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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Whole World on Fire, by CISAC associate director for research Lynn Eden, received the 2004 Robert K. Merton Professional Award from the Science, Knowledge and Technology section of the American Sociological Association. The award was presented to Eden on Aug. 15 during the association's annual meeting in San Francisco.

The award committee cited the book's merits:

"Whole World on Fire is an ambitious undertaking that examines a critical problem using theory and methods from two fields of sociology: the sociology of science and technology and the sociology of organizations. It is a study of how organizational processes led nuclear scientists to drastically underestimate the damage of a nuclear attack. At a deeper level, it is a study in the social construction of organizational knowledge.

"The question Eden addresses is: How and why, for more than half a century, did the U.S. government fail to predict nuclear fire damage as it drew up plans to fight strategic nuclear war? Eden's research shows that U.S. efforts focused on the damage that would result from the explosion while systematically ignoring the far more damaging effects of subsequent fires. How and why could this 'ignorance' continue until today? . . .

"This book takes a position on an ongoing scientific controversy about the predictability of fire damage and on scientists' current assessments of risk. There is a debate in science and technology studies about whether we should take positions on scientific controversies--that is, on the science itself. Some scholars prefer to leave arguments about the 'science' to the scientists and instead follow the activities and political logics of the various debating parties. In this case, Eden chooses to take a stand on the truth claims of the science in question. As such, Whole World on Fire is a work of intellectual daring.

"To our knowledge, there have been few sociological studies that have penetrated the inner workings of the military establishment. Few sociologists have studied the highest reaches of the social structure, as does Eden in this study. In fact, those of us who study science and medicine usually do our research in university-based laboratories or teaching hospitals--that is, we study people who are in some senses like ourselves.

"While the book addresses a critical issue--that is, nuclear-weapons policy, it is an exemplar of how sociological concepts can illuminate important public issues. Eden's analysis can be readily applied to explaining how decision makers construct relevant and legitimate science to illuminate disasters such as the collapse of the Twin Towers. But what convinced one committee member of the book's power was a recent New York Times article describing the findings of the committee investigating the Iraq War. The Committee reported that the CIA had systematically denied the credibility of numerous reports that Iraq's weapons of mass destruction did not exist, in part because those reports were outside its organizational frame.

"Finally, we all believe that this book will have a major public impact. In addition to its accessible style and meticulous research, the book is often riveting and sometimes chilling. We had thought that by now everyone believed that survivable nuclear war is an oxymoron; that people had filled in their bomb shelters long before the close of the Cold War. That a significant portion of the military establishment still believes that a limited, winnable and survivable nuclear war is possible gave us nightmares. That Eden's book may give people nightmares is only appropriate, given the frightening scenario she presents."

Serving on the award committee were Renee Anspach, Department of Sociology, University of Michigan; Sydney Halpern, Department of Sociology, University of Illinois at Chicago; Kathryn Henderson, Department of Sociology, Texas A&M University; and Joan Fujimura (Chair), Department of Sociology and Robert F. and Jean E. Holtz Center for Science and Technology Studies, University of Wisconsin-Madison.

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Richard E. Behrman Professor of Child Health and Society
Senior Fellow, Freeman Spogli Institute for International Studies
rsd15_081_0253a.jpg MD, MPH

Dr. Paul Wise is dedicated to bridging the fields of child health equity, public policy, and international security studies. He is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics, Division of Neonatology and Developmental Medicine, and Health Policy at Stanford University. He is also co-Director, Stanford Center for Prematurity Research and a Senior Fellow in the Center on Democracy, Development, and the Rule of Law, and the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Wise is a fellow of the American Academy of Arts and Sciences and has been working as the Juvenile Care Monitor for the U.S. Federal Court overseeing the treatment of migrant children in U.S. border detention facilities.

Wise received his A.B. degree summa cum laude in Latin American Studies and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children’s Hospital in Boston. His former positions include Director of Emergency and Primary Care Services at Boston Children’s Hospital, Director of the Harvard Institute for Reproductive and Child Health, Vice-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital and Harvard Medical School and was the founding Director or the Center for Policy, Outcomes and Prevention, Stanford University School of Medicine. He has served in a variety of professional and consultative roles, including Special Assistant to the U.S. Surgeon General, Chair of the Steering Committee of the NIH Global Network for Women’s and Children’s Health Research, Chair of the Strategic Planning Task Force of the Secretary’s Committee on Genetics, Health and Society, a member of the Advisory Council of the National Institute of Child Health and Human Development, NIH, and the Health and Human Secretary’s Advisory Committee on Infant and Maternal Mortality.

Wise’s most recent U.S.-focused work has addressed disparities in birth outcomes, regionalized specialty care for children, and Medicaid. His international work has focused on women’s and child health in violent and politically complex environments, including Ukraine, Gaza, Central America, Venezuela, and children in detention on the U.S.-Mexico border.  

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Some years ago, I spent a sabbatical year as a fellow at Stanford’s Center for Advanced Study in the Behavioral Sciences, doing research and finishing a book. A group of psychologists met each week at the center to discuss and (mostly) argue about stigmas and stereotypes, seeking to understand how the social responses to people with disabilities influenced their self-images.

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Speaker's Biography: Richard Garwin is IBM Fellow Emeritus at the Thomas J. Watson Research Center, Yorktown Heights, New York. After three years on the faculty of the University of Chicago, he joined IBM Corporation in 1952, and was until June 1993 IBM Fellow at the Thomas J. Watson Research Center, Yorktown Heights, New York; Adjunct Research Fellow in the Kennedy School of Government, Harvard University; and Adjunct Professor of Physics at Columbia University. In addition, he is a consultant to the U.S. government on matters of military technology, arms control, etc. He has been Director of the IBM Watson Laboratory, Director of Applied Research at the IBM Thomas J. Watson Research Center, and a member of the IBM Corporate Technical Committee. He has also been Professor of Public Policy in the Kennedy School of Government, Harvard University. From 1994 to 2004 he was Philip D. Reed Senior Fellow for Science and Technology at the Council on Foreign Relations, New York.

He has made contributions in the design of nuclear weapons, in instruments and electronics for research in nuclear and low-temperature physics, in the establishment of the nonconservation of parity and the demonstration of some of its striking consequences, in computer elements and systems, including superconducting devices, in communication systems, in the behavior of solid helium, in the detection of gravitational radiation, and in military technology. He has published more than 500 papers and been granted 45 U.S. patents. He has testified to many Congressional committees on matters involving national security, transportation, energy policy and technology, and the like. He is coauthor of many books, among them Nuclear Weapons and World Politics (1977), Nuclear Power Issues and Choices (1977), Energy: The Next Twenty Years (1979), Science Advice to the President (1980), Managing the Plutonium Surplus: Applications and Technical Options (1994), Feux Follets et Champignons Nucleaires (1997) (in French with Georges Charpak), and Megawatts and Megatons: A Turning Point in the Nuclear Age? (2001) (with Georges Charpak).

He was a member of the President's Science Advisory Committee 1962-65 and 1969-72, and of the Defense Science Board 1966-69. He is a Fellow of the American Physical Society, of the IEEE, and of the American Academy of Arts and Sciences; and a member of the National Academy of Sciences, the Institute of Medicine, the National Academy of Engineering, the Council on Foreign Relations, and the American Philosophical Society. In 2002 he was elected again to the Council of the National Academy of Sciences.

His work for the government has included studies on antisubmarine warfare, new technologies in health care, sensor systems, military and civil aircraft, and satellite and strategic systems, from the point of view of improving such systems as well as assessing existing capabilities. For example, he contributed to the first U.S. photographic reconnaissance satellite program, CORONA, that returned 3 million feet of film from almost 100 successful flights 1960-1972.

He has been a member of the Scientific Advisory Group to the Joint Strategic Target Planning Staff and was in 1998 a Commissioner on the 9-person "Rumsfeld" Commission to Assess the Ballistic Missile Threat to the United States. From 1993 to August 2001, he chaired the Arms Control and Nonproliferation Advisory Board of the Department of State. On the 40th anniversary of the founding of the National Reconnaissance Office (NRO) he was recognized as one of the ten Founders of National Reconnaissance. In June, 2002, he was awarded la Grande Medaille de l'Academie des Sciences (France)-2002.

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Dr. Richard L. Garwin Senior Fellow Science and Technology Council on Foreign Relations, NY
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Reuben W. Hills Conference Center, 2nd floor, Encina Hall East

Vipin Gupta Sandia National Laboratory Speaker
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As Mozambique enters its tenth year of peace following a brutal and destructive civil war, the signs of continued democratic transformation and pro-market economic reform appear rosy, at least at first glance. Donors and the international community have quietly lauded Joaquim Chissano's recent announcement that he is "not disposed" to seek a third term as president of this former Portuguese colony of 17 million on the southeast coast of Africa. Together with President Frederick Chiluba's similar announcement in Zambia a few months ago, it looks to many like an indication that these two African democracies are maturing and consolidating the gains that they have made in recent years.

Mozambique's continued place atop the list of the world's fastest-growing economies has been seen as another signal that commitment to the "Washington Consensus" will provide the funds required to bring infrastructure, schools, and health care to the rural majority. It is no wonder, then, that Mozambique finds itself highlighted as a success story for the United Nations in conflict-ridden Africa. Many credit Mozambique's remarkable transformation to the UN's efforts to sustain the drawn-out peace negotiations, demobilize more than 90,000 soldiers, rebuild a unified national army, and foster the rise of a legitimate, peaceful opposition. Donor investments continue to support Mozambique today, funding more than half of the government's annual budget.

On the ground in Mozambique, however, the continuation of this upward trajectory looks anything but guaranteed. The newspapers hint at trouble just beneath the surface: two major bank failures, the assassination of the country's most respected independent journalist, the continued depreciation of the currency, and stop-and-start talks between the Frente de Libertação de Moçambique (or Frelimo, as the ruling party is usually called) and its main political rival, the Resist^encia Nacional Moçambicana (Renamo), about how to share power at the local level. In November 2000, when police in the city of Montepuez killed demonstrators challenging the government's claim to have won that year's national elections, tensions nearly exploded into large-scale violence. 1

The UN's work in Mozambique was unprecedented in scope, and the results have been dramatic. Two consecutive free elections and growth rates approaching 10 percent a year over the past decade cannot be ignored. Some might argue that the items of bad news cited above are merely "bumps on the road" toward lasting peace, as Mozambicans of all stripes learn to resolve problems through dialogue and democratic competition. But a deeper look at Mozambique's political and economic situation suggests a bleaker interpretation.

The truth is that a number of deep cleavages threaten the future of Mozambique's democratic transition. What are these fundamental divisions? And more importantly, how can the political system be reformed in order to prevent them from worsening or even erupting into renewed civil war? A search for answers should begin with some basic background on Mozambique and its troubled recent history.

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The horrifying events of 11 September 2001 serve notice that civilization will confront severe challenges in the twenty-first century. As national security budgets expand in response, we should recognize that only a broad conception of security will be adequate to meet some of the threats that we may face. Biological security provides a powerful example. It must address both the challenge of biological weapons and that of infectious disease. The right approach should benefit public health even if major acts of biological terrorism never occur. Our thinking about biological security must transcend old misplaced analogies to nuclear and chemical security.

Nuclear security has been based on nonproliferation, deterrence, and defense, with intelligence woven throughout. Nonproliferation seeks to prevent the diversion of materials from civilian programs to military or terrorist weapons. Should nonproliferation fail, the United States relies on deterrence through the threat of retaliation. Defense, active or civil, has so far been less central.

Effective biological security requires a different mix. For all its challenges, nuclear nonproliferation is comparatively robust, in part because the production of weapons-usable uranium or plutonium provides a conspicuous bottleneck through which any nuclear program must pass, unless those materials are stolen. This is why preventing nuclear theft is such a high priority in the post-Cold War world. Biological agents

are easier to acquire. Most can be found in naturally occurring outbreaks. Weaponizing these agents has proved challenging for terrorist groups, but the Aum Shinrikyo's unsuccessful efforts to spray the anthrax organism throughout Tokyo in 1993 warned that attempted mass urban attacks were no longer in the realm of the fantastic.

The transfer of dangerous biological agents should be controlled where possible, and the spread of the technologies and personnel to weaponize them should be impeded. But any biological nonproliferation regime will necessarily be less robust than its nuclear counterpart, because the relevant materials, technologies, and knowledge are far more widespread.

Biological terrorism also challenges requirements for successful deterrence. Because some diseases incubate for a week or more, identifying the perpetrators of an attack may prove difficult. A terrorist group might even hope that its attack would go unrecognized; when followers of the Bhagwan Shree Rajneesh infected 750 Oregonians with salmonella in 1984, it took over a year before the infection was determined to have been intentional. Finally, as with any form of terrorism, some groups may simply be unconcerned about retaliation.

In the face of these difficulties, good intelligence is all the more important. Warning and prevention are preferable to coping with the consequences of an attack, but we must also be ready should an attack occur. This requires that greater emphasis be placed on improving public health, a kind of homeland defense that is applicable to both unintentional and intentional disease outbreaks.

Because of disease incubation times, the first responders to a biological attack may well be health-care workers at hospitals and clinics rather than specialized units. The speed and effectiveness of a response will depend on disease surveillance: the recognition by health-care workers that certain illnesses appear unusual and the rapid notification of the proper authorities. Because incubation times often exceed international travel times, both domestic and international components are required. But the domestic component of disease surveillance in most nations, including the United States, is too weak, and international networks are inadequate. Donor nations need to increase support for these efforts. And there are many other needs, such as developing and stockpiling sufficient vaccines, antibiotics, or antivirals and otherwise preparing to meet the enormous challenges that would be posed by a major outbreak. It is time to quicken the pace of these efforts, to which departments of health are as central as departments of defense.

Disease surveillance and response are not nonproliferation measures, so cannot substitute for an effective verification regime under the Biological Weapons Convention. But biological security requires the developed world, especially the United States, to see that its ongoing self-interest is closely allied with sustainable public-health improvements in the developing world. And the explosion of biotechnology, with the weapons implications that follow from it, requires the scientific community to discuss its responsibilities in earnest.

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STANFORD, Calif.- For the past seven years, the United States has been negotiating a verification protocol to the Biological Weapons Convention of 1972, hoping to put teeth into the convention's ban on biological weapons production. The Bush administration recently rejected the latest draft of the protocol, viewing it as irredeemably flawed. This is a good time to ask what a new American strategy should be for security against biological threats. It is difficult to predict the likelihood or scale of biological attack. The right policy will provide benefits whether or not an attack occurs.

The first step is conceptual: we must stop thinking about biological security in the way we think about nuclear security. Few aspects of the United States strategy for nuclear security carry over cleanly to the biological case. Security against nuclear attack has relied upon nonproliferation and deterrence, with comparatively little role, so far, for defense. Security against biological-weapons threats should lean primarily on defense.

Nonproliferation, for example, is far more difficult in the biological case. Biological agents are microscopic organisms that can be grown with equipment readily available all over the world -- although the resulting weapons have proved difficult for terrorists to master. Many of the organisms can be acquired during naturally occurring outbreaks. Controls remain valuable, but they will never play the central role that they do in nuclear security. And as biotechnology explodes in the coming decades, nonproliferation will face ever greater challenges.

Deterrence may likewise be of limited use in preventing attacks with biological weapons. While the use of battlefield biological weapons may be deterred by threats, biological terrorism could remain largely immune. The incubation times of most diseases -- for example, seven to 17 days for smallpox -- may lead terrorists to hope they can cover their tracks through covert releases of biological agents. Deterrence relies on the threat of punishment. An attacker who cannot be identified cannot be threatened.

When the Aum Shinrikyo cultists sprayed an anthrax organism in Tokyo -- they did so unsuccessfully several times before their deadly 1995 nerve-gas attack -- they made no announcements and the attacks went unnoticed. When followers of the Bhagwan Shree Rajneesh infected 750 Oregonians in 1984 with salmonella, it took over a year for the attack to be distinguished from a natural outbreak.

Rather than nonproliferation and deterrence, biological security must emphasize civil defense. Civil defense in the biological realm means improving the public health system. Most important, it requires improving disease surveillance. Unusual disease outbreaks must be recognized quickly, so that a rapid response is possible. Health care workers in clinics, hospitals and private practice must know how to identify such outbreaks and be ready and able to pass their information rapidly to city, state and national authorities.

This kind of preparedness would also help to prevent unintentional outbreaks of disease. Because infected passengers can travel the world in less time than it takes for a disease to incubate, it is crucial, for the national interest as well as for humanitarian reasons, to improve disease surveillance overseas. The United States welcomes 50 million visitors every year and imports $40 billion worth of food. Disease cannot be stopped at the border. The United States must act internationally as well as nationally.

Because biological security would offer protection against both natural and nefarious transmission of disease, a sound policy would directly benefit society even if no attack ever happened. Effective biological security requires that we fit the cure to the disease.

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