Major Issues Raised by Members of Congress about the DGAs At a hearing by the House Committee on Agriculture, Oct 7, 2015
The government website for this hearing can be found here.That the Guidelines have lost credibility/made mistakes/are not adhering to the best and most current science/have not properly reviewed the science or properly used the NEL:
PETERSON (D-MN): these guidelines that have pushed people away from eggs and butter and milk, and so forth, and then they come back and say, well, We were wrong, you know?
What are we going to do to make sure that doesn’t happen in the future?
why are we going off on these tangents, you know, if we have a process that’s so heavily vetted?
I just want you to understand from my constituents, most of them don’t believe this stuff anymore. You have lost your credibility with a lot of people, and they are just flat-out ignoring this stuff. And so that’s why I say I wonder why we’re doing this
SCOTT (D-GA): I’m very concerned that you’re not using the most relevant, basic, and the best science-related information in formulating these guidelines. You certainly did not use some of the most recent peer- reviewed and published nutrition and diet-related science. It was not even considered by the advisory committee and not even included in the evidence-based library to be considered by the advisory committee when they were finalized in the report. That’s a fact.
And Mr. Vilsack, you said you were using the best information. Your quote was that, “We have the best informed opinions.” But if you’re not using the most recent peer review, that information that is there, and your committee has not even agreed to put it into the final report — so maybe you all can give me some level of confidence that your staffs and you will take into consideration the strong scientific evidence with the final policy document, even though it was not included in the evidence-based library throughout the working group process.
A.SCOTT (R-GA): the credibility of the report is arguably the most important thing. It doesn’t matter how much time and money went into it. If it — if we have a credibility gap, we have a problem.
it seems to me that ideology is taking precedence over science, and that creates a tremendous credibility gap, as well.
how do we make sure that we don’t have that credibility gap in the report?
And if the nutrition evidence library is not being used, how do we — how do we guarantee the credibility of the report?
WALZ (D-MN): I think we’re concerned on process
GIBBS (R-OH): why are we doing all this, if it’s really necessary?
LAMALFA (R-CA): we’ve been hearing ever since I was a kid, you know, eggs are bad, so my grandparents had a lot of powdered eggs because of their age and factors like that, and it turns out eggs are OK later. Then you hear, you know, beef, red meat, and then we got high protein diets to help you lose weight. Somebody I was talking to just over the weekend, a constituent there, you know, lost weight but they’re staying away from fruit. Well, because fruit has carbs’ sugar in it. And well, how — how are people supposed to really know when the things are — when the ideals are changing all the time, the guidelines.
So I guess following up on the five year thought, is — is it good to have a hard and fast five year timeline of changing the — the dietary guidelines, or should it be less frequent, more frequent or does it need to be even more — kind of change what you know it would change and have a — and leave the rest alone.
SCOTT (R-GA): I hope that you will take my suggestions to go back and look and make sure we have — we’re using the strong scientific evidence.
CONAWAY (R-TX): And Ms. Burwell, your testimony said that the guidelines don’t change much from — from issue to issue. Is that a bias that the — you know, if I’m a scientist and I’ve got a body of work that is — comes to certain conclusions, and I’m going to be hard-bent to change my conclusions against new evidence, that’s going to be, you know, an issue that’s there.
Hopefully, the next time the question will be asked: Are the guidelines themselves contributing to the problem? The emphasis on carbohydrates over the last 20 years and the impact it’s had on — on these issues that we’re talking about with obesity or diabetes, other things. You know, are the — you know, do we have anybody who’s going to live these guidelines for five years so we can see what it did to them, as an approach to it.
And I know you guys try to — to gather that information, but the guidelines are important. They’re voluntary for me. I’m going to go have lunch in a little bit and I will decide for myself. They’re not voluntary, though, when they get woven into school lunch programs, SNAP, and everything else. So they become the law of the land in many instances.
So it’s important that we get these right.
SCOTT (R-GA): there’s a belief, then, that the people on the committee entered with a bias in some way, shape or form and were searching for the science to back up what they already believed to be true, instead of using the best available science.
Whether it’s true or not, we can debate, but there is that — there’s a credibility gap from those things working their way into the report.
MCGOVERN (D-MA): My colleagues understand that in this country today, one in three school-age children and adolescents is overweight or has obesity. And more than one in three American adults suffers from cardiovascular disease and diabetes.
Clearly, we can do better.
DESJARLAIS (R-TN): It is important for the dietary guidelines to have a strong scientific background, peer-reviewed and published research to give Americans clear advice on their diets and health.
Can you please give me the assurances that you have both taken into account to ensure strong scientific evidence is the foundation for the 2015 guidelines?
HARTZLER (R-MO): I wanted to focus on the nutrition evidence library. We’ve heard much about it, with even the USDA officials (inaudible) describing it as a gold standard. But I have heard concerns that the nutrition evidence library has ignored a large, credible and growing body of peer-reviewed science on low-carb diets, as it contradicts the evidence from previous guidelines.
So can you elaborate on how scientific studies are added to the nutrition evidence library, and what can be done to ensure that cutting-edge research in nutrition science is considered?
ROUZER (R-NC): And from a public policy standpoint, I think perhaps maybe we’ve gotten too smart for our own good. I recognize science has improved dramatically, but mankind has survived for many thousand a year on red meat, whole milk.
In fact, I remember growing up when there was a report that came out that said apple juice was bad for you, and then they came out and said actually, no, we’re wrong. Eggs, bacon. I remember growing up where they said, you know, it may contribute to high cholesterol and heart disease.
So I want to make sure that we get back to common sense and that we do what’s right, you know, for future generations because — not only for the health standpoint but that translates directly in terms of the public policy decisions we have to make as it relates to our budget.
KELLY (R-MS): We’re concerned that the public at large has lost faith in the process to develop the dietary guidelines which will ultimately decrease the adherence to them with potentially costly effects on public health.
Before coming to Congress, I was a prosecutor, and I understand that two people can look at a problem and come to a different solution. And Secretary Vilsack, during your process, you talked about many times the preponderance of evidence, but as a prosecutor, I didn’t get by with that standard because the things that I would do and were so important that I had to prove beyond a reasonable doubt my case. Because for different things and different priorities, the importance of them, sometimes we have to use a different standard of evidence.
And I would say maybe a preponderance of the evidence for scientific evidence is not the right standard. Maybe it’s clear and convincing evidence. Or maybe it’s beyond a reasonable doubt that when we have science that we hold them to a standard that makes sure that the end result is something that we have a good belief that it will be viable and it will be the right answer, although, we won’t always be correct. If we raise the standard, maybe we will be correct more often.
we may want to look at the standards, but over 1,350 percent increase in public comments, it raises some concern with me that people don’t have faith in the system.
it doesn’t matter how good the standards are and it does not matter if we’re doing right things, if the public doesn’t have trust that it’s the right thing, we have to build that trust.
KELLY (R-MS): I just think it’s — I think it’s just important that the citizens want to know that we’re not using science to justify ideology, that it’s the other way around. Thank you.
BENISHEK (R-MI): But one of the questions that I had is, how are the studies taken — how do you determine what studies to put — to base your science on? I mean, I’ve got evidence that this evidence library included some trials while excluding several other larger trials, some of which were funded by the NIH. I don’t know why all the studies aren’t included in the data. I mean, how does that not lead me to believe that there’s a predetermined result that’s been looked for?
Is stuff excluded from the library? Is the — who makes the choice of what goes in the library?
I’m just surprised that NIH-funded studies, some of which are larger than the studies that you rely on for your data, contradictory studies, funded by the NIH are not included in the data. So I’m just kind of wondering why?
ALLEN (R-GA): Yes, and I’ll just follow up on that question it — that as far as the NEL was concerned, you know, it had — you know, the — as far as the dietary guidelines, advisory committee did not use the NEL for more than 70 percent of their research questions. What — what — why was the NEL not used in this — in these guidelines?
NEWHOUSE (R-WA): It — it seems like once every five years this doesn’t work because it changes, and in fact, it can negatively impact ag- commodities that it’s — which is irresponsible to tell people not to eat certain things when the — the next round of research says that you want to eat more of it. Shouldn’t we do something in this day and age with technology, that we just share the best research with folks? A place where people can go to — to get the best possible information on terms of eating and knowing that that changes all the times.
Once every five years, I don’t think this is effective.
ALLEN (R-GA): So they didn’t have the information on more than 70 percent of the research?
in my opinion, it’s very dangerous to set forth guidelines when, you know, everybody’s — you know, has a different DNA and in — at different ages you have different requirements and, of course, we already talked about it, it doesn’t apply necessarily as much to children.
NEWHOUSE (R-WA): Are Americans healthier or less healthy since the guidelines have been published, and therefore, are these — have these — in some way, have these guidelines somewhat failed?
I mean, we’re talking about increasing obesity, the Pentagon is more concerned than ever about having access — having kids that would be able to serve in the military. We haven’t — have these guidelines really been successful, given the disease and chronic illnesses and conditions and — and — and that’s not meant to be criticism, because my second question is how do we do — use these in a way that they could be successful? Because they don’t seem like they’re accomplishing the objective as you two have very well articulated today.
That DGAC strayed from its mandate and that HHS-USDA may have failed to exercise oversight
CONAWAY (R-TX): serious questions have been raised about the overall oversight of the overall DGAC process
NEUGEBAUER (R-TX): Additionally, after the DGAC had officially disbanded, the former advisory committee members decided to hold a public event, acting in their capacity as DGAC members, which they were not, according to the committee’s charter and federal advisory committee act.
It is, however, not the responsibility of the DGAC to educate the general public on a report that still needed to be considered by the HHS and USDA before claiming the nutritional recommendations were based on dietary guidelines.
was their role to then go out and start doing a road show on their recommendation? Is that a part of the scope of that committee?
Well, I think the question here is that one is — did they follow the guidelines? And what steps were taken to make sure that the committee followed the law?
SCOTT (R-GA): Can I ask — can I ask a question there? If the standard is scientific research, how do recommendations for tax on sodas get into the report?
(Also: the issue of sustainability. On both taxes and sustainability, the Secretaries ceded before the meeting)
NEWHOUSE (R-WA): I worry greatly about the process and the guidance and oversight they have been given.
So I think it would be helpful for the committee to — for you to provide these committee evidence in writing to confirm that your agencies did, in fact, make attempts to oversee the advisory committee once it became clear they were delving into areas of public policy. In response, I would like to see evidence that your agencies provided directions to the committee during their assembly to ensure they were staying focus on the right guidance and not straying into policy matters outside their scope or mandate.
Likewise, I’d like to receive documented evidence of the instructions agencies provided to the committee on the public law to help them understand their report must be based on the preponderance of scientific and medical knowledge that’s current at the time of publication.
On the fact that DGAs are still one-size-fits all diet
HARTZLER (R-MO): In the guidelines, are there any disclaimers mentioned in there that say, For certain populations, this may not be true, or certain populations, this might be helpful? Do you include that, or do you just pick one and say this is it?
VILSACK (Secretary of Agriculture): It isn’t so much that, it’s a caveat that these are recommendations focused on prevention. They are guidelines. They are not, you know, You shall do this. There are recommendations and suggestions that you should do this. And I think that sort of in an indirect way — I’m not certain. We obviously haven’t crafted the guidelines yet. So I don’t know whether or not there’ll be caveats, as…
HARTZLER (R-MO): (inaudible) the guidelines may not be one-size-fits- all. Or do you present it as everybody, this is for everybody?
VILSACK (Secretary of Agriculture): It’s a general guideline. It’s a general set of recommendations. It’s — I mean, in theory, you could have 317 million different guidelines because we’re all slightly different and in slightly different circumstances. So you have to create kind of a wide berth here.
But within that wide berth, this is what we’re recommending. If you’re interested in a healthy diet, if you’re interested in reducing your risk of diabetes and cardiovascular, this is a course that you might want to consider. Obviously, people are going to make choices and decisions based on what’s best for them.
ALLEN (R-GA): And — and I think the mistrust here is that, you know, this one- size-fits-all thing because, you know, folks are getting a lot of bad — you know on our SNAP program. They’re getting a lot of — I mean, they — they’re really not getting good information and then the consequences are this epidemic of diabetes that we have
Is there any way to get this more locally based rather than Washington top down?
On lack of nutritional sufficiency
DELBENE (D-WA): I wanted to ask you about dairy. As you know, it has been a distinct food group in the past, and according to the report, dairy products contribute many essential nutrients — Vitamin D, calcium, magnesium, iron, Vitamin A, riboflavin. And yet since 2010, 1 percent flavored milks haven’t been allowed in schools, and we also know that dairy consumption has dropped in girls ages 4 to 8.
DAVIS (R-IL): My most serious concern today is what I see as a lack of evidence to show that the recommended dietary patterns proposed by DGA have been based on any evidence on children. According to the citations in some previous advisory reports for recommendations, the recommended diet has been tested almost exclusively on middle-aged men and women whose nutritional needs obviously are very different from young people and growing children.
In particular, I’m concerned because young children need certain vitamins and minerals, obviously, in order to grow and develop. You know, we’re talking about where in previous reports, the expert report states that their recommended dietary patterns do not meet sufficiency goals for potassium, vitamin D, vitamin E, choline and a vitamin A sufficiency, may be marginal.
You know, these are essential basic nutrients for growth and health in children. As a dad of a freshman in high school and a coach, these are things that concern me on a regular basis, too. At the same time, the DGAC appeared to be deficient in their role in developing nutritional guidance to meet the basic nutritional sufficiency for children to grow and be healthy. They were expanding their review of what has been referred to as the dining out topic. Specifically, the fast food category was broadened to capture other types of dining out venues, including quick serve, casual-formal restaurants and grocery store takeout.
Given today’s busy lifestyle, and really when you look at restaurants, they have offered a lot more healthy choices than what we saw just a decade ago. With that, I’m kind of disappointed and I think others are disappointed that restaurants seem to be singled out, even though they are doing their best to offer healthier options to customers and that concerns me.
I just find it difficult to understand that location in which we would eat without any other consideration automatically impacts the quality or nutritional value of the food served. I certainly understand that some restaurants may serve better food than others, but that’s the consumer that can make that final decision on that too.
So Secretary Burwell, I mean, wouldn’t you agree that the nutrient content of food is more important than where the food is purchased and that rather than directing people away from dining out, maybe we should focus on helping to educate them on their nutritional choices
That the panel had undue conflicts of interest
NEUGEBAUER (R-TX): In a departure from other — from prior dietary guidelines advisory committees, nutritionists and food scientists were not selected to serve on this DGAC. Questions regarding the inherent bias are being raised by the fact that no food industry scientists were included in the DGAC committee.
And one of the things we don’t want is that these advisory committees turn this into some kind of profitable situation on their behalf because of their participation on that advisory committee.
A.SCOTT (R-GA): There are certainly some questions about the fact that Ms. Millen (ph) was from the private sector
there are questions about the fact that she’s now a member of the private sector chairing the committee.
Historically, we have not allowed industry representatives on the panel.
On the fact that low-carbohydrate diets were not reviewed by the 2015 expert report
VILSACK (Secretary of Agriculture): I think that is ultimately in the context of how do you treat a particular condition, obesity, for example. It may very well be that a low-carb diet or a high-protein diet might be a way in which a physician would prescribe for an obese individual to deal with obesity.
HARTZLER (R-MO): Now, I have visited with some people that point out that 52 percent of U.S. adults are pre-diabetic. And they allege that a low-carb diet helps prevent people becoming pre-diabetic. So it is actually…
ROUZER (R-NC): And some of them I know their parents, I knew their grandparents, and obesity was, you know, not an issue in the family until this generation. And so that leads me to think, you know, clearly something has changed in our society over the last 20 years, and — in particular. And I — and i look at it from the perspective of you’ve got different movements out there influencing public policy.
It was mentioned earlier about caloric diet, trying to maintain a certain number of calories. Well, not all calories are the same.
I would suggest just from a common sense perspective, 2,000 calories of beef versus 2,000 calories of doughnuts are very different. Your body reacts to it very different. You know, your body takes the carbohydrate and turns it into sugar, and that often goes straight to the belly. Whereas consumption of protein, same calorie amount, the body treats it very differently. In fact, I think if you go and have a blood test done, they measure protein level in your blood, which suggests that obviously protein is a key component to a healthy lifestyle.
So my main point that I want to drive home this morning is I think it’s very, very important to understand that there’s a difference in terms — not all calories are the same.
BENISHEK (R-MI): As a physician, I have been involved in peer reviewed science in my training and in my career and I’m a little bit concerned about some of the things you guys have said here. He brought up the fact that, you know, the — I think it was the journal of — the AME, brought out that 52 percent of Americans are pre-diabetic or diabetic, and yet, the dietary recommendations that, as I understand it, are not really appropriate for that.
We have — there’s too many carbohydrates. These people have a carbohydrate intolerance and — and there more carbohydrates in the diet that you’re recommending than is really appropriate for that. You mention that this would be a treatment, but this is really not a treatment. This is a preventative problem and I think that, you know, you have to address that more. I guess those are just some of my comments….
BENISHEK (R-MI): My understanding is they are not. That’s why I’m concerned that — because it is leading to me to — some of your comments suggested that, you know, with diabetes and pre-diabetes and obesity are major problems in this country and because of the cutdown in the fat portion of the diet, we’re in — we’re recommending more carbohydrates. Well, this is a — that’s exactly the problem that pre-diabetics and diabetics have is not being able to respond to carbohydrates.
So, I mean, for the majority of the people — 52 percent of the people being pre-diabetic, this is the wrong diet to recommend. So when you say it’s a general diet, well, that’s great, but then it — shouldn’t it be a — you know, the caveats that Ms. Hartwere (ph) mentioned. I mean, this is pretty serious stuff here because I — somebody else mentioned when we were kids, people aren’t as fat back when we were kids; we’re eating more fat.
And it — frankly, it is — it’s not an exercise thing as — as — as far as I can see because, you know, I’m experienced with that. You — if you eat a lot, you can — you can’t exercise it all off. You have to get it right
On lean meat/red meat recommendation:
VILSACK (Secretary of Agriculture): In terms of the issue of red meat, I think it’s fairly clear that there’s a recognition that lean meat is and should be part of a healthy diet. I think the challenge is to understand that as Americans, if we look at the obesity epidemic that we’re confronting in this country, that some of us are consuming more calories than we should.
And so the recommendation is in relationship to the over all consumption of calories, and one way to reduce the overall consumption of calories is obviously to eat less of certain things. And in that category would be red meat, but that’s by no means the only thing in that category. So I want to be clear here…
ROGERS (R-AL): Well, I don’t understand. I’m sorry, Mr. Vilsack, but why would you include in that category red meat? I mean, why wouldn’t you just say anything that takes you over a caloric level that’s unacceptable, you shouldn’t eat. Why would there be a category of things not to eat?
VILSACK (Secretary of Agriculture): There — because of the importance of having balance in terms of what you consume, in terms of what a healthy diet consists of. Again, remember what this is. It’s a set of guidelines which is designed to give you the best chance of reducing cardiovascular, cancer and chronic diseases.
ROGERS (R-AL): But wouldn’t red meat be part of a…
VILSACK (Secretary of Agriculture): It is.
ROGERS (R-AL): … list of things that you should eat as long as you eat lean…
VILSACK (Secretary of Agriculture): It is. It is. That’s what I’m saying.
ROGERS (R-AL): I’m sorry. I thought you said that you would put it in a list of things not to eat.
VILSACK (Secretary of Agriculture): No.
VILSACK (Secretary of Agriculture): I can, and I can also suggest — it’s my understanding — and maybe I’m wrong about this — that the report basically is fairly consistent with the recommendation that was made in the 2010 guidelines with reference to lean meat. I would be surprised if our final conclusion is not to include that as part of a healthy diet.
Points made in response by Burwell and Vilsack:
1. That the DGAC report will not necessarily determine the Guidelines themselves (de-emphasizing the importance of the DGAC report)
BURWELL (Secretary of Health and Human Services): It is important to note that the advisory committee report is one input into the dietary guidelines
VILSACK: The advisory committee report which Secretary Burwell mentioned is not the guidelines, and sometimes, there is confusion about that. The report informs our work, but certainly does not and should not dictate it. Only HHS and USDA can and should write the guidelines based on a variety of inputs.
VILSACK: we do basically take their input into consideration, along with many, many other studies, many, many other opinions to try to formulate the best set of guidelines
VILSACK (Secretary of Agriculture): Congressman, I’d like just simply to again emphasize there is a fundamental difference between the advisory committee’s report and the guidelines, and there is confusion out there. For some reason, people seem to think that the report equals the guidelines. It does not.
It is one aspect of information that will be taken into consideration relative to the dietary and nutrition guidelines that we have to put together. Number one.
VILSACK (Secretary of Agriculture): That — that — that’s one aspect of it, Congressman. It’s not the only thing that we rely on or look at. It’s one piece of a large puzzle.
VILSACK (Secretary of Agriculture): There seems to — again, I have said this several times today, there seems to be a misunderstanding upon some of the folks that the report equals the guidelines and that is not the case. The report is one aspect of our consideration, one aspect of the data, the information that is used to formulate these guidelines. And to me, this debate has been helpful, I hope, in — in getting a better understanding of precisely what the recommendations are, and I think that the discussion we’ve had today is also healthy as it relates to what is the purpose of these guidelines–is it focused on prevention, or is it focused on treatment, or should it be focused on both–I think that’s a healthy discussion.
2. The DGAs are just a recommendation and do not determine feeding programs (in general, de-emphasizing the importance of the guidelines)
VILSACK (Secretary of Agriculture): Iit’s a caveat that these are recommendations focused on prevention. They are guidelines. They are not, you know, You shall do this. There are recommendations and suggestions that you should do this. And I think that sort of in an indirect way…
VILSACK: It’s a general guideline. It’s a general set of recommendations. It’s — I mean, in theory, you could have 317 million different guidelines because we’re all slightly different and in slightly different circumstances. So you have to create kind of a wide berth here.
But within that wide berth, this is what we’re recommending. If you’re interested in a healthy diet, if you’re interested in reducing your risk of diabetes and cardiovascular, this is a course that you might want to consider. Obviously, people are going to make choices and decisions based on what’s best for them.
3. That the DGAs are meant only to prevent disease, not treat it.
VILASCK (Secretary of Agriculture): I think it’s important for people to understand precisely what they [the Guidelines] are and what they are not. This is not about treating disease.
VILSACK: That’s not what these guidelines are about. These guidelines are about preventing that circumstance to begin with. There isn’t an avenue within the guidelines today for that treatment discussion. And that’s I think why there’s a lot of confusion about all of this and why there’s a lot of angst about it, because some people are looking at the guidelines as treating all health issues. And we’re looking at what the law requires us to do, and that is focus on dietary and nutritional guidelines relative to prevention.
4. The committee is, in fact, using the science appropriately
BURWELL (Secretary of Health and Human Services): So I think it is unfair to the committee and unfair to the process to suggest that we’re not looking at the science. We are.
BURWELL (Secretary of Health and Human Services): The gold standard is used.
VILSACK (Secretary of Agriculture): And the key here is taking a look at the preponderance, the greater weight of the evidence, and trying to make a judgment based on the greater weight of the evidence. If you’ve got one study on one side and you’ve got 15 studies on another side, the preponderance of the evidence may be on this side with the 15 studies.
And that’s — you know, that’s a challenge. And that’s why we do this every five years, to give an opportunity for that quality study to be further enhanced so that five years from now, maybe there are 15 studies on this side and 15 studies on this side. It’s an evolving process.
VILSACK (Secretary of Agriculture): This — this discussion suggests that there is some extraordinarily bright line on science, that there is something over here, there is the real science, and then over here there’s not the real science. The science is evolving, it is…
5. Use of NEL specifically
VILSACK: Number two, the National Education Library was used, and there’s an extensive process that’s involved in accumulating information and putting it through a filter, if you will…
BURWELL (Secretary of Health and Human Services): For certain issues like food pattern analysis that they needed to do to understand what we actually are eating, an issue that has been brought up a number of times in this hearing, that is not information that would be available there and they need to turn to other sources for that information to understand what is it that actually Americans are eating. The sources for that are different. I think there are some other issues. The reason it’s not all there is if the question — if that’s not where the source of information can come from, there’s certain data analytics and there are also places where systemic reviews have already been done on the issues and while they do their own systemic review, they at least consider the other systemic reviews. And so I don’t think those are counted in that percentage, but…
VILSACK (Secretary of Agriculture): … that their review process goes through a series of — of — of mechanisms to try to provide an understanding of what the best science is, the best available science is and the least biased science is. And it’s a series of things, the Cochrane collaboration, the Academy of Nutrition and Dietetics, the Aging for Healthcare Research and Quality, the Data Quality — all consistent with the Data Quality Act. It — so that’s the other parameter that we have to work under is that the — the Congress has given us direction under the Data Quality Act as to how this is to be managed.
6. On lack of evidence on children:
BURWELL (Secretary of Health and Human Services): With regard to the issue of children and the amount of research and evidence that we have in that space, even as we are preparing to complete where we are now, the conversation — my team actually brought up the issue of children yesterday as we look to making sure we have appropriate evidence for a number of the things that you are talking about for the next set, because I think what you are appropriately reflecting is the research doesn’t exist because it is on older [people]. So we need to get started on that now.
We don’t have the facts yet. We don’t have the science base, but if we start now, we will for the next.
BURWELL (Secretary of Health and Human Services): (referring to America’s worsening health) We’re on the wrong trajectory.
These quotes were selected directly after the hearing, when only the unofficial transcript was available. The official transcript of the meeting is here.