National Defense Authorization Act For Fiscal Year 2017

Floor Speech

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Mr. DURBIN. Mr. President, is there an order of business that has been agreed to by unanimous consent?

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Mr. DURBIN. Mr. President, I find it hard to understand why anyone would want to eliminate funding for militarily relevant defense medical research--research that offers families hope and improves and saves lives--especially now. When you look at the body of medical research across all Federal agencies, we are getting closer to finding cures for certain cancers, closer than ever to understanding how to delay the onset of neurological diseases like Alzheimer's and Parkinson's, closer than ever to developing a universal flu vaccine. Now is the time to be ramping up our investment in medical research, not scaling it back. Yet, there are two provisions in this Defense authorization bill that would effectively end the Department of Defense medical research program. These two provisions are dangerous. They cut medical research funding, which will cost lives--military lives and civilian lives. That is why I filed a bipartisan amendment, together with Senator Cochran, the Republican chairman of the Senate Appropriations Committee, which will be considered by the Senate this afternoon.

My legislation would remove Chairman McCain's provisions so that lifesaving research at the Department of Defense can continue. Senator McCain's two provisions, found in sections 756 and 898, work hand in hand to end the Department of Defense medical research program.

His first provision requires the Secretary of Defense to certify that each medical research grant is ``designed to directly promote, enhance, and restore the health and safety of members of the Armed Forces''--not veterans, not retirees, not spouses of military members, and not children of military families. In my view, they are all part of our national defense, and they should all be covered by the DOD health care system and research.

Senator McCain's second provision, section 898, would require that medical research grant applicants meet the same accounting and pricing standards that the Department requires for procuring contracts. This is a dramatic change in the law. It is the imposition of miles of redtape on every medical research grant. The regulations that he has subjected them to apply to private companies that sell the Department of Defense goods and services, such as weapon systems and equipment. Among other things, it would require the Defense Contract Audit Agency, or DCAA, to conduct at least one, and probably several, audits on each grant recipient. Do you know what that means? It means there will be 2,433 more audits each year by the Defense Contract Audit Agency. How are they doing with their current workload? They are behind on $43 billion worth of goods and services that is being procured by the Department of Defense, and Senator McCain would send them at least 2,433 more audits next year.

Taxpayers deserve to know that their money is well spent. The existing system does just that. A grant application now is carefully scrutinized, and throughout the 24-year history of this Defense research program, there have only been a handful of instances where serious questions have risen. No grant makes it through this process without first showing clear military relevance. If an applicant fails that test, it is over. If they clear it, they will be subject to a host of criticism and scrutiny by researchers, and then representatives from the National Institutes of Health and the Department of Veterans Affairs sit down and measure each grant against existing research. These rules are in place to protect taxpayers' dollars, and they do. Senator McCain is now seeking to add miles of redtape to a program in the name of protecting it. His provisions go too far.

The Coalition for National Security Research, which represents a broad coalition of research universities and institutes, wrote: ``These sections''--referring to Chairman McCain's sections--``will likely place another administrative burden on the DOD scientific research enterprise and slow the pace of medical innovation.''

When we asked the Department of Defense to give us their analysis of Chairman McCain's provisions, they concluded--after looking at all of the redtape created by Senator McCain--that these issues would lead to the failure of the Congressionally Directed Medical Research Program. That is clear and concise, and, sadly, it is accurate.

What Senator McCain has proposed as a new administrative bureaucratic burden on medical research at the Department of Defense is not fiscally responsible, it doesn't protect taxpayers, and it is not in pursuit of small government by any means. These provisions are simply roadblocks.

Let's talk for a minute about the medical research funded by the Department of Defense. Since fiscal year 1992, this program has invested $11.7 billion in innovative research. The U.S. Army Medical Research and Materiel Command determines the appropriate research strategy. They looked for research gaps, and they want to fund high- risk, high-impact research that other agencies and private investors may be unwilling to fund.

In 2004, the Institute of Medicine, an independent organization providing objective analysis of complex health issues, looked at the DOD medical research program, and they found that this program ``has shown that it has been an efficiently managed and scientifically productive effort.'' The Institute of Medicine went on to say that this program ``concentrates its resources on research mechanisms that complement rather than duplicate the research approaches of the major funders of medical research in the United States, such as industry and the National Institutes of Health.'' This has been a dramatically successful program.

I would like to point to a couple of things that need to be noted in the Record when it comes to the success of this program. This morning Senator McCain raised a question about funding programs that relate to epilepsy and seizures when it comes to the Department of Defense medical research program. In a recent video produced by the Citizens United for Research in Epilepsy, they share heartbreaking stories of veterans suffering from post-traumatic epilepsy and the recovery challenges they face. They shared the story of retired LCpl Scott Kruchten. His team of five marines, during a routine patrol, drove over an IED. He was the only survivor. He suffered severe brain injury. Lance Corporal Kruchten suffered a seizure inside the helicopter while they were transporting him to Baghdad for surgery. He has been on medication ever since. In fact, seizures set back all of the other rehabilitation programs that injured veterans participate in and greatly slow their recovery.

Since the year 2000, over 300,000 Active-Duty military servicemembers have experienced an incident of traumatic brain injury. Many of them are at risk of developing epilepsy. Post-traumatic epilepsy comprises about 20 percent of all symptomatic epilepsy. According to the American Epilepsy Society, over 50 percent of traumatic brain injury victims with penetrating head injury from Korea and Vietnam developed post- traumatic epilepsy. The research we are talking about is relevant to the military. It is relevant to hundreds of thousands who have faced traumatic brain injury. I don't know why Chairman McCain pointed that out this morning as an example of research that is unnecessary to the Department of Defense. It is clearly necessary for the men and women who serve our country.

Let me say a word about breast cancer too. In 2009, after serving the Air Force for over 25 years, SMSgt Sheila Johnson Glover was diagnosed with advanced stage IV breast cancer which had spread to her liver and ribs. She said breast cancer cut her military career short. She was treated with Herceptin, a drug developed with early support from the Department of Defense medical research funding. According to Sheila, ``It is a full circle with me, giving 25 years of service in the DOD and the Department of Defense giving me back my life as a breast cancer patient.''

Sheila is not alone; 1 out of every 8 women is at risk of developing breast cancer in her lifetime and 175,000 women are expected to be diagnosed with the disease each year. With more than 1.4 million Active-Duty females and female spouses under the Federal military health system, breast cancer research is directly related to our military and our military community.

Breast cancer research started this medical research program in the Department of Defense. It was given a mere $46 million at the start. Over the span of the life of medical research programs at the Department of Defense, a little over $11 billion has been spent. Almost one-third of it has gone to breast cancer research, and they have come up with dramatic, positive results, such as the development of this drug Herceptin.

The point I am getting to is this. If you believe the military consists of more than just the man or woman in a uniform but consists of their families and those who have served and who are now veterans, if you believe their medical outcomes are critically important to the future of our military, then you can understand why medical research programs such as this one, which would be virtually eliminated by Chairman McCain's language, is so important for the future strength of our men and women in uniform and the people who support them.

Let me tell you about a constituent who wrote me last month. This photo shows Linda and Al Hallgren. Al is a U.S. veteran, survivor of bladder cancer. Linda wrote to me and said:

When my husband was originally diagnosed in 2013, our only options were bladder removal followed by chemotherapy. Prognosis based on his cancer was months to a year or so. There were so many questions that came to mind, primarily around, ``How did I get this?''

But as she pointed out to me, Al is a fighter, a survivor. Two years later, here they are, the two of them, enjoying a ride on a motorcycle.

When she passed along this photo, here is what she said: ``We continue to fight the battle and take moments out to enjoy life to the fullest one day at a time.''

She noted in her letter that there are many risks with bladder cancer associated with military service. Smoking is the leading cause. The incidence of smoking among our military members is entirely too high.

The Institute of Medicine also took a look at the use of Agent Blue from 1961 to 1971 in the Vietnam war and its linkage to bladder cancer. It is the fourth most commonly diagnosed cancer among veterans but only the 27th highest recipient of Federal research. So the story of this family and what they have been through raises an important question. Do we have an obligation to this individual who served our country, served it honorably, came home and suffered a serious medical illness? Do we have an obligation, through medical research, to try to find ways to make his life better, to make sure we spare him the pain that is associated with many of the things that are linked to his service in our military? Of course, we do. So why do we go along with this language that the chairman put in his authorization bill to eliminate these medical research programs?

I mentioned earlier the advancements that were made in breast cancer research. In 1993, the Department of Defense awarded Dr. Dennis Slamon two grants totaling $1.7 million for a tumor tissue bank to study breast cancer. He began his work several years earlier with funding from the National Cancer Institute, but researchers still lacked the regular source of breast tissue from women. That is when the DOD funding made a difference. Dr. Slamon's DOD-funded work helped to develop Herceptin, which I mentioned earlier.

At lunch just a few minutes ago, we heard from Senator Barbara Mikulski. She told about the lonely battle which she fought for years for women to get medical research. Sadly, the National Institutes of Health and other places were doing research only on men. Thank goodness Senator Mikulski and others spoke up. They spoke up and NIH started changing its protocols. Then they went to the Department of Defense and said: We want you to focus on breast cancer, if you will, for the emerging role of women in our military, and they did with dramatic results. Now comes a suggestion from Chairman McCain that we are to put an end to this research. We should burden it with more redtape. I don't think it makes sense. It certainly doesn't make sense for the men and women serving in the military and the spouses of the men who serve in the military who certainly understand the importance of this research.

DOD-funded research developed a neurocognitive test for diagnosing Parkinson's disease. The Department of Defense research also identified additional genetic risk factors for developing the disease, including two rare variants that we now know connect the risk for Parkinson's with traumatic injury to the head. What we find when we look at the list of research, such as Parkinson's disease, and question why that has any application to the military, it is that they knew there was an application, they knew there was a connection, and it was worth seeking.

Here is the bottom line. People have lived longer and more productive lives because of DOD-funded medical research, and we have an opportunity to help even more people if my amendment passes and we defeat the language that is in this Defense authorization bill.

Sixty-three Senators from 41 States, both sides of the aisle, requested increases in medical research for our next fiscal year. We can't earmark where that research is going to take place--that goes through a professional process--but you can certainly point out to the Department of Defense areas where they might have some interest, and they make the final decision.

If the McCain provisions become law, they put an end to research programs requested by a supermajority of the Senate.

Mr. President, how much time have I used and how much time currently remains?

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Mr. DURBIN. I will yield the floor at this point to see if others are seeking recognition.

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Mr. DURBIN. Mr. President, I would like to respond to my friend from South Carolina. We are friends. We have worked on a lot of things together. I hope we will continue to do so in the future. We clearly see this issue differently today.

Two-tenths of 1 percent of the Department of Defense appropriations will go for medical research--about $1 billion in a budget of $524 billion. It is not an outrageous amount. We are not funding medical research at the expense of being able to defend America. Hardly anyone would argue that, but a small percentage would. I can make an argument--and I have tried effectively here--that when it comes to the medical research that is being done through the Department of Defense, it is extraordinary.

We have achieved so much for a minimal investment in so many different areas. I could go through the list--and I will--of those areas of research that have made such a big difference. I also want to say that there are 149 universities, veterans organizations, and medical advocacy groups that support the amendment that I offered today. The reason they support it is that what has been suggested--that this is not just another procedural requirement being placed in front of these institutions that want to do medical research--really understates the impact it will have.

The Department of Defense itself, after analyzing the McCain language that comes to us on this bill, said it will create a burden, a delay, additional overhead costs. The one thing we have not heard from Chairman McCain or anyone on his side of the issue is what is the reason for this? Why are we changing a process that has been used for 24 years? Has there been evidence of scandal, of waste, of abuse?

Out of the thousands and thousands of research grants that have been given, only a handful have raised questions, and very few of those go to the integrity of the process. It has been a question about the medical procedure that was used. If we are going to impose new bureaucracies, new redtape, new requirements, new audits, why are we doing it? If there is a need for it, I will stand up with everyone here and protect the taxpayers' dollars. But that is not really what is at stake here.

This morning on the floor, Chairman McCain made it clear. He just does not want medical research at the Department of Defense. He wants it limited strictly to certain areas and not to be expanded to include the families of those serving in our military--our veterans--through the Department of Defense. That is his position. He can hold that position. I certainly disagree with it.

If we take an honest look at this, what we have done in creating this new bureaucracy and redtape is simply slow down the process and make it more expensive. For one thing, each one of these universities and each one of these organizations has to go through an annual audit--at least one. The agency within the Department of Defense responsible for those audits is currently overwhelmed, before this new McCain requirement comes in for even more audits.

So it means the process slows down. Research does not take place in a matter of months; it might be years. Do you want to wait for years in some of these instances? I don't. I want timely research to come up with answers to questions that can spare people suffering and spare expense to the families as well as to the Department of Defense. When I go through the long list of things that have been done through these defense research programs, it is amazing how many times they have stepped up and made a serious difference.

Let me give you one other illustration. The incidence of blast injuries to the eye has risen dramatically among servicemembers of Iraq and Afghanistan due to explosive weapons such as IEDs. Current protective eye equipment--glasses, goggles, and face shields--are designed to protect mainly against high-velocity projectiles, not blast waves from IEDs.

In Iraq and Afghanistan, upward of 13 percent of all injuries were traumatic eye injuries, totaling more than 197,000. One published study covering 2000 to 2010 estimated that deployment-related eye injuries and blindness have cost a total of $25 billion. Notably, eye-injured servicemembers have only a 20-percent return-to-duty rate compared to an 80-percent rate for other battle trauma.

Since 2009, $49 million in this Department of Defense medical research program has gone to research for the prevention and treatment of eye injury and disease that result in eye degeneration and impairment or loss of vision. From the Afghanistan and Iraq conflicts, a published study covering 2000 to 2010 estimated that these injuries have cost a total of $25 billion. Eye-injured soldiers have only 20- percent return-to-duty rates.

Research at Johns Hopkins, where they received grants to study why eye injuries make up such a high percentage of combat casualty, found that the blast wave causes eye tissue to tear, and protections like goggles can actually trap blast reverberations. University of Iowa researchers developed a handheld device to analyze the pupil's reaction to light as a quick test for eye damage.

So you look at it and say: Well, why would we do vision research at the Department of Defense? Here is the answer: What our men and women in uniform are facing with these IEDs and the blast reverberations-- damage to their eyesight and even blindness--wasn't being protected with current equipment. Is this worth an investment by the U.S. Government of less than two-tenths of 1 percent of the Department of Defense budget? I think it is. I think it is critically important that we stand behind this kind of research and not second guess people who are involved.

We are not wasting money in this research; we are investing money in research to protect the men and women in uniform and make sure their lives are whole and make sure they are willing and able to defend this country when called upon.

This idea of Chairman McCain--of eliminating this program with new bureaucracy and redtape--is at the expense of military members, their families, and veterans. We have made a promise to these men and women who enlisted in our military that we will stand by them through the battle and when they come home. That should be a promise we keep when it comes to medical research as well.

I retain the remainder of my time.

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Mr. DURBIN. Mr. President, how much time do we have remaining?

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Mr. DURBIN. Mr. President, let me respond to my friend from South Carolina. I keep giving examples of medical research in this program that relate directly to members of the military and their families and to veterans. All I hear back in return is: Well, we ought to be doing this research someplace else. Why? Don't we want the research to be done by the Department that has a special responsibility to the men and women in uniform and their families as well as veterans?

Let me give you another example that I think really helps to tell this story of research that is jeopardized by the McCain language in this authorization bill. Joan Gray graduated from West Point in the first class that included women. She was commissioned in the U.S. Army as a platoon leader, commander, staff officer. After 5 years of service, she sustained a spinal cord injury in a midair collision during a nighttime tactical parachute jump. Joan Gray's wounds required 12 vertebral fusions. She is now an ambulatory paraplegic and a member of the Paralyzed Veterans of America.

Spinal injuries sustained from trauma impact servicemembers deployed overseas and in training. Over 5 percent of combat evacuations in Iraq and Afghanistan were for spinal trauma. Spinal cord injuries require specialized care and support for acute injury, disability adjustment, pain management, quality of life.

Since 2009, Congress has appropriated in this account--which is going to be eliminated by this amendment--over $157 million to research the entire continuum of prehospital care, treatment, and rehab needs for spinal cord injury. The amount and extent of bleeding within the spinal cord can predict how well an individual will recover from a spinal cord injury.

Researchers at Ohio State University and the University of Maryland at Baltimore examined why some injuries cause more or less bleeding. They studied early markers of injury and found an FDA-approved diabetes drug that proved to reduce lesion size and injury duration in spinal cord injuries. At the University of Pennsylvania, researchers have studied how to facilitate surviving nerve axons to grow across an injury site after spinal cord trauma to improve nerve generation and functionality.

Is this research important? I would say it is. It is certainly important to those who serve us. It is important to their families as well. It should be important to all of us. Why are we cutting corners when it comes to medical research for our military and our veterans? Why is this account, which is less than two-tenths of 1 percent of this total budget, the target they want to cut? Medical research for the military and the veterans--every single grant that is approved has to go through the test of military relevance.

It isn't a question of dreaming up some disease that might have an application someplace in the world. A panel looks at the research that is requested and asks: Does this have relevance today to our military and their families and veterans as well? If it doesn't pass this test, it is finished. That is why I am fighting to protect this money. So much has come out of this that it is of value to the men and women in uniform and veterans. Putting this new procedure in here making them go through the procurement requirements that we have for the largest defense contractors in America is unnecessary, burdensome, and will delay this process and make it more expensive.

I would like to hear from the other side one example of abuse in these research grants that would justify changing the rules that have been in place for 24 years. Come up with that example. You are going to be hard-pressed to find it. After more than 2,000 of these grants a year for years--it has gone on for 24 years--I am waiting for the first example.

What I think is really at stake here is an effort to make it more difficult, more cumbersome, and less appealing to the universities to do this kind of research, and we will be the lesser for it.
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Mr. DURBIN. Mr. President, I thank Senator Reed for his comments in support of my amendment. This is about medical research, and if I have a passion for the subject, I do. Certainly, I believe most of us do.

There comes a point in your life where you get a diagnosis or news about someone you love, and you pray to goodness that there has been some research to develop a drug or a procedure or a device which gives them a chance for life.

Do I want to invest more money in medical research so that there are more chances for life? You bet I do. And I believe our highest priority should be the men and women in uniform and their families and our veterans. That is why I will stand here today and defend this Department of Defense medical research program for as long as I have breath in my lungs. I believe it is essential that once we have made the promise to men and women in uniform, we stand by them and we keep our word, and our word means standing by medical research.

Some have made light of issues being investigated under medical research--not anyone on the floor today, but others.

Prostate cancer. What are they doing investigating prostate cancer at the Department of Defense? Servicemembers are twice as likely to develop prostate cancer as those who don't serve in the military. Why? I don't know the answer. Is it worth the research to answer that question? Of course it is.

Alzheimer's and Department of Defense medical research. For the men and women who served our country and have experienced a traumatic brain injury, their risk of developing Alzheimer's disease is much higher. For those suffering from post-traumatic stress disorder, the risk is also higher. So, as to Alzheimer's research at the Department of Defense, here is the reason.

Lou Gehrig's disease, or ALS. We sure know that one; don't we? According to the ALS Association, military veterans are twice as likely to be diagnosed with ALS relative to the general population. Why? Should we ask the question? Do we owe it to the men and women in uniform to ask this question about ALS? We certainly do.

Lung cancer. Of course there is too much smoking in the military and that is part of the reason, but the incidence is higher.

Gulf war illness. It wasn't until the Department of Defense initiated its research that we finally linked up why so many gulf war veterans were coming home sick. Now we are treating them, as we should.

There is traumatic brain injury, spinal cord injury, epilepsy, and seizure. The list goes on. To walk away from this research is to walk away from our promise to the men and women in uniform, their families, and our veterans. I am not going to stand for that. I hope the majority of the Senate will support my effort to eliminate this language that has been put into the Department of Defense authorization bill, and say to the chairman, once and for all: Stop this battle against medical research. There are many ways to save money in the Department of Defense. Let's not do it at the expense of medical research and at the expense of the well-being of the men and women who serve our country.

I reserve the remainder of my time.

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Mr. DURBIN. Mr. President, how much time remains?

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Mr. DURBIN. And on the other side?

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Mr. DURBIN. Mr. President, I will conclude.

I would just say to my friend from South Carolina that I have gone through a long list of research projects at the Department of Defense and their medical research program, and each and every one of them I have linked up to medical families and peculiar circumstances affecting our military. That is why I think this Department of Defense medical research is so critical.

I have yet to hear the other side say that one of these is wasteful, and they can't. If our men and women in uniform are suffering from gulf war illnesses, of course we want the Department of Defense or any other medical research group to try to find out what is the cause of the problem and what we can do about it.

When it comes to the incidents of cancer being higher among veterans, are you worried about that? I sure am. Why would it be? Should we ask that question? Of course we should. And we do that through legitimate medical research.

Here is what the Institute of Medicine said about this medical research program: It ``has shown that it has been an efficiently managed and scientifically productive effort and that it is a valuable component of the nation's health research enterprise.''

This is not wasted money. This is medical research for the men and women in uniform, their families, and the veterans who served this country. I will stand here and fight for it every minute. To those who say we will strengthen our military if we do less medical research on behalf of the men and women in uniform and veterans, that doesn't make us a stronger military.

Let us keep our word to the men and women in uniform and to the veterans. We have told them we would stand behind them when they came home, and we have to keep our word.

American Society of Tropical Medicine and Hygiene, American Society of Nephrology, American Thoracic Society, American Urological Association, Aplastic Anemia and MDS International Foundation, Arthritis Foundation, Association of American Cancer Institutes, Association of American Medical Colleges, Association of American Universities, Association of Public and Land-grant Universities, Asbestos Disease Awareness Organization, Asthma and Allergy Foundation of America, Autism Speaks, AVAC: Global Advocacy for HIV Prevention, Bladder Cancer Advocacy Network, Cancer Support Community, Caring Together New York, Children's Heart Foundation, Children's Tumor Foundation, Citizens United for Research in Epilepsy (CURE), Coalition for National Security Research (CNSR), Cold Spring Harbor Laboratory, Colon Cancer Alliance, Crohn's and Colitis Foundation of America, CureHHT.

Debbie's Dream Foundation: Curing Stomach Cancer, Digestive Disease National Coalition, Duke University, Duke University School of Medicine, Dystonia Medical Research Foundation, Elizabeth Glaser Pediatric AIDS Foundation, Endocrine Society, Esophageal Cancer Action Network, Inc., Fight Colorectal Cancer, FORCE: Facing Our Risk of Cancer Empowered, Foundation for Women's Cancer, Foundation to Eradicate Duchenne, Georgetown University, GBS/CIDP Foundation International, Hartford HealthCare Center, Hepatitis Foundation International, HIV Medicine Association, Hydrocephalus Association, Indiana University, Infectious Diseases Society of America, International Foundation for Functional GI Disorders, International Myeloma Foundation.

Interstitial Cystitis Association, Johns Hopkins University, Kidney Cancer Association, LAM Foundation, Lineberger Clinic Cancer Center at the University of North Carolina, Littlest Tumor Foundation, Living Beyond Breast Cancer, Lung Cancer Alliance, Lupus Foundation of America, Lymphangiomatosis & Gorham's Disease Alliance, Lymphoma Research Foundation, Malecare Cancer Support, Melanoma Research Foundation, The Michael J. Fox Foundation for Parkinson's Research, Michigan State University, Minnesota Ovarian Cancer Alliance, Muscular Dystrophy Association, National Alliance for Eye and Vision Research, National Association of Nurse Practitioners In Women's Health, National Autism Association, National Breast Cancer Coalition, National Fragile X Foundation, National Gulf War Resource Center, National Kidney Foundation.

National Multiple Sclerosis Society, National Ovarian Cancer Coalition, NephCure Kidney International, Neurofibromatosis Arizona, Neurofibromatosis Central Plains, Neurofibromatosis Michigan, Neurofibromatosis (NF) Midwest, Neurofibromatosis Network, Neurofibromatosis Northeast, Nurse Practitioners in Women's Health, The Ohio State University, Oncology Nursing Society, Ovarian Cancer Research Fund Alliance, Pancreatic Cancer Action Network, Parent Project Muscular Dystrophy (PPMD), Pediatric Congenital Heart Association, Penn State University, Prostate Cancer Foundation, Prostate Health Education Network, Pulmonary Hypertension Association, Research!America.

RESULTS, Rettsyndrome.org, Rutgers, The State University of New Jersey, Sabin Vaccine Institute, Scleroderma Foundation, Sleep Research Society, Society of Gynecologic Oncology, State University of New York, Susan G. Komen, Treatment Action Group, TB Alliance, Texas Neurofibromatosis Foundation, Theresa's Research Foundation, Tuberous Sclerosis Alliance, University of Arizona Cancer Center at Dignity Health St. Joseph's Hospital and Medical Center, University of California-Irvine, University of California System, University of Central Florida, University of Kansas, University of Kansas Medical Center, University of Pittsburgh, University of Washington, University of Wisconsin-Madison, US Hereditary Angioedema Association.

Us TOO International Prostate Cancer Education and Support Network, The V Foundation for Cancer Research, Vanderbilt University, Veterans for Common Sense, Veterans Health Council, Vietnam Veterans of America, Washington Global Health Alliance, Washington State Neurofibromatosis Families, Weill Cornell Medicine, WomenHeart: The National Coalition for Women with Heart Disease, Young Survival Coalition, ZERO- The End of Prostate Cancer. Amendment No. 4369

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Mr. DURBIN. Mr. President, I call up amendment No. 4369.

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