FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.
FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.
Calling all Stanford students! Join us to learn about FSI's student opportunities during the summer. FSI has internship positions in policy organizations in over 15 countries. Our programs are fully-funded and mentored by FSI faculty. You will have the chance to speak directly to former interns.
Visit our website for more info: http://fsi.stanford.edu/studentprograms
OBJECTIVE We sought to validate risk equations for complications of type 2 diabetes (RECODe) among diverse populations.
RESEARCH DESIGN AND METHODS We compared risk predictions from RECODe equations and from two alternative risk models (UK Prospective Diabetes Study Outcomes Model 2 and ACC/AHA Pooled Cohort Equations) to observed outcomes in two studies: the Multi-ethnic Study of Atherosclerosis (MESA, n = 1,555 adults with type 2 diabetes, median follow-up 9.1 years) and the Jackson Heart Study (JHS, n = 1,746 adults with type 2 diabetes, median follow-up 8.0 years). Outcomes included nephropathy by multiple measures (microalbuminuria, macroalbuminuria, renal failure, end-stage renal disease, and reduction in glomerular filtration rate), moderate to severe diabetic retinopathy by Airlie House classification, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, congestive heart failure, and all-cause mortality.
OBJECTIVE Identifying patients who may experience decreased or increased mortality risk from intensive glycemic therapy for type 2 diabetes remains an important clinical challenge. We sought to identify characteristics of patients at high cardiovascular risk with decreased or increased mortality risk from glycemic therapy for type 2 diabetes using new methods to identify complex combinations of treatment effect modifiers.
RESEARCH DESIGN AND METHODS The machine learning method of gradient forest analysis was applied to understand the variation in all-cause mortality within the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (N = 10,251), whose participants were 40–79 years old with type 2 diabetes, hemoglobin A1c (HbA1c) ≥7.5% (58 mmol/mol), cardiovascular disease (CVD) or multiple CVD risk factors, and randomized to target HbA1c <6.0% (42 mmol/mol; intensive) or 7.0–7.9% (53–63 mmol/mol; standard). Covariates included demographics, BMI, HbA1cglycation index (HGI; observed minus expected HbA1c derived from prerandomization fasting plasma glucose), other biomarkers, history, and medications.
There is longstanding debate about the contribution of family planning programs to fertility decline. Studying the staggered introduction of family planning across Malaysia during the 1960s and 1970s, we find modest responses in fertility behavior. Higher (but not lower) parity birth hazards declined by one-quarter—but imply only a 5 percent decline in the overall annual probability of birth. Age at marriage rose by 0.48 years, but birth spacing conditional on this did not otherwise change. Overall, Malaysia’s total fertility rate declined by about one quarter birth under family planning, explaining only about 10 percent of the national fertility decline between 1960 and 1988. Our findings are consistent with growing evidence that global fertility decline is predominantly due to underlying changes in the demand for children.
The recent challenges to the Affordable Care Act (ACA), which has increased the number of individuals with health insurance in the United States but has had little effect on cost, has revived the debate about a single-payer health care system.1 Whether a single-payer system is the answer or not depends on what question is being asked and what form single payer will take. Single payer can take many forms, and many questions can be asked. This Viewpoint considers 3 problems of US health care: the uninsured, poor health outcomes (relative to other high-income countries), and high cost. In discussing cost, it will be critical to consider the form that a single-payer health care system might take.
The opioid epidemic has claimed more than 300,000 lives in the United States since 20001 and could claim another half million over the next decade. Although heroin and illicitly manufactured fentanyl account for an increasing proportion of opioid-involved overdoses, the majority of persons with opioid addiction started with prescribed painkillers.2 The search for solutions has spread in many directions, and one tentacle is probing the legal accountability of companies that supply opioids to the prescription market. Even as the federal government, among others, pursues civil and criminal actions against physicians and pharmacies to address inappropriate prescribing and dispensing of opioids, a variety of lawsuits have been filed and continue to be filed against opioid manufacturers and distributors.2
Objective: The purpose of this study was to evaluate the impact of objective isolation and loneliness on Medicare spending and outcomes. Method: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of social contacts and network) and loneliness (positive response to three-item loneliness scale) as predictors of subsequent Medicare spending. In multivariable regression adjusting for health and demographics, we determined marginal differences in Medicare expenditures. Secondary outcomes included spending by setting, and mortality. Results:Objective isolation predicts greater spending, US$1,644 (p < .001) per beneficiary annually, whereas loneliness predicts reduced spending, −US$768 (p < .001). Increased spending concentrated in inpatient and nursing home (skilled nursing facilities [SNFs]) care; despite more health care, objectively isolated beneficiaries had 31% (p < .001) greater risk of death. Loneliness did not predict SNF use or mortality, but predicted slightly less inpatient and outpatient care. Discussion: Objectively isolated seniors have higher Medicare spending, driven by increased hospitalization and institutionalization, and face greater mortality. Policies supporting social connectedness could reap significant savings.
This event has reached capacity. If you would like to be added to the waitlist, please contact Adreana at pinuelas@stanford.edu.
"Making Prescription Drugs Affordable: The National Academies of Sciences, Engineering and Medicine's Report"
In a recent poll, Americans ranked prescription drug prices as the most important domestic issue for Congress to tackle. Prescription drugs now account for 17% of national health care expenditures, and 1 in 4 Americans reports that they or a family member has decided not to fill a prescription or to skip or reduce doses in the past year because of cost worries. To investigate the causes of high drug costs and potential policy interventions, the National Academies of Sciences, Engineering and Medicine convened a committee of experts, which recently released its report. Dr. Mello, a member of the committee, will review the key findings and discuss factors that make the affordability of medicines such a difficult problem to solve.
Please note: All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.
Michelle Mello is Professor of Law at Stanford Law School and Professor of Health Policy in the Department of Health Policy at Stanford University School of Medicine. She conducts empirical research into issues at the intersection of law, ethics, and health policy. She is the author of more than 230 articles on medical liability, public health law, the public health response to COVID-19, pharmaceuticals and vaccines, biomedical research ethics and governance, health information privacy, and other topics.
The recipient of a number of awards for her research, Dr. Mello was elected to the National Academy of Medicine at the age of 40. From 2000 to 2014, she was a professor at the Harvard School of Public Health, where she directed the School’s Program in Law and Public Health.
Dr. Mello teaches courses in torts, public health law, and health policy. She holds a J.D. from the Yale Law School, a Ph.D. in Health Policy and Administration from the University of North Carolina at Chapel Hill, an M.Phil. from Oxford University, where she was a Marshall Scholar, and a B.A. from Stanford University.
The Asia Health Policy Program hosted jointly with the School of Medicine,
Health Research and Policy Department, Division of Epidemiology
Speaker bio: K.M. Venkat Narayan, MD, MSc, MBA. Is Ruth and O.C. Hubert Chair of Global Health, Director, Emory Global Diabetes Research Center and Professor of Medicine & Epidemiology at Emory University in Atlanta, USA. He was formerly, chief of the diabetes science branch at the US Centers for Disease Control and Prevention (CDC), and intramural scholar at the US National Institutes of Health (NIH). Noted for substantial, multidisciplinary work in diabetes, he has published more than 430 peer-reviewed papers, including several high-impact studies. Narayan’s work exemplifies his leadership in diabetes public health, and he is a member of the US National Academy of Medicine. His other honors include the American Diabetes Associations’ Kelly West award for outstanding achievement in epidemiology, Danish Diabetes Academy Visiting Professor award, Government of India, Nehru Chair 2016, Emory University’s Mentor of the Year award, and Marion Creekmore award for Internationalization.
Li Ka Shing Center, LK120
Stanford School of Medicine
"Accuracy of Time Measures Used to Value Surgical Procedures in the Medicare Physician Fee Schedule"
The American Medical Association’s Relative Value Scale Update Committee (RUC) has been called “the most important health care group you’ve never heard of”. It plays a central role in determining how much public and private insurers pay physicians for services. The RUC’s role and performance have been heavily criticized, but subjected to very little empirical evaluation. In a sample of the most common surgical procedures, we assessed the accuracy of a key ingredient of RUC valuations: procedure duration. We identify inaccuracies, and find that they have substantial distributional effects on payments to surgeons. On the other hand, we find that revaluations by the RUC tend to partially correct these inaccuracies, and detect no evidence of bias in the RUC’s choices of procedures to review.
Please note: All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.