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?”

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

REDIRECT 7745
https://dornsife.usc.edu/news/stories/3721/mind-body-studies-minor-maymester/
Story Headline and Deck – USC News *
Students learn the power of the (downward facing) dog
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.
Body Copy *
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.

The post Students learn the power of yoga and mindfulness appeared first on USC News.

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.”

The post Your Brain on Air Pollution appeared first on USC News.

REDIRECT 7698 https://healthpolicy.usc.edu/article/paper-highlights-failures-in-the-generic-drug-market-that-are-costing-patients/
Story Headline and Deck – USC News *
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.

Body Copy *
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.

The post Failures in the generic drug market cost patients millions appeared first on USC News.