Society

FSI researchers work to understand continuity and change in societies as they confront their problems and opportunities. This includes the implications of migration and human trafficking. What happens to a society when young girls exit the sex trade? How do groups moving between locations impact societies, economies, self-identity and citizenship? What are the ethnic challenges faced by an increasingly diverse European Union? From a policy perspective, scholars also work to investigate the consequences of security-related measures for society and its values.

The Europe Center reflects much of FSI’s agenda of investigating societies, serving as a forum for experts to research the cultures, religions and people of Europe. The Center sponsors several seminars and lectures, as well as visiting scholars.

Societal research also addresses issues of demography and aging, such as the social and economic challenges of providing health care for an aging population. How do older adults make decisions, and what societal tools need to be in place to ensure the resulting decisions are well-informed? FSI regularly brings in international scholars to look at these issues. They discuss how adults care for their older parents in rural China as well as the economic aspects of aging populations in China and India.

Program in Human Biology, Building 20
Stanford University
Stanford, CA 94305-2160

(650) 723-2884 (650) 725-5451
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Professor (Teaching), Department of Pediatrics, and by courtesy in the Graduate School of Education
donald_barr.jpeg MD, PhD
Stanford Health Policy Associate
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(650) 723-5331 (650) 723-6450
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Irving Schulman, MD Endowed Professor in Child Health
Professor of Pediatrics and of Medicine
thomas-n-robinson-thumb.jpg MD, MPH

Thomas N. Robinson, MD, MPH is the Irving Schulman, MD Endowed Professor in Child Health, Professor of Pediatrics and of Medicine, in the Division of General Pediatrics and the Stanford Prevention Research Center at Stanford University School of Medicine, and Director of the Center for Healthy Weight at Stanford University and Lucile Packard Children's Hospital at Stanford. Dr. Robinson focuses on "solution-oriented" research, developing and evaluating health promotion and disease prevention interventions for children, adolescents and their families to directly inform medical and public health practice and policy.

His research is largely experimental in design, conducting school-, family- and community-based randomized controlled trials to test the efficacy and/or effectiveness of theory-driven behavioral, social and environmental interventions to prevent and reduce obesity, improve nutrition, increase physical activity and decrease inactivity, reduce smoking, reduce children's television and media use, and demonstrate causal relationships between hypothesized risk factors and health outcomes. Robinson's research is grounded in social cognitive models of human behavior, uses rigorous methods, and is performed in generalizable settings with diverse populations, making the results of his research more relevant for clinical and public health practice and policy.

His research is published widely in the peer-reviewed scientific literature. Robinson received both his B.S. and M.D. from Stanford University and his M.P.H. in Maternal and Child Health from the University of California, Berkeley. He completed his internship and residency in Pediatrics at Children's Hospital, Boston and Harvard Medical School, and then returned to Stanford for post-doctoral training as a Robert Wood Johnson Clinical Scholar. Robinson joined the faculty at Stanford in 1993, was appointed Assistant Professor in 1996, and promoted to Associate Professor with tenure in 2003. He was a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar, was a member of the Institute of Medicine's Committees on Prevention of Obesity in Children and Adolescents and Progress in Preventing Childhood Obesity, and is Principal Investigator on numerous prevention studies funded by the National Institutes of Health. Dr. Robinson also is Board Certified in Pediatrics, a fellow of the American Academy of Pediatrics, and practices General Pediatrics at Lucile Packard Children's Hospital at Stanford.

Stanford Health Policy Associate

Sequoia Hall, Room 228 
390 Serra Mall 
Stanford, CA 94305 

Assistant: Bonnie Chung 
bchung@stanford.edu

(650) 725-2241 (650) 725-6951
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Professor of Biomedical Data Science, Emeritus
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Professor Olshen is a Fellow of The Institute of Mathematical Statistics, The American Statistical Association, The American Association for the Advancement of Science, and The Institute of Electrical and Electronics Engineers.  He is an elected member of the International Statistical Institute. He has been a Guggenheim Fellow and the recipient of a Research Scholar in Cancer Award from the American Cancer Society. His interests include the development of statistical methods for prediction and the assessment of accuracy. He is one of the developers of CARTª binary tree-structured methods for classification, regression, and probability class estimation and of their extensions to survival analysis and clustering. In collaboration with others, he has studied these algorithms theoretically and has applied them to the computer-aided diagnosis of heart attack, as well as to making prognoses for patients with lymphoma, extracting features of organic compounds that tend to make them ulcerogenic, to data compression and the automated detection attempt to find the genes that predispose to hypertension, and to the definition of health states in health services research. His current research also involves the development of parsimonious models for describing longitudinal data, especially as they apply to understanding autoimmune disease of the kidney. Typically, these consist of the sum of an overall mean function and subject-specific coefficients of suitably smoothed eigenfunctions of residuals. In the past, he collaborated with Alan Garber in developing technologies for tracking cholesterol longitudinally in time and quantifying the accuracy of findings. Their ideas are now finding wide-ranging application.

Stanford Health Policy Associate

Stanford University School of Medicine
1000 Welch Road, Suite #203
Palo Alto, CA 94304-1808

(650) 723-5906 (650) 723-9656
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Berthold and Belle N. Guggenhime Professor of Medicine, Emeritus
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Halsted Holman is the Berthold and Belle N. Guggenhime Professor of Medicine, Emeritus, and a CHP/PCOR associate. He was Chairman of the Department of Medicine and Director of the Clinical Scholar Program (CSP) at Stanford. His major research interests include the design, organization, and evaluation of experimental health care systems, studies of the effects of patient education programs on health outcomes in chronic disease, and inquiry into the roles of patients in clinical trials and clinical practice. He is a former President of the American Society for Clinical Investigation and the Western Association of Physicians.

Stanford Health Policy Associate

Crown Quad, #333
Stanford, California 94305-8610

(650) 723-2517
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Deane F. and Kate Edelman Johnson Professor of Law
hank_greely.jpg JD

Professor Greely's work has focused on the legal aspects of the health care financing system. His interests include the incentives for employers and insurers to discriminate among possible insured consumers and the legality of such discrimination. He is also interested in broad issues of health reform, in quality assurance, in practice guidelines, and in bioethics. He has also been increasingly active in the intersection of law and the revolution in genetics, including notably through his role as a co-director of the Stanford Program in Genomics, Ethics, and Society, as co-director of the Stanford Program in Law, Science, and Technology, as a member of the California State Commission on Human Cloning, and as a member of the Human Genome Diversity Project.

Stanford Health Policy Associate

VA Palo Alto Health Care System Medical Service (111) 3801 Miranda Avenue Palo Alto, CA 94304;

Encina Commons, 615 Crothers Way Room 210, Stanford, CA 94305-6006

(650) 493-5000,,1,,1,62105
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Professor, Health Policy
Professor, Medicine (by courtesy)
mary_goldstein_profile.jpg MD, MS

 

Mary K. Goldstein is a Professor of Health Policy and a core faculty member at the Department of Health Policy and the Center for Health Policy, and the Director of the Geriatrics Research Education and Clinical Center (GRECC) at the VA Palo Alto Health Care System. She directs the Primary Care Policy and Practice Advancement program at PCOR, the Stanford/VA Palo Alto Geriatric Medicine Fellowship Program, and the Special Fellowship Program in Advanced Geriatrics at VA Palo Alto. She also serves as associate director for the Physician Post-Residency Fellowship Program in Health Services Research and Development, and for the Postdoctoral Fellowship in Medical Informatics, both at VA Palo Alto Health Care System.

Goldstein studies innovative methods of implementing evidence-based clinical practice guidelines for quality improvement. She leads the ATHENA Decision Support System project that has developed and implemented an automated clinical decision support system for primary care clinicians, using hypertension as a model, and now extended into several other clinical domains.  Goldstein's research also explores older adults' health preferences (health utility) for application to cost-effectiveness analysis.

Goldstein is a fellow of the American Geriatrics Society, and an emerita of the Society's board of directors. Goldstein has received a number of honors and awards including an Advanced Career Development award from the Department of Veterans Affairs Health Services Research and Development (HSR&D) program.  She received a BA in philosophy and an MD, both from Columbia University, and completed her residency in family medicine at Duke University Medical Center. At the Stanford School of Medicine she completed an AHRQ-funded fellowship and an MS in health services research.

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Because the optimal level of medical malpractice liability depends on the incentives provided by the health insurance system, the rise of managed care in the 1990s may affect the relationship between liability reform and defensive medicine. In this paper, we assess empirically the extent to which managed care and liability reform interact to affect the cost of care and health outcomes of elderly Medicare beneficiaries with cardiac illness. Malpractice reforms that directly reduce liability pressure - such as caps on damages - reduce defensive practices both in areas with low and with high levels of managed care enrollment. In addition, managed care and direct reforms do not have long-run interaction effects that are harmful to patient health. However, at least for patients with less severe cardiac illness, managed care and direct reforms are substitutes, so the reduction in defensive practices that can be achieved with direct reforms is smaller in areas with high managed care enrollment. We consider some implications of these results for the current debate over the appropriateness of extending malpractice liability to managed care organizations.

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Working Papers
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NBER
Authors
Daniel P. Kessler
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Context: Helicobacter pylori commonly infects humans; however, its mode of transmission remains unknown.

Objective: To determine how humans-the primary host for H pylori-shed the organism into the environment.

Design: Controlled clinical experimental study conducted from February through December 1998.

Setting: Clinical research unit of a hospital in northern California.

Patients: Sixteen asymptomatic H pylori-infected and 10 uninfected adults.

Intervention: A cathartic (sodium phosphate) and an emetic (ipecac) were given to all infected subjects and an emetic was given to 1 uninfected subject.

Main Outcome Measure: Confirmed H pylori isolates cultured from stool, air, or saliva before and after catharsis and emesis and from vomitus during emesis. Isolates were fingerprinted using repetitive extragenic palindromic (REP) polymerase chain reaction and species identity was confirmed by sequencing the 16s ribosomal RNA gene.

Results: All vomitus samples from infected subjects grew H pylori, often in high quantities. Air sampled during vomiting grew H pylori from 6 (37.5%) of the 16 subjects. Saliva before and after emesis grew low quantities of H pylori in 3 (18.8%) and 9 (56.3%) subjects, respectively. No normal stools and only 22 (21.8%) of 101 induced stools grew the organism, although 7 (50.0%) of 14 subjects had at least 1 positive culture (2 stool culture samples were contaminated by fungus and were not included). Fingerprints of isolates within subjects were identical to one another but differed among subjects. No samples from uninfected subjects yielded H pylori.

Conclusions: Helicobacter pylori can be cultivated uniformly from vomitus and, occasionally, from saliva and cathartic stools. The organism is potentially transmissible during episodes of gastrointestinal tract illness, particularly with vomiting.

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Journal of the American Medical Association
Authors
Julie Parsonnet
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Health care report cards - public disclosure of patient health outcomes at the level of the individual physician and/or hospital - may address important informational asymmetries in markets for health care, but they may also give doctors and hospitals incentives to decline to treat more difficult, severely ill patients. Whether report cards are good for patients and for society depends on whether their financial and health benefits outweigh their costs in terms of the quantity, quality, and appropriateness of medical treatment that they induce. Using national data on Medicare patients at risk for cardiac surgery, we find that cardiac surgery report cards in New York and Pennsylvania led both to selection behavior by providers and to improved matching of patients with hospitals. On net, this led to higher levels of resource use and to worse health outcomes, particularly for sicker patients. We conclude that, at least in the short run, these report cards decreased patient and social welfare.

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NBER
Authors
Daniel P. Kessler
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