Topic: Healthcare
Kids who consume less sugar, starting even before birth, have a lower risk of getting diabetes
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Britain’s postwar sugar craze confirms harms of sweet diets in early life
Sugar restrictions in utero and early childhood reduces risk of chronic disease, study finds
A low-sugar diet in utero and in the first two years of life can meaningfully reduce the risk of chronic diseases in adulthood, according to a study published today in the journal Science. The researchers used contemporary data from the U.K. Biobank to study the effect of exposure to sugar restrictions early in life on health outcomes of adults conceived just before and after the end of wartime sugar rationing in the United Kingdom in September 1953.
The study, published on Halloween, finds that children exposed to sugar restrictions during their first 1,000 days—including in utero—had up to a 35% lower risk of developing Type 2 diabetes and up to 20% lower risk of hypertension as adults. In-utero exposure alone was enough to lower risks, but disease protection increased with length of exposure after birth.
The study—a collaboration by researchers Tadeja Gracner from the University of Southern California, Claire Boone of McGill University, and Paul Gertler of the University of California Berkeley’s Haas School of Business—provides compelling new evidence of the lifelong health effects of early-life sugar exposure.
“Studying the long-term effects of added sugar on health is challenging because it is hard to find situations where people are as-if randomly exposed to different nutritional environments early in life and follow them for 50 to 60 years,” said Gracner (PhD 15, Economics). “The end of rationing provided us with a novel natural experiment to overcome these problems.”
Wartime sugar rationing
The study exploits a natural experiment: the end of sweets and sugar wartime rationing in the U.K. during World War II. Rationing was in effect during the war and ended in September 1953. Sugar intake during that time was about half (around 40 grams per day) the level immediately following rationing. The rationing was not one of extreme food deprivation—in fact, diets generally appeared to have been within today’s USDA/WHO dietary guidelines. WHO, as well as Dietary Guidelines for America adopted in 2020, recommend that children under two should consume no added sugars, and adults should aim to limit their added sugar intake to 7 teaspoons per day and consume no more than 12 teaspoons (50g).
When rationing ended, sugar and sweets consumption skyrocketed–doubling to about 80 grams per day on average. Other foods, like butter, cheese, cereals, and meat were also rationed, but there was little if any change in their consumption after rationing ended. Almost all of the sharp increase in total calorie intake post-rationing was explained by the rise in sugar calorie intake.
The end of WWII rationing therefore created a natural experiment in which children born just before the end of rationing were exposed to sugar-scarce conditions compared to those born just after who were born into a sugar-rich environment. The researchers then identified those born around this time in the UK Biobank data collected more than 50 years later. Enough time has passed since then for chronic diseases to develop and using a very tight birth window around the end of WWII sugar rationing allowed the authors to compare midlife health outcomes of otherwise similar birth cohorts.
Less diabetes, hypertension
The authors found that exposure to sugar restrictions in utero and during the first 1,000 days substantially lowered the risk of developing Type 2 diabetes and hypertension. If diagnosed, reduced early-life sugar intake delayed onset of diabetes by four years and hypertension by two years, respectively. In-utero exposure alone was enough to lower risks, but disease protection increased with the length of time babies had limited exposure to added sugar.
The magnitude of this effect is meaningful as it can save costs, extend life expectancy and, perhaps more importantly, improve quality of life. In the U.S., people with diabetes incur annual medical expenditures of about $12,000 on average. Every decade of earlier diagnosis of diabetes is associated with three-to-four years lower life expectancy, underscoring the value of early interventions that could delay or prevent this disease.
Policy implications
Today, there is a growing concern about children’s long-term health as they are consuming excessive amounts of added sugars during this critical early period. Added sugar is everywhere—even in baby and toddler foods—and children are bombarded with TV ads for sugary snacks. Adjusting sugar consumption is not easy, the researchers acknowledge, but information is key. “Parents need information about what works, and this study provides some of the first casual evidence that reducing added sugar early in life is a powerful step towards improving children’s health over their lifetimes,” said Boone (PhD 22, Public Health).
Gertler adds, “Sugar early in life is the new tobacco, and we should treat it as such by holding food companies accountable to reformulate baby foods with healthier options. We should also tax and regulate the marketing of sugary foods targeted at kids.”
This is the first study out of a larger research effort exploring how early-life sugar restrictions affect a broader set of economic and health outcomes including education, wealth, chronic inflammation, cognitive function, and dementia in later adulthood.
The study was supported by the U.S. National Institutes on Aging, part of the National Institutes of Health.
About the study
“Exposure to Sugar Rationing in the First 1000 Days of Life Protected Against Chronic Disease”
by Tadeja Gracner, Claire Boone and Paul J. Gertler
Science, October 31, 2024
News coverage
- Britain’s postwar sugar craze confirms harms of sweet diets in early life, Science
- Being Sugar-Deprived Had Major Effects on These Childrens’ Health, The New York Times
- Sugar in first 1,000 days linked to poor health later, BBC
- Limiting sugar in infancy is tied to less diabetes and hypertension in adulthood, Stat
- Studying WWII-era rationing shows that sugar is dangerous even in utero, Popular Science
- Diabetes risk soars for adults who had a sweet tooth as kids, Nature
From theory to practice: how MBA students apply classroom knowledge to career and life
A conversation with Anurag Mairal
New Product Management Club at Berkeley Haas gears up for first conference
Berkeley Haas has a thriving community that cares deeply about product management. Among that group is Ansu George, EWMBA 25, who aims to make it even stronger in her role as president of the new student-run Product Management Club (PMC).
With a collaborative team of 13 MBA students, George is now gearing up to host the inaugural Haas Product Con on Oct. 26 at Chou Hall’s Spieker Forum.
“This will be a landmark, full-day event for the Haas community,” said George, the lead product manager at B2B software company RollWorks, a division of NextRoll. “We’re expecting 250 attendees, with 20 speakers, and participants ranging from students to seasoned product professionals across the Bay Area. It’s a chance for us to unite, learn, and support each other’s growth in product management.”
The day will include hands-on AI product experience workshops, personalized coaching sessions, speed networking, and sessions on navigating the job market in today’s economy—along with lightning talks on gaming and healthcare tech.
The Product Con event will feature influential industry speakers including Todd Yellin, former head of product at Netflix, Ami Vora, chief product officer at Faire and former vice president of Product at Whatsapp, Shreyas Doshi, product coach, leader, and founder of High Leverage Labs, Tatyana Mamut, co-founder and CEO of Wayfound, Hubert Palan, founder and CEO of Productboard, Navnith Ramkrishnan, director of product management at Tanium, Rupa Chaturvedi, founder of the Human Centered AI Institute and a partner with Reforge, Ajit Ghuman, co-founder and CEO of Monetizely, and Ashwinder (Ash) Ahluwalia, a former product management head at Google and chief product and UX officer at Findem, among others.
Last month, the PM club hosted its first retreat, a half-day boot camp attended by more than 70 people. George and Sri Josyula, EWMBA 25, opened the retreat, which featured an interactive panel of Haas students who shared product management pivots from careers in the U.S. Army, consulting, design, and engineering. The panel, moderated by the club’s VP of careers, Riddhish Doshi, EWMBA 26, was followed by a session on PM internships moderated by co-president Shilpa Gopal, MBA 25, and closing remarks from Sparsh Agarwal, EWMBA 25, director of product at Salesforce.
A PM Speaker Series also launched this year, kicking off with organizational theorist and management consultant Geoffrey Moore, author of “Crossing the Chasm,” Marty Cagan, founder of the Silicon Valley Product Group and author of “Inspired,” will join the group Nov. 19. Cagan built products for Hewlett-Packard, Netscape Communications, and eBay.
A challenging pivot
A former software engineer, George pivoted to become a product manager in 2019 while working at Yahoo!
“I went through a full year of struggle to make that pivot happen,” she recalled. “At the time, my resume purely read ‘software engineer,’ with no projects or specific PM skills to showcase.”
Drawn to product management because it calls for solving a diverse array of problems on a daily basis, George said she pitched Yahoo’s VP of product, asking for an opportunity to work on a project. “That project was a success,” she recalled. “It opened the door for me to lead the launch and development of a product called Business Maker for Yahoo Small Business.” She left the company as a product manager.
The club has made significant progress over the past year. “I am especially grateful to Henry Hercock and Prachi Mehta, both EWMBA 24, who initially pitched the idea of forming this new club focused on product management,” George said. “Their vision came at a time of growing interest in the field, and their efforts laid the foundation for what the club has become today.”
Swetha Kalyanaraman, MBA 25, who holds a master’s degree in biotechnology, has found the club to be a great source for connections and career advice as she navigates a pivot to product management. She said she was inspired by a product management class she took earlier this year and that she’s now particularly interested in finding a role in the medical device space.
“There’s a lot of science involved in product management in this space, which enables you to talk to surgeons and doctors and medical practitioners,” she said. “The digital health space is also coming up right now.”
Part of George’s role with the club, which is open to all MBA students, is to help students like Kalyanaraman make the career change. ”If the club helps even a few students to pivot to a first-time product manager job or if we help a product manager become a chief product manager that’s a big win,” she said.
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Fertility clinics show how the chain model can improve health care
How chain IVF clinics improve infertility treatment
People are wary of for-profit healthcare. Professor Ambar La Forgia demonstrates that, at least in the realm of infertility treatment, chain clinics perform significantly better than independent operators.
In the U.S., demand for in vitro fertilization (IVF) increased almost 140% between 2004 and 2018. Among other things, this trend suggests a business opportunity; in that same span of time the market share of for-profit chain clinics grew from 5% to 20%, with chains now performing over 40% of IVF treatment cycles nationwide.
“Chain organizations are very common in hotels and restaurants,” says Ambar La Forgia, an assistant professor at the Haas School of Business, UC Berkeley. “But when it comes to healthcare, because it hasn’t traditionally been delivered in this way, it seems to be making a lot of people uneasy.” Policymakers are particularly concerned that chains will chase profit at the expense of patient outcomes.
A new study by La Forgia, published in Management Science and coauthored by Julia Bodner of Copenhagen Business School, provides a more optimistic view in the case of fertility clinics, suggesting chain ownership has improved results. The researchers found that clinics acquired by a chain serve more patients, increasing IVF treatment cycles by 27%, and they increase live birth rates by nearly 14%.
Significant improvement with chain clinics
IVF treatment cycles comprise five main stages that require over 100 distinct steps performed over four to six weeks. Along the way, many subjective decisions must be made.
The goal, of course, is to produce healthy babies, and the last step—when a physician transfers an embryo, or embryos, into a patient’s uterus—is particularly important. Transferring more than one embryo increases the success rate, which is measured by the number of live births divided by number of transfers, but it also increases the chance of multiple births, like twins, which is riskier for both the mother and the newborns.
To compare the performance of chain and independent clinics, La Forgia and Bodner collated a novel set of clinic and patient data that drew from the Centers for Disease Control, and the National Center for Health Statistics. They also manually checked the ownership of every fertility clinic in the U.S. From this effort, they were able to look at two main outcomes between the years 2004 and 2018: How many IVF cycles does each clinic perform? And what is the success rate, measured by live births per transfer?
The researchers found that after a fertility chain acquires a clinic, IVF cycles increase dramatically and live birth rates increase by 13.6%. “This means that these chain clinics are doing more cycles of IVF and converting more of those cycles into live births,” La Forgia says. “They are actually improving the quality of care in a meaningful way.”
Chain clinics are not doing this by simply transferring a lot more embryos, either. La Forgia and Bodner find that they are actually producing more “singleton” births—that is, the birth of one baby—than their independent clinic peers, which implicitly suggests a better embryo selection process.
A product of more resources and knowledge
But what if these results are driven by a more stringent patient screening process, or by chains being more selective about the markets in which they operate?
La Forgia and Bodner investigated these possibilities and found no supporting evidence. There is no appreciable change in the patient population after a chain takes over an independent clinic. In fact, the largest improvement in live births is among patients who are 38 years old and older—the population that typically has the lowest success rates. Nor are their significant differences in the broader demographics of neighborhoods in which chain clinics operate, the researchers found.
Instead, it appears that chains improve outcomes through two mechanisms: the availability of more resources and a heavier focus on sharing best practices. The researchers make this case through several analyses. For instance, chains tend to introduce new processes and procedures known to improve birth rates. In fact, the lowest-performing clinics see the largest improvements when taken over by a chain, and clinics acquired by the highest-performing chains experience the greatest improvements.
Most notably, the researchers found that affiliated IVF clinics, which pay chains for select management support and financing options but retain managerial independence, witness an increase in patient volume and number of IVF cycles, but unlike fully acquired clinics, they don’t demonstrate an improvement in birth rates.
“Basically, in affiliated clinics the number of live births is going up as an absolute value, but they’re not getting better at achieving live births,” La Forgia says. “Our hypothesis is that a chain is willing to share its resources widely, but it may not want to share specific knowledge with an organization it doesn’t own, so we’ll only see this knowledge transfer in acquired clinics.”
The authors demonstrated a final benefit of chains, which is that they increase access to IVF by expanding the market—performing more IVF cycles—rather than stealing business from competitors.
Supporting a better healthcare market
Some of the findings may be explained by the fact that compared with many other parts of the healthcare system, fertility clinics share some characteristics with retail stores and chain restaurants. It’s a relatively more competitive market and patients typically pay up front and out-of-pocket for care. Clinics are also legally required to send their data to the government. Other sectors like dialysis and nursing care are more opaque and dependent on insurance, so chains may have fewer incentives to improve quality of care. But the researchers point out that plenty of health care is shifting toward a retail model, including dermatology providers, urgent care clinics, and physical therapists.
The authors offer three recommendations to help these markets support the kind of competition that ultimately improves patient outcomes.
- Policymakers should increase transparency about quality of care. In the fertility sector, clinics are legally required to send their data to the government, which publishes them as an online report card, so patients can shop around.
- Price transparency is necessary to increase competition among providers. In most healthcare settings, patients do not know how much they will pay, often until months after treatment. Since patients typically pay up front for fertility treatments, clinic chains may compete more on prices to attract new patients.
- Finally, regulators should make sure patients have sufficient choice. In the dialysis market, for instance, two companies own 60% of clinics. Such concentration of power may negatively affect both prices and quality. As chains expand, regulators should make sure this growth doesn’t hinder patient choice.
“Very little research speaks to the ways in which chains are good or bad for patients,” La Forgia says. “We ought to start paying attention to what kinds of markets might lend themselves well to this business model.”
Read the full paper:
Getting Down to Business: Chain Ownership and Fertility Clinic Performance
By Ambar La Forgia and Julia Bodner
Management Science
September 2024
Related content:
Fertility Clinics Show How the Chain Model Can Improve Healthcare
By Ambar La Forgia
Harvard Business Review, October 15, 2024
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More than an MBA: Tony’s journey from pharmacy to entrepreneurship
Chris Boerner, PhD 02
Board Chair & CEO, Bristol Myers Squibb
How does a kid from Arkansas who hated science and wanted to be a professor end up leading a Fortune 100 biopharmaceutical company?
By pursuing meaningful work and valuing the people around him, says Chris Boerner, who was recently named board chair and CEO of Bristol Myers Squibb (BMS).
Boerner swore off science after completing a college biology course and instead majored in economics and history. With an eye toward academia, he enrolled in Haas’ PhD program, where he researched how biotech companies are influenced by organizational factors when developing new products.
After graduation, Boerner joined McKinsey & Co. to consult for biotech clients—a role that changed his life. “I loved working for companies focused on improving patients’ lives,” he says. “I decided then not to go back to academia.”
Boerner went on to Genentech’s oncology department but realized that he needed to learn “the language of science” to achieve success. He spent hours questioning the company’s scientists about their work “to be just smart enough to get through the next day,” he says. His aspiration to enhance patients’ lives was cemented when a cousin died of cancer.
In 2014, he joined BMS to head U.S. operations. Now, as a CEO navigating a changing healthcare industry, he reflects on how his strong sense of community shapes the way he leads.
“I want to be surrounded by brilliant people who are great at what they do and who are also decent humans.”