UNIVERSITY OF SOUTH CAROLINA FALL 2017 / RESEARCH
A plague upon us The toll of America’s opioid epidemic is tragic, but USC researchers are engaged in the struggle, finding tools that could help turn the tide.
Also in this issue • Adjudicating the Rwandan genocide • Targeting a killer • Clinical approach
OFFICE OF RESEARCH UNIVERSITY OF SOUTH CAROLINA President Harris Pastides Vice President for Research Prakash Nagarkatti Research Communications Manager Elizabeth Renedo
Director of University Communications and Marketing/ Chief Communications Officer Wes Hickman Office of Communications and Marketing Creative Director Bob Wertz Editor Chris Horn Magazine Designer Brandi Lariscy Avant Contributing Writers Craig Brandhorst, Chris Horn, Page Ivey, Megan Sexton, Melinda Waldrop Photographer Kim Truett Cover Artist Maria Fabrizio, ’08 B.F.A. Website sc.edu/vpresearch To comment on an item in Breakthrough or to suggest an idea for a future issue, contact the University of South Carolina’s Office of Research at 803-777-5458 or email firstname.lastname@example.org. The University of South Carolina does not discriminate in educational or employment opportunities or decisions for qualified persons on the basis of race, color, religion, sex, national origin, age, disability, sexual orientation, genetics or veteran status. 17-10273 UCS 10/17 This piece was printed on McCoy Sheets manufactured by Sappi Fine Paper North America with 10 percent PCW and FSC® Chain of Custody Certification. One hundred percent of the electricity used to manufacture McCoy Sheets is Green-e® certified renewable energy. The University of South Carolina is committed to sustainability in all facets of operation, including the production of publications such as this one, which is printed on paper certified by SmartWood to the FSC standards.
IN THIS ISSUE 4/
A plague upon us While the opioid crisis has reached epic proportions, several USC researchers are looking for tools to help turn the tide.
Q&A with Bryant Walker Smith An expert on laws concerning self-driving cars takes a broader look at the “law of the newly possible.”
Adjudicating the Rwandan genocide A political scientist’s book examines Rwanda’s grand attempt at reconciliation.
Allergic to penicillin? Not so fast... Pharmacy students and faculty think the number of penicillinallergic patients isn’t really that large.
Targeting a killer A new drug offers hope against an aggressive form of breast cancer.
The Art of Science Intricate patterns embedded on ancient American Indian pottery hold clues to early migration in the southeastern United States.
Digging for answers Archaeologists are finding evidence of a cosmic event of colossal proportions that led to a mass extinction on Earth nearly 13,000 years ago.
In the pipeline Two new clinics in the School of Law will serve the community in practical ways and give students hands-on experience.
Visit at sc.edu/vpresearch for more information
Cover illustration by Maria Fabrizio
Prakash Nagarkatti, Ph.D. Vice President for Research University of South Carolina www.sc.edu/vpresearch
We live in a time of rapid development. It often feels like information, new technologies and ideas move and change constantly, at a frenetic pace. But, it’s important to step away and slow down from time to time and take stock of the milestones worth savoring. And, this fall there is much good news to savor in USC’s research community. This summer, we announced another record-high total in sponsored awards funding — our third in as many years. In fiscal year 2017, our outstanding faculty garnered more than $253 million in competitive external funding for research, training and service. This impressive total handily topped our two previous records of $250.1 million in 2016 and $242.8 million in 2015. Our university-wide research funding programs are also marking exciting new milestones in 2017. We have seen amazing returns on our investments in our competitive faculty funding program ASPIRE, which supports new interdisciplinary collaborations and novel lines of research. Investments in ASPIRE over the past five years have helped to generate more than $120 million in external funding as of 2017. The Office of Undergraduate Research is preparing to mark two milestones this fall as they enter the 25th round of Magellan funding, during which they will present the program’s 1,500th award. Read on for a look ahead at research advancements in the works at USC today, and get a glimpse of potential milestones to come.
2 / Breakthrough
Electrical engineering students inspect a wafer of semiconductor micro-devices in a clean room laboratory.
Fall 2017 / 3
TALKING THROUGH THIN AIR As air traﬃc has grown to nearly 3 billion passengers a year, the ability of aircraft to communicate has struggled to keep up, a troubling development in face of an anticipated doubling of air traﬃc in the next 20 years. College of Engineering and Computing researcher David W. Matolak is working to change that. The electrical engineering professor is the principal investigator in a NASA-funded
ROCKY ROADS USC CIVIL ENGINEERS TEAM WITH CLEMSON TO IMPROVE PAVEMENT DESIGN IN SOUTH CAROLINA
$4.4 million research project to address limitations in aircraft
Ask S.C. drivers about the state’s roadways and they’ll probably tell you
communication networks. The goal is to improve operations
that they need … work.
and increase safety.
Population growth in suburban areas means more daily traﬃc on already-
“We will take advantage of all available aviation frequencies
crumbling roads. But civil engineering experts from USC’s College of Engi-
to create new, faster and more effective wireless commu-
neering and Computing and Clemson University are working on the problem.
nications that are completely adaptive to all conditions,”
The research team has received $1.76 million from the state Department of
Matolak says. “These new aviation radio systems will be able
Transportation/Federal Highway Administration to collect new data on state
to access multiple communication methods and resources —
roadways over the next four years. The research will determine how roads
such as ground stations, other aircraft, satellites, trains and
can better be constructed, repaired and maintained so that new pavement
large sea vessels — for maximum eﬃciency.”
Air traﬃc has grown rapidly for the past 50 years, according
“We are determined to help fix South Carolina’s roads,” said USC civil engi-
to Aerospace America and the Federal Aviation Administra-
neering associate professor Sarah Gassman. “To do this, we’re collecting and
tion. Air passenger traﬃc has skyrocketed from 46 million in
analyzing data on traﬃc volume and other wear factors while also looking at
1965 to 3 billion in 2016; 7.2 billion passengers are expected
new materials that are available for road construction.”
by 2035 — along with millions of drones.
The pavement design method currently used by the state transportation
In July, Matolak briefed members of Congress and NASA
department is based on updates to an original 1961 procedure and S.C.-
leadership in stark terms about key improvements needed
specific local studies conducted at Carolina and Clemson from 1964 to 1973.
in air traﬃc management systems and new wireless commu-
Average truck weight and traﬃc volume is much higher than it was decades
nications to handle expanding air travel and air transport
ago, and new additives for concrete and asphalt weren’t used or weren’t
in the U.S. and globally.
available in the 1960s and ’70s.
Over the next three years, the team’s research will address
Completed last year, the first phase of the project was for researchers to
several challenges to the current systems, including ineﬃ-
examine preliminary data the transportation department already had on
cient airport operations that cause significant travel delays
climate, soil, asphalt and traﬃc data conditions — all of which affect road
and the inability to accurately and continuously monitor
construction and maintenance.
and track all manned and unmanned aircraft.
With the initial phase done, researchers have moved on to collecting and
“We are planning to dramatically improve the capacity and
analyzing soil, concrete and asphalt samples and installing sensors to observe
eﬃciency of all airport communication networks as well,”
cracking, rutting and other impacts. Analysis of the collected data will enable
forecasting of various distresses over the life of the pavement.
The NASA award is part of the space agency’s University
The program will be calibrated with a national database of pavement perfor-
Leadership Initiative, in which select universities identify
mance, and the data will be fed into a national computer model adjusted for
their own projects and lead the technical work with other
S.C. conditions. This procedure will enable engineers to determine if pavement
universities and companies to solve aviation challenges.
performance meets standards or needs improvement.
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IMAGINE THIS PHYSICAL EDUCATION PROFESSOR EXPLORES NEURAL CONNECTIONS OF MOTOR IMAGERY. The guy who wrote the inspirational maxim “if you can imagine it, you can achieve it” could have learned a lot from Eva Monsma. Turns out there are several ways to imagine movement skills, says the USC physical education professor, and the technique might hold promise for helping individuals with neurodegenerative conditions. For more than 20 years Monsma has focused her research on mental practice, known as motor imagery, a method commonly used by athletes to practice motor skills like free throws or golf club swings. “You can imagine an action visually — you ‘see’ the pitch and picture yourself swinging a bat — and you can imagine it kinesthetically, mentally feeling the timing, force and speed of the way your arms and torso bend as you shoot a free throw,” she says. There are two types of visual imagery, Monsma says. The first is TV imagery in which you picture yourself from an external perspective as though watching your own performance. Monsma calls the second type GoPro imagery In which you picture yourself doing something from an internal perspective. Using fMRI instruments, Monsma and her research team looked at brain activity of individuals mentally imagining the same movements using each type of motor imagery. Her subjects were college students, none of them competitive athletes. Different parts of the brain lit up for each type of imaging, and the differences appeared in expected areas — motor areas for kinesthetic and visual areas for visual with some differences between TV and GoPro imagery. Students who considered themselves to be adept at imagery had larger regions of their brains light up during TV imagery. Conventional wisdom has held that individuals who excel at motor imaging would probably have less of their brains engaged in the task because they had become so eﬃcient at doing it. Monsma’s experiment showed that the opposite might be true: More of the brain lights up if you’re good at visual imaging. “I think there’s a potential for using visual imaging to help people with brain injury and stroke or Parkinson’s disease, particularly if there is still connectivity in certain areas of the brain,” she says. “If we can strengthen those connections, we might see substantive improvement in brain function.” And Monsma sees still other applications for visual imaging. “I like talking to athletes about the potential of what they can do,” she says. “Wouldn’t it be cool if we could get them to use imagery not just in sports but for stress management or studying?”
Fall 2017 / 5
IT’S AN EMERGENCY
ECONOMICS STUDY LINKS LENGTHY ER WAITS TO COSTLY OUTCOMES FOR PATIENTS AND HOSPITALS
Treating the sickest emergency room patients first seems like an obviously good idea. Lindsey Woodworth, an assistant professor of economics at the Darla Moore School of Business, is compiling evidence that shows this sort of prioritization can lead to better-served patients and a healthier bottom line. Using five years’ worth of data on ER visits at the University of California, Davis, Woodworth has linked patient records to their medical bills and found that longer wait times increase per-patient costs. “But, the effects are bigger for sicker patients,” she says. “A logical next step would be to make sure ERs are triaging very precisely, so that the sickest patients get to the doctor before anyone else. This alone would save hospitals money.” Woodworth, who completed a postdoctoral fellowship at UC Davis after receiving her Ph.D. in economics from the University of Florida in 2014, was drawn to the ER as a subject while working as a research assistant at the Medical Center at the University of Florida. “ERs are the most exciting place in a med center,” she says. “For the last two years, I’ve spent the majority of my time in a medical center. I’ve gotten to see what things looks like from the inside; this has been really helpful because economists don’t normally spend time around hospitals. “I realized the problem was worse and worse the more that I studied it.” Woodworth has discovered that long, costly wait times are a national phenomenon. “I’ve moved around the country a lot, and everywhere I go, I ask the ER doctors about wait times,” she says. “In the last three states I’ve lived in, for the big, academic ERs, the average wait times are all over five hours right now.” In 2014, the Centers for Disease Control and Prevention reported that the average ER wait time was 30 minutes, with an average treatment time of 90 minutes. A ProPublica study published in February, using data collected by the Center for Medicare and Medicaid Services from April 2015 to March 2016, found that patients in South Carolina wait an average of 30 minLindsey Woodworth
utes in emergency rooms before being seen by a doctor.
In Colorado and Utah, patients waited just 14 minutes, while in Maryland, patients waited 53 minutes. The consequences of long ER waits can be dire. A study of almost a million admissions to 187 California hospitals in 2007 found that patients admitted after going through a very crowded ER had a 5 percent greater chance of dying than those who went through a less-crowded emergency room. Part of the trouble, Woodworth says, is a lack of financial incentive to address the lengthy waits — something she hopes the paper she plans to publish with the results of her research will change. “ER patients don’t bring in a lot of money,” she says. “The overarching goal of this research is to get hospital administrators’ attention. To say, ‘It’s not only causing problems for them, it’s causing problems for you. It would be in your best interest to start addressing these things.’”
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A TALE OF TWO BUSINESS REPORTS HOW ‘BAD’ WRITING CAN HURT THE BOTTOM LINE by Madeleine Vath Everyone understands the importance of effective written communications in business, but could bad writing cost a company real money? Darla Moore School of Business finance professor Hugh Hoikwang Kim set out to answer that after reading a rather incomprehensible corporate disclosure report. “I opened up a well-known company’s disclosure documents,” he says. “It was several hundred pages long. Even as a finance professor with a Ph.D. in the field, it was very hard to understand what was going on.” Kim decided to look into the financial impact of poor writing by examining the correlation between the price an investor is willing to pay for a company’s stock and the quality of that company’s writing in corporate disclosures. What he and his colleague Byoung-Hyoun
Hugh Hoikwang Kim
Hwang at Cornell University found is that the two are linked. “Investors want to trade the company’s stock at a discount price when the company’s disclosure document is written in a complex way,” Kim said. The researchers looked specifically at closed-end funds, which are typically held by smaller companies, making the disclosure document an important source of information. If that information is too diﬃcult to understand, potential shareholders lose interest, he says. This research statistically rejects the idea that hard numbers are the only thing that matter when it comes to selling shares, Kim says.
HOW ‘GOOD’ WRITING HELPS SELL A COMPANY’S STOCK Call it reading between the lines. Recent research by Darla Moore School of Business associate professor Mark Cecchini and his colleagues at Georgia State and Virginia shows that certain words in a financial analyst report could imply that a company will do better in the market than one lacking those words. Using natural language processing tools, Cecchini found that better stock picks could potentially be made based on certain combinations of words. To support his hypothesis that there is subliminal information in what analyst reports say, Cecchini took buy-rated analyst reports and examined the buys a year after they were rated to see if they were actually good investments. Then he split the good from the bad to search for notable differences between what
was written about each. The natural processing technique takes a portion of the good ones and a portion of the bad ones and generates a “dictionary” of differences in language. Cecchini then took that dictionary and applied it to a whole new sample to see if it provided any insights. By taking that sample portfolio and “trading” on it, he determined that money could be made using this method based on the positive returns that resulted. Although natural language processing and other statistical tools he used are not an exact science, these results do provide a solid reason for someone to read the analysts’ reports in addition to looking at the hard numbers to make the best stock buy possible. Considering the theory that analyst report ratings are optimistically biased, Cecchini’s findings suggest that reading the summaries themselves could give someone a better idea of what is actually going on within a company.
Fall 2017 / 7
Front & Center
A PLAGUE UPON US The toll of Americaâ€™s opioid epidemic is tragic, but USC researchers are engaged in the struggle, ďŹ nding tools that could help turn the tide. By Megan Sexton
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THE NUMBERS TELL THE STORY OF THE OPIOID EPIDEMIC. AND THE STORY IS TRAGIC. NINETY-ONE AMERICANS DIE EVERY DAY FROM AN OPIOID OVERDOSE, A FIGURE FROM THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES THAT INCLUDES PRESCRIPTION DRUGS AND HEROIN.
he number of drug deaths is rising, with more than 59,000 overdose deaths in 2016. Six in 10 drug overdose deaths in 2014 involved an opioid, such as a painkiller or heroin, according to the Centers for Disease Control and Prevention. Each day, more than 1,000 people are treated by emergency departments for misusing prescription opioids. In 1999, there were twice as many deaths from car accidents as there were from drug overdoses. That number has flipped, with more than 40 percent more deaths from overdoses in 2014 than from car wrecks. Drug overdoses are now the leading cause of death among Americans under 50. The opioid epidemic is driven by overdoses in prescription drugs, heroin and illegally manufactured fentanyl, a synthetic opioid much more powerful than heroin. The epidemic has destroyed lives across the country, and it affects Americans regardless of age, race, wealth or hometown. It’s a complex situation, with no easy fixes. And it shows no signs of improvement. Researchers at the University of South Carolina are addressing various aspects of the epidemic, focusing on opioid addiction and the Affordable Care Act, the neuroscience of addiction and prescription drug monitoring programs.
“There are a number of people who reach out to me with questions, who are really grasping for answers. There are personal and professional stories across the board,” says Jill Turner, a researcher in the College of Pharmacy. “It’s important for an institution like USC to have a role of leadership, to take a stance and show we care in that we have work going on that’s trying to address these problems from multiple perspectives.” SCIENCE OF ADDICTION
Jill Turner grew up in West Virginia, one of the states hardest hit by the opioid epidemic. When she returned to her picturesque hometown, population 2,000, after college, what she saw changed her. She had long known that West Virginia struggled with adequate health care and poor health insurance options, but this was different. What started as the over-prescribing of opioids had grown into a full-blown crisis. “[The town] was decimated by opioids. It was really incredible,” she says. “People who had been all-star athletes were on heroin. I’ve had a number of friends either die or go to jail because of opioids.”
Fall 2017 / 9
Both of Turner’s grandparents had died from smokingrelated cancer, so she originally thought she would conduct cancer research. But the stark image of addiction — both to nicotine and opioids — stuck with her as she moved on to earn a doctorate in neuroscience from Georgetown University and complete a postdoctoral fellowship in neurogenetics at the University of Pennsylvania. At Carolina, where she is an assistant professor of drug discovery and biomedical sciences in the College of Pharmacy, her research aims to understand the biological factors that make it difficult for smokers and drug addicts to quit. She also looks for ways to tailor treatment based on a person’s genetic makeup. For example, her research has examined the biomolecules that mediate opiate addiction, known as the mu-opioid receptor. Just a small change in a person’s DNA — one point, one nucleotide — can have a large effect on whether that person becomes addicted. Turner has found that people with a certain variant of the mu-opioid receptor can more easily quit smoking and are less likely to become addicted to heroin or opioids. Her work aims to understand the biological factors that cause low success rates of smokers and addicts who want to stop, and to learn how to apply that knowledge to personalized medicine. That has led her to pharmacogenomics, also known as precision medicine, which is designed to adapt therapeutics to a patient’s genetic code. In her lab, that means looking at nicotine and opioids. Her collaborator in Finland has data from twins collected
10 / Breakthrough
since the 1970s, allowing researchers to mine data and ask questions about addiction and specific genes, understanding whether people are predisposed to certain addictions. A key part of the brain — the area that controls executive function — changes with extensive, continued drug use. It’s the area of the brain that lets a person understand both goals and consequences, and it looks completely different in addicts, she says. “They act without forethought. So, you have an individual, and you can’t take them out of the environment where they may be the only sober person and they have impaired inhibitory control,” Turner says. “That means they have increased impulsivity and they live where opioids are readily available. They are set up to fail.” Just as a person can’t unlearn how to ride a bike, an addict is always an addict and must learn what triggers drug use and stay away from it. “Honestly, the brain is very complex. You’re not going to find a single bullet that can help this. To attack it, you have to move outside the idea that there’s one way to fix this,” she says. “We have to change in the way our society views drug addiction and change the way we attack the problem. “You’re treating depression, anxiety, a whole host of other things. You need to treat the person as a whole, and not just as an addict. That means not only understanding how a person’s genetic code may help, but understanding their family history. For example, screening for epigenetic markers may help us understand how genes and family history interact, leading to better treatment. It’s a brave new world.” A SAFETY NET WITH HOLES
Christina Andrews, an assistant professor in the College of Social Work, has watched the opioid epidemic gain more and more attention. “When it reached a point where the CDC said this is an epidemic, where we are losing more people in a year to opioid overdoses than to AIDS at the height of that epidemic, it was a real wakeup call,” she says. “Every addiction is different, and this particular addiction is a very powerful one. Considering the risks related to withdrawal and overdose, it’s particularly dangerous.” Andrews’ research examines the financing of drug abuse treatment systems under the Affordable Care Act, including
how insurance plays a role in access to drug treatment. It’s especially relevant as opioid addiction and changes to the ACA have come to the center of the national debate on the future of health care in America. The ACA put addiction treatment in the same category as other medical services, meaning it must be covered by existing insurance. The ACA also expanded health insurance through Medicaid and the establishment of state health insurance marketplaces. The opioid epidemic caused many states to consider how they treated drug addictions and find potential opportunities offered by the ACA to help address treatment. Andrews’ work uses information from the National Drug Abuse Treatment System Survey, a longitudinal survey that has collected data since 1988. Starting in 2013, she began using the information to determine the impact of the ACA on access to and quality of drug addiction treatment programs. She’s now looking at more recent data to see what has changed with the implementation of the ACA, including the number of people being treated for addiction, the number of insured versus uninsured patients, and whether people are getting treatment longer because they are insured. “The numbers show a three-fold increase in the proportion of clients coming in with opioid addiction,” she says. “We’re looking at data between 2000 and 2017 and have not seen any significant increase in availability of drugs used to treat it despite years of work to achieve that.” She says insurers were initially slow to cover buprenorphine, which has similar properties to methadone as a drug to treat addiction, but with lower risk of abuse. While insurance companies are offering more coverage for that drug, the system is seeing a decrease in the number of providers offering methadone. And because of concerns regarding fraud and misuse of prescriptions, with few exceptions, each provider can prescribe buprenorphine to only 100 clients per year.” Andrews’ research has shown that though the ACA covers substance abuse treatment, the programs and other infrastructure aren’t always in place. For example, more than half of addiction treatment programs do not accept insurance, and many state agencies around the country that assist treatment providers aren’t helping the programs figure out ways to accept the insurance, she says. At the same time, many people struggling with addiction aren’t equipped to navigate the red tape of enrolling in treatment programs.
“It’s exciting to think in the humblest way that the work I’m doing could help inform some aspect of decision making and public policy and could help save lives,” she says. “Unfortunately, the epidemic is not showing any signs of abating right now. But it’s good to see some efforts are being made to foster a national conversation about it.” TRACKING THE EPIDEMIC
Prescription drug monitoring programs — state-run databases used to track the prescribing and dispensing of controlled prescription drugs — can help detect suspected cases of abuse. For Zaina Qureshi, an assistant professor of health services policy and management in the Arnold School of Public Health, information mined from the databases might hold a key to help address part of the opioid crisis. The monitoring programs provide information about a patient’s controlled substance prescription history and can help identify patients who are at high-risk for addiction and could be helped by intervention. In 2010, Qureshi began working with colleagues at Carolina and other institutions to determine how academic detailing — outreach programs that educate physicians about the drugs they are prescribing — could be used to better understand part of the opioid epidemic. “We wanted to figure out if clinicians valued academic detailing programs related to opioids,” she said. “Prescription drug monitoring programs have been shown to work, so we want to educate doctors on how to use the PDMP optimally and inform them about best practices in pain management.”
Fall 2017 / 11
Qureshi and her team used geo-spatial mapping to determine patterns of opioid prescribing from 2010-2011 — the first time that such a technique was applied to study opioids in South Carolina. The findings indicate a relatively small percentage of providers, concentrated in a few counties (Charleston, Richland, Greenville, Barnwell and Aiken), who account for most opioid prescriptions. This group represents a potential target for physician education and engagement in handling pain management and appropriate use of opioids. The initial study didn’t control for prescriptions written at pain management clinics, something that is being added in further research. The next step will use data from 2009 through 2015 to look for doctors who are prescribing well above average amounts of opioids.
“Addressing the opioid crisis is a complicated balancing act — while there is a push for education, prevention and enforcement to reverse the epidemic, physicians must also ensure that patients suffering from legitimate acute and chronic pain have access to appropriate opioid medications,” Qureshi says. “To that end, our long-term goal is to create a shared decision-making tool that would allow patients to share their goal and preferences with providers in order to facilitate more effective opioid prescribing practices.” “In 2014, the American Medical Association Opioid Task Force decided physicians needed to be better educated about effective and evidence-based opioid prescribing,” she says. “We’re trying to figure out now what these trends mean and where can we innovate.”
AN OPIOID PRIMER HERE IS SOME BASIC INFORMATION ABOUT OPIOIDS FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION: • Opioids are a class of drugs used to reduce pain. • Prescription opioids are prescribed by doctors to treat moderate to severe pain, but can have serious risks and side eﬀects. Common types are oxycodone, hydrocodone, morphine and methadone. • Fentanyl is a synthetic opioid pain reliever that is many times more powerful than other opioids and is approved for treating severe pain, typically advanced cancer pain. Many states have seen an increase in illegally made and distributed fentanyl. • Heroin is an illegal opioid, with its use increasing in recent years across the country.
FROM 2000 TO 2015 MORE THAN HALF
• Naloxone, which often goes by the brand name
A MILLION PEOPLE DIED FROM DRUG
Narcan, is the anti-overdose medication used
OVERDOSES. NINETY-ONE AMERICANS DIE
by ﬁrst responders to attempt to revive people
EVERY DAY FROM AN OPIOID OVERDOSE.
during an overdose.
12 / Breakthrough
THE OPIOID EPIDEMIC • From 1999 to 2013, the amount of prescription opioids dispensed in the U.S. nearly tripled, yet there has not been an overall change in the amount of pain that Americans report. • Almost 2 million Americans abused or were dependent on prescription opioids in 2014. • Drug deaths are rising, with more than 59,000 overdose deaths in 2016. More than 6 in 10 of those drug overdose deaths in 2014 involved an opioid, such as a painkiller or heroin. Since 1999, the number of overdose deaths quadrupled. • According to a 2014 CDC study, 12 states — including South Carolina — had more opioid prescriptions written than people in 2012, with Alabama in the top spot with almost 143 prescriptions per 100 people. • From 2014 to 2015, death rates for synthetic opioids other than methadone (including drugs such as tramadol and fentanyl) increased 72.2 percent.
Fall 2017 / 13
You describe your ﬁeld as the “law of the newly possible.” What does that mean? I look at the descriptive, the predictive and the normative. Descriptive is, “What is the world today?” “What is the state of technol-
Q&A Honk! If You’re Not Driving Bryant Walker Smith, USC assistant law professor
ogy?” “What is the state of law?” Predictive is, “How is law going to change?” “How are technologies going to change?” “How are society and society’s values going to change and what will that mean for technology and for the law?” The normative is, “What should the world of tomorrow look like, and what role should the law play in that?” It’s important to start with what we know before we decide where we want to go. Let’s start with the descriptive. What areas of law and technology are on your radar? Everyone is thinking about data and automation, and how the two combine. Specifically, I’m thinking about questions of trust and trustworthiness — earning trust and evaluating trustworthiness. I used to think that simply providing information was suﬃcient. That is, if a government agency released data, or a court released a judgement, or a company released information about the performance of a product, that was the extent of the obligation, and that
As an internationally recognized expert on the law of self-driving vehicles, Bryant Walker Smith is frequently asked to weigh in on legal issues related to automated driving. But the USC assistant law professor’s expertise isn’t limited to self-driving cars. His insights into tort law and product liability, and his broader interest in what he terms “the law of the newly possible,” are helping prepare USC law students for an evolving legal landscape.
in itself was suﬃcient for whatever public policy goals exist. I’ve realized that is not enough. Everybody needs to think about the way that information is used and received — and we need to understand that information as part of a narrative. What speciﬁc challenges does your interdisciplinary approach present? A field of engineering called human factors is concerned with how humans actually use the things that engineers design. So you’ve made a toaster, but are people going to electrocute themselves with it? You’ve made a road, but are people going to feel so comfortable on it that they drive too fast? For years, human factors experts have warned us, “You need to see the human in the system, you need to think about how what you do is going to work in the real world…” So much of the dialogue between engineering and law, between technology and society, is incremental. We don’t ever have a chance to step back and say, “Well, what should be?” rather than just, “What is?” It’s useful to set out benchmarks, to say, “This is what we want the world to look like,” and then to evaluate those benchmarks in a year, five years, ten years, and say either, “Our vision of the world has changed, and that’s OK,” or, “We’ve gone astray.”
14 / Breakthrough
The human factor is a big variable, though. It is, and it’s one that tort law deals with all the time — think
our cars driving us. That’s fully automated driving, and that’s a ways off, but there is a lot of lower-hanging fruit.
about consumer misuse and abuse, warnings and instructions
The first path is increasing driver assistance. Those will do
— but human factors have not been fully appreciated in either
more and more of the real-time driving tasks. The human can
the engineering or the judicial realms. I think we’re coming to a
take their hands off the wheel, and their feet off the pedal, and
greater appreciation for the point these specialists have been
then both hands off the wheel — and then maybe they can
making for a half century — that the same expertise needs to
take their eyes off for a little bit. That takes us to the mushy
be applied in the domain of data and information.
middle of automation that engineers and lawyers have to deal with — imperfect people misusing these systems in all kinds of
But humans are not all the same. How do you adjust for such
ways. Another path is increasing safety systems, introducing
a squishy variable?
intervention systems that won’t act until a crash is imminent.
Everyone from designers to regulators is puzzling over how to treat non-deterministic systems, when you have machines where you’re not sure what the outputs will be even when you know the input. With most machines, if you know the inputs, you know the outputs. Press on the gas, and you know how fast you’re going to go. Increasingly complex systems are non-deterministic: there are so many inputs that you can’t
These are going to get more sophisticated and start intervening earlier, so people might still think they’re driving, but actually they won’t be because these systems will be introduced so often. What fascinates you about the law as it relates to emerging technologies?
understand them, or the interaction between inputs within the
It’s an easy way to explain all the ways that life has
system can’t be fully understood. So you say, “How do we pos-
changed and is changing, and to be a part of that
sibly regulate these non-deterministic systems?” Well, the law
excitement. Think about all of the innovation, for
has been doing that for millennia. The human is the ultimate
good and bad, and all of the people who have had
non-deterministic system — and that may actually offer a
the opportunity to shepherd those or navigate
useful analogy for how we regulate these new, complex
those. That’s a privilege. I’m both intellectually
non-human systems. This is where law and engineering so
fascinated by how that happens, and also,
desperately need the insights of psychology and neurology
practically, as a lawyer and an engineer, very
and social science. This is one reason why the humanities are
interested in being part of that process. Also,
so important. We should really be pulling from those domains
I’ve always been interested in complex relation-
that don’t have perfect answers but probably have better
ships and understanding systems, recognizing
that everything is ultimately part of one system, even though we draw artificial boundaries. New tech-
You’re well known for your work relating to law and self-
nologies give me a chance to see those relationships,
driving cars. We’ve already started down that road — we
the way that new ones emerge, or are strengthened,
have cars that help us park, for example. At what point do
or are challenged.
we even call them self-driving? People talk about the self-driving car as a technology, singular, but, really, it’s this diverse set of technologies, and applications of those technologies. When I got into automated driving in 2011, I joined the Society of Automotive and Aerospace Engineers and became very involved in their efforts to define levels of automation. As a technical matter, not a legal matter, once you can take your eyes off the road, we say the system is highly automated. People imagine sleeping in the backseat and
Fall 2017 / 15
ADJUDICATING THE RWANDAN GENOCIDE Political science professor reﬂects on Rwanda’s grand attempt at reconciliation following genocide By Page Ivey
For roughly 100 days in 1994, as many as 800,000 Tutsi people were murdered by soldiers and members of the Hutu ethnic majority in the central African nation of Rwanda. The murders were carried out at the behest of extreme Hutu nationalists and were committed by more than a million ordinary citizens throughout the country. The killing ended when the Tutsi-led Rwandese Patriotic Front took control of the country. But that led to the displacement of millions of Hutus, who became refugees. Ten years later, a second crisis developed when tribunals set about putting on trial the million-plus people accused of participating in the genocide. Those trials, called “gacaca,” put communities in charge of hearing evidence and doling out justice to their neighbors. “It was the most adjudicated conflict in recent history,” says Anu Chakravarty, assistant professor of political science at Carolina. “There was no wherewithal to try a million perpetrators through the regular court system. So they created 10,000 courts with community-elected panels of judges, who had a grade six or seven education.” The trials themselves took nearly 10 years. There was little hard evidence and a single accusation could get someone convicted. Judges were often from the same ethnic group as those on trial. “Informants were telling on family members,” Chakravarty says. “The question I looked at was why were people participating in their own punishment?” Chakravarty’s book, “Investing in Authoritarian Rule, Punishment and Patronage in Rwanda’s Gacaca Courts for Genocide Crimes” (2017) is an in-depth investigation of the 16 / Breakthrough
courts’ legal operations and shows how incentives, like grants of clemency and opportunities for private gain or career advancement, drew people into the new regime that was dominated by the country’s minority population. “My interest is in people — why and how they fight and how they reconcile,” Chakravarty says. While projecting an image of justice, the courts revealed a sort of patronage-driven relationship, tying the interests of regular citizens to the ruling class, which could withdraw these benefits at any time. “Rwanda presented this case of a political problem that was perpetrated at an intimate level,” Chakravarty says. “The challenge was to tie the empirical analysis to what were the implications for political life as a whole.” The book took 10 years to research and write, including 18 months of fieldwork in Rwanda, living with families and interviewing people with local interpreters to gather data and personal stories. “The challenge of the fieldwork was that people’s lives were on the line,” she says. “These were highly secretive, emotionally charged issues.” She was there while the trials were still ongoing. “This kind of work changes you, shakes you, traumatizes you, hearing these stories day in and day out,” she says. “But I matured as a political scientist doing this fieldwork.” A native of India, Chakravarty earned her bachelor’s in political science from Presidency College, India, and her master’s from Jawaharlal Nehru University. She got a master’s and Ph.D. in government from Cornell University. It was there that she became interested in the Rwandan genocide.
ALLERGIC TO PENICILLIN? NOT SO FAST… Pharmacy students develop new protocol for verifying pencillin allergies. By Craig Brandhorst
A team of undergraduates mentored by associate professor of pharmacy Brandon Bookstaver have developed a new protocol being used at Palmetto Health Richland Hospital to determine if hospitalized patients who report having a penicillin allergy, in fact, are allergic. “If you report a penicillin allergy, that eliminates the opportunity to use any related antibiotics, which then takes you, maybe, to the second tier of antibiotics, or the more toxic, or the more costly,” says Bookstaver. “Testing doesn’t just only open the door for penicillin but for all of the related antibiotics. That gives us a lot better options.” Under the protocol, an infectious disease pharmacist will evaluate hospitalized patients who have reported a penicillin allergy to determine if they are candidates for penicillin allergy skin testing. After consulting with the rest of the antimicrobial stewardship team, which includes the patient’s physician, the infectious disease pharmacist will then administer the test, which takes 45 minutes to one hour. “In over 95 percent of patients, their history of an allergy is actually incorrect,” says Bookstaver. “These patients test negative at least to major allergic reactions. There may be some minor reactions that the test doesn’t look for, but these would be more of a nuisance as opposed to a more serious negative outcome like anaphylaxis.” The protocol is pharmacist-driven for two reasons, according to Bookstaver, who also serves as director of residency and fellowship training at the College of Pharmacy.
“One, they have the knowledge of antibiotics and the ability to reconcile antibiotic allergies,” he says. “Two, you only have to train a couple of pharmacists to be able to cover an entire hospital. If you were to train physicians or nurses, you would have to train a lot more of them.” At present, three pharmacists have been trained in the new protocol and are currently implementing it at Palmetto Health Richland. Two pharmacy residents in the infectious disease residency program will also be trained, along with two recently hired infectious disease pharmacists at the College of Pharmacy. One of those pharmacists works jointly with the Department of Health and Environmental Control; the other works at Palmetto Health Park Ridge Hospital in Irmo, S.C. Because the student team, led by third-year pharmacy student Nicki Griffith, has shepherded the project through the approval process at the S.C. Board of Pharmacy, the S.C. Board of Nursing and the S.C. Board of Medical Examiners, pharmacists at any other hospital in the state can now administer the protocol in the hospital setting. Meanwhile, patients are getting a small dose of training themselves. “We’re trying to make sure that the patient is well educated, so they can tell their pharmacist and their physician’s office that they no longer have a serious penicillin allergy and that they can remove that from their profile,” says Bookstaver. “Our goal is not only to affect a patient’s antibiotic use in one hospitalization but to affect their antibiotic use long term.”
Fall 2017 / 17
TARGETING A KILLER Drug discovered in collaboration with College of Pharmacy researchers holds promise for treating an aggressive form of breast cancer. By Melinda Waldrop
Eugenia Broude doesn’t seem particularly vicious. But the assistant professor of pharmacy and her team of researchers are bound and determined to destroy a stubborn cancer. A promising new drug developed in collaboration with Broude and studied by her team in the College of Pharmacy’s SmartState Translational Cancer Therapeutics program and COBRE Center for Targeted Therapeutics is currently being tested in Russia. The targeted clinical trial aims to combat estrogen-positive breast cancers that have proven resistant to anti-estrogen therapy and was designed on the basis of genetic, cellular and animal studies that were conducted by Broude’s team and published earlier this year. “Cancer cells are learning how to grow without hormones, even when conventional anti-hormone drugs are used. They change their program so that they are able to grow anyway,” Broude says. “But our drug is able to block that program, the transcriptional reprogramming that tumors are using to adapt. That’s the Achilles’ heel of the disease. If you take its ability to adapt from cancer, then it will respond better to the drugs.” Broude, who received a doctorate of philosophy from the Ukrainian Academy of Sciences, was recruited to USC six years ago as part of the SmartState research investment program. Her research team works with Senexin B, an orally administered drug discovered by collaborator Senex Biotechnology, a Columbia-based drug discovery and development company focused on oncology therapeutics. The drug was made by Senex as, in collaboration with Broude, the company searched for a way to combat cancer’s ability to hijack surrounding cells for its own deadly purposes. Broude’s lab tested the new drug in combination with drugs traditionally used in breast cancer treatment.
18 / Breakthrough
“We were looking at preventing transcription of previously silent genes in cancer cells, and Senex had tons of drug-like molecules that they sorted, characterized and improved on through chemical modification,” Broude says. “After discovering the mechanism of action of Senexin B, we made a laundry list of things to look for, adding a little bit of this drug and a little bit of that drug to see which of them would work better with Senexin B. “Then we would look at the cells and see if they expressed less of the genes of interest — the bad guys — or if they changed their growth speed, or their size or their shape.” Broude emphasizes that the clinical trial is in the early stages, but the potential of Senexin B, administered in conjunction with traditional drugs, is promising.
“It could, in combination with chemotherapy, eradicate cancer,” she says. “But my main hope right now is that it will not allow metastasis to happen.” Broude’s post-doctorate background in neuroscience makes her excited about other, far-ranging uses of the drug. It has implications on cardiological fronts and also has “activity in some of the Alzheimer’s disease pathways,” she says. “It doesn’t only work in hormone-positive cancers. It works in many systems where there is transcriptional reprogramming,” Broude says. “Researchers in the SmartState Translational Cancer Therapeutics program are working in prostate cancer, leukemias and lymphomas, metastatic ovarian cancer. There are a lot of potential uses because it’s so specific to the process, not to the cancer. At the same time, it has very little toxicity and low impact on other processes in the body.” The next step is to use preclinical and clinical data from the Russia trial to begin acquiring FDA approval for U.S. trials. “That could happen in parallel with this trial. We are going through the FDA-required preclinical studies,” Broude says. “Targeted drugs are different from conventional chemotherapy. You don’t give it to everybody. You give it to people who have the genetic predisposition to be able to respond to this kind of treatment. “We’re not going to do it blindly. We’ll do as much as possible to make sure the drug is used where and when it is going to be able to help people.”
Eugenia Broude and her team are studying a promising new cancer drug in the College of Pharmacy’s SmartState Translational Cancer Therapeutics program and COBRE Center for Targeted Therapeutics.
Fall 2017 / 19
THE ART OF SCIENCE
READING BETWEEN THE LINES Intricate patterns embedded on these pottery sherds are the hallmark of an Indian pottery tradition in the southeastern United States known as Swift Creek pottery, dating from 100 to 900 A.D. Artisans carved the patterns onto pieces of ﬂat wood about half the size of ping pong paddles, then pressed the engraved paddles onto clay vessels while the clay was still pliable. More than 900 diﬀerent patterns from the Swift Creek era have been identiﬁed on pottery fragments found in Georgia, Florida, South Carolina and neighboring states. “Pottery paddles are like ﬁ ngerprints,” says archaeologist Karen Smith, director of USC’s Institute of Archaeology and Anthropology’s Applied Research Division. “Their uniqueness allows us to see that some vessels in middle Georgia were impressed with the same paddles as vessels from the Gulf Coast of Florida,” she says. Smith is collaborating with Song Wang (engineering and computing), Jun Zhou (Research Computing Center) and Colin Wilder (Center for Digital Humanities) on pattern-matching software that archaeologists will use to more eﬃciently identify Swift Creek patterns among the many pottery sherd collections across the Southeast. “This is a task that is tedious and diﬃ cult to do, and there are large collections of unprocessed pottery,” Wilder says. “We are making [the task] hundreds of times faster. There is a huge mystery out there. What is the actual story of these people and their movements? It’s within the realm of the possible to ﬁnd out.”
20 / Breakthrough
Fall 2017 / 21
DIGGING FOR ANSWERS USC archeologists are part of a team that has found compelling clues that may help explain the disappearance of the Clovis people By Melinda Waldrop
1 OZ PLATINUM 999.5
Approximately 12,800 years
Platinum is rare in the
Exotic as it sounds, an
ago the distinctive spear-
Earth’s crust, but common
points and stone blades
in asteroids and comets.
event is not unprecedented
crafted by early Paleoindian
Moore says its prevalence
hunter-gatherers, known as Clovis, disappeared. Around this same time, more than 35 species of ice-age animals, including the mastodon, mammoth and saber-toothed tiger, went extinct. The exact reason for the extinction event has never been pinpointed, but a prevailing theory has been bolstered by a recent discovery made by a research team including three University of South Carolina archaeologists.
A 13-member team, including USC archaeologists Christopher Moore, Albert Goodyear and Mark Brooks, found an abundance of platinum in soil layers at 11 archaeological sites in North and South Carolina, Arizona, California, New Mexico and Ohio. The presence of the platinum points to a cosmic event, such as a comet or asteroid, that might have set off the Younger-Dryas, a period of extreme cooling that began around 12,800 years ago and lasted about 1,400 years.
is consistent with a hypoth esis of an extraterrestrial impact. While some species that disappeared were on the decline before the Younger-Dryas, virtually none are found after it, he says, strengthening the case for an extinction event. The authors of this study note, however, that further research is needed to establish whether an extraterrestrial impact, human overhunting, chang ing climate conditions or some combination of all three are responsible for these extinctions. The team’s findings are outlined in a March study in Scientific Reports, an online publication of Nature.
22 / Breakthrough
Though similar, the dinosaur extinction was the result of a very large impact from an asteroid, Moore says. The Younger-Dryas likely began after the Earth absorbed hits from fragments of a much smaller comet or asteroid, perhaps up to two-thirds of a mile in diameter. Scientists are still trying to identify a known impact crater for the Younger-Dryas event.
in the Earth’s history The platinum anomaly is remi niscent of the well-documented finding of iridium, another element common in cosmic objects, abundant in rock layers from 65 million years ago. That impact, known by scientists as the Cretaceous-Tertiary or K-Pg, caused the extinction of dinosaurs.
In the Pipeline
By Chris Horn
The School of Law is launching two new clinics this coming academic year as part of its expanded emphasis on hands-on learning opportunities. A medicolegal clinic will team law students with medical students, medical residents and physicians to improve health outcomes for pediatric patients, while a domestic violence clinic will focus on protection, advocacy and community education.
A young girl goes to the pediatrician with asthma symptoms and gets the treatment she needs but is back in the doctor’s office with the same symptoms two weeks later. The repeat visits continue for months because toxic mold growing in her parents’ rental home won’t allow her to get better. Determined to get to the root of the problem, the pediatrician consults a lawyer who convinces the landlord to remove the mold. The girl’s asthma symptoms improve, the frequent trips to the doctor come to a stop and family life gets better. It might sound like fantasy, but that’s the kind of outcome administrators and faculty at USC’s law school are hoping for when they launch the new Carolina Health Advocacy Medicolegal PartnerShip (CHAMPS) Clinic this fall. “We need to get at the social determinants of health — things like living conditions, transportation and income stability — because those have a big effect on a person’s health and wellbeing,” says Emily Suski, a newly appointed assistant professor of law and director of the CHAMPS Clinic. “The main idea of this clinic is to train a new generation of doctors and lawyers to work together to improve health outcomes.” Ten law students, four to six medical students, a master’s of social work student, several pediatric residents and physicians will work in teams on cases referred through pediatric clinics staffed by the Palmetto Health-USC Medical Group. Working under Suski’s supervision, the student teams will discuss the pertinent medical issues of each case and determine what legal remedies might be available to address them.
Emily Suski (left) and Lisa Martin
In addition to the university’s law and medical schools, CHAMPS Clinic partners include Palmetto Health, the Palmetto Health-USC Medical Group and S.C. Legal Services. The clinic begins this fall and will be open regularly every spring semester thereafter. “The students are going to be blown away,” says Caughman Taylor, professor and chair of the Department of Pediatrics in the School of Medicine, which provides medical care at two
Fall 2017 / 23
In the Pipeline
pediatric clinics at Palmetto Health Richland. “They’re going to see how this delivery model can improve health and what a huge benefit it will be to have healthier children who grow up to become healthier adults.” Suski has taught similar clinics at other institutions and says the students will first have to learn to meld their innate differences of perspective and professional lexicons. But once they begin to see results from their joint efforts, their enthusiasm will blossom, she says, pointing to a case from a medicolegal clinic she taught in Atlanta. “We had a child who had a rare neurological disorder who ended up paralyzed; the parents split up because of the emotional strain; the mom lost her job because of missed time, then lost her car and apartment. And all of that impacted the child’s health,” she says. “We were able to help her find a job, which helped them regain housing and a car. We also got the child eligible for Supplemental Security Income. That was satisfying.” Along with improving health outcomes and promoting interdisciplinary cooperation, the CHAMPS Clinic also holds potential for health and educational research, and opportunities abound for collaboration with other campus partners, Suski says. “I’m open to the idea of bringing in psychology and public health students. There’s rich potential here,” she says. Taylor affirms that notion, pointing to the future. “We’re bringing together professions that haven’t always collaborated,” he says. “Just think what those individuals can do when, say, a doctor in a rural community teams up with a lawyer in the same community who agrees to take on a few pro bono cases every year. That could be huge. I can’t wait to kick this off.” STOPPING THE VIOLENCE
When Lisa Martin arrived at USC’s School of Law this past summer, she brought more than 10 years of experience in the law school clinical world in addition to several years as an attorney advocating for teen victims of domestic volence. The new director of the Domestic Violence Clinic has a two-part vision for the new clinic, which will be offered one semester per year. “I see us involved in seeking emergency
24 / Breakthrough
VIOLENCE relief through domestic violence protection orders and addressing other issues that keep people in abusive relationships they otherwise would want to leave, such as financial security and immigration status. I also see us engaged in broader initiatives such as community education projects so that people know what their legal rights are,” she says. Martin’s interest in domestic violence issues began in law school when she worked in an international human rights clinic. After graduation, she worked for a large law firm and took on as much pro bono work as possible in areas of domestic and family violence. She later joined the staff of a nonprofit teen violence prevention organization before joining the law faculty at Catholic University in Washington, D.C. “It’s satisfying to be able to teach about domestic violence, but even more so that I’m able to to make a difference by training law students who will later take on pro bono cases in this arena,” Martin says. Finding a legal remedy for domestic violence cases hinges on determining that a crime has been committed, Martin says. “People experience different forms of abuse in different relationships — the menu of tactics can vary quite widely,” she says. “The law can step in and offer injunctive relief only if there’s been physical or sexual violence. It gets complicated when there is a lot of emotional abuse but no physical abuse. Clients might be terrified of that even more than physical violence.” Eboni Nelson, a USC law school professor, serves as board president of SisterCare in Columbia, an organization that partners with women in abusive relationships. She hopes a collaboration will form with the new clinic when it launches in the spring semester. “There is a dearth of advocates for this kind of work,” Nelson says. “The clinic will train future generations of those who will go into this full time and those who will do this as pro bono work.”
A NEW RECORD TOTAL FOR SPONSORED AWARDS IN 2017 Award Dollars by Source In Millions $151.6 $93.6 $8.4
Award Dollars by Purpose In Millions Research
37% 39% 60%
Major Funding Sources In Millions $50.0
Health and Human Services (excl. NIH) $40.2
National Institutes of Health $18.8
National Science Foundation $11.8
Department of Energy $6.9
Department of Education $3.9
Department of Defense
FOR THE THIRD YEAR IN A ROW, USC HAS BROKEN THE PREVIOUS RECORD, THIS YEAR GARNERING MORE THAN $253 MILLION IN SPONSORED AWARDS. “USC could not continue breaking funding records year after year without our faculty, which is made up of some of the brightest minds in academia today. They are the engine that keeps our research enterprise moving, accelerating us toward an ever brighter future.” — PRAKASH NAGARKATTI, USC Vice President for Research
Nonprofit Organization U.S. Postage PAID Permit #766 Columbia, SC
Columbia, SC 29208
We make South Carolina stronger. Raised by Latino parents in Boston, Julia López-Robertson understands the challenges of underrepresented populations in America. That’s why she is helping other Latino families through her research and outreach. “My goal is to help Latino children and families, as well as their teachers, understand that cultural strengths can increase a child’s academic success.”
CAROLINA CHANGES EVERYTHING SOUTHCAROLINA.EDU/IMPACT
JULIA LÓPEZ-ROBERTSON INSTRUCTION AND TEACHER EDUCATION COLLEGE OF EDUCATION