My daughter, Emily, was teaching English at a middle school in Asahi City, Chiba Prefecture, on the Japan Exchange and Teaching (JET) Program when the 2011 Tohoku earthquake struck on March 11, 2011. Tohoku is a region in the northeast portion of the island of Honshu, the largest island in Japan. Though Asahi City, a coastal city, is not in the Tohoku region, it was still heavily damaged by the resulting tsunami. Several of Emily’s students lost their homes. She was emotionally shaken, of course, but was fortunate not to sustain any injuries.

With the fifth anniversary of the 2011 Tohoku earthquake and tsunami approaching, I have been reflecting upon the tremendous anxiety that I felt that day about Emily’s safety, my wife’s family in Tohoku, and the people of Japan in general. My reflections deepened last week while observing the interaction of SPICE’s Reischauer Scholars Program (RSP) students (American high school students studying about Japan) with SPICE’s Stanford e-Japan students (Japanese high school students studying about the United States) in an informal online “social hour.” The RSP and Stanford e-Japan are distance-learning courses that are offered by SPICE.

Stanford e-Japan instructor Waka Brown and RSP instructor Naomi Funahashi organized the social hour to help to build bridges between youth in Japan and the United States. During the latter part of the social hour, RSP student, David Jaffe (Mesa, Arizona), posed the question, “How is 3.11 remembered today?” Among the many Stanford e-Japan students who spoke was Minoru Takeuchi (Sakura City, Chiba Prefecture), who stated, “When the earthquake happened, I was an elementary school student (12 years old). I still remember very well… at that time, I was in school. Some students were very afraid and crying… Maybe after the earthquake, many Japanese noticed the importance of working together, the preciousness that they could meet their friends…” The Japanese students’ sharing of their experiences related to 3.11 extended the social hour far beyond the hour, and the gratitude expressed by the American students to their counterparts in Japan flowed for many minutes in a text-chat box.

Observing the students was one of the most rewarding experiences of my career at SPICE. The Japanese students’ remembrances of 3.11 brought back poignant and difficult memories for me but also provided me with hopeful thoughts on the future of the U.S.–Japan relationship as I witnessed students from across the Pacific forming budding friendships and discussing topics of mutual relevance.
 

Resources for the classroom
 

My hope is that teachers will carve out some time in their curriculum to engage their students in a study of 3.11 as well as its legacies. The study of natural hazards ought to be a core part of school curriculum. SPICE has undertaken many curricular projects related to 3.11. I would recommend that teachers show the film, After the Darkness, which was produced by Risa Morimoto and Funahashi. After the Darkness is a documentary film that touches upon the events of the disaster itself but also focuses on the experiences of two survivors in particular. It is accompanied with free curricular lessons that are accessible to students of various ages. I also recommend a lecture by Professor Emeritus Daniel Okimoto, Stanford University, on “Japan’s Geological Factors,” which is accompanied by a free lesson plan. Another recommended curricular unit is SPICE’s Examining Long-term Radiation Effects, which was produced prior to 3.11 but can help students understand the radiation-related concerns following the Fukushima Daiichi nuclear disaster. In addition, the film, Live Your Dream: The Taylor Anderson Story, is about one of two American JET Program teachers who lost their lives during 3.11. SPICE developed a teacher’s guide for the film that can be freely downloaded from the Live Your Dream: The Taylor Anderson Story website. Lastly, I recommend the use of the films from the 113 Project in classrooms. Earlier this week, I moderated a panel discussion that included Wesley Julian (director of the 113 Project), Andy Anderson (father of Taylor Anderson and board member of the Taylor Anderson Memorial Fund) as well as other Americans and Japanese who continue to contribute to relief efforts in the Tohoku region.

A substantial share of all malpractice claims in the United States is attributable to a small number of physicians, according to a study led by researchers at Stanford University and the University of Melbourne.

The team found that just 1 percent of practicing physicians accounted for 32 percent of paid malpractice claims over a decade. The study also found that claim-prone physicians had a number of distinctive characteristics, such as practicing specialities that are riskier than others.

“The fact that these frequent flyers looked quite different from their colleagues — in terms of specialty, gender, age and several other characteristics — was the most exciting finding,” said David Studdert, professor of medicine and of law at Stanford. “It suggests that it may be possible to identify high-risk physicians before they accumulate troubling track records, and then do something to stop that happening.”

Studdert is also a core faculty member at Stanford Health Policy and the lead author of the study published in The New England Journal of Medicine.

Concentrated among a small group

“The degree to which the claims were concentrated among a small group of physicians was really striking,” added Studdert, an expert in the fields of health law and empirical legal research.

The researchers analyzed information from the U.S. National Practitioner Data Bank, a data repository established by Congress in 1986 to improve health-care quality. Their study covered 66,426 malpractice claims paid against 54,099 physicians between January 2005 and December 2014.

Almost one-third of the claims related to patient deaths; another 54 percent related to serious physical injury. Only 3 percent of the claims were litigated to verdicts for the plaintiff. The remainder resulted in out-of-court settlements. Settlements and court-ordered payments averaged $371,054.

“The concentration of malpractice claims among physicians we observed is larger than has been found in the few previous studies that have looked at this distributional question,” said Michelle Mello, a co-author of the study and professor of law and of health research and policy at Stanford.

“It’s difficult to say why that is,” Mello added. “The earlier estimates come from studies of single insurers or single states, whereas ours is national in scope. Also, the earlier numbers are more than 25 years old now, and claim-prone physicians may be a bigger problem today than they were then.”

Encouraging greater awareness

The authors recommend that all institutions that handle large numbers of patient complaints and claims develop a greater awareness of how these events are distributed among clinicians.

“In our experience, few do,” they write in the paper. “With notable exceptions, fewer still systematically identify and intervene with practitioners who are at high risk for future claims.”

The most important predictor of incurring repeated claims was a physician’s claim history. Compared to physicians with only one prior paid claim, physicians who had two paid claims had almost twice the risk of another one; physicians with three paid claims had three times the risk of recurrence; and physicians with six or more paid claims had more than 12 times the risk of recurrence.

“Risk also varied widely according to specialty,” the authors noted. “As compared with the risk of recurrence among internal medicine physicians, the risk of recurrence was approximately double among neurosurgeons, orthopedic surgeons, general surgeons, plastic surgeons and obstetrician-gynecologists.”

The lowest risks of recurrence occurred among psychiatrists and pediatricians.

Male physicians had a 40 percent higher risk of recurrence than female physicians, and the risk of recurrence among physicians younger than 35 was about one-third the risk among their older colleagues, the study found.

“If it turns out to be feasible to predict accurately which physicians are going to become frequent flyers, that is something liability insurers and hospitals would be very interested in doing,” Studdert said.

“But institutions will then face a choice,” he added. “One option is to kick out the high-risk clinicians, essentially making them someone else’s problem. Our hope is that the knowledge would be used in a more constructive way, to target measures like peer counseling, retraining, and enhanced supervision. These are interventions that have real potential both to protect patients and reduce litigation risks.”

Other stories about the study:

The New York Times Well Blog

The Huffington Post

KQED Public Radio

U.S. News & World Report

CBS News

Reuters

Medscape

[[{"fid":"221894","view_mode":"crop_870xauto","fields":{"format":"crop_870xauto","field_file_image_description[und][0][value]":"Herbert Abrams","field_file_image_alt_text[und][0][value]":"Herbert Abrams","field_file_image_title_text[und][0][value]":"Herbert Abrams","field_credit[und][0][value]":"","field_caption[und][0][value]":"Herbert Abrams","field_related_image_aspect[und][0][value]":"","thumbnails":"crop_870xauto"},"type":"media","attributes":{"alt":"Herbert Abrams","title":"Herbert Abrams","width":"870","style":"width: 400px; height: 500px; float: right; margin-left: 15px","class":"media-element file-crop-870xauto"}}]]Renowned radiologist Herbert Leroy Abrams, who co-founded the Nobel Prize-winning organization International Physicians for the Prevention of Nuclear War, died Jan. 20 at his Palo Alto home. He was 95.

Abrams was a professor emeritus of radiology at Stanford University, a senior fellow at Stanford's Freeman Spogli Institute for International Studies, and an affiliated faculty member at the Center for International Security and Cooperation (CISAC).

Abrams' illustrious, multi-faceted career embraced what he called the "four dimensions of bio-medicine" – patient care, research, teaching and advocacy.

"For as long as I have known him, I could only describe Herb Abrams as a class act," said Sanjiv "Sam" Gambhir, professor and chair of radiology at Stanford. "It is upon the shoulders of giants such as Herb that we ourselves stand today at the cutting edge of radiology."

Former U.S. Secretary of Defense and CISAC colleague William J. Perry praised Abrams for his "wisdom and carefully chosen words" in his advocacy for better control of nuclear weapons.

"The forces maintaining nuclear weapons and creating the danger that we might use them are very powerful and very hard to stop, and Herb and the International Physicians for the Prevention of Nuclear War were an early voice of sanity in this field, " Perry said.

Visionary pioneer in radiology

Born in 1920 in New York to immigrant parents, Abrams declined to go into the family hardware business. He graduated from Cornell University in 1941 and earned his medical degree from Long Island College of Medicine in 1946.

According to his family, Abrams had planned to become a psychiatrist until he was captivated by radiological imaging, which provided the road map for virtually all surgical and many medical therapies.

Abrams, his wife, Marilyn, and daughter, Nancy, moved to the West Coast in 1948.  Their son, John, was born a year later. Abrams completed his residency in radiology at Stanford in 1952 and joined the faculty as an assistant professor in the department in 1954.

While Abrams rose to become director of diagnostic radiology at Stanford, he and Marilyn raised their children in the Bay Area during what his children say he often called "The Golden Years" – rich with deep friendships, youthful exuberance, guitar-playing, family adventures, and professional success.

Abrams was an internationally known authority on cardiovascular radiology and wrote more than 190 articles and seven books on cardiovascular disease and health policy.

For many years he served as editor-in-chief of Postgraduate Radiology, and he was founding editor-in-chief of the journal Cardiovascular and Interventional Radiology.

In 1961 he published Angiography, the first comprehensive volume on the subject, which now is in its fourth edition (edited by Stanley Baum) under the title Abrams' Angiography: Vascular and Interventional Radiology.

"Under his guidance, Stanford pioneered in the fields of coronary artery imaging and the diagnosis of adult and congenital heart diseases, as well as vascular diseases, such as renal artery narrowing as a cause of hypertension," said Lewis Wexler, professor emeritus of radiology at Stanford, who was a resident under Abrams.   

"For many years, I referred to him as 'Dr. Abrams,' even though he requested a less formal address," Wexler added.  "I think I waited until I was a full professor before I called him 'Herb.' His wife and a number of his old friends from San Francisco called him 'Hoppy,' an endearment that aptly describes his energy, excitement and ability to jump effortlessly from discussing radiology [to discussing] health policy, politics, religion, art and music."

The Boston years

In 1967, with their children pursuing their own paths, Abrams and his wife moved to Boston, where he became the Philip H. Cook Professor of Radiology at Harvard Medical School and radiologist-in-chief at Brigham and Women's Hospital and at the Dana Farber Cancer Center.  The intellectual environment of Boston invigorated him and he devoted himself to building a great radiology department, a new research institute, and an outstanding teaching center.  During their time in Boston he and Marilyn also began a long love affair with Martha's Vineyard, where they built a house in 1975.

Steven Seltzer, chair of the Department of Radiology at Brigham and Women's Hospital, who holds the Philip Cook professorship at Harvard Medical School, which Abrams previously held, remembers his longtime mentor as a visionary who helped broaden the scope of radiology as a discipline.

When Seltzer arrived at Brigham and Women's in 1976 to do his radiology residency in what was then a very small department, he recalled being "incredibly impressed with the professional growth opportunities and the values and quality of the program that Abrams was building." He added that radiology was "still growing up" at that time and that Abrams had a vision that began during his years at Stanford and developed during his years in Boston.

"He was a very determined man. I fully bought into that vision. I thought this is a good person to have as a mentor and a role model, because I also aspired to live in a world that had similar characteristics that Herb had dreamed of," Seltzer said.

As a mentor and teacher, Seltzer remembered, Abrams pursued and demanded excellence and sometimes exhibited impatience.  During the time that Seltzer held the post of chief resident in radiology at Brigham and Women's, the hospital scored one of the first CT scanners in the city. The device operated 18 hours a day, seven days a week, and was staffed by residents after hours and on weekends. This was in addition to the residents' regular on-call duties. When the residents balked, Seltzer approached his boss and questioned the fairness of the arrangement and suggested that the residents be compensated with a stipend. "He just looked at me and said, 'Steve, you're doing this. This is your responsibility, and you need to get the residents comfortable with it.'"

During their 40-year relationship, Seltzer got to know another side of Abrams, whose approach to being a grandfather and great-grandfather was far different from the "tough love" he doled out to his students.

Anti-nuclear advocacy

Toward the end of the Boston years, in the early eighties, Abrams developed a keen interest in the effects of ionizing radiation and nuclear weapons and the problems of accidental or inadvertent nuclear war, which led to the next phase of his career as an anti-nuclear activist.

"He leveraged his training in radiology to become one of the leading experts on the health effects of low-dose radiation," said David Relman, professor of medicine at Stanford and current co-director of CISAC.

"It's a problem that doesn't get as much attention as the catastrophic effects of a nuclear blast, but the long-term consequences of low-dose radiation was something that Herb … helped promote as a serious issue, worthy of attention and study," Relman added.

Abrams discussed the threats posed by radiation in a story published in the Spring 1986 issue of Stanford Medicine magazine. He said that, for physicians, nuclear weapons and nuclear war were "the central health issue of the 20th century."

"We need to educate not only our colleagues and our students, but our constituents – the patients  – and ultimately policymakers about the consequences of nuclear war," Abrams said in the article. "Medical students are seldom taught about the effects of radiation. It's important because there have been radiation disasters unrelated to nuclear weapons, and there will be more in the future."

He was founding vice president of International Physicians for the Prevention of Nuclear War (IPPNW), which won the Nobel Peace Prize in 1985, just five years after the organization was established. He also served for many years on the national board of directors and as national co-chair of Physicians for Social Responsibility (PSR), a U.S. affiliate of IPPNW.

"His contributions were huge," said Scott Sagan, Caroline S.G. Munro professor of political science at Stanford. Sagan added that under Abrams' leadership the IPPNW "did yeoman's work to try to educate the public and world leaders about the consequences of nuclear war at a time when many, including some in the Reagan administration, were minimizing the consequences of nuclear weapons use."

Abrams returned to Stanford in 1985 as a professor of radiology, but spent most of his time in research at CISAC, working to link various disciplines and philosophies in the political, international and academic arenas to create a better understanding of international security during the nuclear age.

Presidential disability

In the 1990s Abrams began to focus on presidential disability and its potential impact on decision-making.

In 1992 he published The President Has Been Shot: Disability, Confusion and the 25th Amendment, which brought together important issues at the intersection of medicine, politics and humanism.

"[H]is contributions to our intellectual life and to our knowledge of the presidency and so much more were significant and lasting," said CISAC co-founder John Lewis, who invited Abrams to join CISAC after he returned to Stanford.

Near the end of his long life, Abrams wrote about the effects of aging, not only on leaders but also on himself.

Sagan said Abrams "continued to make both scholarly and policy contributions" even toward the end of his long career.

"Herb lectured every year at Stanford on how the physical and psychological health of leaders influenced their decision-making about war and peace," Sagan said.

CISAC co-director Amy Zegart said Abrams "was vibrant to the end," attending seminars and "asking hard-hitting questions."

"He had an incredible mind and an incredible heart, and I think everybody saw both of those things in him, which is why he was such a bedrock of our community for such a long time," Zegart said.

A vibrant family life

Always at the core of Abrams' life was bringing together his family to travel, to ski, to play tennis, and to celebrate birthdays and holidays. 

On his 95^th birthday Abrams played four-generation tennis with his son, grandson, and great-grandson on Martha's Vineyard, where his family spent summers for 45 years. Until the last month of his life, he played doubles three times a week.

In addition to Marilyn, to whom he was married for 73 years, daughter Nancy (Richard Eilbert), of Lincoln, Mass. and son John (Christine) of West Tisbury, Mass. ,Abrams is survived by three grandchildren (Pinto and Sophie Abrams, and Natasha Eilbert) and three great-grandchildren (Kalib, Silas, and Axel Abrams).

Memorial donations in memory of Abrams may be made to Physicians for Social Responsibility 1111 14^th St. NW, Suite 700, Washington, DC, 20005, or by visiting that organization's website at www.PSR.org.

A service to celebrate his life will be held on the Stanford campus on March 19; details will be announced.

The Department of Energy's long-term plan for dealing with material contaminated with plutonium and heavier elements from the U.S. weapons program is to bury it underground at the Waste Isolation Pilot Plant in southeastern New Mexico.

The Energy Department's plan aims to safeguard nuclear material for the next 10,000 years. But three Stanford nuclear scientists point out in a new commentary article in the journal Nature that the Waste Isolation Pilot Plant (WIPP) was not designed to hold as much plutonium as is now being considered for disposal there. And, in fact, the site has seen two accidents in recent years.

"These accidents during the first 15 years of operation really illustrate the challenge of predicting the behavior of the repository over 10,000 years," said Rod Ewing, the Frank Stanton Professor in Nuclear Security at Stanford and a senior fellow at the Center for International Security and Cooperation.

What's more, there's more plutonium proposed for disposal at WIPP in the future, a result of treaties with the former Soviet Union and now Russia to decrease the number of nuclear weapons by dismantling them.

A recent assessment of what to do with the plutonium from dismantled weapons has proposed that the material be diluted and disposed of at WIPP. But this analysis does not include a revision of the safety analysis for the site, wrote Ewing and his two Stanford co-authors in the Department of Geological Sciences, postdoctoral scholar Cameron Tracy and graduate student Megan Dustin.

They call on the U.S. Department of Energy, which operates WIPP, to take another look at the safety assessment of the site. Particular emphasis should be on the estimates of drilling activity in the oil-rich Permian Basin, where WIPP is located, and on the effects of such a huge increase in the plutonium inventory for the pilot plant.

"The current regulatory period of 10,000 years is short relative to the 24,100-year half-life of plutonium-239, let alone that of its decay product, uranium-235, which has a half-life of 700 million years," the researchers wrote.

"We cannot be certain that future inhabitants of the area will even know WIPP is there," they added. As a result, it is important to understand the impact of future drilling in the area.

The waste is stored 2,150 feet below the surface in hundreds of thousands of plastic-lined steel drums in rooms carved out of a 250-million-year-old salt bed. The repository is at about half of its planned capacity and slated to be sealed in 2033.

The researchers question some of the assumptions used in the safety studies. For example, to determine the odds of oil drilling in the future, the study uses a 100-year historical average drill rate, even though drilling has intensified in recent decades, throwing this assumption into question.

The Stanford experts also suggest more attention to how the buried materials may interact with each other, particularly with salty brine, over centuries. A single storage drum may contain a variety of materials, such as lab coats, gloves and laboratory instruments; thus, the chemistry is complex.

Ewing said that the complacency that led to the accidents at WIPP can also occur in the safety analysis. Therefore, he advises, it is important to carefully review the safety analysis as new strategies for more plutonium disposal are considered.

This month Stanford researchers are in one of the largest slums – or favelas – in Latin America to launch the first-of-its kind comprehensive study on the use of body-worn cameras by the military police in Rio de Janeiro, Brazil. Over 350 police officers will start wearing cameras clipped to their uniforms during their patrols to record interactions with residents. The yearlong Stanford study aims to determine the effects of this technology on reducing lethal violence, as well as other forms of violent interactions with community members.
 
Led by Beatriz Magaloni, associate professor of political science and director of the Program on Poverty and Governance (PovGov) at Stanford’s Center on Democracy, Development, and the Rule of Law, this study comes at a significant moment when police brutality is tearing apart the social fabric in communities worldwide, and body-worn cameras are being tested as a way to curb the excessive use of force by law enforcement officials. A study of this nature has never been conducted in a location characterized by extraordinary levels of violence, and the strong presence of armed criminal groups.
 
“Police-body worn cameras have been adopted in many police departments in the U.S.,” said Magaloni who is also a senior fellow at Stanford’s Freeman Spogli Institute for International Studies. “However, it is not clear how this technology will work in Rio de Janeiro’s context. Even when police officers are instructed to turn on their cameras, we do not know if they will obey. “
 
To evaluate the use of body-worn cameras, Magaloni established a partnership with TASER International, who is supplying 75 cameras for the study, along with the Military State Police of Rio de Janeiro to introduce this technology in the Rocinha favela. Cameras will be assigned randomly in this study to vary the frequency (number of cameras) and the intensity (hours) of the use of the cameras across territorial police units in the favela.
 
Magaloni described the two protocols for the use of body-worn cameras that will be explored in the study.
 
“The first will examine police compliance with the cameras, as some officers will be asked to turn on their cameras during their entire shifts, which is significantly harder to disregard, while others will only turn on their cameras when interacting with citizens, the prevalent practice in the U.S.,” she said.
 
“Second, the research hopes to contribute towards the development of protocols for the processing of the images, which is a huge challenge for police departments everywhere,” said Magaloni. “It will also help to determine which videos should be audited and what strategies commanders and supervisors can follow to deliver feedback to police officers.”
 
Rio de Janeiro’s police are considered one of the deadliest in the world. And while this violence has been decreasing since 2008, distrust between the police and favela residents is at a high after the recent police killing of five unarmed young men in Costa Barros, in Rio’s North zone. At the same time, police are being killed at significantly higher rates, which has only further strained their interactions with residents.
 
Over the past two years, Professor Magaloni and her team at PovGov have been working in partnership with the Military State Police of Rio de Janeiro and the Secretary of Security of Rio de Janeiro to examine the use of lethal force by police officers and the impact of public security efforts in Rio’s favelas. This ongoing relationship has allowed Professor Magaloni unprecedented access to criminal data and police personnel. Detailed analysis of homicide patterns and ammunition usage by police officers, together with the application of surveys and in-depth interviews with police officers and favela residents, have unearthed some of the contextual, individual, and institutional factors that give rise to greater use of deadly force by the police.
 
As the camera study launches this month in Rio de Janeiro, Magaloni and the PovGov team are hopeful that their research will improve theory and science about police behavior, and provide critical feedback to improve measures aimed at reducing police violence in Brazil and beyond.  
 

To learn more about the Program on Poverty and Governance, please visit: povgov.stanford.edu.
 

CONTACT:
Professor Beatriz Magaloni
Stanford Department of Political Science and the Freeman Spogli Institute for International Studies
magaloni@stanford.edu
(650) 724-5949

A day after President Obama's address on the San Bernardino shootings, FSI Senior Fellow Larry Diamond speaks with Michael Krasny of NPR News on the U.S. response to global terrorist threats. In addition to a unified, international coalition, Diamond believes one of the keys to defeating ISIS lies with empowerment of the people of Iraq and Syria, addressing the need for political change in the region. Diamond was accompanied by Jessica Stern, research professor at Boston University and Shibley Telhami, senior fellow at the Center for Middle East Policy at the Brookings Institution.