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.

CHP/PCOR’s three new faculty members bring a varied background in behavioral health economics, law and children’s health outcomes

By Teal Pennebaker

Three researchers, whose work spans the globe as well as disciplines, have joined CHP/PCOR.  They include a health law professor, a physician economist interested in how behavioral issues influence patient outcomes, and another physician economist who will focus on health economic issues among children in developing countries.

“We are thrilled to welcome Marcella Alsan, David Studdert, and David Chan to our centers. Each of these folks fit into our centers' mission to produce rigorous relevant research by people who care deeply about the topics they probe,” CHP/PCOR Executive Director Kathryn McDonald said. “We credit the current community of scholars at Stanford with attracting these talented individuals to join forces with us.”

Professor David Studdert has spent the past six years at the University of Melbourne’ Law School teaching and studying policy issue at the intersection of health and legal systems.  His most recent research has investigated the relationship between speeding tickets and auto accidents, how patient complaints can be used as indicators health care quality, and how claimants move through workers’ compensation systems.

“David is one of the leading scholars in the world in health law and we are fortunate to have him join our faculty,” CHP/PCOR Director Doug Owens said. “David’s recruitment provides a terrific opportunity to expand our policy work, and his research will serve as the nucleus for joint training and research with our colleagues in the law school.”

Studdert, who will spend a quarter of his time at Stanford Law School, plans to focus on regulatory “hot spotting” in the short term—an approach that uses statistical profiling techniques to make regulation more efficient in areas ranging from medical malpractice to road safety. “There’s a lot going on in health care regulation in the United States,” Studdert said. “I hope to be able to collaborate with others at PCOR--it’s a very exciting, bright group of researchers with plenty of areas of mutual interest.”

Studdert has actually worked with CHP/PCOR members before—he was at RAND in the late 1990s while CHP/PCOR Professor Jay Bhattacharya was there. Similarly, CHP/PCOR’s newest faculty Marcella Alsan and David Chan have actually spent ample time together—before coming to Stanford, they did the same internal medicine residency program at the Brigham Women’s in Boston. Both Chan and Alsan will also practice medicine at the Veteran Affairs hospital part-time as is the case for some of the other clinical faculty members at CHP/PCOR. 

“We are delighted that we were able to recruit two exceptional physician economists to our centers,” Owens said. “Marcella brings deep understanding of global health from her training in infectious diseases along with the methodologic skills of an economist.  It is a rare combination and will enable her to make exceptional contributions in understanding the interplay of health and economics in the developing world. "  

Assistant Professor Marcella Alsan, who has a PhD in economics, a master’s in public health and a medical degree, will focus her research on policy questions in international health, particularly among children in developing countries.  Right now she’s finishing up a project looking at the spillover effects for the siblings and family members of children participating in a large-scale immunization program in Turkey. Alsan is also in the midst of revising a job market paper about how disease affects long-term economic development of Africa. 

“I’m a researcher, a physician and a past global health resident at Brigham and Women's hospital. All of that fits in best here at CHP/PCOR. Stanford is a stellar academic institution and has a growing global health and development community,” Alsan said. “At PCOR, they do excellent research and have wide interests. There isn’t pressure to be narrowly focused on one topic or one publication style.”

Assistant Professor David Chan, who has a PhD in economics and training in internal medicine, will focus on how behavioral issues impact productivity in health care systems. 

"Dave is uniquely trained to study the productivity of  healthcare systems.  Given the extraordinary need to reduce costs and provide high-value care, we believe Dave’s work on health care productivity will be enormously important in understanding some of the most difficult challenges for medicine today," Owens said.

Chan’s current work includes studying the impact of whether doctors choosing which patients they see affects their patients’ health outcomes; the effects on patients’ health outcomes if a doctor sees them at the beginning or end of the doctor’s shift; and whether providing doctors financial incentives—e.g. linking the number of ultrasounds a doctor gives out to their pay—impacts patient health outcomes.

“The environment at the centers is just great for someone who’s multidisciplinary. It’s a small place but surrounded by so many great partners within walking distance -- the business school, economics department, Stanford Institute for Economic Policy Research (SIEPR), the computer science department, and so on,” Chan said.  “It’s great to be back in California. I even bought a bike—I’ve never really ridden a bike this much!”