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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Abstract: The American Lab, published by Johns Hopkins University Press in 2018, tells the story of the Lawrence Livermore National Laboratory (the Lab) from the events leading to its founding in 1952 through its transfer to private status in 2008 (after 66 years of sole University of California management). It highlights the important episodes in that journey beginning with the invention of Polaris, the first submarine launched ballistic missile, continuing through the Lab’s controversial role in the Star Wars program, and helping lead the development of the stockpile stewardship program after the cessation of nuclear testing. It describes the intense focus on-laboratory-scale thermonuclear fusion with early work in magnetic fusion to the world’s largest effort on laser fusion that ultimately resulted in the construction of the National Ignition Facility. It includes a number of smaller projects ranging from its participation in founding the Human Genome Project (and its subsequent effort in biodefense) to its array of activities on global climate and basic research. Throughout, the book emphasizes the national security environment in which the Lab existed and the increasing role of politics in “big science”.

 

Bio: C. Bruce Tarter is a theoretical physicist with a BS from MIT and a PhD from Cornell. He began as a researcher at the Lawrence Livermore National Laboratory in 1967 and eventually served as its Director from 1994-2002. Since that time as Director Emeritus he has served on a number of Boards and Task Forces including the National Academy study of the Comprehensive Test Ban Treaty and the Congressional Commission on the Strategic Posture of the United States. He is a Fellow of the American Physical Society and the American Association for the Advancement of Science.

 

Bruce Tarter Former Director Lawrence Livermore National Laboratory
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This study’s purpose was to highlight the changing safety and security landscape engendered by the emergence of new genome editing technologies, help policy-makers and other stakeholders navigate this space, and illuminate broader trends in the life sciences that may impact the biosecurity landscape.

The two-year Editing Biosecurity study was led by four researchers from George Mason University and Stanford University. The centerpiece of the study was three invitation-only workshops that brought together the study leads and the core research group for structured discussions of the benefits, risks, and governance options for genome editing.

The study leads and research assistants prepared two working papers to frame the workshop discussions. The first working paper reviewed past studies that assessed the risks posed by emerging dual-use technologies. The goal of this working paper was to provide a baseline for understanding the security implications of genome editing and to identify best practices in risk assessment. The second working paper provided an overview of the current governance landscape for biotechnology and a framework for evaluating governance measures. Each workshop included a range of scientific, policy, ethics, and security experts. The study leads gathered additional information from subject-matter experts in the form of five commissioned issue briefs. Several of the study’s experts served as discussants who critically engaged the content of the issue briefs through iterative commentary and feedback. The study leads and core research group have backgrounds in various disciplines, including the life sciences, social sciences, and the humanities, an approach designed to ensure a rigorous research process underpinned by the inclusion of a variety of perspectives, and further complemented by numerous areas of expertise. The study and its products relied on unclassified, open, and publicly accessible information. The study was an independent academic work in which the charge and scope were determined by the research team. In combination, these factors were motivated by the team’s goal of producing open and accessible research outputs that can assist stakeholders in crafting more effective and informed policies.

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Megan Palmer
David Relman
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Abstract: This commentary reviews and discusses HBO’s new documentary, Atomic Homefront, which shows how communities are still struggling to live with radiation from radioactive waste generated more than 70 years ago during the race to build the atomic bomb—part of a secret government effort during World War II known as the Manhattan Project.

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Bulletin of the Atomic Scientists
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François Diaz-Maurin
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Abstract: The failure of experts and lay people to understand each other has been fueling conflict around the environmental clean-up of the many sites in the United States that are contaminated by the nuclear weapons program. This mutual distrust was exacerbated by the culture of secrecy surrounding the atomic weapons program during World War II, and later by the innate culture of bureaucracy in the federal agencies that have sprung up since then. A prime example of this problem can be found in the regulation of chronic long-term risk from low-level radiation exposure affecting communities in Missouri’s North St. Louis County. This case study illuminates this divide, and illustrates opportunities to close it.

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The maternal body is a site of contested dynamics of power, identity, experience, autonomy, occupation, and control. Representations of the maternal body can mis/represent the childbearing and mothering form variously, often as monstrous, idealized, limited, scrutinized, or occupied, whilst dominant discourses limit motherhood through social devaluation. The maternal body has long been a hypervisible artifact: at once bracketed out in the interest of elevating the contributions of sperm-carriers or fetal status; and regarded with hostility and suspicion as out of control. Such arguments are deployed to justify surveillance mechanisms, medical scrutiny, and expectation of self-discipline.

This volume helps to develop a more critical understanding of what it means to be an embodied mother. The materiality of maternity and its centrality to family and social life remains too often viewed as a ‘fringe’ subject, the province of feminists, activists, hysterical women. For too long, the maternal body has been subject to ‘expert’ advice, guidance, censure, and control. Those of us maternal bodies are at risk of being commodified and diminished, having our bodily realities reduced to mechanistic functions and our lived experience disregarded. From art to medical surveillance, from genetics to radioactivity, goddess to breastfeeding, poetry to Indigenous community, dance to body size, the critical eye of the academic and the lived experience of the mother bring into being in this work a body of understanding, of expression, of knowledge and the power and authority of the lived experience, through and about the embodied mother. This critical-creative work encompasses new insights, new research, and redeveloped perspectives which combine the personal with the pervasive and point to new meaning-making in critical motherhood studies via the medium of the maternal body.

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maxime_polleri_hr.jpeg PhD

Maxime Polleri is an Assistant Professor in the Department of Anthropology at Université Laval and a member of the Graduate School of International Studies. As an anthropologist of technoscience, he studies the governance of disasters, waste and misinformation, with a primary focus on nuclear topics and a regional expertise on Japan.

Dr. Polleri is the author of “Radioactive Governance: The Politics of Revitalization in Post-Fukushima Japan” (New York University Press, 2026), which examines the aftermath of the 2011 Fukushima nuclear disaster.

Dr. Polleri has also critically studied the search for an informed and willing host regarding the disposal of Canada’s high-level radioactive waste in a deep geological repository situated in the province of Ontario. Similarly, he is interested in underscoring how temporal imaginaries influence the governance of spent nuclear fuel in Japan, as well as its burial for millennia.

Other areas of interests include an anthropological approach to misinformation and disinformation studies. An edited volume on this topic is currently under advance contract with Routledge.

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Abstract: Clay fired bricks are a primary building material used in the rapidly expanding construction sector across South Asia. These bricks are primarily manufactured by small enterprises using inefficient, highly polluting coal-fired kilns. The black carbon and the greenhouse gases emitted by brick kilns across South Asia is comparable to the global radiative forcing of the entire US passenger car fleet. The pollution generated by these brick kilns also affect human health. In Dhaka, Bangladesh brick kilns contribute 40% of the ambient particulate matter during winter and are estimated to result in 5000 adult deaths each year. In addition, the coercive collection of topsoil as part of clay mining undermines agricultural productivity in settings of high poverty and malnutrition.

This talk will discuss why bricks are manufactured in Bangladesh using an approach that is so damaging to the environment and to public health. It will explore combined technical, financial and political strategies to transform the sector.

Speaker bio:  Prof. Luby studied philosophy and earned a Bachelor of Arts summa cum laude from Creighton University. Prof. Luby earned his medical degree from the University of Texas Southwestern Medical School at Dallas and completed his residency in internal medicine at the University of Rochester-Strong Memorial Hospital. He studied epidemiology and preventive medicine at the Centers for Disease Control and Prevention.

Prof. Luby's former positions include leading the Epidemiology Unit of the Community Health Sciences Department at the Aga Khan University in Karachi, Pakistan for 5 years and working as a Medical Epidemiologist in the Foodborne and Diarrheal Diseases Branch of the Centers for Disease Control and Prevention exploring causes and prevention of diarrheal disease in settings where diarrhea is a leading cause of childhood death.  Immediately prior to his current appointment, Prof. Luby served for 8 years at the International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), where he directed the Centre for Communicable Diseases. Prof. Luby was seconded from the US Centers for Disease Control and Prevention (CDC) and was the Country Director for CDC in Bangladesh.

During his over 20 years of public health work in low income countries, Prof. Luby frequently encountered political and governance difficulties undermining efforts to improve public health. His work at FSI engages him with a community of scholars who provide ideas and approaches to understand and address these critical barriers.

Stephen Luby Professor of Medicine Stanford University
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The Center for International Security and Cooperation now has more than 46 podcasts, dating all the way back to Oct. 19, 2016. Listen to them on the CISAC page on the iTunes website. Simply mouse over the title and click play. Open iTunes to download and subscribe to CISAC podcasts. Seminars and events at CISAC are routinely audiotaped for use as podcasts. Also, the Freeman Spogli Institute for International Relations offers the World Class podcast series, featuring scholars and experts from FSI, CISAC and beyond.

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CISAC co-director Amy Zegart wrote the following essay in the Oct. 25 online edition of The Atlantic:

Pity the professionals. In the past month, President Trump has sideswiped certification of the Iran nuclear deal, sandbagged his own secretary of state’s diplomatic efforts with North Korea, and even provoked the ever-careful Senate Foreign Relations Committee Chairman, Bob Corker, to uncork his deepest fears in a series of bombshell interviews. “The volatility, is you know, to anyone who has been around, is to a degree alarming,” Corker told the Times earlier this month, revealing that many in the administration were working overtime to keep the president from “the path to World War III.” He doubled down on those comments a few weeks later, declaring that Trump, among other things, was “taking us on a path to combat” with North Korea and should “leave it to the professionals for a while.”

The professionals sure have their hands full. So far, the Trump Doctrine in foreign policy appears to consist of three elements: baiting adversaries, rattling allies, and scaring the crap out of Congress. The administration has injected strategic instability into world politics, undermining alliances and institutions, hastening bad trends, and igniting festering crises across the globe. “America first” looks increasingly like “America alone.” The indispensable nation is becoming the unreliable one. Even without a nuclear disaster, the damage inflicted by the Trump presidency won’t be undone for years, if ever.

But it’s also important to understand that today’s foreign-policy challenges— whether it’s Iran’s hegemonic ambitions in the Middle East, North Korea’s breakneck nuclear breakout, China’s rise, Russia’s nihilism, Europe’s populism and fragmentation, Syria’s civil war, or transnational terrorism and cyber threats—did not start with Trump. This is the most challenging foreign-policy environment any White House has confronted in modern history.

Three swirling complexities explain why.

Threat complexity

Take a look at any of the annual threat assessments issued by the Director of National Intelligence over the past few years. They will make your head spin. They are filled with rising states, declining states, weak states, rogue states, terrorists, hackers, and more. Bad actors don’t just threaten physical space these days. Adversaries are working on ways to cripple America in cyberspace and even outer space—by compromising all those satellite systems on which its digital society depends. In this threat landscape, the number, identity, magnitude, and velocity of dangers facing America are all wildly uncertain. Exactly how many principal adversaries does the United States have? Who are they and what do they want? What could they do to us? How are these threats changing and how can we keep up without spending ourselves into oblivion or leaving ourselves vulnerable to other nasty surprises? These are fundamental questions. There are no consensus answers. Uncertainty is what fuels America’s foreign-policy anxieties today.

The Cold War was different. Then, certainty was what fueled American foreign-policy anxieties. It was clear to all that the U.S. faced a single principal adversary. The Soviet Union had territory on a map and soldiers in uniforms. Thanks to U.S. intelligence, Soviet intentions and capabilities were fairly well understood. The threat landscape was deadly but slower-moving: Communists never met a five-year plan they didn’t like. And while superpower nuclear dangers were terrifying, they were also constraining in a helpful but insane sort of way. In 1961, President Kennedy invoked the specter of a “nuclear sword of Damocles, hanging by the slenderest of threads” over the earth. Every American foreign-policy decision had to consider the question: What would Moscow think of that? Today, the nuclear sword of Damocles is still hanging—indeed, China, India, Pakistan, and North Korea have all successfully tested nuclear devices since 1961—but no singular threat guides U.S. foreign policy as the Soviet Union once did.

Organizational complexity

As threats have grown more complex, organizational arrangements to deal with them have, too. Coordinating Soviet policy was one thing. Developing coherent U.S. foreign policy in the face of so much uncertainty across so many issues is quite another. Little wonder special advisers, envoys, commissions, boards, initiatives, czars, and new agencies have been growing like mushrooms. This may not sound so bad. But it is. Every new agency or czar or special arrangement says, “the regular process here ain’t working.” The crux of the problem is that bureaucracies are notoriously hard to kill or change. Ronald Reagan famously quipped that bureaucracy is the closest thing to immortal life on earth. Whenever a crisis hits, the natural response is to add a new organization and stir. But if today’s chief challenge is developing coherent, coordinated policy in the face of complexity, creating more organizations to coordinate doesn’t get you very far. Over time, the whole bureaucratic universe just keeps growing bigger, filled with obsolete organizations alongside new organizations; fragmented jurisdictions, overlapping jurisdictions, and unclear jurisdictions; and silos so specialized that nobody can see across all the key issues easily.

Cognitive complexity

Humans are not superhuman. Research finds that most people can remember at most seven items at a time, fewer as they grow older. Even the biggest brains have limits. In 2001, Peter Pronovost of Johns Hopkins noticed that highly trained medical teams at the university’s medical center were screwing up insertions of central line catheters, causing infections in critically ill patients at alarming rates. Why? Because they often forgot one of just five simple steps (like washing their hands) before starting the procedure. (Pronovost instituted a checklist that has since become widely used and is credited with saving thousands of lives.)

In foreign policy, too, the stakes are high and humans are frequently overloaded by complexity, resulting in catastrophic errors that nobody ever intended. One of the chief findings of the 9/11 Commission, for example, was that many inside the FBI simply didn’t know or couldn’t remember all the legal requirements and rules for sharing intelligence and law-enforcement information. Even the Bureau’s own 1995 guidelines were “almost immediately misunderstood and misapplied,” the commission concluded. As a result, clues to the terror plot emerged weeks before 9/11 but were marooned in different parts of the bureaucracy.

In 1935, an advanced bomber nicknamed “the Flying Fortress” crashed during a test flight. The Army Air Corps investigation found that the machine worked fine. The problem was the human. The airplane was so sophisticated, flying required the pilot to remember too many things, and he forgot one of them: unlocking the rudder and elevator controls during takeoff. It was “too much airplane for one man to fly,” one reporter later wrote. That crash sparked the invention of pilot checklists which have been used for nearly a century, transforming global aviation.

U.S. foreign policy is becoming too much airplane for one person to fly. “The professionals” surrounding Trump—Secretaries James Mattis and Rex Tillerson, Chief of Staff John Kelly, National-Security Adviser H.R. McMaster, and others—are trying to keep the whole thing from crashing with a pilot who has never flown before. Let’s hope they can.

America’s approach to the world is a complicated mess, for reasons that predate the current president.

Amy Zegart is co-director of the Center for International Security and Cooperation and professor of political science, by courtesy. She is also the Davies Family Senior Fellow at the Hoover Institution and directs the Cyber Policy Program. She wrote this essay as a contributing editor to The Atlantic.

 

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A new biosecurity initiative at the Freeman Spogli Institute for International Studies (FSI) aims to identify and mitigate biological risks, both natural and man-made, and safeguard the future of the life sciences and associated technologies.

The initiative will be led by David A. Relman, a senior fellow at the Center for International Security and Cooperation and FSI. Relman, the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and Microbiology & Immunology, has served as the science co-director at CISAC for the past four years. He will leave this position on Aug. 31 to lead the new initiative.

Michael McFaul, director and senior fellow at FSI, said, “With exceptional leadership skills, valuable experience and abundant energy, David Relman is ideally positioned to work with scholars from across campus who offer critical expertise in biosecurity. This is an exciting, challenging and important new initiative for FSI that is designed to protect public health from the many new risks now accelerating.”

Relman said the biosecurity initiative will seek to advance the beneficial applications of the life sciences while reducing the risks of misuse by promoting research, education and policy outreach in biological security. His CISAC leadership gives him the know-how to lead such a wide-ranging effort across diverse disciplines and communities.

Relman said, “The opportunity to serve as co-director at CISAC has been a wonderful experience, one that has afforded me the chance to get to know outstanding faculty and staff, their scholarship, and critical policy-relevant work, all of which I had not fully appreciated sitting across campus. This experience has made clear the unusual qualities of Stanford University, and the great people that work here. I am now greatly looking forward to this new opportunity at FSI.”

Biosecurity collaborations

During Relman’s term as CISAC’s science co-director from 2013-2017, he led an expansion of the transdisciplinary work in science and security to include biology, biological and other areas of engineering, medicine, and earth and environmental sciences.

The foundations for work in biological science, technology and security were established at CISAC, especially in the hiring of Megan Palmer, a senior research scholar at CISAC and FSI. Both Relman and Palmer worked together on engagements and discussions with a growing network of more than 20 faculty involved in biosecurity across Stanford.

Palmer said, “Stanford has an opportunity and imperative to advance security strategies for biological science and technology in a global age. Our faculty bring together expertise in areas including technology, policy, and ethics, and are deeply engaged in shaping future of biotechnology policy and practices.”

New insights, new risks

In his new post, Relman said he intends to build on this foundation by creating an initiative that consolidates and focuses activity in biosecurity, develops research and educational programs, attracts new resources, and looks outward at opportunities for policy impact and changing practices across the globe.

Relman said that “new capabilities and insights are reshaping important aspects of the life sciences and associated technologies, and are accompanied by a host of new risks.” If misused, whether by malice or accident, “they pose the potential for large-scale harm,” he noted.

Relman added that the initiative will bring together interest and expertise across the centers and programs of FSI in partnership with Schools and Departments across the university.

At FSI, CISAC will co-sponsor the biological security initiative, which will leverage Stanford expertise in the life sciences, engineering, law and policy.  Key partners will include Tim Stearns (biology), Drew Endy (bioengineering), Mildred Cho (bioethics), and Hank Greely (law), according to Relman. The biosecurity group will also partner with another new program at FSI in global health and conflict, which is led by Paul Wise, Frank Fukuyama, Steve Stedman, Steve Krasner, and others, he added.

Stanford’s School of Medicine and Department of Medicine will also co-sponsor the initiative, thanks to leadership from Lloyd Minor, Michele Barry and Robert Harrington. Relman looks forward to establishing similar relationships with other schools and departments, he said.

 “These partnerships are critical. I’m excited to work with a growing community both within and beyond Stanford towards the goal of a peaceful and prosperous world in the century of biology,” he said.

MEDIA CONTACTS:

David Relman, Center for International Security and Cooperation: relman@stanford.edu

Megan Palmer, Center for International Security and Cooperation:  mjpalmer@stanford.edu

Clifton B. Parker, Center for International Security and Cooperation: (650) 725-6488, cbparker@stanford.edu

 

 

 

 

 

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The Stanford Biosecurity Initiative will be led by David A. Relman, senior fellow at CISAC and FSI.
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