Drug development is among the slowest, most failure-prone processes in modern science, with . Today, artificial intelligence methods have accelerated the first step — plucking promising molecules out of endless possibilities — but countless challenges remain. A successful drug must be not only safe and effective, but also able to bypass the body’s defenses and reach the right target.

Most drug candidates fail such optimizations. That’s where a new 91���� institute at the 91���� has focused its attention. Housed in the UW School of Pharmacy, the brings together experts in artificial intelligence, drug discovery, pharmacology, data science and biotechnology to ease the bottleneck between promising molecules and successful drugs.��

The Institute opened in July 2026 and is led by three UW faculty members: , an associate professor of medicinal chemistry who oversees the Institute’s AI-enabled molecular design; , the Milo Gibaldi Chair of Pharmaceutics and expert in drug metabolism and disposition; and , a professor of psychiatry and behavioral science in the UW School of Medicine, who leads drug discovery, translation and commercialization efforts.

UW News spoke with the three co-directors about why drug candidates fail, how AI is speeding drug development and how I2D3 hopes to help get drugs to market more quickly.

What separates a promising molecule from a full-fledged drug? What properties need to be considered, and how can a developer work toward them?

Gaurav Bhardwaj: It really depends on the disease indication you are targeting and the therapeutic modality. Let’s say you have a promising molecule that interacts with the disease-causing protein. Delivery becomes equally important — do we need an orally delivered drug? Do we need to cross the blood-brain barrier? If the disease requires daily dosing, then injectable or IV methods aren’t optimal. If it’s delivered orally, then the molecule needs to be able to get across the gut barrier, and also needs to be stable enough that it doesn’t get chewed up by the body. It also needs to stay in the body for a reasonable time. A successful drug molecule has to meet all these and more criteria, and ultimately all these criteria are encoded by the sequence and structure of the molecule.

The Institute is devoted to aspects of drug development that are often overlooked. What problem do you see the Institute being able to help solve?��

GB: Traditional drug discovery and development is a trial-and-error-based process. Either you find a useful molecule in nature and spend years optimizing it for human use, or you create many random combinations of molecules and hope that one of them has the function you need. Both of these approaches are highly unsuccessful, which has created a bottleneck.

Now the field is also focusing on an idea called rational drug design. It started long before AI but is now becoming even more common. People are using AI methods to design new molecules. However, a lot of that work has focused on the first step — finding a molecule that binds to a specific protein, or has a specific function in the body. That’s still not a drug, it’s just more candidates.

The bottleneck has now shifted. It’s no longer finding that first molecule, but now, how do you add all the other drug-like properties? That’s what the Institute is trying to do. Let’s build the models that ultimately make molecules that are going to be successful all the way through the drug development pipeline.��

Marco Pravetoni: I see our work also as accelerating discovery. I work on substance use disorders, and my lab develops vaccines, antibodies and next-generation antibody-like molecules that target drugs in the body. With these new tools, instead of working to design 10 antibody candidates in a lab, we could design 1,000 or more, and then we can accumulate enough data to reduce any risks, so that what we bring to clinical trials is more likely to be successful. AI can do a lot of that.

How can you make it more likely that a drug candidate succeeds in trials?��

Nina Isoherranen: Part of it is predicting what’s going to happen to a drug in humans before it’s ever given to humans. That should increase the success rate and eliminate the waste of doing a lot of unsuccessful trials.��

We can also build machine learning and AI approaches to predict drug disposition in an individual person. What we talk about today are ‘digital twins,’ which refers to a computational model of the individual patient and their characteristics. For example, how does your kidney function? What is your body mass index? And so forth. Then we generate a digital version of you. We can then predict how a certain drug would behave in your body and build the best strategy.��

There’s also an access-to-treatment question here. Pregnancy is a great example — we often don’t know how drugs work in pregnant women because we’ve never done trials. To be safe, we say that pregnant people shouldn’t take those drugs, but that means they don’t have access to a potentially hugely beneficial medication. If we can use AI and machine learning to predict how pregnant people respond to medications and how their bodies handle drugs differently from nonpregnant people we can make more medications accessible

Now with AI and machine learning, I think we can get to a place where we can truly sample the full space of possibilities.��

How can the methods you’re building help with these individualized treatments?��

NI: We know that drugs behave differently in different people. Even if we give them the exact same drugs and concentrations, people may still have different responses because of factors inherent to our bodies.

During drug development the candidate drug needs to be studied to see responses in different populations. Before you get a drug approved, you need to understand how liver disease, for example, is going to change exposure to that drug and whether you need to change the dosing. There’s a lot of guidance on drug interactions. Pharmacists manage drug interactions all the time, but it gets very complicated when you combine multiple patient factors. Now, if we have good predictive tools, we can predict what’s going to happen without having to do trials.��

The ultimate goal here is to be able to predict, using model computational tools, what’s going to happen in individual humans before you ever give them a drug. What’s the right dose? The right timing?��

UW has established itself as a leader in these fields already. I’m thinking especially of the UW Medicine , whose director, , recently won the Nobel Prize in Chemistry. How does I2D3 fit into the broader UW ecosystem?��

MP: IPD is a world leader in designing novel proteins, and the UW also has outstanding capabilities in clinical testing and implementation through the . However, there remains a critical translational space between discovery and clinical application —�� one that focuses on the pharmaceutical development needed to turn promising innovations into viable therapeutic products. That’s where I2D3 can play a leading role.

For example, when 91����ers at IPD develop a new protein, I2D3 can partner with them early to address formulation, manufacturability, stability, delivery, and other key pharmaceutical considerations that are essential for advancing a discovery toward the clinic and ultimately the marketplace. I2D3 would serve as a core translational partner, helping bridge the gap between innovation and implementation.

IPD brings unmatched strengths in protein design, ITHS provides expertise in clinical translation, and I2D3 contributes the drug development and pharmaceutical sciences capabilities needed to move discoveries across the translational continuum. Together, these organizations can create a powerful and highly integrated ecosystem.

For more information, visit . To reach the 91����ers, contact Alden Woods at acwoods@uw.edu.

New images of cigar-shaped M82 galaxy capture millions of stars

The Messier 82 galaxy, known as M82 or the Cigar galaxy, has long fascinated 91����ers with its astronomical rate of star formation — approximately 10 times faster than the Milky Way. Researchers have pored over grainy, low-resolution, images taken by previous generations of telescopes, which weren’t powerful enough to see through the thick cloud of dust surrounding the galaxy. The , however, can pierce straight through with extremely sharp vision. That enabled a team of astronomers from multiple institutions, including NASA and the UW, to capture new high-resolution images. Posted June 23, the images include more than 16.5 million individual stars and provide the clearest look yet at M82’s , the flattened central hub that contains most of the galaxy’s stellar mass. That could help scientists understand how M82 formed and for how long it has been producing stars so prodigiously.

For more information, contact team member a UW 91���� professor of astronomy, at benw1@uw.edu.

All images are included in NASA’s

New study maps pollution disparities by state and sector across almost 20 years

Air quality in the United States has improved markedly since the landmark Clean Air Act passed in 1970. However, the gains have not been equally shared: Today, communities of color and low-income communities are exposed to disproportionately more air pollution than the overall population. In in Science Advances, UW 91����ers created the first comprehensive map cataloging how air quality inequity has changed per state and economic sector from 2002 to 2019. The study confirmed that, despite improvements in overall air quality, pollution tends to be concentrated in Black, Hispanic and low-income communities. The findings include specific state-level opportunities for improvement across 11 sectors — for example, disparities in construction-related emissions in Florida increased significantly during the study period. The findings and resulting database could help policymakers across the country prioritize environmental justice projects.

For more information, contact senior author , UW professor of civil and environmental engineering at jdmarsh@uw.edu.

The other UW co-authors are , , and . A full list of co-authors is .��

Researchers observe ultrafast chemistry happening in real time

Molecules are not static. Instead, they are having little dance parties — their atoms wiggle and twist around in space. Occasionally, upon receiving a burst of energy, the bonds holding atoms together in a molecule can break and reform with the atoms in a different configuration. While the number of atoms stays the same, the orientation of these atoms determines a molecule’s chemical properties — an important part of its identity. In , a UW-led team witnessed firsthand, and for the first time, a molecule turning into its “alter ego.” The 91����ers observed a hydrogen atom, also known as a proton, jump to a new position by bonding to a different atom in the same molecule. This process, which happens within a few millionths of billionths of a second, is important for various fundamental processes, including photosynthesis, and when DNA acquires mutations. To understand why, and how, this happens so fast, the 91����ers developed a new tool that probes molecular structure on an ultrafast timescale. They were able to use this technology to detect how the molecule’s wiggles allowed the proton transfer to happen. These findings will help 91����ers test existing theories about these ultrafast chemical dynamics and develop new molecules for clean energy processes.

For more information, contact senior author , UW professor of chemistry, at mkhalil@uw.edu.������

Co-authors , and completed this work while at the UW. Funding information is .

Random events leave lasting signature on the atmospheric methane record, new study shows

Methane is a powerful greenhouse gas with a complicated life cycle. It’s released into the atmosphere by both natural and industrial processes, and there are multiple pathways by which it’s broken down. Recently, atmospheric methane levels have reached record highs but the rate of accumulation has been somewhat inconsistent over time. To understand why, 91����ers are looking at climate records preceding the industrial era, via ice cores. These deep cylinders of glacial ice document slow swings in atmospheric methane levels spanning decades, or even centuries. This pattern is typically associated with gradual climate change, but in , UW 91����ers show that it doesn’t have to be. Instead, they reveal that short-term, random events, such as fires or changes in wetlands, can spark gradual shifts. Not only does this clarify the historical record, but it also adds nuance to modern trends.

For more information, contact senior author , UW doctoral student of atmospheric and climate science at emei@uw.edu.

The other UW co-authors are and . A full list of co-authors is .

Over the past five years, the national conversation around health and nutrition has become ’ Most prominently, Health and Human Services Secretary Robert F. Kennedy Jr.’s blames these foods for a host of chronic health issues and has to remove some UPFs from the food supply.��

But there’s a glaring problem: Nobody can agree on how, exactly, to define ultra-processed foods. The lack of a clear definition has stymied legislative and regulatory efforts to curb UPF consumption, and caused confusion for people evaluating their own diets.��

This spring, a panel of 14 nutrition, food science, policy and legal experts gathered to create a more practical and operational definition. The panel’s final report, , suggests an ingredient-based approach to identify ultra-processed foods, while also recommending a series of policies to reduce people’s exposure to them.��

The panel was co-chaired by , clinical professor emeritus of health systems and population health at the UW and executive director of the nonprofit group . UW News sat down with Krieger to discuss the new definition, the debate around ultra-processed foods and how people can limit their consumption.

How have we traditionally defined ultra-processed foods, and where does that definition fall short?��

Jim Krieger: The ultra-processed food concept was developed by who’s a physician and epidemiologist at the University of Sao Paolo in Brazil. He was trying to understand an increase in obesity and chronic disease rates, particularly in kids and young adults, and noticed some important changes in the diet that weren’t fully explained by just the usual nutrient profiling — like fat, sugar, salt. Monteiro came up with this concept of ultra-processed foods. The categorization system is called , which means ‘new’ in Portuguese, and classifies foods across a spectrum beginning with unprocessed ingredients and ending in ultra-processed. Ultra-processed foods are the ones that are the most highly processed industrial products, basically.��

The Nova definition is geared toward 91����, to really examine the effects of ultra-processed foods on a range of health outcomes. Using it, numerous studies have found ultra-processed foods to be associated with a whole host of health problems, like diabetes and heart disease and depression. That’s the basis to say, well, there’s probably sufficient evidence to figure out what we can do to reduce exposure to ultra-processed foods by reducing sales and consumption. That requires policy, and to have policy you need to have a definition of ultra-processed food that’s suitable for regulation or legislation, and that’s where the rub comes. The definition for 91���� doesn’t really work in a policy context, because the Nova 91���� definition uses multiple factors, including ingredients, processing techniques, and other factors to identify products as ultraprocessed. Applying Nova can require individual-level review of ambiguous products by skilled nutrition experts that may not be feasible in policy contexts.

You co-chaired a panel of 14 experts who came up with a new definition. What did that work look like, and what’s your new definition?

One criticism of the movement against UPFs has been that some foods that are technically ultra-processed are actually quite nutritious. I’m thinking of products like yogurts, whole-grain breads and tofu. How does your definition account for that?

JK: You want your definition to be sensitive enough to pick up most UPFs, but also specific — that is, not capture foods that are not truly UPFs or even those that can be part of a healthy diet. The way we addressed that was the FDA, a couple years ago, developed criteria for what they call a . If a company wants to say its products are healthy and put that on the package, it has to meet .��

We decided that even if a product is ultra-processed, if it meets the FDA’s criteria for a ‘Healthy’ food, then it should be exempted from policy. That cuts out edge cases — healthier foods that are also UPFs.

Your final report also dives into policy and makes recommendations for lawmakers to consider. What is the current status of ultra-processed food policy across the U.S.?��

JK: Over the last couple of years there has been a flurry of activity, particularly at the state legislative level. Some states say they’re getting rid of ultra-processed foods in school meals, for example, but they have a somewhat random list of ingredients or additives they don’t like.��

A few states have tried to take a more evidence-based approach. The best example of that is California, where they passed . They used the same kind of ingredient-list approach that we recommend, simplified a little bit. However, for a food to be a UPF under California’s definition, it must also be high in fat, sugar or salt, which raises a problem — about 35% of all ultra-processed foods do not have those levels. Proposed legislation in states like Pennsylvania have avoided this problem by sticking with the Nova-based definition, as recommended by our expert panel, rather than adding on fat, sugar and salt criteria.����

There’s also been a huge amount of movement in a couple of countries, especially in Latin America. Furthest along is , where the government just issued a regulation to require ultra-processed food labels on packages. They’re basically using the Nova definition as well.

There are policies moving now, which is why we felt it was important to say, use a good definition of ultra-processed for what you’re doing, and then think about certain policy ideas as the best bets for doing something about the problem. For us, those ideas include requiring labels on packages identifying a product as ultra-processed and removing UPFs from food served in schools, childcare and in government facilities.��

Many of the factors that lead people to choose ultra-processed foods are systemic. As an example, food deserts leave some people without easy access to affordable fresh foods. How did the panel consider those factors in making your policy recommendations?

JK: Increasing access to healthy foods gets into another set of policies that are well-described and, to varying extents, are being put into place. Our panel focused specifically on UPF policies. We did assess whether any of our policy recommendations would have unintended consequences of making food less available or affordable for people with low incomes and then we figured out strategies for mitigating those effects.��

A great example would be if you tax even a subset of ultra-processed foods, that’s going to make them less affordable, and that’s a challenge. We recommend that the tax revenues raised from these policies go toward vouchers or incentives for people with lower incomes that they can cash in for fruits and vegetables at a more affordable price.��

We also rejected some policy ideas. One was restricting the use of SNAP (the Supplemental Nutrition Assistance Program, commonly known as food stamps) benefits for purchasing ultra-processed foods. We felt that would have too much of a negative impact on food affordability for people using SNAP, so we did not recommend that.��

What comes next for this 91����?��

JK: Our next step is to share this definition with as many policymakers as we can, and then offer them technical support if they want to figure out how to use this in legislation or regulation. The second thing is if any legislators, policymakers or advocates want to pursue policies, we’re available to provide technical support and assistance.��

There’s also a bunch of additional 91���� that would be useful. We have some of those recommendations at the end of the report, but as an example, there’s controversy right now over different subgroups of UPFs and whether some are more harmful than others. The 91���� that’s been done so far has been somewhat confusing and flawed. There’s also 91���� on how, exactly, ultra-processed foods cause all these problems. There are a lot of great, interesting hypotheses, but I wouldn’t say any of them are definitive.��

As an expert in this field, how do you approach ultra-processed foods in your own life, and how would you recommend people think about reducing their own consumption?��

JK: Right now, about 60% of the calories that Americans consume are ultra-processed foods. Starting there, small and incremental steps are great. You can’t totally change your diet overnight, so the bottom-line message is to think about small things you can do.��

The first challenge is identifying UPFs, which is where we started this conversation. If there are ingredients in food that you don’t have in your kitchen, it’s likely going to be a UPF, and if it’s a long ingredient list that looks like a chemistry lab, it’s probably a UPF. Then you can consider what the food looks like. If it’s super bright, like Froot Loops or Doritos, that probably means it’s a UPF.��

But then once you’ve identified ultra-processed foods, what do you do? Let’s think about one thing you want to do. Say you drink a lot of sweetened beverages. You can think of what you can swap in that works for you, like sparkling water that doesn’t have a lot of additives, or coffee or tea.

As for me, I don’t eat many ultra-processed foods. When I started doing this work, when my kids were younger, I fed them all sorts of UPFs. I certainly wouldn’t do that now and wish I had known better. But if I want to have something that’s ultra-processed, that’s fine, it’s not going to kill you to have just a little bit. As long as your , then that’s great.��

The panel was co-chaired by Krieger and Lindsey Smith Taillie of the University of North Carolina at Chapel Hill and convened by Mary Story and Megan Elsener Lott of Duke University. A full list of panel members is included in the panel’s This work was funded by Healthy Eating Research and the Robert Wood Johnson Foundation.��

For more information or to contact Krieger, email Alden Woods at acwoods@uw.edu.��

The human mouth is full of wonders. It’s home to hundreds of species of bacteria, fungi, viruses and protozoa, which work in delicate harmony to maintain our oral health. Sometimes, though, this complex system — known as the oral microbiome — can fall out of balance. Anaerobic bacteria build up on the tongue and in the little pockets between our teeth and gums. There, they break down organic matter and spew out a foul odor.

To rebalance the oral microbiome and cure chronic halitosis, 91����ers at the 91���� are embarking on a first-of-its-kind experiment. These clinical trials transplant bacteria and other minuscule critters from healthy donors into patients with halitosis. If successful, the healthy microbiota will crowd out the bad and patients’ bad breath will improve.

“We know the oral microbiome can get out of whack. The question is, can you rebalance it? That is the hypothesis we’re proposing,” said , a UW professor of restorative dentistry and co-lead of the project.��

The experimental procedures build off recent breakthroughs in , commonly known as stool transplants, which have become a go-to treatment for gastrointestinal infections and bacterial imbalances.��

The 91���� team has so far completed four transplants, with preliminary evaluations underway. They’re seeking pairs of participants — a patient with chronic halitosis and a donor, ideally an intimate partner, family member or trusted friend — to undergo these relatively simple procedures.

To start, 91����ers complete a full periodontal exam of the donor to ensure their microbiome is healthy. Then they collect bacteria from the donor and suspend it in a small volume of saline. At the same time, recipients undergo a deep cleaning to remove the harmful bacteria and disrupt the — the thin, sticky layer of microorganisms that lines surfaces in the mouth. Recipients rinse with the donor solution, and 91����ers inject a concentrated version into the gumline. Ninety days after the transplant, participants self-report whether their breath has improved.��

“What we’re trying to do is severely disrupt the original bacteria, and then we bring in the new guys to take hold and establish a new biofilm,” said co-lead , a 91���� scientist and affiliate faculty member in the UW School of Dentistry. “If we bring enough of the new bacteria and they outcompete the ones that we disrupted, the healthy ones will take over. It’s a numbers game.”��

This 91���� was funded by the Dean and Margaret Spencer Clinical Research Fund. Co-investigators include professor of clinical practice and professor , both of the UW School of Dentistry. For more information, to reach the 91����ers or to inquire about participating, contact Pozhitkov at pozhit@uw.edu or Wee at awe@uw.edu.

Biodiversity loss is directly threatening human health and welfare, according to new 91���� by a multi-institution team including the 91����. The study, , reveals for the first time how the decline of insect pollinators undermines essential ecosystem services that support human nutrition and livelihoods.

It’s been long known that insect pollinators are vital for producing many of the fruits, vegetables and legumes that supply essential vitamins and minerals in our diets, yet clear evidence of how their decline affects people has been limited.

Working in 10 smallholder farming villages and their surrounding landscapes in Nepal, 91����ers traced the full chain of connections between wild pollinators, crop yields and the nutrients families rely on. By tracking diets, crop nutrients and the insects visiting those crops over a year, the 91���� team showed how pollinators directly support both nutrition and livelihoods.

“This study directly connects the crops that local pollinators visit with people’s diets, nutrition and income,” said , a 91���� scientist in the Department of Environmental and Occupational Health Sciences at the UW. “It was a real collaborative effort across many partners to collect and analyze a large body of data, making it possible to explore these links.”

The study found insect pollinators were responsible for 44% of people’s farming income and contributed more than 20% of their intake of vitamin A, folate and vitamin E. When pollinators decline, families risk poorer nutrition leading to higher vulnerability to illness and infections, and deeper cycles of poverty and poor health. One quarter of the global population currently suffer from this “hidden hunger.”

The 91���� shows there is real potential for positive change — nutrition and income can improve when communities support pollinators. Simple steps like planting wildflowers, using fewer pesticides or keeping native bees can help boost pollinator numbers, strengthening both nature and people’s wellbeing.

Even though smallholder farmers are highly vulnerable to biodiversity loss, these practical local actions could enhance their food security and economic resilience. The findings could also help improve the health and livelihoods of millions of smallholder farmers around the world.

“Our study shows that biodiversity is not a luxury — it is fundamental to our health, nutrition and livelihoods,” said lead author who completed the 91���� while at the University of Bristol and is now a postdoctoral 91���� associate at the University of York, both in the United Kingdom. “By revealing how species like pollinators support the food we eat, we highlight both the risks of biodiversity loss for human health and the powerful opportunities to improve human lives by working with nature.”

The 91���� shows that human health is deeply tied to the health of nature. By tracking how pollinators support food production and diets, the study reveals that biodiversity loss isn’t just an environmental problem, it threatens public health and economic stability — as highlighted in the recent U.K. government.

With around 2 billion people relying on smallholder farming and with many facing vitamin deficiencies, protecting the ecosystems that support nutritious food is essential and crucial for sustainable development.

The study’s findings offer a practical framework to help policymakers and farmers design more nature‑positive farming systems. Although the 91���� is focused on Nepal, the same connections shape food systems everywhere. Diets, even in industrialized countries, still depend on the pollinators and ecosystems that sustain global agriculture.

The 91����ers — spanning universities and non-governmental organizations across Nepal, the U.K., the U.S. and Finland — are now putting their findings into action across Nepal to tackle pollinator declines and repair the pollination systems that support food production. Working with farmers, local organizations, 91����ers and government partners, they are helping people understand the value of pollinators and how to support them in everyday farming.

By demonstrating why pollinators matter, and sharing simple, practical techniques to support them, the 91����ers are already seeing farmers adopt changes that boost crop yields, nutrition and income.

“A ‘win-win’ scenario exists where we can simultaneously improve conditions for both biodiversity and people,” said co-author , professor of ecology at the University of Bristol. “It takes ecological understanding, but it costs remarkably little and there are significant gains for both parties.”

This story was adapted from a

For more information or to contact the 91����ers, email Alden Woods at acwoods@uw.edu.

It took less than 22 years after the discovery of the hepatitis C virus (HCV) for a fast-acting, highly effective treatment to become available. at curing hepatitis C infection, yet the virus remains a critical public health problem. It’s the most common bloodborne illness in the United States, and disproportionately impacts low-income people and marginalized communities.��

A directive aimed to eliminate the disease from Washington state by 2030. The first-in-the-nation plan called for coordination between public health agencies, increased screening, removal of barriers to care and a new approach to purchasing antiviral medications at a discount.��

A new study led by the 91���� found that the plan not only expanded access to tests and treatment, but may save money in the long run. , the study found that total costs for hepatitis C-related care rose when the program was first implemented but have declined since, even as increased screening identifies more cases.��

“Comprehensive health insurance claims data can help us see how patterns in testing, treatment and healthcare costs are changing over time across a large population,” said lead author , who worked on the study while completing a doctoral degree at the UW. “That kind of information can help states better understand how initiatives to expand access to care may affect both patients and the healthcare system.”

Working in collaboration with the Washington State Health Care Authority and the Washington State Department of Health, 91����ers analyzed medical claims data between January 2017 and September 2022. Records included medical and pharmacy claims collected from both private insurance companies and public payers. The data represented about 70% of Washington residents, approximately 6-8 million individuals per year.��

Researchers found that the number of HCV tests administered increased sharply after Washington implemented the elimination initiative. There was a median of 28,375 tests per month at the end of 2017, peaking at 99,161 by July 2020. The number of tests then leveled off at a median of 55,844 per month throughout 2021. Researchers noted that these shifts also aligned with new national guidelines that recommended all adults receive at least one HCV test. Consistent with increased screening, the study observed an initial increase in the total number of HCV cases, followed by a significant decline over time as more people received treatment.

The study also found that total HCV-related costs spiked immediately after implementation of the initiative, but then dropped closer to initial levels. Total monthly costs rose from $45.6 million in 2017 to $70.8 million in 2019, an increase the 91����ers attributed to expanded screening, which identified more cases to treat. Monthly costs then declined to $56.8 million in 2021.��

While total HCV care costs rose, costs per patient declined by more than 45%. Researchers said the decline may be due to increased screening catching more infections in otherwise healthy people, which would likely improve treatment outcomes and reduce associated risks over time.��

“As an observational study, we cannot directly attribute the changes over time to the state initiative,” said co-author , a professor of global health and of child, family and population health nursing at the UW. “However, it does support the idea that investing in screening and treatment of healthy people without symptoms is more cost-effective than waiting until they become sick.”��

Other authors include , professor of health economics and director of the Comparative Health Outcomes, Policy and Economics (CHOICE) Institute at the UW; , teaching professor of biobehavioral nursing and health informatics in the UW School of Nursing; , assistant professor of child, family and population health nursing and of allergy and infectious diseases at the UW School of Medicine; , 91���� coordinator in the Department of Child, Family and Population Health Nursing at the UW; Judy Zerzan-Thul, Leta Evaskus, Donna Sullivan, Stella Chang and JoEllen Colson of the Washington State Health Care Authority; and Emalie Huriaux and Jon Stockton of the Washington State Department of Health.

This study was funded by the Laura and John Arnold Foundation.

In the three-and-a-half years since the U.S. Supreme Court overturned the constitutional right to an abortion in Dobbs v. Jackson Women’s Health Organization, the fragmented state of abortion access has put medical professionals in a precarious position. Many states have tightened abortion restrictions, with some enacting criminal penalties up to in for physicians who perform abortions. Medical schools have

New 91���� led in part by the 91���� found that the new restrictions are not only affecting the current medical workforce — they may be shaping the next generation of physicians. The study, , found that applications to medical residency programs in states that enacted new abortion restrictions dropped sharply following the Dobbs ruling.

The decrease occurred among both male and female applicants. Applications to specialties related to reproductive health — obstetrics and gynecology, family medicine, internal medicine and emergency medicine — saw the largest decreases.

The new study builds on that had shown decreased application rates to residency programs in states with abortion restrictions by applying causal methodologies to understand the impact of the Supreme Court decision and isolating results from male and female applicants.

“This 91���� provides important empirical evidence about how state-level policy changes following Dobbs may influence decisions made by medical trainees about where to pursue their graduate medical education,” said co-author , a UW professor of health economics and director of the Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute.

To learn more about the 91����, UW News sat down the paper’s three authors: Basu; lead author , assistant professor of medicine at the University of North Carolina at Chapel Hill; and co-author , assistant clinical professor of internal medicine at the University of Arizona. Both Ganguly and Morenz completed their internal medicine residencies at the UW School of Medicine.

The medical residency match process is quite different from traditional higher-ed applications. Can you explain how that works, and how it relates to your study’s findings?

Dr. Anna Morenz: Applicants may apply to as many programs as they want, with some applying to dozens of programs. At the end of interviews, they’ll rank those programs based on their preferred landing spots. The programs, in turn, will rank all the applicants that they received. A computer algorithm then matches everyone with the goal of filling all the residency slots, and it’s very good at that. We know that . So programs are still filling their residency slots even in states with restrictions.

What concerns us about these findings is that there’s an early signal of people avoiding applications to these states. That has potential implications for the quality of the applicants to restricted states, which could not be assessed in our data. There’s typically a high likelihood that people stay where they train for their residency, but if you landed in a restricted state that was low on your rank list, you may be more likely to complete your training and then leave to a non-restricted state. We aim to look at this very important question in projects to come.

Anisha and Anna, you’re both practicing primary care physicians. How big a part of a physician’s training is abortion and other pregnancy-related care?��

Dr. Anisha Ganguly: It’s not a big part of our training traditionally, though there has been a movement to integrate more abortion care into primary care residencies. That’s more the case in family medicine rather than internal medicine, because medication abortion has now become the most common means for abortion care. As internists, we commonly diagnose pregnancies and care for women with medical conditions as they consider family planning.

AM: I do think it’s important to note that a huge percentage of primary care physicians are trained in family medicine. And family medicine physicians are trained in delivery of babies, management of prenatal care, miscarriage management, contraception and abortion. Anisha and I trained in internal medicine, and there is increasing interest to include medication abortion training in internal medicine, as it is fully within our scope of practice.

The effects of the Dobbs decision have been well-documented, and previous work on this topic highlighted changes in OB/GYN residency applications. What’s new in your study specifically?��

Anirban Basu: We had a much longer pre-period than previous studies. We looked back to 2019 to see what had been happening to application rates in these two kinds of states — those that eventually restricted abortion access and those that didn’t — and we showed that these rates had been moving similarly until the ruling. That gives a little more weight to the evidence to say the change is due to the ruling.��

The second big thing is that previous studies did not distinguish whether men and women were changing their behavior similarly. I think that’s a very important finding in our study, that male applicants are changing their behavior at an even higher rate.��

AG: I agree that the gender stratification was an important contribution. The other stratified analysis that we explored was about how specialty type may be driving some of the effects that we saw. A lot of people can reason that OB/GYN applicants would be affected by this directly, and there’s a lot of literature to support that. But what we’re showing is that it’s not just the OB/GYN workforce that’s going to be impacted. It’s the primary care workforce and the emergency medicine workforce.��

We’re hoping that message spreads a little more broadly. This is not just about women’s health. It’s about the future of primary care and the person who’s going to save you from your heart attack in the future.

Let’s talk a little more about that gender stratification. You found that male applicants changed their application preferences at a greater rate than female applicants, which looks like a surprising result. What’s going on there?��

AG: When we generated our original hypotheses, we thought we were going to see increased effects among women applying to residency, but we actually ended up seeing that there were long-term disparities that existed pre-Dobbs between restricted and non-restricted states. This was likely because of the and other state-level laws that were affecting women’s behavior. What we’re seeing is that women had been reading the tea leaves about access to reproductive health care prior to the Dobbs decision, but the decision did unmask a wider problem that drove a lot of new behavior among men.

One of the messages that we are getting from this paper is this is an “all of us” problem. It’s not just about women physicians. It’s about men who are also making choices about their professional autonomy and also about access to reproductive health care for their families. Women have been and will be considering their personal access to care and autonomy before this decision, but perhaps these state restrictions after Dobbs may have newly increased awareness among men.��

Among all these shifts, you found one group whose application rates didn’t change significantly: people applying to highly competitive medical specialities. What do you think explains that stickiness?��

AG: Anna and I had brainstormed about this being a potential effect modifier, because people who are applying in highly competitive specialties like orthopedic surgery or dermatology apply very broadly and don’t get to exercise a lot of choice about where to go. Whereas for large specialities like internal medicine, family medicine or pediatrics, there are a lot of programs in a lot of places, so applicants have more options. In those cases, state-level policies like abortion restrictions can factor more into people’s decision-making.

At an institutional level, what changes could be made to address these trends?��

AG: Institutions can make choices to mitigate some of these effects by supporting candidates with access to reproductive care within the scope of the restrictions that exist. Other industries are building in travel benefits for women who may need to travel to access these services.��

It’s not this aspect of a decision alone that shapes a residency applicant’s choice to go to a specific place or program. But there are other things that institutions can do to make trainees, particularly women, feel supported and valued. If you’re existing in an environment where state policies make women feel a lack of autonomy, then there are workforce policies that can be in place to bolster that sense of autonomy. That could take the shape of parental leave policies, lactation policies, other things that institutions can do to make women feel like, even if this part of your voice has been taken away, we’ll help you with the rest.

AB: One policy that has a long history of literature supporting it is financial incentives. Physicians do respond to financial incentives, but in many cases those incentives need to be quite steep to get people to change their decisions.��

AM: The other option is training opportunities. A lot of programs in states that had laws or restrictions that preceded the Dobbs decision would set up partnerships with organizations in another state where they could send their trainees to learn about pregnancy termination and miscarriage management. That’s a burden on residency programs and residents both. You have to set up housing and travel agreements. But that’s another key thing that programs need to keep in mind in order to recruit applicants.��

For more information or to contact the 91����ers, contact Alden Woods at acwoods@uw.edu.

Over five decades, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has become known as the nation’s. Low-income families receiving WIC benefits — which provides nutritious food in designated categories, nutrition education and access to other social services — have .��

But many families who are income eligible to participate in WIC aren’t receiving those benefits. Research has found that households who don’t use the full amount of their nutrition benefits are more likely to drop from the program.��

New 91���� by the 91���� has found that households who redeem more of their benefits in the most popular food categories are more likely to remain in the program long-term. Better understanding these patterns could help WIC agencies identify families who might need a little extra encouragement to stay enrolled.

The study was .��

“Finding ways to identify kids and families that are at risk of dropping out of the program is of high importance,” said , a UW assistant professor of health systems and population health and first author of the study. “That’s basically what we’ve identified — a way to flag families who may be at risk of dropping off.”

WIC provides families with food benefits in , with fruits and vegetables and eggs as the most popular. In partnership with (PHFE WIC), a Southern California WIC agency with a large 91���� and evaluation division, 91����ers analyzed redemption data from 188,000 participating infants and children 0-3 years old, between the years 2019 and 2023.��

Among those children, higher redemption of fruits and vegetables, eggs, whole milk and infant formula was associated with lower risk of their household discontinuing WIC participation.��

The risk of discontinuation decreased in a somewhat linear fashion as redemption rates increased.

Chaparro hopes that local WIC agencies will build on these findings and seek new ways to engage families at risk of dropping off. All WIC providers must offer nutrition education, which could be an opportunity to target households with lower redemption rates in popular categories.��

The findings come just over a year after the U.S. Department of Agriculture, which oversees WIC, . Among other changes, the 2024 rule significantly increased benefits for fresh fruits and vegetables, which has proven popular.

“The expansion of fruit and vegetable benefits for WIC families has been among the most important policy changes of the last decade,” said , director of 91���� and evaluation at PHFE WIC and co-author of the study. “Families want more fruits and vegetables, and this 91���� demonstrates that their inclusion in the WIC food package is essential for longer-term engagement in the program.”

of the University of Tennessee and PHFE WIC is the corresponding author. This study was funded by .

When uncontrolled wildfires moved from the foothills above Los Angeles into the densely populated urban areas below in January 2025, evacuation ensued and a thick layer of toxic smoke spread across the region. Air quality plummeted. Local hospitals braced for a surge,.����

Research led by the 91���� and Kaiser Permanente Southern California sheds new light on how the Los Angeles fires affected people’s health, and how people navigated the health care system during an emergency. In the rapid study, published , 91����ers analyzed the health records of 3.7 million Kaiser Permanente members of all ages living in the region. They found that health care visits did rise above normal levels, especially virtual services.����

In the week after the fires ignited, Kaiser Permanente members made 42% more virtual visits for respiratory symptoms than expected. Those living near a burn zone or within Los Angeles County also made 44% and 40% more virtual cardiovascular visits, respectively, than expected.��

In-person outpatient visits for respiratory symptoms also increased substantially. Members who lived near a burn zone or within Los Angeles County made 27% and 31% more virtual cardiovascular visits, respectively, than expected.��

Extrapolating to all insured residents of the county, the 91����ers estimated an excess of 15,792 cardiovascular virtual visits, 18,489 respiratory virtual visits and 27,903 respiratory outpatient visits in the first week of the fires.��

The results suggest that people may rely more heavily on virtual health care during climate-related emergencies, and that providers should better prioritize virtual and telehealth services as they prepare for future crises.��

“We saw over 6,241 excess cardiorespiratory virtual visits in the week following the fire ignition. This represents a substantial increase in care,” said, a UW associate professor of environmental and occupational health sciences and of epidemiology who led the 91����. “While the fires clearly impacted health, virtual care likely enhanced the ability of providers to meet the health care needs of people experiencing an ongoing climate disaster.”��

In collaboration with Kaiser Permanente Southern California, an integrated health care system with millions of members across the region, 91����ers analyzed health records of people who were highly or moderately exposed to wildfires. They defined high exposure as living within about 12 miles (20 kilometers) of a burn zone, and moderate exposure as living within Los Angeles County but farther than 12 miles during the time of the fires.����

Researchers looked back three years to estimate how many health care visits to expect in the weeks following Jan. 7 — the first day of the fires — under typical conditions. They then estimated how many people sought care in the first week of the fires, when smoke levels were highest, evacuations took place, and Los Angeles County public schools were closed.

In addition to the spike in cardiovascular and respiratory visits, 91����ers found a sharp increase in the number of visits for injuries and neuropsychiatric symptoms. On Jan. 7, outpatient injury visits were 18% higher than expected among highly exposed members, and virtual injury visits were 26% and 18% higher than expected among highly and moderately exposed groups, respectively. Among those same groups, outpatient neuropsychiatric visits rose 31% and 28% above expectations, respectively.

While both groups made significantly more visits than expected, proximity to the fires mattered. When 91����ers zoomed in on respiratory-related virtual visits, they found that minimally exposed members made 31% more visits, moderately exposed members made 36% more, and those living in highly exposed areas made 42% more.����

“While healthcare systems often plan to increase the number of hospital beds available or clinic staffing during an emergency, this work highlights the importance of considering virtual care capacity,” said, a UW doctoral student of epidemiology and co-author on the study. “This may be particularly true for climate disasters like wildfires, during which people are advised to stay indoors or when people must evacuate — motivating them to seek care online if at all possible. As climate disasters increase in frequency and intensity, it is essential that health care systems know how to prepare for a sudden and dramatic surge in health care utilization.”��

Other authors on this study are , and of Kaiser Permanente Southern California; of the University of California, Berkeley; of Kaiser Permanente Hawaii; and of Columbia University; and of the Scripps Institution of Oceanography at UC San Diego; and of the Scripps Institution and the University of Rennes in France.

This 91���� was funded by the National Institute on Aging and the National Institute for Environmental Health Sciences.��

For more information or to reach the 91���� team, contact Alden Woods at acwoods@uw.edu.

Let’s get one thing out of the way: All hummingbirds fight. Most species fight for food, using their tiny bodies and sharp bills to force competitors away from flowers. But the green hermit hummingbird, which lives primarily in mountain forests of Central and South America, fights to win a mate.

“They gather together at a place in the forest that looks just like a singles bar,” said , an associate professor of biology at the 91����. “They all have perches, and if someone else takes their perch — their place in the singles bar — they go bananas, and they fight.”

Hummingbirds’ weapon of choice? Their own bills. Like medieval knights in a joust, the birds raise a long, needle-thin bill into the air before driving it into their opponent. The stakes are high: Hummingbirds also use their bills to eat, poking them deep into flowers to reach nutrient-rich nectar. Losing a fight means a hummingbird might not find a mate. Breaking a bill could mean they starve.��

New 91���� led by 91����ers at the , where Rico-Guevara is the curator of birds, found that these fights have shaped the species’ evolution, yielding significant differences in bill shape for male and female green hermits. Compared to their female counterparts, male green hermits’ bills are straighter, sharper and structurally stronger. The straighter bills work better as weapons, while female birds’ more curved bills provide improved access to nectar in some flowers. The findings suggest that green hermits’ bill sexual dimorphism — when two sexes of a species exhibit different characteristics — was likely driven by their tendency to fight, not solely by ecological factors.

“Adult male green hermits have reinforced bills because they fight so much,” Rico-Guevara said. “It’s the same tool, but in very different contexts. This is an example of how much we can still learn from sexual dimorphism in nature.”��

In the study, , 91����ers selected green hermit specimens from the Ornithology Collection at the Burke Museum and used to develop 3D models of male and female bills. Through curvature and angle analyses of those models, 91����ers found that male bills are 3% straighter and 69% sharper, respectively, with a dagger-like tip not found on female bills.

But the differences, 91����ers found, extend beyond bill shape. CT scans revealed that the male bill’s internal structure provided additional strength by transmitting forces more efficiently.��

Finally, 91����ers ran the models through a series of simulated stabbings to stress-test the bills in both head-on and angled attacks. They observed that the male’s straighter bill expends��52.4% less energy due to deformation, and is more resistant to breaking. The male bill experienced on average 39% less stress than the female bill.��

They also found that male bills’ straighter shape can accommodate a wider variety of attack angles, requiring less precision while fighting.��

“It’s a really cool example of sexually dimorphic weapons in birds,” said co-author , a graduate student at Michigan State University who completed this work while studying at the UW. “When you think of sexually dimorphic weapons, you usually think of deer and moose, animals with big antlers. There aren’t many examples of things like that in the bird world. It’s fun to explore a more cryptic or hidden weapon.”

Co-authors include of the Centro de Investigación Colibrı́ Gorriazul in Colombia and Ornithology Collections Manager at the UW Burke Museum. This 91���� was funded by a Walt Halperin Endowed Professorship at the UW Department of Biology and by the Washington Research Foundation.��

For more information or to contact the 91����ers, email Alden Woods at acwoods@uw.edu.��