More young adults are living with their parents than previous generations did

Source: The Conversation – USA (2) – By Rohan Shah, Assistant Professor of Economics, University of Mississippi; Institute for Humane Studies

Welcome back: The number of young adults living with their parents has risen by 1.5 million over the past decade. Maskot/DigitalVision via GettyImages

A potentially worrisome trend is emerging among young adults. Instead of landing a job and moving to the big city after graduation, many are moving back into their childhood homes instead. About 1.5 million more adults under 35 live with their parents today than a decade ago. That’s a 6.3% jump, more than double the rate of growth for the young adult population overall.

The issue is affordability. Over the past decade, urban rents have climbed about 4% per year, while wages for full-time workers have increased by only 0.6% annually. That means it’s harder than ever to live in a big city on the typical salary – especially if you’re a new graduate without much work experience.

The situation is even more challenging for aspiring homeowners: The median house price in the U.S. has risen about 90% in just 10 years, or more than 6% each year. And as prices rise – the median home sells for more than $400,000 now – so too do the ages of homebuyers. The median first-time U.S. homebuyer is 38 years old, up from 31 about a decade ago.

Why is the rent so high?

Put simply, there isn’t enough housing. As an economist, I know that when demand rises faster than supply, prices have to increase. And supply is severely limited in the places where people most want to live: big cities such as New York and San Francisco.

In most of these cities, planning and zoning laws prevent developers from building enough to meet demand. For example, rezoning a plot of land from commercial to residential often requires mountains of paperwork. And in many cities, objections from neighbors can stall a proposed development. These are just two of many obstacles local governments throw in homebuilders’ way.

One city that has tried something different is Austin, Texas. After deliberately relaxing its zoning laws a few years ago, Austin has seen a boom in home construction. Rents fell by 10% in one year and by as much as 22% in two years after that change. By making it easier to build, Austin has made it cheaper to live there.

I don’t think it’s a coincidence that Austin has a far lower share of its young adults living with their parents than many other cities do. Just 6% of working adults in the Austin metro area live with their parents, one analysis found, versus nearly 14% in Greater San Antonio and 20% in Greater Los Angeles.

The pros and cons of living with the ’rents

One obvious advantage of living with parents is that they tend to charge below-market rents, or nothing at all. That makes it easier to save for a deposit on a house, helping young adults get on the property ladder sooner than they would otherwise. Indeed, homeownership rates among those 25 to 34 have risen slightly since 2016.

There are also potential disadvantages, however, particularly when it comes to socializing. Living at home with parents can make it much more challenging to meet new people. This, in turn, could partly help explain why Americans are getting married and having children later in life. These delays might not seem important, but they can leave people feeling like they’re behind in life, which can affect their health and well-being.

I also wonder whether living with parents is indirectly making young adults unhappier at work. That’s because older adults often live far from the urban centers where young people are most likely to find jobs directly related to their degrees. Job satisfaction rates are substantially lower among 18- to 29-year-olds than among the rest of the working population.

A problem for the entire US

The housing shortage isn’t just an issue for young adults. A recent analysis I found insightful was headlined “The housing theory of everything.” It argued that the issue helps explain at least part of the current malaise in the U.S. economy.

For example, when people can’t live and work where they want, they’re unable to use their talents fully. That contributes to the relatively slow productivity growth the U.S. has experienced in recent years.

Similarly, if people can’t live in areas where they might meet and work with like-minded individuals, they have fewer opportunities to share ideas, which can hinder innovation.

And if the housing shortage is indeed encouraging young adults to delay having children, it could make it harder for the U.S. to fund Social Security and other government programs in the future.

Making it easier to build new homes in places people want to live and work could go a long way to easing these problems. It’s possible high rents translate into high barriers to adulthood, too.

The Conversation

I am acquaintances with the authors of the article “The Housing Theory of Everything.”

ref. More young adults are living with their parents than previous generations did – https://theconversation.com/more-young-adults-are-living-with-their-parents-than-previous-generations-did-264570

Even small drops in vaccination rates for US children can lead to disease outbreaks

Source: The Conversation – USA (3) – By David Higgins, Assistant Professor of Pediatrics, University of Colorado Anschutz Medical Campus

Xerius Jackson, age 7, gets an MMR vaccine during the Texas measles outbreak in March 2025. Jan Sonnenmair via Getty Images

More than three-quarters of U.S. counties and jurisdictions are experiencing declines in childhood vaccination rates, a trend that began in 2019, according to a September 2025 NBC News–Stanford University investigation. The report also found a “large swath” of the U.S. no longer has the “basic, ground-level immunity” needed to stop the spread of measles.

Dr. David Higgins, an assistant professor of pediatrics at the University of Colorado CU Anschutz Medical Center and a pediatrician who researches vaccines, discusses the dangers of not vaccinating your children.

Dr. David Higgins discusses back-to-school vaccinations.

The Conversation has collaborated with SciLine to bring you highlights from the discussion, edited for brevity and clarity.

What vaccines are typically required for schoolchildren, and why?

David Higgins: The vaccine requirements for kids to attend school are set by states, not the federal government. Most states require kindergartners get vaccines for pertussis – that’s whooping cough – and tetanus, measles, mumps, rubella and chickenpox.

For older kids, a booster of the tetanus and pertussis vaccine is typically required, as well as a vaccine for meningococcal disease.

Vaccines reduce the risk of outbreaks in places where transmission of these diseases is easy. Not only do vaccinations help keep both students and teachers safe, it also encourages overall higher community coverage for these vaccines.

How do scientists track the safety of vaccines over time?

Higgins: Before vaccines are approved, they undergo rigorous trials. During this process, scientists look at the safety and effectiveness of the vaccine, testing it first in small groups to assess safety, then in larger groups to confirm protection and detect uncommon side effects. That process continues after the vaccine is approved. Those systems continually monitor the safety of vaccines, both here in the U.S. as well as around the world.

What are the vaccination coverage trends for kindergartners?

Higgins: What we have seen is a small downward trend since 2019, the year prior to the COVID-19 pandemic. It slipped from 95% of new kindergartners being up to date on many of their routine vaccines to about 92%.

That’s a small percentage decrease, so a great majority of parents are still vaccinating their kids. But at the same time, anything below our target of 95% for diseases like measles becomes a problem, because that’s below the level that’s needed for what we call herd immunity, or community immunity. When that happens, it’s not a matter of if, but when, we see an outbreak of these infectious diseases.

And while nationwide rates are important to look at, outbreaks happen at local community levels. For example, earlier this year, an outbreak of measles in West Texas spread rapidly through communities where vaccination rates had slipped well below the state average.

So, the vaccination rate at your own school or community is much more meaningful than what the national vaccination rate is.

How do non-medical vaccine exemptions work?

Higgins: First, actual medical exemptions are rare, and these occur when the vaccine is unsafe for the child to receive, like when he or she has a known severe allergic reaction to vaccine ingredients.

Non-medical exemptions for vaccines are often for religious, personal or philosophical reasons. They have been increasing for the past several years, rising from the range of 1 to 2% up to 3.6% in the 2024–25 school year. That’s a small increase, but again, it’s still concerning.

{What are some reasons why parents are} Why are some parents vaccine hesitant?

Higgins: There are multiple reasons. These include misinformation which algorithm-driven echo chambers on social media can spread at an alarming rate right now. Also, Americans report less trust in institutions and experts, and studies have found growing partisanship around vaccines.

Additionally, vaccines are victims of their own success. They have worked so well that many diseases like polio aren’t routinely seen anymore. That might lead a parent to think the risk for their child is so low that the vaccine is not necessary. But the fact is, vaccines are simply holding these diseases at bay. And as vaccination rates drop, these diseases will come back and more kids will be at risk.

What advice do you have for parents?

Higgins: The most important thing you can do as a parent is to keep your kids up to date on required vaccines. That includes the annual flu shot. Follow your state’s requirements and current recommendations from trusted sources like the American Academy of Pediatrics and your own personal pediatrician to know which vaccines your child should have.

You also want to reinforce other common sense approaches to keeping your children healthy. Make sure they know how to wash their hands properly and that they stay home when they’re sick. Teach them to sneeze and cough into their elbow instead of into their hands – even though doing so isn’t a perfect solution.

As a pediatrician, I love when my families come and talk to me about their concerns. I help them walk through their worries so they can feel more confident that they’re making a truly informed decision that’s in the best interest of their child’s health.

SciLine is a free service based at the American Association for the Advancement of Science, a nonprofit that helps journalists include scientific evidence and experts in their news stories.

The Conversation

David Higgins is a member of the American Academy of Pediatrics. He is also on the board of directors (volunteer) for Immunize Colorado.

ref. Even small drops in vaccination rates for US children can lead to disease outbreaks – https://theconversation.com/even-small-drops-in-vaccination-rates-for-us-children-can-lead-to-disease-outbreaks-265555

From the pulpit to the picket line: For many miners, religion and labor rights have long been connected in coal country

Source: The Conversation – USA (3) – By Richard J. Callahan, Jr., Associate Professor of Religious Studies, Gonzaga University

Harlan County is the heart of eastern Kentucky’s coal region. Scott Olson/Getty Images

In October 2025, Cecil Roberts will officially retire from his role as president of the United Mine Workers of America. A sixth-generation coal miner, he has led the union for 30 years. Only one man held the role longer: John L. Lewis, whom many consider one of the most important labor leaders of the 20th century.

Roberts has seen the union through an especially difficult period for the coal industry and grew up immersed in it. He was raised in Cabin Creek, West Virginia, where his great-grandmother – an activist in her own right – let miners camp on her property during a legendary strike in 1912. Bill Blizzard, his great-uncle, led miners during the Battle of Blair Mountain, the largest labor uprising in U.S. history. Both of his grandfathers died in mine accidents.

And there’s another way Roberts is steeped in Appalachian history: Before an audience of workers, observers have often noted, he speaks like a preacher. Roberts likens miners’ struggles to biblical stories, references the power of God and the teachings of Jesus, and speaks in the dynamic cadences found in an Appalachian church.

A man with white hair raises his arms as he speaks animatedly at a podium, while he and other men nearby wear camo-colored t-shirts.
United Mine Workers of America President Cecil Roberts speaks to about 4,000 retired members in Lexington, Ky., on June 14, 2016.
AP Photo/Dylan Lovan

“Be like Jesus,” he told a rally in Charleston, West Virginia, in 2015, opposing a “right to work” bill that allowed workers in union-run shops to opt out of paying dues. “Jesus saw the money changers in the temple, and Jesus drove the money changers from the temple. So let me tell the National Right to Work Committee, the Chamber of Commerce, the Koch Brothers, and all those who gave money: you got your money’s worth, but we’re not for sale in West Virginia.”

“How many of you have been to a Baptist church? We’re going to take up a collection. It is altar call time,” he continued. “Now, I’m going to ask you something: Are you fed up? Let me hear you say, ‘Fed up.’… Are you so fed up that you are now fired up? Let me hear you say, ‘Fired up!’”

Capping off the rousing call-and-response, he shouted, “God bless all of you, you’re the salt of the earth!”

Roberts’ style is a glimpse into a bigger story. For over a century, coal has transformed central Appalachia: from the shape of the landscape to place names, and from folk music and crafts to economic conditions.

All the while, religion has been transforming in the mountains, too. Labor and religion are deeply entangled here – a subject I explored in my book “Work and Faith in the Kentucky Coal Fields: Subject to Dust.”

‘Railroad religion’

In the 1880s, two groups rushed into the central Appalachian Mountains: industrialists seeking coal, and missionaries seeking moral reform. Both changed the region forever, and their stories were intertwined.

At the time, central Appalachia was widely depicted in the popular press as a backward, ignorant region whose mountainous terrain kept its people isolated, outside the flow of progress – a stereotype still common today. Equating economic progress with moral progress, many Americans assumed that developing industry would lift people out of what they perceived as fatalism and superstition.

The coal industry used this idea to promote its rapid exploitation of mountain resources. Companies built railroads to connect the region to the national market, developed industrial coal mines and reshaped the central Appalachian economy. Missionaries opened churches, schools and camps.

A black and white photo of a settlement on a small hill along a river.
Henry Ford founded Twin Branch, W.Va. – shown here in the 1920s – as a town for coal miners.
Bettmann via Getty Images

Company-owned coal towns encompassed miners’ lives. People who had long farmed for themselves and lived, as the Bible told them to, “by the sweat of their brow,” became dependent upon coal companies as mine development shrank the size of family farms. Not only did employers own the miners’ houses, but they also paid workers in “scrip,” which was redeemable only at the company store.

Many company towns included theaters, offered films and music, and even built churches and paid pastors’ salaries. These were typically mainline Protestant churches, such as Methodist or Presbyterian.

To some Appalachian natives, these denominations were known as “railroad religion” because of the way they entered the mountains. And, for many miners, these were the churches of management. When there was labor unrest, the coal town churches tended to side with the companies, advising miners against strikes or agitation.

Faith and action

The churches of most miners born in central Appalachia, meanwhile, were in the mountain communities – independent Baptist or Holiness congregations whose pastors were usually miners themselves.

Pastors preached about the dangers and sacrifices miners faced deep underground, in an age of few regulations. God was on the side of the oppressed and downtrodden, they stressed – and those who gained at others’ expense would ultimately face divine judgment.

Their passionate preaching was meant to inspire action, whether it was committing one’s life to Jesus or to the union. Labor rights were deeply understood as religious issues, rooted in Christian concerns for justice and care.

John Sayles’ 1987 film “Matewan” powerfully depicted the divided role that religion played in West Virginia’s coalfields. One preacher, played by Sayles, equates the union with “the Prince of Darkness.” Another, a young miner, advocates in biblical terms for the union’s righteousness and helps to lead a strike. The result was the Matewan Massacre of 1920: a bloody battle between miners and armed guards hired by the mine owners.

Miner preachers and independent churches were central to the organization of miners in eastern Kentucky in the 1930s, too, during another period of violence between mine operators and miners over conditions, wages and unionization. It was during this time that miner’s wife and singer Sarah Ogan Gunning penned “Dreadful Memories,” turning the traditional hymn “Precious Memories” into a visceral depiction of miners’ struggle and a call for unionization:

“Dreadful memories, how they linger,
How they ever flood my soul.
How the workers and their children
Died from hunger and from cold.”

A black and white photo of several men in slacks and shirts standing outside a small white building.
Miners in Harlan County, Ky., arrive at the Pentecostal Church of God building for a union meeting in 1946.
Department of the Interior/National Archives at College Park via Wikimedia Commons

Looking to the future

Today, it is still not surprising to find religious – particularly Christian – rhetoric in labor organizing. United Auto Workers President Shawn Fain is another example of a union leader whose speeches draw from the Bible.

But the dynamics of religion and class forged by industrial mining have shaped central Appalachia’s culture in lasting ways particular to the coalfields. The history of labor struggle, infused with religious idioms, is a source of identity and values evident in everything from union meetings in churches to prayers on picket lines.

Today, the United Mine Workers of America is focused less on coal itself, which miners know cannot last forever. The union represents members in other sectors, too, including public employees, manufacturing, health care and employees of the Navajo Nation. It has also focused its work on an equitable transition to renewable energy: one that accounts for the economic, cultural and environmental destruction that a single-industry economy has wreaked on central Appalachia.

A black wall with paler silhouettes of men standing along it, positioned above a low stone wall next to the road.
A memorial in Whitesville, W.Va., honors the 29 miners killed in a 2010 explosion in Massey Energy’s Upper Big Branch coal mine in nearby Montcoal.
Kristian Thacker for The Washington Post via Getty Images

Likewise, the United Mine Workers of America has fought to hold coal companies to their pension and health care obligations toward retired and sick miners whose work fueled the country and made companies rich.

And that struggle, Roberts would say, is a religious one as well.

The Conversation

Richard J. Callahan, Jr. does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. From the pulpit to the picket line: For many miners, religion and labor rights have long been connected in coal country – https://theconversation.com/from-the-pulpit-to-the-picket-line-for-many-miners-religion-and-labor-rights-have-long-been-connected-in-coal-country-262472

Health insurance subsidy standoff pits affordable care for millions against federal budget constraints

Source: The Conversation – USA (3) – By Wendy Netter Epstein, Professor of Law, DePaul University

Lawmakers limited Affordable Care Act subsidies to a few years, setting the stage for a fight over them in 2025. Ted Eytan/Wikimedia Commons, CC BY-SA

As the federal government entered a shutdown on Oct. 1, 2025, competing narratives quickly emerged about the cause.

Some Republican lawmakers objected to Democrats’ push to include an extension of the expanded Affordable Care Act premium subsidies in a short-term funding bill and cited concerns about long-term spending. Democratic leaders countered that the subsidies are not a new demand but rather the continuation of a program that has helped keep record numbers of Americans insured since the pandemic – and therefore that the issue could not be delayed.

The result is a standoff that blends fiscal and policy disagreements – a hallmark of contemporary budget politics.

As experts in health law, we see this issue as simple but consequential from a legal standpoint. Congress authorized the enhanced subsidies in 2021, originally to cushion the economic fallout from COVID-19 for families, and extended them through 2025 in the Inflation Reduction Act.

Without new legislation, the subsidies revert to pre-2021 levels on Jan. 1, 2026 – which would lead to a jump in the cost of health insurance and would make coverage unaffordable for millions of Americans.

Enhanced subsidies explained

Most Americans under age 65 get insurance through their employers, which the federal government subsidizes by making it tax-free. Medicare, the program for older Americans, and Medicaid, the program that mainly serves low-income Americans, are heavily supported by subsidies too.

But as of 2025, about 1 in 6 people under age 65 do not have access to this coverage, including many small-business owners and tradespeople, as well as part-time workers and those in the gig economy. For them, unsubsidized health insurance can be prohibitively expensive.

To address this affordability problem, the ACA provided for households earning between 100% and 400% of the federal poverty level to receive subsidies for purchasing policies on the ACA marketplace, effectively lowering premiums. The original law limited subsidies only to those making under 400% of the federal poverty level, which is, for a family of four in 2025, around US$128,000 per year. A family making $129,000 a year, however, would have to pay full price.

Family in the kitchen, mom cooks dinner as daughter watches.
If the current ACA subsidies expire, almost 5 million people are likely to lose their health insurance coverage.
FG Trade/E+ via Getty Images

The American Rescue Plan temporarily made two major changes in 2021:

  • It removed the 400%-of-poverty eligibility ceiling, extending help to many middle-income families.

  • It capped the maximum household contribution at 8.5% of income for everyone, ensuring affordability regardless of income.

If these reforms expire in 2026, the Internal Revenue Service must revert to the older, less generous formula.

What the subsidies accomplished

The enhanced subsidies drove ACA marketplace participation to historic highs – more than 24 million people selected plans for 2025, up from about 11 million in 2020. The Department of Health and Human Services found disproportionate enrollment gains among Black and Latino Americans, helping to reduce racial disparities in coverage.

For many low-income enrollees, mid-level plans – called silver plans in the ACA marketplace – effectively became free. Middle-income families who previously earned just above the cutoff gained meaningful relief, sometimes saving thousands of dollars a year.

What happens if subsidies expire?

Analysts broadly agree that returning to the pre-2021 rules would mean large cost increases and coverage losses. On average, the premiums that Americans will pay for ACA marketplace plans would more than double. The Kaiser Family Foundation estimates that average annual out-of-pocket premiums for an individual would jump from about $888 in 2025 to $1,900 in 2026.

With these increases, millions of Americans will lose their health insurance coverage. The Urban Institute, a think tank, projects that 7.3 million fewer people would receive subsidized marketplace coverage and 4.8 million more would become uninsured.

This is highly consequential, as research shows that insurance coverage saves lives by ensuring access to care. Knocking nearly 5 million people off insurance may cause as many as 500 additional deaths per year.

Losses would disproportionately impact low- and middle-income families. Free premium plans would disappear. Those making below 250% of the federal poverty level could see their net premiums rise more than fourfold, while those between 250% and 400% would see their premiums double. What’s more, rural Americans, already under pressure from the state of the economy, face higher risks.

The fiscal and policy trade-offs

On the flip side, making the enhanced credits permanent would add about US$350 billion to federal deficits between 2026 and 2035, according to the Congressional Budget Office’s estimates. Proponents argue that the cost is justified by reduced medical debt, fewer uninsured, greater household stability and ultimately saving lives. Short-term savings from cutting the subsidies would also lead to higher health care costs, longer-term. But critics worry it’s a broad and expensive way to support affordability, benefiting some higher-income households that could otherwise afford coverage, even though it would cost more than 8.5% of their income.

Another concern is how the subsidies affect price competition. Under the ACA, the government pays most of the difference between what a household is expected to contribute and the actual cost of a standard benchmark plan. That means if health insurance companies raise their premiums, those who receive subsidies don’t feel the effect of the premium increases, because the federal subsidy simply grows to cover it. That means companies have fewer reasons to compete on price.

Legal and administrative constraints

Because the subsidies are written into the tax code, only Congress can extend them or make them permanent. The question of whether to renew them was already debated strenuously when Congress passed the big tax and spending package that President Donald Trump signed into law on July 4, 2025. By omitting the subsidies, the bill effectively raised health care costs for millions of middle-income Americans. States that run their own marketplaces may add some aid, but few can match the scale of federal support.

Administrative timing matters too. The IRS, health insurers and the online marketplace all need to know how the subsidy amounts will be calculated – in other words, which income limits and premium caps Congress wants to use. These figures determine how much financial help people get when they sign up for coverage. Late or temporary fixes can create confusion for both consumers and administrators.

Options before Congress

Lawmakers have several options, each with different trade-offs.

A permanent extension would provide stability for consumers and insurers – but at the cost of higher long-term federal spending. A short-term renewal of one to four years could soften the immediate jump in premiums while giving Congress time to reassess the policy, but it would continue the cycle of temporary fixes.

Alternatively, a targeted approach might preserve the larger subsidies for lower-income households but gradually reduce assistance for higher earners so that they aren’t guaranteed a cap of 8.5% of their income for insurance. This would make the policy more fiscally restrained but less universal.

Some legislators have also proposed offsetting the cost of ACA subsidies by pairing an extension with savings elsewhere in the health system. Those savings could come from trimming what the government pays insurers to lower patients’ out-of-pocket costs or by reducing Medicare payments to doctors.

Each of these options reflects a different balance among affordability, fiscal responsibility and administrative simplicity. Together, they highlight how difficult it is to design a policy that meets all three goals at once.

A structural challenge

The problem isn’t just political – it’s built into how time-limited programs like the enhanced ACA subsidies are designed. The subsidies have always reflected partisan divides, but their temporary nature makes those divides even sharper. Lawmakers limited them to a few years to keep costs down, but that choice now means Congress has to reopen the same debate every year.

When deadlines for renewing programs collide with larger funding fights, important benefits can lapse, not because lawmakers chose to end them but because the fights over broader spending leave little room for resolution.

In the end, it’s up to Congress to decide not only whether these subsidies continue, but whether big social policies like this should be settled through last-minute budget showdowns. For now, getting the government running and keeping health insurance affordable are part of the same fight.

The Conversation

Wendy Netter Epstein is a member of the Illinois Health Benefits Exchange Advisory Committee.

Christopher Robertson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. Health insurance subsidy standoff pits affordable care for millions against federal budget constraints – https://theconversation.com/health-insurance-subsidy-standoff-pits-affordable-care-for-millions-against-federal-budget-constraints-266851

How does your immune system stay balanced? A Nobel Prize-winning answer

Source: The Conversation – USA – By Aimee Pugh Bernard, Associate Professor of Immunology and Microbiology, University of Colorado Anschutz Medical Campus

Regulatory T cells (red) interact with other immune cells (blue) and modulate immune responses. National Institute of Allergy and Infectious Diseases/NIH via Flickr

Every day, your immune system performs a delicate balancing act, defending you from thousands of pathogens that cause disease while sparing your body’s own healthy cells. This careful equilibrium is so seamless that most people don’t think about it until something goes wrong.

Autoimmune diseases such as Type 1 diabetes, lupus and rheumatoid arthritis are stark reminders of what happens when the immune system mistakes your own cells as threats it needs to attack. But how does your immune system distinguish between “self” and “nonself”?

The 2025 Nobel Prize in physiology or medicine honors three scientists – Shimon Sakaguchi, Mary Brunkow and Fred Ramsdell – whose groundbreaking discoveries revealed how your immune system maintains this delicate balance. Their work on two key components of immune tolerance – regulatory T cells and the FOXP3 gene – transformed how researchers like me understand the immune system, opening new doors for treating autoimmune diseases and cancer.

The 2025 Nobel Prize in physiology or medicine was awarded to Shimon Sakaguchi, Mary Brunkow and Fred Ramsdell.

How immune tolerance works

While the immune system is designed to recognize and eliminate foreign invaders such as viruses and bacteria, it must also avoid attacking the body’s own tissues. This concept is called self-tolerance.

For decades, scientists thought self-tolerance was primarily established in the parts of the body that make immune cells, such as the thymus for T cells and the bone marrow for B cells. There, newly created immune cells that attack “self” are eliminated during development through a process called central tolerance.

However, some of these self-reactive immune cells escape this process of elimination and are released into the rest of the body. Sakaguchi’s 1995 discovery of a new class of immune cells, called regulatory T cells, or Tregs, revealed another layer of protection: peripheral tolerance. These cells act as security guards of the immune system, patrolling the body and suppressing rogue immune responses that could lead to autoimmunity.

Diagram showing Tregs interacting with effector T cells and dendritic cells through various signaling molecules
Regulatory T cells suppress immune responses using a variety of molecular signals.
Giwlz/Wikimedia Commons, CC BY-SA

While Sakaguchi identified the cells, Brunkow and Ramsdell in 2001 uncovered the molecular key that controls them. They found that mutations in a gene called FOXP3 caused a fatal autoimmune disorder in mice. They later showed that similar mutations in humans lead to immune dysregulation and a rare and severe autoimmune disease called IPEX syndrome, short for immunodysregulation polyendocrinopathy enteropathy X-linked syndrome. This disease results from missing or malfunctioning regulatory T cells.

In 2003, Sakaguchi confirmed that FOXP3 is essential for the development of regulatory T cells. FOXP3 codes for a type of protein called a transcription factor, meaning it helps turn on the genes necessary for regulatory T cells to develop and function. Without this protein, these cells either don’t form or fail to suppress harmful immune responses.

Harnessing the immune system for medicine

Regulatory T cells can be heroes or villains, depending on the context. When regulatory T cells don’t work, it can lead to disease. A breakdown in immune tolerance can result in autoimmune diseases, where the immune system attacks healthy tissues. Conversely, in cancer, regulatory T cells can be too effective in suppressing immune responses that might otherwise destroy tumors.

Understanding how FOXP3 and regulatory T cells work launched a new era in immunotherapies that harness the immune system to treat autoimmune diseases and cancer. For autoimmune diseases such as rheumatoid arthritis and Type 1 diabetes, researchers are exploring ways to boost the function of Tregs. For cancer, the goal is to inhibit Tregs, allowing the immune system to target tumors more aggressively.

Diagram of immune activation scale in the shape of a rainbow wedge, with 'vulnerable to infection' at the smaller end, 'sweet spot' in the middle, and 'autoimmunity' at the larger end
Too much or too little immune activation can lead to illness.
Kevbonham/Wikimedia Commons, CC BY-SA

Beyond disease treatment, this research may also improve organ transplantation, where immune tolerance is crucial to prevent rejection. Scientists are exploring how to engineer or expand Tregs to help the body accept transplanted tissues over the long term.

Continuing to unlock the secrets of immune regulation can help lead to a future where the immune system can be precisely tuned like a thermostat – whether to turn it down in autoimmunity or rev it up against cancer.

The 2025 Nobel Prize reminds us that science, at its best, doesn’t just explain the world – it changes lives.

The Conversation

Aimee Pugh Bernard is affiliated with Immunize Colorado as a volunteer and unpaid board member.

ref. How does your immune system stay balanced? A Nobel Prize-winning answer – https://theconversation.com/how-does-your-immune-system-stay-balanced-a-nobel-prize-winning-answer-266842

Conflict at the drugstore: When pharmacists’ and patients’ values collide

Source: The Conversation – USA (3) – By Elizabeth Chiarello, Associate Professor of Sociology, Washington University in St. Louis

Pharmacists see themselves as vital gatekeepers – but at times, some critics treat them as physicians’ sidekicks. Witthaya Prasongsin/Moment via Getty Images

Imagine walking into your pharmacy, handing over your prescription and having it denied. Now imagine that the reason is not insufficient insurance coverage or the wrong dose, but a pharmacist who personally objects to your medication. What right does a pharmacist have to make moral decisions for their patients?

Lawmakers have wrestled with this question for decades. It reemerged in August 2025 when two pharmacists sued Walgreens and the Minnesota Board of Pharmacy, saying they had been punished after refusing to dispense gender-affirming care medications that go against their religious beliefs.

According to the pharmacists, Walgreens refused their requests for a formal religious accommodation, citing state law. One pharmacist had her hours reduced; the other was let go. If Minnesota law does not allow such an accommodation, their lawsuit argues, it violates religious freedom rights.

As a sociologist of law and medicine, I’ve spent the past 20 years studying how pharmacists grapple with tensions between their personal beliefs and employers’ demands. Framing the problem as a tension between religious freedom and patients’ rights is only one approach. Debates about pharmacists’ discretion over what they dispense also raise bigger questions about professional rights – and responsibilities.

Duty to dispense?

The most famous controversy, perhaps, dealt with contraception. In the early 2000s, some pharmacists refused to dispense Plan B, also known as “emergency contraception” or the “morning-after pill.” Their refusal stemmed from a belief that it caused an abortion.

That is inaccurate, according to medical authorities. When Plan B first became available in 1999, the label said the medication might work by expelling an egg that had already been fertilized. In 2022, the Food and Drug Administration relabeled Plan B to say that it acts before fertilization. From a medical perspective, both mechanisms are contraception, not abortion.

A pair of tweezers holds a white pill, photographed in front of a box that says 'PlanB One Step.'
Plan B’s early labeling contributed to confusion over how it works.
Justin Sullivan/Getty Images

States responded to pharmacists’ refusals by adopting “responsibility laws.” Some states adopted “conscience clauses” that permitted pharmacists not to fill the prescription. Others opted for “duty to dispense” laws that required pharmacists or pharmacies to provide the medication, or “refuse and refer” laws obligating objecting pharmacists to hand the prescription off to a colleague.

This fight largely broke down across political lines. Groups that oppose abortion rights argued that pharmacists should have the right to opt out, while groups in favor of abortion rights argued that pharmacists should be required to dispense.

As this fight escalated, the conflict became about more than contraception or abortion. It revealed Americans’ views about what kinds of professionals pharmacists should be, and whether they are professionals at all – that is, members of occupational groups that have specialized knowledge and skills, and exclusive rights to do particular kinds of work.

In 2015, for example, the advocacy group NARAL Pro-Choice American – now called Reproductive Freedom for All – released an ad with a man and a woman in bed, their feet hanging out of the sheets. Stuck between them was someone else wearing heavy black shoes. “Who invited the pharmacist?” the ad asked.

Pro-choice organizations insisted that pharmacists had no right to question a doctor’s prescription. “A pharmacist’s job is to dispense medication, not moral judgment,” said the president of Planned Parenthood Chicago.

Some pharmacists felt that such messages did not just criticize “moral gatekeeping” but also undermined their claims to professional authority. Pharmacists undergo six years of training to earn a doctorate and are health care’s medication specialists. The idea that pharmacists were simply technicians, hired to fill whatever a prescription said, made them seem like physicians’ underlings.

Keeping patients safe

A short time later, when the opioid overdose crisis began to escalate, pharmacists again found themselves pulled in two directions. This time, the question was whether they should be both medical and legal gatekeepers.

When the U.S. first tried to crack down on unauthorized opioid use, many pharmacists felt ambivalent about tasks like identifying people who were misusing or selling medications. One pharmacist told me, “Although I’m in the business of patient safety, I’m not in the police business.”

Later, pharmacists began to see policing tasks as health care tasks. They reasoned that policing patients helped keep patients safe, and they embraced enforcement as a key component of their work.

Fast-forward to 2021. America was in the throes of the COVID-19 pandemic, and some doctors were prescribing hydroxychloroquine and ivermectin to treat sick patients, though the FDA had not approved the medications for that purpose. Many pharmacists refused to fill those prescriptions, citing lack of scientific evidence and potential harm.

A box with an image of a horse's silhouette, running in front of an orange-and-yellow sunset.
During the COVID-19 pandemic, some physicians wrote off-label prescriptions for ivermectin – a drug used to kill worms and other parasites, intended for use in horses.
AP Photo/Ted S. Warren

Legislators in Missouri, where I teach, responded by passing a bill that required pharmacists to dispense the two medications, no questions asked – though that rule was later struck down by a federal judge. Similar conflicts played out in Iowa and Ohio, among other states.

Again, the fight broke down along political lines, but in the opposite direction. Liberals tended to oppose the bills, portraying pharmacists as skilled professionals whose expertise is essential to prevent harm. Conservative supporters claimed that pharmacists should dispense whatever the doctor writes.

Professional power

Each of these controversies has focused on a specific legal, ethical or medical issue. By extension, though, they are also about what kinds of professional discretion pharmacists should be able to exercise.

When it comes to medication, doctors prescribe, nurses administer and pharmacists dispense. Before the 20th century, pharmacists diagnosed disease and also compounded drugs. That changed when physicians placed themselves at the top of the medical hierarchy.

When it comes to professional autonomy, states regulate health care, but they permit health care professions to regulate themselves: to educate, license and discipline their own workers through professional boards. In exchange, these boards must do so “in the public interest” – prioritizing public health, safety and welfare over professionals’ own interests.

Health care professionals, including pharmacists, must also follow ethical codes. The day they receive their iconic white coats, pharmacists vow to “consider the welfare of humanity and relief of suffering [their] primary concerns.” Pharmacists also commit to “respecting the autonomy and dignity of each patient,” which means that pharmacists partner with patients to make choices about their health.

Self-regulation has legally given pharmacists the right to act as “medical gatekeepers” – to use their professional expertise to keep patients safe. This role is critical, as patients whose lives have been saved by pharmacists catching errors can attest.

It has not, however, given them the right to be “moral gatekeepers” who put their personal beliefs above the patient’s. Pharmacists control medications because of professional commitments, not personal beliefs. The code of ethics describes the pharmacist-patient relationship as a “covenant” that creates moral obligations for the pharmacist – including helping “individuals achieve optimum benefit from their medications,” being “committed to their welfare” and maintaining their trust.

If pharmacists wish to regulate themselves, history makes clear they need to define what it means to act in the public interest and ensure that other pharmacists comply. If not, the state has proved more than willing to step in and do the job for them. They may not like the results.

The Conversation

Elizabeth Chiarello has received funding from the National Science Foundation.

ref. Conflict at the drugstore: When pharmacists’ and patients’ values collide – https://theconversation.com/conflict-at-the-drugstore-when-pharmacists-and-patients-values-collide-264844

A fragmented legal system and threat of deportation are pushing higher education out of reach for many undocumented students

Source: The Conversation – USA (2) – By Vanessa Delgado, Professor of Sociology, Washington State University

Students protest at Arizona State University in January 2025 against a Republican student group encouraging students to report their peers to Immigration and Customs Enforcement for deportation. Ross D. Franklin/Associated Press

The Trump administration is upending norms and policies across the American educational system. One of the many groups facing uncertainty are prospective and current students living in the country without legal authorization.

For those students, applying to and attending college has long been a complicated, patchwork process that varies greatly across states.

In August 2025, the Department of Justice sued Oklahoma for a state law that allowed Oklahoma students living in the country without legal permission to pay a lower tuition rate that is guaranteed to in-state residents.

The Department of Justice also sued Kentucky, Texas and Minnesota over the summer on the same grounds.

Texas, Kentucky and Oklahoma have all announced they will no longer offer in-state tuition to students who are living in the U.S. illegally. Minnesota is currently challenging the Justice Department’s lawsuit.

Amy Lieberman, the education editor at The Conversation U.S., spoke with Vanessa Delgado, a scholar of Latino families and their educational experiences, to understand the higher education pathways for students living in the U.S. without legal authorization – and how the Trump administration is affecting their options.

A young woman with brown hair in a blue shirt holds a sign that says 'Support Undocumented Students.' Other people stand around her in blue shirts and also hold signs.
Daniela Valadez, a UCLA student majoring in labor studies, holds a sign at a protest for undocumented students in the University of California system in Los Angeles in May 2023.
Jay L. Clendenin/Los Angeles Times via Getty Images

How large is the population of students who are living in the U.S. without legal authorization?

There are 408,000 undocumented students enrolled in U.S. colleges and universities – that’s about 2% of the entire U.S. college population.

California and Texas have the greatest number, with about 21% of all undocumented college students living in California and 14% in Texas. Those numbers are likely to be an underestimate, as there are no official surveys that track this information.

We don’t have strong data on the high school graduation rates of college students who are not living in the U.S. legally. The best estimates suggest that about 5% to 10% of all undocumented high schoolers go off to college.

Research shows that legal battles over Deferred Action for Childhood Arrivals, or DACA, have contributed to a drop in college enrollment. DACA is a federal immigration policy that allows some immigrants who came to the U.S. as young children to receive temporary protection from deportation and to get work permits.

College graduation rates are shaped by a number of factors, including the state an immigrant student lives in and whether they can receive in-state tuition and state-based financial aid. Other important factors are whether there are undocumented student resource centers and supportive mentors on campus.

How is attending college different for students without legal authorization?

Undocumented high school students thinking about college may be unaware of their legal and financial options. Undocumented students frequently receive incorrect information about college options – and sometimes they do not want to disclose their immigration status to a school counselor.

Where an undocumented student lives determines whether they can afford to pay for college, or in some cases whether they can attend at all. Undocumented students cannot receive any federal student aid, regardless of where they live, because you need to be an American citizen to receive this aid. Financial help is critical for many students, including immigrants, as most students receive some financial aid to pay for college.

There are 22 states, as well as Washington, that allow undocumented students to pay in-state tuition. In addition, undocumented high schoolers are eligible for state-based financial aid in 14 states.

Conversely, 10 states, like Wisconsin and Oklahoma, have enacted laws to block undocumented students from receiving in-state tuition.

Can these students receive merit-based scholarships?

That depends. Some scholarship programs require a lawful immigration status. Some scholarships might require students to be eligible for Pell Grants, meaning they also need lawful immigration status. Other programs, like public colleges in California and Washington state, have merit-based scholarships that undocumented students can apply for. Several national private scholarships are also available for undocumented students.

Are there some cases where these students simply cannot legally attend college?

There are three states – Georgia, Alabama and South Carolina – where undocumented students cannot apply to most public universities. For these states, the board of regents prohibits admission for undocumented students.

In Washington state, undocumented students who are residents can apply for state-based financial aid. Other states, like California, provide similar forms of aid.

What are other practical questions prospective students need to consider?

First, there’s the cost of going to college. Undocumented students are much more likely than citizens to be living in poverty. And in general, college tuition is rising. If you do not have access to resources, such as in-state tuition and state-based financial aid, the cost will likely be a prohibitive factor.

Then there is the question of what comes after college. Generally, without a lawful immigration status, undocumented students struggle to find work. Some states, like California and Washington, have enacted policies to remove barriers for professional licenses, letting undocumented immigrants still pursue different career paths.

How is Trump changing the education landscape for immigrant families?

The Trump administration’s aggressive enforcement of immigration policy is prompting more undocumented students to consider whether they need to stay close to home, as many fear that they or their family members will be deported.

Many undocumented students face significant family obligations at home, as I find in my research. This can dissuade them from going far from home, or even from going to school at all.

I know students who are now contemplating taking a year of absence, or dropping out altogether. I also know students who cannot concentrate on school work, because they are anxious about whether their loved ones will be detained. Many also have younger siblings and feel the pressure of stepping into a guardian role.

Texas is an example of a place where undocumented students are particularly under stress. It was one of the first states to provide in-state tuition for undocumented students. In June 2025, the state rescinded the policy.

Now, undocumented college students in Texas need to pay out-of-state tuition costs, even if they have paid in-state so far. That roughly doubles the cost of annual tuition. Students and staff on the ground are scrambling to figure how to make sense of this abrupt policy shift. Similar rollbacks have happened in Florida and other states, and all of these measures are making it more challenging for undocumented students to consider pursing higher education.

The Conversation

Vanessa Delgado does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. A fragmented legal system and threat of deportation are pushing higher education out of reach for many undocumented students – https://theconversation.com/a-fragmented-legal-system-and-threat-of-deportation-are-pushing-higher-education-out-of-reach-for-many-undocumented-students-266324

Watchdog journalism’s future may lie in the work of independent reporters like Pablo Torre

Source: The Conversation – USA (2) – By Alex Volonte, Graduate Research and Teaching Assistant in Journalism, University of Florida

As traditional media outlets struggle to hold power to account, citizen watchdogs can still make a splash. Man_Half-tube/DigitalVision Vectors via Getty Images

In September 2025, podcaster Pablo Torre published an investigation alleging that the NBA’s Los Angeles Clippers may have used a side deal to skirt the league’s strict salary cap rules. His reporting, aired on multiple episodes of “Pablo Torre Finds Out,” focused on star forward Kawhi Leonard.

Leonard, one of the NBA’s most sought-after free agents, signed a four-year, US$176 million contract renewal with the Clippers during the 2021-22 off-season – the maximum allowed under league rules at the time. But Torre reported that in early 2022, Leonard’s LLC, KL2 Aspire, signed a cash and equity deal amounting to roughly $50 million through a brand sponsorship with Aspiration, a now-bankrupt financial technology startup that marketed itself as a climate-friendly bank.

Torre highlighted how the sponsorship coincided with major investments in Aspiration by Clippers owner Steve Ballmer and another team investor. The arrangement, Torre suggested, looked less like a conventional endorsement deal and more like a “no-show” side payment that could have helped the Clippers keep their star without technically violating the salary cap.

Leonard has denied that the partnership was improper, insisting he fulfilled his contractual obligations. The Clippers and Ballmer have also rejected claims of wrongdoing.

Torre’s reporting nevertheless had an immediate impact. Major outlets picked up the story, Aspiration’s bankruptcy filings drew renewed scrutiny, and the NBA announced it was investigating the matter.

In the wake of Pablo Torre’s revelations, many legacy media outlets highlighted his reporting.

At the University of Florida’s College of Journalism & Communications, part of my research involves unpacking the importance of decentralized networks of local outlets that cover stories from underrepresented areas of the country.

I see Torre’s work as a clear example of the growing need for this kind of bottom-up, citizen journalism – particularly given media industry trends.

An eroding fourth estate

Watchdog journalism is supposed to hold power to account.

This is sometimes referred to as the “fourth estate.” A term that dates back to the 17th century, it reflects the idea that an independent press is supposed to act as a fourth pillar of power, alongside the three traditional branches of modern democracies – legislative, executive and judicial.

Proudly independent from political or financial influence, fourth estate news media has traditionally demonstrated a public service commitment to exposing corruption, encouraging debate, highlighting issues that are important and forcing leaders to address those issues.

The need for watchdog journalism appears more urgent than ever.

In the Western world, with authoritarianism on the rise, the fourth estate is experiencing widespread threats. Reporters Without Borders’ latest World Press Freedom Index found that global press freedom reached an all-time low in 2025. For the first time, it classified the situation as “difficult.”

Meanwhile, market forces and profit motives have weakened the media’s role in upholding democratic checks and balances. Fierce competition for clicks, eyeballs and ad revenue impacts the type of content and stories that commercial outlets tend to focus on.

There appears to be less and less of a financial incentive to put in the time, resources and effort required for deep investigative reporting. It’s just not worth the return on that investment for commercial outfits.

A full-court press

In the U.S., the Trump administration and media consolidations have further weakened the press’s ability to serve as a check on those in power.

Over the past year, two major TV networks — ABC and CBS — reached settlements for separate lawsuits brought forward by President Donald Trump tied to editorial choices on their broadcast programming. Needless to say, both decisions create significant precedents that could prove consequential for journalistic integrity and independence.

In July 2025, the GOP-led Congress stripped over $1 billion from the Corporation of Public Broadcasting, dealing a blow to public nonprofit outlets NPR, PBS and their local affiliates.

More recently, Washington Post columnist Karen Attiah lost her job after speaking out against gun violence on social media in the wake of Charlie Kirk’s assassination.

From a structural standpoint, the U.S. media ownership landscape has, for decades, been plagued by consolidation. Media channels have become merely one slice of the massive asset portfolios of the conglomerates that control them.

It’s probably fair to say that producing costly and burdensome watchdog journalism isn’t exactly a priority for busy executives at the top of these holding companies.

What about local media?

Independent local outlets are a dying breed, too.

Studies have shown that news deserts – areas with little or no local coverage – are multiplying across the U.S.

This has dire consequences for democratic governance: News deserts often correlate with lower civic engagement, reduced voter turnout and less accountability for business and political leaders.

What’s more, fewer local journalists means less scrutiny of local governments, which undermines transparency and enables corruption.

For these reasons, more readers seem to be getting their news from social media and podcasts. In fact, according to a new Pew Research Center report, 1 in 5 Americans get their news from TikTok alone. And in its 2025 Digital News Report, the Reuters Institute noted that “engagement with traditional media sources such as TV, print, and news websites continues to fall, while dependence on social media, video platforms, and online aggregators grows.”

With this in mind, the U.S. government’s latest framework for a deal for TikTok’s parent company, ByteDance, to sell the social media platform’s stateside operations to a consortium of American investors takes on even more significance. Many of these investors are allies of Trump. They’ll get to control the algorithm – meaning they’ll be able to influence the content that users see.

Hand holding mobile phone in foreground featuring the words 'TikTok,' while President Donald Trump smiles in the background.
President Donald Trump brokered a deal to hand ownership of TikTok’s U.S. operation to a group of investors that includes a number of the president’s close allies.
Jaap Arriens/NurPhoto via Getty Images

Bottom up

At the same time, social media has also allowed independent journalists such as Torre to find an audience.

Granted, with past journalistic stints at both Sports Illustrated and ESPN, Torre is not exactly a pure outsider. Yet he’s far from a household name, with fewer than 200,000 podcast subscribers.

Luckily, he’s by no means the only independent journalist serving as a citizen watchdog.

In January 2025, freelance journalist Liz Pelly published her book “Mood Machine,” which details her investigation into Spotify’s dubious financial practices. Through her research and reporting, she alleges that the music technology company conspired to suppress legitimate royalty payments to artists.

Andrew Callaghan of Channel 5 News fame on YouTube runs one of the largest crowdfunded independent newsrooms in the world. His exclusive interview with Hunter Biden in July 2025 got him a type of access that established mainstream media couldn’t get.

In 2020, Canadian siblings Sukh Singh and Harleen Kaur founded GroundNews, an online platform providing news aggregation, curation and rigorous fact-checking. All Sides and Straight Arrow News are similar bottom-up projects designed to expose media bias and fight misinformation.

Meanwhile, the nonprofit media outlet ProPublica has published award-winning investigative journalism through a distributed network of local reporters. Their “Life of the Mother” series, which explored the deaths of mothers after abortion bans, earned them multiple awards while prompting policy changes at federal and state levels.

All have surfaced meaningful stories worth bringing to light. Historically, these types of stories were the purview of newspapers of record.

Today, underground sleuths might be among the last bulwarks to abuses of power.

The work isn’t easy. It certainly doesn’t pay well. But I think it’s important, and someone has to do it.

The Conversation

Alex Volonte does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. Watchdog journalism’s future may lie in the work of independent reporters like Pablo Torre – https://theconversation.com/watchdog-journalisms-future-may-lie-in-the-work-of-independent-reporters-like-pablo-torre-265839

Conflict at the counter: When pharmacists’ and patients’ values collide

Source: The Conversation – USA (3) – By Elizabeth Chiarello, Associate Professor of Sociology, Washington University in St. Louis

Pharmacists see themselves as vital gatekeepers – but at times, some critics treat them as physicians’ sidekicks. Witthaya Prasongsin/Moment via Getty Images

Imagine walking into your pharmacy, handing over your prescription and having it denied. Now imagine that the reason is not insufficient insurance coverage or the wrong dose, but a pharmacist who personally objects to your medication. What right does a pharmacist have to make moral decisions for their patients?

Lawmakers have wrestled with this question for decades. It reemerged in August 2025 when two pharmacists sued Walgreens and the Minnesota Board of Pharmacy, saying they had been punished after refusing to dispense gender-affirming care medications that go against their religious beliefs.

According to the pharmacists, Walgreens refused their requests for a formal religious accommodation, citing state law. One pharmacist had her hours reduced; the other was let go. If Minnesota law does not allow such an accommodation, their lawsuit argues, it violates religious freedom rights.

As a sociologist of law and medicine, I’ve spent the past 20 years studying how pharmacists grapple with tensions between their personal beliefs and employers’ demands. Framing the problem as a tension between religious freedom and patients’ rights is only one approach. Debates about pharmacists’ discretion over what they dispense also raise bigger questions about professional rights – and responsibilities.

Duty to dispense?

The most famous controversy, perhaps, dealt with contraception. In the early 2000s, some pharmacists refused to dispense Plan B, also known as “emergency contraception” or the “morning-after pill.” Their refusal stemmed from a belief that it caused an abortion.

That is inaccurate, according to medical authorities. When Plan B first became available in 1999, the label said the medication might work by expelling an egg that had already been fertilized. In 2022, the Food and Drug Administration relabeled Plan B to say that it acts before fertilization. From a medical perspective, both mechanisms are contraception, not abortion.

A pair of tweezers holds a white pill, photographed in front of a box that says 'PlanB One Step.'
Plan B’s early labeling contributed to confusion over how it works.
Justin Sullivan/Getty Images

States responded to pharmacists’ refusals by adopting “responsibility laws.” Some states adopted “conscience clauses” that permitted pharmacists not to fill the prescription. Others opted for “duty to dispense” laws that required pharmacists or pharmacies to provide the medication, or “refuse and refer” laws obligating objecting pharmacists to hand the prescription off to a colleague.

This fight largely broke down across political lines. Groups that oppose abortion rights argued that pharmacists should have the right to opt out, while groups in favor of abortion rights argued that pharmacists should be required to dispense.

As this fight escalated, the conflict became about more than contraception or abortion. It revealed Americans’ views about what kinds of professionals pharmacists should be, and whether they are professionals at all – that is, members of occupational groups that have specialized knowledge and skills, and exclusive rights to do particular kinds of work.

In 2015, for example, the advocacy group NARAL Pro-Choice American – now called Reproductive Freedom for All – released an ad with a man and a woman in bed, their feet hanging out of the sheets. Stuck between them was someone else wearing heavy black shoes. “Who invited the pharmacist?” the ad asked.

Pro-choice organizations insisted that pharmacists had no right to question a doctor’s prescription. “A pharmacist’s job is to dispense medication, not moral judgment,” said the president of Planned Parenthood Chicago.

Some pharmacists felt that such messages did not just criticize “moral gatekeeping” but also undermined their claims to professional authority. Pharmacists undergo six years of training to earn a doctorate and are health care’s medication specialists. The idea that pharmacists were simply technicians, hired to fill whatever a prescription said, made them seem like physicians’ underlings.

Keeping patients safe

A short time later, when the opioid overdose crisis began to escalate, pharmacists again found themselves pulled in two directions. This time, the question was whether they should be both medical and legal gatekeepers.

When the U.S. first tried to crack down on unauthorized opioid use, many pharmacists felt ambivalent about tasks like identifying people who were misusing or selling medications. One pharmacist told me, “Although I’m in the business of patient safety, I’m not in the police business.”

Later, pharmacists began to see policing tasks as health care tasks. They reasoned that policing patients helped keep patients safe, and they embraced enforcement as a key component of their work.

Fast-forward to 2021. America was in the throes of the COVID-19 pandemic, and some doctors were prescribing hydroxychloroquine and ivermectin to treat sick patients, though the FDA had not approved the medications for that purpose. Many pharmacists refused to fill those prescriptions, citing lack of scientific evidence and potential harm.

A box with an image of a horse's silhouette, running in front of an orange-and-yellow sunset.
During the COVID-19 pandemic, some physicians wrote off-label prescriptions for ivermectin – a drug used to kill worms and other parasites, intended for use in horses.
AP Photo/Ted S. Warren

Legislators in Missouri, where I teach, responded by passing a bill that required pharmacists to dispense the two medications, no questions asked – though that rule was later struck down by a federal judge. Similar conflicts played out in Iowa and Ohio, among other states.

Again, the fight broke down along political lines, but in the opposite direction. Liberals tended to oppose the bills, portraying pharmacists as skilled professionals whose expertise is essential to prevent harm. Conservative supporters claimed that pharmacists should dispense whatever the doctor writes.

Professional power

Each of these controversies has focused on a specific legal, ethical or medical issue. By extension, though, they are also about what kinds of professional discretion pharmacists should be able to exercise.

When it comes to medication, doctors prescribe, nurses administer and pharmacists dispense. Before the 20th century, pharmacists diagnosed disease and also compounded drugs. That changed when physicians placed themselves at the top of the medical hierarchy.

When it comes to professional autonomy, states regulate health care, but they permit health care professions to regulate themselves: to educate, license and discipline their own workers through professional boards. In exchange, these boards must do so “in the public interest” – prioritizing public health, safety and welfare over professionals’ own interests.

Health care professionals, including pharmacists, must also follow ethical codes. The day they receive their iconic white coats, pharmacists vow to “consider the welfare of humanity and relief of suffering [their] primary concerns.” Pharmacists also commit to “respecting the autonomy and dignity of each patient,” which means that pharmacists partner with patients to make choices about their health.

Self-regulation has legally given pharmacists the right to act as “medical gatekeepers” – to use their professional expertise to keep patients safe. This role is critical, as patients whose lives have been saved by pharmacists catching errors can attest.

It has not, however, given them the right to be “moral gatekeepers” who put their personal beliefs above the patient’s. Pharmacists control medications because of professional commitments, not personal beliefs. The code of ethics describes the pharmacist-patient relationship as a “covenant” that creates moral obligations for the pharmacist – including helping “individuals achieve optimum benefit from their medications,” being “committed to their welfare” and maintaining their trust.

If pharmacists wish to regulate themselves, history makes clear they need to define what it means to act in the public interest and ensure that other pharmacists comply. If not, the state has proved more than willing to step in and do the job for them. They may not like the results.

The Conversation

Elizabeth Chiarello has received funding from the National Science Foundation.

ref. Conflict at the counter: When pharmacists’ and patients’ values collide – https://theconversation.com/conflict-at-the-counter-when-pharmacists-and-patients-values-collide-264844

What are solar storms and the solar wind? 3 astrophysicists explain how particles coming from the Sun interact with Earth

Source: The Conversation – USA – By Yeimy J. Rivera, Researcher in Astrophysics, Smithsonian Institution

The Sun occasionally ejects large amounts of energy and particles that can smash into Earth. NASA/GSFC/SDO via WikimediaCommons

Curious Kids is a series for children of all ages. If you have a question you’d like an expert to answer, send it to curiouskidsus@theconversation.com.


What is meant by solar storm and solar wind? – Nihal, age 11, Amalapuram, India


Every day on Earth, you experience weather. You feel the wind blowing and see clouds move across the sky. Sometimes there are storms where the wind gets really strong, it might rain, or there might be thunder and lightning.

Did you know that there’s weather in space too? It all starts with the Sun.

The Sun: The bright star in our solar system

The Sun is a very hot, very big ball of gas at the center of our solar system. Its surface can reach a blistering 10,800 degrees Fahrenheit (6,000 degrees Celsius). That’s nearly five times hotter than lava that spews from volcanoes on Earth, and just like lava, the Sun glows from the heat.

The Sun is made up of what solar physicists like us call plasma.

Normal gases, like the air you breathe on Earth, are made up of atoms bouncing around. Atoms consist of a positively charged bundle of particles called the nucleus and negatively charged particles called electrons. The nucleus and the electrons are tightly stuck together so that atoms are overall neutral – that is, they have no charge.

A gas becomes a plasma when the atoms it’s made of become so hot that their negatively charged electrons split apart from their positively charged nuclei. Now that the charged particles are separated from each other, the plasma can conduct electricity, and magnetic fields may pull the plasma or push it away.

Plasma is made up of charged particles.

Solar wind blows out of the Sun all the time

Sometimes, the Moon lines up with Sun, blocking it from view and turning the sky dark. This phenomenon is called a total solar eclipse. During an eclipse, you can see faint, wispy structures surrounding the Moon that extend across the sky. In that moment, what you are seeing is the Sun’s atmosphere: the corona.

The corona can reach millions of degrees, which is much hotter than the Sun’s surface. In fact, the corona is so hot that the particles shoot out of the Sun, escaping from the Sun’s gravity, engulfing the entire solar system. This stream of plasma is called the solar wind.

The solar wind’s invisible, continuous gust of plasma fills a bubble in space that extends far beyond the orbit of Pluto. It can reach up to 2 million miles per hour (3 million kilometers per hour) – at that speed, the solar wind would take less than a minute to circle the Earth. For comparison, the International Space Station takes 90 minutes to go around the Earth.

While it’s hard to see the solar wind directly in photos once it leaves the corona, we can measure the gas directly with instruments in space. Scientists have recently gotten up close and personal with it by sending missions such as the Parker Solar Probe closer to the Sun than ever before. The Parker Solar Probe flies directly into the solar wind and measures the gas directly just as it escapes the Sun – like a weather station.

The Parker Solar Probe also has a specialized camera that points sideways to see the Sun’s light as it scatters off the solar wind. Light scattering is the same process that makes the sky blue on Earth.

Big solar explosions

The solar wind surrounds and engulfs the Earth and other planets all the time, but most of the time it is safely guided around us by our planet’s magnetic field. However, occasionally the Sun also generates huge explosions that release big clouds of plasma into our solar system, some of which are directed toward Earth. These massive events are called coronal mass ejections.

NASA spacecraft track solar storms from their eruptions on the Sun until their impact on Earth.

Compared to the solar wind, which is always blowing, coronal mass ejections are short-lived but extreme. You can think of them as solar storms. Solar storms also involve one important force that doesn’t really play a role in the weather on Earth: magnetism.

The Sun is like a giant magnet. All magnets create what we call magnetic field lines, which are lines along which charged particles such as plasma have an easy time traveling. The Sun’s magnetic field lines can be very twisted, and the solar wind and coronal mass ejections deform and drag them outward from the Sun.

When these solar storms reach Earth, their coiled magnetic fields can sometimes interact with our planet’s own magnetic field and cause disturbances called space weather.

Space weather is caused by the Sun

The Earth has a magnetic field and a protective bubble: the magnetosphere. The magnetosphere shields us from the Sun’s solar wind and solar storms, acting like a force field to keep living things safe from the energetic particles released by the Sun.

Magnetic reconnection happens when the magnetic field from a coronal mass ejection interacts with Earth’s magnetic field.

Most of the time this protective bubble works so well that you can’t tell that there is anything special happening out in space. During particularly big storms, however, some solar wind plasma can make it down into the Earth’s atmosphere. As coronal mass ejections pass over Earth, their magnetic field can interact with Earth’s magnetic field. The Sun and Earth’s magnetic field lines untangle and rearrange, and for a short while these fields can link together and let the Sun’s plasma in.

When this happens, it can cause big magnetic storms all over the world. This interaction between ejections from the Sun and the Earth is what scientists refer to as space weather.

Green lines of light crossing the night sky, above a snow-covered landscape.
Space weather causes beautiful light shows near the North and South Poles on Earth.
AP Photo/Rene Rossignaud, File

Space weather is just like the weather on Earth, generated by its atmosphere. It is important for scientists to understand and predict this space weather, as it can lead to power blackouts, interrupt communication and even cause satellites to prematurely fall down to Earth.

Besides these dangers though, space weather can create beautiful light shows in the sky called Northern Lights, or aurora borealis, and Southern Lights, or aurora australis. You can observe these if you’re near the North or South Poles. If you ever get a chance to see them, remember what you’re seeing is space weather, the result of eruptions and solar wind from the Sun.


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Yeimy J. Rivera receives funding from NASA’s Parker Solar Probe project through the SAO/SWEAP subcontract 975569.

Tatiana Niembro receives funding from NASA’s Parker Solar Probe project through the SAO/SWEAP subcontract 975569 and the LWS grant number 80NSSC23K0897.

Samuel Badman receives funding from NASA’s Parker Solar Probe project through the SAO/SWEAP subcontract 975569.

ref. What are solar storms and the solar wind? 3 astrophysicists explain how particles coming from the Sun interact with Earth – https://theconversation.com/what-are-solar-storms-and-the-solar-wind-3-astrophysicists-explain-how-particles-coming-from-the-sun-interact-with-earth-264013