Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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The U.S. Department of Health and Human Services (HHS) and the White House are currently reconsidering existing policy to manage “dual use research of concern” and research that would enhance potential pandemic pathogens, with expected new guidance in January. 

As biotechnology has advanced with remarkable speed and impact, so have the needs and demands for benefits, along with concerns about risks. Policy for managing these tradeoffs and mitigating risks has not kept up.

Today, two researchers at Stanford’s Freeman Spogli Institute for International Studies, David Relman and Megan Palmer, are among the co-authors on a Policy Forum article that appears in Science magazine, entitled Strengthen Oversight of Risky Research on Pathogens.”

The article calls for a series of specific measures to enhance U.S. policy and spur the development of policy elsewhere in the world to address the serious gaps and challenges of the current guidance framework.

The recommendations include:

  • The ‘dual use research of concern’ (DURC) framework should apply to all human pathogens, not just the 15 agents currently listed.
  • Improved review processes must evaluate the risk and potential consequences of accidents, theft or insider diversions.
  • Research proposals should be required to go through independent, government-led risk–benefit assessments to determine whether the work should proceed and under what conditions.
  • The U.S. government should seek nongovernmental expertise for the review process. Currently, the HHS process involves only governmental experts, and the identity of these individuals is not publicly available.
  • All U.S. agencies and institutions that fund work related to the enhancement of potential pandemic pathogens should have that work evaluated under the revised enhanced potential pandemic pathogens framework.

In addition to Relman and Palmer, the other co-authors are Jassi Pannu, Anita Cicero, and Tom Inglesby at the Johns Hopkins Center for Health Security, and Marc Lipsitch at the Harvard School of Public Health.

“It is vital to get these policies right, not only for the US, but to inspire policy development in other countries with growing life science and biotechnology sectors,” write the authors. “Few countries have policies that fully manage these issues.”

 

Media Contact: Ari Chasnoff, Associate Director for Communications, Freeman Spogli Institute for International Studies

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The White House in Washington D.C.
Q&As

At White House Summit on Bioeconomy, Work of Stanford Scholars Takes Major Leap Forward

With more funding and resources being allocated to America's biotech sector, CISAC affiliate Megan Palmer and core faculty member Drew Endy describe the opportunities and challenges of developing a more robust, ethical, and equitable bioeconomy.
At White House Summit on Bioeconomy, Work of Stanford Scholars Takes Major Leap Forward
Researchers examine medical vials
Commentary

5 Questions: David Relman on Investigating Origin of Coronavirus

Microbiologist David Relman discusses the importance of understanding how the coronavirus emerged.
5 Questions: David Relman on Investigating Origin of Coronavirus
The flag of Taiwan flies over a military monunment in Kinmen, Taiwan.
Commentary

Understanding the Stakes in Taiwan

Larry Diamond and Oriana Skylar Mastro join Michael McFaul on the World Class podcast to discuss China’s ambitions against Taiwan, and how the U.S. and its allies can deter Beijing.
Understanding the Stakes in Taiwan
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In Science magazine, Stanford researchers Megan Palmer and David Relman are among co-authors recommending a reset of U.S. and global policy
to address the gaps and challenges of current guidance.

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PhD

Trond is a futurist, scholar, podcaster, venture partner, nonresident Fellow at the Atlantic Council, co-founder of Yegii, and Lead Ecosystem evangelist at Tulip. He formerly worked with MIT, WPP, Oracle, and the EU. He’s a co-author (with Natan Linder) of Augmented Lean (Wiley 2022), an author of Health Tech (Routledge 2021), Future Tech (Kogan Page 2021), Pandemic Aftermath (Atmosphere Press 2020), Disruption Games (Atmosphere Press 2020), and Leadership From Below (Lulu Press 2008). In addition, he hosts two podcasts, Augmented and Futurized, and is a Forbes columnist. He holds a Ph.D. on the future of work and artificial intelligence.

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Steve Lohr
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When the family house in Devon, Pa., caught fire, Drew Endy, then 12, carried out his most cherished possession — his personal computer.

Years later, as a graduate student, Mr. Endy was accepted to Ph.D. programs in biotechnology and political science.

The episodes seem to sum up Mr. Endy, a most unusual scientist: part engineer, part philosopher, whose conversation is laced with references to Descartes and Dylan, as well as DNA.

He’s also an evangelist of sorts. Mr. Endy, a 51-year-old professor of bioengineering at Stanford University, is a star in the emerging field of synthetic biology. He is its most articulate enthusiast, inspiring others to see it as a path to a better world, a transformational technology to feed the planet, conquer disease and combat pollution.

Continue reading here

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Drew Endy is squarely focused on the potential of redesigning organisms for useful purposes. He also acknowledges significant challenges.

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Stephen Hummel, Paul Cruickshank, Don Rassler
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The Combating Terrorism Center at West Point interviews Drew Endy, Associate Chair, Bioengineering, Stanford University, who has served on the U.S. National Science Advisory Board for Biosecurity. He argues the United States urgently needs a bio strategy to take advantage of rapid advances in biotechnology, protect against the growing danger posed by its potential malevolent use, and prevent the United States from permanently falling behind as a biopower. “First, we need to demonstrate operational mastery of cells by learning to build them. Second and third, we need to build and secure the bio net. And we have to do this now, within the decade, so that we can translate these advances as infrastructure undergirding a uniquely American bio economy that projects power while advancing life, liberty, pursuit of happiness. If we do this, then we have a chance of taking infectious disease off the table. If we don’t develop and implement a coherent bio strategy, it’s game over, not to be dramatic.

Read the interview here

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Drew Endy argues the United States urgently needs a bio strategy to take advantage of rapid advances in biotechnology, protect against the growing danger posed by its potential malevolent use, and prevent the United States from permanently falling behind as a biopower.

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Pallabi is a staff member at the Sandia National Laboratories Livermore, California campus and supports the International Nuclear/Radiological Security program office. She currently coordinates activities related to the security of radioactive materials across a diverse set of partners including international and domestic government officials, other US government laboratories, NGOs, industry, and academia. Through her role, Pallabi also provides recommendations and develops innovative methods and approaches to enhancing awareness of radioactive material security.

Before joining Sandia, Pallabi completed the U.S. Department of Energy/National Nuclear Security Administration Graduate Fellowship Program with Defense Nuclear Nonproliferation’s Office of Radiological Security (ORS). Upon completing the fellowship in 2017, Pallabi joined ORS as a contractor, where she supported multiple international portfolios as a Program Manager. Her role at ORS played an integral role in molding her understanding of international nuclear and radiological security and developing an interest to continue exploring the nexus between science, technology, and policy.

Pallabi earned a Master of Science in Media, Communication and Development from the London School of Economics and Political Science (LSE) in 2014 and her interest within the field of international security emerged through her graduate studies, where she gained a broad perspective on development and security issues in the Global South. Prior to attending LSE, Pallabi completed her undergraduate studies at Cornell University’s School of Industrial and Labor Relations in 2013, where her concentration was in domestic labor policy and employment law. 

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Clifton B. Parker
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When David Relman learned in April that he was elected to the American Academy of Arts and Sciences, he was humbled – and a bit surprised. 

Relman is a senior fellow at the Center for International Security and Cooperation and the Thomas C. and Joan M. Merigan Professor and a professor of medicine and of microbiology & immunology. AAA&S honors exceptional scholars, leaders, artists, and innovators engaged in advancing the public good. 

When he received notification, Relman went to the organization’s web site to check on the discipline area and specialty with which he was affiliated. 

“I looked at the areas and specialties that pertained to my background and expertise (medical sciences, microbiology and immunology, other aspects of the biological sciences), but I could not find my name,” he said. “I thought that maybe the notification was in error.” Then he looked more closely at AAA&S’s letter, and found that his nominators had proposed the “public affairs and public policy section.” 

Arguably that distinction truly reflects Relman’s wide-ranging and serious policy impact in biosecurity, as well as his groundbreaking career work on the nature of the human indigenous microbiota (microbiome). AAA&S’ section of 220 policy luminaries includes former President Barack Obama, former Secretary of Labor Robert Reich, and former Secretary of State Madeleine Albright. Indeed, Relman’s extensive knowledge in microbiology and immunology has played key roles on several critical U.S. and international policy fronts – most recently, the pandemic. 

 Boundless curiosity 

“When you consider the history of the academy and its origins in 1780 during the American Revolution by John Adams and John Hancock, it’s really quite awe-inspiring. You’re joining those who follow in that history,” said Relman, who received an S.B. (Biology) from MIT, M.D. from Harvard Medical School, and joined the faculty at Stanford in 1994. 

Relman’s scholarship is characterized by boundless curiosity – he asks the deeper questions about the pandemic, about human-microbial relationships – both beneficial and harmful, and what they portend for humanity and the future of life on Earth. With grace and diligence, he’s explored the assembly, diversity, stability, and resilience of human microbial communities, while collaborating with other scholars and policy makers on issues paramount to humanity. 

“When I step back and think about the pandemic, it’s clear that it is about much more than just the virus, but also about the social, political, and environmental factors that contribute to the emergence and impact of such pathogens,” said Relman, currently director of a Biosecurity and Global Health initiative at FSI. 

Why do pandemics and more localized outbreaks arise, and how do they uniquely manifest themselves, he ponders. 

“What are the factors that underlie these events, and can we anticipate them better? We much consider three categories of factors: One, is the microbes themselves – and microbes evolve and find ways to do new things. The second category is the hosts – humans, plants, and animals. And humans are undertaking new activities as individuals and as populations that tend to make us more vulnerable, such as immune suppressing ourselves to treat cancer and autoimmune disorders and crowding ourselves into megacities. The third is environmental, and that relates to climate change, and our changing use of land, such as deforestation, intrusion into previously isolated habitats, and other factors,” Relman said. 

Intrusion into new habitats, making contact with animal hosts such as bats that harbor potential disease-causing microbes and viruses, and then bringing these potential pathogens into a lab where we manipulate and alter these agents can lead to human error and accidents, not without grave consequence. “The choices we make in an effort to understand the world around us all come with risk,” he said. 

As far as the microbes and viruses go, “transmissibility is the key,” Relman said. The COVID pandemic reinforced this view for him. 

“When you see what happens when a virus can travel around the globe so quickly, transmissibility has to be viewed as the critical attribute. Viruses evolve and can outrun anything that we might throw in their way, even when we’re already prepared. So, we have to be agile, quick, and shrewd, and we desperately need a far better public health system across the globe that can respond and implement needed measures much more quickly.” 

It’s not just drugs and vaccines and science when it comes to tackling a pandemic. “It’s the social factors, the political factors, and the willingness of humans to work together, and trust, respect and believing in each other. We’ve learned the hard way that this is a tall order. Sometimes we really don’t work together very well,” he said. 

Long-view perspectives 

Relman quotes Joshua Lederberg, a Nobel Prize-winning geneticist and Stanford professor on this age-old war between humanity and viruses: 

“The future of humanity and microbes likely will unfold as episodes of a suspense thriller that could be titled, ‘Our Wits Versus Their Genes,’” Lederberg wrote in an essay, “Infectious History,” in 2000. 

That perspective inspires Relman, who considers this suspense thriller with open eyes and an open mind – digging deeply into complex scientific challenges while understanding long-view perspectives. 

“If you step back in time and consider the history of this planet,” he said, “realize the Earth is about 4.6 billion years old. The earliest life forms we know of were microscopic organisms (microbes) that left signs of their presence in rocks at least 3.7 billion years ago. They have had literally billions of years to diversify, adapt, and secure niches – including on and in animals.” 

On the other hand, modern humans (homo sapiens) have been around for only 200,000 years. “So, we’ve basically been here for the last 3 or 4 seconds of a 24-hour period that started with the formation of Earth. Compare this to microbial life, which has been here for more than 19 hours of this 24-hour period, and will be continue to persist and evolve on this planet for far longer than humanity,” Relman said. 

Relman contemplates and studies the intricacies of the human-microbe relationship, and delves into the issue of how do “favorable” relationships become established, whose interests do they serve, and how can they be supported or restored? 

“This is fundamental to my laboratory work. And why do those relationships sometimes go off the rails? What causes an unusual turn of events such as pandemics? And in what ways and for what reasons do humans mess with these storylines and relationships with these microbes? Those are the puzzles and mysteries that intrigue me,” he said. 

Health equity is a major concern for Relman. Pandemics and public health crises invariably result in harsher consequences for underserved populations than more privileged ones. Many of these communities lack ready access to vaccines, treatments and safeguards, and suffer more disproportionate economic and social turmoil. This is true regardless of how a pandemic arises, including and especially those that might arise because of irresponsible or deliberately malevolent human activities. 

“Subsequent generations are going to be looking at how we’ve handled this pandemic across society, especially for the underserved,” Relman said. “We need to, and can do, much better on this front.” 

Relman was a long-time volunteer for the Rock Medicine program organized by the Haight Ashbury Free Clinics, a free health care service provider serving more than 34,000 people who need access to quality medical care. He served as the chief medical officer for the program for more than a decade. In the 1990s he was featured on MTV for his work providing free medical care at concerts through the program. “Don’t get me started on the dangers of mosh pits,” he once said

Scientific truth-telling 

A pioneer in his field, Relman’s research paper on bacillary angiomatosis and a method for the discovery of new pathogens was selected as “one of the 50 most important publications of the 

past century” by the American Society for Microbiology. In other research, ecological theory and predictions are tested in clinical studies with multiple approaches for characterizing the human microbiome. His work has led to the development of molecular methods for identifying novel microbial pathogens, and the subsequent identification of several historically important microbial disease agents. He was one of the first to characterize microbial diversity in the human body using modern molecular methods. Relman is also the Chief of Infectious Diseases at the Veterans Affairs Palo Alto Health Care System in Palo Alto, California, and served as science co-director at CISAC from 2013-2017. 

During the pandemic, scientific knowledge has been expressed in many ways – but political polarization in the U.S. has sometimes worked against crafting sound policy. 

Relman said, “All good scientists know what they’re good at. You need to be very mindful about what you know and what you don’t know. While people are pretty quick to say what they know, they’re not terribly quick to admit what they don’t know. This goes to the issue of ‘lanes’ and the roles of scientists in policy formulation.” 

Many scientists, he added, may think that scientific information alone determines the ultimate public policy. “But it’s only a piece of it. Lots of other factors go into policy, such as social, cultural, political, and economic considerations,” he said. 

National security policy 

Relman served as vice-chair of the National Academy of Sciences Committee that reviewed the science performed as part of the FBI investigation of the 2001 “Anthrax Letters.” He’s also been a member of the National Science Advisory Board on Biosecurity, and was president of the Infectious Diseases Society of America. He is currently a member of the Intelligence Community Studies Board and the Committee on Emerging Infectious Diseases and 21st Century Health Threats, both at the National Academies of Science, as well as the Science and Security Board of the Bulletin of Atomic Scientists and the Defense Science Board at the Pentagon. He received an NIH Pioneer Award, an NIH Transformative Research Award, and was elected a member of the National Academy of Medicine in 2011

He also chaired and led the work on the National Academies of Science 2020 report on “Havana syndrome,” cases of unexplained health disorders – aka, “anomalous health incidents” – among U.S. government personnel and their families at overseas embassies. Their findings pointed to a “plausible role of directed, pulsed radiofrequency energy,” though “no hypothesis has been proven, and the circumstances remain unclear.” 

Relman said, “I think that we’re going to be facing challenges like this one, that is, complex poorly-explained health problems at the interface of emerging science and national security, more frequently, and that’s what I’ve told our national leadership.” In the report, the scientists wrote, “We as a nation need to address these specific cases as well as the possibility of future cases with a concerted, coordinated, and comprehensive approach.” 

Megan Palmer, the executive director of the Bio Policy & Leadership Initiatives and Relman’s longtime colleague, said, “David is an exceptional scientist, mentor, colleague and friend. He is deeply thoughtful, especially about the role of science and scientists in society, and he is committed to work with integrity for the service of others. He is compelled to tackle the most difficult problems with great care, and he inspires others to follow suit. I am so grateful for his mentorship; he believes in and brings out the best in people.” 

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When David Relman learned in April that he was elected to the American Academy of Arts and Sciences, he was humbled – and a bit surprised.

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For spring quarter 2022, CISAC will be hosting hybrid events. Many events will offer limited-capacity in-person attendance for Stanford faculty, staff, fellows, visiting scholars, and students in accordance with Stanford’s health and safety guidelines, and be open to the public online via Zoom. All CISAC events are scheduled using the Pacific Time Zone. 

SEMINAR RECORDING

Virtual to Public. Only those with an active Stanford ID with access to William J Perry Conference Room in Encina Hall may attend in person. 

Dean Winslow
Seminars
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For spring quarter 2022, CISAC will be hosting hybrid events. Many events will offer limited-capacity in-person attendance for Stanford faculty, staff, fellows, visiting scholars, and students in accordance with Stanford’s health and safety guidelines, and be open to the public online via Zoom. All CISAC events are scheduled using the Pacific Time Zone. 

SEMINAR RECORDING

Virtual to Public. Only those with an active Stanford ID with access to William J. Perry Conference Room in Encina Hall may attend in person. 

Frances Butcher
Sigrid Lupieri
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Sigrid Lupieri
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Thousands of refugees and migrants became pawns at the border between Belarus and Poland in recent weeks. Many had flown to Belarus anticipating a route into the European Union but couldn’t proceed farther because of Poland’s hard-line policies barring them entry. A number of stranded migrants died of cold and a lack of access to food and health care.

Read the rest at Monkey Cage

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Countries like Belarus are counting on E.U. governments to see refugees as a security threat.

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Frances Butcher is a Ph.D. candidate at University of Oxford’s Ethox Centre and the Wellcome Centre for Ethics and Humanities. She is supported by a Wellcome Trust Fellowship for Health Professionals in Humanities and Social Science. Her research, which utilizes empirical ethics methodologies and explores ethical dimensions of global health security, looks at the definition and limits of what should be included in the global health security regime, and how this might effect good practice. Frances is also a Specialty Registrar (physician) in Public Health undertaking dual clinical-research training. During her training in the UK, she has worked in various roles including in clinical medicine and public health for Public Health England, the UK Health Security Agency, and NHS England. Frances has a medical degree from Brighton and Sussex Medical School, an MA in Bioethics and Society from King’s College London, and an MSc in Global Health Science from the University of Oxford. She was a 2022 Pre-Doctoral Fellow at CISAC and a 2019 Fellow on the Johns Hopkins Emerging Leaders in Biosecurity Program.

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