Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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On May 1, 2003, President Bush publicly declared an end to combat in Iraq. Four years later, the conflict had only intensified, fueled by a violent insurgency, sectarian strife, and a resurgent al-Qaeda in Iraq. More than 3,000 American servicemen and servicewomen had been killed and 790,000 Iraqi civilians were dead. What had gone so disastrously wrong? Charles Ferguson, an MIT-trained political scientist, determined to find out.

Drawing on shockingly frank interviews with U.S. government officials, military personnel, diplomats, journalists and Iraqi leaders and citizens, his first film, No End in Sight: The American Occupation of Iraq, examines comprehensively how the Bush administration constructed the Iraq war and subsequent occupation. The film won the Special Jury Prize, documentary competition, at the 2007 Sundance Film Festival, as a “timely work that clearly illuminates the misguided policy decisions that have led to the catastrophic quagmire of the U.S. invasion and occupation of Iraq.”

“Overnight rendered unemployed and infuriated are 500,000 armed men,” one of many ill-advised moves that ignited resentment, desperation, and a still-raging insurgency.On May 23, the Freeman Spogli Institute hosted a special screening of the film, followed by a distinguished panel of experts. Among the film’s central themes was the failure to commit sufficient troops to maintain order, secure the borders, or protect government ministries, historic sites, or ammunition depots. The destruction of national treasures, depicted vividly, was heartbreaking.

Soon after one watershed—the toppling of Saddam Hussein and the defeat of the military—there was another watershed, characterized by widespread looting, lawlessness, and a growing feeling among Iraqis that Americans could not protect them. The film chronicles three especially fateful decisions: to halt the formation of an Iraqi interim government (as Iraqi opposition leaders felt they had been promised) and impose an American occupation instead; a wide-ranging campaign of de-Baathification—the purging of higher-level Baath Party officials who ran the civil service and even staffed many schools and hospitals; and the hasty decision to disband the Iraqi military and intelligence services.

Said Col. Paul Hughes (Ret.), “We could have used Iraqi units to clean up, build roads, and rebuild their country.” Instead, the military were told they were going to be out of work, leaving millions of Iraqis suddenly without support. The film recounts, “Overnight rendered unemployed and infuriated are 500,000 armed men,” one of many ill-advised moves that ignited resentment, desperation, and a still-raging insurgency. Ambassador Barbara Bodine recalled, “When we were first starting the reconstruction, we used to joke that there were 500 ways to do it wrong and two to three ways to do it right. What we didn’t understand is that we were going to go through all 500.”

The riveting documentary was followed by a lively panel discussion among Stanford political scientists, historians, and experts on the war in Iraq. Moderating the panel was Larry Diamond, Hoover Institution senior fellow and coordinator of the Democracy Program at FSI’s Center on Democracy, Development, and the Rule of Law, who called the war “one of the greatest policy tragedies in American history.” Diamond served as an advisor to the Coalition Provisional Authority and wrote a book about the experience, titled %publication1%.

Writer and director Charles Ferguson noted that the shooting to inclusion ratio was 100:1 and said he will release more than 100 hours of film and 3,000 pages of transcripts as a public archive for the historical record. Col. Christopher Gibson, a 2006–07 National Security Affairs fellow at the Hoover Institution, who served in both the Gulf and Iraq wars, observed in his opening remarks, “For this to work in a republic, soldiers have to be there to take the tough questions.” Drawing on his experience during two tours of duty supervising national elections, he underscored the Iraqi people’s desire for freedom and “their deep and sincere desire for democracy.”

David Kennedy, Stanford’s Donald J. McLachlan Professor of History and a 2000 Pulitzer-Prize winner, commended the film for making an important contribution to the historical record. Future historians will have to consider a number of major questions, Kennedy said, including these two: “What was the deep strategic rationale for this war and how was that rationale related to the declared reasons for going to war,” namely the now discredited claims that the regime possessed weapons of mass destruction and had verifiable links to al-Qaeda.

In a lively discussion among panelists, it was agreed that the calculus was complex and many factors converged—an Iraq believed both to be a menace and weakened by many years of sanctions under a brutal leader; a son wishing to redress the policy of the father and avenge a near assassination attempt. But the ideological factor was significant—the belief that we had the ability to effect political change in a country that would transform the character of an entire region.

The debate addressed other critical issues—could the outcome have been better had policy been better informed and more skillfully implemented? Could anything change the outcome now? Said Diamond, the only thing that could materially change the outcome now “would be to combine a military surge with a diplomatic surge,” involving the United Nations, the European Union, the United States, and a cooperative Iraqi leadership. The United States should let Iraq know we’ll leave, he stated, if Iraqi leaders fail to undertake the requisite political reconciliation and compromise. As the lively debate and discussion with more than 300 audience members ended, there was little doubt that all these questions would be debated for some time to come.

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“Preparing the next generation of leaders and creating more informed elementary and secondary students means changing and improving curricula, setting higher standards, and ensuring that content is based on current research relevant to the world’s critical problems and urgent issues.” Coit “Chip” Blacker, FSI Director and Co-Chair, International Initiative

SPICE was established more than 30 years ago and serves as a bridge between FSI and elementary and secondary schools in the United States and independent schools abroad. SPICE’s original mission in 1976 was to help students understand that we live in an increasingly interdependent world that faces problems on a global scale. For 30 years, SPICE has continued to address this original mission and currently focuses its efforts primarily in three areas:

  1. curriculum development for elementary and secondary schools;
  2. teacher professional development; and
  3. distance-learning education.

SPICE hopes to continue to educate new generations of leaders by addressing five key initiatives of The Stanford Challenge, announced by President Hennessy last fall.

Initiative on Human Health / 1

SPICE is working with the School of Medicine and the Center for Health Policy on a high school curriculum unit that focuses on HIV/AIDS. SPICE is collaborating with Drs. Seble Kassaye, David Katzenstein, and Lucy Thairu of the School of Medicine’s Division of Infectious Diseases & Geographic Medicine. Using an epidemiological framework, students will be encouraged to consider the many issues involved in the pandemic, including but not limited to poverty, gender inequality, and biomedical research and development. Two Stanford undergraduates, Jessica Zhang and Chenxing Han, are working with the physicians on this unit.

Initiative on the Environment and Sustainability / 2

SPICE recently completed a curriculum unit called 10,000 Shovels: China's Urbanization and Economic Development. 10,000 Shovels examines China’s breakneck growth through a short documentary that integrates statistics, video footage, and satellite images. The documentary, developed by Professor Karen Seto of the Center for Environmental Science and Policy, focuses on China’s Pearl River Delta region while the accompanying teacher’s guide takes a broader perspective, exploring many current environmental issues facing China. Stanford’s School of Earth Sciences is helping to promote this unit and documentary.

The International Initiative / 3

All of SPICE’s curriculum units focus on international topics. Two of SPICE’s most popular units are Inside the Kremlin: Soviet and Russian Leaders from Lenin to Putin and Democracy-Building in Afghanistan. Inside the Kremlin introduces students to key elements of Soviet and Russian history through the philosophies and legacies of six of its leaders—Lenin, Stalin, Khrushchev, Gorbachev, Yeltsin, and Putin. The unit includes (on DVD) six lectures by six FSI faculty members, including FSI director Coit D. Blacker; professors David Holloway and Gail W. Lapidus, CISAC; professor and deputy FSI director Michael A. McFaul; history professor Norman M. Naimark; and history professor Amir Eshel, Forum on Contemporary Europe.

Democracy-Building in Afghanistan is a teacher’s guide for a film called Hell of a Nation. The film’s lead advisor and SPICE’s key advisor was former CDDRL fellow J. Alexander Thier. Hell of a Nation documents the lives of two Afghans participating in the political process to develop a new constitution for Afghanistan—illustrating the “human face” of democracy-building and elucidating the complexities and difficulties of democratic construction in a divided and historically conflict-ridden nation.

Arts and Creativity Initiative / 4

Following 9/11, SPICE decided to develop a unit called Islamic Civilization and the Arts, which introduces students to various elements of Islamic civilization through a humanities approach. Lessons on art, the mosque, Arabic language and calligraphy, poetry, and music provide students with experience analyzing myriad primary source materials, such as images, audio clips, sayings of Muhammad, and excerpts from the Quran. In each lesson, students learn about the history, principles, and culture of Islam as they pertain to particular forms of art.

SPICE recently completed a new unit called Along the Silk Road, which explores the vast ancient network of cultural, economic, and technological exchange that connected East Asia to the Mediterranean. Students learn how goods, belief systems, art, music, and people traveled across such vast distances to create interdependence among disparate cultures. This was a collaboration with the Silk Road Project, the Art Institute of Chicago, Stanford’s Cantor Arts Center and Center for East Asian Studies, and the Shorenstein Asia-Pacific Research Center.

The K-12 Initiative / 5

SPICE develops curriculum based on FSI scholarship, conducts teacher professional development seminars locally, nationally, and internationally, and also offers a distance-learning course called the Reischauer Scholars Program to U.S. high school students. At seminars at Stanford, FSI faculty members offer lectures to the teachers and SPICE curriculum writers give curriculum demonstrations that draw upon the content presented in the lectures. Last summer, Stanford professor Al Dien (Asian Languages) and the SPICE staff gave a workshop for 80 teachers in the Chicago Public Schools. World-renowned cellist Yo-Yo Ma performed at the workshop.

The Reischauer Scholars Program is a distance-learning course sponsored by SPICE. Named in honor of former ambassador to Japan Edwin O. Reischauer, a leading educator and noted scholar on Japanese history and culture, the RSP annually selects 25 exceptional high school juniors and seniors from throughout the United States to engage in an intensive study of Japan. This course provides students with a broad overview of Japanese history, literature, religion, art, politics, and economics, with a special focus on the U.S.-Japan relationship. Top scholars affiliated with the Shorenstein Asia-Pacific Research Center (including Ambassador Michael H. Armacost, Professor Daniel I. Okimoto, and Professor Gi-Wook Shin), leading diplomats, and young professionals provide web-based lectures as well as engage students in online dialogue. These lectures and discussions are woven into an overall curriculum that provides students with reading materials and assignments.

SPICE has for many years focused on the initiatives that have been identified by President Hennessy to be at the core of The Stanford Challenge. By continuing to focus on these initiatives, the SPICE staff hopes to continue to make FSI scholarship accessible to a national and international audience of educators and students, with the ultimate goal of empowering a new generation of leaders with the tools needed to deal with complex problems on a global scale.

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The Bill & Melinda Gates Foundation’s Agricultural Development Program has awarded Stanford University’s Program on Food Security and the Environment (FSE) and a team of collaborators $3.8 million over three years to conduct a quantitative assessment of the effect of biofuels expansion on food security in the developing world. This work will determine how different scenarios of expanded biofuels production in rich and poor countries will affect global and regional food prices, farmer incomes, and food consumption of the poor. In three case-study countries (India, Mozambique, Senegal), it will make a more detailed assessment of the opportunities and pitfalls associated with an array of possible biofuels development scenarios (e.g., using different crops for biofuels production, using marginal land versus highly productive land, etc.). We expect the work will represent the first systematic, detailed effort to address the effects of biofuels expansion on welfare in poor countries and the first available analytic tool for assessing possible biofuels investments in individual developing countries. Project collaborators include FSE, the International Food Policy Research Institute, the Center on Chinese Agricultural Policy, and the University of Nebraska.

Through this grant, the Bill & Melinda Gates Foundation aims to assess how biofuels may affect smallholder farmers in the developing world. This includes assessing both the risks, such as increasing food prices, and the potential opportunities for smallholder farmers to leverage biofuels to boost their productivity, increase their incomes, and build better lives for themselves and their families. The foundation and Stanford University will disseminate the findings widely to inform a broad audience, including policymakers.

FSE is also very pleased to announce a private gift from Lawrence Kemp for further work in the biofuels area. The Kemp gift will be devoted to building a team of faculty and students on campus who will analyze the transmission of global price effects to local markets, provide policy advice and communication on biofuels, and expand the field-level coverage of Stanford’s biofuels work.

In the November 2007 issue of Environment, project collaborators Rosamond L. Naylor (FSE), Adam Liska, Marshall Burke (FSE), Walter P. Falcon (FSE), Joanne Gaskell, Scott Rozelle (FSE), and Kenneth Cassman demonstrate how high energy prices and biofuelspromoting agricultural policy result in higher food prices generally and then examine in detail the potential global effects of biofuels expansion in four countries for four crops—corn in the United States, cassava in China, sugarcane and soy in Brazil, and palm oil in Indonesia. They argue that in each case, the threats to global food security from biofuels expansion likely outweigh the benefits, especially in the short run. This is because in many poor countries these crops play an important role in the diets of the poor and because the poorest in the world typically spend more money on food than they earn in income through farming. They also note that “second generation” technologies such as cellulosic biofuels will likely not play a significant role in biofuels production over the next decade or longer—and thus in the near-term are very unlikely to be the win-win that their proponents suggest. “The ripple effect: biofuels, food security, and the environment” excerpted from Environment, November 2007

The integration of the agricultural and energy sectors caused by rapid growth in the biofuels market signals a new era in food policy and sustainable development. For the first time in decades, agricultural commodity markets could experience a sustained increase in prices, breaking the long-term price decline that has benefited food consumers worldwide. Whether this transition occurs—and how it will affect global hunger and poverty—remain to be seen. Will food markets begin to track the volatile energy market in terms of price and availability? Will changes in agricultural commodity markets benefit net food producers and raise farm income in poor countries? How will biofuels-induced changes in agricultural commodity markets affect net consumers of food? At risk are more than 800 million food-insecure people—mostly in rural areas and dependent to some extent on agriculture for incomes— who live on less than $1 per day and spend the majority of their incomes on food. An additional 2–2.5 billion people living on $1 to $2 per day are also at risk, as rising commodity prices could pull them swiftly into a food-insecure state.

The potential impact of a large global expansion of biofuels production capacity on net food producers and consumers in low-income countries presents challenges for food policy planners and raises the question of whether sustainable development targets at a more general level can be reached. Achieving the 2015 Millennium Development Goals adopted by the United Nations General Assembly in 2000, which include halving the world’s undernourished and impoverished, lies at the core of global initiatives to improve human well-being and equity, yet today virtually no progress has been made toward achieving the dual goals of alleviating global hunger and poverty. The record varies on a regional basis: Gains have been made in many Asia-Pacific and Latin American-Caribbean countries, but progress has been mixed in South Asia and setbacks have occurred in numerous sub-Saharan African countries. Whether the biofuels boom will move extremely poor countries closer to or further from the Millennium Development Goals remains uncertain.

Biofuels growth also will influence efforts to meet two sets of longer-run development targets. The first encompasses the goals of a “sustainability transition,” articulated by the Board on Sustainable Development of the U.S. National Academy of Sciences, which seeks to provide energy, materials, and information to meet the needs of a global population of 8–10 billion by 2050, while reducing hunger and poverty and preserving the planet’s environmental life-support systems. The second is the Great Transition of the Global Scenario Group, convened by the Stockholm Environment Institute, which focuses specifically on reductions in hunger and greenhouse gas (GHG) emissions beyond 2050. As additional demands are placed on the agricultural resource base for fuel production, will ecosystem services (such as hydrologic balances, biodiversity, and soil quality) that support agricultural activities be eroded? Will biofuels development require a large expansion of crop area, which would involve conversion of marginal land, rainforest, and wetlands to arable land? And what will be the net effect of biofuels expansion on global climate change?

Although the questions outnumber the answers at this stage, two trends seem clear: Total energy use will continue to escalate as incomes rise in both industrial and developing countries, and biofuels will remain a critical energy development target in many parts of the world if petroleum prices exceed $55–$60 per barrel. Even if petroleum prices dip, policy support for biofuels as a means of boosting rural incomes in several key countries will likely generate continued expansion of biofuels production capacity. These trends will have widespread ripple effects on food security—defined here as the ability of all people at all times to have access to affordable food and nutrition for a healthy lifestyle—and on the environment at local, regional, and global scales. The ripple effects will be either positive or negative depending on the country in question and the policies in play.

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Former Senator Gary Hart has served as chairman of the Council for a Livable World since 2006. Since retiring from the United States Senate, he has been extensively involved in international law and business, as a strategic advisor to major U.S. corporations, and as a teacher, author and lecturer. He is currently Wirth Chair Professor at the University of Colorado and Distinguished Fellow at the New America Foundation.

Hart was co-chair of the U.S. Commission on National Security for the 21st Century. The Commission performed the most comprehensive review of national security since 1947, predicted the terrorist attacks on America, and proposed a sweeping overhaul of U.S. national security structures and policies for the post-Cold War new century and the age of terrorism. He was also co-chair of the Council task force that produced the report: "America Unprepared-America Still at Risk", in October, 2002.

Hart has been Visiting Fellow, Chatham Lecturer, and McCallum Memorial Lecturer at Oxford University, Global Fund Lecturer at Yale University, and Regents Lecturer at the University of California. He has earned a doctor of philosophy degree from Oxford University and graduate law and divinity degrees from Yale University. He was visiting lecturer at the Yale Law School.

Hart represented the State of Colorado in the United States Senate from 1975 to 1987. In 1984 and 1988, he was a candidate for his party's nomination for President.

Senator Hart has written numerous books including Under the Eagle's Wing: A National Security Strategy of the United States for 2009 (Fulcrum Books, January 2008), The Courage of Our Convictions: A Manifesto for Democrats (Henry Holt/Time Books 2006), and The Shield and The Cloak: The Security of the Commons (Oxford University Press, 2006).

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Under the Eagles Wing Gary Hart
About Under the Eagle’s Wing: A National Security Strategy of the United States for 2009:

Aimed at the new administration of 2009, Under the Eagle's Wing provides a sound national security strategy for the new century. Speaking from experience, former U.S. senator Gary Hart served on the United States Commission on National Security for the 21st century, which predicted the events of 9/11. Hart argues that threats such as terrorism, disease, and climate change are global challenges that should be addressed as such. He addresses a difficult question: How does a republic make itself secure in a revolutionary age without yielding to the temptations of empire? A thoughtful treatise, Under the Eagle's Wing makes a compelling plea for our leaders to embrace a new world order, one in which the U.S. and other nations draw strength from a united approach.

CISAC Conference Room

Former Senator Gary Hart Chairman, Council for a Livable World; Wirth Chair Professor, University of Colorado; and Distinguished Fellow, New America Foundation Speaker

Encina Hall
616 Jane Stanford Way
Stanford, CA 94305-6055

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Senior Fellow, Freeman Spogli Institute for International Studies
Ken Olivier and Angela Nomellini Professor of International Studies, Department of Political Science
Peter and Helen Bing Senior Fellow, Hoover Institution
mcfaul_headshot_2025.jpg PhD

Michael McFaul is the Ken Olivier and Angela Nomellini Professor of International Studies in Political Science, Senior Fellow at the Freeman Spogli Institute for International Studies, and the Peter and Helen Bing Senior Fellow at the Hoover Institution, all at Stanford University. He joined the Stanford faculty in 1995 and served as FSI Director from 2015 to 2025. He is also an international affairs analyst for MSNOW.

McFaul served for five years in the Obama administration, first as Special Assistant to the President and Senior Director for Russian and Eurasian Affairs at the National Security Council at the White House (2009-2012), and then as U.S. Ambassador to the Russian Federation (2012-2014).

McFaul has authored ten books and edited several others, including, most recently, Autocrats vs. Democrats: China, Russia, America, and the New Global Disorder, as well as From Cold War to Hot Peace: An American Ambassador in Putin’s Russia, (a New York Times bestseller) Advancing Democracy Abroad: Why We Should, How We Can; and Russia’s Unfinished Revolution: Political Change from Gorbachev to Putin.

He is a recipient of numerous awards, including an honorary PhD from Montana State University; the Order for Merits to Lithuania from President Gitanas Nausea of Lithuania; Order of Merit of Third Degree from President Volodymyr Zelenskyy of Ukraine, and the Dean’s Award for Distinguished Teaching at Stanford University. In 2015, he was the Distinguished Mingde Faculty Fellow at the Stanford Center at Peking University.

McFaul was born and raised in Montana. He received his B.A. in International Relations and Slavic Languages and his M.A. in Soviet and East European Studies from Stanford University in 1986. As a Rhodes Scholar, he completed his D. Phil. in International Relations at Oxford University in 1991. 

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Herbert L. Abrams, CISAC member-in-residence and Stanford professor of radiology, emeritus, looks at the issue of a presidential candidate's age and its effect on decision-making.

In the 1996 presidential election, the age of Sen. Robert Dole, who at 73 was the oldest man ever to run for the office, was a substantive issue. Although he was thought to be in good general health, his right kidney had been removed, his remaining left kidney had stones, his electrocardiograms in 1980 and 1981 were abnormal, he had pre-cancerous colonic polyps removed in 1985, and he had undergone a radical prostatectomy for cancer in 1991.

He had smoked for many years and had a family history of heart disease, aneurysm, emphysema and cancer. In 2004, which would have been the last year of a second term if he had won, he had hip replacement surgery followed by a brain hemorrhage.

After the election, Richard Brody, a political scientist at Stanford, and I, in an extensive study of the media coverage at the time (published in 1998 in the Political Science Quarterly,) found that allusions to Dole's age were common, but with only occasional comments on its potential consequences. The impact of aging and ill health on the cognitive capacities essential for an effective presidency was poorly conveyed to the American public.

Hence, more than 60 percent of respondents to surveys were not concerned about Dole's age. Among those for whom age was an important consideration, four times as many voters believed that Dole's age would hamper him as president. That group of the electorate was far more likely to vote for Clinton.

The issue of age is with us once more with Senator John McCain's run for the office. James Reston, the great New York Times journalist of the last century, believed that younger presidents might be more resistant to the stresses of the job. "It is not responsible in this violent age to pick candidates for the presidency from men in their 60s," he wrote.

How would he have reacted to a president who would be 72 at his inauguration and 80 years old in the last year of a second term? The question is a fair one because McCain, if elected, would be the oldest person to be inaugurated in our history. While the Constitution endorsed age discrimination by setting 35 years as the youngest age of a president, it established no upper age limit, perhaps because life expectancy was so much shorter in 1787 than in 2008. When we choose presidents 65 or older, we must grapple with the possibility that they may be unable to fulfill the 208-week-long contractual obligation implicit in their candidacy.

Dominating the illnesses that affect the elderly are heart disease, stroke, cancer, infection, hip fractures, the complications of major surgery and dementia. Heart attacks are frequently accompanied by anxiety, depression, impaired concentration and problems with sleep. Following a stroke, depression, anxiety and emotional lability characterize many patients. A major sequel of surgery is confusion severe enough to impede one's ability to think clearly. The many drugs that the elderly use have significant side effects and may produce cognitive changes.

Dole and McCain supporters may respond, "Why worry about it when the institutional constraints guard us from irrational behavior in the White House?" Because the inherent risks are too great. As Sen. McCain said in a recent interview, "I understand that my age would be a factor at any time."

The term "cognition" refers to the interaction of mental processes that produce human thought. Under its rubric come such faculties as concentration, attention, inventiveness, intuition, memory, foresight, abstract and logical thought. All are applicable to meaningful decision-making, and many are essential when time is short and tensions high. The elderly are more sluggish at processing and retrieving information from short- and long-term memory. There is a 60 percent slowing in the rate of memory search between the ages of 20 and 50 years.

To be sure, both the health problems and the memory changes are unevenly distributed among the population. But why take a chance? Why push the odds and run for the most demanding job in the western hemisphere at an age when illness abounds, memory suffers and energy flags? This is the period when the elderly need their afternoon nap and the absent-minded become more so.

Clearly, some great leaders have functioned well beyond the age of 70. But the presidency is a position that is uniquely and awesomely demanding, extending well beyond thoughtful, meditative policy decisions. It includes many large and pressing operational components, interacting with the White House staff, the cabinet, the Congress, the media, the public, the international community and many elements within the political party system. It is a stressful, power-packed, exhausting job, requiring stamina and energy during long days, weeks and months. It may involve rapid responses to emergencies and crises, with decisions based on a level of accelerated information retrieval and processing that elderly presidents may lack.

Those for whom Dole's age was important and who voted for Clinton in 1996 understood the increased likelihood of illness: in comparison to men aged 45 to 54 years, those aged 75 to 84 years are 34 times more likely to die of stroke, 17 times more likely to die of heart disease, and 12 times more likely to die of malignancy. Nineteen percent of those between 75 and 84 years and almost half over 85 are affected with Alzheimer's disease. While older Americans might have thought that an older person such as Dole would best represent their interests, they were also profoundly aware of their own fragility as they moved along in their seventies.

The media have an obligation to the public. If age affects the quality and duration of a president's performance, as it does, the national interest is best served by making certain that the public is well informed. Thus far, attention to McCain's age has focused on the importance of his choice for vice president. By this time, the media should have demanded and obtained the most recent medical data from McCain.

Dole made public his medical record in detail when he ran. McCain did so in 1999, but has not released the results of a recent comprehensive examination. The voters deserve no less from him, from Clinton, and from Obama. Certainly McCain will want his physicians to inform the voters on the status of his malignant melanomas, diagnosed on four occasions, one more serious than the others.

The Congress also has an obligation. An upper limit on the age of candidates could be achieved by passing a Congressional resolution. This would represent a powerful deterrent to seniors who wish to run and to politicians who would like to nominate them, while leaving the Constitution intact. Madison and Hamilton, who understood the wisdom of a lower limit 200 years ago (when emergency decisions were rarely required) would appreciate the deference to the radically different, complex, interconnected world that we live in today.

An upper limit of 60 to 65 would recognize that the presidency is too demanding - physically, intellectually, psychologically, and emotionally - to place the burden on the shoulders of a senior citizen.

Herbert L. Abrams is a professor at Stanford University School of Medicine and a member-in-residence of the Stanford Center for International Security and Cooperation. He is the author of "The President Has Been Shot: Disability, Confusion and the 25th Amendment" (1992, WW Norton Inc.) and has written about presidential disability and its impact on decision-making.

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At an April 11 symposium in Washington, D.C., Homeland Security Secretary Michael Chertoff said while the best-laid plans are likely to change if a pandemic or bioterrorism attack hits the United States, having no plans in place is a sure guarantee for disaster. CISAC members Lynn Eden, Martha Crenshaw, and Mariano-Florentino Cuéllar participated in "Germ Warfare, Contagious Disease and the Constitution," a daylong event co-hosted by Stanford Law School. CISAC affiliate Laura K. Donohue conceived and developed the project, which aimed to bring together senior policy-makers and legal experts to discuss how issues of constitutional law inform responses to natural pandemics or bioterrorism attacks.

Secretary Michael Chertoff of the Department of Homeland Security delivered the keynote address April 11 at the panel titled “Germ Warfare, Contagious Disease and the Constitution” in Washington, D.C.

Although the best-laid plans are likely to change if a pandemic or bioterrorism attack hits the United States, having no plans in place is a sure guarantee for disaster, Homeland Security Secretary Michael Chertoff told policy-makers, government officials, constitutional law experts and law students at a symposium April 11 in Washington, D.C.

"Preparation won't eliminate the problems and the stress, and it is often said that no battle plan has ever survived first contact with the enemy," Chertoff told the roughly 200 people attending the event, "Germ Warfare, Contagious Disease and the Constitution," hosted by Stanford Law School and the Constitution Project, a nonprofit organization.

"But I can tell you this," Chertoff continued. "If you don't have a plan, you are definitely going to have the worst-case outcome. A plan at least gives you a running start."

During the symposium, experts discussed the need to reform the complex web of federal and state laws to enable agencies to respond effectively to deadly natural or manmade epidemics—from pandemic flu to smallpox and aerosolized anthrax—while protecting individual rights.

Earlier that day, about 60 people from the current and two previous presidential administrations, public health officials, Stanford academics and law students participated in a closed-door, fictitious scenario that explored the federal government's response to an unfolding deadly epidemic as it crossed state lines. Lynn Eden, associate director for research at Stanford's Center for International Security and Cooperation (CISAC) at the Freeman Spogli Institute for International Studies, moderated the session, which was developed in cooperation with experts from the Department of Homeland Security.

"I think it's the first time detailed issues of constitutional law have been brought to bear in a natural pandemic or bioterrorism exercise," Eden said afterward. "It's very hard to plan for a catastrophe. This approach brought another facet to bear on disaster planning."

Margaret Hamburg, a former assistant secretary in the Department of Health and Human Services, opened the symposium, which was broadcast live on C-SPAN from the Dirksen Senate Office Building. Kathleen Sullivan, director of the Stanford Constitutional Law Center, moderated a panel featuring Stanford law Professors Pamela Karlan and Robert Weisberg; Christopher Chyba, director of the Program on Science and Global Security at Princeton and a former CISAC co-director; Jeff Runge, assistant secretary in the Department of Homeland Security; Michael Greenberger, director of the Center for Health and Human Security at the University of Maryland; and Martin Cetron, director of the Division of Global Migration and Quarantine at the U.S. Centers for Disease Control and Prevention.

Sullivan opened the panel by reflecting on how recent health crises have informed ongoing legal and policy debates: "West Nile virus. Anthrax mailings. Avian flu—responses to these infectious disease issues and concern about bioterrorism are running about our minds as we think about the response to 9/11 and Hurricane Katrina, and the complex web of local, state and federal authority to deal with such emergencies. What does the Constitution have to say about our ability to deal with infectious disease, whether it's naturally occurring or composed as a weapon of violence?"

In the 21st century, Cetron explained, health officials still rely on a "14th-century toolbox of isolation and quarantine" to control an outbreak. That is "part of our modern reality," he said. "The biggest area is not lack of specific authority, but the fact that jurisdictions are highly complex when it comes to international ports of entry [and] interstate movement. There are often overlapping jurisdictions and overlapping authorities. If there's a gap in some of this, the risk is that neither the state nor the feds would want to step up to that responsibility."

Greenberger said state officials are often ignorant about what they can do in an emergency. "The powers given to governors are extraordinary," he said. Three statutes exist in Maryland to authorize declarations of emergency and allow the governor to enforce isolation and quarantine of infected people, order citizens to take treatment against their will, force doctors to serve in dangerous situations and seize hospitals. "What's extraordinary is that most governors don't even know they have this power," Greenberger said. "The extent of legal illiteracy in this area is shocking."

Despite such challenges, Chertoff praised the participants for tackling the issue. "I think for the first time we've begun to think very seriously and in a disciplined fashion about how to plan for dealing with a major natural pandemic or a major biological attack," he said. "I wish I could tell you these things are unthinkable. But the one thing I've learned in the last seven years is there's pretty much nothing that's unthinkable."

Stanford in Washington

Laura K. Donohue, a CISAC affiliate and a 2007 Stanford Law School graduate who is the inaugural fellow at the Stanford Constitutional Law Center, conceived the daylong event to bring together policy-makers and constitutional experts to discuss response to natural pandemics and bioterrorism. "It was a chance to bring together the policy world, both operational and strategic, and give them the opportunity to talk to legal experts," she said. "This helped policy-makers think through the issues and think outside the box, and it did so in a non-threatening manner."

Donohue said she was prompted to create the symposium after directing a CISAC-supported terrorism-response exercise in 2003 that involved more than 25 agencies at the national, state and local levels. "In these exercises involving first responders, legal issues always got pushed off the table," Donohue said. "I was struck by this. In an emergency, the law goes out the window. Then, when I got to law school, I saw the broader legal and constitutional context for this discussion."

With support from the directors at CISAC and Stanford Law School, and funding from donor Peter Bing and the Stanford Constitutional Law Center, Donohue brought the two groups together in a high-profile setting.

"This was Stanford in Washington," she said. "It was an opportunity for Stanford to be visible at the U.S. Senate with participation from leading people on these issues. There is no doubt we got an audience we wouldn't otherwise have attracted."

This article first appeared in Stanford Report, 4/16/2008.

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Arms races among invertebrates, intelligence gathering by the immune system and alarm calls by marmots are but a few of nature’s security strategies that have been tested and modified over billions of years. This provocative book applies lessons from nature to our own toughest security problems—from global terrorism to the rise of infectious disease to natural disasters. Written by a truly multidis­ciplinary group including paleobiologists, anthropologists, psychologists, ecologists, and national security experts, it considers how models and ideas from evolutionary biology can improve national security strategies ranging from risk assessment, security analysis, and public policy to long-term strategic goals.

Terence Taylor is the President and Director of the International Council for the Life Sciences and a former CISAC Science Fellow. He previously served with the United Nations as a Commissioner and Chief Inspector for Iraq on weapons of mass destruction and was a career officer in the British army. He also serves on the U.S. National Academy of Sciences Forum on Microbial Threats and is an adviser to the International Committee of the Red Cross. Mr. Taylor was also a member of the National Research Council Steering Committee on Genomic Databases for Bioterrorism Threat Agents and served as Chairman of the Permanent Monitoring Panel on Risk Analysis of the World Federation of Scientists.

Raphael Sagarin received his Ph.D. in marine ecology in 2001 from the University of California, Santa Barbara. Dr. Sagarin has served as a Geological Society of America congressional science advisor in the office of U.S. Representative Hilda L. Solis. Dr. Sagarin has used his insights as a biologist and policy advisor in his recent work on using biological insights to guide security planning and policy. Based on a short treatment of this topic in Foreign Policy, he organized a working group at the National Center for Ecological Analysis and Synthesis to explore a wide range of evolutionary insights into security analysis. Comprised of paleobiologists, psychologists, ecologists, anthropologists and security experts, the working group produced the forthcoming University of California Press volume: Natural Security: A Darwinian Approach to a Dangerous World, edited by Dr. Sagarin and Terence Taylor.

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Terence Taylor Director Speaker International Council for the Life Sciences
Raphael Sagarin Associate Director for Ocean and Coastal Policy, Nicholas Institute for Environmental Policy Solutions, Duke University Speaker
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