Title: Research in Progress: Doug Owens - Development of the New USPSTF Guidelines on Screening for Lung Cancer and Colorectal Cancer
Brief Abstract:
Discuss the development of the two new draft guidelines from the U.S. Preventive Services Task Force. Screening for lung cancer and colorectal cancer are two of the most complex and important cancer screening guidelines in the USPSTF portfolio. Describing the methods the USPSTF uses, including the evidence reviews and modeling that helped us create these new recommendations.
Zoom Meeting
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Encina Commons, Room 201
615 Crothers Way Stanford, CA 94305-6006
Executive Assistant: Soomin Li, soominli@stanford.edu
Phone: (650) 725-9911
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.)
Zoom Meeting
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https://stanford.zoom.us/meeting/register/tJcuf-2sqzkoE93jEPn9deZKTTBJoze-2d6u
After registering, you will receive a confirmation email containing information about joining the meeting.
Encina Commons, Room 201
615 Crothers Way Stanford, CA 94305-6006
Executive Assistant: Soomin Li, soominli@stanford.edu
Phone: (650) 725-9911
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.)
Title: Academic Scientists in Court: Pros or Cons?
Steven Goodman, MD, MHS, PhD is Associate Dean of Clinical and Translational Research and Professor of Epidemiology and Population Health, and Medicine. He is co-founder and co-director of the Meta-research innovation Center at Stanford (METRICS), a group dedicated to examining and improving the reproducibility and efficiency of biomedical research.
Abstract: Most of what academics say are public. However, expert testimony they provide in court is often impossible to access. Thus, even though decisions they affect often have profound importance for public health or health policy, such experts are typically not accountable to the scientific community. This talk will review some high-profile examples, some from personal involvement, of court testimony from leading health scientists that embrace questionable scientific principles or causes contrary to their public positions or values. Solutions to this problem will be discussed.
Zoom Meeting
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Maya Rossin-Slater, PhD
Associate Professor of Medicine
SIEPR Faculty Fellow
NBER Faculty Research Fellow
IZA Faculty Affiliate
Title:
"Trauma at School: The Impacts of Shootings on Students' Human Capital and Economic Outcomes"
Abstract:
We examine how shootings at schools---an increasingly common form of gun violence in the United States---impact the educational and economic trajectories of students. Using linked schooling and labor market data in Texas from 1992--2018, we compare within-student and across-cohort changes in outcomes following a shooting to those experienced by students at matched control schools. We find that school shootings increase absenteeism and grade repetition; reduce high school graduation, college enrollment, and college completion; and reduce employment and earnings at ages 24--26. These effects span student characteristics, suggesting that the economic costs of school shootings are universal.
Zoom Meeting
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Encina Commons,
615 Crothers Way Room 184,
Stanford, CA 94305-6006
Maya Rossin-Slater is an Associate Professor of Health Policy at Stanford University School of Medicine. She is also a Senior Fellow at the Stanford Institute for Economic and Policy Research (SIEPR), a Research Associate at the National Bureau of Economic Research (NBER) and a Research Fellow at the Institute of Labor Economics (IZA). She received her PhD in Economics from Columbia University in 2013, and was an Assistant Professor of Economics at the University of California, Santa Barbara from 2013 to 2017, prior to coming to Stanford. Rossin-Slater’s research includes work in health, public, and labor economics. She focuses on issues in maternal and child well-being, family structure and behavior, and policies targeting disadvantaged populations in the United States and other developed countries.
With vaccines against SARS-CoV-2, the virus that causes Covid-19, on the near-term horizon, U.S. policymakers are focusing on how to ensure that Americans get vaccinated. This challenge has been compounded by reports that White House officials are exerting undue influence over the agencies that would ordinarily lead such efforts, the Food and Drug Administration and the Centers for Disease Control and Prevention.
India is facing a mounting burden of noncommunicable diseases (NCDs) such as diabetes, cancers, and cardiovascular diseases. NCDs affect more than 20 percent of the Indian population and their prevalence is projected to expand substantially as the population aged 60 and over increases. Left unchecked, the costs of managing chronically ill and aging sectors of the population grow exponentially.
To control costs and address the growing chronic disease burden, India’s public programs must integrate curative hospital services with the most cost-effective preventive and primary interventions, argue Karen Eggleston, APARC’s deputy director and the director of the Asia Health Policy Program (AHPP), and Radhika Jain, a postdoctoral research fellow with AHPP. India must also urgently expand and improve the evidence base on economic evaluations of both preventive and curative health interventions in the country.
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In a correspondence piece published by BMC Medicine, Eggleston and Jain examine the features and limitations of a study that takes an important first step in that direction: a cost-effectiveness study of the Kerala Diabetes Prevention program (K-DPP) that adds such evidence on how to prevent diabetes cost-effectively in India and other low- and middle-income countries.
The study’s authors present a cost-effectiveness analysis of 1007 participants in the K-DPP, and their estimates indicate that K-DPP was cost-effective. Indeed, Eggleston and Jain determine that the analysis shows potential cost-effectiveness in “nudging” the participants towards a healthier lifestyle through suggestive reductions in tobacco and alcohol use and waist circumference. The results of the cost-effectiveness analysis of the K-DPP “highlight the importance of continued research on community-based promotion of healthy lifestyles,” say Eggleston and Jain.
Evidence-based approaches to chronic noncommunicable disease intervention are essential for providing cost-effective care and creating models for future programs like the K-DPP. Eggleston and Jain conclude that future studies advancing evidence-based approaches to chronic noncommunicable disease intervention — ones that cover larger and more representative populations over longer time periods — remain important for more generalizable assessments to inform policy decisions.
Addressing the epidemic of chronic diseases in India and other low- and middle-income countries requires comprehensive evidence on the cost-effectiveness of health interventions, argue APARC’s Asia Health Policy Program Director Karen Eggleston and Postdoctoral Fellow Radhika Jain.
Few issues in the policy response to the coronavirus disease 2019 (COVID-19) pandemic have inspired as impassioned debate as school reopening. There is broad agreement that school closures involve heavy burdens on students, parents, and the economy, with profound equity implications, but also that the risk of outbreaks cannot be eliminated even in a partial reopening scenario with in-school precautions. Consensus largely ends there, however: the approaches states and localities have taken to integrating these concerns into school reopening plans are highly variable.
On August 17, 2020, the Los Angeles Unified School District launched a program to test more than 700,000 students and staff for SARS-CoV-2. The district is paying a private contractor to provide next-day, early-morning results for as many as 40,000 tests daily. As of October 4, a total of 34,833 people had been tested at 42 sites. The program is notable not only because it’s ambitious, but also because it’s unusual: testing is conspicuously absent from school reopening plans in many other districts. Typically, exhaustive attention has instead focused on physical distancing, face coverings, hygiene, staggering of schedules, and cohorting (dividing students into small, fixed groups). Although the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics, the National Academies of Sciences, Engineering, and Medicine, and state officials have urged schools to prepare for Covid-19 cases, they have offered strikingly little substantive guidance on testing. Immediate attention to improving testing access and response planning is essential to the successful reopening of schools.
The distribution of health care payments to insurance plans has substantial consequences for social policy. Risk adjustment formulas predict spending in health insurance markets in order to provide fair benefits and health care coverage for all enrollees, regardless of their health status. Unfortunately, current risk adjustment formulas are known to underpredict spending for specific groups of enrollees leading to undercompensated payments to health insurers. This incentivizes insurers to design their plans such that individuals in undercompensated groups will be less likely to enroll, impacting access to health care for these groups. To improve risk adjustment formulas for undercompensated groups, we expand on concepts from the statistics, computer science, and health economics literature to develop new fair regression methods for continuous outcomes by building fairness considerations directly into the objective function. We additionally propose a novel measure of fairness while asserting that a suite of metrics is necessary in order to evaluate risk adjustment formulas more fully. Our data application using the IBM MarketScan Research Databases and simulation studies demonstrates that these new fair regression methods may lead to massive improvements in group fairness (eg, 98%) with only small reductions in overall fit (eg, 4%).
