Stanford University

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.

Research in Progress (RIP): "Can private insurers fail to cream-skim the public option? Evidence from the individual mandate in Germany."

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Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

Conventional wisdom suggests that if private health insurance plans compete alongside a public option, they may endanger the latter's financial stability by cream-skimming good risks. Documenting cream-skimming in dual insurance systems is challenging because of the co-existence of selection and moral hazard. I use a fuzzy regression discontinuity design based on exogenous variation in the propensity of choosing private health insurance to address this challenge. The empirical setting is Germany, where there exists an unsubsidized non-group for-profit private health insurance market in parallel to a statutory alternative. Federal regulation mandates individuals with income below an annually set threshold to enroll into the statutory system. I do not find compelling support for concerns of cream-skimming by private insurers. Using a discrete choice model of demand for private insurance, I explore heterogeneous preferences and long-term contract design of private insurers as potential explanations for this optimistic result about insurance design.

Maria Polyakova Assistant Professor Health Research and Policy
Seminars

Research in Progress (RIP): "Trends and Effects of the Use of Biologic Therapy for the Treatment of Ulcerative Colitis"

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Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

Ulcerative colitis is typically treated with medications including steroids and immunomodulators; patients refractory to medications undergo curative surgical resection of the colon and rectum. In 2005, biologic therapy was approved for ulcerative colitis as it improves short-term remission rates, but the long-term clinical benefit is unknown. The aims of the study are to assess the effect of biologics on the need for surgery in ulcerative colitis, describe treatment patterns for ulcerative colitis, and measure the economic impact of biologic therapy in the management of the disease.  Results demonstrate an increase in the use of biologics for ulcerative colitis, no change in rates of surgery for ulcerative colitis after approval of biologics, and dramatically increased overall costs.

Cindy Kin
Seminars

REAP and OneSight: Vision Care for 7,000 Kids in 8 Days

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by Hannah Myers
 
As the bus lurches up the pot-holed dirt road into the village, a storm of seventh- and eight-graders comes rushing out to meet it.  This bus isn't taking them to class, but to a clinic that will revolutionize their school careers.  They are travelling to a OneSight Vision Clinic.  By the end of the day, they will have had their eyes examined, lenses edged, and frames selected for a brand new pair of eyeglasses.  For these children, such a simple intervention can have a huge impact on their education and future.
 
Three years ago, REAP researchers noticed something surprising: in rural China, almost no children wear glasses.  In response, REAP launched the Seeing is Learning program, and have screened over 30,000 children in a series of randomized controlled trials. REAP found that in a nine-month period, nearsighted students who were given glasses learned almost twice as much as those without them--putting them essentially a full grade-level ahead.
 
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Next, REAP and regional governments in China designed a scaleable sustainable vision care centers based in county hospitals. The vision centers target rural primary school students, and to date have provided new glasses to virtually all 3rd through 6th grade students who need them in two pilot counties.
 
But what about older rural students who need glasses, and whose schoolwork is suffering as a result?  The REAP-supported vision care centers are already operating at capacity to meet the needs of primary school students.  Therefore, from March 15th to 27th, OneSight—with support from REAP—operated a charitable clinic to provide vision care to all middle-school students in Yongshou county Shaanxi Province.  The REAP team trained Yongshou's middle-school teachers to screen their students, then organized buses to transport students who failed the vision tests to the Onesight clinic in the county seat.  OneSight's 65 volunteer optometrists and eye care specialists efficiently diagnosed each student, custom-ground lenses, and delivered a new pair of glasses.  In total, approximately 7,000 students were screened and almost 3,500 received new glasses in the 12-day clinic.
 
In this remote corner of rural China, the group of foreigner eye doctors pulling up in a massive OneSight truck stocked with autorefractors, eye-dilating medicines, and enormous lens-grinding machines was certainly a sight to see.  Local media captured much of the clinic, broadcasting it throughout Yongshou and surrounding areas.  Moving forward, REAP plans to use this momentum to expand its sustainable vision care model into more counties across rural China.

 

Contacts

Matthew Boswell: Project Manager, Seeing is Learning (boswell@stanford.edu)

Scott Rozelle: REAP Co-Director (rozelle@stanford.edu)

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Health Policy Forum: The Problem of Prescription Opioids

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Prescription opioids provide much needed relief to people in acute pain, but are also widely misused, leading to addiction and over one thousand overdose deaths per month. As the annual number of prescriptions has soared to over 200 million, policymakers have been struggling with how to limit the risks of these medications while at the same time keeping them available for people in pain. In this Stanford Health Policy Forum, addiction medicine expert Anna Lembke, M.D. and pain medicine expert Sean Mackey, M.D., Ph.D., will debate and discuss how to balance the benefits and costs of prescription opioids.

Guest Speakers:

Dr. Anna Lembke received her undergraduate degree in Humanities from Yale University and her medical degree from Stanford University. She is on the faculty of the Stanford University School of Medicine, a diplomate of the American Board of Psychiatry and Neurology, and a diplomate of the American Board of Addiction Medicine. She is the Program Director for the Stanford Addiction Medicine Program and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic.

Under Dr. Sean Mackey’s leadership, researchers at the Stanford Pain Management Center and the Stanford Systems Neuroscience and Pain Laboratory (SNAPL) have made major advances in the understanding of chronic pain as a disease in its own right, one that fundamentally alters the nervous system. Dr. Mackey has overseen efforts to map the specific brain and spinal cord regions that perceive and process pain, which has lead to the development of a multidisciplinary treatment model that translates basic science research into innovative therapies to provide more effective, personalized treatments for patients with chronic pain.

Moderator:

Paul Costello is Chief Communications Officer at the Stanford School of Medicine.

For event details, visit http://med.stanford.edu/healthpolicyforum/event-calendar.html.

Berg Hall
291 Campus Dr.
Stanford, CA 94305

Panel Discussions

Current Status of the Health System in Mongolia

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The Asian Liver Center and the Asia Health Policy Program joint event.

Current Status of the Health System in Mongolia
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Asian Liver Center

780 Welch Road, CJ 130

Palo Alto, CA

Enkhbold Sereenen Deputy Director, National Center for Communicable Disease, Ministry of Health, Mongolia
Seminars

Primary Healthcare and the Private Sector in Low- and Middle-Income Countries: Asia in Comparative Perspective

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Anne Mills will speak about primary healthcare and the private sector in low- and middle-income Countries, drawing from her wide-ranging expertise and careful empirical evaluation of health policies in a range of countries in Asia, Africa, and other parts of the developing world. Linking themes of good health at low cost and equitable paths toward universal coverage, Professor Mills will argue how policymakers might best strengthen healthcare systems in the Asia-Pacific region, including the opportunities for health and efficiency improvements and the opportunity costs of continuing hospital-centric delivery systems. Professor Mill embodies a distinctive ability to combine broad thinking on the role of primary care with specific examples of how to harness the private sector toward public health objectives, an inter-linked theme the Asia Health Policy Program’s colloquium series and policy research. 

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Dame Anne Mills DCMG, CBE, FRS  Vice Director and Professor of Health Economics and Policy at the London School of Hygiene and Tropical Medicine. In 2014 she became a Fellow of the Royal Society and was made a Dame in the 2015 New Year's Honors. Her main research interests are: (1) issues concerned with the financing and organization of health care in low and middle income countries, including the impact on demand, utilization, equity and efficiency, and the private health sector; (2) the economics of tropical disease control; and (3) how to encourage the use of economic thinking and analysis in decision making. Professor Mills has been active in making economic evaluation techniques accessible to a non-specialist audience, as well as initiatives to build capacity in health economics. She chaired the Board of the Alliance for Health Policy and Systems Research, based in WHO; was a member of the Commission on Macroeconomics and Health; and co-chaired Working Group 1 of the High Level Taskforce on Innovative International Financing for Health Systems.  Dr. Mills was President of the International Health Economics Association for 2012-13, and is currently a Board member of Health Systems Global.

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Philippines Conference Room

Encina Hall, 3rd Floor Central

616 Serra Street,

Stanford, CA 94305

Anne Mills Vice Director and Professor of Health Economics and Policy London School of Hygiene and Tropical Medicine
Seminars
Innovations in Primary Care

Announcing three postdoctoral fellows for 2015-16

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Each year the Walter H. Shorenstein Asia-Pacific Research Center offers fellowship opportunities to recent graduates to further their research and engage with scholars at Stanford. Postdoctoral fellows have the opportunity to develop their dissertations for publication, present their research to the Stanford community, and participate in Center activities.

Fellows often go on to pursue teaching positions and advisory roles at top universities and research organizations around the world. Into the future, they remain engaged with the Center and continue to contribute to Shorenstein APARC publications, conferences and related activities.

Shorenstein APARC is pleased to welcome three postdoctoral fellows for the 2015-16 academic year:

Asia Health Policy Fellow

darika profile
Darika Saingam

Saingam’s research interests are public health, substance abuse, drug policy and Southeast Asia. While at Shorenstein APARC, she will research the evolution of substance-abuse control measures and related policy in Thailand.

Saingam seeks to identify potentially effective policy directions suitable for Thailand, and other developing countries in Southeast and East Asia.

“There are a lot of lessons to be learned from substance abuse policy implementations in other countries…coping and dealing with substance abuse is a complex story and cannot respond successfully with only one strategy.”

Saingam completed her doctorate in epidemiology at the Prince of Songkla University in 2012, and has served as a researcher at the University’s epidemiology unit since, as well as a researcher at the Thailand Substance Abuse Academic Network since 2014.

Shorenstein APARC Postdoctoral Fellows

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Booseung Chang

Chang’s research interests are comparative policy analysis and political institutions in East Asia, mainly South Korea and Japan. While at Shorenstein APARC, Chang will conduct research on how countries respond differently to the same external challenges, and how institutions are interpreted and applied in different ways.

His dissertation, which he seeks to build upon, is titled “The Sources of Japanese Conduct: Asymmetric Security Dependence, Role Conceptions, and the Reactive Behavior in response to U.S. Demands.” It is a qualitative comparative case study of how key U.S. allies in Asia – namely Japan and South Korea – and major powers in Europe - the United Kingdom and France responded to the U.S.-led Persian Gulf War and the Iraq War.

“East Asia is a treasure island of new theory building because some of the big challenges facing East Asia – finding a new role for Japan, denuclearization of North Korea, unification of the Korean peninsula, democratization of China and reconfiguration of its relations with the world, and development and integration of Southeast Asian countries – are truly new ones…”

Chang completed his doctorate in political science from the Paul H. Nitze School of Advanced International Studies at Johns Hopkins University in 2014.

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Nico Ravanilla

Ravanilla’s research interests are political economy and governance, comparative politics and Southeast Asia. While at Shorenstein APARC, Ravanilla will research how political selection impacts governance, and evaluate possible routes for incentivizing capable and virtuous citizens to run for public office.

His project titled “Nudging Good Politicians” looks at the case of the Sangguniang Kabataan, a governing body in the Philippines comprised of elected youth leaders. Ravanilla aims to apply his research to develop and scale up programs for politicians, especially those at the onset of their careers, which would include specialized leadership training and merit-based endorsement.

“If we could design a policy that screens-in and incentivizes competent and honest citizens to run for office, would it play a catalytic role in improving the quality of the political class, and ultimately, the quality of government?”

Ravanilla is also a Southeast Asia Research Group (SEAREG) Young Southeast Asia Fellow for 2015-16. He will complete his doctorate in political science and public policy from the University of Michigan in summer 2015.

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New bio-based supply chains for drugs

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Abstract: Recent advances in synthetic biology are transforming our capacities to make things with biology. This bio-based manufacturing technology has the potential to be most disruptive around products for which existing material supply chains result in limited access. For example, broad access to medicines and the development of new medicines has been difficult to achieve, largely due to the coupling between material supply chains and these therapeutic compounds. We are developing a biotechnology platform that will allow us to replace current supply chains for already approved medicines with stable, secure, scalable, distributed, and economical microbial fermentation. Our initial target is the opioids, an essential class of medicines for pain management and palliative care, which are currently sourced through opium poppy cultivation. In addition, we will leverage this technology to access novel compound structural space that will open up tremendous opportunity for transforming the discovery and development of new drugs over a longer-time frame.

About the Speaker: Christina D. Smolke is an Associate Professor, Associate Chair of Education, and W.M. Keck Foundation Faculty Scholar in the Department of Bioengineering and, by courtesy, Chemical Engineering at Stanford University. Christina’s research program develops foundational tools that drive transformative advances in our ability to engineering biology. For example, her group has led the development of a novel class of biological I/O devices, fundamentally changing how we interact with and program biology. Her group uses these tools to drive transformative advances in diverse areas such as cellular therapies and natural product biosynthesis and drug discovery. Christina is an inventor on over 15 patents and her research program has been honored with numerous awards, including the NIH Director’s Pioneer Award, WTN Award in Biotechnology, and TR35 Award.

Encina Hall (2nd floor)

Christina Smolke Associate Chair for Education, Associate Professor, Bioengineering Speaker Stanford University
Seminars

New Tools for Genome Editing and the Future of the Earth

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Abstract: CRISPR-Cas9 and other new tools are making genome editing faster, cheaper, and more accurate. When coupled with cheaper sequencing and our more slowly increasing understanding of the effects of DNA sequencing, this breakthrough technology may bring within our reach the power to transform, fundamentally, all of life.  Most of the attention so far has focused on human germ line genome editing, but the implications stretch much farther. This talk will explore some of the issues for the use of this technology, in humans (germ line or somatic cell) and in other life-forms. It will also note the limits of our current understanding and regulatory framework.

About the Speaker: Hank Greely is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University.  He specializes in ethical, legal, and social issues arising from advances in the biosciences, particularly from genetics, neuroscience, and human stem cell research.  He directs the Stanford Center for Law and the Biosciences and the Stanford Program in Neuroscience and Society; chairs the California Advisory Committee on Human Stem Cell Research; and serves on the Neuroscience Forum of the Institute of Medicine, the Advisory Council for the National Institute for General Medical Sciences of NIH, the Committee on Science, Technology, and Law of the National Academy of Sciences, and the NIH Multi-Council Working Group on the BRAIN Initiative. He was elected a fellow of the American Association for the Advancement of Science in 2007.

Professor Greely graduated from Stanford in 1974 and from Yale Law School in 1977.  He served as a law clerk for Judge John Minor Wisdom on the United States Court of Appeals and for Justice Potter Stewart of the United States Supreme Court.  After working during the Carter Administration in the Departments of Defense and Energy, he entered private practice in Los Angeles in 1981 as a litigator with the law firm of Tuttle & Taylor, Inc.  He began teaching at Stanford in 1985.  

Encina Hall (2nd floor)

Hank Greely Deane F. and Kate Edelman Johnson Professor of Law Speaker Stanford Law School
Seminars
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