Keck School of Medicine of USC launches and sustains innovative programs with health equity at heart
By Wayne Lewis
People around the world rely on new leaps in biomedical science to live longer, healthier lives in the face of scourges such as cancer, metabolic disorders and neurodegenerative disease. In recent years, research teams at the Keck School of Medicine of USC have assembled an extraordinary record of success in this regard, and the excellence has been met with federal grant support.
Multimillion-dollar awards from the National Institutes of Health have launched vital efforts such as a Cancer Moonshot project and a Regional Minority Health Center, while established enterprises have earned stellar reviews from peer evaluators. The virtuous cycle not only reflects the impact and potential of the Keck School of Medicine’s studies but also enables further progress in human health.
A key, common element that drives these Trojan research projects is a commitment to diversity, equity and inclusion. The dedication is baked into the Keck School’s research endeavor in multiple dimensions — including, but not restricted to, race and ethnicity, gender and age.
“We embrace diversity, equity and inclusion as fundamental to all we do because that approach is essential to addressing the most complex questions in health and disease,” said Dean Carolyn C. Meltzer, MD, FACR, holder of the May S. and John H. Hooval Dean’s Chair in Medicine and professor of radiology. “Ensuring that every person has the opportunity to attain their full health potential is the ultimate goal of our investigators, in partnership with the communities we serve.”
Some major investigations seek to understand how certain conditions disproportionately affect Blacks, Latinos and other underrepresented populations. Other programs actively recruit understudied groups for clinical research. Focusing on the diverse patients of Los Angeles that the school’s health professionals serve, many initiatives aim to improve health locally in tangible, measurable ways. In the process, Trojan scientists and physicians further the effort to personalize care for each patient.
“We embrace diversity, equity and inclusion as fundamental to all we do because that approach is essential to addressing the most complex questions in health and disease.”
–Dean Carolyn C. Meltzer, MD
According to Tom Buchanan, MD, vice dean for research and holder of the Bernard J. Hanley Chair in Medicine at the Keck School, the focus on diversity, equity and inclusion has USC poised for future impact in Southern California and beyond.
“We exist in one of the biggest, most diverse urban centers in the world,” he said. “If you look at population trends, more and more people are going to be living in urban areas over the next 20 years. It’s going to produce a number of problems that won’t be one-size-fits-all. At USC, we have the culture, we’re developing the understanding, and we have the commitment to do the vital work to develop the health solutions the world is going to need.”
Diversity at the heart of the urban med school of the future
It’s well-documented that medical studies have traditionally focused on men of European descent to the exclusion of other groups. USC has been a leader in a sea change to draw underrepresented groups into the patient studies that determine which health interventions are widely available.
The endeavor has yielded new advances that draw support and praise from federal grantors, with three projects attracting close to $50 million in awards and two foundational grants on course for $86 million in renewals.
There are organized programs to attract diverse clinical trial participants at USC Norris Comprehensive Cancer Center and at the Southern California Clinical and Translational Science Institute (SC CTSI). Both are partnerships between the Keck School and Children’s Hospital Los Angeles (CHLA). The SC CTSI partners with the Los Angeles County Department of Health Services as well. They provide the resources and support needed to develop promising research findings into new health solutions.
“We have this great opportunity to add substantially to the genomic data around Latinos for cancer genomics.”
–John Carpten, PhD, Chair of the Department of Translational Genomics
In 2021, Norris cancer center renewed its core grant from the National Cancer Institute (NCI) with a distinction of “outstanding,” its best-ever rating from NCI reviewers. Similarly, the SC CTSI received a perfect score in 2021 from peer evaluators with the National Institutes of Health (NIH).
“Without clinical trials, we don’t know what works and what doesn’t,” said Buchanan, who is the director of the SC CTSI. “If there’s no diversity in the clinical trial, then the results will not be applicable to the broad spectrum of people from communities of color. So one of the important things we want to do is to increase the diversity of people participating in our clinical trials.”
The chair of the Department of Translational Genomics, John Carpten, PhD, secured a prestigious Cancer Moonshot grant from the NCI in 2021. The program he leads is meant to increase Latino participation in genetic studies of colorectal cancer — which strikes Latinos disproportionately hard — and other malignancies.
“We continue to see limitations in the representation of underrepresented minorities in biomedical research, including genomic studies and in clinical trials,” said Carpten, who is also Norris cancer center’s associate director for basic research and Royce and Mary Trotter Chair in Cancer Research at the Keck School. “We have this great opportunity to add substantially to the genomic data around Latinos for cancer genomics.”
Meanwhile, a multi-institutional collaboration involving the USC Mark and Mary Stevens Neuroimaging and Informatics Institute received NIH support in 2021 to merge gigantic stores of research data about Alzheimer’s disease in order to promote drug development.
The Alzheimer’s Disease Sequencing Project Phenotype Harmonization Consortium, co-led by Vanderbilt University and the University of Miami, will use more than 30 datasets to produce a single large-scale, racially diverse set of standardized data. USC is taking lead on rationally combining image data under the leadership of Arthur Toga, PhD, director of the USC Stevens Neuroimaging and Informatics Institute.
“With today’s statistical power and analytic tools, we can begin to understand these differences between subpopulations, sometimes nuanced and in other cases more significant,” said Toga, holder of the Ghada Irani Chair in Neuroscience and Provost Professor of Ophthalmology, Neurology, Psychiatry and the Behavioral Sciences, Radiology and Engineering at USC. “That’s exciting, because it further helps you understand the biology and the degree to which a given strategy can apply to everybody.”
Respectfully engaging our community
It’s important to note that USC’s approach is anything but top-down. Instead, health-related research often begins by asking local communities what they need.
That mindset animates the SC CTSI’s community-engaged research, with local outreach preceding the launch of any initiative. And a main prong of Carpten’s NCI-funded work to expand knowledge in the genomics of cancer among Hispanics focuses upon asking people about both the barriers that keep them from participating in biomedical research and the things that could be done to mitigate these issues toward greater participation.
“We want to come up with best practices for engaging patients in the clinic to participate in a study,” Carpten said. “We’re learning from them to figure out how to increase those numbers.”
“At USC, we have the culture, we’re developing the understanding, and we have the commitment to do the vital work to develop the health solutions the world is going to need.”
–Tom Buchanan, MD, Vice Dean for Research
Another program, initiated by Michael Goran, PhD, professor of pediatrics at the Keck School, unites USC and CHLA to combat obesity among Latino youth. With a multimillion-dollar NIH grant, the Southern California Center for Chronic Health Disparities in Latino Families and Children seeks to devise interventions that will set Hispanic kids up for lifelong health.
The center is co-led by Lourdes Baezconde-Garbanati, PhD, the Keck School’s associate dean for community initiatives and the SC CTSI’s associate director for community outreach and engagement. She emphasizes that community input is a keystone of this work.
“The center is looking for people to eat healthy, not outside of their own realm and their own scope, but in a culturally specific way that makes sense for them as well,” said Baezconde-Garbanati, a tenured professor in population and public health sciences at the Keck School.
Speak to people where they are
In addition, biomedical science initiatives at the Keck School — whether long-established or newly begun — have facets that help the interventions hit home by ensuring communications reach people where they are.
“It’s not only about cultural specificity, but also language specificity and numeracy, in order to really reach these communities in the most appropriate and specific way.”
–Lourdes Baezconde-Garbanati, PhD, Associate Dean for Community Initiatives
The SC CTSI, funded by the NIH since 2010, employs community health advocates who directly deliver the institute’s messages to their neighbors and experts who assist in shaping communications aimed at diverse groups. Likewise, the Southern California Center for Chronic Health Disparities in Latino Families and Children will customize its outreach for different populations. After all, the Hispanic HisHiHcommunity of the region is anything but a monolith. Families originate from places all over Central and South America, may have lived in the U.S. anywhere from weeks to generations, speak variations of the same languages, and hold varying immigration status.
“There’s a real need for cultural adaptation,” Baezconde-Garbanati said. “It’s not only about cultural specificity, but also language specificity and numeracy, in order to really reach these communities in the most appropriate and specific way.”
Culture goes a long way
Trojan scientists and physicians identify a deeper vein that influences the Keck School’s success at creating and fortifying biomedical research programs with impact: a certain tradition and culture that prioritizes diversity, equity and inclusion.
USC’s pioneering history in making health sciences relevant to more people goes back at least as far as the 1993 establishment of the Multiethnic Cohort, a longitudinal health study with 215,000 diverse participants, in collaboration with the University of Hawaii.
“The environment of our medical school is truly unique,” Carpten said. “It encourages exactly that kind of work.”
In Buchanan’s view, the opportunity to make a difference for the people of Los Angeles is one innate advantage that both entices and inspires researchers.
“We have this culture that’s attracted a lot of people who want to do this,” he said. “Therefore we have a lot of experience, and we consistently win competitions for funding — not for bragging rights, but to leverage those resources to fuel the good that we want to create for our communities.”
He added, “I think if you don’t come here for that specific reason, you live in and work in it, and you develop that phenotype. We attract people, but we also develop people.”
Baezconde also sees USC investigators manifesting — and boosting — the broader momentum for social and health justice of recent years.
“The younger populations, and many in my own generation, just aren’t satisfied with getting promoted, getting tenure, and writing another journal article,” she said. “We’re really interested in making a difference.”
Equity makes for excellent science
The bottom line for these USC research leaders is that broadening representation, among study participants, but also students and faculty, amplifies the Keck School’s impact.
“The science says that minor differences in people can have profound effects,” Toga said. “You can’t understand it unless you get participants that represent the entire range of the human condition. I think there’s been an epiphany in scientific circles, that this is important not just to satisfy politicians, not just to satisfy your own conscience, but to satisfy fundamental science.”
That line of thinking also influences funders.
“The science says that minor differences in people can have profound effects.”
–Arthur Toga, PhD, Director of the USC Stevens Neuroimaging and Informatics Institute
“I think that the NIH no longer reviews a grant application solely based on a great scientific approach,” Baezconde-Garbanati said. “To get a high score, a project has to be significant, it has to be innovative, and it has to really have an impact in the population.”
Across the medical field, there is a growing focus on precision medicine, which calls for care to be customized as narrowly as possible to each patient, encompassing both genetic and environmental factors. To do that right, the world needs more and better understanding of disease and health in as many populations as possible. Health disparities research and precision medicine studies thus become sides of the same coin, and the quest to fill in the void of knowledge about underrepresented and disadvantaged groups becomes absolutely essential.
Buchanan added: “Reflecting racial and ethnic diversity as well as socioeconomic diversity makes us better at what we do, because we can have more real-world impact with the communities we serve.”
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