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.

For inmates, pricey hepatitis C drug could make financial sense

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Despite its $7,000-per-week cost, sofosbuvir provides better value than other current treatments for prisoners with hepatitis C, according to Stanford researchers.

New, significantly improved hepatitis C drugs have revolutionized how the disease is treated, but they are also expensive. One such drug, sofosbuvir, costs more than $7,000 a week for 12 weeks of treatment.

That could amount to a hefty price tag for American prison systems, which house more than 500,000 people infected with hepatitis C, a chronic viral infection that causes liver damage and is spread via contact with infected blood. Government officials in some states have expressed concerns about the cost and are working to limit its use.

Nonetheless, a team of Stanford University researchers has found that treating inmates with sofosbuvir is cost-effective compared with other treatments approved by the U.S. Food and Drug Administration.

“It looks like the additional benefits of sofosbuvir are sufficiently large even in this high-risk population to justify its increased cost,” said Jeremy Goldhaber-Fiebert, PhD, an assistant professor of medicine at the Stanford School of Medicine and senior author of the study. Inmates who use drugs or get unclean tattoos are at higher risk of reinfection. Goldhaber-Fiebert noted, however, that there are still concerns about affordability given the high drug price.

The study was published Oct. 21 in the Annals of Internal Medicine. The lead author is Shan Liu, PhD, a former graduate student in management science and engineering at Stanford’s School of Engineering.

The search for better treatments

Until a few years ago, hepatitis C patients depended on a 48-week, two-drug treatment — pegylated interferon and ribavirin — that caused a host of side effects, including fatigue, nausea and headache. The drugs knocked out the virus in less than 50 percent of recipients.

Then, in 2011, the FDA approved boceprevir, brand name Victrelis, that — when used with the two traditional drugs — was more effective, but also more expensive. Now, if available, patients receive a significantly more effective and even more costly drug like sofosbuvir in combination with the interferon and ribavirin. (Sofosbuvir, brand name Solvaldi, was approved for chronic hepatitis C treatment in December 2013.) Goldhaber-Fiebert and his team created a computer model to compare the performance and cost of these two treatment options within a hypothetical prison population.

In one scenario, infected inmates received 12 weeks of sofosbuvir plus interferon and ribavirin; in the other, they received 28 weeks of boceprivir plus interferon and ribavirin. The researchers also compared the therapies to no treatment at all. The model accounted for the variations in inmates’ sentence length and liver condition, as well as increased rates of reinfection in the inmate population.

They measured outcomes in quality-adjusted life years, or QALYs, which are used to gauge the effectiveness of a health intervention. For example, an intervention that adds an additional year of optimal health to a patient’s life equals one QALY. An intervention that yields half that quality of health for an additional two years also would be counted as one QALY (each year equals 0.5 QALYs).  

They found that the sofosbuvir treatment yielded an additional 2.1 QALYs at an additional cost of $54,000 when compared with no treatment. The boceprivir treatment added only 1.3 additional QALYs.

Upfront versus long-term costs

In accordance with standard practices for cost-effectiveness studies, this study examined the overall societal cost without accounting for where the money came from. In reality, a prison system that offers sofosbuvir will pay a high upfront cost. But the investment could save its health-care program and other taxpayer-supported health programs, such as Medicaid, from paying out even more in the future to treat the complications of long-term hepatitis C, such as liver failure.

“Overall, sofosbuvir is cost-effective in this population, though its budgetary impact and affordability present appreciable challenges,” said Goldhaber-Fiebert,who is also a faculty member at Stanford’s Center for Health Policy/Center for Primary Care and Outcomes Research, which is part of the university’s Freeman Spogli Institute for International Studies.

Goldhaber-Fiebert called hepatitis C a “public health opportunity.”

“Though often not the focus of health-policy research, HCV-infected inmates are a population that may benefit particularly from a highly effective, short-duration treatment,” he said.

Mark Holodniy, MD, professor of infectious diseases and geographic medicine and director of the AIDS Research Center at the Veterans Affairs Palo Alto Health Care System, is another Stanford co-author.

A researcher at UC-San Francisco also contributed to the research.

The study was funded by a National Institute on Aging Career Development Award (K01AG037593-01A1).

Information about Stanford’s Department of Medicine, which also supported the work, is available at http://medicine.stanford.edu.

 

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Can we feed the world in the 21st century?

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In a recent speech, Stanford professor Rosamond Naylor examined the wide range of challenges contributing to global food insecurity, which Naylor defined as a lack of plentiful, nutritious and affordable food. Naylor's lecture, titled "Feeding the World in the 21st Century," was part of the quarterly Earth Matters series sponsored by Stanford Continuing Studies and the Stanford School of Earth Sciences. Naylor, a professor of Environmental Earth System Science and director of the Center on Food Security and the Environment at Stanford, is also a professor (by courtesy) of Economics, and the William Wrigley Senior Fellow at the Freeman Spogli Institute for International Studies and the Stanford Woods Institute for the Environment.

"One billion people go to bed day in and day out with chronic hunger," said Naylor. The problem of food insecurity, she explained, goes far beyond food supply. "We produce enough calories, just with cereal crops alone, to feed everyone on the planet," she said. Rather, food insecurity arises from a complex and interactive set of factors including poverty, malnutrition, disease, conflict, poor governance and volatile prices. Food supply depends on limited natural resources including water and energy, and food accessibility depends on government policies about land rights, biofuels, and food subsidies. Often, said Naylor, food policies in one country can impact food security in other parts of the world. Solutions to global hunger must account for this complexity, and for the "evolving" nature of food security.

As an example of this evolution, Naylor pointed to the success of China and India in reducing hunger rates from 70 percent to 15 percent within a single generation. Economic growth was key, as was the "Green Revolution," a series of advances in plant breeding, irrigation and agricultural technology that led to a doubling of global cereal crop production between 1970 and 2010. But Naylor warned that the success of the Green Revolution can lead to complacency about present-day food security challenges. China, for example, sharply reduced hunger as it underwent rapid economic growth, but now faces what Naylor described as a "second food security challenge" of micronutrient deficiency. Anemia, which is caused by a lack of dietary iron and which Naylor said is common in many rural areas of China, can permanently damage children's cognitive development and school performance, and eventually impede a country’s economic growth.

Hunger knows no boundaries

Although hunger is more prevalent in the developing world, food insecurity knows no geographic boundaries, said Naylor. Every country, including wealthy economies like the United States, struggles with problems of food availability, access, and nutrition. "Rather than think of this as 'their problem' that we don't need to deal with, really it's our problem too," Naylor said.

She pointed out that one in five children in the United States is chronically hungry, and 50 million Americans receive government food assistance. Many more millions go to soup kitchens every night, she added. "We are in a precarious position with our own food security, with big implications for public health and educational attainment," Naylor said. A major paradox of the United States' food security challenge is that hunger increasingly coexists with obesity. For the poorest Americans, cheap food offers abundant calories but low nutritional value. To improve the health and food security of millions of Americans, "linking policy in a way that can enhance the incomes of the poorest is really important, and it's the hard part,” she said.” It's not easy to fix the inequality issue."

Success stories

When asked whether there were any "easy" decisions that the global community can agree to, Naylor responded, "What we need to do for a lot of these issues is pretty clear, but how we get after it is not always agreed upon." She added, "But I think we've seen quite a few success stories," including the growing research on climate resilient crops, new scientific tools such as plant genetics, improved modeling techniques for water and irrigation systems, and better knowledge about how to use fertilizer more efficiently. She also said that the growing body of agriculture-focused climate research was encouraging, and that Stanford is a leader on this front.

Naylor is the editor and co-author of The Evolving Sphere of Food Security, a new book from Oxford University Press. The book features a team of 19 faculty authors from 5 Stanford schools including Earth science, economics, law, engineering, medicine, political science, international relations, and biology. The all-Stanford lineup was intentional, Naylor said, because the university is committed to interdisciplinary research that addresses complex global issues like food security, and because "agriculture is incredibly dominated by policy, and Stanford has a long history of dealing with some of these policy elements. This is the glue that enables us to answer really challenging questions." 

 

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Research in Progress: "Evidence of Strategic Behavior in Medicare Claims Reporting"

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

 

Abstract:

Recent Medicare legislation has been directed at improving patient care quality and cutting costs by stopping reimbursement of healthcare-associated conditions (HACs). However, recent evidence suggests that the policy has not been effective in reducing HACs. We study national trends of two particular HACs, central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). We find sharp differences in HAC reporting rates for hospitals in states that had strong regulations on adverse event reporting prior to the Medicare legislation. In particular, our results suggest that hospitals in states without prior regulations may be engaging in "upcoding", a practice where hospitals report HACs as being present-on-admission, resulting in greater reimbursement. Our findings have important implications for future legislation: we hypothesize that the upcoming HAC Reduction Program starting in 2015 may also not be effective at reducing HACs, and may unfairly punish more truthful hospitals if proper incentives for discouraging upcoding are not implemented.

Based on joint work with Hamsa Bastani, Joel Goh, and Stefanos Zenios

 

CHP/PCOR Conference Room
117 Encina Commons, Room 119
Stanford, CA 94305

Mohsen Bayati Assistant Professor of Operations, Information and Technology in the Graduate School of Business and, by courtesy, of Electrical Engineering Speaker
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Research in Progress: "Whose QALYs Count in Cost-Effectiveness Analyses? How Interventions That Affect Fertility and Childbearing are Evaluated"

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

Abstract:

Current guidelines for economic evaluations of health interventions (cost-effectiveness or cost-benefit analyses) define relevant outcomes as those accruing to individuals receiving interventions. Little consensus exists on how to count health impacts of interventions that affect current and future fertility and childbearing. We sought to characterize current practices for counting such health outcomes. To do so, we developed a framework characterizing health interventions with direct and/or indirect effects on fertility and childbearing. We identified interventions that span the framework and performed a targeted literature review for economic evaluations of these interventions. For each article, we characterized how the potential health outcomes from each intervention were considered, focusing on QALYs associated with fertility and childbearing. This review of 108 economic evaluations led to striking insights about choices analysts make in the absence of clear guidance about how to include such QALYs. We will discuss these insights and their implications as well as the rationales on which they are based. In brief, economic evaluations inconsistently consider QALYs from current pregnancies and future fertility in ways that frequently appear biased. Given this, we believe that further guidance should be given by bodies like the Panel on Cost-Effectiveness in Health and Medicine to help to standardize practice and reporting in this important area.

CHP/PCOR Conference Room
117 Encina Commons, Room 119
Stanford, CA 94305

Jeremy Goldhaber-Fiebert

Encina Commons, Room 220
615 Crothers Way
Stanford, CA 94305-6006

(650) 721-2486 (650) 723-1919
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Professor, Health Policy
jeremy-fisch_profile_compressed.jpg PhD

Jeremy Goldhaber-Fiebert, PhD, is a Professor of Health Policy, a Core Faculty Member at the Center for Health Policy and the Department of Health Policy, and a Faculty Affiliate of the Stanford Center on Longevity and Stanford Center for International Development. His research focuses on complex policy decisions surrounding the prevention and management of increasingly common, chronic diseases and the life course impact of exposure to their risk factors. In the context of both developing and developed countries including the US, India, China, and South Africa, he has examined chronic conditions including type 2 diabetes and cardiovascular diseases, human papillomavirus and cervical cancer, tuberculosis, and hepatitis C and on risk factors including smoking, physical activity, obesity, malnutrition, and other diseases themselves. He combines simulation modeling methods and cost-effectiveness analyses with econometric approaches and behavioral economic studies to address these issues. Dr. Goldhaber-Fiebert graduated magna cum laude from Harvard College in 1997, with an A.B. in the History and Literature of America. After working as a software engineer and consultant, he conducted a year-long public health research program in Costa Rica with his wife in 2001. Winner of the Lee B. Lusted Prize for Outstanding Student Research from the Society for Medical Decision Making in 2006 and in 2008, he completed his PhD in Health Policy concentrating in Decision Science at Harvard University in 2008. He was elected as a Trustee of the Society for Medical Decision Making in 2011.

Past and current research topics:

  1. Type 2 diabetes and cardiovascular risk factors: Randomized and observational studies in Costa Rica examining the impact of community-based lifestyle interventions and the relationship of gender, risk factors, and care utilization.
  2. Cervical cancer: Model-based cost-effectiveness analyses and costing methods studies that examine policy issues relating to cervical cancer screening and human papillomavirus vaccination in countries including the United States, Brazil, India, Kenya, Peru, South Africa, Tanzania, and Thailand.
  3. Measles, haemophilus influenzae type b, and other childhood infectious diseases: Longitudinal regression analyses of country-level data from middle and upper income countries that examine the link between vaccination, sustained reductions in mortality, and evidence of herd immunity.
  4. Patient adherence: Studies in both developing and developed countries of the costs and effectiveness of measures to increase successful adherence. Adherence to cervical cancer screening as well as to disease management programs targeting depression and obesity is examined from both a decision-analytic and a behavioral economics perspective.
  5. Simulation modeling methods: Research examining model calibration and validation, the appropriate representation of uncertainty in projected outcomes, the use of models to examine plausible counterfactuals at the biological and epidemiological level, and the reflection of population and spatial heterogeneity.
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Research in Progress: "Trials of Clinical Reminders Using the Electronic Medical Record"

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

Abstract:

One of the important benefits of an electronic medical record is the potential to provide targeted decision support and reminders for care. In addition to improving care these reminders serve a secondary purpose of documenting care that is now required for public reporting or pay for performance programs. Thus, there is pressure to add an ever increasing number of reminders with unclear consequences. I will review past studies using computerised reminders and present several randomized trials conducted or planned at the Palo Alto VA and Stanford hospitals. The goals of these reminders include increasing life-prolonging heart failure medications and device use, reducing inappropriate cardiac imaging, and rapid treatment for sepsis. Clinical reminders can be considered quality improvement and I will discuss the potential for conducting methodologically rigorous randomized reminder trials that are not "research".

CHP/PCOR Conference Room
117 Encina Commons, Room 119
Stanford, CA 94305

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Research in Progress: "Who Enrolls in Medicare Advantage? Evidence from the Health and Retirement Study"

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

"Who Enrolls in Medicare Advantage? Evidence from the Health and Retirement Study"

CHP/PCOR Conference Room
117 Encina Commons, Room 119
Stanford, CA 94305

Kate Bundorf Speaker
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Can We Put a Price on Good Health? Controlling the Cost of Healthcare

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The United States healthcare system is a three trillion dollar enterprise, the largest in the developed world. Spending more than two to three times more money on healthcare, than the second leading country. When you consider that we are only the fifteenth healthiest country, it begs the question, are we getting our money's worth? This forum features two renowned experts who will discuss the causes and potential solutions to the extraordinary cost of American healthcare. Physician, journalist and Stanford alum Elisabeth Rosenthal has drawn national attention to the rising costs of U.S. health care through her widely-praised “Paying Till It Hurts” series in The New York Times. She will be joined by Professor Doug Owens, the Director of Stanford’s Center for Health Policy and an expert in health care cost-effectiveness research.

The Stanford Health Policy Forum is free and open to the public. For more information visit: http://healthpolicyforum.stanford.edu/.

Clark Center Auditorium 

Stanford, CA

Elisabeth Rosenthal Speaker

Douglas K. Owens

Encina Commons, Room 201 
615 Crothers Way Stanford, CA 94305-6006 

Executive Assistant: Soomin Li, soominli@stanford.edu
Phone: (650) 725-9911

(650) 723-0933 (650) 723-1919
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Henry J. Kaiser, Jr. Professor
Professor, Health Policy
Senior Fellow, Freeman Spogli Institute for International Studies
Professor, Management Science & Engineering (by courtesy)
doug-headshot_tight.jpeg MD, MS

Douglas K. Owens is the Henry J. Kaiser, Jr. Professor, Chair of the Department of Health Policy in the Stanford University School of Medicine and Director of the Center for Health Policy (CHP) in the Freeman Spogli Institute for International Studies (FSI). He is a general internist, a Professor of Management Science and Engineering (by courtesy), at Stanford University; and a Senior Fellow at the Freeman Spogli Institute for International Studies.

Owens' research includes the application of decision theory to clinical and health policy problems; clinical decision making; methods for developing clinical guidelines; decision support; comparative effectiveness; modeling substance use and infectious diseases; cardiovascular disease; patient-centered decision making; assessing the value of health care services, including cost-effectiveness analysis; quality of care; and evidence synthesis.

Owens chaired the Clinical Guidelines Committee of the American College of Physicians for four years. The guideline committee develops clinical guidelines that are used widely and are published regularly in the Annals of Internal Medicine. He was a member and then Vice-Chair and Chair of the U.S. Preventive Services Task Force, which develops national guidelines on preventive care, including guidelines for screening for breast, colorectal, prostate, and lung cancer. He has helped lead the development of more than 50 national guidelines on treatment and prevention. He also was a member of the Second Panel on Cost Effectiveness in Health and Medicine, which developed guidelines for the conduct of cost-effectiveness analyses.

Owens also directed the Stanford-UCSF Evidence-based Practice Center. He co-directs the Stanford Health Services Research Program, and previously directed the VA Physician Fellowship in Health Services Research, and the VA Postdoctoral Informatics Fellowship Program.

Owens received a BS and an MS from Stanford University, and an MD from the University of California-San Francisco. He completed a residency in internal medicine at the University of Pennsylvania and a fellowship in health research and policy at Stanford. Owens is a past-President of the Society for Medical Decision Making. He received the VA Undersecretary’s Award for Outstanding Achievement in Health Services Research, and the Eisenberg Award for Leadership in Medical Decision Making from the Society for Medical Decision Making. Owens also received a MERIT award from the National Institutes on Drug Abuse to study HIV, HCV, and the opioid epidemic. He was elected to the American Society for Clinical Investigation (ASCI) and the Association of American Physicians (AAP.)

Chair, Department of Health Policy, School of Medicine
Director, Center for Health Policy, Freeman Spogli Institute for International Studies
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Informing Health Care System Innovation at Both Ends of Life: Improving Care in Pediatrics and Geriatrics

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

CHP/PCOR Conference Room

Lee M. Sanders

Encina Commons Room 210,
615 Crothers Way,
Stanford, CA 94305-6006

(650) 723-1919
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Professor, Pediatrics
Professor, Health Policy
Professor, Epidemiology & Population Health (by courtesy)
sanders_photo_20153.jpg MD, MPH

Dr. Lee Sanders is a general pediatrician and Professor of Pediatrics at the Stanford University School of Medicine, where he is Chief of the Division of General Pediatrics. He holds a joint appointment in the Center for Health Policy in the Freeman Spogli Institute for International Studies, where he is a co-director of the Center for Policy, Outcomes and Prevention (CPOP).

An author of numerous peer-reviewed articles addressing child health disparities, Dr. Sanders is a nationally recognized scholar in the fields of health literacy and child chronic-illness care.  Dr. Sanders was named a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar for his leadership on the role of maternal health literacy and English-language proficiency in addressing child health disparities.  Aiming to make the US health system more navigable for the one in 4 families with limited health literacy, he has served as an advisor to the Institute of Medicine, the Centers for Disease Control and Prevention, the Food and Drug Administration, the American Academy of Pediatrics, the Academic Pediatric Association, and the American Cancer Society.  Dr. Sanders leads a multi-disciplinary CPOP research team that provides analytic guidance to national and state policies affecting children with complex chronic illness – with a focus on the special health-system requirements that arise from the unique epidemiology, care-use patterns, and health-care costs for this population.  He leads another CPOP/PCOR-based research team that applies family-centered approaches to new technologies that aim to improve care coordination for children with medical complexity.    Dr. Sanders is also principal investigator on two NIH-funded studies that address health literacy in the pediatric context: one aims to assess the efficacy of a low-literacy, early-childhood intervention designed to prevent early childhood obesity; the other aims to provide the FDA with guidance on improved labeling of pediatric liquid medication.  Research settings for this work include state and regional health departments, primary-care and subspecialty-care clinics, community-health centers, WIC offices, federally subsidized child-care centers, and family advocacy centers.

Dr. Sanders received a BA in History and Science from Harvard University, an MD from Stanford University, and a MPH from the University of California, Berkeley.  Between 2006 and 2011, Dr. Sanders served as Medical Director of Children’s Medical Services South Florida, a Florida state agency that coordinates care for more than 10,000 low-income children with special health care needs.  He was also Medical Director for Reach Out and Read Florida, a pediatric-clinic-based program that provides books and early-literacy promotion to more than 200,000 underserved children.  At the University of Miami, Dr. Sanders directed the Jay Weiss Center for Social Medicine and Health Equity, which fosters a scholarly community committed to addressing global health inequities through community-based participatory research.  At Stanford University, Dr. Sanders served as co-medical director of the Family Advocacy Program, which provides free legal assistance to help address social determinants of child health.

Fluent in Spanish, Dr. Sanders is co-director of the Complex Primary Care Clinic at Stanford Children’s Health, which provides multi-disciplinary team care for children with complex chronic conditions.  Dr. Sanders is also the father of two daughters, aged 11 and 14 years, who make sure he practices talking less and listening more.

Co-Director, Center for Policy, Outcomes & Prevention (CPOP)
Chief, Division of General Pediatrics, School of Medicine
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Mary K. Goldstein

VA Palo Alto Health Care System Medical Service (111) 3801 Miranda Avenue Palo Alto, CA 94304;

Encina Commons, 615 Crothers Way Room 210, Stanford, CA 94305-6006

(650) 493-5000,,1,,1,62105
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Professor, Health Policy
Professor, Medicine (by courtesy)
mary_goldstein_profile.jpg MD, MS

 

Mary K. Goldstein is a Professor of Health Policy and a core faculty member at the Department of Health Policy and the Center for Health Policy, and the Director of the Geriatrics Research Education and Clinical Center (GRECC) at the VA Palo Alto Health Care System. She directs the Primary Care Policy and Practice Advancement program at PCOR, the Stanford/VA Palo Alto Geriatric Medicine Fellowship Program, and the Special Fellowship Program in Advanced Geriatrics at VA Palo Alto. She also serves as associate director for the Physician Post-Residency Fellowship Program in Health Services Research and Development, and for the Postdoctoral Fellowship in Medical Informatics, both at VA Palo Alto Health Care System.

Goldstein studies innovative methods of implementing evidence-based clinical practice guidelines for quality improvement. She leads the ATHENA Decision Support System project that has developed and implemented an automated clinical decision support system for primary care clinicians, using hypertension as a model, and now extended into several other clinical domains.  Goldstein's research also explores older adults' health preferences (health utility) for application to cost-effectiveness analysis.

Goldstein is a fellow of the American Geriatrics Society, and an emerita of the Society's board of directors. Goldstein has received a number of honors and awards including an Advanced Career Development award from the Department of Veterans Affairs Health Services Research and Development (HSR&D) program.  She received a BA in philosophy and an MD, both from Columbia University, and completed her residency in family medicine at Duke University Medical Center. At the Stanford School of Medicine she completed an AHRQ-funded fellowship and an MS in health services research.

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Bertrand Patenaude

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Lecturer in History and International Relations
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Bertrand M. Patenaude teaches history, international relations, and human rights at Stanford, where he is a Faculty Fellow at the Center for Innovation in Global Health (CIGH) and a Lecturer at the Center for Biomedical Ethics (SCBE). His first book, The Big Show in Bololand: The American Relief Expedition to Soviet Russia in the Famine of 1921 (Stanford University Press, 2002), won the 2003 Marshall Shulman Book Prize and was the basis of a PBS documentary film broadcast in 2011. His most recent book, Trotsky: Downfall of a Revolutionary, published by HarperCollins in 2009, was serialized for radio by the BBC. His previous work, A Wealth of Ideas: Revelations from the Hoover Institution Archives (Stanford University Press, 2006), is a generously illustrated large-format book featuring rare documents, photographs, posters, and artifacts from the Hoover Institution Archives at Stanford.

Patenaude is the editor of several books, including The Russian Revolution and Stalin and Stalinism. His documentary film credits include associate producer of the Emmy Award-winning PBS film Inside the USSR and of the FRONTLINE documentary A Journey to Russia, and story editor of Stalin's Ghost, an NBC News Special Report. He was educated at Boston College and the University of Vienna and received his PhD in History from Stanford in 1987. He taught for eight years (1992-2000) in the Department of National Security Affairs at the Naval Postgraduate School in Monterey, California, where his outstanding performance as a classroom instructor was recognized with the Schieffelin Award for Teaching Excellence for two consecutive years (1998, 1999). Patenaude has lectured throughout Europe for Stanford Travel/Study, Smithsonian Journeys, and Lindblad Expeditions.

Ami Laws

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Adjunct Associate Professor Medicine
ami_photo2.jpg MD

Dr. Laws obtained her undergraduate degree in music at Oberlin College. She attended Stanford University School of Medicine where she graduated with Honors for Research. She did her internal medicine residency at Stanford University Hospital, then completed three post-doctoral fellowships: 1) Preventive Cardiology at the Stanford Research Prevention Center; 2) Diabetes, Endocrinology & Metabolism; 3) Geriatric Medicine. She is currently board-certified by the American Board of Internal Medicine in Internal Medicine and Diabetes, Endocrinology and Metabolism.

While a fellow at Stanford, Dr. Laws conducted medical research on the relations of diabetes and insulin resistance to cardiovascular risk factors. She was a co-investigator on the Insulin Resistance Atherosclerosis Study (IRAS), a multi-center study funded by the NIH to examine these relations. Together with Gerald M. Reaven, MD, she edited a ground-breaking book on insulin resistance and its relation to cardiovascular disease.

Dr. Laws has published more than 50 scientific articles, abstracts and book chapters and has presented her research at national and international scientific meetings. 

She currently teaches two classes titled Physicians and Social Responsibility (Autumn) and Physicians and Human Rights (Winter). 

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