Clinical Scholars
In a study published in the Journal of General Internal Medicine, Michael Hochman, MD, (’10) and colleagues found that the results of medication studies in top medical journals may be misleading to readers. For “Endpoint Selection and Relative (Versus Absolute) Risk Reporting in Published Medication Trials,” Hochman and colleagues reviewed all the randomized medication trials published in the six highest-impact general medicine journals between June 1, 2008, and September 30, 2010, to determine the prevalence of three types of outcome measures that make data interpretation difficult: surrogate outcomes (37 percent of studies), composite outcomes (34 percent), and disease-specific mortality (27 percent). They also reviewed each study’s abstract to determine the percentage of studies that reported results using relative rather than absolute numbers, which can be misleading. The six journals examined were the New England Journal of Medicine, Journal of the American Medical Association, The Lancet, Annals of Internal Medicine, British Medical Journal, and Archives of Internal Medicine. The study received media coverage in the Salt Lake Tribune, e! Science News, and ScienceDaily among other media.

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• Clinical Scholars
• Health & Society Scholars
• Investigator Awards in Health Policy Research
• Nurse Faculty Scholars
• Physician Faculty Scholars

Clinical Scholars
In the study “A History of Medical Student Debt: Observations and Implications for the Future of Medical Education,” published in Academic Medicine, Ryan Greysen, MD, MA, (’09) takes an historical look at medical student debt and explores its implications for the future of medical education. Greysen argues that the issue is significant for several reasons. First, the current mechanisms for students’ educational financing may not withstand debt levels above a certain ceiling, which is rapidly approaching. Second, there are no standards for costs of medical school attendance; these can vary dramatically between different schools, even within a single city. Third, there is no consensus on the true cost of educating a medical student, which limits accountability to students and society for these costs. And fourth, policy efforts to improve physician workforce diversity and to mitigate shortages in the primary care workforce are inhibited by rising levels of medical student indebtedness. Greysen sees current efforts to expand the U.S. physician workforce as a unique opportunity to confront the unsustainable growth of medical student debt and to explore new approaches to the financing of medical students’ education. His study was featured in a post on the New York Times “Well” blog by columnist Pauline Chen, MD.

Raina Merchant, MD, (’07) assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania, was the lead author on a “Perspective” in the New England Journal of Medicine about the integration of social media into emergency-preparedness efforts. Merchant—who authored the column with Clinical Scholars alumna and the assistant secretary for preparedness and response in the U.S. Department of Health and Human Services, Nicole Lurie, MD, MSPH—discusses how social media can better position the medical and public health community to respond to disasters. However, she cautions that using social media has limitations, such as the ability to reach at-risk and vulnerable populations, and should not supersede our current approaches to disaster-management communication or replace our public health infrastructure. She notes it is critical that we start developing meaningful metrics of social media’s effectiveness, and of the accuracy and usefulness of the information they provide. Merchant also was featured in a Q&A on the topic with SmartPlanet.

Adding to his body of work on the health and health care of American Muslims, Aasim Padela, MD, (’08) assistant professor of medicine and director of the Initiative on Islam and Medicine at the University of Chicago, published a recent article. “Traditional Healing Practices Among American Muslims: Perceptions of Community Leaders in Southeast Michigan,” was published online in the Journal of Immigrant Minority Health on July 8, 2011. Despite the growing numbers of American Muslims, little empirical work exists on their use of traditional healing practices. Padela and colleagues explore the types of these practices used by American Muslims in southeast Michigan.

Health & Society Scholars
Margaret Takako Hicken, PhD, (’10) authored an analysis and commentary, “How Cumulative Risk Warrants a Shift in Our Approach to Racial Health Disparities: The Case of Lead, Stress, and Health Disparities,” in the October 2011 issue of Health Affairs. Hicken and co-authors analyzed recent research that finds that social and environmental factors, such as high levels of stress and exposure to lead, can help explain racial disparities in hypertension. The researchers argue for a “fundamental shift in approaches to health disparities to focus on these sorts of cumulative risks and health effects.” They recommend that federal and state agencies learn more about such connections and apply broader findings to policies to improve health disparities.

Mark Pachucki, PhD, (’10) has authored new research that finds that spouses are influenced by their partners’ eating choices. The study, released online on September 22 by the American Journal of Public Health, finds that certain eating patterns appear to be socially transmissible across different kinds of relationships, particularly spouses. The study’s authors note, “The knowledge that our eating patterns are similar to the eating patterns of those with whom we are socially connected contributes to the perspective—increasingly more supported in the public health field—that when people are connected, their health is connected. To the extent that people’s eating choices are influenced by the eating choices of those to whom they are connected, it may not simply be that ‘you are what you eat.’ It may be that ‘you are what people in your social network eat’ as well.” Researchers investigated whether eating behaviors were concordant among diverse sets of social ties. They analyzed the socioeconomic and demographic distribution of eating among 3,418 members of the Framingham Heart Study (1991–2001).

Andrew Papachristos, PhD, (’10) co-authored a study in the City & Community journal examining the influence of coffee shops in gentrifying neighborhoods on homicide and other forms of crime. Released online in September, the study found that an increasing number of coffee shops in a neighborhood is associated with declining homicide rates for White, Hispanic, and Black neighborhoods. “With regards to homicide, more coffee does equate with less crime—and the effect is similar for both White and Black neighborhoods,” according to the study, “More Coffee, Less Crime? The Relationship Between Gentrification and Neighborhood Crime Rates in Chicago, 1991 to 2005.” However, the authors note that an increasing number of coffee shops is associated with increasing street robberies in Black gentrifying neighborhoods.

Health & Society Scholars alumni David Van Sickle, PhD, MA, (’06) and Sheryl Magzamen, PhD, MPH, (’07) co-authored a study, “Understanding Socioeconomic and Racial Differences in Adult Lung Function,” in the September 2010 issue of American Journal of Respiratory Critical Care Medicine. The research finds that completion of high school is associated with racially patterned improvements in lung function for women and men. The contribution of socioeconomic factors to racial differences in the distribution of lung function is not well understood. The researchers investigated this contribution using statistical tools that allow for examination across the population distribution of lung function. John Mullahy, PhD, a professor in population health science and a Health & Society Scholars co-director at the University of Wisconsin-Madison, is also a co-author.

Investigator Awards in Health Policy Research
The September issue of Health Affairs features research and analysis by several RWJF grantees representing the broad spectrum of issues in the current debate over increasing Americans’ access to health insurance and high-quality care while controlling federal and state spending. Among the authors are three Investigators:

• In “Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries,” Miriam Laugesen, PhD, (’09) and Sherry Glied, PhD, (’95) compared physicians’ fees paid by public and private payers for primary care office visits and hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States. They also compared physicians’ incomes net of practice expenses, differences in financing the cost of medical education, and the relative contribution of payments per physician and of physician supply in the countries’ national spending on physician services. They found that public and private payers paid somewhat higher fees to U.S. primary care physicians for office visits and much higher fees to orthopedic physicians for hip replacements than public and private payers paid these physicians’ counterparts in other countries. U.S. primary care and orthopedic physicians also earned higher incomes than their foreign counterparts. Laugesen and Glied conclude that higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher U.S. spending in these two areas. The study received extensive media attention, including the Washington Post, NPR Online, Kaiser Health News, and New York Times, among others. Read also the RWJF Web story and blog post by Laugesen.
• In “Model Safety-Net Programs Could Care for the Uninsured at One-Half the Cost of Medicaid or Private Insurance,” Mark Hall, JD, (’04) and his co-authors conducted a comparative case study assessing the costs of care provided by four large, well-structured, comprehensive safety-net programs for the uninsured in Colorado, Michigan, North Carolina, and Texas. They found the average monthly resource cost was 25 to 50 percent less than the estimated cost of care for comparison groups covered by local Medicaid programs, or by private insurance that provided similar services.

For other grantees’ articles in the October issue of Health Affairs, see the listings for Health & Society Scholars (Margaret Takako Hicken, PhD) and Physician Faculty Scholars (Renee Hsia, MD, MSc) in this section.

The journal Neurology published, “Addressing the Ethical, Policy, and Social Challenges of Preclinical Alzheimer’s Disease,” a paper by Jason Karlawish, MD, (’08) on October 11, 2011. In the paper, Karlawish outlines the challenges of being able to diagnose the onset of Alzheimer’s disease before a patient shows symptoms. Karlawish suggests the development of a National Alzheimer’s Education Program to develop policies and procedures to translate preclinical Alzheimer’s disease into both clinical practice and policy. Karlawish also contributed a Human Capital Blog post about Coach Pat Summit’s diagnosis of Alzheimer’s disease. Read the Human Capital Blog post.

Nurse Faculty Scholars
Physician-diagnosed illnesses increased in the United States after September 11, 2001, according to a study co-authored by E. Alison Holman, PhD, FNP (’10). The reason may be collective stress following the September 11 attacks, which may have especially affected patients with pre-existing health conditions. Holman’s study was featured in a United Press International article.

Physician Faculty Scholars
Renee Hsia, MD, MSc, (’09) published “Changes in Geographical Access to Trauma Centers for Vulnerable Populations in the United States” in the October issue of Health Affairs. With closures of hospital trauma centers accelerating since 2001, Hsia studied the closures’ impact on disadvantaged communities. By 2007, 24 percent of Americans had to travel farther to the nearest trauma center than they did in 2001, and communities with disproportionately high numbers of African American residents, uninsured people, and people living in poverty, as well as people living in rural areas, were more likely than others to be affected. Hsia proposes that policy-makers should consider measures to reduce these discrepancies, such as paying higher amounts for treatment of injuries to trauma centers serving these communities. The study received widespread media coverage, including U.S. News & World Report, MSN Health, USA Today Online, and the Associated Press.

Michael Ong, MD, PhD, (’09) published “Primary Care Providers Advising Smokers to Quit: Comparing Effectiveness Between Those With and Without Alcohol, Drug, or Mental Disorders,” in the August 23 Nicotine and Tobacco Research. The study concluded that smokers with or without alcohol, drug, and mental disorders could benefit greatly from smoking-cessation counseling from their primary care physicians, and could be five times more successful at kicking the habit than smokers in both groups who did not use smoking-cessation counseling. The findings were featured in multiple news outlets, including MSN.com and U.S. News & World Report Online.