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.

The government’s far-reaching health care foreign aid program has contributed to a significant decline in adult death rates in Africa, according to a new study by Stanford researchers. 

Between 2004 and 2008, the U.S. President’s Emergency Plan for AIDS Relief was associated with a reduction in the odds of death of nearly 20 percent in the countries where it operated. The researchers found that more than 740,000 lives were saved during this period in nine countries targeted by the program, known by its acronym, PEPFAR.

“We were surprised and impressed to find these mortality reductions,” said Eran Bendavid, an affiliate at Stanford Health Policy, part of the university’s Freeman Spogli Institute for International Studies.

“While many assume that foreign aid works, most evaluations of aid suggest it does not work or even causes harm,” said Bendavid, an assistant professor of medicine at Stanford’s School of Medicine. “Despite all the challenges to making aid work and to implementing HIV treatment in Africa, the benefits of PEPFAR were large and measurable across many African countries.”



The study is the first to show a decline in all causes of death related to the program. It appears in the May 16 issue of the Journal of the American Medical Association.

Bendavid is the lead author of the study. It was co-authored by Grant Miller and Jay Bhattacharya, who are both core faculty members of Stanford Health Policy and associate professors of medicine. The study was funded by the National Institutes of Health and the Dr. George Rosenkranz Prize for Health Care Research in Developing Countries.

PEPFAR began in 2003 under the Bush administration with a five-year, $15 billion investment in fighting AIDS around the world and a focus on treatment and prevention in 15 countries. It was reauthorized by Congress in 2008 and has expanded its reach to 31 countries.

To measure the impact of the program, Bendavid and his colleagues analyzed health and survival information for more than 1.5 million adults in 27 African countries, including nine countries where PEPFAR has focused its efforts. The researchers examined data available in the Demographic and Health Surveys, a USAID-funded project that involves a representative sampling of in-person interviews among women in which they discuss their health and the health of their family members. These surveys form the foundation of many health measurements in developing countries.

They found the odds of death from any cause among adults were 16 to 20 percent lower in the PEPFAR-targeted countries.

To bolster the results, the scientists did a separate analysis using specific data on PEPFAR programs in Rwanda and Tanzania. They compared regions of the two countries where PEPFAR’s investments led to widespread increases in the number and size of sites providing antiretroviral therapy, with areas where PEPFAR had fewer services available.



“We observed a similar reduction in mortality when exploring PEPFAR’s effects using a different lens,” Bendavid said.

In Tanzania, the odds of death were found to be 17 percent lower and in Rwanda 25 percent lower in the districts with greater support from PEPFAR.

Bendavid speculates that the program’s commitment to building an infrastructure that includes drug distribution systems, clinics, pharmacies, laboratories and testing facilities has been an important factor for its success.

“The scale of PEPFAR’s investment was unprecedented,” Bendavid said. “People working in PEPFAR’s focus countries describe working supply chains, stocked pharmacies and staffed clinics.”



Although the program was targeted to address HIV, these services could have benefitted patients with a variety of other health concerns. For example, one study found that some uninfected, pregnant women in Ethiopia, Rwanda and Tanzania chose to deliver their babies in facilities supported by PEPFAR, Bendavid said.

Some have argued that focusing resources on a specific disease, such as AIDS, may detract efforts from other diseases and activities, undermining some of the benefits of such programs. But the latest study does not support this argument. Rather, it suggests that PEPFAR helped prevent additional deaths from causes other than HIV/AIDS.

“Whether disease-specific programs like PEPFAR have synergies with other health improvement efforts – or instead undermine them, as some have worried – is really an open question,” Miller said. “There are reasons to think either scenario is possible, and more research is needed. We don’t find much evidence of PEPFAR undercutting other initiatives. If anything, we see hints of synergies.”



Bendavid said the program managed to accomplish the reduction in mortality in the face of enormous challenges – from persuading people to go for HIV testing and treatment to dealing with problems of drug shortages and drug resistance.

Historically, few other large-scale health initiatives have succeeded to such an extent. Smallpox, which was eradicated by 1979, is among the rare and more notable examples.

“PEPFAR’s success with HIV … may be considered the clearest demonstration of aid’s effectiveness in recent years,” the researchers concluded.

In 2009, PEPFAR was folded into a new Global Health Initiative that calls for a broader agenda, with some resources redistributed to other programs, such as maternal and child health.

Its budget, which rose dramatically in the early years, has remained relatively flat or declined slightly since then. It peaked at $6.8 billion in fiscal year 2010, then declined to $6.7 billion and $6.6 billion in fiscal years 2011 and 2012, respectively, according to figures from the Kaiser Family Foundation. The Obama administration’s budget request for the 2013 fiscal year is $6.4 billion.

While the program appears to have had an impact within a few years of its implementation, Bendavid noted that reduced investments in fighting AIDS, both through PEPFAR and other international aid programs, could have implications for the future of the epidemic.

“We are transforming the face of the epidemic but funding shortfalls will change the road ahead,” he said.



Ruthann Richter is Director of Media Relations for the Stanford School of Medicine.