This 2016 newsletter from the Stanford Department of Medicine is neither a yearbook of our recent accomplishments nor an annual report replete with facts and figures. It’s most like an anthology, giving readers glimpses of some recent progress we’ve made as we addressed Stanford Medicine’s tripartite mission: to teach our students and trainees, to do research, and to care for our patients. As we move toward the future, it’s important to reflect on the past, which created the culture of the Stanford Department of Medicine. The report also features Stanford Health Policy's Marcella Alsan's work about the impact of the tsetse fly on African economies.

In this video, Robert Harrington, MD, chair of the Department of Medicine, gives an overview of the department's vision for the future, as well as highlighting the department's four strategic priorities.

See the multimedia report here.

The U.S. Senate summary report on the allegations of CIA torture during the "war on terror" failed to live up to its original purpose, according to Amy Zegart, co-director of Stanford's Center on International Security and Cooperation (CISAC).

In a new journal article, Zegart wrote that the report has "not changed minds on either side of the torture debate and is unlikely to do so."

In December 2014, after five years of research, the U.S. Senate Select Committee on Intelligence issued a summary report of its investigation into the Central Intelligence Agency's terrorist detention and interrogation program between 2001 and 2006.

As Zegart noted, the Senate's summary released to the public amounted to less than a tenth of the full report, most of which remains classified. In an interview, she said the issue at hand should concern all Americans.

"How do secret agencies operate in a democratic society? Were the CIA's interrogation methods effective? Were they legal or moral? What role should the Congress have played when decisions about detainees were being made? All of these are vital questions which, sadly, remain unanswered and hotly contested – in large part because they have been caught in the maw of politics on both sides," said Zegart, the co-director of the Center for International Security and Cooperation at Stanford and a senior fellow at the Hoover Institution.

'A tiny portion of the full study'

Zegart explained that four key errors have doomed the Senate report to "eternal controversy."

"It was not bipartisan, took too long to write, made little effort to generate public support along the way and produced a declassified version that constituted a tiny portion of the full study," she said.

In contrast, Zegart said, the U.S. Senate's 1975-76 Church Committee investigation of intelligence abuses made different calls on all four issues, which helped it achieve significantly more impact. That committee was formed in the wake of Watergate and disclosures in the New York Times that U.S. intelligence agencies had engaged in a number of illegal activities for years, including widespread domestic surveillance on American citizens.

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Zegart wrote, "This was deliberate: As one Church Committee source told the New York Times in December 1975, 'If you wait too long, both the public and the members of Congress forget what you're trying to reform.' He was right."

On the other hand, she said, the Senate committee investigating CIA torture consisted entirely of Democrats and took five years to deliver what turned out to be a heavily redacted report. U.S. Sen. Dianne Feinstein (D-Calif.) chaired the committee.

While Feinstein's staff worked from 2009 to 2014, Zegart said, public outrage about torture faded – in fact, public support for coercive techniques actually increased. According to Zegart, a 2007 Rasmussen poll showed that 27 percent of Americans said the U.S. should torture captured terrorists, while 53 percent said the U.S. should not. A 2012 YouGov national poll conducted by Zegart found that support for torture rose 14 points while opposition fell 19 points.

Another problem was that the investigation did not hold a single public hearing to generate public attention or support, she said. In contrast, Church's investigation held 21 public hearings in 15 months.

Finally, the Senate report is still almost entirely classified, Zegart said.

"The 'report' released in December 2014 was a redacted executive summary of 500 pages – that's less than 10 percent of the 6,700-page report. No one knows when the other 6,200 pages will see the light of day," she wrote.

'Extraordinary resistance'

The aforementioned factors gave CIA defenders the upper hand when the report was eventually issued, she said.

"When the summary was released, former CIA officials launched an unprecedented public relations campaign replete with a web site, op-ed onslaught, and even a 'CIAsavedlives' Twitter hashtag," Zegart wrote.

And so, the episode represented one of the controversial episodes in the history of the CIA's relationship with the U.S. Senate, Zegart said.

"They [the Senate] faced extraordinary resistance from the CIA that included spying on the investigation; stonewalling and whittling away what parts of the report would be declassified; and a publicity campaign to discredit the study as soon as it was released," she wrote.

Zegart said the Feinstein investigation serves as a "cautionary tale" for Congress in its constitutional role of intelligence oversight.

"Even those who consider the interrogation and detention programs a dark mark on American history should be wary of calling the Senate report the definitive account of the subject or a model of intelligence oversight success," she wrote.

A day after President Obama's address on the San Bernardino shootings, FSI Senior Fellow Larry Diamond speaks with Michael Krasny of NPR News on the U.S. response to global terrorist threats. In addition to a unified, international coalition, Diamond believes one of the keys to defeating ISIS lies with empowerment of the people of Iraq and Syria, addressing the need for political change in the region. Diamond was accompanied by Jessica Stern, research professor at Boston University and Shibley Telhami, senior fellow at the Center for Middle East Policy at the Brookings Institution.

The cold and flu season is upon us — and with that comes the potential overuse of antibiotics. All too often, physicians prescribe antibiotics for viral infections, which typically is ineffectual and can even be dangerous for elderly Medicare patients.

An estimated 2 million Americans are infected with drug-resistant organisms each year, resulting in 23,000 deaths and more than $20 billion in excess costs, according to the Centers for Disease Control and Prevention.

Excessive antibiotic use in cold and flu season is not only costly, but it also contributes to antibiotic resistance, writes Stanford Health Policy's Marcella Alsan and her co-authors in a study published in the December edition of Medical Care. The study’s objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of clinically appropriate or inappropriate prescribing.

Alsan and senior author, Dartmouth economist Jonathan Skinner, concluded that flu-related antibiotic use was correlated with prescribing high-risk medications to the elderly.

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When Former New York City Mayor Michael Bloomberg took a stand on sugary drinks, banning large sizes to encourage moderation, his efforts were met with some applause—but also with jeers of derision, one New York Post headline dubbing him the “Soda Jerk.”

But with one third of the nation’s adult population considered obese, and alarming evidence about the health dangers and economic toll of obesity, research on ways to slim America’s collective waistband is sorely needed.  

Stepping back from the frenzy, faculty and students at Stanford Law School are digging into the issue to try to tease out the data and offer an unbiased empirical view. 

Last spring, Jordan Flanders, JD ’15, worked with Michelle Mello (BA ’93) and David Studdert, two members of Stanford Law’s health law faculty, on a research paper that analyzed legal, economic, and political issues raised by sugary drink laws in different countries, explaining five major categories of regulations (taxes, government procurement regulations, school-based regulations, advertising restrictions, and labeling rules) and parsing out the biggest challenges to implementing each. The result, “Searching for Public Health Law’s Sweet Spot: The Regulation of Sugar-Sweetened Beverages,” was published in July in PLoS Medicine, a highly regarded international medical journal, and went a long way to inform the debate. 

Stanford has taken the need for lawyers working in the critical area of health law seriously. Mello and Studdert, both professors of law with joint appointments with the medical school, were hired in the last two years. They joined Hank Greely, Deane F. and Kate Edelman Johnson Professor of Law, and Daniel Kessler, professor of law—increasing to four the number of faculty who are fully focused on health law. They are joined by half a dozen law faculty whose scholarship often touches on diverse subjects such as psychology, drug regulation, and environmental issues at this intersection of law.

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