Research Presentations (1 of 3) - Aosaki, Pandya and Ramanathan
In this session of the Shorenstein APARC Corporate Affiliate Visiting Fellows Research Presentations, the following will be presented:
Minoru Aosaki, "Banking System and Sovereign Risk in Japan"
After the financial crisis of 2008, European financial markets have experienced sharp increases of sovereign risk. This adversely affected the solvency of banking institutions as they suffered losses from their sovereign holdings and deterioration in their funding conditions. Meanwhile, Japan's sovereign market remained stable, but market participants were cautious as the country’s debt-to-GDP ratio is the highest in the world, and its banking sector holds as much as 44% of domestic sovereign debt. The question is how Japanese policy makers should address the sovereign risk in the banking system. In pursuit of this question, Aosaki compares the market environment in Japan and the Euro Area, examining the reasons banks hold sovereign bonds and the channels that connect sovereign risk with the banking system.
Prashant Pandya, "Cell-based Therapies -- Current Trends and Future Prospects"
Stem cells have been the subject of considerable excitement and debate over the last decade. Stem cell therapy is emerging as a potentially revolutionary new way to treat disease and injury, with wide-ranging medical benefits. Stem cell research provides the opportunity to advance our understanding of human biology and treatment of various diseases. In Pandya’s research, he shares his experience about major challenges related to the commercial development of stem cell therapies and key technology drivers. This research is based on consultations with several prestigious regulatory agencies—including the U.S. Food and Drug Administration, European Medicines Agency, and Therapeutic Goods Administration of Australia—as well as interviews with 45 CEOs and senior scientists of large and small biotech companies and professors from leading universities across five countries. Pandya’s research reveals that there are many intriguing aspects of stem cells still remaining to be elucidated. Stem cells have the potential to treat an enormous range of diseases and conditions that plague millions of people and offer exciting promise for future therapies. But significant technical hurdles remain that will only be overcome through years of intensive research, and successful commercialization of cell-based therapies requires more than proving safety and efficacy to regulators. Ultimately the therapy must be commercially viable.
Ramnath Ramanathan, "Designing Toxicology Studies for Small Interfering Ribo Nucleic Acid"
The field of medicine has improved drastically over the period of time. Medical treatment has evolved from using plant extracts to chemical drugs to stem cell and gene therapies. Discovery of small interfering Ribo Nucleic Acid (siRNA) was one of the most important recent breakthroughs in the field of medicine. This was due to siRNA’s capability of posttranscriptional gene silencing by destruction of mRNA and thereby reducing the protein synthesis. Though the efficacy studies conducted in vitro and in animal models are promising, there have also been circumstances where there were adverse effects including mortality of animals treated with siRNA. Since RNA interference is a relatively new technique, it is very important to understand the toxicity involved before using it as a therapy. For this purpose, toxicology studies have to be designed in order to address all questions on the safety aspects of siRNA. In addition to the traditional toxicity studies, several other tests will have to be conducted. These additional studies will have to address issues specific to siRNA therapy such as immune activation, formation of tetraplex DNA, down regulation of non-target mRNA, interaction with cellular proteins, etc. Through Ramanathan’s work, he has designed a battery of toxicology studies to understand the side effects so that only relatively safe therapy is tried on humans during clinical trials. Ramanathan will present his findings.
Philippines Conference Room
Redefining Security Along the Food-Health Nexus: report of a conference and center launch held at Stanford University on November 10, 2011
For most scholars the concept of security encompasses issues of state legitimacy, economic and political sovereignty, and protection from military, nuclear, or terrorist assault. Yet billions of people, particularly in the developing world, face more severe, individual security threats on a daily basis, such as inadequate nutrition, disease burdens, lack of potable water, and risks of sexual assault or human trafficking. Such human security concerns can become national security issues when citizens rise up against their governments or threaten to rebel. Human security issues can also emerge as international security threats—those that create conflict or galvanize cooperation among governments—with escalating income and resource inequities between countries. Stanford University has a strong tradition of scholarship in conventional areas of national and international security, as well as in the areas of global food security and health policy. On November 10, 2011, Stanford’s Freeman Spogli Institute for International Studies (FSI) held a major conference to integrate these areas of scholarship, and to launch the Center on Food Security and the Environment (FSE) as a major thrust of its international research and teaching agenda.
Patterns of Elderly Life Expectancy in Three Chinese Cities: Hong Kong, Shanghai and Taipei
Life expectancy at aged 65 is remarkably similar in the three Chinese cities of Hong Kong, Shanghai, and Taipei, even though the cities differ in levels of socioeconomic development, health systems, and other factors. Edward Jow-Ching Tu will discuss research that aims to understand this phenomenon. Despite unprecedented increases in life expectancy and attainment of similar current levels of life expectancy, the cities differ in the contributions of changes in major causes of death to the improvements in life expectancy among the elderly. Tu and colleagues have explored several possible determinants of these different patterns and trends in the three cities, including socioeconomic development, health service delivery systems, cause-of-death classification systems, and competing risks from cardiovascular disease and other diseases. Their analysis suggests that the effect of equity of health service delivery has become more important over time.
Edward Jow-Ching Tu is a senior lecturer of demography in the Division of Social Science at Hong Kong University of Science and Technology. His work is focused on the impact of fertility, mortality, and migration on socio-economic changes in East Asia countries with special emphasis on nations experiencing a transition from planned economy to market economy; on causes and impacts of mortality changes and health transition on aging societies; and on the causes of lowest-low fertility in many East Asia countries. He has several active research projects ongoing in China, Japan, Taiwan, Hong Kong, and Singapore. He holds graduate degress from West Virginia University, the University of Pennsylvania, and the University of Tennessee (Knoxville). Tu has worked extensively in Asia, and has served as an adjunct professor and taught in many universities in China, including Peking University, Peoples University, Nankai Univerity, and Fudan University. He had served as a senior research scientist at the New York State Health Department and as a research fellow (full professor) at the Institute for Social Sciences and Philosophy at Academia Sinica. Tu has also taught at the State University of New York in Albany.
Philippines Conference Room
Ivar Sønbø Kristiansen
117 Encina Commons
Room 186
Stanford, CA
Ivar S. Kristiansen is a professor of public health at the Department of Health Management and Health Economics, University of Oslo, Norway and adjunct professor of pharmacoeconomics at the University of Southern Denmark at Odense. He is visiting scholar at Stanford Health Policy 2011-12.
Kristiansen’s research focuses on technology assessment, cost-effectiveness analysis, and valuation of health outcomes. Also, he has worked for many years on the topic of risk communication in the context of chronic diseases when time is a crucial factor. He is one of the founders of Odense Risk Group.
Kristiansen received an MD from the University of Oslo in 1972, completed his internship at the University Hospital of Trondheim and then worked for 10 years as a combined family physician/public health officer in two remote communities in Norway. He received an MPH degree from Harvard University i 1986 and a PhD from University of Tromsø, Norway in 1996. Kristiansen is a past-President of the Norwegian Public Health Association and has served on numerous public committees in Norway.
Assessing Screening Policies for Childhood Obesity
To address growing concerns over childhood obesity, the United States Preventive Services Task Force (USPSTF) recently recommended that children undergo obesity screening beginning at age 6. An Expert Committee recommends starting at age 2. Analysis is needed to assess these recommendations and investigate whether there are better alternatives. We model the age- and sex-specific population-wide distribution of BMI through age 18 using National Longitudinal Survey of Youth (NLSY) data. The impact of treatment on BMI is estimated using the targeted systematic review performed to aid the USPSTF. The prevalence of hypertension and diabetes at age 40 are estimated from the Panel Study of Income Dynamics (PSID). We fix the screening interval at 2 years, and derive the age- and sex-dependent BMI thresholds that minimize adult disease prevalence, subject to referring a specified percentage of children for treatment yearly. We compare this optimal biennial policy to biennial versions of the USPSTF and Expert Committee recommendations. Compared to the USPSTF recommendation, the optimal policy reduces adult disease prevalence by 3% in relative terms (the absolute reductions are <1%) at the same treatment referral rate, or achieves the same disease prevalence at a 28% reduction in treatment referral rate. If compared to the Expert Committee recommendation, the reductions change to 6 and 40%, respectively. The optimal policy treats mostly 16-year olds and few children under age 14. Our results suggest that adult disease is minimized by focusing childhood obesity screening and treatment on older adolescents.
Socioeconomic Correlates of Inpatient Spending for Patients with Type 2 Diabetes Mellitus in China: Evidence from Hangzhou
Aims:
We evaluated the factors associated with inpatient costs including total costs, pharmaceutical costs and laboratory costs for diabetes-related admissions.
Patients and Methods:
Using data for 960 adult patients admitted between May 2005 and April 2008 with a primary or secondary diagnosis of type 2 diabetes mellitus (DM) at Sir Run Run Shaw Hospital affiliated with Zhejiang University Medical School (SRRSH) in Hangzhou, China, we evaluate the association between patient characteristics and inpatient costs with multivariable regression analyses.
Results:
Total inpatient costs were positively associated with age, higher UKPDS stroke risk score, and presence of any complication. A regression that included patient socioeconomic and clinical characteristics explained 21.5% of the variation in total inpatient costs; regression estimates indicate that patients with coronary artery disease, retinopathy, nephropathy, neuropathy, and diabetic foot had inpatient costs that were respectively 93.7%, 14.0%, 17.5%, 11.5% and 89.0% higher than otherwise similar patients without those complications. Pharmaceutical costs did not differ by insurance coverage. Insured patients spent 7-16% more on laboratory tests than otherwise similar patients did.
Conclusions:
Clinical factors, especially presence of diabetes-related complications, appear to be the primary determinants of variation in inpatient costs for patients with type 2 DM in China. To mitigate the health costs increases associated with China's DM epidemic, policymakers should focus on cost-effective ways to manage patients in outpatient settings to prevent the complications associated with diabetes.