Shifting paradigms, saving lives

On his office desk at the USC Leonard D. Schaeffer Center for Health Policy & Economics, Professor Neeraj Sood displays a photograph of himself photoshopped into a Batman suit. Colorful graphics on either side of his face exclaim “Bam!” and “Pow!” — the signature sounds of Batman’s fighting technique in comic books.

The photograph, given to him by a former student, hints at the economist’s healthy sense of humor. “I thought it was fun,” says Sood, who now jokes with students that he flies out the window when he leaves campus.

Like the Caped Crusader, Sood — a professor at the USC Price School of Public Policy with joint appointments at the Keck School of Medicine of USC and the USC Marshall School of Business — is a polymath conversant in numerous disciplines. He’s an exceptional problem-solver who uses his skills to tackle seemingly intractable issues, improve large-scale systems and save people’s lives. Batman applied these qualities to fighting crime; Sood’s goal is to improve global health and health care delivery.

“The way I judge potential research projects is, they have to be innovative, intellectually exciting to me and on a big-picture problem,” Sood says.

His latest study, recently published in Science, exemplifies the kind of impactful health-economics research he is best known for. The paper investigates why doctors in India, where diarrhea is the second leading cause of death, do not commonly prescribe oral rehydration salts (ORS), a lifesaving and inexpensive remedy for diarrhea-related dehydration.

The study, which enrolled about 2,000 medical providers in 250 towns in Sood’s native India, tested three theories on why ORS is underprescribed. These included supply chain issues, financial incentives for providers to sell more lucrative treatments, and patient preferences.

Sood and his research team found that providers shy away from prescribing ORS because of a misconception: The majority believe that patients do not want to receive ORS because the salts, which are dissolved in water, taste bad or are not perceived as “real” medicine like antibiotics.

“This was a surprising finding,” Sood says. “Normally, as economists, we think having stuff in stock or the financial incentives probably play a much bigger role.”

Sood approaches his research questions with an eagerness to find the true answers — even ones that go against what he and others may initially hypothesize. “Sometimes, you do a study and you find out that the conventional wisdom is right, and that’s fine,” Sood says. “But I feel more excited when I’ve come up with a new way to think about the problem and I’m challenging what the conventional wisdom is.”

“Neeraj is an exemplar of an academic researcher,” notes Dana Goldman, dean of USC Price. “He is unflinching in this pursuit of the truth, following the facts to reach conclusions that frequently defy expectations.”

Changing the conversation

Sood confronts popular yet erroneous beliefs that pose a barrier to public health. He made waves early in the COVID-19 pandemic when he questioned prevailing assumptions about the virus’ lethality. While COVID-19 tests were initially reserved for people with symptoms, Sood made the case for testing asymptomatic people to obtain an accurate assessment of how infective and deadly the virus was. “If the true rates for the coronavirus are similar to those of the flu, then it isn’t necessary to shut down the global economy and lose trillions of dollars,” Sood argued in a Wall Street Journal op-ed in March 2020.

In partnership with the Los Angeles County Department of Public Health, he pursued one of the country’s first studies to test the blood of volunteers for antibodies to the virus. The findings — which confirmed that many of the infected never showed symptoms and the death rate was lower than initially thought — became a national flashpoint. Critics of stay-at-home orders used the study as ammunition to fight lockdowns, thousands of researchers scrutinized his work and Sood appeared on major news channels to explain and defend his findings.

Sood was undaunted by the critiques he encountered. In fact, he welcomed them. “As a scientist, you have to be somewhat thick-skinned,” he says. “But at the same time, you cannot ignore everything, because then you’re not a good scientist. You need to recognize constructive criticism.”

Another of his studies that challenged scientific consensus examined the impact of health insurance on the longevity of impoverished villagers in India. “Other people had shown that all health insurance does is increase health care costs, but it doesn’t really have a dramatic impact on improving health,” Sood says. “We showed that in India, this wasn’t true — that if you provide insurance for the big stuff, like surgeries and cancer care, it does improve health.”

For Sood, the thrill of such discoveries lies not in merely upending flawed beliefs but in meaningfully shaping decision making. After he presented the results of the study to Indian officials, they introduced a government health insurance program for 65 million households.

Erin E. Trish, associate professor of pharmaceutical and health economics at the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences and co-director of the Schaeffer Center for Health Policy & Economics, which Sood co-founded, believes that Sood’s ORS study holds similar promise for effecting far-reaching change.

“Neeraj is one of USC’s most original — and productive — researchers,” Trish says. “His study about oral rehydration salts was elegant in its simplicity and profound in its findings. It embodies what is core to our mission at the Schaeffer Center — research with real-world impact.”

Lifting all boats

Sood is already planning follow-up studies to find the most effective strategies for encouraging doctors to increase ORS prescribing and for coaxing patients to explicitly ask for the treatment.

“I want to be able to say 10 years from now that diarrhea is not the second leading cause of death,” Sood says. “People have been trying to solve this problem for decades — and haven’t been successful. So, we’re hoping that we can really move the needle.”

High-impact research — which Sood defines as being groundbreaking, addressing a big societal problem and influencing real-world decision-makers — is Sood’s hallmark. He’s helped many of his USC colleagues point their research enterprises in this direction, too.

When he was appointed vice dean for research and faculty affairs at USC Price in 2015, he told the dean, “My job is not to raise money for the school or to get more research dollars. My job is to help faculty do high-impact research.”

Ironically, this focus had the effect of boosting funding. “We doubled our research funding in five years,” says Sood, whose tenure as vice dean ended in 2022. “If you’re focusing on big-picture questions and trying to be innovative and trying to solve problems, you will find the funding.”

He’s also helped colleagues across USC do consequential work related to COVID-19 and its impact on work, school achievement and more. As director of the COVID-19 Initiative at the USC Schaeffer Center, Sood manages a grant that funds COVID-19 research. He doles out not only grant money but also research advice for ambitious projects.

Sood encourages his students to think big in their research as well. For the ORS study, Sood collaborated with his former student Zachary Wagner — now an economist at RAND Corp. and professor of policy analysis at Pardee RAND Graduate School — and his current postdoc mentee Rushil Zutshi, whom Wagner previously mentored.

“I have my academic ‘children’ and ‘grandchildren’ as part of the study team,” Sood says. “That’s very exciting for me.”

Following his curiosity

Sood’s current research interests are all over the map. He wants to follow up his ORS studies in India by investigating how to curb the overprescription of antibiotics for diarrhea. “A lot of children are given antibiotics when they don’t need them,” Sood says. “That can lead to drug-resistant bacteria, which can be a problem for the whole world, not just for India.”

He’s also training his eyes on the American health care system. Sood is intrigued by the rise of Medicare Advantage plans, which are private health insurance plans offered to the elderly. “Twenty years ago, only 5 million people on Medicare were on private plans,” he notes. “And now more than 30 million are on private plans. We want to understand what it does to health care costs and health outcomes.”

His concern about spiraling prescription drug costs has led him to scrutinize the impact of pharmacy benefit managers (PBMs) — “middlemen” between drugmakers and consumers — on drug prices. “Most people blame manufacturers for high drug spending,” Sood says. “But if I or my health plan is paying $100 for a drug, only $60 reaches the drug manufacturer — $40 is taken by the middlemen.” His findings have raised interest among members of Congress in regulating PBMs.

As part of the U.S. National Hepatitis C Elimination Initiative, Sood is working with the White House on a multipronged effort to eradicate the virus. In 2016, he came up with a solution for getting a lifesaving yet cost-prohibitive hepatitis C drug into the hands of Medicaid patients. Louisiana and other states adopted his plan to pay drugmakers a lump sum up front, in exchange for allowing the state to provide the pills for free for a limited time. Sood hopes the federal government will implement this approach nationally.

He acknowledges that projects such as these can take years to reach their full impact. Luckily, Sood has a continual source of what he calls “instantaneous gratification”: teaching.

“Research takes decades,” he says. “You teach a class and students come to you and say, ‘I love the class,’ and, ‘You taught me a new way to think about stuff.’ That’s very gratifying.”