its very core, this is a debate about what we as a society are willing to accept. if we paid any attention to the debate it might appear to be a black-and-white choice, either we side with law enforcement and grant them access to encrypted technology thus weakening our digital structure privacy or we can side with the technology community and prevent law enforcement from accessing encrypted technologies thus creating a warrantless safe haven for terrorists, pedophiles and other evil and terrible
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actors. it's important that we move beyond the us krer us is them mentality that encomes thatted this discussion for foo long. this debate is not about picking sides, it's about evaluating options. it begins by acknowledging the equities on both sides. from the technology perspective, there's no doubt strong encryption is a benefit to our society. as more of our daily lives become integrated with the digital universe, encryption is critical to the security and privacy of our personal and corporate secrets. as evidenced by the breaches over the past year, data theft can have a devastating effect on our personal privacy, economic strength, and national security. in addition, encryption doesn't just enable terrorists and wrongdoers to do terrible things. it provides a safe haven for dissident, victims of domestic violence and others who wish to remain hidden for noble purposes and as we look to the future and see that more and more aspects
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of our lives will become connected to the internet, including such things as our cars, medical devices and the electric grid, encryption will play an important role in minimizing the risk of physical harm or loss of life should these technologies be compromised. from the law enforcement perspective, while strong encryption helps protect information and lives, it also prepresents a serious risk to public safety. as a strong inaccessible encryption becomes the norm, law enforcement loses access to valuable tools and evidence necessary to stop bad actors from doing terrible things as we will hear today, this cannot always be offset by alternative means such as metadata or other investigative tools. there are certain situations such as identifying the victims of child exploitation, not just the perpetrators, where access to contend is critical. these are but a few of the many valid reasons on both sides of this debate which leads us to the question what's the answer? sitting here today i don't have
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the answer, nor do i expect that we' l find it during this hearing. this is a complex issue that will require a lot of difficult conversations but that's not an excuse to put our head in the sand or resort to default positions. we need to confront these issues head on because they won't go away and they'll only get more difficult as time continues to tick. identifying a solution to this problem may involve tradeoffs and compromise on both sides but ultimately it comes down to what society accepts as the appropriate balance between government access to encryption and security of encrypted technologies. if for that reason and others many have called on us -- this committee -- to confront the issues here. that's why we're holding the hearing and why chairman goodlatte and i as well as chairman palone and conyers established a a group to examine this issue. in order for congress to confront the issue it will require patience, creativity,
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courage and more importantly cooperation. it's easy to call on congress to take on an issue but you better be prepared to answer the call when we do. this issue is too important to have key players sitting on the sidelines and therefor i hope all of you are prepared to participate as we take to heart what we hear today and be part of the solution moving forward. i yield back. >> gentleman yields back, now recognize mr. palone for five minutes. >> thank you, mr. chairman. i welcome the opportunity to hear today from both law enforcement and the tech community as we seek to understand and develop solutions to this encryption debate. encryption enable the privacy and security that we value but it also creates challenges for those seeking to protect us. law enforcement has a difficult job of keeping our nation safe and they're finding some encrypted devices and programs are pampering their efforts to conduct thorough investigations. even when they obtain a warrant they find themselves unable to access information protected by end-to-end encryption.
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this raises questions of how comfortable we are as a nation with these khark areas that cannot be reached by law enforcement. at the same time, the tech community helps protect our most valuable information and the most secure way to do that is by using end-to-end encryption meaning the device or app manufacturer doesn't hold the key to that information. when the tech community tells us providing back doors will make the information more difficult, we should heed that warning and work towards a solution that won't solve one problem by creating others. it's clear both sides in this discussion have compelling arguments but repeating those arguments is not a sufficient response. we need to work together to move forward and i hope today's hearing is the beginning of that conversation. in the last several months and years we have seen major players look to congress for solutions. in 2014 fbi director comey said "i'm happy to work with congress, with our partners in the private sector and with my law enforcement and national
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security counterparts and with the people we serve to find the right answer, to find the balance we need. in an e-mail to apple employees, apple's ceo tim cook wrote about his support for congress to bring together, and i quote "experts on intelligence, technology and civil liberties to discuss the implications for law enforcement, national security privacy and personal freedoms." and he wrote that apple would gladly participate in such an effort. so if we have any hope of moving this debate forward, we need all parties to come to the table. the participation of our witnesses today should serve as a model to others who have been reluctant to participate in this discussion. we can't move forward if each party remains in its corner unwilling to compromise or propose solutions. both sides need to rise there is an effort to strike a balance between security an privacy of personal data and public safety. the public needs to feel confident their information is secure but at the same time we need to assure them law enforcement has the cools it needs to do their jobs
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effectively. so mr. chairman i'd like to yield the remaining time to the gentleman from new york, ms. clark. >> i thank ranking member pallone. let me thank chief galati. many refer to new york city police department as new york's finest but i'd like to think of them as the world's finest. welcome chief gallotti. our constitution is about the balance of power. it's about balancing power among the federal government, state government and the rights of individuals. through the years, getting that balance just right has been challenging and at times tension fill bud we have prevailed. the encryption versus privacy rights is another opportunity for us to recalibrate and fine tune the balance in our democracy and as the cold cliche states, democracy is not a
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spectator sport so it's time for all of us to participate. it's time to roll up our sleeves and work together to resolve this issue as an imperative because it's not going away, so i'm glad we are having this hearing because i do believe working together we can find a way to balance our concerns and to address this issue of physical security with our rights to private security so i look forward to hearing the perspectives of our witnesses today and i yield back the remainder of the time. thank you, mr. chairman. >> thank you. i would just ask unanimous consent that the members' written opening statements be written into the record. without objection the documents will be entered into the record. now i'd like to introduce the witnesses of our first panel for today's hearing. our first witness is miss amy hess, miss hess is the executive director for science and
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technology, the federal bureau of investigations in this role. she is responsible for the executive oversight of the criminal justice information as much ass laboratory and operational technology divisions. ms. hess has logged time in the field as an fbi special agent as well as the bureau's headquarters in, what and we thank ms. hess for preparing her testimony and look forward to your insights. we also want to welcome chief thomas gallotti from the new york city police department. the chief is a 32-year-old -- not 32 years old, a 32-year veteran of the new york city police department and currently serves as chief of intelligence. as chief of intelligence he's responsible for the activities of the intelligence bureau, the western hemisphere's largest municipal law enforcement intelligence operation. thank you, chief, for your testimony today and we look forward to your comments. and we welcome captain charles cohen of the indiana state police, currently he is the commander of the office of intelligence and investigative
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technologies where he is responsible for the cyber crime electronic surveillance and internet crimes against children. we appreciate his time and thank witnesses for being here. i want to know that sheriff ron hickman of the harris county sheriff's county office won't join us due to the tragic flooding of the houston area. our prayers and thoughts are with the people of houston. we wish sheriff hickman could be with us but we understand logistics can make these things impossible. i would ask unanimous consent that sheriff hickman's testimony be entered into the record and without objection this testimony will be entered into the record. to our panelists, as you were aware, the committee is holding a hearing and when doing so has the practice of taking testimony under oath, do any of you have objections to taking testimony under oath? they all say no. the chair then advises you that under the rules of the house and committee you're entitled to be advised by council. do any of you desire to be advised by council during the hearing today? all say no as well. in that case, would you rise,
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raise your right hand, i'll swear you in. do you swear the testimony you are about to give is the truth, the whole truth and nothing but the sfloout thank you, you may be seated. all the witnesses answered in the affirmative and you are now under oath and subject to the penalties set forth in title 18, section 1001 of the united states code. you may now give a five-minute summary of your opening statement, ms. hess, you're recognized for five minutes. >> thank you, good morning chairman murphy, ranking member degette -- >> just make sure your microphone is called as close as possible. >> thank you for the opportunity to appear before you today and engage in this important discussion. in recent years we've seen new technologies transform our society, most notably by enabling digital communications and facilitating e-commerce. it's essential we protect these communications to promote free expressi expression, secure commerce and trade and safeguard sensitive information. we support strong encryption but we've seen how criminals including terrorists are using
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advances in technology to their advantage. encryption is not the only challenge we face in today's technological landscape, hour. we face significant obstacles in lawfully tracking suspects because they can communicate while changing from a known wi-fi service to a cellular connection to a phi phi hot spot. they can move from one application to another and carry multiple conversations simultaneously. commune companies don't have standard stay day a retention policies and it's difficult to put pieces of the puzzle together. some foreign communication providers have millions of users in the united states but no point of presence here making it difficult if not impossible to execute a lawful court order. we encounter platforms that render suspects virtually anonymous on the internet and if we can not attribute communications and actions to a specific individual, critical leads and evidence may be lost. the problem is exponentially increased when we face one or more of these challenges on top of another. since our nation's incription
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we've had a reasonable expectation of privacy. this means only with probable cause and a corps order can law enforcement listen to an individual's private conversations or enter their private spaces but when changes in technology hinder or prohibit our ability to use in ordered investigative tools and follow critical leads we may not be able to root out child interpret or thes or violent criminals targeting our neighborhoods. we may not be able to identify and stop terrorists using today's communication platforms to execute attacks in our country. so we are in this country trying to maximize security as we move into a world where increasingly information is beyond the reach of judicial authority and trying to maximize privacy in this era of rapid technological advancement. finding the right balance is a complexion ender and it should not be left to corporations or to the fbi to solve. it must be piublicly debated an deliberates. the american people should
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decide how we want to govern ourselves in today's world. it's law enforcement's responsibility to inform the american people the investigative tools we have used in the past are increasingly becoming less effective. if discussion so far has been highly charged at times because people are passionate about privacy and security. but this is an essential discussion which mubs include a productive, meaningful and rational dialogue on how encryption as implemented poses significant barriers to law enforcement's ability to do its job. as this discussion continues, we're committed to working with industry, academia and other parties to develop the right solution. we have an obligation to ensure understands public safety and national security risks that result from the use of new technologies and encryptioned platforms by malicious actors. to be clear, we're not asking to expand the government's surveillance authority but to ensure we can continue to obtain electronic information and evidence pursuant to the legal authority that congress has provided by us to keep america safe. there is not and will not be a
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one-size-fits all solution to address the variety of challenges we face. the fbi is pursuing multiple avenues to overcome these challenges but we realize we can not overcome them on our own. mr. chairman, we believe the issues posed by this growing problem are grave and extremely complex. we must therefore continue the public discourse on how best to ensure that privacy and security can co-exist and reinforce each other and this hearing today is a vital part of that process. thank you again for your time and attention to this important matter. >> thank you ms. hess. i recognize chief gallotti for five minutes. >> thank you. >> mike sure your microphone is turned on and pull it as close as you can. >> on behalf of mayor de blasio and police commissioner bratton and myself thanks for the opportunity to speak with you this morning. years ago criminals and their accomplices stored their information in closets, drawers, saves and glove boxes. there was and continues to be an expectation of privacy in these areas but the high burden imposed by the fourth amendment which requires lawful search be warranted and authorized by a neutral judge has been deemed
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sufficient protection against unreasonable government search-and-seizure for the past 224 years. now it seems that legal authority is struggling to catch up with the times because today nearly everyone lives their life on a smart phone, including criminals so evidence that once would be stored in a final cabinet or notebook is archived in e-mail or text. the same information that would solve a murder, catch a rapist or prevent a mass shooting is stored on that device. but where law enforcement has legal access to the file cabinet it's shut out of the phone. not because of constraints built into the law but limits i want posed by technology. when law enforcement is unable to access evidence necessary to the investigation, prosecution and prevention of a crime despite the lawful right to do so we call this going dark. everyday we deal with this evidence share dl-- evidentiary in two fronts. first when the actual device, computer, tablet or phone is in
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law enforcement's position but the information stored within it is inaccessible. in a six month period from october 2015 through march of this year, new york city lab locked out of 67 apple devices lawfully seized pursuant to the investigation of 44 violent crimes. in addition, there are 35 non-apple devices. of these apple devices, these incidents include 23 felonies, 10 homicides, two rapes and two police officers shot in the line of duty. they include robberies, criminal weapons possession, criminal sex acts and felony assaults. in every case we have the file cabinet, so to speak, and the legal authority to open it but we lack the technical ability to do so because of encryption protects its contents. but in every case these crimes deserve our protection, too. the second type of going dark is an incident known as data in motion. in these cases law enforcement is legally permitted through a warrant or other judicial
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process to intercept and access a suspect's communications but the encryption built into the applications such as what's app, telegram or wicker and others blunt this is lawful surveillance. so we may know a criminal group is communicating but we are unable to understand why. in the past, a phone or a wiret wiretap, again, legally obtained from a judge, would alert the police officer to dropoff locations, hideouts and target locations, now we are literally in the dark and criminals know it, too. we recently heard a defendant in a serious felony case make a call from rikers island where he exalt it had apple ios 8 and its encryption software as a gift from god. this leaves prosecutors and people we are sworn to protect in a precarious position. what is more alarming is that the position is not dictated by elected officials or judiciary system or laws. it's created and controlled by
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corporations like apple anding into who will have taken it upon themselves to decide who can access critical information and investigations. as a bureau chief in our nation's largest municipal police department, an agency charged with protecting eight and a half million residents and millions of daily computers and tourists everyday i'm comfort court ceos don't hold themselves to the same safety standards as our elected officials and law enforcement professionals. how do we keep people safe? the answer cannot be warrant-proof encryption which creates a landscape of criminal information outside the reach of search warrants or subpoena and outside legal authority to establish centuries of jurisprudence. but this has not always been apple's answer. until 19 months ago they held the key that could override protections and open phones. they used this master key to comply with court orders in kidnappings, murders and terrorism cases. there was no documented incident or kwoed getting out to hackers or the government. if they were able to comply constitutionally, legally
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through court orders, why not now? ramifications to this fight extend far beyond san bernardino, california, a tend 14 people murdered there. it's important to recognize that more than 90% of all criminal prosecutions in our country are handled at the state or local level. these cases involve real people. families, your friends, your loved ones, they deserve police departments that are able to do everything within the law to bring them to justice and they dederve corporations to appreciate their ethical responsibilities. i applaud you for holding this hearing today. it's critical we work together across silos to fight crime and disorder because criminals are not bound by jurisdictional boundaries or industry standards but increasingly they are aware of the safety net the warrant-proof encryption provides them and we must all take responsibility for what that means. for the new york city place department it means investing more in people's lives then in quarterly earnings reports and putting public safety back into the hands of the brave men and women who have sworn to defend it. thank you and i will take any
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questions. >> now captain cohen you're recognized for five minutes. again, pull the microphone close to you. mr. chairman, members of the subcommitt subcommittee, that you think for allow manager to testify. i'm chuck cohen, a captain with the indiana state police. i serve with the internet crimes against children task force commander. i would not be here today if i were not for encountering serious problems with inscriptiencryption that don't have technological fixes. we need your help. as far as i know the fbi is not exaggerating or trying to mislead anyone when they say there is no way to recover data from newer iphones. apple has intentionally designed an operating system and device combination that acts as a locked container without a key. the sensitivity of the personal information people keep within their phones should be compared with the sensitivity of information that people keep in bank deposit boxes and bedrooms. criminal investigators with proper legal authorize have the technical means to access both deposit boxes and bedroom bus we lack the technical means to access newer cellular phones running default hard encryption. we are asked, for example, how
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encryption hinders law enforcement's ability to conduct investigations. there are numerous encrypted phones sitting in the indiana state police evidence rooms waiting for a situation. some of those phones belong to murder victims and child sex crime victims. earlier this year a mother and son were shot to death in indiana. both victims had newer iphones. i'm confident if they were able both would give consent for us to forensically examine their phones to help us find their killer or killers but being deceased they were unable to give consent and unfortunately for investigators, they chose to buy phones running encrypted operating systems by default. we are not talk just talking about suspects' phones but victims' phones and not just about increme nating evidence but also exculpatory evidence that cannot be recovered. it's difficult to know what evidence and contraband is not being recovered. the child victims not being rescued and child sex offenders not arrested as a result of encryption but the investigation, prosecution and
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federal contribution of randall fletcher helps to shed light on the type of evidence being concealed by encryption. fletcher lived in northern indiana. during the course of an investigation for production and possession of child pornography, computer hard drives with encrypted partitions and encrypted thumb drive were seized. the encryption was a bust such that it was not possible to examine the data despite numerous attempts by several law enforcement agencies. a federal judge compelled flesher to disclose the key. he then provided by law enforcement with a pass code that opened the partitions but not the thumb drive. in the newly opened data, law enforcement found videos depicting minors being caused to engage in sexually explicit conduct. investigators believe the thumb drive has homemade child pornography but have no way of confirming or disproving that belief. fletcher had continuing and on going access to children, including a child he previously photographed in lascivious poses. he has previous convictions for conspiracy to commit murder and child sex offenses detailed in
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my written testimony. there is good reason to believe that because of hard encryption on the usb storage device additional crimes committed by him cannot be investigated. that means additional child victims can not be provided by services or access to the justice they richly deserve. i hope congress takes the time to truly understand what is at stake with the going dark phenomenon and what problems krb created. there is a cost associated with a scheme that allows lawfuling a swiss a theoretically higher chance of loss data but there is a greater and human cost we see across the country because of investigations that fail due to default hard inscription. in my daily work, i feel the impact of law enforcement going dark. it's a strong feeling of frustration because it makes detectives and forensic examiners for whom i am responsible less effective but for crime victims and their families it's different. it's infuriating, unfair and incomprehensible why such critical information for solving crimes should be allowed to be completely out of reach.
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i have heard some say law enforcement can solve crimes using metadata alone. that is not true. that is like asking a detective to process a crime scene by only looking at the street address on the outside of the house where a crime was committed. i strongly encourage committee members to contact your state investigative agency or local police department and ask about this challenge. i greatly appreciate your invitation to share my perspective and i'm happy to answer questions today or any point in the future. thank you, mr. chairman, members of the committee. >> i now recognize myself five minutes for questions. ms. hess, i think sometimes the fbi's concerns about encryption are characterized as being against encryption. considering the fbi's work on investigations like the sony data breach or the ransom wear attacks on hospital, i have a tough time believing your sorgs against a technology that's against protecting information. does the fbi agree strong inscription is important to the security and privacy of our
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citizens and strength of national security? >> yes, sir. >> and it benefits law enforcement, yes? can you elaborate on that? >> yes, sir. and you are correct. as i stated in my opening statement, we do support strong encryption because it does the things you just said. we recognize that we have an increasing struggle to access readable information content of communications caused by that inscription that's now in place by default. >> so it brings a question of are you witnessing an increase in individual's intentionally or even unintentionally evading the law through availability of default inscription? >> i think it's difficult to discenter whether or not they're intentionally doing it however we are significantly seeing increases in the use and deployment of dekripgs because it's a default setting now on most devices. >> so related to that chief
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galati, would you say the default application of encryption can create significant hurdles for law enforcement? is that the issue as ms. hess was saying? the default one? >> yes, sir. the encryption, the apps being used today even with legal process our coverage on the phone you cannot intercept those conversations, often we hear criminals both -- criminals and also in the terrorism cases that we do people encouraging part pants to go to apps like telegram, what's app, wicker and so on! captain cohen, your testimony was moving about people involved with murder and victimizing children this debate has often been about picking sides, the most notable being apple and the fbi. so either you support law enforcement and the tech community, that feels like a lose-lose proposition. i understand people want to have
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encrypted technology but based upon the responses you heard and the chief, do you think this is an us versus them debate or their answers that can be going for them? you're on the front lines dealing with these terrible cases. is there an answer? >> mr. chairman, i definitely do not think it's an us-them. what we do see, though, is a challenge with default encryption that can't be turned off. i don't have the option to disable that encryption. the difference, the example i gave you was that after two prior to convictions he then learned he needed to do something to protect himself better from criminal investigation and then went out in search of, we assume epikripgs and ways to do that. the difference is now what we are seeing to talk to -- your question to ms. hess as well, discussion among a wide variety of criminals and i see it daily that sexually solicit children
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on line, sexually extort children, trade in child pornography discussing the best possible systems to buy, the best combination of cell phone and operating system to buy to prevent encryption. make no mistake criminals are learning which messaging app to use to protect themselves, they are learning which messaging app is located outside the united states and has no bricks and location outside the united states, which are located with countries that have treaties with us and which we don't. criminals are using this as an education to make themselves mrs. effective at the criminal trade graft. >> what answer we have here for whether the terrorist is planning a plot or they have already killed people and we're trying to find out the next move or it's a child predator. will there be an answer for this? >> yes, sir. and to clarify my earlier statement we see individuals, criminal, terrorists encouraging
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others to move to encrypted platforms and the solution for us is no investigator, no agent will take that as an answer to say that they should stop investigating, they will try to find whatever work around they possible can but those solutions may be time intensive. they may not be effective. they may require an additional amount of resources or an additional amount of skill in order to get to those solutions but primarily we are in a race against the clock and that's the key component of how we're finding solutions around this problem. >> i think i know this is a frightening aspect for americans. we understand privacy but if there is some child predator hiding in the bushes by the playground watching to snatch a victim, you can find them but if this is giving them this close of invisibility, it's frightening. we better find an answer. i now recognize ms. degette for five minutes. >> well, just to follow up on
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the chairman's question iing th problem isn't really default inscription because if you eliminated default encryption criminals could still get encryption and they do, isn't that correct, ms. hess? >> yes, that is correct. >> right, so the problem is that criminals can have easy access to encryption. and i think we can stimulate that encryption is great for people like me who have bank accounts who don't want them to be hacked but it's a horrible challenge for all of us as a society, not just law enforcement, when you have a child sex predator trying to encryption or just as bad, really, a terrorist. so what i want to know is what are we going to do about it? and the industry says that if congress forces them to develop
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tools so that law enforcement with probable cause and a warrant can get access to that data that then will just open the door, do you believe that's true, ms. hess? >> i believe that there certainly will be always no such thing as 100% security. however industry leaders today have built systems that enable us to be able to get or receive readable content. >> and chief galati, what's your view on that? >> i believe that in order provide -- i don't want to call it a back door but rather a front door, i think if the companies can provide law enforcement, i don't believe that would be abused. >> why not? why not? >> we have the calea law from 1994 and that was not abused so yo don't see howe --
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>> what they're saying is the technology, once they develop that technology then anybody could get access to it and they could break the encryption i believe that if we look at apple, they had the technology going back to about 18, 19 months ago where they were doing it for law enforcement and i am not aware of cases that abuse that came out when apple had the key so if they still had the key today, they hold it. >> i'll ask them because they're coming up. captain cohen? >> i think it might be helpful to look at real world analogies. if you look at an iphone or android os phone as a safety deposit box, the key the bank holds is the private encryption, the key the public holds is the public key encryption but the bank builds firewalls around that. there's a difference between encryption and firewalls. >> and you they that technology exists? >> the technology does exist. >> i'm sorry i don't have a lot of time but i'm going ask them
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the same question. now there's something else that can be done, forcing the industry to comply or like in the san bernardino case, the fbi hired a third party to help them break the code in that phone and that was what we call gray hat, people who are sort november n this murky market. what do you think about that suggestion ms. hess? >>. >> that certainly is one potential solution but that takes me back to my prior answer which is that these solutions are very case-by-case specific. they may not work in all instances, they're very dependent upon the fragility of the systems and also they're very time intensive and resource intensive which may not be scalable to ann i believe us to be successful. >> do you think there's an ethical issue with using third-party hackers to do this? . i think that certainly there are vulnerabilities that we should review to make sure that we
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identify the risks and benefits of being able to explait those vulnerabilities in a greater setting. >> well, i understand you're doing it because you have to in certain cases. do you think it's a good policy to follow? >> i do not think that that should be the solution. >> and one more question is if third party individuals can develop these techniques to get into these encrypted devices or programs, why can't we bring more capabilities in house to the government to be able to do that? >> certainly these types of solutions and, as i said this should not be the only solution but these types of solutions that we do employ and can employ, they require a lot of highly skilled specialized resources that we may not have immediately available to us. >> can we develop those with the right


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