The Japan–U.S. alliance is the cornerstone of security, stability, and prosperity in the Asia-Pacific region. As we look at the global challenges we face today, I believe that we must strive to ensure that our special relationship remains strong and vital. One way to accomplish this is by preparing the best and brightest of our young people with the kind of learning opportunities that will deepen mutual understanding. It is my belief that the Reischauer Scholars Program and Stanford e-Japan are admirably working toward this goal by providing the knowledge and expertise our young people will need as future leaders in Japan–U.S. relations. 

Waka Brown and Naomi Funahashi at podium

Attendees represented people from the Stanford community and the U.S.–Japan community in the Bay Area, including Dr. Takeo Hoshi, Director, Japan Program, and Junichiro Hirata, Visiting Scholar, Shorenstein Asia-Pacific Research Center, FSI; and Dr. Kazuhiko Hasegawa, Executive Director, San Francisco Office, Osaka University, Kathleen Kimura, Japan Society of Northern California, and Dr. Yoichi Aizawa, Executive Director, San Francisco Office, Waseda University. Amanda Minami Chao and David Chao were recognized for their many years of support to SPICE.   

Q&A with Rodney C. Ewing, co-director of the Center for International Security and Cooperation, a senior fellow at the Freeman Spogli Institute for International Studies and a Professor in the School of Earth, Energy and Environmental Sciences. Written with Nicole Feldman.

With the Trump-Kim Summit fresh in our minds, Americans are ready to confront nuclear challenges that have been on hold for decades. What many may not realize is that one of the biggest challenges is on the home front. Since the Manhattan Project officially began in 1942, the United States has faced ever-increasing stores of nuclear waste. In Part Three of our series on the consequences of nuclear war, expert Rodney C. Ewing tells us how the U.S.’s failure to implement a permanent solution for nuclear waste storage and disposal is costing Americans billions of dollars a year.

Where does our nuclear waste come from, and what is being done with it?

Broadly speaking, there are two types of nuclear waste.

The first is spent fuel from nuclear reactors used to generate electricity. Those reactors have left us with about 80,000 metric tonnes of used spent fuel, and we don’t have a way forward for the disposal of this waste. It’s stored at more than 75 sites in 35 states around the country, so many of us have some in our state, including California.

The second category is the waste generated by our nuclear weapons complex. That defense waste has accumulated since the earliest days of the Manhattan Project. The highly-radioactive waste from chemical processing is mainly stored in very large metal tanks. They are located at the Savannah River site in South Carolina, the Hanford site in Washington State, at Idaho National Laboratory in Idaho, and Nuclear Fuel Services site at West Valley in New York State.

I think it’s discouraging that we continue to release radioactivity to the environment because after more than 40 years we still have not developed a successful plan for going forward.

What’s wrong with what’s happening now?

This waste is problematic because the volume is large, many hundreds of thousands of cubic meters. The tanks in Hanford and Savannah River are way beyond their design lifetimes, so they’re corroding and some have leaked. The radioactive fluid is being released to the environment. The rates are not high, but I think it’s discouraging that we continue to release radioactivity to the environment because after more than 40 years of effort we still have not developed a successful plan for going forward.

The spent fuel from commercial power plants is much smaller, some 80,000 metric tonnes, but the total amount of radioactivity is roughly 20 to 30 times greater than defense waste. Today, it’s the spent fuel that demands the most attention as an immediate problem, particularly financially.

How much is nuclear waste costing American taxpayers?

The two categories of waste are separated in the budget. At the moment, the budget for the Department of Energy is about $30 billion. Of that budget, about $12 billion is for the nuclear weapons programs. That leaves us $18 billion to use for all things related to energy — nuclear power, fossil fuel, wind, and solar. About $6 billion, one third, is used to deal with the legacy high-level waste from the Manhattan Project. We as taxpayers pay $6 billion every year to address that problem, a huge cost that we will incur for many decades into the future. The projected total cost of clean-up after the Manhattan Project is well over $300 billion. That’s more than the original cost of the weapons programs and the actual total will be even higher. That’s just the defense waste.

What about the waste from nuclear energy? Is that clean-up cost also high?

In short, very. The Nuclear Waste Policy Act of 1982 created a tax on electricity generated by nuclear power plants. This tax would accumulate into the Nuclear Waste Fund for us to build a geologic repository — a mined facility deep within the earth — to safely dispose of the waste. What’s happened to that?

The fund has a balance of more than $40 billion. It’s controlled by Congress on an annual basis, and congressional budget rules make it very difficult to use those funds. It’s not a lockbox where the money goes and waits to be spent. Instead, it’s been applied against our national debt, so even though the fees have been collected, they haven’t been used for their intended purpose.

We pay about half-a-billion dollars a year to the utilities for their simply keeping the fuel because there’s no place for it to go.

The Department of Energy was to take ownership of this fuel on January 1, 1998, but they didn’t because there was no geologic repository. Now the utilities who have the fuel have to continue to deal with it onsite. They have sued the federal government for its failure to take ownership of the fuel, so now we pay about half-a-billion dollars a year to the utilities for their simply keeping the fuel because there’s no place for it to go. The projected cost of this penalty, let’s say, is something on the order of many tens of billions of dollars, depending on how long the spent fuel has to remain at the reactor sites. The cost of doing nothing over time will be equivalent to what we charge the rate payers, $40 billion over time. That doesn’t even include compensation to workers in defense facilities, soldiers exposed during atmospheric testing of nuclear weapons, and so on.

Clearly, the financial cost to taxpayers is high. What about the cost to the environment?

For the spent fuel, the volume — 80,000 metric tons — sounds like a lot, but compared to Gigatonnes of carbon emitted by burning fossil fuels, its volume is not so great. It’s well-contained, but there are some difficulties with how it’s stored. In some cases, the used fuel is kept in pools. Those pools have filled, and they weren’t meant for extended storage. We should be trying to get that fuel into what are called dry casks: obelisks concrete and metal.

Are there other challenges people may not be aware of?

What people don’t realize is that it is actually a serious technical challenge.

It’s very common for people to say there are no technical problems, that it’s just political. They say, “We know how to do it. It’s just a difficult public. Strict regulations. No one will let us solve this problem.”

I think what people don’t realize is that it is actually a serious technical challenge. The half-lives of some of these elements stretch into tens, if not hundreds of thousands of years. We’re asked to design solutions that will last as long as the risk. That’s not something we usually do. The technical and scientific challenge for nuclear waste is, whatever our solution, that we will never see whether we were correct or not. Designing a system where you don’t have feedback is very difficult.

What will happen if we don’t find a solution?

There will not be an immediate catastrophe; I don’t expect anything to explode. There will be environmental contamination, but the biggest problem is financial. We’re spending $6 billion a year trying to deal with the problem, and we’ll continue to spend $4.5 to $5 billion a year without solving the problem. That $5 billion could go to education or research. Imagine if instead of working on waste, we were working on solving our future energy needs.

What’s the best way for us to move forward?

At Stanford, over a two-year period we had a series of meetings to ask just this question: how does the U.S. break out of its gridlock situation and move ahead? We brought in international experts, members of the public, really quite an extraordinary effort, over 75 speakers in five meetings. We have a number of recommendations. We need a new, single purpose nuclear waste management organization. We need a new process for engaging not only the scientific and technical communities, but also the public. We need a new regulatory framework that recognizes the challenges of predicting repository performance over hundreds of thousands of years. Most importantly, we need to realize that dealing with nuclear waste is not only a technical issue, but also requires careful attention to social issues. It is very important to design an approach that engages local communities, states, and tribes. This report, Reset of U.S. Nuclear Waste Management Strategy and Policies, will be released this summer.

While the Trump administration may still believe in CVID, Gi-Wook Shin and Joyce Lee argue that–at present–it is no longer a realistic goal.

In an article for for 38 North, Shin and Lee explain why it may be too late for CVID, explore Kim Jong-un’s possible agenda, and provide their thoughts on what the goal of negotiations should now be going forward.

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African-American doctors could help reduce cardiovascular mortality among black men by 19 percent — if there was more racial diversity among physicians, according to a new study led by Stanford Health Policy’s Marcella Alsan.

After conducting a randomized clinical trial among 1,300 black men in Oakland, the researchers found that the men sought more preventive services after they were randomly seen by black doctors for a free health-care screening compared to non-black doctors.

“We found that, once African-American men were at the clinic, even though all services were free, those assigned to a black doctor took up more services,” such as flu shots and diabetes and cholesterol screenings, said Alsan, an economist and infectious disease physician who focuses on  health and socioeconomic disparities here at home and around the world.

“It was surprising to see the results,” said Alsan, an associate professor of medicine at Stanford Medicine, a faculty fellow at the Stanford Institute for Economic Policy Research, and an investigator at the VA Palo Alto Health Care System. “Prior to doing the study, we really were not sure if there would be any effect, much less the magnitude. The signal in our data ended up being quite strong.”

Those signals include the men were 29 percent more likely to talk with black doctors about other health problems and seeking more invasive screenings that likely required more trust in the person providing the service. They found subjects assigned to black doctors increased their uptake of diabetes and cholesterol screenings by 47 percent and 72 percent, respectively.

The researchers calculated that black doctors could reduce cardiovascular mortality by 16 deaths per 100,000 per year, accounting for 19 percent of the black-white gap in cardiovascular-related deaths. They believe that the results would be even larger if extrapolated to other leading causes of death that are amenable to prevention, such as cancer and HIV/AIDS. 

“I was definitely surprised,” said Owen Garrick, president and COO of Bridge Clinical Research, an Oakland-based organization that helps clinical researchers find patients from targeted ethnic groups. “If you ask most people, they feel that there is some impact of black men seeing black doctors — but it has never been quantified using an experimental design.”

Alsan and Garrick, along with U.C. Berkeley graduate student Grant Graziani, published their findings in this working paper for the National Bureau of Economic Research.

Garrick, himself an African-American physician, said black doctors tend to present themselves in a manner that puts a black patient at ease, making him more willing to open up and agree to certain care. “The black doctor might explain the medical services in a way that the black patient more clearly understands.”

Garrick called the findings “astounding,” but he warned that increasing the number of black doctors and getting black men to routinely see them are no small tasks.

There is a yawning gap between white physicians and those of color. While African-Americans comprise about 13 percent of the population, only 4 percent of physicians and less than 6 percent of medical school graduates are black, according to the study.

This is compounded by African-American men having the lowest life-expectancy in the country, due to lack of health insurance, lower socioeconomic status and structural racism. 

And there remains a distrust of the U.S. healthcare system at least partially attributed to the infamous Tuskegee study that began in 1932, when the U.S. Public Health Service began following about 600 African-American men in Tuskegee, Alabama. Some two-thirds of the men had syphilis, and USPHS declined to inform those afflicted by the disease. Even after penicillin became the standard of care for syphilis treatment in the mid-1940s, the USPHS continued to withhold treatment. The study was finally halted when a whistleblower went to the press in 1972.

Alsan— with her colleague Marianne Wanamaker at the University of Tennessee — published a study in The Quarterly Journal of Economics in February that found the 1972 Tuskegee study revelation was correlated with a reduction in health-seeking behavior and increases in medical mistrust and mortality among African-American men.

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The men who participated in the recent study were recruited from barbershops and flea markets in Oakland, a city known for its diversity, yet plagued by a 20 percent rate of poverty.

Field officers —including minority and low-income pre-med students from around the Bay Area — approached men to enroll in the study. After obtaining written consent, the men were given a short survey about socio-demographics, health care and mistrust. For completing the survey, the men received a voucher with up to $25 for their haircut or, in the flea market, a cash incentive.

The men were also given a coupon to receive a free health-care screening for blood pressure, BMI, cholesterol and diabetes at the clinic where the Stanford team operated on Saturdays in the fall and winter of 2017-2018. The patients who did not have transport to the clinic were given free rides courtesy of Uber. Attendance at the clinic was encouraged with another $50 incentive.

Subjects and the 14 participating doctors were told that they were taking part in a Stanford study designed to improve preventive health-care for African-American men.

On top of the significant increases in patients who agreed to diabetes or cholesterol screenings if suggested by a black doctor, the researchers found that the men were 56 percent more likely to get a flu vaccine if randomized to one of the African-American doctors.

The results suggested the more invasive the test, the greater the advantage of being assigned a black doctor. And the findings were even stronger among subjects who had a high mistrust of the medical system as well as those who had limited prior experience with routine medical care.

“In curative care, the patient feels ill and then may seek out medical care to fix the problem,” Alsan said. “But in preventive care, the patient may feel just fine — but must trust the doctor when he is told that certain measures must be taken to safeguard health.” 

The policy implications would suggest that medical schools need to open the pipeline to students from diverse backgrounds who are training for health-care professionals. 

Garrick recommends exposing more young people of color to the field of medicine and helping them to become more competitive applicants through tutoring and interview prep.

“And you need advocates,” he said. “Since much of the medical school selection process is subjective, you need to get people on the selection committees who will relate and see the potential of black applicants as much as people relate to other applicants.”

Some links to other media outlets that have written about this research: 

The New York Times

Harvard Business Review

The Daily Mail

ColorLines

"In what may be looked back upon as the most important election in the United States in 2018, the voters of Maine rejected political cynicism on Tuesday and preserved ranked-choice voting (RCV) for its future elections. To appreciate the historic significance of this vote for greater democratic choice, it’s important to understand what Mainers were up against—a two-party duopoly in which “all the levers of power” (in the words of one grassroots activist) were overtly or covertly working to block political reform," writes Larry Diamond in American Interest. Read here.