In a Queen's School of Business (QSB) article, David Chan, an assistant professor of Medicine and CHP/PCOR core faculty member, discusses his new study on the cost of variation in medical practices.  The article shows that large variation in medical testing caused by "weak best practices" leads to greater healthcare spending.  According to Chan, there is significant variation in general medicine practices but little variation in specialty areas, and he found that "worker characteristics and formally learned differences have little role in explaining practice variation, at least within organizations.”  Decreasing practice variation could decrease healthcare spending in the U.S. substantially.

A three-week seminar focused on digital health innovation and entrepreneurship in China came to a close last week, culminating in the final pitch presentations from four cross-cultural, entrepreneurial student teams. The winning team, LiveBright, presented a way to improve access to personal counseling in China using digital, peer-to-peer methods, with the mission of reducing stress among students and young professionals.

Sponsored by the Stanford Center at Peking University (SCPKU), the course was developed by Dr. Robert Chang, digital health inventor and Assistant Professor of Ophthalmology at Stanford University, and Ravi Pamnani, medical technology executive and alumnus of Stanford’s Biodesign Innovation Fellowship, a pioneering training program in biomedical innovation.

The hands-on course paired Stanford students with Peking University students in collaborative teams and immersed them in the Chinese healthcare system. Students shadowed physicians and interviewed patients to identify unmet needs and market opportunities. Students then brainstormed solutions and developed rapid prototypes to test their ideas and obtain user feedback. Next, they selected business models to ensure the sustainability of their solutions. Along the way, students got feedback from physicians, digital health entrepreneurs, and investors who evaluated their ideas in real-world contexts.

SCPKU seminar instructors, Dr. Robert Chang and Ravi Pamnani.

SCPKU seminar instructors, Dr. Robert Chang and Ravi Pamnani
Courtesy of Stanford University
 

Other teams focused on a telemedicine approach to physical therapy, a more convenient way to obtain eyeglasses prescriptions at home, and a novel subscription box service to promote women’s health education.

“We have been really impressed with the outside-the-box thinking that the students have employed to identify new opportunities,” said Dr. Chang. “China has seen tectonic changes in the mobile and consumer internet sectors. With this in mind and given the unique characteristics of the Chinese healthcare system, a digital health revolution is inevitable, and in many ways has already begun. The rest of the world can learn a lot by observing how digital technologies will transform healthcare here in China over the next five years.”

For more information about the seminar, visit http://www.dhealthchina.com/.

Demographic change is fast becoming one of the most globally significant trends of the 21st century. Declining fertility rates and rising life expectancy -- two of the patterns triggering demographic change -- will cause vast socioeconomic strains, especially in the Asia-Pacific region, which has some of the world's most populous countries. Stanford health researcher Karen Eggleston says comparison and cross-collaboration are needed to induce creative solutions.

In an interview with the Office of International Affairs, Eggleston discusses her research approaches and partnerships in the study of healthcare systems and health policy in the Asia-Pacific region. She leads a multiyear research initative that examines comparative policy responses to demographic change in East Asia. Eggleston says the goal is to help move global health policy to a place where everyone has an "equal opportunity for a healthier and longer life."

The Q&A may be viewed in full by clicking here.

Analyzing demographic change in China, Japan and South Korea is the focus of the book Aging Asia, an outcome of a conference between the Walter H. Shorenstein Asia-Pacific Research Center and the Stanford Center on Longevity.

Eggleston also coedited a special issue of the Journal of the Economics of Ageing with David Bloom, a professor at Harvard University, looking at a range of economic issues related to population change in China and India.

For Matthew Kohrman and his students, the war against tobacco needs a new communications strategy.

After all, he noted, three times as many cigarettes are currently manufactured and sold worldwide than were in the 1960s. And the global cigarette industry is the greatest cause of preventable death on the planet today.

That’s why the Stanford associate professor of anthropology decided to teach an introductory seminar this spring, Anthro 182N, titled Smoke and Mirrors in Global Health. Kohrman led his 10 students on a journey into the “strange optics” that the global tobacco industry uses – and what to do about them.

As noted in the syllabus, “entrenched challenges” to global health require society to develop “new methods” to communicate the real truth about tobacco.

Just what are those “new methods?” At the culmination of the class, the students presented some variations on that theme. Their end-of-the-quarter projects were web-based efforts profiling various features of global tobacco. They included exposés on how academicians in China assist the industry in that country, humorous parodies and critiques of Philip Morris, and flawed approaches to tobacco control in South Korea.

They tackled big-picture questions, Kohrman said. For example, they asked what exactly constitutes cigarette manufacturing and how new strategies could help slow the spread of tobacco-related diseases worldwide.

Kohrman, the director of Stanford’s Cigarette Citadels project, envisioned his class as a way for students to offer some thought-provoking and original ideas grounded in solid data. After viewing the student projects, he was astounded – and proud.

“My overall impression has been a feeling of awe,” he said. “Mostly freshmen and sophomores, the students who enrolled in this new course quickly synthesized complex intellectual concepts introduced early in the quarter, conceived their own innovative project ideas, collected relevant data, generously worked with each other, designed apt strategies for evocatively visualizing their messages, and chose and implemented strong interactive media tools – most of which were utterly new to me.”

One of those students was Minkee Sohn, a communication major, who created a video, “Fresh Recruits,” to highlight what he believes is the hypocrisy in the language of some cigarette manufacturers’ recruitment efforts.

“While cigarette manufacturers,” Sohn said, “often frame smoking as an act of free choice, that choice is just an illusion. Free choice is denied to people in all stages of cigarette manufacturing and consumption.”

For example, he explained that children in the African country of Malawi are coerced to work with their families in tobacco fields. “It’s deeply disturbing to hear companies associate freedom with high-paying jobs in cigarette manufacturing.”

For biology major Annabel Chen, the most important thing she learned was to analyze information skeptically. “Industries like big tobacco have influences in unexpected places, so you always need to do sleuthing to find out the truth,” she said.

She chose to examine the links between tobacco and academic research in China. “Seeing as China is the biggest tobacco market in the world, this was a problem we needed to address.”

Kohrman appreciates how students like Sohn and Chen were willing to try an experimental course, never taught before, and which for many was outside of their comfort zone. He said the course will be taught again in 2015-16.

“Looking back, it was the perfect-size group for all the work and one-on-one teaching we did,” he said.

The course was a classic collaboration, according to Kohrman, who also credits Claudia Engel, a lecturer in the Anthropology Department who helped with the technology and his own experiences mentoring undergraduate research, all of which proved instrumental to designing Smoke and Mirrors in Global Health.

“It was a great success today,” he said after seeing the student projects on the last day of class. Tom Glynn, a top adviser to the American Cancer Society, was on hand to see the presentations.

Kohrman added, “Students got tremendous feedback, and there was lots of enthusiasm about how this experimental course unfolded.”

Clifton Parker is a writer for the Stanford News Service.