The back-end of the nuclear fuel cycle has become the Achilles Heel of nuclear power, as CISAC’s Rodney Ewing writes in this new article. After more than 50 years of effort, no operating nuclear waste repositories exist in the U.S. for the spent nuclear fuel from commercial nuclear power plants – or for the high-level waste from the reprocessing of spent fuel. It is time to compare and evaluate the different strategies for nuclear disposal. Read more.

With each passing day, computer hacking against countries, organizations and people is forcing the subject of cybersecurity to the top of national security agendas.

An estimated 42.8 million cyber attacks will take place this year, according to experts. Scaling up to meet this challenge is why more than 140 people from science, politics, business and the military attended the fourth annual Cyber Security Summit at Stanford’s Center for International Security and Cooperation (CISAC) on Sept. 19-20.

The Munich Security Conference and Deutsche Telekom sponsored the event. CISAC is in the Freeman Spogli Institute for International Studies. Participants delved deep into issues associated with today’s online world, including how to balance privacy and civil liberties with the need for intelligence, for example. Discussions ranged on questions such as:

• What will the future of warfare look like – human soldiers or killer robots?

• How do we ensure that technological progress does not escape human control?

• What are the biggest challenges combatting the online activities of groups like the Islamic State?

• What are the possible cyberspace conflicts between the U.S., Russia and China?

• Are countries ready for cyber attacks against key infrastructure such as energy, water and utilities, or the U.S. election system, for example?

Electoral impact

In a talk on cyber attacks and the U.S. elections, panelists discussed how such electoral manipulation in the ongoing presidential campaign might happen, and what could be done about it. While it was noted that foreign adversaries could undermine the American public’s confidence in its election system, one expert pointed out that it’s unlikely to occur undetected on a widespread basis.

Credibility is now the battlefield, one panelist said. If hacking occurs, how will an election be validated? The track record shows that Russian has attempted to influence elections in Eastern Europe, so hacking into U.S. political entities is their way to sow doubt among voters.

The economic costs of cyber attacks – $400 to $500 billion a year was one participant’s estimate – and “cyberspace norms” were other issues explored. Countries and companies are grappling with the losses associated with these incursions, and with how – and who – should set the rules for the “digital game.”

On encryption, questions in one discussion revolved around how the public and private sectors can resolve such issues, how far data privacy could be compromised for effective intelligence work, and vice versa.

Online jihadism was another subject. The conference panelists talked about which tools are most effective in countering jihadist propaganda and recruitment on the Internet. Also, the need for Europe and the U.S. to work together on such fronts was mentioned.

CISAC and FSI participants included Amy Zegart, co-director of CISAC and senior fellow at the Hoover Institution; Michael McFaul, director of the Freeman Spogli Institute and senior fellow at the Hoover Institution; Martin Hellman, professor emeritus of electrical engineering; among others. Other attendees hailed from U.S. and European Union agencies and businesses, and local Silicon Valley companies.

Zegart said a collaborative spirit and drive for innovation characterizes Stanford. “In the past three years, we have built an exciting program dedicated to educating current and future cyber leaders, producing policy-driven knowledge, and convening leaders across sectors and borders,” she wrote in the program guide.

McFaul, in his opening statement, noted the origins of CISAC – it was created when there was a different technological concern – nuclear materials. Then, scientists and social scientists at CISAC got together to work on nuclear proliferation. Today, the threat is cyber attacks, and CISAC is confronting this challenge. He said the scariest briefing he had in his ambassador position at the U.S. Department of State was on cybersecurity.

For his discussion on terrorism, Hellman brought pages of pro-encryption quotes from government officials. He suggested end-to-end encryption was good for Americans.

Crossing borders

The Munich Security Conference is considered to be the most important informal meeting on security policy. Outside speakers included Michael Cherthoff, former secretary of Homeland Security; Jane Holl Lute, the under secretary general for the United Nations; and Christopher Painter, coordinator for cyber issues at the U.S. Department of State.

Wolfgang Ischinger, the chair of the Munich Security Conference, said at the press conference that, “cybersecurity has over the last few years evolved to be one of the most indispensable agenda items.”

The “quest for rules” in cyberspace, he noted, is overwhelmingly difficult and vitally important.

Thomas Kremer, board member for co-sponsor Deutsche Telekom AG, said, “cyber attacks don’t accept national borders.” Cybersecurity has become a global issue, he explained, with ramifications for countries, companies and everyday people.

He added, “Our chances to fight cyber crime are far better when we collaborate.”

Stanford and CISAC are at the forefront of the national discussion on cybersecurity. The university launched the Stanford Cyber Initiative; hosted President Obama’s cybersecurity summit and defense secretary Ashton Carter’s unveiling of a new U.S. cyber strategy; and CISAC and the Hoover Institution have teamed up in recent years for media roundtables and Congressional bootcamps on cybersecurity.

Finally, CISAC senior research scholar Joe Felter and other experts held Hacking for Defense & Diplomacy class for educators and sponsors on Sept. 7-9. (See the final class presentations here). In spring 2016, they held the first such class to train students in cybersecurity for defense purposes. Steve Blank, a consulting associate professor in the Stanford School of Engineering’s Department of Management Science and Engineering, helped develop the class. This fall, they will prototype a Hacking for Diplomacy course at Stanford.

Click here for the Munich Security Conference’s agenda for this event and a list of participants. 

Ponte a prueba. Put yourself to the test.

As he explained during the recent Rosenkranz Prize Symposium, Stefano M. Bertozzi used this slogan to promote health reform in the Mexico City prison system. By encouraging inmates to step up and get themselves tested for HIV and other chronic illnesses, Bertozzi, dean and professor of health policy and management at the UC Berkeley School of Public Health, was able to decrease the spread of illnesses in Mexican prisons and the surrounding communities.

The Rosenkranz Prize Symposium celebrated research projects that—like Bertozzi’s—address the health care needs of the world’s most vulnerable populations. With support from the Rosenkranz Prize for Health Care Research in Developing Countries, Stanford scholars have stepped up to tackle health issues in regions in need.

Since 2010, the award has funded six young Stanford researchers who aim to improve health in developing countries. The symposium celebrated their achievements.

The award honors the work of Dr. George Rosenkranz who spent his career reducing health disparities around the globe. Rosenkranz, who was the first to synthesize cortisone and the active ingredient in the first oral contraceptive, also celebrated his 100^th birthday at the symposium.

Producing research that will increase care for vulnerable populations globally is the ultimate goal of the Rosenkranz Prize.

Andrés Moreno-Estrada, the 2012 winner, has used the award to study genetics in Latin American and Caribbean populations, aiming to increase knowledge of potential genetic illnesses. He said, “The Rosenkranz Prize is a clear, important step forward to demonstrate that we can do cutting edge science in developing countries that is of international relevance.”

Other winners include Eran Bendavid, Sanjay Basu, Marcella Alsan, Jason Andrews and Ami Bhatt. Their projects range from the effect of AIDS relief efforts on health care delivery to the treatment of diabetes in India to low-cost diagnostic tools for regions lacking infrastructure.

“I can’t think of a better way to celebrate (my father’s) birthday than listening to the bright future of science,” said Ricardo T. Rosenkranz, son of Dr. George Rosenkranz and a prize donor. “We can’t wait to hear what the next Rosenkranz Prize winners tell us.”

Click below for event photo gallery:

The 12th annual Draper Hills Summer Fellows Program gathered 25 democracy leaders from around the developing world for a three-week training program on democracy, good governance, and the rule of law reform. Selected from a large pool of applicants, the fellows have diverse backgrounds across sectors and geographies, working in civil society, public service, social enterprise, media and technology.

Fellows were instructed by an all-star roster of Stanford scholars and policy experts, including former U.S. Secretary of State Condoleezza Rice; FSI Director and former U.S. Ambassador to Russia Michael McFaul; CDDRL Mosbacher Director Francis Fukuyama and Larry Diamond, senior fellow at the Freeman Spogli Institute for International Studies. Fellows also met industry leaders such as Eric Schmidt of Google, democracy leaders such as Carl Gershman of the National Endowment for Democracy and others. During the program, they shared their personal stories about the struggle in their home countries, but also stories of their fight for justice, equality, and democracy, stories of optimism and endurance.

You can find some of their talks below and for more videos visit our YouTube channel. 

Kasha Nabagesera (Uganda)

The founding member of Uganda's LGBTI Movement

"I am the only founding member of Uganda's LGBTI movement who is still based in the country"

Kasha Nabagesera is the executive director of Kuchu Times Media Group, the first LGBTI media platform in Africa. She is known as the “founding mother” of the LGBTI movement in Uganda - where homosexuality is illegal - advocating for equal rights and the eradication of all forms of discrimination based on sexual orientation. Listen to her story about big losses and big wins, everyday dangers and hope.

Rafael Marques de Morais (Angola)

Investigative reporter, MakaAngola

"Why the government is after you when you are sleeping so much?"

Rafael Marques de Morais is an award-winning journalist and human rights activist in Angola, working to investigate corruption and abuse of power by the country’s ruling family. He founded Makaangola, a watchdog website dedicated to exposing corruption and human rights abuses in Angola. Find out why his son thinks that his father is harmless for the government.

Belabbes Benkredda (Algeria)

The founder of Munathara Initiative

"Debate is the central part of the democratic equation."

Belabbes Benkredda is an award-winning social innovator and the founder of the Munathara Initiative, the Arab world’s largest online and television debate forum highlighting voices of youth, women, and marginalized communities. Operating in 11 Arab countries, Munathara’s monthly prime-time TV debates are the only civil society-run, independent political talk program on Arabic television. Munathara Initiative organized over 650 workshops with more than 10 thousand participants from 12 countries. They have around 90 thousand of registered users. More importantly, Munathara Initiative provided safe public space for young women to voice their opinions and mark their presence in public, traditionally dominated by the middle-aged men.  

An independent panel of medical experts has updated 20-year-old guidelines for evaluating cost-effectiveness in health and medicine, in an effort to help everyone from policymakers to patients make more informed decisions about tests and treatments.

Released in a special communication in the Journal of the American Medical Association, the panelists spent more than three years building on the work of the 1996 Panel on Cost-Effectiveness in Health and Medicine, originally convened by the U.S. Public Health Service. They developed recommendations by consensus.

The new recommendations are intended to guide decision-makers in using new methods for analyzing evidence, reporting standardized results, incorporating both health-care system and societal perspectives, as well as weighing ethical issues in the use of cost-effectiveness analysis (CEA).

“Some people question the use of economic analyses in health care, but cost-effective analysis is a way to ensure that we are proving high-value care,” said Stanford Health Policy’s Douglas K. Owens, a professor of medicine and senior investigator of the VA Palo Alto Heath Care System, who sat on the panel.

“If we do interventions without understanding their value, we may well spend money on something that may not really be worth it,” said Owens. “Cost effectiveness analysis is one approach to understanding how we can help control health-care costs and provide high-value health care.”

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The panel was led by co-chairs Gillian D. Sanders, Professor in the Department of Medicine and a member of both the Duke Clinical Research Institute and the Duke-Margolis Center for Health Policy, and Peter J. Neumann, Director, Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center and Professor of Medicine at Tufts University.

Sanders said CEA could help inform decisions about how to apply new or existing medical tests, therapies, and prevention techniques so that decision-makers use health-care resources wisely.

“As health-care costs continue to rise at unsustainable rates, these recommendations provide a framework for comparing the relative value of different health-care interventions, and help decision-makers across the spectrum from policymakers to patients sort through alternatives and decide what tests and treatments make sense,” she said.

Neumann noted that in the 20 years since the original panel’s report, the field of cost-effectiveness analysis has advanced, as has the need to deliver health-care efficiently.

“Updating the guidelines provides an opportunity to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers,” he said.

Primarily funded by grants from the Robert Wood Johnson Foundation and the Bill & Melinda Gates Foundation, the panel recommends several key changes to the guidelines, while confirming other principles from the first panel, including:

1. Broadening the scope and number of reference cases in a cost analysis, which describe standard methodology that should be followed to ensure quality analysis by creating comparable measurements. The panel is recommending that all CEAs should not report two reference cases: one based on a health-care sector perspective and another based on a societal perspective.
2. Using an “impact inventory” that lists the health and non-health effects of a health-care intervention to ensure that all consequences are considered, including those to patients, caregivers, social services and others outside the health-care sector. This tool also allows analysts to look at categories of impacts that may be most important to stakeholders.
3. Measuring health effects in terms of quality adjusted life years, a common measure used by health researchers that includes both the quality and quantity of life lived.
4. Including both costs reimbursed by third-party payers and those paid for out-of-pocket by patients in health-care sector analyses.
5. Including a reporting checklist and guidelines for transparency that includes assumptions in any analysis and the disclosure of potential conflicts of interest.

The complete report of the so-called Second Panel will be published in October.

The panelists noted that the field of CEA has emerged dramatically since the last guidelines 20 years ago. For example, the Advisory Committee for Immunization Practices, which establishes national immunization policy recommendations on behalf of the Centers for Disease Control and Prevention, now uses CEA in its calculations.

“The need to deliver health-care efficiently and the importance of using analytic techniques to understand clinical and economic consequences of strategies to improve health, have only increased,” the Second Panel authors wrote in the JAMA paper.

Health-care spending in the United States comprised 13 percent of GDP in 1995; today it approaches 18 percent. And the total national health expenditures have tripled during that period, jumping to more than $3 trillion in 2014, according to the Kaiser Family Foundation.

“The goal of the Second Panel is to promote the continued evolution of CEA and its use to support judicious, efficient, and fair decisions regarding the use of health-care resources,” the experts wrote in the JAMA article.