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Northwestern's Buehler Center within Feinberg's Institute of Public Health and Medicine provides services to its network of scientists, helping to foster high-quality, policy-relevant economic research and to disseminate it widely to decision-makers in the public and private sectors.
'The Buehler Center Wishes You a Warm and Happy Thanksgiving!' 
'Danielle M. McCarthy, MD, MS'
Danielle McCarthy is an Associate Professor and the Vice Chair of Research in the Department of Emergency Medicine at Northwestern University Feinberg School of Medicine. She completed her undergraduate studies at Harvard University followed by medical school at Northwestern University. After finishing residency training at Northwestern in 2010, she completed a National Service Research Award T32 fellowship and earned a Masters degree in Health Services and Outcomes Research. 
Dr. McCarthy’s early research focused on describing communication patterns in the ED, related to both the content of the conversation and characteristics of the interactions. She subsequently conducted a number of studies to better understand patients’ knowledge about their care and their diagnosis after leaving the ED.
More recently, McCarthy’s research has focused on developing patient-centered communication interventions to improve patient’s understanding of their care. Her current funding is focused on risk communication about opioids and improving communication about diagnostic uncertainty at the time of ED discharge.
We asked Dr. McCarthy to tell us how her work is relevant to health policy and economics, how the EM broader research enterprise has policy and economic underpinnings, and why we need a strong partnership:

The opioid epidemic has affected practice in all quarters of medicine, but emergency care has been particularly influenced. In the ED we serve both as first line providers to those with opioid overdoses, but also treat opioid-naïve patients in pain and those with opioid use disorder. The care we provide, and the research we conduct, have been heavily influenced by policy changes in the past five years. For example, as a result of policy in Illinois, we are seeing decreased prescribing of opioids, increasing access to medication assisted treatment and strengthening of data collection to be able to better understand the epidemic and impact of these interventions. Specific to my research, one finding of our recent study was that despite high implementation of a patient-centered prescription wording for opioid prescription (Take-Wait-Stop PRN label) at the point of prescribing, there was low uptake at the point of dispensing in the commercial pharmacies. This finding made me more attuned to the role that policy plays in delivering interventions to patients. Outpatient pharmacies have many regulations to observe regarding font size, required elements on a label, etc. Despite best intentions, if the patient-centered label wording is not supported by policy, it is unlikely to be translated to the patient due to these competing priorities.
 
Looking at Emergency Medicine more broadly, the value of emergency care is a major topic in both the lay and political press as well as research publications. Although ED care is typically acknowledged to be responsible for ~2% of healthcare spending, the costs to individual patients are often high.  There are many recent publications in the EM literature about the value of care provided and how to both add value and control cost.  Innovative research is being done in our department to streamline care pathways and add value for patients with many conditions (including geriatrics, musculoskeletal pain, intracranial hemorrhage).  Further study of the cost-effectiveness of these interventions will help to minimize costs and maximize value for all parties involved. Working with the Buehler Center has strengthened this aspect of our department’s research portfolio and we look forward to continuing this strong partnership in years ahead. READ MORE
'Improving Patient Knowledge and Safe Use of Opioids'

Recent research by featured faculty member, Danielle McCarthy, and colleagues ultimately showed improvement in the patients’ ability to safely dose their opioid medication. Read the publication in Academic Emergency Medicine.

'Mergers in Medicare Part D: Assessing Market Power, Cost Efficiencies, and Bargaining Power'

In recent paper published in the International Journal of Industrial Organization, Anna Chorniy and colleagues examined horizontal mergers amongst Part D insurers. The research demonstrated market power raises premiums, but the effect occurs in markets locally where the merging firms overlap. Read more

Dr. Joe Feinglass' work was recently published in American Society of Hematology. Sickle cell disease (SCD) is associated with acute healthcare utilization and an estimated annual cost of $2 billion that is primarily covered through public insurance.

Understanding factors contributing to acute healthcare utilization among SCD patients is crucial to decrease costs associated with services. The study describes trends of acute care utilization among Illinois (IL) residents with SCD over a 3 year period and examines factors associated with hospital admissions from the emergency department (ED). Read the full publication Acute Healthcare Utilization and Predictors of Admission for Sickle Cell Disease in Illinois. 

'Behavioral Responses to Health Innovations and Consequences for Socioeconomic Outcomes'

Anna Chorniy recently attended the University of Copenhagen for an event surrounding behavioral responses to health innovations and the consequences for socioeconomic outcomes. During her time at UCPH, Dr. Chorniy presented her research on The Effects of Foster Care Payments on Children's Placement, Health Care Utilization and Quality.

'International Day for the Elimination of Violence Against Women'

On International Day for the Elimination of Violence Against Women, we honor and remember the victims of gender-based violence and stand in solidarity with survivors and advocates who are working to end violence against women and girls.

'The Violence Against Women Act'

The Violence Against Women Act of 1994 (VAWA) was a United States federal law (Title IV, sec. 40001-40703 of the Violent Crime Control and Law Enforcement Act, H.R. 3355) signed as Pub.L. 103–322 by President Bill Clinton on September 13, 1994 (codified in part at 42 U.S.C. sections 13701 through 14040). The Act provided $1.6 billion toward investigation and prosecution of violent crimes against women, imposed automatic and mandatory restitution on those convicted, and allowed civil redress in cases prosecutors chose to leave un-prosecuted. The Act also established the Office on Violence Against Women within the Department of Justice.

VAWA was cosponsored by Senator Joe Biden (D-DE) and Senator Orrin Hatch (R-UT (R-UT) in 1994 and gained support from a broad coalition of advocacy groups.[1] The Act passed through Congress with bipartisan support in 1994, clearing the United States House of Representatives by a vote of 235–195 and the Senate by a vote of 61–38, although the following year House Republicans attempted to cut the Act's funding.[2] In the 2000 Supreme Court case United States v. Morrison, a sharply divided Court struck down the VAWA provision allowing women the right to sue their attackers in federal court. By a 5–4 majority, the Court overturned the provision as exceeding the federal government's powers under the Commerce Clause.[3][4]

VAWA was reauthorized by bipartisan majorities in Congress in 2000 and again in December 2005. The Act's 2012 renewal was opposed by conservative Republicans, who objected to extending the Act's protections to same-sex couples and to provisions allowing battered undocumented immigrants to claim temporary visas, but it was reauthorized in 2013, after a long legislative battle. As a result of the United States federal government shutdown of 2018–2019, the Violence Against Women Act expired on December 21, 2018. It was temporarily reinstated via a short-term spending bill on January 25, 2019, but expired again on February 15, 2019. The House of Representatives passed a bill reauthorizing VAWA in April 2019 and includes new provisions protecting transgender victims and banning individuals convicted of domestic abuse from purchasing firearms.[5] In an attempt to reach a bipartisan agreement, Senators Joni Ernst (R-IA) and Dianne Feinstein (D-CA) led months of negotiation talks that came to a halt in November 2019. Senator Joni Ernst has said she plans to introduce a new version of the bill and hopes it will pass in the U.S. Senate.[6]

The House version of VAWA, H.R. 1585, currently does not include any federal penalties for Female Genital Mutilation (FGM).[7] According to the Centers for Disease Control and Prevention, an estimated 513,000 women and girls in the U.S. are at risk of FGM or have already undergone the operation.[8] Independent Women's Forum has urged Congress to include provisions enhancing penalties for female genital mutilation as well as funding to combat FGM.[9] The House version also does not include measures to deter honor killings, sex trafficking or forced child marriages.[7]

The Violence Against Women Act reauthorization was passed by the House March 2019 but will likely not be approved by the Senate. While most countries have passed similar legislation at the urging of the United Nations, the United States withdrew from the Human Rights Council at the UN two years ago.

References

  1. ^ "Report: 1 Is Too Many: Twenty Years Fighting Violence Against Women and Girls from The White House" (PDF). whitehouse.gov. Retrieved May 6,2018.
  2. ^ Cooper, Kenneth (July 15, 1995). "House GOP Budget Cutters Try to Limit Domestic Violence Programs"Washington PostArchived from the original on July 24, 2012. Retrieved April 19, 2012.
  3. ^ Bierbauer, Charles (May 18, 2000). "Supreme Court strikes down Violence Against Women Act"CNN. Archived from the original on February 13, 2008. Retrieved April 19, 2012.
  4. ^ Greenhouse, Linda (May 16, 2000). "Women lose right to sue attackers in federal court"New York TimesArchived from the original on February 5, 2012. Retrieved April 19, 2012.
  5. ^ "House passes reauthorization of Violence Against Women Act". CNN. April 4, 2019.
  6. ^ "Senate talks on crafting bipartisan Violence Against Women Act break down". RollCall. November 7, 2019.
  7. Jump up to:a b "H.R.1585 - Violence Against Women Reauthorization Act of 2019". US Congress. April 10, 2019.

In 1492, there were approximately 5.3 million Native Americans living in America. By 1900, disease, forced migration and conflict reduced their numbers to just a few thousand.

'The Rape Tax: Tangible and Intangible Costs of Sexual Violence'

A recent Supreme Court ruling determined rape to be a “non-economic violent” crime that does not affect inter-state commerce. The Supreme Court’s decision calls into question society’s understanding of the economic cost of rape in particular and sexual violence in general. While the etiology of rape and sexual violence may not be economically motivated, the costs to society exceed all crimes that are economic in origin such as robbery and embezzlement. To that end, we questioned the Supreme Court’s decision by estimating the financial costs of sexual violence.
 
Buehler Center Director examined the justice system’s decision that sexual violence, particularly rape, is not an economic crime. Post et al. estimate the tangible and intangible financial costs of sexual violence. If divided equally as a “rape tax,” every man, woman, and child, will pay nearly $700 per year to cover the cost of sexual violence. The implication is that prevention is the best way to reduce the high cost of sexual violence. Furthermore, rape and sexual assault need to be identified as a public health issue to raise awareness about sexual violence. Finally, courts and prosecutors need to think about sexual violence as an economic crime to better protect victims and survivors of sexual violence. The Rape Tax: Tangible and Intangible Costs of Sexual Violence.
 
Why is sexual violence so costly?

  1. In general survivors of sexual assault are very young when victimized dramatically changing their life trajectory that impacts their lifelong income.
  2. A large portion of rape survivors drop out of college, move, quit their jobs post-assault.
  3. Sexual violence has a rippling effect. It affects not only the rape survivor but his/her families and friends. The consequences are intergenerational.
  4. There are both “tangible” outcomes such as court costs, costs to police departments to investigate rape, and intangible costs, such as lifelong post-traumatic stress disorder that reduces the survivors earning capacity,

Post LA, Mezey NJ, Maxwell C, Wibert WN. The rape tax: Tangible and intangible costs of sexual violence. Journal of Interpersonal Violence. 2002 Jul;17(7):773-82.

The Way We Never Were

A year before the first Thanksgiving, the pilgrims raided Native American graves.

When the pilgrims arrived in Cape Cod, they were incredibly unprepared. “They were under the persistent belief that because New England is south of the Netherlands and southern England, it would therefore be warmer,” says Mann. “Then they showed up six weeks before winter with practically no food.” The Pilgrims spent their first year living on the Mayflower because they were so unprepared. They had no food, supplies, or warm clothing.

In a desperate state, the pilgrims robbed corn from Native Americans graves and storehouses soon after they arrived; but because of their overall lack of preparation, half of them still died within their first year. To learn how to farm sustainably, they eventually required help from Tisquantum, an English-speaking Native American who had been staying with the Wampanoag. Tisquantum had been taken prisoner and sent to England to live for ten years. On his return, he translated for the pilgrims and helped them to survive.

The pilgrims could only settle at Plymouth because thousands of Native Americans, including many Wampanoag, had been killed by disease.

If the pilgrims had arrived in Cape Cod three years earlier, they might not have found those abandoned graves and storehouses … in fact, they might not have had space to land.

Europeans who sailed to New England in the early to mid-1610s found flourishing Native American communities along the coast, and little room for themselves to settle. But by 1620, when the Mayflower arrived, the area looked abandoned.

Sleeping in graveyards, stealing food from Native American graves. Apparently, the pilgrims had not seen the movie Poltergeist yet. How creepy! How colonial of the pilgrims!

“A couple of years before, there’d been an epidemic that wiped out most of the coastal population of New England, and Plymouth was on top of a village that had been deserted by disease,” says Mann.

“The pilgrims didn’t know it, but they were moving into a cemetery,” he adds.

The Europeans were valuable trading partners for the Wampanoag and other Native Americans in the area because they traded steel knives and axes for beaver pelts—something that, in the beaver-rich New England area, the Wampanoag considered essentially worthless.
 
“It’s a little like somebody comes to your door, and says I’ll give you gold if you give me a rock,” Mann says. “The Wampanoag thought: if we tie ourselves to these guys, everybody else will be hesitant to attack us, because they could drive away these people who are willing to pay gold for rocks.”

Mann CC. 1491: New revelations of the Americas before Columbus. Alfred a Knopf Incorporated; 2005.
Little, Becky, National Geographic, November 20, 2018

'Thanksgiving is the Busiest Travel Day of the Year'

Thanksgiving day is the busiest travel day of the year. The American Automobile Association (AAA) has estimated that over 42 million Americans travel 50 miles or more by car over the holiday weekend. Another 4 million people fly to visit their loved ones for the holiday. Be safe in your travels!

'RSVP for IPHAM Population Health Forum'
The IPHAM Population Health Forum is taking place on 12/9/19. The event features a keynote by Ana Diez Roux, Dean and Distinguished University Professor of Epidemiology in the Dornsife School of Public Health at Drexel University. There will be a community panel with the Chicago Department of Public Health,and a poster session with 130+ posters. CLICK TO RSVP
'Open Buehler Center faculty positions'
The following positions are currently open at the Buehler Center for Health Policy and Economics within the Institute for Public Health and Medicine at Northwestern University Feinberg School of Medicine:
Health Policy Professor Assistant, associate or full professor – Tenure Track. The Buehler Center for Health Policy and Economics at the Institute for Public Health and Medicine at the Northwestern Feinberg School of Medicine, is seeking a full-time health policy professor at any rank. Learn more

Health Economist Professor Assistant, associate or full professor – Tenure Track. The Buehler Center for Health Policy and Economics at the Institute for Public Health and Medicine at the Northwestern Feinberg School of Medicine, is seeking a full-time health policy professor at any rank. Learn more

Health Policy Evaluation Professor Assistant, associate or full professor – Team Scientist. The Buehler Center for Health Policy and Economics at the Institute for Public Health and Medicine at the Northwestern Feinberg School of Medicine is seeking a full-time health policy evaluation professor at any rank. Learn more

Questions can be directed to Lori Post, PhD, at BuehlerCenter@northwestern.edu
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