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It’s one thing to receive an award. It’s another to have it handed to you by a Supreme Court justice who also happens to be a friend.

Gerhard Casper, Stanford’s ninth president, was presented with the American Law Institute’s distinguished service award by Justice Ruth Bader Ginsburg last month during the organization’s annual meeting.

Ginsburg and Casper became friends three decades ago when they both served as directors of the American Bar Foundation. They remained close and worked together as members of ALI’s council.

Casper, a senior fellow at Stanford’s Freeman Spogli Institute for International Studies and expert on constitutional law, served 30 years on the council. His ideas led to the creation of the Young Scholars Medal and he recently served on the three-member search committee for ALI’s new director, Richard Revesz.

Ginsburg noted the award is reserved for those “who are contributors supreme to the well-being of the institute.” Referencing “The Winds of Freedom,” Casper’s latest book on the challenges he faced as Stanford’s president, Ginsburg called him a “prominent and uncommonly successful leader in the academic world.”

“What makes the American Law Institute so unique is that it provides a place for the intelligent, rational discussion of important issues without the polarization that characterizes so much of our legislative discourse,” Casper said.

While the occasion was formal, the exchange between Casper and Ginsburg could not have been more personal.

After a hug, Casper thanked his friend for presenting him with the award.

“Justice Ginsburg,” he began. “I have known her as Ruth for 30 years and she is still Ruth to me. And I love you, Ruth. I am moved to tears.”

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Abstract:

The United States spends over 17 percent of GDP on health care; the next six highest countries spend over 11 percent. This six percent differential indicates an excess spending of approximately one trillion dollars per year. Depending on the benefit from the extra spending, this suggests the possibility of a huge misallocation of resources. Also, because the federal government funds almost half of total health care spending, there are significant effects on the deficit and the debt. The main reasons for the excess are (1) the U.S. pays higher prices for drugs, devices, and equipment and higher fees to specialists and sub-specialists; (2) higher administrative costs; and (3) a more expensive mix of medical care. The seminar will focus on institutional and political explanations for the three proximate reasons.

 

Speaker Bio:

Victor R. Fuchs is the Henry J. Kaiser Jr Professor Emeritus at Stanford University, in the Departments of Economics and Health Research and Policy.  He is also a Research Associate of the National Bureau of Economic Research and a Senior Fellow at SIEPR.  He applies economic analysis to social problems of national concern, with special emphasis on health and medical care.  He is author of nine books, the editor of six others, and has published over two hundred papers and shorter pieces.  His current research focuses on male-female differences in mortality, reform of medical education, and the future of U.S. health care.

His best known work, Who Shall Live?  Health, Economics, and Social Choice (1974; expanded edition 1998, 2nd expanded edition 2011), helps health professionals and policy makers to understand the economic and policy problems in health that have emerged in recent decades.  Other books include The Service Economy (1968), How We Live (1983), The Health Economy (1986), Women’s Quest For Economic Equality (1988), and The Future of Health Policy (1993).  He is the editor of Individual and Social Responsibility: Child Care, Education, Medical Care, and Long-term Care in America (1996).

Professor Fuchs was elected president of the American Economic Association in 1995.  He has also been elected to the American Philosophical Society, the American Academy of Arts and Sciences, the Institute of Medicine of the National Academy of Sciences, and is an Honorary Member of Alpha Omega Alpha.  He has received the John R. Commons Award, Emily Mumford Medal for Distinguished Contributions to Social Science in Medicine, Distinguished Investigator Award (Association for Health Services Research), Baxter Foundation Health Services Research Prize, and Madden Distinguished Alumni Award (New York University).  ASHE’s (American Society of Health Economists) Career Award for Lifetime Contributions to the Field of Health Economics and the RAND Corporation prize for the Best Paper published in the Forum for Health Economics and Policy are named and awarded in honor of Professor Fuchs.

This event is sponsored by the Stanford Center on Democracy, Development and the Rule of Law and the Center for Health Policy/Center for Primary Care and Outcomes Research.

 

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Victor Fuchs the Henry J. Kaiser Jr Professor Emeritus Speaker Stanford University
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Andres Moreno is not just unearthing the genetic backgrounds of many Latin Americans and Caribbeans. He’s also making sense of the history of this region, and piecing together a clearer genetic medical history of understudied populations. By looking at the genetic history of Mexicans, Cubans, Puerto Ricans, Dominicans, Hondurans and Colombians, Moreno’s research unearths these populations’ ties to Europe, native tribes and Africans, and serves as a way to understand the waves of migration in these populations.

And he’s able to do much of this work because of the Dr. George Rozenkranz Prize for Health Care Research in Developing Countries, given out by the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR) to a promising young researcher.

“The Rosenkranz Prize is such a unique opportunity to promote the work of some of Stanford’s most promising young investigators,” CHP/PCOR Director Douglas K. Owens, also a senior fellow at the Freeman Spogli Institute for International Studies and a professor of medicine, said. “We’ve had researchers from within our centers, and with Andres we have a Rosenkranz recipient who’s thinking about international health from a completely new angle for CHP/PCOR.”

The $100,000 prize is given to young Stanford researchers focusing on how to improve health care access in developing countries. The award’s namesake, George Rozankranz, first synthesized cortisone in 1951, and later progestin (the active ingredient in oral birth control pills). He went on to establish the Mexican National Institute for Genomic Medicine, and his family created the Rosenkranz Prize in 2009.

“The Rosenkranz Prize has allowed me to build research independence upon original ideas and collaborative efforts initiated in different regions throughout Latin America and the Pacific,” Moreno said. “These efforts are paving the way to conduct population and medical genomics research in populations from developing regions traditionally underrepresented in large-scale genetic projects.”

Moreno continued: “This is only the beginning though. There is much to do to bridge the gap between developed and developing countries in terms of biomedical research, so funding opportunities like the Rosenkranz Award are essential to tackle this problem.”

As part of this work, Moreno published article in PLOS Genetics in November 2013, with two more anticipated in 2014.

“In this publication we especially wanted to focus on people in the Caribbean,” Moreno said. “We felt that this region has been understudied in terms of genetic complexity, and wanted to know which part of Africa, Europe and a Native American tribal genes existed. And its implications for medicine.”

In understanding a person’s genetic history, a doctor can determine whether a patient has gene variants that correlate with a disease. For example, because Ashkenazi Jewish women have an increased likelihood of having breast and ovarian cancer, their health providers are more likely to monitor for these cancers. 

Moreno’s advisor and co-author on the PLOS papers, Stanford Genetics Professor Carlos Bustamente, described Moreno’s work on this project: “Andres was extraordinary in putting the data all together, developing algorithms and doing simulation work,” he said. Moreno would seek to understand the implications of their findings, think through how this would affect their design of the next round of experiments and  “translate it into future genetic studies and interpretation of genomes that come into the clinic.”

The findings also tell a historical story of the region. In the Caribbean, Moreno and his co-authors were able to pinpoint where in Africa particular segments of the population had come from and when they contributed to the genetic pool. The first wave of Africans came from the western tip of Africa (present day Senegal and Gambia), a region that was an original contributor for all African slaves. But another strand of African heritage also emerged in their studies—from Africa’s gold coast (Nigeria and the Gulf of Guinea). Moreno explained, “We can now genetically pinpoint when and where ancestry came from in Africa.”

Moreno said in looking at the populations, a major difference was between the genetic heritage of the island and mainland populations. In the case of the four islands, there were very consistent results of roughly the same date of European genes—about 500 years ago, which, Moreno pointed out, is exactly when colonization happened.

But in the mainland areas, Moreno and colleagues didn’t find European lines until two generations later, meaning Europeans first settled in the islands and then moved to the mainland.

Similarly, the Native American strands are distinct. Moreno and his co-authors believe that the Native American genes among the Caribbean populations are from inland Amazon tribes—a completely different Native American background than what’s typically found among Native American descendants in the United States.

Bustamente said Moreno has great breadth, commanding the whole operation—sampling in the field, collecting the data in the lab, doing the data scrubbing and analysis. Each of these tasks is typically undertaken by a different person. “He does all of this—and it gives him a real edge,” Bustamente said. “He thinks in a very integrated fashion. Plus he’s an MD!”

Kathryn McDonald, executive director for CHP/PCOR, said Moreno’s work represents the essence of the Rosenkranz Prize. “We really wanted this award to reach all angles of the Stanford health policy research community, and Andres embodies this. He’s expanding our understanding of health care and predisposition for diseases in a host of developing countries. It’s exciting—and such important—work.”

Teal Pennebaker is a freelance writer.

 

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Andres Moreno is studying the DNA of indigenous groups and cosmopolitan populations living in Mexico, South America and the Caribbean.
Rod Searcey
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There has been much policy focus on reducing readmissions, however it is unclear what the hospital response to this will be. Preliminary data from the Centers for Medicare and Medicaid Services shows that readmissions have declined significantly. We evaluate the extent that this represents real reductions versus misclassification 

Background: Cancer is the second leading cause of death in the United States and disproportionately affects elderly patient populations. Many describe poor quality of life and experience, unnecessary suffering, and treatment options with little benefit. Additionally, many elderly patients with cancer also are less likely to receive a full diagnosis or engage in shared-decision making. No studies have evaluated the influence of health coaches and shared-decision making tools on patient and caregiver experiences and receipt of goal concordant care.

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Political and economic transition is often blamed for Russia’s 40% surge in deaths between 1990 and 1994 (the “Russian Mortality Crisis”). Highlighting that increases in mortality occurred primarily among alcohol- related causes and among working-age men (the heaviest drinkers), this paper investigates a different explanation: the demise of the 1985-1988 Gorbachev Anti-Alcohol Campaign. We use archival sources to build a new oblast-year data set spanning 1970-2000 and find that:

  • The campaign was associated with substantially fewer campaign year deaths,
  • Oblasts with larger reductions in alcohol consumption and mortality during the campaign experienced larger transition era increases, and
  • Other former Soviet states and Eastern European countries exhibit similar mortality patterns commensurate with their campaign exposure.

The campaign’s end explains between 32% and 49% of the mortality crisis, suggesting that Russia’s transition to capitalism and democracy was not as lethal as commonly suggested.

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American Economic Journal: Applied Economics
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Grant Miller
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