Roe v. Wade repeal may exacerbate women’s health inequities even as candidates use it to gain votes, USC experts say

The U.S. Supreme Court’s majority opinion to overturn Roe v. Wade leaves much in question, including the future of women’s health and other rights protected by court precedent. USC experts believe the opinion issued Friday will exacerbate inequities for women — and may impact voters’ decisions in the upcoming midterm elections.

The high court’s opinion leaves abortion access up to the states. Clinical Nursing Professor Cynthia Sanchez notes, though, that 13 states were ready for this day. Lawmakers in Texas, Tennessee, Missouri and other Republican-led states developed bans on abortion that were triggered by the opinion issued on Friday. Economics and politics will determine whether a woman can access abortion, she warned.

“The stripping away of patients’ rights always has a greater impact on the most vulnerable,” said Sanchez, of the USC Suzanne Dworak-Peck School of Social Work. “Women with resources will be able to seek care in other states that don’t have these repressive policies, meaning those that do not have the resources will be the most negatively impacted.”

Abortion rights: California offers most protections

California offers the most protections for abortion in the United States, and with SB 1375, state lawmakers are considering allowing first-trimester care by nurse practitioners — increasing the pool of providers beyond just physicians who perform abortion.

Despite providing greater access to abortions, California still has room to improve on contraception access, says Dima Qato, associate professor of clinical pharmacy at the USC School of Pharmacy.

Expanding access to birth control — emergency and preventive contraception — at local pharmacies should also be prioritized.

Dima Qato, USC School of Pharmacy

A Health Affairs study she co-authored in 2020 revealed that not all California pharmacies prescribe emergency and preventive contraception. In Los Angeles County, for instance, only 1 in 10 pharmacies provided the service, Qato noted.

“Expanding access to birth control — emergency and preventive contraception — at local pharmacies should also be prioritized,” Qato said. “All pharmacies should be required to carry and mandated to dispense birth control to anyone that requests it with or without a prescription. Title X funding can be used to finance the costs for those seeking contraceptives at a pharmacy.”

Although health experts argue abortion is a public health issue, for politicians, it’s a tool to drive voter turnout. Since Roe v. Wade was decided in 1973, politicians have used abortion as a wedge issue to motivate single-issue voters. It has taken on greater importance this year. With the midterm elections just months away, control of Congress is at stake, and candidates are leveraging the abortion issue.

Abortion rights could motivate voters on both sides

“In past midterm elections, social issues have motivated voters both on the right and the left to turn out,” said Christian Grose, a political scientist at the USC Dornsife College of Letters, Arts and Sciences who is the academic director for the USC Schwarzenegger Institute for State and Global Policy. “When the economy is bad, political parties have used social issues like abortion to motivate their base.

“This has recently been an effective tactic of Republican candidates,” Grose added. “However, this time the issue of abortion very well may help Democrats and it is highly mobilizing to their base of voters in what could be a Republican year.”

Using abortion as an election issue has its risks. Polls show most Americans support abortion. A Gallup poll in May showed that 85% of Americans support abortion, though 50% supported access only under certain circumstances. A Pew Research Center pollt shows that 61% believe abortion should be legal in all or most cases.

This time the issue of abortion very well may help Democrats.

Christian Grose, USC Dornsife

“Abortion policies and the choices of women of reproductive age and their families should not simply be a flag for political parties to wave,” said Pamela McCann, an associate professor at the USC Price School of Public Policy.

“When we use partisan shortcuts and demonize one side or the other, we lose sight of the truly crucial features of policy,” McCann said. “What are the current outcomes that we see in the world and find unacceptable? What are the possible changes we could make to improve that situation? How can we enact that change?”

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Students learn the power of yoga and mindfulness

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Through a summer course in Tulum, Mexico, USC students learn yoga and mindfulness. It’s part of a new minor aimed at helping students take control of their health.
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Some 800 years ago, the Maya worshipped the god of honey in the sacred town of Tulum, Mexico. Murals of Ah-Muzen-Cab, who resembles a stingless bee diving to Earth and is known as the “descending god,” still remain on the walls of a temple there.

Worship of Ah-Muzen-Cab may have dwindled over the last few centuries, but Tulum’s importance as a site of spiritual practice remains. Thousands of people now visit the area annually to attend yoga and meditation retreats.

If practicing 5,000-year-old Indian traditions in Mexico seems a little unusual, yoga teacher Isabelle Pilliere Mazumdar says the draw for modern visitors is likely the same reason the ancient Mayans built Tulum where they did, on the Yucat?n Peninsula.

“It’s the special energy of the area,” says Mazumdar, a senior lecturer in the physical education and mind-body health department at the USC Dornsife College of Letters, Arts and Sciences. “We don’t have this belief in Western society, but a lot of cultures believe in the importance of energy, whether it’s Chinese, Japanese or the Mayan culture.”

Mazumdar recently led a small group of USC students on a week-long Maymester trip to Tulum, where they took yoga lessons, meditated and explored the region’s history. It’s an elective course for the newly launched Mind-Body Studies Minor, which trains students in the fundamentals of good health, from sleep to mindfulness to physical exercise. With rising levels of anxiety and depression, as well as high obesity rates among college students, it’s timely and important coursework.

Rise and shine, it’s yoga time

The new Mind-Body Studies Minor aims to help students tackle stress and stay fit. (Photo: Courtesy Isabelle Pilliere Mazumdar)

A yoga retreat in Mexico might just sound like a relaxing vacation, but Mazumdar’s Maymester course had a packed schedule. Each day, students took two yoga classes, participated in group discussions and settled down for evening meditation. They also made time for excursions, exploring the ruins of the Mayan civilization and the spectacular caves in Gran Cenote.

The students ranged from novices to budding yoga enthusiasts. They ate all of their meals together and practiced yoga side-by side morning and evening, so the trip was also an exercise in living closely among people with different backgrounds and beliefs. “I had a very diverse group, different ethnicities, religions, sexual orientations. It was really nice that they all got along because you’re pretty much together 24/7,” says Mazumdar.

Mind and body

The new Mind-Body Studies minor, which launches this fall, also includes courses on human anatomy, nutrition and the brain as well as other electives like swimming and hiking. More than 20 students have already enrolled in the minor, which was designed to meet the demand from students for more tools to manage their stress and health.

The minor also helps students who are planning a career in medicine learn techniques for helping people that don’t involve prescriptions or surgery; a growing trend in health care.

For Christina Maineri, who is majoring in neuroscience and cognitive science, the new minor connects directly with her career interests. “I hope to use what I learn from the Mind-Body Studies minor, particularly in regard to how we train our brain, to assist dementia patients,” says Maineri.

Mazumdar could be the poster woman for how yoga can be a lifelong, fulfilling practice. She first encountered it some 40 years ago, when she was vacationing at a resort hotel in the late 1970s, when yoga wasn’t yet a mainstay in gyms. “Yoga was a little bit out there, it was experimental,” she says. As a dancer, she was attracted to the way it stretched and lengthened the body, and she’s been practicing the sport ever since.

Students from the Maymester course such as Anya Khurana, who is pursuing a degree in public health education and promotion at the Keck School of Medicine of USC, are planning a similar trajectory.

“The practices of yoga and mindfulness are great tools for stress management and overall wellness, but this course taught me how to apply those skills to my own life, which I will take with me as I attend professional school and begin my career,” says Khurana.

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Willingness to give away money among older adults linked to cognitive profile of early Alzheimer’s

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Willingness to give away money among older adults linked to cognitive profile of early Alzheimer’s disease

A new study from the Keck School of Medicine of USC, one of the first to test the relationship using real money, showed participants who gave away more money scored significantly lower on cognitive tests known to be sensitive to Alzheimer’s disease than those who gave less.
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To help protect older adults from financial exploitation, researchers are working to understand who is most at risk. New findings from the Keck School of Medicine of USC, published this week in the Journal of Alzheimer’s Disease, suggest that willingness to give away money could be linked to the earliest stages of Alzheimer’s disease.

Sixty-seven older adults who did not have dementia or cognitive impairment completed a laboratory task where they decided whether to give money to an anonymous person or keep it for themselves. They also completed a series of cognitive tests, such as word and story recall. Those who gave away more money performed worse on the cognitive assessments known to be sensitive to Alzheimer’s disease.

“Our goal is to understand why some older adults might be more susceptible than others to scam, fraud or financial exploitation,” said the study’s senior author, Duke Han, PhD, director of neuropsychology in the Department of Family Medicine and a professor of family medicine, neurology, psychology and gerontology at the Keck School of Medicine. “Trouble handling money is thought to be one of the early signs of Alzheimer’s disease, and this finding supports that notion.”

Earlier research that tested the link between altruism and cognition relied on self-report measures, such as asking older adults whether they would be willing to give money in certain scenarios. The present study used real money to examine the link.

“To our knowledge, this is the first study to explore the relationship using a behavioral economics paradigm, meaning a scenario where participants had to make decisions about giving or keeping actual money,” said Gali H. Weissberger, PhD, a senior lecturer in the Interdisciplinary Department of Social Sciences at Bar-Ilan University in Israel and first author of the study.

Giving and cognition

The researchers recruited 67 adults for the study, with an average age of 69. They collected data about participant demographics and controlled for the effects of age, sex and education level in the final analysis. Participants were excluded from the study if they met criteria for dementia or cognitive impairment.

In the lab, each participant was told they had been paired with an anonymous person who was completing the study online. They were then given $10 and instructed to allocate it however they wished, in $1 increments, between themselves and the anonymous person.

The older adults in the study also completed a series of neuropsychological tests, including several that are commonly used to help diagnose Alzheimer’s disease in its early stages. The tests included story and word recall tasks where participants are asked to remember information after a short delay; a category fluency test that involves listing words on a specific topic; and several other cognitive assessments.

Participants who gave more away scored significantly lower on the neuropsychological tests known to be sensitive to early Alzheimer’s disease. There were no significant performance differences on other neuropsychological tests.

Clarifying the link

More research is needed to confirm the nature of the relationship between financial altruism and cognitive health in older adults, including with larger and more representative samples. Future studies could also collect both behavioral and self-report data on financial altruism to better understand participants’ motivations for giving.

Han, Weissberger and their colleagues are now collecting data for a longitudinal study using the same giving task, which could help determine whether some older adults are becoming more altruistic over time.

“If a person is experiencing some kind of change in their altruistic behavior, that might indicate that changes are also happening in the brain,” Weissberger said.

Clarifying these details about the link between altruism and cognition could ultimately improve screening for Alzheimer’s disease and help people protect their loved ones from financial exploitation. It can also help researchers distinguish between what represents healthy giving behavior versus something that could signify underlying problems.

“The last thing we would want is for people to think that financial altruism among older adults is a bad thing,” Han said. “It can certainly be a deliberate and positive use of a person’s money.”

About this study

The study’s other authors are Laura Mosqueda, Annie L. Nguyen and Aaron C. Lim from the Department of Family Medicine, Keck School of Medicine of USC; Laura Fenton from the Department of Psychology, USC Dornsife College of Letters, Arts and Sciences; and Anya Samek from the Department of Economics, University of California San Diego.

This work was supported by the National Institutes of Health [R01AG068166, T32AG000037] and the Elder Justice Foundation.

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Groundbreaking study shows substantial differences in brain structure in people with anorexia


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Groundbreaking study shows substantial differences in brain structure in people with anorexia

New findings from the largest study to date by an international group of neuroscience experts show significant reductions in grey matter in people with anorexia nervosa.
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Eating disorders are often misunderstood as lifestyle choices gone awry or oversimplified as the unfortunate result of societal pressures. These misconceptions obscure the fact that eating disorders are serious and potentially fatal mental illnesses that can be treated effectively with early intervention. Mortality rates for people with eating disorders are high compared to other mental illnesses, particularly for those with anorexia nervosa, a condition characterized by a severe restriction of food intake and an abnormally low body weight. People with anorexia can literally starve themselves, causing severe and potentially fatal medical complications. The second leading cause of death for people with anorexia is suicide.

Now, a groundbreaking new study by a global team of researchers led by the Keck School of Medicine of USC’s Mark and Mary Stevens Neuroimaging and Informatics Institute (Stevens INI) has revealed that individuals with anorexia demonstrate notable reductions in three critical measures of the brain: cortical thickness, subcortical volumes, and cortical surface area. These reductions are between two and four times larger than the abnormalities in brain size and shape of individuals with other mental illnesses. Reductions in brain size are particularly concerning, as they may imply the destruction of brain cells or the connections between them.

Equipped with these results, the research team is calling attention to the pressing need for prompt treatment to help people with anorexia avoid long-term, structural brain changes, which could lead to a variety of additional medical issues. Anorexia can be successfully treated with healthy weight gain and cognitive behavioral therapy. Ongoing work by the same group shows that successful treatment can have a positive impact on brain structure.

“By comparing nearly 2,000 pre-existing brain scans for people with anorexia, people in recovery and healthy controls, we found that for people in recovery from anorexia, reductions in brain structure were less severe,” says Paul M. Thompson, PhD, associate director of the Stevens INI. “This implies that early treatment and support can help the brain to repair itself.”

In addition to researchers from the Stevens INI, the research team includes neuroscientists from the Technical University in Dresden, Germany; the Icahn School of Medicine at Mount Sinai, New York; University of Bath, UK; and King’s College London. The researchers came together under the ENIGMA Eating Disorders working group (ENIGMA-ED), a part of the ENIGMA Consortium, co-founded and led by Thompson. ENIGMA is an international effort to bring together researchers in imaging genomics, neurology, and psychiatry, to understand the link between brain structure, function and mental health.

Through advances in neuroimaging, researchers are gaining a better understanding of the link between serious mental health disorders and brain abnormalities. By demonstrating the effects of anorexia on brain structure, ENIGMA-ED has underscored the severity of the condition and the need for early intervention, while paving the way for the development of more effective treatments.

“The international scale of this work is extraordinary. Because scientists from twenty-two centers worldwide pooled their brain scans together, we were able to create the most detailed picture to date of how anorexia affects the brain, “says Thompson, professor of ophthalmology, neurology, psychiatry and the behavioral sciences, radiology, pediatrics and engineering. “The brain changes in anorexia were more severe than in any other psychiatric condition we have studied. Effects of treatments and interventions can now be evaluated, using these new brain maps as a reference.”

“This study exemplifies why the work at the Stevens INI is so essential,” says INI Director and longtime colleague of Thompson, Arthur W. Toga, PhD. “The goal of the ENIGMA Consortium is to bring researchers together from around the world so that we can combine existing data samples and really improve our power to examine the brain and detect the subtle brain alterations associated with a given illness. At the Stevens INI we apply this goal to all our large-scale studies. We are committed to participating in large studies with diverse research cohorts and sharing data to advance the entire scientific community.”

Access the full study ‘Brain Structure in Acutely Underweight and Partially Weight-Restored Individuals with Anorexia Nervosa – A Coordinated Analysis by the ENIGMA Eating Disorders Working Group’ published in the Journal Biological Psychiatry. Other USC co-authors contributing to the study include Neda Jahanshad, PhD, associate professor of neurology and biomedical engineering, and Sophia Thomopoulos, BS, consortium manager for the ENIGMA study.

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Discovery of significant reductions in the brain structure of anorexia nervosa patients by a @KECKSchool_USC study reinforces the urgent need for early intervention and treatment of the mental illness.
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Brain Shrinkage in Anorexia: Compiled from worldwide brain scans in the largest study to date, these brain maps show (in warmer colors) brain regions with gray matter deficits–abnormal tissue reductions–in anorexia. Deficits are less strong in partially-w
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Stress accelerates aging of immune system, study finds

Stress — in the form of traumatic events, job strain, everyday stressors and discrimination — accelerates aging of the immune system, potentially increasing a person’s risk of cancer, cardiovascular disease and illness from infections such as COVID-19, according to a new USC study.

The research, published Monday in the Proceedings of the National Academy of Sciences, could help explain disparities in age-related health, including the unequal toll of the pandemic, and identify possible points for intervention.

“As the world’s population of older adults increases, understanding disparities in age-related health is essential. Age-related changes in the immune system play a critical role in declining health,” said lead study author Eric Klopack, a postdoctoral scholar in the USC Leonard Davis School of Gerontology. “This study helps clarify mechanisms involved in accelerated immune aging.”

As people age, the immune system naturally begins a dramatic downgrade, a condition called immunosenescence. With advanced age, a person’s immune profile weakens, and includes too many worn-out white blood cells circulating and too few fresh, “naive” white blood cells ready to take on new invaders.

Potential problems relating to stress and the immune system

Immune aging is associated not only with cancer, but with cardiovascular disease, increased risk of pneumonia, reduced efficacy of vaccines and organ system aging.

But what accounts for drastic health differences in same-age adults? USC researchers decided to see if they could tease out a connection between lifetime exposure to stress — a known contributor to poor health — and declining vigor in the immune system.

They queried and cross-referenced enormous data sets from University of Michigan’s Health and Retirement Study, a national longitudinal study of the economic, health, marital, family status, and public and private support systems of older Americans.

To measure exposure to various types of social stress, the researchers analyzed responses from a national sample of 5,744 adults over the age of 50. They answered a questionnaire designed to assess respondents’ experiences with social stress, including stressful life events, chronic stress, everyday discrimination and lifetime discrimination.

Blood samples from the participants were then analyzed through flow cytometry, a lab technique that counts and classifies blood cells as they pass one-by-one in a narrow stream in front of a laser.

As expected, people with higher stress scores had older-seeming immune profiles, with lower percentages of fresh disease fighters and higher percentages of worn-out white blood cells. The association between stressful life events and fewer ready-to-respond, or naive, T cells remained strong even after controlling for education, smoking, drinking, BMI and race or ethnicity.

Some sources of stress may be impossible to control, but the researchers say there may be a workaround.

T-cells — a critical component of immunity — mature in a gland called the thymus, which sits just in front of and above the heart. As people age, the tissue in their thymus shrinks and is replaced by fatty tissue, resulting in reduced production of immune cells. Past research suggests that this process is accelerated by lifestyle factors like poor diet and low exercise, which are both associated with social stress.

“In this study, after statistically controlling for poor diet and low exercise, the connection between stress and accelerated immune aging wasn’t as strong,” said Klopack. “What this means is people who experience more stress tend to have poorer diet and exercise habits, partly explaining why they have more accelerated immune aging.”

Stress and the immune system: Impact of diet and exercise

Improving diet and exercise behaviors in older adults may help offset the immune aging associated with stress.

Additionally, cytomegalovirus (CMV) may be a target for intervention. CMV is a common, usually asymptomatic virus in humans and is known to have a strong effect accelerating immune aging. Like shingles or cold sores, CMV is dormant most of the time but can flare up, especially when a person is experiencing high stress.

In this study, statistically controlling for CMV positivity also reduced the connection between stress and accelerated immune aging. Therefore, widespread CMV vaccination could be a relatively simple and potentially powerful intervention that could reduce the immune aging effects of stress, the researchers said.

In addition to Klopack, other authors include Eileen Crimmins, a University Professor and the AARP Chair in Gerontology at the USC Leonard Davis School; and Steve Cole and Teresa Seeman of UCLA.

The study was supported by grants from the National Institute on Aging (P30AG017265, U01AG009740).

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Your Brain on Air Pollution

Another blue-sky morning dawns in Southern California as Jiu-Chiuan Chen prepares for his daily run through his tree-lined Fullerton neighborhood. When the USC physician and epidemiologist steps outside, he spots a gray-brown haze hugging the horizon. He checks the Air Quality Index on his phone and goes back inside.

About 35 miles north in Glendale, Jennifer Ailshire wonders whether she should hop on her bike and explore the San Gabriel Mountain foothills. The USC sociologist clicks on the Air Quality Index on her laptop before deciding it’s safe to ride.

In Culver City to the west, Lauren Salminen considers the wisdom of hiking in the Santa Monica Mountains. She can see a misty scrim in the distance, but is that morning fog or smog? The USC neurology instructor decides this might be a day for yoga indoors.

These USC scientists–each an experienced researcher in brain aging–know that air pollution does more than ruin a good workout. Medical science has long recognized the impact of air pollution on the lungs, but now research at USC is helping define the environment’s impact on the brain. Growing evidence links the long-term effects of dirty air to accelerated cognitive decline and dementia.

USC researchers, including Chen, hope to better understand environmental effects and gene-environment interactions on brain health. “USC has the perfect soil to grow this new area of research,” he says.

An Inspiration Point

The USC Children’s Health Study, launched in 1993 and now involving about 12,000 school-age children, is one of the nation’s largest and longest-running research projects on children’s respiratory health. Its researchers have contributed crucial data that have deepened understanding of lung health, including evidence that kids who live in more polluted areas have poorer lung function, reduced lung growth, and more asthma and lung damage than those in less-polluted areas.

When kids move away from polluted neighborhoods, their lung function improves, a discovery that has inspired other scientists to ask: If L.A.’s bad air is affecting our breathing, what about our brains?

The aging brain is vulnerable to air pollution.

Caleb Finch

What they’re finding is critical, including who is most at risk. “The aging brain is vulnerable to air pollution,” says Caleb Finch, a USC gerontologist and expert on the biology of aging and also co-principal investigator in the AirPollBrain Group. “For too long, the role of environmental neurotoxins in Alzheimer’s disease has been neglected.”

Within a few years of joining forces, Chen and Finch reported the first evidence that a critical Alzheimer’s risk gene–APOE4–speeds brain aging when it interacts with fine air particles.

In 2011, the colleagues received the first-ever National Institutes of Health grant to study the connections between air pollution and Alzheimer’s. Since then, about one-fourth of the 220 NIH-funded research grants focused on air pollution and dementia have come to USC.

Finch and Chen have also succeeded in attracting more than two dozen USC scientists to the AirPollBrain Group, crossing disciplines and schools to unite neuroscientists, environmental health experts, engineers, gerontologists, physicians, sociologists and more.

The result: In 2018, the National Institute on Aging awarded USC researchers a five-year $11.5 million grant to examine how urban air pollution contributes to an increased risk of dementia.

Small Particles Make a Big Impact

Air pollution wreaks havoc primarily through systemic inflammation, Finch says, and that exposure can lead to the formation of amyloid plaques, the proteins that form between the brain’s nerve cells that are the hallmarks of Alzheimer’s. Researchers have fine particle pollution, also known as PM2.5, in their sights. The tiny, inhalable pollutants come from cars, power plants and coal and wood-burning fuel. Its name comes from its size–smaller than 2.5 microns in diameter or about 30 times smaller than the width of a human hair. But the impact, once inhaled, is huge.

The microscopic particles can pass directly through the nose or lungs and slip through the blood-brain barrier, which is supposed to protect our brains from all invaders. “Pollution is breaking down our barriers,” says Megan Herting, a USC public health scientist whose lab uses advanced neuroimaging to study how the brain develops during childhood.

For reasons not yet fully understood, women in their 70s and 80s who live in areas with high levels of air pollution are at particular risk for Alzheimer’s-like brain shrinkage compared with women who routinely breathe cleaner air.

But kids aren’t immune. USC studies have shown that even at relatively low levels, toxic air may alter the size of a child’s developing brain and boost the risk of cognitive and emotional problems in adolescence.

How Bad is Our Air?

The Los Angeles-Long Beach region ranks first in the nation for ozone pollution and fourth in year-round fine particle pollution, according to the American Lung Association.

Pollution declines in the last 10 to 15 years nationally and in L.A. have been a public health success story. “It shows that if we put our minds to it, we can make our environment a healthier place to live,” Ailshire says. In 2021, she and Finch, her colleague in the USC Leonard Davis School of Gerontology, reported in separate studies that showed a decrease in neurotoxic PM2.5 air pollution in humans and in laboratory studies.

Air pollution isn’t just a physical characteristic, it’s a social phenomenon produced by humans, for the most part.

Jennifer Ailshire

In the last few years, she has seen some backsliding to unhealthy levels. “We have to be constantly vigilant,” she says. “We can’t get ahead of ourselves and declare a victory.”

Ailshire is particularly interested in the “social ecology” of air pollution–the intersection of socioeconomic and physical risks–driven by the fact that polluted air tends to be worse in poorer neighborhoods. “Air pollution isn’t just a physical characteristic,” Ailshire says. “It’s a social phenomenon produced by humans, for the most part.”

Finch has been studying brain health for decades. In experimental studies, he and his team have shown that air pollution damages some parts of the brain that also are vulnerable to Alzheimer’s disease. Multiple factors influence the odds someone will develop Alzheimer’s disease. “There’s no silver bullet–it’s a machine gun,” Finch says. An individual’s risk can be a combination of several things, and air and chemical pollution are high on that list.

Tracking Pollution’s Impact Across the Lifespan

Within the Southern California Environmental Health Sciences Center at USC, program leaders Chen and Herting work at opposite ends of the age spectrum to pinpoint the environmental determinants of cognitive decline.

Increasingly, evidence shows that older people are more likely to develop dementia if they live in places that have high PM2.5. Chen’s research has shown that women in their 70s and 80s are particularly vulnerable to structural changes in the brain and memory loss, for reasons not yet fully understood.

Chen also has found that PM2.5 particles are tied to the disproportionate number of Black Americans affected by dementia, partly because people of color are statistically more likely to live in neighborhoods near polluting facilities. Even when researchers accounted for the incidence of cardiovascular disease and other factors, Black women were twice as susceptible as non-Hispanic whites to dementia risk from air pollution. “That is a puzzle we still have to solve,” Chen says.

Air pollution also can affect children’s brain development. “One of the young brain’s most important jobs is creating efficient pathways,” Herting says. These pathways are critical because they form the essential brain circuitry that supports future learning and life skills. Lately, she’s focusing on kids 9 to 10, ages at which, she says, brain cells proliferate and prune themselves as kids head into adolescence. Herting’s team has demonstrated that kids exposed to noxious air have smaller areas in their brains associated with cognitive function and larger areas associated with emotion than kids breathing less-polluted air.

Air pollution can increase dementia risk and vascular problems decades after exposure.

Lauren Salminen

Her work is part of the national Adolescent Brain Cognitive Development Study, the largest investigation of its kind in the U.S. “We’re adding the environmental factor, one of the least-investigated areas,” she says.

To understand the bigger picture across the lifespan, Chen and Herting collaborated with Salminen, instructor of research neurology at the USC Mark and Mary Stevens Neuroimaging and Informatics Institute, to create the ENIGMA-ENV Working Group. “We know things like air pollution can increase dementia risk and vascular problems decades after exposure,” Salminen says. “But we have so much to learn about the processes that underlie those changes.”

Together, they are pooling brain scans from more than 60,000 people worldwide, who span all ages and range from healthy to those diagnosed with neurological disorders. The scientists rely on geospatial technology to map each participant’s home location and pollution exposure.

This global study builds on the success of ENIGMA Consortium, an international medical network of neuroimaging researchers studying major diseases of the brain, led by USC Stevens Associate Director Paul M. Thompson. “The ENIGMA-ENV Working Group is a truly global quest to identify environmental factors that help or harm our brain,” says Thompson, one of USC’s leading Alzheimer’s researchers. “Comparing data worldwide should reveal what factors help our brains develop and age, and what protects us against mental illness, which may ultimately guide public health policy.”

With this big-picture effort, USC is reaching beyond its Los Angeles roots to examine air pollution across all ages and sources. “We’re excited to be able to get more specific about what we mean when we say ‘air pollution,'” Salminen says.

Protecting Ourselves Now and Beyond

What can we do to protect our brain health? Moving away from highly polluted areas may be the ultimate protective strategy, but that option isn’t open to everyone. So USC scientists are on the hunt for other defenses. In a study published in August 2020, Chen and his fellow authors looked at the protective powers of eating fish loaded with omega-3 fatty acids. “We found that women with higher blood levels of omega-3s had larger volumes of white matter in their brains,” he says–even women living in locations with higher PM2.5 levels. White matter, most of the brain’s volume, represents a vast system of neural connections. Its loss is considered an early marker of Alzheimer’s disease.

You can’t walk around the city with a scuba tank filled with oxygen on your back.

Caleb Finch

Next, Chen and Finch plan to expand their search for pollution counterbalances into supplements such as vitamins B, C and E. But they expect that any potential formula will not be one-size-fits-all.

The data generated at USC could have lasting implications for clean air standards and other regulations. Chen would like to see laws restricting placement of assisted living facilities near freeways much as is done now with schools. Herting wants air pollution facts to empower people to make their own decisions, “including who they want to elect to represent them on this life-critical issue,” she says.

She moved to Los Angeles from Oregon, where she was an avid runner. She’s mostly given that up. Now expecting her first child, she has been studying the locations of day care centers and schools in relation to L.A.’s byways.

When Finch arrived at USC in 1972, the federal Environmental Protection Agency was just 2 years old, and L.A. was infamous for its thick, hazy air. For decades, air quality officials warned the public to stay indoors on high smog days. Finch searched the L.A. Basin for a place with cleaner skies, eventually landing in northern Pasadena.

He lives there still and considers that health decision as important as the ones made about diet and exercise. When he drives, he keeps his car vents closed. A little self-protection goes a long way, he says, “but you can’t walk around the city with a scuba tank filled with oxygen on your back.”

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Failures in the generic drug market cost patients millions

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Schaeffer White Paper Highlights Failures in Generic Drug Market That Cost Patients

Growing evidence suggests that U.S. consumers overpay for generics–by as much as 20% according to one analysis–while pharmacy benefit managers use opaque and arcane pricing practices to pad profits.

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Cheaper generic alternatives to brand-name drugs are supposed to save consumers and the healthcare system money. But a new USC Schaeffer Center white paper highlights tactics used by intermediaries in the pharmaceutical distribution system, including pharmacy benefit managers (PBMs) and insurers, that are costing patients, employers and the government billions for what should be inexpensive medicines.

“Generics are overlooked when we talk about drug pricing issues in this country,” said Erin Trish, co-director of the USC Schaeffer Center. “But the same lack of transparency that is causing outrage over high and rising spending on branded drugs is also creating issues in the generic drug space. If you filled a prescription for a generic medicine recently, there is a good chance you overpaid, and PBMs and other intermediaries are making record profits.”

Trish and coauthors Karen Van Nuys and Robert Popovian argue that policymakers can reduce overpayments for generic drugs by:

encouraging transparency in transactions across the distribution chain; and
encouraging competition and deterring anticompetitive practices in the sale and distribution of generic drugs.
Consolidation and lack of transparency pad profits for middlemen
Generic markets are, in many ways, the lynchpin in our pharmaceutical innovation ecosystem. The generic drug market was jump-started nearly four decades ago by the 1984 Hatch-Waxman Act, which established the legal and economic foundation for the industry. Under the law, U.S. brand-drug manufacturers are granted patent protection for a designated period, providing an incentive to develop new therapies. But after the brand protections expire, the law provides consumers fast access to generic versions of the drugs. The promise of inexpensive generics in the future was in many ways the “payback” mechanism used to justify expensive patent-protected drugs.

Nearly four decades later, generics have made high-value, effective medications affordable. They make up 90% of U.S. prescriptions while accounting for only 18% of total drug expenditures. By one estimate, use of generic and biosimilar drugs in place of branded drugs resulted in a savings of $330 billion in 2020 alone.

PBMs–intermediaries who negotiate price and formulary placement on behalf of health plans–played an essential role in driving uptake of generics early on. However, pricing practices and distortions across the market have allowed them to inflate prices of generics in recent years, at the expense of patients and payers. Any inefficiencies in generic markets have important and far-reaching impacts on both drug affordability today and drug innovation in the future.

“We have a pathway to make drugs very low-cost and widely available, but middlemen are increasingly prioritizing their bottom line instead of making the system more efficient,” said Van Nuys, executive director of the Value of Life Sciences Innovation program at the USC Schaeffer Center.

The researchers point to the three strategies employed by PBMs and insurers that lead to overpayment of generics:

Copay Clawbacks – Copayments paid by commercially insured patients can exceed the cost of the drug. Any overpayment–or clawback–is pocketed by PBMs, who have used contract clauses that prohibit pharmacists from advising patients when their prescription can be purchased with cash for less than their copay.
Spread Pricing – The PBM reimburses the pharmacy one price when a beneficiary fills a prescription while charging the health plan a higher price, and then pocketing the difference or “spread.” Neither the pharmacy nor the health plan knows what the other side was paid or charged, allowing PBMs to pocket profits in some cases.
Profit-Oriented Formulary Designs – PBMs may prioritize branded drugs over lower-priced generic versions because the branded medicine comes with lucrative manufacturer rebates, a portion of which they may keep.
The researchers estimate that practices like these add up to billions in overpayment. A recent study by Van Nuys and Trish found that Medicare Part D standalone plans paid $2.6 billion more in 2018 for 184 common generics compared with prices paid by cash-paying Costco members.

While generic drugs represent a small share of overall healthcare spending, they are often the only interactions patients have with healthcare markets, Van Nuys said.

“The bottom line is that distribution-system inefficiencies, anticompetitive practices and a lack of transparency are increasing middlemen profits, with patients footing the bill,” said Van Nuys. “If patients are being cheated on what are supposed to be inexpensive generic drugs, one wonders what must be happening in other parts of the healthcare market where profit margins are much higher.”

Tools for curbing profit-taking on generic drugs
The researchers suggest several policy solutions to spur competition and deter these kinds of practices, including restricting rebate contracting that drives PBMs to prefer brands over generics and using fixed fees per transaction rather than fees determined as a share of a drug’s price.

To improve the PBM market, the researchers recommend increasing competition and using business models that commit to price transparency. Employers and the government should also have audit rights that allow them to review PBM transactions and prices.

“If we can bring greater price transparency into the generic drug market, clinical and financial benefits will follow, with everything flowing to the patient,” Trish said.

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Study find links between inflammatory bowel disease and depression

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New study shows bidirectional link between inflammatory bowel disease and depression
Link also extends to siblings of patients with inflammatory bowel disease or depression
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LOS ANGELES — Inflammatory bowel disease (IBD) is a chronic condition involving inflammation of the digestive tract, affecting some 1.6 million Americans. Depression affects more than 16 million Americans.
A new study from Keck Medicine of USC shows that patients diagnosed with IBD were nine times as likely to develop depression than the general population. In addition, their siblings who did not suffer from IBD were almost two times as likely to develop depression.
Conversely, patients with depression were two times as likely to develop IBD, and their siblings without depression were more than one and a half times as likely to develop IBD.
“This research reveals a clinical overlap between both conditions, and is the first study to investigate the two-way association between IBD and depression in siblings,” said Bing Zhang, MD, a gastroenterologist with Keck Medicine and co-lead author of the study.
Zhang and his fellow researchers analyzed the data of more than 20 million people from Taiwan’s National Health Insurance Research Database, which contains comprehensive medical information on more than 99% of Taiwanese residents.
For 11 years, they tracked patients with either IBD or depression and their siblings without either condition, comparing onset of depression or IBD with a control group of people without either condition, but with similar age, sex and socioeconomic status.
Zhang hypothesizes that many factors may contribute to the bidirectional nature of the disorders, including environmental stressors, the gut microbiome (consisting of bacteria, fungi and viruses) and genetics.
“The finding that people with IBD are more prone to depression makes sense because IBD causes constant gastrointestinal symptoms that can be very disruptive to a patient’s life,” he said. “And the elevated depression risk among siblings of IBD patients may reflect caregiver fatigue if the siblings have a role in caring for the patient.”
What surprised researchers was that patients with depression were prone to IBD. Zhang speculates that this discovery may have to do with what is known as the gut-brain axis, a scientifically established connection between the gastrointestinal system and the central nervous system, which consists of the spinal cord and the brain.
For example, he said, inflammation of the brain, which plays a role in depression, may be linked to the inflammation of the gastrointestinal tract, a hallmark of IBD.
The researchers are not sure why siblings of patients with depression are more likely to be diagnosed with IBD. Zhang surmises that there may be a shared genetic susceptibility for either disease that presents differently in family members.
Zhang hopes that the study findings will encourage health care professionals to take both family history and the relationship between gastrointestinal and mood disorders into consideration when evaluating or treating patients with either IBD or depression.
Through more research and better understanding of the gut-brain axis, he envisions leveraging the newfound connection between the conditions to improve the prevention, diagnosis and treatment of IBD and mental disorders.
The study was supported by grants from the Taipei Veterans General Hospital and the Ministry of Science and Technology, Taiwan.

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Deaf children with learning delays benefit from cochlear implants more than hearing aids

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Deaf children with learning delays benefit from cochlear implants more than hearing aids
Keck Medicine of USC study demonstrates the need for early cochlear implant use for deaf children, regardless of developmental impairments
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LOS ANGELES — Up to three out of every 1,000 infants in the United States are born with profound hearing loss.
Typically, infants with hearing loss are first treated with hearing aids, and if these fail to help them develop early language and speech skills, they then become eligible for cochlear implants at 12 months or older. Cochlear implants — considered the gold standard of treatment — are small, electronic devices surgically placed under the skin that stimulate nerve endings in the ear to provide a sense of sound.
However, some insurance companies have traditionally denied coverage of cochlear implants to deaf children with severe developmental delays (such as low cognitive skills and low adaptive, or learned, behavior), under the belief that the implants will not help them learn to communicate.
Now, a new study from Keck Medicine of USC has found that infants with hearing loss and severe developmental delays are better served with cochlear implants than hearing aids.
“We demonstrated that cochlear implants improve the skills of deaf children with early developmental impairment across the board in every skill tested — cognitive, adaptive behavior, language and auditory” said John Oghalai, MD, an otolaryngologist with Keck Medicine, chair of the USC Caruso Department of Otolaryngology – Head and Neck Surgery and lead author of the study.
In 2010, researchers identified children with severe to profound hearing loss at two large pediatric cochlear implant centers in Texas and California.
Children were given a baseline assessment in cognition, adaptive behavior, language and auditory skills. (Auditory skills are the ability to notice, compare and distinguish sounds in words.) Some were identified as having learning delays.
All infants began the study wearing hearing aids. From the approximately 200 children enrolled in the study, researchers identified and compared the progress of children who continued to use hearing aids and those who received cochlear implants.
Researchers gave the children repeated evaluations over the next few years. By the time of the final assessment, those with cochlear implants — including children with learning delays — showed up to almost 25% more improvement in the tracked skills than those using hearing aids.
“This study demonstrates that deaf children with developmental impairment should not be overlooked in getting cochlear implants,” Oghalai said. “Cochlear implantation should be considered regardless of the presence of learning delays so all children can develop to their maximum potential.”
Over the course of the study, more insurance providers began covering cochlear implants for deaf children, regardless of developmental impairments. However, according to Oghalai, some insurance providers, as well as some pediatricians and cochlear implant teams, are still unwilling or slow to provide implants to children with developmental delays.
Janet Choi, MD, MPH, a former resident at the Keck School of Medicine of USC, co-authored the study. Shane Zhou, MD, a resident at the Keck School, was also an author.
The study was led by the USC Caruso Family Center for Childhood Communication and supported by the National Institutes of Health under award R01DC010075.
For more information about Keck Medicine of USC, please visit

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USC awarded more than $16 million for research on vascular dysfunction, Alzheimer’s disease


NIH awards USC more than $16 million for research on vascular dysfunction and Alzheimer’s disease

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NIH awards USC more than $16 million for research on vascular dysfunction and Alzheimer’s disease

Research funded by the grant will capitalize on the development of biomarkers and advanced imaging by scientists at the Keck School of Medicine of USC to launch studies tracking changes in the blood-brain barrier, neurovascular function and cognition.
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The National Institute on Aging, a division of the National Institutes of Health, awarded Berislav Zlokovic, MD, PhD, director of the Zilkha Neurogenetic Institute, and Arthur W. Toga, PhD, director of the USC Mark and Mary Stevens Neuroimaging and Informatics Institute (Stevens INI), $16.1 million to continue research on the role that blood vessel dysfunction plays in the development of dementia and Alzheimer’s disease.

“There is increasing evidence that neurovasculature has a major role in early cognitive decline,” said Zlokovic, chair and professor of physiology and neurosciences at the Keck School of Medicine of USC. “This grant allows us to continue important research on how changes in the blood-brain barrier and blood flow interact with amyloid-beta and tau pathology to trigger structural and functional changes in the brain, leading to cognitive impairment and early Alzheimer’s disease.”

More than 30 years ago, Zlokovic was among the first to propose that flaws in the blood-brain barrier, which keeps harmful substances in the blood from moving into brain tissue, could be the early, underlying cause of most cognitive disorders, rather than the accumulation of amyloid beta plaque, which had long been the focus of Alzheimer’s research. With this award, he and his colleagues can further test this so-called neurovascular hypothesis.

“This work will build on our earlier work, which has shown that people can progress to mild cognitive impairment, independent of amyloid beta and tau if the blood-brain barrier is damaged,” said Zlokovic.

Documenting Alzheimer’s disease progression

The funding will allow the team of researchers to launch longitudinal studies comparing the progress of more than 400 people who have a genetic variant putting them at high risk for developing Alzheimer’s disease — known as apolipoprotein E4 (APOE4) — with more than 450 people with APOE3, a different variant which puts them at lower risk for developing Alzheimer’s disease.

About 75% of the participants will be cognitively unimpaired at the start of the study and about 25% will have only mild impairment. The researchers will follow them for five years, tracking changes in the blood-brain barrier, blood flow and the brain’s structure and function while monitoring participants for cognitive impairment, using neuroimaging and molecular biomarkers indicating blood vessel dysfunction, which were developed by Zlokovic, and advanced brain imaging technology developed by Toga.

“Using our ultra-high field 7T magnetic resonance imaging (MRI) scanner has transformed our understanding of how fluid-filled regions in the brain — perivascular spaces — impact brain health. Here at the Stevens INI, we have successfully used this advanced imaging to facilitate breakthroughs, including the central role that perivascular space plays in brain changes associated with aging, including neurodegenerative disorders,” said Toga, Provost Professor of Ophthalmology, Neurology, Psychiatry and the Behavioral Sciences, Radiology and Engineering at the Keck School of Medicine. “Our imaging capabilities have allowed us to create a multimodal assessment of the role of neurovasculature in cognitive decline, a comprehensive research program on perivascular spaces, and numerous close-up investigations of how fluids travel through the brain, including via the blood-brain barrier. I’m thrilled to have received this funding to continue our work in partnership with Dr. Zlokovic.”

Researchers hope the work will lead to a better understanding of the onset and progression of Alzheimer’s disease and the identification of the best interventions for different stages of the disease.

Testing treatments in the lab

Simultaneously, the team will conduct complementary laboratory research using mice that have been genetically altered to carry human APOE gene variants to help document changes in the brain that lead to cognitive decline and to test a potential treatment.

The treatment is an experimental neuroprotective enzyme co-developed by Zlokovic’s team, in collaboration with John Griffin, PhD, from the Scripps Research Institute, called 3K3A-APC, an engineered form of human activated protein C. Researchers will test it in the altered mice to see if it can protect the integrity of the blood-brain barrier and prevent cognitive decline. In addition they hope to examine whether this type of intervention is effective at the earliest signs of vascular dysfunction or at later stages of disease in mouse models that also have amyloid beta and tau. The National Institute of Neurological Disorders and Stroke (NINDS) recently awarded funding for a pivotal Phase 3 clinical trial of 3K3A-APC in stroke patients, led by Patrick Lyden, MD, professor of physiology and neuroscience at the Zilkha Neurogenetic Institute.

“We hope that the results of this research will eventually lead us to new treatments for people with the APOE4 gene,” said Zlokovic.

Turning biomarkers into a blood test for Alzheimer’s disease

Zlokovic added that they continue to improve on key molecular biomarkers, and he hopes eventually to discover biomarkers detectible in blood, which would make the process of identifying people at risk for Alzheimer’s disease simpler and more accessible.

“We have been pursuing several avenues of research that all complement one another,” said Zlokovic. “We believe that this research will contribute to important new findings about the pathogenesis of cognitive decline and will also lead to development of important new therapies for cognitive impairment, dementia and Alzheimer’s disease.”

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