Stanford Health Policy’s Douglas K. Owens was named chair of the U.S. Preventive Services Tasks Force, an independent panel of national experts in prevention and evidence-based medicine that makes health-care recommendations to Congress and the American public.

Owens, the Henry J. Kaiser, Jr. Professor at Stanford University and a general internist at the VA Palo Alto Health Care System, is also a professor of medicine, health research and policy, and management science and engineering at Stanford. He is the director of the Center for Health Policy in the Freeman Spogli Institute for International Studies, where he is also a senior fellow, and the Center for Primary Care and Outcomes Research in the Department of Medicine.

“The goal of the Task Force is to help people live longer and healthier lives,” said Owens. “We aim to bring the best science about prevention to our guideline recommendations on more than 70 preventive services, including screening, behavioral counseling and preventive medications."

Owens noted that the Task Force guidelines — unbiased, independent assessments of the benefits and harms of preventive services — impact virtually every primary care patient in the country. From statins, mammograms and cervical cancer screening, to depression, HIV screening or cardiovascular disease, the 16 volunteer members of the Task Force weigh all the medical evidence to determine the safest course of action from adolescence to old age.

A guideline this January about perinatal depression, for example, was highlighted in this New York Times article. Depression hits one-in-seven women during and after giving birth, prompting the Task Force to recommend that clinicians refer at-risk women to counseling, specifically cognitive behavioral or interpersonal therapy.

“I am delighted to congratulate Dr. Owens on his appointment as chair of the Task Force,” said Susan J. Curry, a distinguished professor in the Department of Health Management and Policy at the University of Iowa. “Over the years, he has brought invaluable expertise in evidence synthesis, clinical decision-making and modeling — all critical to the methods we use to develop evidence-based recommendations.”

Some other recent recommendations by the Task Force include that men aged 55 to 69 talk to their doctors about prostate cancer screenings; patients at high risk of HIVshould take a daily preventive drug; and that adults aged 50 to 75 be screened for colon cancer. 

Each year, the Task Force makes a report to Congressthat identifies critical evidence gaps in research related to clinical prevention services. It recommends priority areas that deserve further explanations, all of which are made public on the Task Force website for public comment.

On January 18, 2019, Stanford Global Studies and the Stanford Program on International and Cross-Cultural Education (SPICE) hosted a book talk by Professor Michael McFaul. McFaul served for five years in the Obama administration, first as Special Assistant to the President and Senior Director for Russian and Eurasian Affairs at the National Security Council (2009–2012), and then as U.S. Ambassador to the Russian Federation (2012–2014). He is also one of several contributing scholars to Inside the Kremlin, SPICE’s lesson plan on Soviet and Russian history. McFaul’s talk was given to approximately 30 community college and secondary school educators from the San Francisco Bay Area. Three of the educators—Nancy Willet, Phillip Tran, Don Uy-Barreta—are 2018–19 Stanford Education Partnership for Internationalizing Curriculum (EPIC) Fellows, and this article highlights their reflections.

Ambassador McFaul has described From Cold War to Hot Peace as “three books in one.” First, it is a book that explains the arc of U.S.–Russia relations since the end of the Cold War. Second, it a book that describes the “reset” in U.S.–Russia relations and its aftermath during the Obama presidency. Third, it is a book about McFaul’s life that describes how his involvement with the debate team at Bozeman High School, Montana, sparked his interest in Russia and led to his subsequent study of Russia at Stanford University, Oxford University, and in Russia itself. During his talk, he touched upon all three.

McFaul’s reflections not only provided the educators with important content on U.S.–Russia relations and insights from his youth to his ambassadorship, but also prompted the educators to consider effective teaching and pedagogical strategies. McFaul’s use of storytelling, presentation of multiple perspectives, emphasis on interdisciplinarity, and sharing of first-hand accounts gave the educators a glimpse into McFaul not only as an academic and diplomat but as a teacher.

EPIC Fellow Nancy Willet, Co-chair of the Business & Information Systems Department, College of Marin, noted, “I was most impressed with Ambassador McFaul’s engaging storytelling. His first-hand insights of his time spent studying and working in Russia challenged some of my misguided assumptions and helped expand my understanding of the complexities of U.S.–Russia relations. I grew up during the Cold War and the Ambassador disrupted some of my deep-rooted misconceptions about the former Soviet Union and further opened my mind for a more nuanced understanding.” In a follow-up communication, Willet said that she is devouring From Cold War to Hot Peace and plans to share McFaul’s scholarly insights with her law students—particularly when discussing democracy and rule of law—here and abroad.

EPIC Fellow Philip Tran, Instructor of Business, San Jose City College, remarked that “Ambassador McFaul’s talk reinforced the complicated notion of human relations and the importance of an interdisciplinary study of it—including political science, business, economics, etc. Interdisciplinarity is a key to grasping a better understanding of human relations.” He continued by noting that the biggest take-away from McFaul’s talk was that it cautioned him as a teacher to “refrain from the natural ‘knee-jerk’ reactions and to seek a deeper understanding of the situation from all sides…. Even though Ambassador McFaul is a subject matter expert on U.S.–Russian relations, he displayed humility and acceptance of ambiguity in his responses to some of the toughest questions regarding the U.S. relationship with Russia and Vladimir Putin.”

EPIC Fellow Don Uy-Barreta, Instructor of Economics, De Anza College, reflected upon the significance of sharing first-hand experiences with students. He noted that “Reading about Ambassador McFaul’s experience is very informative, but being able to ask questions and hearing it from the source is a whole different level of experience. As he was telling us about his days in Russia, it felt like I was right next to him, and it gave me goosebumps.” Uy-Barreta found inspiration in McFaul’s talk as he prepares for his presentation on global economics at the EPIC Symposium on May 18, 2019 during which the 2018–19 EPIC Fellows will present their research at Stanford.

McFaul has given numerous talks on From Cold War to Hot Peace but this was the first geared to an audience of educators. As I observed his talk, I was primarily attentive to the pedagogical strategies that he utilized to engage the educators. For me, his effective teaching made the history and insights in From Cold War to Hot Peace come alive and feel more like “four books in one.”

This book talk was made possible by a U.S. Department of Education Title VI grant that provides professional development opportunities for K–12 teachers and community college instructors. Among these opportunities is EPIC, a program that provides one-year fellowships to community college instructors. Title VI grant collaborators include Stanford Global Studies (SGS), SPICE, Lacuna Stories, and the Stanford Graduate School of Education’s Center to Support Excellence in Teaching. SGS’s Denise Geraci and SPICE’s Jonas Edman organized and facilitated the talk by Ambassador McFaul.

SPICE also offers professional development opportunities for middle school teachers and high school teachers. To stay informed of SPICE news, join our email list or follow us on Facebook and Twitter.

Congress’s annual worldwide-threat hearings are usually scary affairs, during which intelligence-agency leaders run down all the dangers confronting the United States. This year’s January assessment was especially worrisome, because the minds of American citizens were listed as key battlegrounds for geopolitical conflict for the first time. “China, Russia, Iran, and North Korea increasingly use cyber operations to threaten both minds and machines in an expanding number of ways,” wrote Director of National Intelligence Dan Coats. Coats went on to suggest that Russia’s 2016 election interference is only the beginning, with new tactics and deep fakes probably coming soon, and the bad guys learning from experience.

Deception, of course, has a long history in statecraft and warfare. The Greeks used it to win at the Battle of Salamis in the fifth century b.c. The Allies won the Second World War in Europe with a surprise landing at Normandy—which hinged on an elaborate plan to convince Hitler that the invasion would be elsewhere. Throughout the Cold War, the Soviets engaged in extensive “active measure” operations, using front organizations, propaganda, and forged American documents to peddle half-truths, distortions, and outright lies in the hope of swaying opinion abroad.

But what makes people susceptible to deception? A colleague and I recently launched the two-year Information Warfare Working Group at Stanford. Our first assignment was to read up on psychology research, which drove home how vulnerable we all are to wishful thinking and manipulation.

Read the rest at The Atlantic

An air of uncertainty remains prevalent in the Indo-Pacific region. The South China Sea continues to be in contention, with six governments exerting claims on overlapping areas. The threat of a full-blown trade war between China and the United States puts the stability of the regional (and global) economy in question. Meanwhile, the Korean peninsula appears to swing between the brink of conflict to the possibility of dramatic diplomatic breakthroughs. It was in the midst of this precarious period for the region that the third annual gathering of the U.S.-Japan Security and Defense Dialogue Series took place in Tokyo from January 30 to February 1.

The 2019 meeting was co-sponsored by the Sasakawa Peace Foundation and APARC’s U.S.-Asia Security Initiative (USASI). For the past three years, the series has convened senior Japanese and American policymakers, military leaders, scholars, and regional experts to discuss Japan's security strategy and the alliance between Japan and the United States. Support for the workshop came from the Carnegie Corporation of New York.

Since its inception in 2016, the dialogue series has provided a venue for in-depth discourse on contemporary Asia-Pacific security issues, and has helped build bridges between American and Asian academics, government and military officials, and other defense and security policy specialists. “We have continued to expand the range of attendees from the Japanese and U.S. government and military,” said USASI Director Karl Eikenberry. “This has ensured for our dialogue even greater policy relevance with each iteration.”

“The U.S.-Japan security dialogue is unique because it combines civilians and military officers, both retired and serving, which simply does not take place elsewhere,” observed Stanford Lecturer in International Policy Daniel Sneider, a regular participant. “It also avoids the sometimes-empty rhetoric about our alliance in favor of an operational, but strategically informed, approach that gets at not only what is being accomplished, but where the gaps exist in our alliance.”

Threats, Challenges, and the Appropriate Responses

L to R: Amb. Karl Eikenberry and Lt. General Noboru Yamaguchi (Workshop Co-Chairs)

The 2019 dialogue opened with a day of discussions on many of the challenges facing the U.S.-Japan security alliance, including an assessment of the latest security trends in the Indo-Pacific, as well as Japan’s new National Defense Program Guidelines (NDPG). Passed by the Japanese Cabinet only a month earlier, the NDPG was the focus of two sessions on day one, including a discussion of its implications for Indo-Pacific security, as well as a session on the guideline’s ramifications for concepts of Integrated Air and Missile Defense and Archipelagic Defense

“Unsurprisingly, the global rise of China—along with the U.S. and Japan’s separate and combined responses to PRC strategy in the Indo-Pacific Region—helped shape both our agenda and the selection of participants,” observed Eikenberry. “We were specifically interested in the implications for the maritime domain and certain operational aspects of the U.S.-Japan security alliance.”

The day one closing ceremony featured remarks from the U.S. Ambassador to Japan, the Honorable William Hagerty.

Developing Policy Recommendations, Meeting with Policymakers

L to R: Major Rodger Welding and Colonel Daniel Munter (United States Pacific Air Forces), and Lt. Colonel Yuka Nakazato, (Japan Air Self-Defense Force)

Days two and three were designed for small group sessions. Referred to as “Core Group”, its U.S. and Japanese members met the morning of January 31 to review the preceding day’s workshop and develop corresponding policy recommendations. The quality and depth of the conversations underscored just how great an impact the expanded range of participants had on the resulting policy.

“Participants weren't afraid to address sensitive, big-picture questions,” said Phillip Lipscy, a Center Fellow at the Freeman Spogli Institute for International Studies at Stanford, “like the slow growth of Japanese military spending in the face of increasing regional threats and the challenges posed by unpredictable US administration policies.”

“Even as an expert of Japanese politics, I found the dialogue extremely informative and stimulating,” shared Lipscy.

Sneider agreed as well. “One thing that stood out this year, in contrast to the previous years, was a greater willingness on the part of our Japanese colleagues to air their sense of unease about and even opposition to the direction of American foreign and security policy under the Trump administration,” he said. “In the past, the American participants were much more open about their criticism of their own government, the Japanese tended to be polite—not so much this year, which made for a lively exchange on many issues.”

In the afternoon, core U.S. participants again met with the US Ambassador, along with his embassy team, as well as with senior Cabinet Office officials from the government of Japan.

Field Testing Ideas

During the second annual gathering in 2018, the dialogue began including a visit by the core workshop participants to a combined U.S. military—Japanese Self Defense facility. As part of the 2019 dialogue, the Core Group spent their third and final day visiting Yokota Air Base, the headquarters of both United States Forces Japan and Japan Air Self Defense Force Air Defense Command.

“ “These visits allow us to better understand Alliance operational challenges in the field,” noted Eikenberry. “Just as importantly, it affords us an immediate opportunity to test out some of the very ideas discussed during the preceding days.”

Yokota Air Base, Japan

Chatham House Rules applied to the dialogue, but a workshop report is forthcoming.

View the reports from the first and second annual workshops.

The U.S.-Asia Security Initiative is part of Stanford University’s Walter H. Shorenstein Asia-Pacific Research Center (APARC). Led by former U.S. Ambassador and Lieutenant General (Retired) Karl Eikenberry, USASI seeks to further research, education, and policy relevant dialogues at Stanford University on contemporary Asia-Pacific security issues.

(L to R: Karl Eikenberry, Michael McFaul, Major Marcus Morgan (U.S. Army LNO to Japan Ground Self Defense Force Northern Army and Stanford University Center for East Asian Studies MA ’18), Phillip Lipscy, Daniel Sneider)

Why does cellist Yo-Yo Ma refer to the Silk Road as the ‘Internet of antiquity’? What is globalization? What is economic interdependence? What are diversity and inclusion? These are some of the questions that high school students from Yokohama Science Frontier High School (YSFH) considered during a visit to the San Francisco Bay Area in January 2019. Alumni of the U.S.-Japan Council’s TOMODACHI Emerging Leaders Program (ELP) and SPICE staff encouraged the students to critically consider the questions during their visits to Facebook, Apple, and Stanford University.

Prior to their arrival, YSFH students shared their goals for the trip. YSFH student Ken Horikoshi, who aspires to become a robotics engineer, noted, “I will need communication skills, skills of thinking deeply, and of course, knowledge about space or robotics to make my dreams come true. So, I’d like to make an effort to improve these skills.” With the students’ goals in mind, ELP Chair and SPICE’s Rylan Sekiguchi organized visits to Apple and Facebook and assisted with a one-day seminar at Stanford.

Derek Kenmotsu talks with students and teachers on Apple campus.

Mana Nakagawa gives students and teachers a tour around Facebook headquarters.

During the seminar at Stanford, SPICE staff introduced the YSFH students to SPICE lessons from Along the Silk Road to illustrate that globalization is not just a modern phenomenon. The staff noted that in some ways, the ancient Silk Road was the first real conduit of globalization, as it connected vast lands into a trade network that spread goods, beliefs, and technologies far from their areas of origin. ELP alumna Naomi Funahashi, instructor of SPICE’s online course on Japan, illustrated this by showing how musical instruments were carried along the Silk Road and gradually adapted to cultural and geographic features of local environments. She mentioned, for example, similarities and differences of lutes that can be found in Europe, China, Korea, and Japan. She also noted a description of the Silk Road by cellist Yo-Yo Ma, founder of Silkroad, who has described the Silk Road as the “Internet of antiquity”; expounding upon this notion, Sekiguchi and SPICE’s Jonas Edman noted that by studying about the Silk Road, we can gain historical insights into how the contemporary stage of globalization is changing our world and our lives.

A highlight of the seminar featured the YSFH students giving presentations on their science-related research to the SPICE staff and visiting scholars at Stanford from Japan. YSFH student Kazuhiro Okada’s presentation on his ambition to design underwater cities stretched the audience’s notions of globalization and interconnectedness. One commented, “It would be interesting if you could someday design a subway stop under the ocean between Aomori Prefecture and Hokkaido.”

The ELP identifies, cultivates, and empowers a new generation of leaders in the U.S.–Japan relationship. Chair Sekiguchi, other ELP alumni, and SPICE staff extended this mission to the generation behind them. YSFH teacher Nobuyo Uchimura described the experiences that they provided her students as very precious ones that expanded their learning beyond the confines of a classroom, and YSFH teacher Yukimasa Uekusa noted his desire to prioritize programs such as this into the future.

Americans know that choosing a health insurance plan can tough. And once you’re retired and possibly on a limited or fixed income, it can become downright brutal.

Stanford Health Policy’s M. Kate Bundorf and Maria Polyakova and their colleagues set out to develop an online decision-support tool to test whether machine-based expert recommendations would influence choice among Medicare Part D enrollees — and make it easier.

“The use of technology seems like a natural way to address the challenges of choosing among plans,” they write in their study published in Health Affairs.

Medicare beneficiaries have been choosing among Medicare Advantage and Part D prescription drug plans for years, and more recently the Affordable Care Act established health insurance marketplaces for those who are younger than 65.

All that choice is supposed to create incentives for plans to offer a variety of low-cost, high-quality products that allow people to choose the plan that best meets their needs.

But sometimes too many good choices can lead to bad outcomes.

“Health insurance is a complex financial product with complicated cost-sharing rules, and the implications of different benefit designs for out-of-pocket spending and health care use vary across consumers depending on their needs,” wrote Bundorf, chief of the Department of Health Research and Policy and an associate professor of medicine at Stanford Medicine.

Another researcher in the study was Albert Chan, chief of digital patient experience and an investigator at Sutter Health, in Palo Alto, as well as an adjunct professor at the Stanford Center for Biomedical Informatics Research. Ming Tai-Seale, a professor of family medicine and public health at University of California San Diego, was also a principal investigator of the study.

Choosing Health Plan is Complicated

“Consistent with these challenges, researchers have documented that many consumers, both young and old, do not understand the characteristics of their plans,” they wrote in the March issue of Health Affairs, which is holding a public briefing on patients-as-consumers at the National Press Club on March 5th. Bundorf will present their research at the briefing in Washington, D.C., which will be streamed live and will be posted here once it has aired.

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“(Patients) often make decisions that may signal inaccurate evaluation of the costs and benefits of coverage — such as staying in their plan when better options are available, not enrolling in the plan that provides the best coverage for their drugs, or enrolling in plans that are objectively inferior to other available choices,” the authors wrote.

The Centers for Medicare and Medicaid Services (CMS) offers a tool to help beneficiaries choose among plans, but older adults — even those with high levels of formal education — find it difficult to use.

So, the research team developed a decision-support software tool called CHOICE to assist Medicare beneficiaries in choosing a Part D prescription plan. The software automatically imported the user’s list of current drugs from their electronic medical records (allowing users to adjust the list if desired); the algorithm would then crunch the numbers to come up with three recommended plans which were likely to be the least expensive for the user.

The team then conducted a randomized trial of this software tool among 1,185 patients of the Palo Alto Medical Foundation (PAMF), a large health-care provider in Northern California. Fifty-four percent of those patients were women, 65 percent were white, and 54 percent were married. Living in the Bay Area, their income and education levels were fairly high: They lived in areas in which the median income is $106,808 and 54 percent of the population has a college degree or more education.

While not representative of the general population of seniors in the United States, the researchers emphasized that it was important to conduct this study among these potential users, who are more likely to respond positively to an interaction with a computer. If these users didn’t find this software helpful or user friendly, it would not likely be a useful tool to roll out across the country as a whole.

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The study participants received access to one of two versions of the CHOICE tool: expert recommendations or individual analysis. Both versions automatically imported information on patients’ prescription drugs from their electronic health records and combined it with information on plan benefit design to provide individually customized information on users’ likely spending on both premiums and prescription drugs in each of the stand-alone Part D plans available in their area. The version of CHOICE that offered expert recommendations combined this information with an explicit recommendation on which plans were best for the user.

Willing and Able

The researchers found that providing an online tool not only increased older adults’ satisfaction with the process of choosing a prescription drug plan, but they also spent more time choosing that plan.

“The most significant finding of our trial is that individually customized information alone didn’t seem to be enough,” Bundorf, who is also a senior fellow at the Stanford Institute for Economic Policy Research (SIEPR), said in an interview. “The tool we developed was most effective when individually customized information paired with a clear-cut algorithmic expert recommendation that highlighted three plans that the computer thought were the best for the user based on total spending for prescription drugs.”

She said she was surprised to see that people spent more time choosing a plan and were more satisfied with the process when they had access to the CHOICE tool.

“Prior to our trial, I thought people might spend less time choosing a plan when they had access to expert recommendations because it would make the process easier,” Bundorf said. “But taken together, these results suggest that people are more engaged in decision-making when they have access to a patient-centered tool.”

Polyakova, who is also a faculty fellow at SIEPR, said a key takeaway from the trial is that people who are likely to use sophisticated tools are already more likely be more sophisticated shoppers of health care and prescription plans.

President Trump caught the world by surprise once again yesterday with a decision not to sign a deal with his North Korean counterpart, Chairman Kim Jong-un, in Hanoi, Vietnam. While walking away is a common tactic in working-level negotiation, what happened in Hanoi was a rare case and the least expected outcome.

Read the full article on Axios.