Aging in America

Abstract: The Aging Society Index, a multidimensional measure of the status of older persons and the degree to which their societal context facilitates successful aging,  has thus far only been applied to developed countries. The current analysis examines the trends in scores on the Index between individual States in the US for the period 2002-2016 and evaluates the contributions of potential drivers of the substantial observed differences between States and over time. 

Jack Rowe, MD
Professor, Department of Health Policy & Management, Joseph Mailman School of Public Health, Columbia University
Adjunct Affiliate at the Center for Health Policy and the Center for Primary Care and Outcomes Research

Dr. John Rowe is the Julius B. Richmond Professor of Health Policy and Aging at the Columbia University Mailman School of Public Health.  Previously, from 2000 until his retirement in late 2006, Dr. Rowe served as Chairman and CEO of Aetna, Inc., one of the nation's leading health care and related benefits organizations.  Before his tenure at Aetna, from 1998 to 2000, Dr. Rowe served as President and Chief Executive Officer of Mount Sinai NYU Health, one of the nation’s largest academic health care organizations. From 1988 to 1998, prior to the Mount Sinai-NYU Health merger, Dr. Rowe was President of the Mount Sinai Hospital and the Mount Sinai School of Medicine in New York City.

Before joining Mount Sinai, Dr. Rowe was a Professor of Medicine and the founding Director of the Division on Aging at the Harvard Medical School, as well as Chief of Gerontology at Boston’s Beth Israel Hospital.  He was Director of the MacArthur Foundation Research Network on Successful Aging and is co-author, with Robert Kahn, Ph.D., of Successful Aging (Pantheon, 1998). Currently, Dr. Rowe leads the MacArthur Foundation’s Network on An Aging Society.

Dr. Rowe was elected a Fellow of the American Academy of Arts and Sciences and a member of the Institute of Medicine of the National Academy of Sciences. He serves on the Board of Trustees of the Rockefeller Foundation and is Chairman of the Board of Trustees at the Marine Biological Laboratory in Woods Hole, Massachusetts and the Board of Overseers of Columbia University’s Mailman School of Public Health. He is Chair of the Advisory Council of Stanford University’s Center on Longevity and was a founding Commissioner of the Medicare Payment Advisory Commission ( Medpac) and Chair of the Board of Trustees of the University of Connecticut. 

Are the Mentally Ill Rational? Evidence from Insurance Behavior
Eric Sun, MD, PhD
Assistant Professor in the Department of Anesthesiology, Pain and Perioperative Medicine

Eric Sun received his PhD in business economics from the University of Chicago Booth Graduate School of Business in 2006 and a MD from the University of Chicago Pritzker School of Medicine in 2010.  He then completed his residency in anesthesiology at Stanford University in 2014.  Currently, he is an Assistant Professor in the Department of Anesthesiology, Pain and Perioperative Medicine at Stanford University, where his research examines the economic effects of physician consolidation as well the economics of policies related to chronic pain.

Improvements in medical treatment have clearly contributed to significant increases in medical spending, yet there is relatively little quantitative evidence on whether the rise in expenditure is “worth it” in the sense of producing health outcomes of commensurate value. This seminar will focus on empirical research assessing the net value of health care for patients with chronic disease, using the case of type 2 diabetes mellitus. Based on analysis of detailed longitudinal, patient-level data, the collaborating researchers from Hong Kong, Japan, Taiwan, the Netherlands, and the US describe patterns in resource use and quality outcomes as measured by clinical markers and predicted risk of complications and death. In most of the studied cases, increases in spending were accompanied with improvements in outcomes of commensurate or greater value, given a range of values for a quality-adjusted life year. The authors conclude with a discussion of what the results imply about productivity of medical care, quality adjustment of price indices for healthcare, and policies for healthy aging in Asia (based on a forthcoming book).

Abstract: The American Lab, published by Johns Hopkins University Press in 2018, tells the story of the Lawrence Livermore National Laboratory (the Lab) from the events leading to its founding in 1952 through its transfer to private status in 2008 (after 66 years of sole University of California management). It highlights the important episodes in that journey beginning with the invention of Polaris, the first submarine launched ballistic missile, continuing through the Lab’s controversial role in the Star Wars program, and helping lead the development of the stockpile stewardship program after the cessation of nuclear testing. It describes the intense focus on-laboratory-scale thermonuclear fusion with early work in magnetic fusion to the world’s largest effort on laser fusion that ultimately resulted in the construction of the National Ignition Facility. It includes a number of smaller projects ranging from its participation in founding the Human Genome Project (and its subsequent effort in biodefense) to its array of activities on global climate and basic research. Throughout, the book emphasizes the national security environment in which the Lab existed and the increasing role of politics in “big science”.

Bio: C. Bruce Tarter is a theoretical physicist with a BS from MIT and a PhD from Cornell. He began as a researcher at the Lawrence Livermore National Laboratory in 1967 and eventually served as its Director from 1994-2002. Since that time as Director Emeritus he has served on a number of Boards and Task Forces including the National Academy study of the Comprehensive Test Ban Treaty and the Congressional Commission on the Strategic Posture of the United States. He is a Fellow of the American Physical Society and the American Association for the Advancement of Science.

The Longitudinal Study of Handgun Ownership and Transfer (LongSHOT)
David Studdert, LLB, ScD, MPH
Professor of Medicine
Professor of Law
Stanford University

The prevalence of civilian-owned guns in the US is the highest in the world, and the incidence of firearm-related injury is among the world’s highest.  Evidence that the relationship between these two phenomena is causal has grown, but still has major gaps.  We recently completed assembly of a large cohort of California residents.  Our goal is to assess firearm ownership as a risk factor for firearm-related mortality in this population.  The seminar will outline the project and describe results of some preliminary analyses.

David M. Studdert is a leading expert in the fields of health law and empirical legal research. His scholarship explores how the legal system influences the health and well-being of populations. A prolific scholar, he has authored more than 150 articles and book chapters, and his work appears frequently in leading international medical, law, and health policy publications.

Professor Studdert joined Stanford Law School faculty on November 1, 2013, in a joint appointment as Professor of Medicine (PCOR/CHP) and Professor of Law.

Before joining the Stanford faculty, Professor Studdert was on the faculty at the University of Melbourne (2007-13) and the Harvard School of Public Health (2000-06). He has also worked as a policy analyst at the RAND Corporation, a policy advisor to the Minister for Health in Australia, and a practicing attorney.

Professor Studdert has received the Alice S. Hersh New Investigator Award from AcademyHealth, the leading organization for health services and health policy research in the United States. He was awarded a Federation Fellowship (2006) and a Laureate Fellowship (2011) by the Australian Research Council. He holds a law degree from University of Melbourne and a doctoral degree in health policy and public health from the Harvard School of Public Health.

The Effects of U.S. School Shootings on Children’s Antidepressant Use

More than 220,000 American students have experienced a school shooting since the 1998 Columbine High massacre. School shootings are vastly more common in the U.S. than in any other developed country, and are becoming more frequent and deadly in recent years. While these events receive widespread media coverage and incite public debates, there is little empirical research quantifying their population-level mental health impacts. We combined data on 44 school shootings between January 2008 and April 2013 with data on antidepressant prescriptions filled at retail pharmacies between January 2006 and March 2015. We compared the number of antidepressants prescribed to children under age 20 by providers located in close proximity of a school that experienced a shooting (shooting-exposed area) to those prescribed to children by providers located slightly further away (reference group), both in the two years before and the two years after a shooting. The average number of monthly antidepressant prescriptions written to children was significantly higher in the shooting-exposed areas relative to the reference groups in the two years after a fatal shooting versus the two years before. The effect persisted when extending the post-shooting observation window to three years and was similar when using an alternative reference group of providers located in close proximity to observationally similar schools without a shooting. We found no significant effects on children’s antidepressant prescriptions following non-fatal shootings or on adult antidepressant use. Our results suggest that local exposure to fatal school shootings increases antidepressant use among children under 20 years old, a previously unmeasured cost of these events.

Maya Rossin-Slater
Assistant Professor of Health Research and Policy, Stanford University
Faculty Fellow, SIEPER
Faculty Research Fellow, NBER
Research Affiliate, IZA

Maya Rossin-Slater is an Assistant Professor of Health Research and Policy at Stanford University School of Medicine. She is also a Faculty Fellow at the Stanford Institute for Economic Policy Research (SIEPR), a Faculty Research Fellow at the National Bureau of Economic Research (NBER) and a Research Affiliate at the Institute of Labor Economics (IZA). She received her Ph.D. 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. 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.

This study focused on an important but often overlooked aspect of safety in medicine: physician safety. In China, patients may violently protest against doctors via disruptive behaviors when facing unsatisfying results, jeopardizing physicians’ security, affecting their diagnostic reasoning, and ultimately harming patient safety. We investigated the relationship between disruptive behaviors, government intervention, and protest results. Statistical analyses reveal that the ‘paying for peace’ mechanism can create distorted incentives for patients and encourage more riots. Efforts should be made to improve service quality and channel medical disputes into the legal framework.

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