Over the last decade, clinics have popped up across Southern California and beyond advertising something called magnetic e-resonance therapy, or MERT, as a therapy for autism.

Developed by the Newport Beach-based company Wave Neuroscience, MERT is based on transcranial magnetic stimulation, a type of brain stimulation that’s approved by the Food and Drug Administration to treat depression, obsessive-compulsive disorder, migraines and smoking addiction.

Clinics licensing MERT have claimed that their trademarked version of the treatment can also produce “miraculous results” in kids with autism, improving their sleep, emotional regulation and communication abilities. A six-week course of MERT sessions typically costs $10,000 or more.

The FDA hasn’t approved MERT for this use. However, prescribing drugs or devices for conditions they aren’t approved for, which is known as off-label prescribing, is a legal and common practice in medicine.

But when such treatments are offered to vulnerable people, a group of researchers argue in a new peer-reviewed editorial in the medical journal Transcranial Magnetic Stimulation, they should be evidence-based, clearly explained to patients and priced in a way that reflects the likelihood that they will work as advertised.

Most clinics advertising off-label TMS as a therapy for autism don’t meet those standards, the researchers say.

Autism is “the biggest off-label business … [and] the one that is the greatest concern,” said Dr. Andrew Leuchter, director of UCLA’s TMS Clinical and Research Service.

Leuchter is one of three researchers with TMS expertise who recently called for the establishment of ethical guidelines around off-label TMS marketing in the field’s primary journal.

Written with Lindsay Oberman, director of the Neurostimulation Research Program at the National Institute of Mental Health, and Dr. Holly Lisanby, founder of the NIMH Noninvasive Neuromodulation Unit and dean of Arizona State University’s School of Medicine and Advanced Medical Engineering, the editorial singles out MERT as an “example of off-label TMS where there is negligible evidence of efficacy.”

“There is extremely limited scientific evidence at present that any form of TMS has efficacy and safety in improving the core symptoms of language, social skills, or behavioral disturbances associated with [Autism Spectrum Disorder],” the editorial states. “Websites and other promotional materials that fail to acknowledge this limited evidence-base can create a risk of bias and potential for false expectations.”

Dr. Erik Won, Wave’s president and chief medical officer, did not respond to requests for comment.

A Times investigation last year found there are no large scientific studies demonstrating that MERT is significantly better than a placebo at improving speech and communication challenges associated with autism. Wave has not conducted any clinical trials on MERT and autism.

Won said last year that Wave is working to obtain funding “for further studies and ultimately an FDA indication.”

Websites for clinics offering MERT often feature written testimonials from parents describing what they saw as positive changes in their children’s moods or spoken-language abilities after treatment sessions.

Without data, however, there is no way to know whether a patient’s anecdotal experience is typical or an outlier, according to Zoe Gross of the Autistic Self Advocacy Network, a nonprofit group run by and for autistic adults.

“Be wary of therapies that are sold to you with testimonials. If you go to a clinic website and they have dozens of quotes from parents saying, ‘This changed my child’s life in XYZ ways,’ that isn’t the same as evidence,” Gross told The Times last year.

A therapy could have only a 1% success rate, she said, and still yield dozens of positive testimonials once thousands of people have tried it.

For families unsure of whether a particular commercial therapy might be valuable for their child, “ask the advice of a clinician or an autism scientist who is not connected to the facility providing a service, just to get a frank appraisal of whether it’s likely to be helpful or likely to be worth the money,” said James McPartland, director of the Yale Center for Brain and Mind Health, who is currently studying the relationship between TMS and social perception in autistic adults. “Before you want to ask someone to spend resources on it, you want to have a certain degree of confidence [that] it’s going to be useful.”

The vast majority of urban, public grade schools in California are paved-over “nature deserts” sorely lacking in trees or shade — leaving most of the state’s 5.8 million school-age children to bake in the sun during breaks from the classroom as rising global temperatures usher in more dangerous heat waves.

That’s the conclusion of a team of California researchers from UCLA, UC Davis and UC Berkeley who studied changes in the tree cover at 7,262 urban public schools across the Golden State between 2018 through 2022.

The ongoing joint project, which drew from urban tree canopy maps developed by study partners the California Department of Forestry and Fire Protection and the U.S. Forest Service, revealed that 85% of the schools lost about 1.8% of tree cover on average in that four-year span.

The situation appears to be just as worrisome today, the team said.

The researchers also collaborated with the nonprofit Green Schoolyards America, which found in its own 2024 study that California’s public K-12 schoolyards have a median tree cover of just 6.4%. And more than half of that canopy exists only as decoration at school entrances, in parking lots and along campus perimeters.

“Extreme heat is becoming a major public health concern in California and across the country, and trees can play a really big role in helping us cool down those schools and also build climate resilience,” said Kirsten Schwarz, the research lead at UCLA.

Results from the 2018 to 2022 study, which was funded by the U.S. Forest Service, were recently published in the journal Urban Forestry and Urban Planning.

While 15% of the schools surveyed saw gains in tree cover thanks in part to schoolyard greening projects — particularly in the Central Valley, around Sacramento and in Imperial County — many individual schools surveyed experienced big losses in net tree cover in that time. In some cases, those added up to more than 40%.

Among the state’s largest school districts, San Francisco had the greatest canopy loss, 16.3%. On the other end of the spectrum, Sacramento had the greatest gain at 7.5%, followed by Long Beach, which saw a 4% canopy increase.

Schools in Los Angeles showed a small net loss of 0.5%. The researchers cautioned not to read too much into that modest figure, because longstanding disparities in tree cover and shade across the city still expose schools in poorer neighborhoods away from the ocean to greater sun and intense outdoor heat than schools that benefit from their proximity to cooling ocean breezes and lingering marine cloud cover.

As part of the continuing data collection, the team conducted new field research in a subset of schools this summer — some in Southern California, some in the Bay Area and some in the Central Valley. Due to research agreements with the different districts, Schwarz said she could not disclose the exact locations.

Researchers from UCLA performed a complete tree inventory for 16 schools in each district, counting all of the trees they found on a campus, mapping their exact locations, identifying the many different species they came across, measuring trees at the base and crown and assessing the overall health of each tree.

Accompanying the UCLA researchers to a selection of schools in each district were researchers from UC Davis who took heat measurements.

They brought portable weather stations and sensors, as well as swatches of different paving materials such as grass, mulch, turf, rubber and concrete to each site. The researchers took thermal images, captured air temperatures and measured the humidity around the surface materials at different times of day when kids are most likely to be outside at school. This allowed the team to examine the microclimates that are specific to those campuses over an extended span.

It’s important to measure outdoor temperatures on school property because children spend so much of their time at school during the academic year and because their smaller statures place them at increased risk from heat radiating from pavement, said Alessandro Ossola, an urban plant scientist who leads the UC Davis team.

Children also haven’t fully developed the ability to regulate their body temperature they way adults can, making them more vulnerable to extreme heat and potentially hindering their ability to learn.

In addition, Ossola stressed that for children who live in places without grass or safe parks and playgrounds, school might be the one place where they can experience cooling outdoor environments and unpaved surfaces.

“With that information combined — looking at the complete tree inventory and looking at the really extensive heat measurements on an individual campus — we can better understand the cooling benefits of those trees,” Schwarz said. “We can also look at what tree species that are there and how well-adapted they are to future climate change.”

Schwarz said the team also interviewed locals at each location to find who is taking care of the trees at schools, what barriers exist that prevent good tree maintenance and what programs are in place to make tree care easier.

There are many obstacles to making campuses more hospitable. Schwarz cited a 2024 policy report by her UCLA team that examined the greening of inadequately shaded schools and policies that make it difficult to carry out improvements. In some cases, a lack of staffing, bureaucratic hurdles, state seismic safety standards that encourage building outward rather than vertically and funding models that prioritize low-maintenance campuses stood in the way of schoolyard greening, that report said.

Schwarz, an urban ecologist, said she was surprised to learn about the extent to which regulations requiring non-grass surfaces for sports and outdoor physical education dictated the design of some schoolyards.

Other schools have to choose between conflicting long-term priorities, the student report said: Plans for the future construction of additional classrooms to accommodate growing student enrollments can outweigh the desire to create shadier open spaces.

The tree canopy researchers plan to present each participating school with a tree inventory, analysis of findings, policy recommendations and suggestions for incorporating their study into classroom lessons and parent outreach.

The researchers said their main motivation in initiating the study was to help communities get the most from $150 million in Cal Fire grants approved by the state Legislature that schools can apply for to plant grass and trees on their campuses and reduce the harm of heat-radiating surfaces such as asphalt.

“That’s a really key part of this conversation about schoolyard greening, because de-paving is that critical first step,” Schwarz said. “The overarching goal is, how can we maximize these investments that we’re making in school greening?”

Ossola said that in some ways, Californians who want to improve their children’s schoolyards are playing catchup even with community will and funding sources in place. It can take decades for young trees planted today to mature enough to provide the necessary cooling effects that can make children safer on a warming planet.

“This is a critical investment that we should’ve done 20 or 50 years ago,” Ossola said. “Now we’re kind of missing the bus.”

SACRAMENTO — The state does not have the fiscal capacity to make up for the massive, oncoming federal cuts to healthcare programs used by millions of vulnerable Californians, a stark reality that will force state lawmakers to consider reducing benefits and eligibility and swell the number of residents without medical insurance.

That blunt assessment, released by the state’s Legislative Analyst’s Office, comes at a time when the state faces ongoing budget deficits — with a $17-billion shortfall estimated for the next fiscal year — and imminent cuts to food support programs, such as SNAP, caused by the government shutdown.

On Tuesday, Gov. Gavin Newsom said the combined fallout from the shutdown and the Republican-backed “Big, Beautiful Bill” has left states in the lurch.

We’re looking at “the largest cuts to Medicaid in American history,” Newsom said at a news conference. “They supported the largest cuts to food stamps and SNAP in American history — $186 billion over the next ten years — before this manufactured crisis, this decision they are making not to provide the contingency funds to mitigate the impacts.”

The governor said he’s working with state legislators to identify additional resources to help offset the cuts, but there’s only so much states can do.

Top California health officials on Monday also warned that the federal cuts will deliver a devastating blow to public health and affect all Californians, including those with private health insurance, as the state struggles to mitigate the damage.

“These changes will impact our emergency departments, rural hospitals, private and public hospitals, community health centers, ambulance providers and the broader health care system that serves every community,” said Michelle Baass, director of the California Department of Health Care Services.

Baass was among several experts who spoke at a briefing about the effects of HR 1, a massive tax and spending bill passed by the Republican-led Congress and signed by President Trump that shifts federal funding away from safety-net programs for the vulnerable and toward tax cuts and immigration enforcement. She said the legislation makes sweeping changes to Medi-Cal, as Medicaid is known in California.

It “will cause widespread harm by making massive reductions in federal funding and potentially cripple the health care safety net,” Baass said. “These changes put tens of billions of dollars of federal funding at risk for California and could result in a loss of coverage for millions of Californians.”

The nonpartisan Legislative Analyst’s Office, which advises the California Legislature on budget and policy issues, in an Oct. 24 report estimated the federal cuts could reduce funding “as much as tens of billions of dollars.” The report warned that about 1.2 million people may lose coverage under Medi-Cal, which provides healthcare to eligible low-income residents. Baass predicts that number may be much higher.

“The state does not have fiscal capacity to backfill all of the lost federal revenue resulting from H.R. 1,” the legislative report stated. “As such, the Legislature will want to consider how to balance Medi‑Cal eligibility, benefits, and financing moving forward. Changes to Medi‑Cal will come with key policy trade‑offs around access, costs, and other priorities that the Legislature will need to weigh.”

To alleviate some of the effects, state lawmakers could possibly raise existing taxes on private health plans and hospitals, but those extra costs probably would increase costs for all Californians seeking care at a time when people already are struggling with the state’s high cost of living.

About 15 million Californians — a third of the state — are on Medi-Cal, with some of the highest percentages being in rural counties. More than half of the children in California receive healthcare coverage through Medi-Cal, according to the state Department of Health Care Services.

Baass explained that the federal legislation creates new eligibility requirements for Medicaid. Starting in 2027, many individuals ages 19 to 64 will need to work for at least 80 hours a month, or perform 80 hours of community service or be enrolled in an educational program, to qualify. The law allows various exemptions, including pregnancy, disabilities, or caring for children under the age of 19.

She estimated that 3 million Medi-Cal recipients could lose coverage as a result.

“This would significantly drive up the uninsured rate that raises cost for hospitals treating uninsured patients,” Baass said.

Baass said HR 1, the “Big, Beautiful Bill,” also bans abortion providers from receiving federal Medicaid funding — even for healthcare services they offer that are not related to the procedure — and reduces federal dollars for emergency medical care for undocumented immigrants. It additionally limits state funding mechanisms, such as taxes paid by managed care providers, and establishes federal penalties for improper payments.

CalFresh, the state name for the Supplemental Nutrition Assistance Program, is expecting long-term cuts of at least $1.7 billion annually, said Jennifer Troia, director of the California Department of Social Services. About 395,000 people could lose their benefits for government food assistance.

SNAP benefits are also being hit by the current government shutdown, with payments temporarily halting altogether in November.

At the heart of the shutdown is a political standoff in Washington over the expiring tax credits for people who get health insurance through the Affordable Care Act, also known as Obamacare. Democrats said they will not vote to reopen the government until Republicans agree to renew the expanded subsidies. Republican leaders refused to negotiate until Democrats vote to reopen the government.

Covered California, the state’s Affordable Care Act health insurance marketplace, estimated over the summer that as many as 660,000 of the roughly 2 million people in the program will either be stripped of coverage or drop out because of increased cost and the onerous new mandates to stay enrolled.

Effects of the new federal cuts and policies are already being felt across the state and nation.

A Planned Parenthood program in Orange and San Bernardino counties announced its imminent closure earlier this month due to being federally defunded. Los Angeles County’s health system has implemented a hiring freeze and is bracing to lose $750 million per year for the county Department of Health Services, which oversees four public hospitals and roughly two dozen clinics. Meanwhile, food banks nationwide are seeking donations and preparing for longer lines.

Kim Johnson, secretary of the state Health and Human Services Agency, discussed how California is fighting back.

Newsom recently announced he is deploying the National Guard and fast-tracking $80 million to support food banks, she said. This came alongside the governor’s decision to allocate $140 million in state funding to Planned Parenthood.

Johnson said Atty. Gen. Rob Bonta has filed more than two dozen lawsuits related to HR 1.

“Here in California,” she said, “we will continue to mitigate the harm of these federal changes wherever we can.”