Health and Health Care

With voters in Colorado and Washington deciding to legalize marijuana last election season and a recent poll indicating that 52 percent of Americans now support legalizing the use of marijuana—the first such majority in more than 40 years of polling—serious discussions about drug policy abound.

To weigh in on these developments and more, Beau Kilmer, co-director of the RAND Drug Policy Research Center and coauthor of Marijuana Legalization: What Everyone Needs to Know, hosted an “Ask Me Anything” (AMA) session on Reddit this week. Kilmer fielded questions from participants on a variety of drug policy issues.

This commentary appeared in New England Journal of Medicine on April 24, 2013.

At 2:50 p.m. on April 15, nearly 3 hours after the first runner completed the Boston Marathon, two blasts ripped through the crowd that was gathered along the approach to the finish line, killing 3 people and injuring more than 260. Within moments, the crowd's initial panic was replaced by purposeful action, as bystanders ran to, rather than from, the horror to help the injured. Law-enforcement and emergency medical services (EMS) personnel swiftly converged on the scene. Within minutes, ambulances began transporting the most critically injured to nearby hospitals....

The remainder of this op-ed can be found at nejm.org.

In Sub-Saharan Africa, illness and death from malaria remain harsh realities. While the psychological and social consequences are keenly felt by those living in countries where the malady is most endemic, the economic implications are less well understood.

Our ongoing work on malaria shows that tackling the illness in this region will not only have positive effects for the economy as a whole, but possibly also a redistributive effect—slowing down the rising income inequality in Sub-Saharan Africa. As people across the globe mark World Malaria Day 2013 on April 25, the economics of the disease should be part of the discussion.

Spending money on malaria reduction is, from an economic perspective, a long-term investment. Whilst the effects of increasing the use of bed nets or other preventative interventions on public health are immediately visible, it will take decades before we can observe a visible impact on the economy.

This commentary appeared on Ms. Magazine on April 22, 2013.

The Affordable Care Act requires that birth control be made available through health plans, in some cases without co-pays or deductibles. That's prompted religious institutions to object to paying for care that's not consistent with their values. But Boston College's recent steps to stop free condom distribution doesn't involve sponsoring birth control—it involves location. Boston College Students for Sexual Health, an unofficial campus group formed in 2009, gives away condoms on a sidewalk next to campus and from about 15 dorm rooms, which the group calls “safe sites.”

Until recently, Boston College, a private Jesuit institution, appeared to have taken an approach common among Catholic colleges: tolerating condom distribution by its students as long as it was done offsite, but officially banning the activity on its property. There is some dispute about whether the college previously asked the student groups to stop the on-campus distribution program; however, it recently informed students that any reports that they were distributing condoms on campus would be referred to the student conduct office for disciplinary action. At issue is whether public health policy should protect such actions by students, or whether Boston College and other private universities can ban condom distribution on their property on religious grounds.

This commentary appeared on CNN on April 18, 2013.

A pair of deadly bomb blasts marked a violent and tragic finish to this year's Boston Marathon. But as shocking as the attack may have been, an act like this has been anticipated for some time. It was a surprise, because none of us awoke the morning of the Marathon anticipating the race would end this way. Yet a terrorist attack against a symbolic target or a heavily attended event was something for which authorities had long prepared.

Authorities have known for some time that a wide range of terrorist organizations, extremist groups and individuals — both foreign and domestic — seek to inflict harm on the United States. And this knowledge motivated federal, state and local agencies to devise protocols to enhance their response to mass casualty events. Although official after-action reports are still being compiled, it looks like Boston's first responders and hospitals delivered under difficult circumstances....

The remainder of this op-ed can be found at cnn.com.

It wasn't just a storm, but a superstorm that ravaged America's Northeast last October. And recently, parched earth became charred earth as wildfires blazed anew in Colorado.

More superstorms and drier droughts are consistent with the expected impacts of climate change, so that such impacts may become more common over time. Difficult-to-predict, ever changing conditions may become our new normal.

The question is: How do we respond, in our homes and in our communities, to climate change challenges amid such uncertainty?

On the eve of Earth Day, we suggest the path to climate change preparedness should start at the intersection of resilience and robustness — that is, building resilient communities with the individuals and organizations within those communities making robust decisions, ones designed to work well over a wide range of ever-changing conditions.

Skyrocketing rates of obesity in the United States have received substantial attention in both the popular press and medical journals alike. Research has shown that obesity increases the risk—or worsens the prognosis—for a variety of diseases, including arthritis, cancer, diabetes, and heart disease. Obesity is also tremendously costly; the Centers for Disease Control and Prevention estimate that obesity costs nearly $150 billion per year. That's roughly ten percent of what the United States spends on health care costs.

Clearly, the obesity epidemic is a serious public health concern. What's less clear, however, is how our surroundings fit into the equation.

President Obama has said he intends to enroll, personally, in one of the health insurance exchanges created under the Affordable Care Act (ACA) when they become active later this year. So which one?

Speculation has focused on his home jurisdictions of Illinois or District of Columbia. But the President may want to consider a multistate plan (MSP). A recent RAND study analyzed MSPs and the population that may seek to enroll in them.

This commentary appeared in Los Angeles Times on March 29, 2013.

Don't want to cut benefits? Then allow the system to pay for lower-cost drugs or care.

Now that the budget “sequester” is in effect, Congress is shifting its attention to entitlement reform. There's simply no way to achieve long-term reductions in federal spending without touching the big health programs, particularly Medicare. Although raising the age of Medicare eligibility from 65 to 67 appears off the table, at least for now, the budget plan that Rep. Paul D. Ryan (R-Wis.) is proposing would shift a greater share of the program's growing costs to beneficiaries in the years to come.

The bipartisan deal that kept the federal government from hurtling over the “fiscal cliff” on Jan. 2 actually increased Medicare spending. At the last minute, a powerful bipartisan group of senators inserted a provision into the bill that blocked Medicare, for two years, from getting a better price on an expensive drug used by kidney dialysis patients. This was in addition to a previous two-year extension obtained by Amgen, the drug's manufacturer. The move saddled Medicare with roughly $500 million in added costs over the next two years and generated a windfall for Amgen.

This commentary appeared in New York Daily News on March 25, 2013.

According to a poll released this month by the Pew Research Center, nearly half of American gun owners report that their main reason for having a gun is protection; fewer than a third own a gun primarily for hunting. This is a striking change from 1999, when nearly half of gun owners kept firearms mainly for hunting and only about one quarter cited protection as their most important reason.

Pew's results might make sense if violent crime were surging. But it's not. Since 1993, homicide and non-negligent manslaughter in the U.S. have been cut in half. Violent crime overall is down 48%. But perhaps even more important — and less understood — an ample body of evidence indicates that the benefits of keeping a gun for protection are substantially outweighed by the associated risks.