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Borrowing for the Cure: Debt Financing of Breakthrough Treatments

April 24, 2015 Comments off

Borrowing for the Cure: Debt Financing of Breakthrough Treatments
Source: RAND Corporation

Recent market entries of breakthrough pharmaceutical products have reignited the debate about the affordability of high-priced drugs for public and private payers worldwide. Payers had voiced concerns about such drugs before but, faced with a possible outcry of patients and advocates, grudgingly accepted them. But as more high-cost drugs reach the market and treat more-prevalent conditions, medical professionals and government ministers have complained that this “blank check” might not be sustainable. Concerns about short-term budget impact have led countries to restrict access to expensive drugs, even when they met cost-effectiveness criteria and could lead to long-term savings. This paper offers a research-grounded perspective on innovative financing mechanisms to facilitate access to expensive yet highly effective breakthrough medical treatments. The authors outline the scope of the problem; describe several policy and market options, including bond financing and linking repayment to real-world value generation; and describe real-world applications.

Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers

April 14, 2015 Comments off

Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers
Source: RAND Corporation

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Given the unprecedented demands placed on U.S. military forces since 2001, there has been growing concern about the prevalence and consequences of sleep problems for servicemembers. Sleep problems often follow a chronic course, persisting long after servicemembers return home from combat deployments, with consequences for their reintegration and the readiness and resiliency of the force. Therefore, it is critical to understand the role of sleep problems in servicemembers’ health and functioning and the policies and programs available to promote healthy sleep. This report provides the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense (DoD), along with a set of actionable recommendations for DoD, commanders, researchers, and medical professionals who treat U.S. servicemembers. The two-year multimethod study also examined the rates and correlates of sleep problems among post-deployed servicemembers, finding negative effects on mental health, daytime impairment, and perceived operational readiness. The research reviewed evidence-based interventions to treat sleep disturbances among servicemembers and veterans and exposed several individual- and system-level barriers to achieving healthy sleep. Implementing evidence-based treatments is just one step toward improving sleep across the force; as the research recommendations highlight, it is equally important that policies and programs also focus on preventing sleep problems and their consequences.

The Ukrainian Crisis and European Security: Implications for the United States and U.S. Army

April 13, 2015 Comments off

The Ukrainian Crisis and European Security: Implications for the United States and U.S. Army
Source: RAND Corporation

Vladimir Putin’s decision to annex Crimea and attempt to destabilize eastern Ukraine have sparked widespread concern among Western policymakers that Russia has embarked on a confrontational national security policy that could have far-reaching implications for Russia’s relations with the United States and for European stability. The annexation of Crimea challenges two basic assumptions underlying U.S. policy toward Europe in the post–Cold War era: (1) that Europe is essentially stable and secure, thereby freeing the United States to focus greater attention on other areas, particularly Asia and the Middle East, and (2) that Russia had become more of a partner than an adversary. The annexation of Crimea and attempt to destabilize eastern Ukraine suggests that both these assumptions need to be revisited because Russia can hardly be viewed as a partner. The requirement that NATO may now have to build a much more robust deterrence and defense posture in Eastern Europe would require the Army and the Air Force to revisit their planning assumptions that have minimized U.S. military commitments to the region since the end of the Cold War.

When Jihadis Come Marching Home: The Terrorist Threat Posed by Westerners Returning from Syria and Iraq

April 2, 2015 Comments off

When Jihadis Come Marching Home: The Terrorist Threat Posed by Westerners Returning from Syria and Iraq
Source: RAND Corporation

Although the numbers of Westerners slipping off to join the jihadist fronts in Syria and Iraq are murky, U.S. counterterrorism officials believe that those fighters pose a clear and present danger to American security. This Perspective seeks to examine the scope of the threat posed by Western fighters who return to their homes after fighting in Syria and Iraq; what can be done to reduce the threat, and whether military action is necessary in combating it, as well as whether a more ambitious American military intervention in Iraq and Syria is required.

Lessons from 13 Years of War Point to a Better U.S. Strategy

March 31, 2015 Comments off

Lessons from 13 Years of War Point to a Better U.S. Strategy
Source: RAND Corporation

The rise of irregular threats and the decline of national budgets have posed an acute dilemma for those crafting U.S. global strategy. More than ever, U.S. civilian and defense leaders are being called on to find ways to achieve satisfactory outcomes to multiple simultaneous conflicts at an acceptable cost.

In particular, U.S. land forces face the need to become more agile in adapting their strategy as circumstances warrant and more capable of working with all manner of partners. The growing role of special operations forces (SOF) represents an important potential advantage in this regard, but future threats call for a broader array of options for the application of joint, interagency, intergovernmental, and multinational power. Future U.S. land operations will likely require not just a greater use of SOF but also improved interaction with conventional forces.

The performance of the past 13 years also suggests a need to remedy the nation’s strategic deficiencies at the levels of policy and strategy. Moving forward, war and statecraft should be viewed along the same spectrum, with the exercise of national power understood as a marriage of force and diplomacy — a marriage that wields the various elements of national power in a coordinated, seamless manner.

Developing Robust Strategies for Climate Change and Other Risks: A Water Utility Framework

March 30, 2015 Comments off

Developing Robust Strategies for Climate Change and Other Risks: A Water Utility Framework
Source: RAND Corporation

RAND researchers and collaborators present a comprehensive approach for water utilities to assess climate risks to their systems and evaluate adaptation strategies. The approach, based on Robust Decision Making, is demonstrated through pilot studies with two water utilities: Colorado Springs Utilities and New York City Department of Environmental Protection.

A Review of Research on Problematic Internet Use and Well-Being: With Recommendations for the U.S. Air Force

March 27, 2015 Comments off

A Review of Research on Problematic Internet Use and Well-Being: With Recommendations for the U.S. Air Force
Source: RAND Corporation

This report reviews the scientific literature on the epidemiology, prevention, and treatment of problematic Internet use (PIU) with the goal of informing Air Force policies aimed at mitigating PIU’s negative impact on operations and the mental health of Airmen. The report is motivated by a recent RAND study estimating that 6 percent of Airmen have PIU. Individuals with PIU, similar to people with substance addictions, suffer from excessive and compulsive online activities, symptoms of tolerance and withdrawal, and functional impairment. PIU is also strongly associated with other mental health problems including major depression. However, at present there is no single accepted definition of PIU, and no up-to-date estimates of the prevalence of PIU in the general U.S. population are available. A range of prevention and treatment approaches have been developed, but none has been rigorously tested in clinical trials. Prevention programs rely on workplace Internet policies and strategies to help individuals self-regulate their Internet use. Treatment approaches that have proven feasible and acceptable to patients with PIU include adaptations of cognitive-behavioral therapy, an evidence-based treatment for depression and anxiety, to the specific symptoms of PIU. Based on our findings, we recommend: (1) increasing awareness of PIU among organizational leadership and mental health professionals, (2) incorporating content related to PIU into existing trainings related to mental health, (3) providing support for self-regulation of Internet use on the job by incorporating PIU management principles into Internet use policies, and (4) continuing monitoring of the emerging scientific literature on PIU.

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