Last month, HBO premiered a new single from British pop/rock outfit Florence + The Machine titled, “Jenny of Oldstones”, which debuted to close out an episode for the hit series, Game of Thrones. Over the weekend, the rock band gave the haunting ballad its live debut during their headlining set at Arizona’s FORM Festival on Friday.Related: Game Of Thrones Live Concert Experience Announces 2019 Fall Tour Dates“I would like to dedicate this song to Arya Stark, who saved us all” singer Florence Welch told the audience to loud approval before starting into the mythical ballad–a nod to the victorious achievement played out by the popular character a recent episode of Game of Thrones. She was joined in the performance by American singer and cellist, Kelsey Lu. Fans can watch the band’s performance of the dreamy ballad from Friday’s show below.Florence + The Machine – “Jenny of Oldstone” – 5/10/2019[Video: florencemachine]“When I first heard the song it sounded like a Celtic lullaby to me,” Welch said with the song’s arrival last month. “Celtic music has always been in my blood, so I felt like I could do something with it … I am honored to be a part of the final season.”Florence + The Machine continues its North American spring tour in promotion of their latest studio album, 2018’s High As Hope, with a performance at the Santa Barbara Bowl in Santa Barbara, CA on Sunday (May 12th). Fans can head to the band’s website for tickets and tour info.[H/T NME]
Professor of Scandinavian and Folklore Stephen A. Mitchell examines witches, wizards, and seeresses in literature, lore, and law, as well as surviving charm magic directed toward love, prophecy, health, and weather.
Lila (the patient’s name has been changed) was only in her 20s when she learned that she could be at increased risk for breast cancer. A genetic test had revealed that her mother carried a mutation signaling a heightened risk for the disease. But Lila opted to live with uncertainty — and the hope it engendered — a little longer. She wouldn’t test, but she would be vigilant, opting for frequent mammograms.At age 34, Lila, now the mother of two small children, learned she had breast cancer. Personalizing her treatment would require genetic testing. This time she consented. The procedure verified the mutation and revealed another detail: Her tumor flourished with exposure to hormones.“She knew the mutation increased her risk for a second cancer, so she chose bilateral mastectomy,” says Judy Garber, a Harvard Medical School (HMS) associate professor of medicine at Dana–Farber Cancer Institute and Brigham and Women’s Hospital. But because the tumor was hormone-receptor-positive, Lila faced another decision: take drugs to cut her hormone levels, or have the source of those hormones, her ovaries, removed. She chose the surgery.Garber, who directs the Cancer Risk and Prevention Program at Dana–Farber, describes Lila’s decisions as aggressive for a young woman, even one burdened with a mutation promising a lifelong threat of cancer. Could her choices have been driven by her desire to remain a mother to her children for as long as possible?“Oh, of course,” says Garber, adding softly, “For young mothers, that’s often the issue.”Lila’s story underscores how genetic diseases thread throughout a family and how decisions made by individuals — to test, to treat, to disclose — are fraught with difficulties and emotions that can strain, and sometimes break, family ties. The reach of genetic diseases goes beyond the individual, often visiting ethical dilemmas upon a patient’s entire family.Over the past three decades, genetic testing and its offspring — personalized medicine — have matured; tests for more than a thousand diseases are now available. Yet while the ability to identify genetic signposts for patients allows doctors to recommend screening, offer preventive surgeries, and fine-tune drug treatments, that same ability delivers unsettling futures to those with genetic evidence of diseases that as yet have no cure, such as Huntington’s disease, cystic fibrosis, hemophilia, and Alzheimer’s disease.Often, patients and doctors become entangled in such issues as how to best share at-risk information, access treatment options, and weigh decisions about hidden threats to the young and unborn. And sometimes these issues mushroom, becoming quandaries for society as a whole.It’s a family affairPatients rely on physicians to deliver medical news directly and in confidence, good or bad. Medicine’s growing ability to plumb a person’s genetic information, however, can challenge this expectation.“People are accustomed to keeping some details private,” says Ting Wu, an HMS professor of genetics and director of the Personal Genetics Education Project. “But genetic information is explicit; it speaks to pedigree.”Wu notes that while patients might seek genetic testing as a means of customizing their treatment and prevention strategies, others — particularly at-risk family members — may be less amenable to testing and the possibility of news of an incurable condition.“Patients realize that information can sometimes be used in a way that hurts someone,” says Wu. “That possibility — and that fear — can present a slippery slope: The more we learn, the more information we have to use, properly or improperly.”How deeply those details penetrate family defenses can be found in a story Wu cites of a 23-year-old woman who chose to be tested for Huntington’s disease. The young woman’s grandfather had been ravaged by the rare brain disorder for three decades, a maternal aunt had tested positive for it, and she was now witnessing a cousin’s debilitation. Her mother, however, refused to test and became embattled with her daughter over the issue. Undeterred, the young woman went ahead with her plans. She learned she carried the gene — as did her mother, by implication. Her mother severed their ties, unable to forgive her daughter for inflicting upon them both what she viewed as future-robbing news.A fine lineKenneth Offit ’81, chief of the Clinical Genetics Service at New York City’s Memorial Sloan–Kettering Cancer Center, has seen the difficulties that disclosure can bring to families. “When it comes to handling the results of genetic testing,” he says, “health professionals must respect the boundaries imposed by the ethical practice of medicine by encouraging, but not coercing, patients to share their news with family members.” But when the patient can’t meet that responsibility, the custodianship of genetic information — and the duty to warn — may be left to the physician.“Two decades ago, a breast cancer patient we’d enrolled in a study of the genetic risks of certain cancers died before learning she had a mutation linked to her cancer,” Offit recalls. “We needed to tell her daughters of their own risk — but we didn’t know their locations.”Offit called the woman’s mother to explain his need to contact her granddaughters. She rejected his plea and ignored his follow-up letter. Years later, after she had died, the daughters found a letter that Offit had written — and showed up at his clinic. One daughter tested positive for the mutation and began regular screening.Offit once told this story to a group of lawyers to illustrate how he had tried to fulfill his duty to warn. Terse, unsettling comments followed. One lawyer chided him for failing to hire a private detective, find the daughters, and tell them their risks. Another frostily said she would have offered to represent the daughters should they have developed breast cancer before they were notified and elected to sue.Open housePhysicians aren’t the only ones tussling at the ethical edges of genetic testing. Patients, too, wrestle with such dilemmas. They share test results to warn siblings and cousins, help adult children make childbearing decisions, or explain their medical care to others. But patients also withhold information to avoid causing alarm and to notify only those relatives at greatest risk. Information sharing may hit additional barriers, both real and perceived, such as geographic distance, adoption, and stigma.Disclosure requires a middleman when the patient is very young. Parents must act on behalf of newborns, children, and adolescents whose genetic disorders may not manifest until adulthood. “We often avoid testing children unless it’s absolutely necessary,” says Joseph Thakuria, an HMS instructor and clinical geneticist at Massachusetts General Hospital. “We worry about how testing can negatively affect this population.”Thakuria, who trains medical students and house staff as well as genetic counselors, says that his worries about stigma and self-concept sometimes begin with the parents. “It’s not unusual for one to say to the other, ‘It’s from your side of the family.’ Usually it’s said half-jokingly, but I always try to nip that thought in the bud.”He does so by sharing a fact: We are all carriers. Geneticists estimate that each of us has 6 to 25 genes that, under the right conditions, could trigger a disorder or disease in a person or in his or her offspring. Understanding this helps move parents away from shock, guilt, and grief and into proactive postures, such as joining a support group, learning about treatments and interventions, and safeguarding their child’s quality of life.Protective servicesProtecting quality of life for all who undergo genetic testing has gained legal ground in recent years. Worries about institutional discrimination that might deny medical coverage, employment, and equitable access to the benefits of personalized medicine have been eased in the United States by provisions forged in the Genetic Information Nondiscrimination Act, or GINA, and in the recent health care reform legislation.Since 2008, GINA has accorded genetic information the same privacy protections that the Health Insurance Portability and Accountability Act, or HIPAA, has provided to medical data. GINA has also prohibited genetic discrimination by health insurers and employers.GINA does not, however, affect life, disability, or long-term care insurance. Nor does it prevent insurers from determining eligibility or rates based on a person’s gene-linked disease or disorder that has already manifested. And while GINA mandates payments for tests for mutations linked to diseases such as breast cancer and colon cancer, it doesn’t require coverage for preventive interventions.Health care reforms signed into law in 2010 may help flesh out just what personalized medicine can and can’t deliver. The reform act creates an independent Patient-Centered Outcomes Research Institute charged with examining the use and comparative effectiveness of medical products and services within groups differentiated along traditional lines — such as race, sex, and age — as well as new ones distinguished by genetic and molecular characteristics.Society’s acceptance of personal genomics will surface in its laws, says HMS geneticist Wu. Preimplantation genetic diagnosis, for example, which screens for genetic diseases in embryos used for in vitro fertilization, may come under scrutiny. Studies have found that parents see an advantage to this screening procedure if it means they can avoid receiving a prenatal diagnosis requiring them to consider terminating a pregnancy. But others fear that choosing an embryo based on its genetic makeup is mere prelude to selecting for gender, IQ, and eye color — in short, a slide toward eugenics.For Wu, education is the right response. “We need to understand the social, legal, and ethical outcomes of our decisions,” she says. “When we know the issues surrounding genetic testing, we’ll consider carefully before judging the decisions of others. For when we categorize others, we categorize ourselves.”Ann Marie Menting is associate editor of Harvard Medicine.
The initial assessment of a blood test to help diagnose major depressive disorder indicates it may become a useful clinical tool.In a paper published in the journal Molecular Psychiatry, a team including Harvard-affiliated Massachusetts General Hospital (MGH) researchers reports that a test analyzing levels of nine biomarkers accurately distinguished patients diagnosed with depression from control participants without significant false-positive results.“Traditionally, diagnosis of major depression and other mental disorders has been made based on patients’ reported symptoms, but the accuracy of that process varies a great deal, often depending on the experience and resources of the clinician conducting the assessment,” says George Papakostas of the MGH Department of Psychiatry and an associate professor of psychiatry at Harvard Medical School, lead and corresponding author of the report. “Adding an objective biological test could improve diagnostic accuracy and may also help us track individual patients’ response to treatment.”The study authors note that previous efforts to develop tests based on a single blood or urinary biomarker did not produce results of sufficient sensitivity, the ability to detect the tested-for condition, or specificity, the ability to rule out that condition. “The biology of depression suggests that a highly complex series of interactions exists between the brain and biomarkers in the peripheral circulation,” says study co-author John Bilello, chief scientific officer of Ridge Diagnostics, which sponsored the current study. “Given the complexity and variability of these types of disorders and the associated biomarkers in an individual, it is easy to understand why approaches measuring a single factor would not have sufficient clinical utility.”The test developed by Ridge Diagnostics measures levels of nine biomarkers associated with factors such as inflammation, the development and maintenance of neurons, and the interaction between brain structures involved with stress response and other key functions. Those measurements are combined using a specific formula to produce a figure called the MDDScore — a number from 1 to 100 indicating the percentage likelihood that the individual has major depression. In clinical use the MDDScore would range from 1 to 10.The initial pilot phase of the study enrolled 36 adults who had been diagnosed with major depression at the MGH, Vanderbilt University, or Cambridge Health Alliance in Cambridge, Mass., along with 43 control participants from St. Elizabeth’s Hospital in Brighton, Mass. MDDScores for 33 of the 36 patients indicated the presence of depression, while only eight of the 43 controls had a positive test result. The average score for patients was 85, while the average for controls was 33. A second replication phase enrolled an additional 34 patients from the MGH and Vanderbilt, 31 of whom had a positive MDDScore result. Combining both groups indicated that the test could accurately diagnose major depression with a sensitivity of about 90 percent and a specificity of 80 percent.“It can be difficult to convince patients of the need for treatment based on the sort of questionnaire now used to rank their reported symptoms,” says Bilello. “We expect that the biological basis of this test may provide patients with insight into their depression as a treatable disease rather than a source of self-doubt and stigma. As we accumulate additional data on the MDDScore and perform further studies, we hope it will be useful for predicting treatment response and helping to select the best therapies.”Papakostas adds, “Determining the true utility of this test will require following this small research study with larger trials in clinical settings. But these results are already providing us with intriguing new hints on how powerfully factors such as inflammation — which we are learning has a major role in many serious medical issues — contribute to depression.”
Ronold Wyeth Percival King was born on September 19, 1905, in Williamstown, Massachusetts, where his father was a professor of German at Williams College. He received a B.S. degree in physics from the University of Rochester in 1927. Under a German-American Fellowship, he studied in Munich and then received a master’s degree in 1929 from the University of Rochester and earned a Ph.D. in 1932 from the University of Wisconsin. After two more years at Wisconsin doing research, King moved to Lafayette College in Easton, Pennsylvania, to serve as an instructor in physics. In the spring of 1936, Professor E. L. Chaffee, who headed a group in Communication Engineering in the Graduate School of Engineering at Harvard, searched out Dr. King as successor to Professor G. W. Pierce, who was retiring. In 1938 King returned from a year-long Guggenheim Fellowship in Germany to become an instructor in the School of Engineering at Harvard. He retired from Harvard as Gordon McKay Professor of Applied Physics in 1972, but stayed many years beyond, remaining active and productive until after his one-hundredth birthday.Over the course of his career King produced 12 books and more than 300 journal articles in the field of applied electromagnetics in specialized areas related to antennas. His lectures and publications make the word “thorough” seem like a gross understatement. Fortunately he usually began with a physical description of the problem followed by a rigorous theory containing a large variety of symbols. His giant and intimidating volume, The Theory of Linear Antennas, was used to train most of his students. Without taking the antenna course, AP 234, you could never be a true King antenna person. He could spend an entire lecture explaining a concept that others would dash off in five minutes.In many areas of electrical engineering, Maxwell’s equations would form the basis for King’s theoretical treatment. Generally he would add experimental results carried out by his students. Many of his journal publications were co-authored with the students and, in an efficient process, were ultimately incorporated into his books. Other areas to which King made major contributions were antennas over and in earth and water and the biological effects of electromagnetic radiation. During the war he taught courses in the Harvard Radar School and pre-Radar School.According to King himself, his greatest achievement was the 101 graduate students who wrote their Ph.D. dissertations under his guidance, including one father-son pair: John and George Fikioris. His large body of students referred to him as “Professor King” even after they themselves became professors. In spite of this formality, his Ph.D. students enjoyed a relationship with him that was both familial and collegial. Students regularly had lunch with him at the lab and were invited to dinners at his house in Winchester. He took equal interest in outstanding students and those in need of help of any kind. His students honored him with the Golden Dipole Award at his retirement dinner in 1972 and celebrated milestones with him regularly up to and including his one-hundredth birthday.King received many awards for contributions to research and education. In 1984 he received the IEEE Centennial Medal; in 1986 the Harold Pender Award from the Moore School of Electrical Engineering of the University of Pennsylvania; in 1991 the IEEE Distinguished Achievement Award of the Antennas and Propagation Society, the citation for which stated: “To Ronold W.P. King for over a half century of outstanding contributions to the field of electromagnetics particularly in the area of linear antennas; for the exemplary standards in research and teaching and, above all, for a lifetime of dedication to his students.” One award that made him particularly proud was being elected to the Bavarian Academy of Sciences.King married Justine Merrell in 1937, and their son, Christopher, was born in 1941. After Justine’s death in 1990, he married Mary Govoni in 1991. King’s personal life is hard to separate from his public life as professor and researcher. He spent most of his summers, from boyhood on, at his family’s oceanfront cottage in Rockport, Maine.It was a classic wooden cottage with a wood stove that kept his family from freezing on cold and foggy Maine days. When he was an undergraduate he took on the job of wiring his family’s farm in Waldoboro, Maine. He designed the systems himself and bought all the parts from Sears Roebuck. No soldering in the walls was allowed, so he had to have exact lengths to put in conduit. With the help of his younger brother, Don, the job took two summers to complete, but he said, “It made electricity very real. In a small way it was the beginning of my long career in electromagnetic theory.” When he observed that boats often had a hard time navigating Rockport Harbor in the fog, he devised and published a paper on a beacon antenna array system to guide the boats.Much can be said of Ronold King’s life work: his energetic commitment to his 101 Ph.D. advisees; his skill at conveying a deep physical understanding of a problem; his extraordinary analytical abilities and experimental prowess. King’s success as a teacher also benefited from a unique talent for choosing words and crafting sentences to communicate complex and subtle ideas. His writing was as precise as his science, and both were exceptionally deep and elegant.In addition, Professor King’s industry was truly remarkable. How many individuals reach the age of 90 and have 30 more scientific, peer-reviewed papers and one more comprehensive technical book yet to write and publish?Professor King’s students and colleagues have greatly admired his long life and many accomplishments. Most complimentary of all, many have modeled their lives after his fine example.Respectfully submitted,Frederick H. AbernathySheldon Sandler, Boston UniversityTai T. Wu, Chair
Physicist Jenny Hoffman ’99 and political theorist Eric Beerbohm are this year’s winners of the Roslyn Abramson Award, given annually to assistant or associate professors for excellence in undergraduate teaching.The $10,000 award, established with a gift from Edward Abramson ’57 in honor of his mother, goes each year to members of the Faculty of Arts and Sciences (FAS) “in recognition of his or her excellence and sensitivity in teaching undergraduates.” Recipients are chosen on the basis of their accessibility, their dedication to teaching, and their ability to communicate with and inspire undergraduates.“Jenny Hoffman and Eric Beerbohm are outstanding young scholars who also have the ability to inspire students’ curiosity in the classroom and beyond,” said FAS Dean Michael D. Smith, the John H. Finley Jr. Professor of Engineering and Applied Sciences. “Each has a passion not only for their fields of study, but also for helping undergraduates to learn and explore. On behalf of the College and the entire FAS, I offer my thanks and congratulations.”Jenny HoffmanHoffman, associate professor in the Department of Physics, said that she is flattered to receive this year’s Abramson Award, but she’s not entirely comfortable with the term “teaching.”“It’s kind of a funny word,” said Hoffman, who teaches “Wave Phenomena” and has created the freshman seminar “Building a Scanning Tunneling Microscope.” “Students do the learning. I try to guide them and to provide an environment that fosters self-confidence and curiosity. But the most important learning happens outside of the classroom, when they work together in the lab or on the problem sets.”Hoffman’s willingness to go where the learning happens is part of what makes her a remarkable teacher. Rather than holding her office hours in the Department of Physics, she holds them in the Houses the night before her problem sets are due. There, she not only answers students’ questions about physics, but also advises them on their academic careers.“I usually show up at 8 or 9 p.m. and leave around 11 p.m. or later,” Hoffman said. “Half the class comes. We do physics and have life conversations. I talk to them about where they’re going to graduate school and what they’re doing for summer research. Sometimes they gripe about being up late and doing their problem sets, but mostly they seem to think it’s fun.”Hoffman said that as an alumna she understands that many of the students in her classes won’t become research scientists, but physics teaches students problem-solving skills that will serve them well, regardless of what they choose to study or do for a living later.“Are they going to remember all the quantum mechanics formulae?” she asked. “Probably not. But physics is great for problem solving. It teaches you that, if you think and dig hard enough, there’s a right answer at the end. Students get a good education here at Harvard, then take those skills into whatever else they do.”Hoffman plans to use the award money for something that’s even more important to her than physics: motherhood.“The award will pay my maternity leave,” she said, smiling. “So, in a way, I guess I’ll still be teaching.”“In my teaching, I try to convey the hazards of living in a representative democracy like ours — the way we can be implicated in the acts of our state, even if we attempt to opt out of political life,” said Eric Beerbohm, one of this year’s Roslyn Abramson Award. Photo by Stephanie Mitchell/Harvard Staff Photographer Eric BeerbohmBeerbohm, associate professor in the Department of Government, teaches students about democracy. And, like most good teachers, he tries to put concepts into practice.“For those of us who work in democratic theory,” Beerbohm said, “breaking down the authoritarian relationship between the lecturer and student can help us clarify the concept of democracy itself.”In class, Beerbohm pushes students intellectually to get them to push back. He engages them in a “thought experiment of the day” to get them to consider how people ought to govern themselves, and to sound out the students’ convictions. He also uses technology, running a live online feed of students’ comments during his lecture. He says that undergraduates’ questions about political theory not only further their learning process, but also help him to advance his own studies.“It’s extremely difficult to do political theory — at least sustainably — without teaching,” Beerbohm said. “In political philosophy, we need a sense of where peoples’ convictions lie before they delve into the canon in political thought. We need to see how they react when they try on a theory for size. In some cases, student expressions of bewilderment at the premises or conclusions of a theory can be just as important to my research as engaging with published work in the field.”Beerbohm said that political theory isn’t optional for those who live in a democracy. It’s crucial for students to reflect on values such as equality, liberty, and dignity in order to be good citizens. He pointed out that everyone is political in a government of the people, by the people, and for the people.“In my teaching, I try to convey the hazards of living in a representative democracy like ours — the way we can be implicated in the acts of our state, even if we attempt to opt out of political life. If democracy has this hazardous character, there’s a sense in which political theory is a mandate that falls upon all of us privileged enough to have the time to reflect on the justifiability of our political institutions.”The fact that political theory is a practical exercise in no way detracts from its intellectual rigor, Beerbohm contends. On the contrary, he believes that students develop as intellectuals precisely by breaking theories down and seeing whether or not they can withstand rigorous scrutiny.“Reducing a political theory to its component parts and testing it is enormously difficult,” he said. “That’s part of what makes it such a rewarding activity. In class, I try to show how the moments of surprise — when the conclusion of an argument isn’t expected or even welcome — are evidence that one is doing it right. That’s the excitement of following the argument where it leads.”Beerbohm will use the proceeds from the award to develop new undergraduate courses on theories of law and lawmaking.
By tailoring geoengineering efforts by region and by need, a new model promises to maximize the effectiveness of solar radiation management while mitigating its potential side effects and risks. Developed by a team of leading researchers, the study was published in the November issue of Nature Climate Change.Solar geoengineering, the goal of which is to offset the global warming caused by greenhouse gases, involves reflecting sunlight back into space. By increasing the concentrations of aerosols in the stratosphere or by creating low-altitude marine clouds, the as-yet hypothetical solar geoengineering projects would scatter incoming solar heat away from the Earth’s surface.“Our research goes a step beyond the one-size-fits-all approach to explore how careful tailoring of solar geoengineering can reduce possible inequalities and risks,” says co-author David Keith, Gordon McKay Professor of Applied Physics at the Harvard School of Engineering and Applied Sciences. Photo by Eliza Grinnell/SEAS CommunicationsCritics of geoengineering have long warned that such a global intervention would have unequal effects around the world and could result in unforeseen consequences. They argue that the potential gains may not be worth the risk.“Our research goes a step beyond the one-size-fits-all approach to explore how careful tailoring of solar geoengineering can reduce possible inequalities and risks,” says co-author David Keith, Gordon McKay Professor of Applied Physics at the Harvard School of Engineering and Applied Sciences (SEAS) and professor of public policy at Harvard Kennedy School. “Instead, we can be thoughtful about various trade-offs to achieve more selective results, such as the trade-off between minimizing global climate changes and minimizing residual changes at the worst-off location.”The study — developed in collaboration with Douglas G. MacMartin of the California Institute of Technology, Ken Caldeira of the Carnegie Institution for Science, and Ben Kravitz, formerly of Carnegie and now at the Department of Energy — explores the feasibility of using solar geoengineering to counter the loss of Arctic sea ice.“There has been a lot of loose talk about region-specific climate modification. By contrast, our research uses a more systematic approach to understand how geoengineering might be used to limit a specific impact. We found that tailored solar geoengineering might limit Arctic sea ice loss with several times less total solar shading than would be needed in a uniform case.”Generally speaking, greenhouse gases tend to suppress precipitation, and an offsetting reduction in the amount of sunlight absorbed by Earth would not restore this precipitation. Both greenhouse gases and aerosols affect the distribution of heat and rain on this planet, but they change the temperature and precipitation in different ways in different places. The researchers suggest that varying the amount of sunlight deflected away from the Earth both regionally and seasonally could combat some of this problem.“These results indicate that varying geoengineering efforts by region and over different periods of time could potentially improve the effectiveness of solar geoengineering and reduce climate impacts in at-risk areas,” says co-author Ken Caldeira, senior scientist in the Department of Global Ecology at the Carnegie Institution for Science.The researchers note that although their study used a state-of-the-art model, any real-world estimates of the possible impact of solar radiation management would need to take into account various uncertainties. Further, any interference in Earth’s climate system, whether intentional or unintentional, is likely to produce unanticipated outcomes.“While more work needs to be done, we have a strong model that indicates that solar geoengineering might be used in a far more nuanced manner than the uniform one-size-fits-all implementation that is often assumed. One might say that one need not think of it as a single global thermostat. This gives us hope that if we ever do need to implement engineered solutions to combat global warming, that we would do so with a bit more confidence and a great ability to test it and control it.”
Harvard Medical School (HMS) faculty members are working with the city of Cambridge to provide mental health services in partnership with police, schools, and youth services programs, as part of a wide-ranging effort to keep kids out of court.Since its founding in 2007, the Cambridge Safety Net Collaborative has successfully diverted hundreds of Cambridge youths into structured activities — such as athletic leagues and after-school programs — and linked them to counseling and mental health services, when needed.James Barrett, an instructor in psychology in HMS’s Department of Psychiatry and with the Harvard-affiliated Cambridge Health Alliance, heads the mental health assessment and treatment part of the program. Barrett meets with representatives of the other key organizations involved — Cambridge police, schools, and the Department of Human Service Programs — every other week. Together, they review cases involved with the Safety Net Collaborative and refer them to an appropriate program.Safety Net got its start in 2007, when Robert Haas arrived as Cambridge’s police commissioner. In surveying the department, Haas, who had served as the state’s secretary of public safety, realized there were limited options for officers dealing with juvenile crime. The officers could arrest the kids, disperse them, or send them home to their parents.Haas launched a youth and family services unit, assigning a handful of officers to deal exclusively with young people. The program developed ties with the schools and youth centers and approached the health alliance to provide mental health assessment and services.A diversion program is important, Haas said, because once young people become involved with the criminal justice system, more trouble tends to follow.“There’s lots of research that once a kid is in the court system, it’s difficult to get them on another path,” Haas said. “We tried to move from a reactive model to a preventive one.”The program has evolved, Haas said, and youth officers today are looked at as resources rather than merely agents of enforcement. Officers have been trained to recognize red flags in behavior that indicate a role for Safety Net, Barrett said. Each officer has Barrett’s cellphone and pager numbers.“It really is a role shift for these police officers,” said Barrett.In the years since the program was founded, it has expanded to serve younger kids. Now it routinely receives referrals for fifth, sixth, and seventh graders, rather than the older teens targeted when the program started. Some referrals come from youth resource officers noticing behavior on the streets, or from teachers concerned about classroom behavior. Some come from parents.That means the youths tend to have been involved in relatively minor issues, such as running away from home or exhibiting defiant behavior, Haas said. The result, according to Barrett and William Pollack, an associate clinical professor of psychology at HMS and senior consultant to Safety Net, is that the programs have been able to divert kids before they are involved in outright crimes.“When teenagers get into trouble, it tends to be more serious. Often there’s a legal charge,” Barrett said. “It has gotten to be more preventative than we had even hoped.”Too often, youths are ignored outside the schools until they get into trouble, Pollack said. In a city like Cambridge, with a wealth of resources — it has five youth centers —Safety Net helps to coordinate resources and reduce the chance that kids will fall through the cracks.“You often see disconnects between youth workers, police, and mental health. [In this case] they’re all connected, with Harvard and Harvard Medical School” nearby, Pollack said. “Unfortunately, our interventions for youth, especially around crime and criminal behavior, [often] occur out of fear when a major event occurs. People say, first we have to have safety, then we have to do something.”Officials involved with Safety Net shared their experiences with authorities on juvenile crime and diversion programs from around the country in October, during a workshop convened at the Harvard Faculty Club.Safety Net currently serves about 70 young people, though the number can vary. While there are more boys than girls in the program, girls make up a sizeable minority.Barrett and Pollack are beginning an in-depth assessment of the program, though there is anecdotal evidence of its effectiveness. Just two Cambridge juveniles were arrested last summer, and city officials have recently noticed fewer kids with a history with the courts applying for city jobs programs.“It’s gone well beyond my expectations when I took over,” Haas said. “It’s really been a remarkable partnership.”
Gov. Deval Patrick ’82 has nominated Gloria Tan, a clinical instructor at HLS’s Criminal Justice Institute, to a seat on the Massachusetts Juvenile Court. A leading national authority in the field of juvenile justice, Tan brings a wealth of experience and expertise to the juvenile bench in Massachusetts.As a judge on the Juvenile Court, Tan will rule on cases regarding delinquency, children in need of services, care and protection petitions, cases in which an adult contributes to the delinquency of a minor, adoption, guardianship, termination of parental rights proceedings, and youthful offender cases.Currently, Tan teaches and supervises law students who represent indigent adults and youth in criminal and delinquency proceedings. Prior to joining CJI, Tan served as a public defender for the Committee for Public Counsel Services in Boston, as well as an attorney for CPCS’s Youth Advocacy Division.On Sunday, the students presented their model policies and participated in a discussion with Dean Minow. “After the presentations, we had an utterly fascinating conversation with the panelists that lasted about an hour longer than we had scheduled,” said Daniel Doktori ’13, an organizer of the event and one of the dean’s liaisons to the Harvard Innovation Lab. “This was a great example of Dean Minow’s commitment to alternative methods of legal education and her support of student-led initiatives.” Read Full Story
With the announcement of changes to the University’s health benefits for faculty and nonunion staff in 2015, the Gazette recently sat down with four members of the University Benefits Committee, a group of faculty and administrators from across Harvard charged with advising on potential reforms to the University’s benefits plans. The four discussed how the committee came to make these recommendations, how they believe these changes are designed to protect benefits for the long term, and how faculty and staff will be affected. Participating were Michael Chernew, professor of health care policy at Harvard Medical School (HMS) and benefits committee chair; Barbara McNeil, founder and head of the health care policy department at HMS; Brigitte Madrian, the Aetna professor of public policy at the Harvard Kennedy School; and Patricia Byrne, executive dean at Harvard Divinity School.GAZETTE: What are the biggest changes that employees will see next year?MICHAEL CHERNEW: The main changes are that the premiums that employees pay monthly will go down, and the cost that employees and their dependents will pay at the point of service will rise in certain cases. In-network deductibles will be introduced, as will coinsurance. Out-of-pocket maximums, the total amount that employees potentially pay out-of-pocket, will decrease. Finally, we are adding a new lower-premium, high-deductible plan. Overall, we hope to give individuals and families more visibility into and control over their health care spending.BRIGITTE MADRIAN: Another important change is an increase in the level of coverage available under the dental insurance plan.GAZETTE: Tell us more about that.CHERNEW: The dental plan used to be structured so that once an employee or family member hit a cap of approximately $3,000 in benefits, coverage ended. The new dental plan still has cost sharing, but we’ve added a catastrophic component to provide additional coverage.GAZETTE: Are there things that aren’t changing?BARBARA McNEIL: A number of important things aren’t changing. Preventive care coverage will not change — it will still be fully covered by Harvard. Nor will regular doctors’ visits change.Two other points: In terms of the overall program, Harvard is paying about 77 percent of premium costs. That overall premium subsidy is competitive with its peers, but Harvard’s strategy does favor families and lower-paid employees, by subsidizing their premiums at a higher rate. The eligibility thresholds will be essentially the same: 17.5 hours a week or $15,000 per year will make most individuals eligible for benefits.GAZETTE: What costs are increasing?PATRICIA BYRNE: There are some cost increases. When you move out of preventive care — which isn’t changing — and into hospital stays and surgeries, for example, the employee will now share a portion of that cost with Harvard. The smaller portion, by far. When you are in your network of physicians, there will now be a deductible of $250 for an individual and a maximum of $750 for a family. You will be responsible for the remaining 10 percent of the costs up to the out-of-pocket maximum. The emergency room copay will also go up from $75 to $100, an increase consistent with our peers.GAZETTE: What costs are decreasing?MADRIAN: There are several aspects of the health plan that will actually make health care costs less expensive along some dimensions. I think the most noticeable one is that the monthly premium payment for health insurance coverage will go down. If you stay with the same type of coverage that you have now, the deduction from your paycheck for health insurance every month will be lower under these plan changes.In addition to out-of-pocket maximums going down, both pharmacy costs and office visits will be included in the out-of-pocket maximum calculation.GAZETTE: Who’s immediately affected by these changes?CHERNEW: The specific benefit design changes for 2015 apply to faculty and nonunion staff. For unionized staff, these changes will be subject to negotiation.GAZETTE: Why is Harvard making these changes? And why now?CHERNEW: The University and the benefits committee are continually looking at the benefits structure. We’ve been making changes of various types and have been thinking of making changes for a long time.The motivating factor, frankly, is that health care costs have been rising. Between 2002 and 2012, benefits costs have risen from 8 percent of the University’s overall budget to 12 percent. Even for an institution as well off as Harvard, that sort of growth isn’t sustainable. There are a lot of other revenue pressures that the University is facing, such as the tuition net of financial aid and research funding. So, we are constantly trying to come up with a benefits package that is competitive in the marketplace and enables employees to have some control over their spending but is fiscally sustainable given the competing needs for Harvard resources. So on balance the new benefit package reduces the rate of increase in Harvard’s spending on health care.McNEIL: The committee spent more than two years deliberating this particular set of changes. We looked at a host of possible options, how they would impact our budget, compared how these changes related to the similar activities going on at our peer institutions, and assessed how they would affect our community. We also hired a consulting firm to provide us with data from our peers and to help us with analysis of our own data.BYRNE: It was a very impressive set of conversations, and there was a lot of lively debate and argument about this on the committee. It was not pro forma. In addition, we worked with senior leadership to put the health care plans out to bid to make sure we were starting with as low a cost base as possible, and worked with outside consultants to analyze various contract and plan design alternatives.GAZETTE: What were the guiding principles of the committee as they went through this process?CHERNEW: As Harvard University and the country as a whole grapple with health care spending, people are constantly trying to figure out how to provide coverage that meets people’s needs in a fiscally sustainable way.Remember that the members of the committee also are faculty and staff, so we’re very sensitive to how these changes will impact people. Our guiding principles include preserving access to health care and increasing transparency and control over health care costs for individuals in our plans.We’ve tried to do all of this in a way that avoids putting individuals at significant risk and studied many alternative benefit designs, all in the context of massive payment reform ongoing in Massachusetts and the rest of the country now.BYRNE: I think anyone who eavesdropped on the benefits committee would be impressed by the extent to which the committee thinks about the individual. The committee brings up a lot of “what-if” situations to explore all kinds of scenarios. We realize how diverse the workforce is and how important wellness and health insurance are to faculty and staff members.McNEIL: We also discussed in detail the impact of heavy-duty drug costs. We wanted to make sure our community was protected against the possibility of enormous prescription drug costs by having an out-of-pocket maximum that included pharmacy costs — recall that this maximum is now lower than it had been before.CHERNEW: Lower out-of-pocket costs and the reimbursement plan for those who earn less are designed to mitigate the sort of potentially negative financial consequences of health shocks. Some costs may increase, but we wanted to avoid having anyone in a really catastrophic situation.GAZETTE: Are these changes going to mean that people have to switch doctors?McNEIL: The changes in our benefit design do not imply that an individual has to change his or her doctor. That doesn’t mean that it might not happen, however. For example, the plan in which an individual is enrolled might change its list of physician providers. This happens frequently, and it’s totally outside Harvard’s control.GAZETTE: You mentioned that there is a new high-deductible plan option. Can you tell us more about that?MADRIAN: With this high-deductible plan, the employee is completely responsible for a higher initial level of medical expenditures, but in exchange will have a lower monthly premium. In addition, those who choose this plan will have the option to set up a health savings account where they can make tax-deferred contributions that can be used to cover health care expenses, including those that go toward meeting the deductible.Those funds can be rolled over from year to year, are fully portable, and can also be used to pay for post-retirement health expenses, tax-free. This is a tax-advantaged way to save for health care expenditures, while at the same time getting a lower monthly premium. For those who choose the high-deductible plan and set up a health savings account, the University will seed that health savings account with a $500 contribution for individuals and $1,000 for families.CHERNEW: These changes give individuals who consume health care more efficiently an option to capture some of those savings.GAZETTE: How does the new plan compare with our peers?CHERNEW: Our goal was to stay on average about where the market is — in this case, our peers in the Ivy League as well as local employers — and we believe that these changes are about where the market is. Our plan is skewed to favor lower-income individuals, but in the grand scheme of things we think this benefit structure is comparable and competitive across the board.MADRIAN: In terms of plan design, most large organizations have a deductible, they have coinsurance, and most large organizations have added the option of a high-deductible health plan. So the changes that we are making are in line with the direction that employer-provided health plans across the country are moving.CHERNEW: We didn’t make these changes because others are making these changes but because of the underlying set of market dynamics which are common across a lot of similar organizations. So what you’re seeing is similar organizations responding similarly to a set of market environment changes.GAZETTE: Harvard has a huge endowment. Why can’t it use that to offset some of these costs?MADRIAN: A large fraction of the endowment is earmarked for specific expenditure purposes, such as funding a faculty chair, financial aid, or a new building. The money from those gifts — which make up the endowment — isn’t available to fund employee health benefits. While we need to provide an attractive benefits and compensation package to retain the best faculty and staff, we’re a university, and we can’t lose sight of our primary mission: teaching, research, and the dissemination of knowledge.GAZETTE: It seems like my health insurance changes every year, while other benefits are more static. Why is that?CHERNEW: In an ideal world, things would be stable for all employees from year to year. However, all of the vendors that we purchase coverage from, be it our pharmacy benefit management firm or the health plans, are constantly making changes as they try to address ongoing issues in the health care sector. We try to minimize the ramifications of that, but there will inevitably be some individuals who are affected by that.I think that, from the benefits committee’s standpoint, what we would like to convey is, first, a sense that we are aware of and paying attention to the complexities going on in health care. Secondly, frankly, we want to manage expectations because there’s no optimal set of things that will work for everybody. Thirdly, that most of what is done involves a set of tradeoffs, and we would like, to the extent possible, to allow those tradeoffs to be made by individuals and their families as best they can. By shifting more of the costs from premiums to point of service, we give individuals more awareness and control over their own health care spending.GAZETTE: Are there any changes to pharmacy benefits?McNEIL: We are switching pharmacy vendors to further lower premium cost and to ensure the best possible customer service. We kept the pharmacy copayment structure the same. There will likely be some disruptions because people will have to make some changes — for example, get a new pharmacy insurance card and perhaps get prescriptions rewritten for certain things. Hopefully, after this early transition period, customers will have a positive experience.GAZETTE: Why is health care so expensive?CHERNEW: Essentially, the reason you see the change is because of the fiscal consequences of medical progress. Over time, there have been a lot of advances in health care, which are wonderful. The way we treat cancer, heart disease, almost any medical condition we have, has changed. That’s generally a good thing, but it’s also more expensive.