The world’s leading economic policymakers are “on the right track” to ensure a global financial upturn, the chief of the International Monetary Fund told a Stanford audience on Tuesday.

But she warned the recovery will be derailed without the creation of more jobs, better education systems and a way to shrink the gap between rich and poor. And she cautioned against the potential pitfalls of untested exchanges and digital currencies such as Bitcoin.

“We are on the right track, but we need to ask – the right track to where? And the right track to what growth?” said Christine Lagarde, the IMF’s managing director. “Will it be solid, sustainable, and balanced – or will it be fragile, erratic, and unbalanced? To answer this question, we need to look at the patterns of economic activity in the years ahead, and especially the role of technology and innovation in driving us forward.”

Lagarde’s visit to Stanford was co-sponsored by the Freeman Spogli Institute for International Studies and the Stanford Institute for Economic Policy Research. In addition to delivering public remarks at FSI’s Bechtel Conference Center, Lagarde met privately with faculty and students during the day.

Just returning from the G-20 summit in Sydney, Lagarde said she is optimistic that the world’s economic leaders are committed to taking the steps that will guard against another large-scale financial collapse. She said the G-20 members agreed to complete a set of financial reforms by the end of this year, a move that will make the “financial sector safer and less likely to cause crisis.”

She said the member countries and their central banks have also agreed to better cooperate and be more transparent in their policymaking.

But she’s worried that unless more sustainable jobs are created, economic disparities will increase. And that, she said, will “harm the pace and sustainability of growth over the long term.”

As technology has helped create a more interconnected world, it is playing an increasing role in the economic landscape. Machines have made our lives easier. Artificial intelligence has led to cars that can drive themselves, robots that can do things in place of humans and smartphones that are more powerful than the first supercomputers.

But so far, there’s been no measure of how new technology has increased productivity.

“We certainly need to keep an eye on this,” she said. “One of the biggest worries is how this technological innovation affects jobs. Put simply: will machines leave workers behind?”

She said technology creates “huge rewards for the extraordinary visionaries at the top, and huge anxieties for workers at the bottom.”

Lagarde said it is up to educators to better prepare the next generation of workers.

“Educational systems are not keeping pace with changing technology and the ever-evolving world of work,” she said. “We need to change what people learn, how people learn, when people learn, and even why people learn. We must go beyond the traditional model of students sitting in classrooms, following instructions and memorizing material. Computers can do that.”

Instead, humans must “outclass computers” in cognitive, interpersonal and sophisticated coding skills, she said.

“Think of creative jobs, caring jobs, jobs that entail great craftsmanship – imagination,” she said. “And given the rate and pace of change, we will need the ability to constantly adapt and change through lifelong learning.”

She called on institutions such as Stanford to play a key role in the process.

“Stanford’s model of education was innovative from the very first day—co-educational, non-denominational, and always practical, focusing on the formation of cultured and useful citizens,” she said. “Stanford was ahead of its time back then. I know that it will continue to be ahead of its time as we venture into the exciting period ahead.”

But that exciting period carries with it uncertainty and risk.

Asked about the role that emerging digital currencies such as Bitcoin could have on the evolving economy, Lagarde was skeptical, calling it a “shaky and wobbly” system.

The currency’s trading website went offline this week, spooking investors and calling into question Bitcoin’s future.

“It’s a glamorous, sexy attractive new system,” she said. “But a monetary system is a public good. It has to be supervised and sufficiently regulated so it is accountable. At this point in time, I think Bitcoin is outside that perimeter of both supervision and regulation.”

Lagarde is the 11th managing director of the IMF, and the first woman to lead the 188-country organization. Since she took over the organization in 2011, she has played a role in the world’s most pressing financial matters, working on solutions to a sluggish global economy and the debt crises in Europe.

The IMF gives both policy advice and financing to countries in difficult economic situations. It also helps developing countries reduce poverty and become more economically stable. 

The organization is now poised to assist Ukraine, which is at risk of running out of money to pay its bills in the midst of a political crisis. The country is struggling to cobble together a temporary government in the wake of President Viktor Yanukovych leaving Kiev and being removed from power.

But until a provisional government is formed, the country cannot technically ask for help. When it does, Lagarde said the IMF will send “technical assistance.”

“We are ready to engage,” she said.

Genetic mapping has led scientists to a better understanding of human disease and how to fight ailments like diabetes, mental illness and cancer.

But the information they have to work with is limited, drawing mostly from the DNA of people with European bloodlines. When it comes to figuring out how genetic disorders affect groups who don’t share that ancestry or have only trace amounts of it in their family histories, researchers are often at a loss.

Andres Moreno is changing that. Thanks to the $100,000 he is receiving as this year’s recipient of the George Rosenkranz Prize for Health Care Research in Developing Countries, the Stanford researcher will analyze the DNA of indigenous groups and cosmopolitan populations living in Mexico, South America and the Caribbean.

The data he gathers will lay the groundwork for scientists interested in knowing how genetic diseases take hold and manifest themselves among Latin Americans – one of the most underrepresented populations in the field of genetics.

“We can’t start talking about how to deliver personalized medicine in Latin America because we still have much to learn about their genetic makeup at the population level,” said Moreno, a research associate at School of Medicine’s genetics department.

“We need to draw the genetic map that will allow us to better understand the genetic basis of multiple conditions that lead to major health problems in Latin America,” he said.

Scientists have found numerous genetic variants linked to complex traits among people with European backgrounds, and that connection has allowed doctors to better treat and prevent diseases in that group.

But without a rich database built on the DNA of people whose family trees are rooted in Latin America, researchers have yet to find the genetic key to explain why descendants of region’s indigenous populations are predisposed to particular conditions.

Obesity, for example, is more prevalent in Mexico than in other parts of the world, Moreno said.

“We need to find population-specific gene variants that don’t exist anywhere else but locally,” he said. “Then we can maybe find the gene behind obesity there.”

Other conditions may be addressed by studying locally adapted populations, such as those living at high altitude in the Andes where pregnant women have a five-fold higher rate of maternal hypertension than the native population.

“We are trying to identify the genetic variants underlying the mechanisms for this protection, which may help to design preventive and therapeutic measures worldwide,” Moreno said.

Stanford’s Center for Health Policy, a center of the university’s Freeman Spogli Institute for International Studies, administers the Rosenkranz award that will fund Moreno’s work. The prize was created in 2007 to foster the research of a young Stanford scholar committed to improving health care in developing countries and reducing health disparities across the globe.

The first recipient was Eran Bendavid, an assistant professor of medicine and a CHP associate.

“We believe Andres’ work will deepen our understanding of the genetics of disease across populations, and we are delighted to recognize his important scientific contributions,” said Douglas Owens, director of the Center for Health Policy, the Henry J. Kaiser, Jr. Professor in the School of Medicine and an FSI senior fellow.

The Rosenkranz prize was established by the friends and family of Dr. George Rosenkranz, the scientist who helped first synthesize Cortizone in Mexico in 1951.

Rosenkranz, who lives in Menlo Park, also synthesized the active ingredient for the first oral birth control and served as a CEO of Syntex, a Mexican pharmaceutical company.

In addition to Owens, members of the award selection committee included: Donald Kennedy, president emeritus of Stanford; Rosamond Naylor, the William Wrigley Senior Fellow at FSI and Stanford’s Woods Institute for the Environment; Paul Yock, the Martha Meier Weiland Professor in the medical school; and Michele Barry, the medical school’s senior associate dean of global health and director of the Center for Innovation in Global Health.

A once-a-day pill to help prevent HIV infection could significantly reduce the spread of AIDS, but only makes economic sense if used in select, high-risk groups, Stanford researchers conclude in a new study.

The researchers looked at the cost-effectiveness of the combination drug tenofovir-emtricitabine, which was found in a landmark 2010 trial to reduce an individual’s risk of HIV infection by 44 percent when taken daily. Patients who were particularly faithful about taking the drug reduced their risk to an even greater extent – by 73 percent.

The results generated so much interest that the Stanford researchers decided to see if it would be cost-effective to prescribe the pill daily in large populations, a prevention technique known as pre-exposure prophylaxis, or PrEP.

They created an economic model focused on gay men, as they account for more than half of the estimated 56,000 new infections annually in the United States, according to the Centers for Disease Control and Prevention.

“Promoting PrEP to all men who have sex with men could be prohibitively expensive,” said Jessie Juusola, a PhD candidate in management science and engineering in the School of Engineering and first author of the study. “Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank.”

For instance, using the pill in the general population of gay men would cost $495 billion over 20 years, compared to $85 billion when targeted to those at particularly high risk, the researchers found. The study will be published in the April 17 issue of the Annals of Internal Medicine.

Senior author Eran Bendavid, an affiliate of Stanford Health Policy at the Freeman Spogli Institute, said the results are a departure from a previous study. Earlier research found PrEP was not cost-effective when compared with other commonly accepted prevention programs.

The new Stanford study differs in a few important respects, taking into consideration the decline in transmission rates over time as more individuals take the pill. The Stanford team also assumed individuals would stop taking PrEP after 20 years, not stay on the drug for life, as the previous study had assumed.

The pill combination, marketed under the brand name Truvada, is widely used for treating HIV infection. But it wasn’t until a landmark trial, published in the New England Journal of Medicine in November 2010, that individuals and their doctors began to seriously consider using the drug as a preventive therapy. The drug’s maker, Foster City, Calif.-based Gilead Sciences Inc., has filed a supplemental new drug application to market it for prevention purposes.

The CDC issued interim guidelines on the drug’s use in January 2011, suggesting that if practitioners prescribe it as a preventive measure, they regularly monitor patients for side effects and counsel them about adherence, condom use and other methods to reduce their risk of infection.

In developing their model, the Stanford researchers took into account the cost of the drug – about $26 a day, or almost $10,000 a year – as well as the expenses for physician visits, periodic monitoring of kidney function affected by the drug, and regular testing for HIV and sexually transmitted diseases.

“We’re talking about giving uninfected people a drug that has some toxicities, so it’s crucial to have them monitored regularly,” said Bendavid, who is an assistant professor of medicine in Stanford’s School of Medicine.

Without PrEP, the researchers calculated there would be more than 490,000 new infections among gay men in the United States in the next 20 years. If just 20 percent of these men took the pill daily, there would be nearly 63,000 fewer infections.

However, the costs are substantial. Use of the drug by 20 percent of gay men would cost $98 billion over 20 years; if every man in this group took PrEP for 20 years, the costs would be a staggering $495 billion.

Given these figures, the researchers looked at the option of giving PrEP only to men who are at high risk – those who have five or more sexual partners in a year. If just 20 percent of these high-risk individuals took the drug, 41,000 new infections would be prevented over 20 years at a cost of about $16.6 billion.

At less than $50,000 per quality-adjusted life year gained (a measure of how long people live and their quality of life), that strategy represents relatively good value, according to Juusola.

“However, even though it provides good value, it is still very expensive,” she said. “In the current health care climate, PrEP’s costs may become prohibitive, especially given the other competing priorities for HIV resources, such as providing treatment for infected individuals.”

She said the costs could be significantly reduced if the pill is found to be effective when used intermittently, rather than on a daily basis. Current trials are examining the effectiveness of the drug when used less often.

Other co-authors are Margaret L. Brandeau, the Coleman F. Fung Professor of Engineering, and Douglas K. Owens, the Henry J. Kaiser, Jr. Professor at Stanford and senior investigator at the Veterans Affairs Palo Alto Health Care System. Owens also is director of Stanford’s Center for Health Policy and Center for Primary Care and Outcomes Research.

The study was funded by the National Institutes of Health and the Department of Veterans Affairs and supported by Stanford’s departments of Medicine and Management Science and Engineering.

Young Stanford researchers focusing on improving health care access in developing countries are eligible for the Dr. George Rosenkranz Prize.

The $100,000 award is given to a non-tenured professor, post-doctoral student or research associate during a two-year period. The deadline to apply is May 11. The recipient will be announced in early June

Rosenkranz, who helped first synthesize Cortisone in 1951 and went on to synthesize progestin  – the active ingredient for the first oral birth control – dedicated his career to improving health care access around the world. Born in Hungary in 1916, the chemist started his career in Mexico and helped establish the Mexican National Institute for Genomic Medicine. He lives with his wife in Menlo Park.

The award is being funded by the Rosenkranz family and administered by Stanford Health Policy, a center within the Freeman Spogli Institute for International Studies and the Center for Primary Care and Outcomes Research. It also is designed to give its recipients access to a network that will help them develop their careers.

Eran Bendavid, a SHP affiliate and Stanford Medical School instructor, received the first award in 2010 to support his analysis of whether money going to HIV and malaria programs in sub-Saharan Africa has improved the overall health of children and their mothers.

More application information is available at http://healthpolicy.stanford.edu/fellowships/rosenkranz_prize.