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The Senate Health, Education, Labor, and Pensions (HELP) Committee voted 15-6 Wednesday to send the nomination of Monica Bertagnolli, MD, to serve as NIH director to the full Senate for a floor vote, despite opposition from committee chair Sen. Bernie Sanders (I-Vt.).

Sanders, who usually votes with the committee's 10 Democrats, voted "no" this time to make a point about the rising cost of prescription drugs. Under the current broken healthcare system in the U.S., "we don't have enough doctors, nurses, or dentists," Sanders said. "And then on top of all of that, we pay by far the highest prices in the world for prescription drugs."

Sanders said that although he liked Bertagnolli, "I think this is a moment when we need leadership at the NIH which is really prepared to take on the greed of the pharmaceutical industry, lower prescription drug prices in America, and move the NIH in a very, very different direction. For that reason I will be voting 'no'" on her nomination.

At a HELP Committee hearing last week on the nomination, Sanders asked Bertagnolli about one mechanism he believes would help rein in these high prices: the "reasonable pricing clause" in NIH contracts. "If the federal government puts money into the research and development of a drug, will you insist that the price is not higher than it is in other countries?" he asked.

Bertagnolli stressed her commitment to ensuring that the benefits of NIH research are "affordable and available" to all Americans, but said she could not provide "further specifics" about how she would achieve those goals at this time.

Sen. Bill Cassidy, MD (R-La.), the committee's ranking member, pressed Bertagnolli to commit to precisely the opposite stance: excluding reasonable pricing clauses from NIH contracts. He said the clauses have "discouraged the uptake of breakthrough discoveries" by the private sector and that former NIH Director Harold Varmus, MD, decades ago because he blamed the policy mechanism for driving industry away from potential scientific collaborations.

"History tells us that if you do it, patients are damaged," Cassidy said of the clauses, despite whatever "rhetoric" may be circulating in their favor. Again, Bertagnolli said she could not commit to "any specific action" right now, but said "I will work with you on this issue."

On Wednesday, Cassidy noted that NIH has gone 20 months without a permanent director, and explained why he was supporting Bertagnolli's nomination. "I appreciated her refusal to commit to extreme and counterproductive drug pricing policies like ... reasonable pricing clauses," he said. "When pressed, she committed to following the law. As I pointed out in our confirmation hearing, the law is clear and so is the history."

"If confirmed, I expect Dr. Bertagnolli to listen to the NIH experts who have consistently concluded that it is not the NIH's role to weigh in on drug pricing," Cassidy added. "I'll be watching her work closely to ensure she does not bow to political pressure from progressives ... I have decided I will support her nomination as she is qualified, and I think she'll provide the leadership we need now." He was one of several committee Republicans who voted in favor of the nominee.

Sen. Patty Murray (D-Wash.) also weighed in with her support for Bertagnolli, who is currently the director of the National Cancer Institute. "She is a renowned leader. She's a seasoned oncologist, she's a researcher and director, and her record and numerous accomplishments leave no doubt she's an excellent choice to lead the NIH at this critical moment," Murray said.

"Getting a permanent NIH director on board is of the utmost importance, and she will bring to the agency steady leadership, a wealth of professional knowledge, and strong personal experience that will no doubt inform her approach to this role," she added. "Dr. Bertagnolli is the right person to ... keep our nation competitive and give patients across the world real hope for the future."

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