The RAND Blog

On Memorial Day two years ago I wrote: “There's no better way to honor the men and women who have died by suicide — and the families and friends they left behind — than to ensure that the country is doing all it can to avoid future premature deaths.” This message is even more important this year, as the U.S. Department of Defense (DoD) continues to grapple with a growing number of suicides among service members.

I believe that research can make a difference, and at RAND we're focusing considerable efforts on conducting high-quality, objective research to prevent suicide. This work began with the DoD. In 2011, RAND published The War Within, which identified the strengths and gaps in the current approaches to prevent suicide among military personnel. The conclusions and recommendations in that report helped influence Senator Patty Murray's amendment to the National Defense Authorization Act of 2013 requiring a comprehensive military suicide prevention program.

Why shouldn't England's National Health Service (NHS) be as fully available to patients at the weekend as on any other day of the week? In a recent article in the British Medical Journal, NHS Medical Director Bruce Keogh sets out his support for new proposals (PDF) for a 24/7 NHS. The main motivations seem to be efficiency and quality of care — but our analysis suggests those proposals could actually make the quality of care worse.

Keogh is concerned about medical equipment and facilities standing idle over the weekend. In addition, he cites evidence to suggest that a patient's chance of dying is higher at the weekend than during the week. The hope is that having more doctors and nurses working weekend hours would improve the quality of care, increase efficiency in the use of facilities, and give patients increased choice.

RAND Europe's work for the Boorman review on NHS health and well-being suggests that there is a strong association between the health and well-being of staff and the quality of patient care. This association is perceived by about 90% of the 11,000 NHS staff surveyed for the review and is corroborated by NHS productivity data. Our data analysis shows that NHS Trusts with better staff health and well-being (according to indicators such as lower staff turnover, lower absenteeism rates, and higher staff satisfaction) also appear to have better quality of care (for example, lower MRSA infection rates and better scores on composite quality indices such as the Annual Health Check). Such Trusts also typically have higher patient satisfaction.

This commentary appeared on Project Syndicate on May 22, 2013.

President Bashar al-Assad's fall is inevitable, but Syria's subsequent collapse need not be. Syria's sizable émigré community has so far remained far away from the devastation, waiting in cities like Paris and London to see where the political chips will fall. But, by taking a more active role, the diaspora can help to end the conflict at home — and to rebuild in its wake.

According to the Syria's Ministry of Expatriates, more than 18 million Syrians — including Sunni, Christian, and Alawite professionals and business leaders — live abroad, largely in North and South America and Europe. Some left to pursue a better life or a better education; others established second homes abroad that have now become their primary residences. It is time that this community used its considerable means and influence to help shape Syria's future.

This commentary appeared on U.S. News & World Report on May 22, 2013.

The options for the United States are narrowing rapidly as the Syrian civil war rages on. Although Secretary of State John Kerry and his Russian counterpart, Foreign Minister Sergey Lavrov, announced recently that they are arranging an international conference aimed at ending the conflict, their effort may not be any more successful than previous failed attempts to find a diplomatic solution. With the violence continuing to escalate, evidence indicating that chemical weapons have been deployed, and a growing refugee problem, the United States must act quickly to assist the opposition....

The remainder of this commentary is available at usnews.com.

This commentary appeared on The Health Care Blog on May 21, 2013.

Monday's massive tornado ripped through Moore, a suburb of Oklahoma City, devastating homes and businesses and killing at least two dozen people. The disaster came just over a month after an explosion at a fertilizer plant devastated the town of West, Texas, killing 15 people and injuring some 200 others. Just two days earlier the bombings at the Boston Marathon left three dead and more than 260 injured.

Three mass-casualty events occurring in three very different settings show that disaster preparedness should not be limited to large cities or “target” areas in the United States. One trait that is common to all such events—whether urban, suburban or rural—is the need for coordinated, responsive trauma care for victims.

This commentary appeared on NYTimes.com on May 22, 2013.

Much of the marijuana consumed in the U.S. comes from Mexico. It's impossible to know exactly, but my colleagues and I put the range at 40 to 67 percent for 2008. Our research also suggests that legalizing commercial marijuana production at the national level could drive out most of the marijuana imported from Mexico.

With marijuana legalization at the state level, imports from Mexico would depend on several factors, like how taxes influenced the market price, whether legally sold marijuana were illegally diverted to other states, and the severity of the federal response.

We don't expect the passage of legalization in a few states to significantly affect demand for Mexican marijuana. But what would happen to Mexican drug trafficking organizations if many states legalized marijuana or if there were national legalization?

The ER is for emergencies — or at least it should be. Nearly everyone agrees on that point. But when it comes to implementing policies to reduce non-urgent use of ERs, opinions quickly diverge.

For the past few years, Washington State has been ground zero for this fight. In 2011, the state's health care authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries “when those visits are not necessary for that place of service.” Because the plan was based on a retrospective determination of what was — or was not — an emergency, the proposal faced strong opposition from a range of health care stakeholders. Ultimately, a compromise was worked out.

This commentary appeared in The Wall Street Journal on May 22, 2013.

The U.S. and EU made opposing choices. Both failed because the private economy wasn't taken into account.

Why is it that in the United States the “stimulus” solution to the economy's ills has performed badly while in Europe the opposite approach, “austerity,” has performed even worse?

The answer is that austerity (defined as substantial reductions in debt-financed government spending) or stimulus (defined as high-levels of debt-financed government spending) will promote growth only in some countries and in some circumstances.

Whether either policy will work depends critically on the responses of the private sector. What is missing from consideration today is whether the private sector's reactions will enhance, retard or reverse either a policy of austerity or of stimulus. In both the European Union and the U.S., policies would have been more effective if efforts had been made to anticipate and mitigate the reasons for adverse responses of private businesses.

This commentary appeared on GlobalSecurity.org on May 21, 2013.

As Daddy Warbucks once observed, “You always have to skin your own skunks.” Perhaps this insight is particularly appropriate if the United States adopts the elimination of chemical weapons as a goal for involvement in Syria.

First of all, neither side of the Syrian conflict has committed to elimination of chemical weapons. If the United States chooses to intervene militarily to stop chemical weapon use, it should recognize from the start that it has limited ability to destroy chemical munitions through strikes even if it has the ability to destroy Syrian forces. Large chemical weapon stocks will survive even a sustained bombing campaign.

This commentary appeared on CNN on May 21, 2013.

The announcement by prosecutors that charges had been filed against suspected cyber thieves believed responsible for stealing $45 million in a matter of hours from ATM's in two dozen countries should send a stark message to governments around the world — banks could be the most vulnerable front in cyber space.

Plenty of people have been warning us these days to worry about cyber attacks, but generally we have been worrying about the wrong things. Most “cyber Armageddon” scenarios focus on gaps in our physical infrastructure and even far-fetched scenarios such as infant incubators in hospitals being turned off. But major swathes of the United States have routinely gone without electricity and water for days following natural disasters. Soon enough, life gradually gets back to normal. Want real chaos? Destroy confidence in the banking system (or even a part of it), and just stand back and watch....

The remainder of this commentary is available at cnn.com.