The decision by voters in Colorado and Washington state to legalize the recreational use of marijuana has “changed the rules of the game” for the administration of Mexican President-elect Enrique Peña Nieto in the U.S.-backed drug war, according to a report by the Washington Post’s William Booth.

Applying for a Rhodes Scholarship gave Margaret Hayden a chance to talk about her quest to better understand mental illness.

Hayden, whose older sister committed suicide after a sudden and severe depression, wrote in her essay that she "could not begin to craft a meaningful life without acknowledging and trying to understand her [sister's] experience."

In the spring quarter of her freshman year, she enrolled in a class on the anthropology of mental illness. Later, she began pursuing research related to mental illness, working with faculty at Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies.

Now a senior, Hayden is one of two Stanford students joining 30 other newly minted Rhodes Scholars from the United States who will receive full financial support to pursue degrees in England.

The Rhodes Scholarships are the oldest and most celebrated international fellowship awards in the world. Scholars are chosen for their outstanding scholarly achievements as well as their character, commitment to others and to the common good, and potential for leadership in whatever careers they choose.

Hayden, 21, of Brunswick, Maine, is majoring in human biology. She is writing an honors thesis in the Program in Ethics in Society, with an emphasis on the art and ethics of patient care. She plans to pursue a master's degree in medical anthropology at Oxford.

Margaret Hayden

Margaret Hayden

Her honors thesis, "The Ethical Implications of Biological Conceptions of Mental Illness and Personhood," explores the consequences of viewing mental illness as solely a matter of the brain.

In her Rhodes Scholarship application, Hayden said that approach to mental illness may alleviate responsibility from patients, but it also introduces troubling implications: What kind of person do you become when your brain is "broken?"

"It is here I envision my intellectual future – working at the interface of medicine, anthropology and ethics," she wrote. "Anthropology grounds my ethical investigations, because I believe that without the context of the everyday moral experiences of individuals, without attention to emotional, social and political setting, the practice of ethics risks becoming an abstract academic exercise with little relevance to the day-to-day struggles of real people trying to craft lives in this tenuous, unpredictable world. It is these people and their struggles that motivate my own intellectual ambitions."

Hayden is a co-author of "Parents' Perceptions of Benefit of Children's Mental Health Treatment and Continued Use of Services," published Aug. 1, 2012 in Psychiatric Services.

In one of her studies at Stanford Health Policy, she analyzed Latina women's perceptions of post-partum depression. In another, she assessed the success of a program to improve outcomes of low-birth-weight infants by analyzing the mothers' use of and attitudes toward a web-based information portal and social network.

Since the fall of 2010, Hayden has served as a patient advocate at the Mayview Community Health Center in Palo Alto. At the clinic, she conducted a research project on available mental health resources for clients. Since the fall of 2011, she has been a clinic coordinator at the center, serving as a liaison among student volunteers, Stanford program staff and clinic staff.

Hayden was a member of Stanford's varsity squash team and its varsity sailing team.

Hayden will be studying at Oxford with Rachel Kolb, '12, who is currently pursuing a master's degree in English at Stanford

Kolb, 22, of Los Ranchos, N.M., earned a bachelor's degree in English with honors and a minor in human biology in 2012 from Stanford.

Rachel Kolb

Rachel Kolb

Kolb, who was elected as a junior to Phi Beta Kappa, wrote an honors thesis titled, "Grains of Truth in the Wildest Fable: Literary Illustrations, Pictorial Representation, and the Project of Fantasy in Jane Eyre."At Oxford, Kolb plans to pursue a master's degree in contemporary literature and a master's degree in comparative social policy.

In her Rhodes Scholarship application, Kolb, who was born with a profound bilateral hearing loss, wrote: "As someone who understands the different forms communication can take, from spoken to sign language, I understand the value of flexibility in transmitting ideas.

"I see well-rounded, effective communication as essential to ideas, creativity and progress. I want to be a writer committed to exploring issues of access, equality and difference, and the nature of communication itself. Our world often does not know how to talk about these things, just as it does not know how to talk about disability, about differing abilities and strengths, distinct personal styles and challenges."

Kolb, who was active with Christian ministries, wrote a weekly opinion column for The Stanford Daily in 2011. She is the managing editor of Leland Quarterly, a campus literary magazine.

She is a member of the on-campus student advocacy group, Power to ACT: Abilities Coming Together, and was one of several students featured in a new video that welcomes students with disabilities to Stanford. The university's Office of Accessible Education released the video last month.

Kolb won several prizes for her writing at Stanford, including the Marie Louise Rosenberg Award for her honors thesis and the 2011 Creative Nonfiction Prize for her essay, "Seeing at the Speed of Sound."

Kolb is co-president of Stanford's equestrian team and represented the university at the 2010 and 2011 Intercollegiate Horse Show Association National Finals.

Kathleen J. Sullivan is a writer for Stanford's University Communications.

A government-backed panel of medical experts says everyone between the ages of 15 and 65 in the United States should be tested at least once in their lives for HIV, a policy that Stanford’s Douglas K. Owens says could have a substantial impact on the course of the epidemic.

Owens, a professor of medicine and director of Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies, is a member of the U.S. Preventive Services Task Force, which issued its draft recommendation on Nov. 19.

Currently, there are an estimated 1.2 million people in the nation infected with HIV, and some 20 to 25 percent of them aren’t aware they carry the virus that causes AIDS. If they were diagnosed, they could get into treatment programs, which would benefit them as well as helping to prevent the spread of the disease.

“We think it’s important for everyone to be screened once because treatment helps people live longer, healthier lives and also prevents transmission to others,” said Owens, who is also a senior investigator at the Veterans Affairs Palo Alto Health Care System.

Those at very high risk, including gay men and injection drug users, should be tested every year, while others considered at increased risk also should undergo repeat testing with the frequency depending on risk, the task force recommends. In addition, the panel said practitioners should screen all pregnant women for the virus; the practice, now common in this country, has helped virtually eliminate the incidence of mother-to-child transmission, Owens noted.

In 2005, the task force strongly recommended HIV screening in adolescents and adults considered at increased risk for HIV, but it stopped short of recommending a universal testing program.  The new recommendation for widespread screening reflects the changing world of AIDS science, Owens said.

For instance, studies have shown that an early diagnosis — even before symptoms begin to emerge — followed by effective antiretroviral treatment, can help prevent individuals from developing life-threatening complications. Moreover, HIV-infected individuals who are treated with antiretroviral drugs are much less likely to pass on the virus to others. A landmark study published in August 2011 and involving 1,763 heterosexual couples (in which one was HIV-positive and the other was not) found that treating the infected partner reduced his or her chance of transmitting the virus by 96 percent.

In addition, once people are diagnosed, they can be counseled about changing their behaviors to help prevent the spread of the disease. Observational studies have shown that people who know their HIV status are more likely to take precautions, for instance, by using condoms, avoiding sex with sex workers or having sex in exchange for money or drugs, the task force noted.

In 2006, the federal Centers for Disease Control recommended routine voluntary screening for everyone aged 13 to 64, but allowed them to opt out of testing. Many other professional groups, such as the American College of Physicians, also advise routine patient screening. Yet universal screening, followed by treatment, has never been achieved in this country.

Owens said the task force did consider the potential harms of screening and testing. One potential drawback is a false-positive test result, though the screening test is highly accurate, so this risk is quite small, he said. Treatment also may carry side effects, including the possibility of a slightly increased risk for heart problems. Stigmatization and labeling are other potential downsides of testing, he said.

But on balance, he said, “We feel the benefits are so substantial that they far outweigh the potential harm.”

He said the task force also emphasized the importance of prevention: “The best way to reduce HIV disease and death is to avoid becoming infected. So we want people to take actions to reduce their risk behaviors, such as using safe sex practices and avoiding other behaviors that put them at risk.”

The task force’s draft recommendation has been posted for public comment on its website at http://www.uspreventiveservicestaskforce.org. Comments can be submitted from Nov. 20 to Dec. 17 at www.uspreventiveservicestaskforce.org/tfcomment.htm. The panel then will finalize its recommendations, which will be published in the Annals of Internal Medicine.

Ruthann Richter is the director of media relations at the Stanford School of Medicine.

You’re in the supermarket eyeing a basket of sweet, juicy plums. You reach for the conventionally grown stone fruit, then decide to spring the extra dollar per pound for its organic cousin. You figure you’ve just made the healthier decision by choosing the organic product — but new findings from Stanford University cast some doubt on your thinking.

“There isn’t much difference between organic and conventional foods, if you’re an adult and making a decision based solely on your health,” said Dena M. Bravata, the senior author of a paper comparing the nutrition of organic and non-organic foods, in the Annals of Internal Medicine.

A team led by Bravata, a senior affiliate with Stanford’s Center for Health Policy, and Crystal Smith-Spangler, a Veterans Affairs physician fellow at the center, did the most comprehensive meta-analysis to date of existing studies comparing organic and conventional foods. They did not find strong evidence that organic foods are more nutritious or carry fewer health risks than conventional alternatives, though consumption of organic foods can reduce the risk of pesticide exposure.

The popularity of organic products, which are generally grown without synthetic pesticides or fertilizers or routine use of antibiotics or growth hormones, is skyrocketing in the United States. Between 1997 and 2011, U.S. sales of organic foods increased from $3.6 billion to $24.4 billion, and many consumers are willing to pay a premium for these products. Organic foods are often twice as expensive as their conventionally grown counterparts.

Although there is a common perception — perhaps based on price alone — that organic foods are better for you than non-organic ones, it remains an open question as to the health benefits. In fact, the Stanford study stemmed from Bravata’s patients asking her again and again about the benefits of organic products. She didn’t know how to advise them.

So Bravata, who is also chief medical officer at the health-care transparency company Castlight Health, did a literature search, uncovering what she called a “confusing body of studies, including some that were not very rigorous, appearing in trade publications.” There wasn’t a comprehensive synthesis of the evidence that included both benefits and harms, she said.

“This was a ripe area in which to do a systematic review,” said first author Smith-Spangler, who jumped on board to conduct the meta-analysis with Bravata and other Stanford colleagues.

For their study, the researchers sifted through thousands of papers and identified 237 of the most relevant to analyze. Those included 17 studies (six of which were randomized clinical trials) of populations consuming organic and conventional diets, and 223 studies that compared either the nutrient levels or the bacterial, fungal or pesticide contamination of various products (fruits, vegetables, grains, meats, milk, poultry, and eggs) grown organically and conventionally. There were no long-term studies of health outcomes of people consuming organic versus conventionally produced food; the duration of the studies involving human subjects ranged from two days to two years.

After analyzing the data, the researchers found little significant difference in health benefits between organic and conventional foods. No consistent differences were seen in the vitamin content of organic products, and only one nutrient — phosphorus — was significantly higher in organic versus conventionally grown produce (and the researchers note that because few people have phosphorous deficiency, this has little clinical significance). There was also no difference in protein or fat content between organic and conventional milk, though evidence from a limited number of studies suggested that organic milk may contain significantly higher levels of omega-3 fatty acids.

The researchers were also unable to identify specific fruits and vegetables for which organic appeared the consistently healthier choice, despite running what Bravata called “tons of analyses.”

“Some believe that organic food is always healthier and more nutritious,” said Smith-Spangler, who is also an instructor of medicine at the School of Medicine. “We were a little surprised that we didn’t find that.”

The review yielded scant evidence that conventional foods posed greater health risks than organic products. While researchers found that organic produce is 30 percent less likely to be contaminated with pesticides than conventional fruits and vegetables, organic foods are not necessarily 100 percent free of pesticides.

What’s more, as the researchers noted, the pesticide levels of all foods fell within the allowable safety limits. Two studies of children consuming organic and conventional diets did find lower levels of pesticide residues in the urine of children on organic diets, though the levels of urinary pesticides in both groups of children were below the allowable safety thresholds. Also, organic chicken and pork appeared to reduce exposure to antibiotic-resistant bacteria, but the clinical significance of this is unclear.

As for what the findings mean for consumers, the researchers said their aim is to educate people, not to discourage them from making organic purchases. “If you look beyond health effects, there are plenty of other reasons to buy organic instead of conventional,” noted Bravata. She listed taste preferences and concerns about the effects of conventional farming practices on the environment and animal welfare as some of the reasons people choose organic products.

“Our goal was to shed light on what the evidence is,” said Smith-Spangler. “This is information that people can use to make their own decisions based on their level of concern about pesticides, their budget and other considerations.”

She also said that people should aim for healthier diets overall. She emphasized the importance of eating of fruits and vegetables, “however they are grown,” noting that most Americans don’t consume the recommended amount.

In discussing limitations of their work, the researchers noted the heterogeneity of the studies they reviewed due to differences in testing methods; physical factors affecting the food, such as weather and soil type; and great variation among organic farming methods. With regard to the latter, there may be specific organic practices (for example, the way that manure fertilizer, a risk for bacterial contamination, is used and handled) that could yield a safer product of higher nutritional quality.

“What I learned is there’s a lot of variation between farming practices,” said Smith-Spangler. “It appears there are a lot of different factors that are important in predicting nutritional quality and harms.”

Other Stanford co-authors are Margaret Brandeau, the Coleman F. Fung Professor in the School of Engineering; medical students Grace Hunter, J. Clay Bavinger and Maren Pearson; research assistant Paul Eschbach; Vandana Sundaram, assistant director for research at CHP/PCOR; Hau Liu, clinical assistant professor of medicine at Stanford and senior director at Castlight Health; Patricia Schirmer, infectious disease physician with the Veterans Affairs Palo Alto Health Care System; medical librarian Christopher Stave; and Ingram Olkin, professor emeritus of statistics and of education.

The authors received no external funding for the study.

Michelle Brandt is the associate director of digital communications and media relations at the Stanford School of Medicine.

From Shanghai to São Paulo, people around the world are living longer than ever, challenging long-held ideas about retirement and well-established national retirement systems. Stanford health economists Karen Eggleston and Victor R. Fuchs offer an innovative view of the global aging phenomenon in an article published recently in the Journal of Economic Perspectives.

Drawing on a century of demographic data from 17 countries, Eggleston and Fuchs show that the share of increases in life expectancy realized after age 65 was only about 20 percent at the beginning of the 20th century but close to 80 percent by the dawn of the 21st century. Expected lifetime labor force participation as a percent of life expectancy is now declining. Eggleston and Fuchs share four interrelated responses to the economic and social challenges posed by this “new demographic transition:”

• Increase the retirement age.
• Encourage savings.
• Strengthen education.
• Emphasize healthy lifestyles early to ensure productivity in old age.

Eggleston is director of the Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center. Fuchs is Henry J. Kaiser, Jr., Professor Emeritus, in Stanford’s Department of Economics and Department of Health Research and Policy, and a senior fellow at FSI and SIEPR.

Of the four policy responses the article proposes, is one especially critical?

Fuchs: The most important solution in terms of its potential impact would be people changing their attitudes toward retirement. This would mean people postponing retirement and saving more during their working years. If you work five years longer, for example, you would have greater savings and a shorter period of time when you would need the money.

Eggleston: We tend to think of the solutions as being interrelated. To address this longstanding and inevitable global demographic transition, organizations and policy structures need to support changes in individual behavior. In the case of the retirement age in the United States and European countries, policymakers need to change the many incentives that encourage people to retire younger.

What do you most hope policymakers will take away from the article?

Fuchs: We hope they will recognize the absolute need for individuals and organizations to plan for later retirement.

What are the special challenges faced by China and India, the world’s largest populations?

Eggleston: Longer lives in China and India contribute to improved human development, yet population aging also brings special challenges. China’s population is aging more rapidly than India’s and both countries need to invest more in the education and health of their young people, especially in poor rural areas.

In India, nutrition and education will help to reap a one-time boost to economic growth if the large cohorts of the working age population can be productively employed, while building a foundation for sustained improvement of living standards. China’s youth need to be as productive as possible to support the elderly while continuing to improve the national living standard.

The coming decade will be crucial in China, as the country transitions into a new economic phase and expands its fledging social protection system. The goal should be to ameliorate disparities and protect the vulnerable, while maintaining a financially sustainable and culturally appropriate balance of government and family responsibility for old-age support.

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.