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    ‘We are failing’: doctors and students in the US look to Mexico for basic abortion training

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    On paper, it should not be difficult for Dr Sebastian Ramos to learn to perform abortions. As a family medicine doctor, Ramos works in a specialty that frequently provides the procedure. He lives in deep-blue California, where it is still allowed. And the administrators running Ramos’s residency program – a kind of apprenticeship that US doctors must undergo to become full-fledged physicians – support Ramos’s desire to learn how to do it.But over the course of his three-year-long residency, Ramos is guaranteed just three days’ worth of training at Planned Parenthood. Residents get to participate in only a handful of abortions.“That’s just not enough if you want to practice abortion care,” said Ramos, who asked to go by a shortened version of his last name to protect his privacy. “I knew that if I wanted to do this, I needed more experience.”That’s why, earlier this month, Ramos traveled to a clinic in Mexico City for two weeks’ worth of training in abortion provision. During his first week at the clinic, which is run by the global organization MSI Reproductive Choices and its Mexican arm Fundación MSI, Ramos performed roughly 60 abortions.In the years since the US supreme court overturned Roe v Wade, paving the way for more than a dozen states to ban virtually all abortions, a small but growing number of would-be abortion providers have begun to leave the country in search of an education. In 2023, MSI trained nine American doctors to perform abortions at clinics in Mexico. In 2024, it trained 27. So far this year, it is on track to double that number.View image in fullscreen“On one hand, it’s a tremendous relief to know that medical students and residents aren’t going to have to forego this very important part of their training in their education,” said Pamela Merritt, executive director of Medical Students for Choice. Last year, Merritt’s organization helped eight medical students and residents receive abortion training in Mexico and the UK.Merritt continued: “It’s also incredibly sad that in the United States, we are failing to train people even to the standard of care indicated by abortion bans.”Every abortion ban in the US permits abortions to save a patient’s life. But without adequate training, doctors may not be skilled enough to perform abortions even in those dire circumstances.‘It’s a shame’Medical schools and residency programs are run by massive hospitals that are heavily dependent on public funding; such institutions tend to be, by nature, leery of anything as controversial as abortion. The Accreditation Council for Graduate Medical Education (ACGME) has required OB-GYN residencies to teach doctors how to perform abortions since the 1990s, but rather than offer training in-house, hospitals have often farmed their residents out to freestanding abortion clinics for training.Even before Roe fell, this system was faulty: a 2019 study found that, despite the ACGME requirement, just 64% of OB-GYN residency programs offered “routine training with dedicated time” for abortions. Family medicine residents who want to learn to perform abortions face a greater disadvantage, since the ACGME does not require their residency programs to offer any kind of abortion training.View image in fullscreenEven most OB-GYN residents, program directors reported in the 2019 study, did not achieve what doctors call “competency” when it came to abortion. Without competency – a qualification that’s measured through a melange of doctors’ knowledge, skills and attitudes – doctors may not be able to safely perform abortions on their own.Abortion training and competency is now even harder to come by. Since Roe’s collapse, more than 100 abortion clinics have closed. Those that are left are often besieged by patients fleeing abortion bans, leaving them without the time and space to teach everybody who wants to learn.If an OB-GYN residency program is located in a state that bans abortion, ACGME rules currently dictate that the residency “must provide access to this clinical experience in a different jurisdiction where it is lawful”. The ACGME declined to respond to a request for information about how many residency programs are currently compliant with its abortion-training requirement, although records show that no OB-GYN programs have lost their accreditation status in the last year. Patricia Lohr serves as the director of research and innovation for the British Pregnancy Advisory Service (Bpas), a UK non-profit that provides abortions up until about 24 weeks of pregnancy. Lohr trained to become an OB-GYN in the US. “Having been a resident and a medical student in the United States, I could really see the importance of having access to abortion education that wasn’t entirely reliant on what was being delivered within academic training programs,” Lohr said. “Because often, abortions weren’t being provided in those academic hospitals.”View image in fullscreenWhen Lohr moved to the UK, she quickly moved to create a two-week training program at Bpas where medical students could learn about abortions and observe – but not perform – the procedure. In the years since Roe fell, that training program has received a surge of applications from American medical students and residents.“It’s a shame that people would have to travel to learn a basic part of women’s health care,” Lohr said. “There are many trainees out there at the moment who would like to obtain abortion skills, but cannot get it locally, and so they get diverted into doing something else.”Lauren Wiener, a New Jersey medical student, had originally planned to travel to Arizona in summer 2022 to learn how to provide abortions. But when Roe’s fall led Arizona abortion providers to temporarily stop working, Wiener had to cancel her trip. Instead, she ended up undergoing a week-long training at Bpas last fall.“It is something that you need to know how to do, because there are emergency situations,” Wiener said of abortions. “You might not want to electively perform an abortion at 24 weeks, but if someone comes in and they’re miscarrying, you need to know how to evacuate that uterus. It’s a skill you need to have to save a life.”‘We will be there’While training in the US dwindles, the country’s increasingly conservative approach to abortion has also put it at odds with much of the rest of the world. Only four countries – including the US – have tightened their abortion laws over the last 30 years, while more than 60 countries and territories have loosened theirs, according to a tally by the Center for Reproductive Rights.Mexico is one of them. In 2023, its supreme court decriminalized abortion nationwide; the procedure is now available in about half of all Mexican states. And providers aren’t the only people taking advantage of Mexico’s liberalized abortion laws: last year, Fundación MSI provided first-trimester abortions to 62 women from the United States.“Training, training, training – it is key, to have less danger for actual patients,” said Araceli López-Nava, managing director of MSI Latin America. “We understand how difficult the situation is becoming in the US, so we’re happy to help.”The organization has the capacity to train up to 300 doctors a year to perform abortions, López-Nava estimated.View image in fullscreenMSI is not, however, a solution for everybody. Would-be trainees need to speak Spanish. And although the organization has in past years trained medical students, MSI’s Mexico clinics have started focusing on teaching residents who have already performed 20 abortions. Because residents have already chosen their specialties and secured berths in residency programs – which can be highly competitive – they are more likely to become abortion providers.Training in Mexico can also be pricey, especially since the program does not pay for travel and lodging. Ramos’s entire trip cost about $5,000, although a scholarship helped him cover most of the costs.“It’s a way, at least for me, to be exposed to a different medical system, learn from different providers from a different country, exchange knowledge,” Ramos said. “I feel like I’m being adequately prepared to meet the needs of my patients in the US.” More

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      NHS medicines could be at risk due to Trump tariffs and global trade friction, ministers warned

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      The availability of around 85 per cent of NHS medicines could be at risk unless the UK government strengthens its supply chains to prepare for worsening geopolitical tensions, ministers have been warned.Manufacturers in Britain have urged the government to treat it as a defence issue, with the supply of drugs such as antibiotics under threat if global tensions continue to rise as a result of Donald Trump’s decision to impose hefty tariffs across the world.If pharmaceutical and medical suppliers are hit by the US-led tariff war, the NHS could have to pay more for medicines, another expert has said.The warnings come after health secretary Wes Streeting said UK medicines supplies could be impacted by the tariffs imposed on trade by President Trump.Mr Streeting said during an interview on Sky News that there are a “number of factors at play” when it comes to the UK’s supply of medicines, including manufacturing and distribution challenges, and he warned that tariffs pose “another layer of challenge”.The health secretary was responding after the US president said he was not looking to pause the sweeping tariffs that have plunged global markets into turmoil. Although the US tariffs have so far exempted the pharmaceutical industry, some medical devices and equipment are affected, so UK manufacturers would still be hit by 10 and 20 per cent tariffs when exporting to the US.Some companies which rely heavily on exports to the US are likely to consider moving their manufacturing from the UK to America, according to RBC analysts quoted in Endpoints News, which could push prices higher for Britons. The UK also imports £4.5bn in medical products from the US, where companies may raise prices due to tariffs on imported raw materials.Health secretary Wes Streeting said ministers are watching the situation ‘extremely closely’ More

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      in UK Politics

      Global trade friction sparked by Trump tariffs could put 85% of NHS medicines at risk, ministers warned

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      The availability of around 85 per cent of NHS medicines could be at risk unless the UK government strengthens its supply chains to prepare for worsening geopolitical tensions, ministers have been warned.Manufacturers in Britain have urged the government to treat it as a defence issue, with the supply of drugs such as antibiotics under threat if global tensions continue to rise as a result of Donald Trump’s decision to impose hefty tariffs across the world.If pharmaceutical and medical suppliers are hit by the US-led tariff war, the NHS could have to pay more for medicines, another expert has said.The warnings come after health secretary Wes Streeting said UK medicines supplies could be impacted by the tariffs imposed on trade by President Trump.Mr Streeting said during an interview on Sky News that there are a “number of factors at play” when it comes to the UK’s supply of medicines, including manufacturing and distribution challenges, and he warned that tariffs pose “another layer of challenge”.The health secretary was responding after the US president said he was not looking to pause the sweeping tariffs that have plunged global markets into turmoil. Although the US tariffs have so far exempted the pharmaceutical industry, some medical devices and equipment are affected, so UK manufacturers would still be hit by 10 and 20 per cent tariffs when exporting to the US.Some companies which rely heavily on exports to the US are likely to consider moving their manufacturing from the UK to America, according to RBC analysts quoted in Endpoints News, which could push prices higher for Britons. The UK also imports £4.5bn in medical products from the US, where companies may raise prices due to tariffs on imported raw materials.Health secretary Wes Streeting said ministers are watching the situation ‘extremely closely’ More

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      in UK Politics

      Voices: ‘I no longer recognise it’: Former staff and patients share experiences of the NHS

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      Public dissatisfaction with the NHS has reached record levels, sparking a passionate debate about the future of healthcare in the UK and what patients can reasonably expect from the service.When we asked for your views, many Independent readers shared deeply personal and often distressing experiences of being let down by an overstretched and under-resourced system. Common themes included poor access to GPs, long waits for hospital care, and essential services being cut without adequate communication. Some described surgeries reduced to little more than dispensaries, and a growing burden of travel for even the most routine care.Others highlighted serious breakdowns in communication between hospitals and GPs, outdated technology, and a bureaucratic rigidity that fails to reflect individual needs. There were also moving testimonies from people who received timely, life-saving care and praised the professionalism and compassion of NHS staff – even under immense pressure.But despite widespread frustration, most contributors expressed continued support for the founding principles of the NHS. Many agreed that the current problems stem not from the frontline workers, but from years of political neglect, underfunding, and systemic mismanagement.Here’s what you had to say:My local surgery is now just a glorified pharmacyI live in rural Devon and my local GP service is part of a medical group 14 miles away. My surgery (½ a mile away) only has a GP there two days a week, and mostly you are told to go to the “main” surgery, which is a 28-mile round trip, and there is no bus to it. There are 20 GPs on the medical group’s website and I have never met or spoken to any of them. Now they are refusing to do hospital-ordered blood tests at either surgery, so this means I have the “choice” of going somewhere else between 28–78 miles round trip for blood tests that I will need regularly for the rest of my life.My local surgery is now just a glorified pharmacy. You cannot get an appointment for weeks or even months. You used to go into the surgery and there would be a queue and people waiting to be seen, but now it’s like a ghost town. I have no choice but to be registered at this surgery as it is the only one I am in the catchment area for, but I want as little as possible to do with them after the way they have treated people like me needing blood tests. Callous disregard – that is all I receive from this surgery. As my conditions worsen and I get older, my world gets smaller, and yet I am expected to travel further and further for services that I should get in my own town.ValBI’ve been waiting over a year for sleep study results and a diagnosis. I have pain and chronic fatigue. I will be moving to another area in June and I’m not sure if I’ll have to start the process again. I feel I’ll be dead before I get seen!Mx5I cannot fault the treatment I receivedLast summer I fell over a pothole whilst crossing the road and seriously fractured my wrist. The irony is that although the state of the road was appalling, the treatment I received from the NHS was second to none. I was in an ambulance within 10 minutes, had major restorative surgery the next day and was home after 3 days. (The stay on the ward was another matter with too few staff having to deal with dementia patients who could not be discharged. Even so, they remained kind and polite despite the awful abuse they received from patients who should not have been in hospital.)My post-operative appointments were well managed with very little excessive waiting, and the consultants shared X-rays and their analyses of the improvements with me in an adult-to-adult way. The second operation to remove the plate went ahead as scheduled and I recovered well, although I did have to seek private physiotherapy as timely appointments were just not available. I cannot fault the treatment I received. Having lived and worked abroad (USA) in the past, I shudder to think what such service would have cost me (or my insurer, if I even had one willing to pay out without quibble).OK, perhaps I was just lucky, and I appreciate that many people do not have such timely and successful treatment. However, this was the first time in my life (and I am in my late 70s) that I have ever been admitted into hospital, and all I can say is that the interactions I had with ALL STAFF were thoroughly professional, and it was absolutely evident that at all times, my welfare was their primary concern. It is this ethos that is so important and significantly contributes to patient recovery. Despite the incredible demands that are made of them, the staff I encountered never fell short of this ideal.MikeJWI was talking to a care assistant yesterday. They had a resident needing urgent hospital admission on Saturday night. Eventually, the patient was prioritised (collect within two hours). To achieve this, the GP had to argue over the phone with the ambulance driver and the admissions nurse, who didn’t think (without seeing the patient) that it should be an admission. Madness!DafBDoes the NHS low rating reflect more on us?What should we expect? On May 17 last year I was rushed to the Norfolk and Norwich University Hospital in critical condition. During the three weeks I stayed there, I received treatment that was, to say the least, satisfactory. It was sufficient to restore me to a healthier state. If we’re assisted when we need it most, does that meet an objective standard by which to measure universal health care?Maybe I was lucky to get a lot more than that: the nursing staff provided genuinely kind attention. The doctors were engaged in my care and worked to find appropriate solutions, applying their expert judgement. The technicians were efficient and thoughtful. The contract staff also deserve a mention for their efforts. With only a few exceptions, the staff were friendly, considerate, dedicated, cheerful, and effective.Does the low rating the NHS has received reflect more on the society of moaners and whiners we have become? Want to take the NHS away? Not from my dead, lifeless hands – which might have been the case under a privatised system that I could not afford. Keep greed at bay and the profit motive in its place. Those who want to make health care exclusively “user pays” are only interested in making a killing (pun intended).SpineFilmPolitical footballA massive influx of migrants over many years with no corresponding increase in infrastructure. Many European doctors and nurses left after Brexit because they felt unwelcome. British-trained doctors are leaving the UK in numbers for where the grass is greener. The huge disruption of Covid. Around 50,000 clinical vacancies nationwide. Nowhere near enough doctors and nurses in training. The NHS is a political football at the mercy of posturing politicians. Just a few reasons for the massive mess.NomoneyinthebankLacking in common senseI had breast cancer resulting in a double mastectomy in 2008 and then again in 2017 when a new cancer developed from the tissue of my skin used in the reconstruction 8 years later. I had an ultrasound exam for five years after that. Then nothing.After querying this with The Royal Marsden, they refused to do further annual check-ups because I was told the NHS “guidelines” state that check-ups are only required for five years after a double mastectomy. These are guidelines, not rules, which my body clearly does not adhere to, given the eight-year gap between my cancers.I have twin daughters – one in Canada, the other in Australia. The guidelines for these countries mean they both receive an annual MRI scan from the age of 30, because of my history. Yet the NHS refuses to check me. Rigid, lacking in common sense, false economy.Aryhian1Going privateNot enough beds or staff to match the workload. I have recently gone private to have an operation (the NHS waiting list is nearly 12 months) to relieve extreme pain when walking or standing. Ironically, I could only afford to do this because of my NHS pension (which I paid into for 47 years).AndyBNothing but praiseI was diagnosed with stage four cancer four years ago. I had an operation five weeks later and, I’ve been on chemotherapy more or less continuously ever since. Currently, I attend the hospital every two weeks for chemo, as well as a mix of face-to-face and phone consultations. I have nothing but praise for the treatment I’ve received, and I am very grateful to the NHS and all the staff who’ve treated me.BozI’m not sure what my surgery doesI’m not sure what my surgery does anymore. It used to be full of people waiting to see the doctor. I got called for a check-up by the nurse. I sat in an empty waiting room, saw one person come in, and no one came out of the rooms. I was called 20 minutes later than my appointment time, which I would have considered acceptable in the past, but now I wondered what the nurse sitting in the room was doing during her time on her own.MorganErrors of communication… but excellent treatmentI can only speak as I find, and that is that I have received excellent treatment from the NHS over many years, notwithstanding errors of communication that occasionally happen in any organisation. Family connections have told me of computer system incompatibilities, which must be annoying, but not my experience of course. Covid messed things up a fair amount, as did progressive attempts by some politicians to go the American way and push insurance medicine.DaveN12Good care if you’re seriously illThe data communication between hospital and GP is seemingly incompatible, which causes problems, and there are numerous systemic shortfalls which are too numerous to mention.If you are seriously ill, however, the quality and provision of treatment services are still excellent and should be applauded rather than continually criticised.My husband was diagnosed with a very serious and life-threatening condition in November 2022. His treatment started in December 2022 and has continued to date.All of the staff, ranging from consultants, surgeons, and nurses to all ancillary staff, have shown nothing but care and kindness in a very skilled and professional manner throughout. This has been a very difficult time for us, but we have nothing but praise for the skills, hard work, and dedication provided.newmarketThree examples of an NHS in chaosFirst example: The NHS in our area (Bucks) is as close to a total joke as one can find! I’ve been waiting more than 14 months for a GP-assessed “urgent” dermatology appointment for a burn that won’t heal, and the county dermatology group downgraded it to “routine” WITHOUT ever even seeing me! I have just this week been back to our GP who has again raised an “urgent” referral, which I strongly believe will lead to nowt.Second example: I was in hospital (Berks.) in Dec 2019 for a severe bout of pneumonia. I had Bupa at the time and then saw a Bupa specialist (a Bucks NHS doctor!) who confirmed some additional lung investigation and a procedure likely would be needed. When I lost my job, after waiting 18 months to get back to that NHS doctor, she discounted everything she said needed to be/would be done.Third example: After I was discharged from the hospital for that 2019 stay, I was given 17 pages of printouts. I asked what to do with them and why they weren’t being sent electronically. I was told the NHS trusts don’t share electronically between (at least) Berks and Bucks. Great stuff, as we are now reverting back to the 1970s!Farce. Waste of time. Waste of money.SpendThriftyI don’t recognise the institution I trained inBoth my husband and I are ex-NHS workers – now retired. Our son is also an NHS frontline worker and, like many, suffered a great deal during the pandemic. I don’t now recognise the institution I trained and worked in, where the emphasis was on ever-improving patient care.I do remember the Blair years when the NHS flourished with proper funding, waiting lists were shorter, staffing levels and morale were high, and the delivery of care was motivated by patient needs.For nearly 15 years I have lived with a post-surgical complication which has had a huge impact on my life. Instead of care, I have been gaslighted, intermittently offered help, then left waiting years for nothing, several times ‘lost in the system’ and frequently being passed from one department to another. I know I am not alone.I really want to see care for the NHS restored by proper funding, and management allowed to do the time-consuming background work that is needed to keep it on its feet, instead of being vilified. Clinical staff should be free to deliver patient care; they can only do this with adequate funding and managed support. I would like to see a return to smaller regions and more equity nationally. As pensioners, neither myself nor my husband have confidence that we will receive the care we might need in our older age.Worrying times, in more ways than one.ClaraknellSome of the comments have been edited for this article for brevity and clarity. You can read the full discussion in the comments section of the original article here.The conversation isn’t over. To join in, all you need to do is register your details, then you can take part in the discussion. You can also sign up by clicking ‘log in’ on the top right-hand corner of the screen.Make sure you adhere to our community guidelines, which can be found here. For a full guide on how to comment click here. More

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      in US Politics

      Second child dies of measles in Texas amid rising outbreak

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      A second child with measles has died in Texas amid a steadily growing outbreak that has infected nearly 500 people in that state alone.The US health and human services department confirmed the death to NBC late Saturday, though the agency insisted exactly why the child died remained under investigation. On Sunday, a spokesperson for the UMC Health System in Lubbock, Texas, said that the child had been hospitalized before dying and was “receiving treatment for complications of measles” – which is easily preventable through vaccination.The family of the child in question had chosen to not get the minor vaccinated against the illness.Michael Board, a news reporter at Texas’s WOAI radio station, wrote on Sunday that official word from the state’s health and human services department was that the child died from “measles pulmonary failure” while having had no underlying conditions.Citing records it had obtained, the New York Times described the child as an eight-year-old girl.That marked the second time a child with measles had died since 26 February. The first was a six-year-old girl – also hospitalized in Lubbock – whose parents had not had her vaccinated.The Trump administration’s health secretary, Robert F Kennedy Jr, on Sunday identified the two children to have died with measles as Kayley Fehr and Daisy Hildebrand. Daisy was the one who died more recently, and Kennedy said in a statement that he traveled to her funeral on Sunday to be with her family as well as the community in its “moment of grief”.Kennedy for years has baselessly sowed doubt about vaccine safety and efficacy. He sparked alarm in March among those concerned by the US’s measles outbreak when he backed vitamins to treat the illness and stopped short of endorsing protective vaccines, which he minimized as merely a “personal choice” rather than a safety measure that long ago was proven effective.In his statement on Sunday, Kennedy said: “The most effective way to prevent the spread of measles is the MMR vaccine,” which also provides protection against mumps and rubella. He also said he would send a team to support Texas’s local- and state-level responses to the ongoing measles outbreak.A third US person to have died after contracting measles was an unvaccinated person in Lea county, New Mexico, officials in that state announced in early March.Dr Peter Marks, who recently resigned as the Food and Drug Administration’s vaccine while attributing that decision to Kennedy’s “misinformation and lies”, blamed the US health secretary and his staff for the death of the child being buried on Sunday.“This is the epitome of an absolute needless death,” Marks said Sunday during an interview with the Associated Press. “These kids should get vaccinated – that’s how you prevent people from dying of measles.”Marks also told the AP that he had warned US senators that the country would endure more measles-related deaths if the Trump administration did not more aggressively respond to the outbreak. The Senate health committee has called Kennedy to testify before the group on Thursday.One of that committee’s members is the Louisiana Republican and medical doctor Bill Cassidy, who frequently speaks about the importance of getting vaccinates against diseases but joined his Senate colleagues in voting to confirm Kennedy as the US health secretary.Cassidy on Sunday published a statement saying: “Everyone should be vaccinated.”There is “no benefit to getting measles”, Cassidy’s statement added. “Top health officials should say so unequivocally [before] another child dies.”Measles, which is caused by a highly contagious, airborne virus that spreads easily when an infected person breathes, sneezes or coughs, had been declared eliminated from the US in 2000. But the virus has recently been spreading in undervaccinated communities, with Texas and New Mexico standing among five states with active outbreaks – which is defined as three or more cases.The other states are Kansas, Ohio and Oklahoma. Collectively, as of Friday, the US had surpassed 600 measles cases so far this year – more than double the number it recorded in all of 2024. Health officials and experts have said that they expect the measles outbreak to go on for several more months at least – if not for about a year.Texas alone was reporting 481 cases across 19 counties as of Friday, most of them in the western region of the state. It registered 59 previously unreported cases between Tuesday and Friday. There were also 14 new hospitalizations, for a total of 56 throughout the outbreak.More than 65% of Texas’s measles cases are in Gaines county, which has a population of just under 23,000, and was where the virus started spreading in a tightly knit, undervaccinated Mennonite community.Gaines has logged 315 cases – in just over 1% of the county’s residents – since late January.The Associated Press contributed reporting More

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      in US Politics

      ‘A case study in groupthink’: were liberals wrong about the pandemic?

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      Were conservatives right to question Covid lockdowns? Were the liberals who defended them less grounded in science than they believed? And did liberal dismissiveness of the other side come at a cost that Americans will continue to pay for many years?A new book by two political scientists argues yes to all three questions, making the case that the aggressive policies that the US and other countries adopted to fight Covid – including school shutdowns, business closures, mask mandates and social distancing – were in some cases misguided and in many cases deserved more rigorous public debate.In their peer-reviewed book, In Covid’s Wake: How Our Politics Failed Us, Stephen Macedo and Frances Lee argue that public health authorities, the mainstream media, and progressive elites often pushed pandemic measures without weighing their costs and benefits, and ostracized people who expressed good-faith disagreement.View image in fullscreen“Policy learning seemed to be short-circuited during the pandemic,” Lee said. “It became so moralized, like: ‘We’re not interested in looking at how other people are [responding to the pandemic], because only bad people would do it a different way from the way we’re doing’.”She and Macedo spoke to the Guardian by video call. The Princeton University professors both consider themselves left-leaning, and the book grew out of research Macedo was doing on the ways progressive discourse gets handicapped by a refusal to engage with conservative or outside arguments. “Covid is an amazing case study in groupthink and the effects of partisan bias,” he said.Many Covid stances presented as public health consensus were not as grounded in empirical evidence as many Americans may have believed, Macedo and Lee argue. At times, scientific and health authorities acted less like neutral experts and more like self-interested actors, engaging in PR efforts to downplay uncertainty, missteps or conflicts of interest.It’s a controversial argument. Covid-19 killed more than a million Americans, according to US government estimates. The early days of the pandemic left hospitals overwhelmed, morgues overflowing, and scientists scrambling to understand the new disease and how to contain it.Still, Macedo and Lee say, it is unclear why shutdowns and closures went on so long, particularly in Democratic states. The book argues that in the US the pandemic became more politically polarized over time, after, initially, “only modest policy differences between Republican- and Democratic-leaning states”.After April 2020, however, red and blue America diverged. Donald Trump contributed to that polarization by downplaying the severity of the virus. Significant policy differences also emerged. Ron DeSantis, the Republican governor of Florida, moved to re-open physical schools quickly, which progressives characterized as irresponsible.Yet in the end there was “no meaningful difference” in Covid mortality rates between Democratic and Republican states in the pre-vaccine period, according to CDC data cited in the book, despite Republican states’ more lenient policies. Macedo and Lee also favorably compare Sweden, which controversially avoided mass lockdowns but ultimately had a lower mortality rate than many other European countries.The shutdowns had foreseeable and quantifiable costs, they say, many of which we are still paying. Learning loss and school absenteeism soared. Inflation went through the roof thanks in part to lockdown spending and stimulus payments. Small businesses defaulted; other medical treatments like cancer screenings and mental health care suffered; and rates of loneliness and crime increased. The economic strain on poor and minority Americans was particularly severe.Covid policies escalated into culture wars, amplifying tensions around other social issues. Teachers’ unions, which are often bastions of Democratic support, painted school re-openings as “rooted in sexism, racism, and misogyny” and “a recipe for … structural racism”, the book notes, despite the fact that minority and poor students were most disadvantaged by remote learning.These measures also had a literal price. “In inflation-adjusted terms,” Macedo and Lee write, “the United States spent more on pandemic aid in 2020 than it spent on the 2009 stimulus package and the New Deal combined” – or about what the US spent on war production in 1943.View image in fullscreenYet of the $5tn that the US Congress authorized in 2020 and 2021 for Covid expenditure, only about 10% went to direct medical expenses such as hospitals or vaccine distribution, according to the book; most of the spending was on economic relief to people and businesses affected by shutdowns. Ten per cent of that relief was stolen by fraud, according to the AP.The pandemic was an emergency with no modern precedent, of course, and hindsight is easy. But In Covid’s Wake tries to take into account what information was known at the time – including earlier pandemic preparedness studies. Reports by Johns Hopkins (2019), the World Health Organization (2019), the state of Illinois (2014) and the British government (2011) had all expressed ambivalence or caution about the kind of quarantine measures that were soon taken.“We take a look at the state of the evidence as it was in early 2020,” Lee said. “It was clear at the time that the evidence was quite unsettled around all of this, and if policymakers had been more honest with the public about these uncertainties, I think they would have maintained public trust better.”The Johns Hopkins Center for Health Security hosted a wargaming exercise in October 2019, shortly before the pandemic began, to simulate a deadly coronavirus pandemic; the findings explicitly urged that “[t]ravel and trade … be maintained even in the face of a pandemic”. Similarly, a WHO paper in 2019 said that some measures – such as border closures and contact tracing – were “not recommended in any circumstances”.“And yet we did all of that in short order,” Macedo said, “and without people referring back to these plans.”He and Lee also believe there was a strong element of class bias, with a left-leaning “laptop class” that could easily work from home touting anti-Covid measures that were much easier for some Americans to adopt than others. Many relatively affluent Americans became even wealthier during the pandemic, in part due to rising housing values.At the same time, the laptop class was only able to socially isolate at home in part because other people risked exposure to provide groceries. Stay-at-home measures were partly intended to protect “essential workers”, but policymakers living in crisis-stricken major metropolitan areas such as New York or Washington DC did not reckon with why social distancing and other measures might be less important in rural parts of the country where Covid rates were lower.Lockdowns were intended to slow Covid’s spread, yet previous pandemic recommendations had suggested they only be used very early in an outbreak and even then do not buy much time, Macedo said.View image in fullscreenPolicymakers and experts often embraced stringent measures for reasons that are more political than medical, Macedo and Lee argue; in a pandemic, authorities are keen to assure anxious publics that they are “in charge” and “doing something”.In strange contrast, policymakers and journalists in the US and elsewhere seemed to take China as a model, the book argues, despite the fact that China is an authoritarian state and had concealed the scale of the outbreak during the crucial early days of the pandemic. Its regime had obvious incentives to mislead foreign observers, and used draconian quarantine measures such as physically welding people into their homes.When the WHO organized a joint China field mission with the Chinese government, in February 2020, non-Chinese researchers found it difficult to converse with their Chinese counterparts away from government handlers. Yet the WHO’s report was “effusive in its praise” of China’s approach, the book notes.“My view is that there was just a great deal of wishful thinking on the part of technocrats of all kinds,” Lee said. “They wanted there to be an answer – that if we do X and Y, we can prevent this disaster. And so they’re kind of grasping at straws. The Chinese example gave them hope.” She noted that Covid policymakers might have been better served if there had been people assigned to act as devil’s advocates in internal deliberations.Lee and Macedo are not natural scientists or public health professionals, they emphasize, and their book is about failures in public deliberation over Covid-19, rather than a prescription for managing pandemics.But they do wade into the debate about Covid-19’s origin, arguing that the “lab leak” hypothesis – that Covid-19 accidentally leaked from the Wuhan Institute of Virology, rather than spontaneously leaping from animals to humans – was unfairly dismissed.The Wuhan Institute studied coronaviruses similar to the one responsible for Covid-19, had a documented history of safety breaches, was located near the outbreak, and is known to have experimented on viruses using controversial “gain-of-function” methods funded by the US, which involve mutating pathogens to see what they might look like in a more advanced or dangerous form.Perhaps because Trump had fanned racial paranoia by calling Covid-19 the “China virus” and rightwing influencers were spreading the notion that it had been deliberately engineered and unleashed on the world by China, many scientists, public health experts and journalists reacted by framing the idea of a lab leak – even an accidental one – as an offensive conspiracy theory. Dr Anthony Fauci and other top public health figures were evasive or in some cases dishonest about the possibility of a lab leak, Macedo and Lee say, as well as the fact that a US non-profit funded by the National Institutes of Health allegedly funded gain-of-function research at the Wuhan Institute.Since then, though, the CIA and other US intelligence agencies have cautiously endorsed the lab leak theory, and the discourse around Covid has softened somewhat. The economist Emily Oster sparked immense backlash by arguing against school closures in 2020. Now publications such as New York Magazine and the New York Times have acknowledged the plausibility of the lab leak hypothesis, for example, and there is growing consensus that school closures hurt many children.The reception to In Covid’s Wake has been more positive than Macedo and Lee expected – perhaps a sign that some of their arguments have penetrated the mainstream, if not that we’ve gotten better as a society at talking about difficult things. “The reception of the book has been much less controversial [and] contentious than we expected,” Macedo said.Yet the wounds fester and debates continue. Some readers of the New York Times were furious when The Daily, the newspaper’s flagship podcast, recently interviewed them, with subscribers arguing that the episode was not sufficiently critical of their stance. And some coverage of the book has criticized it for underplaying the danger of the disease.Macedo and Lee said that a few of their colleagues have expressed concern that their critique could fuel political attacks on science – a worry that crossed their minds too. “Our response is that the best way to refute criticisms that science and universities have been politicized is to be open to criticism and willing to engage in self-criticism,” Macedo said.“We need to make sure these institutions are in the best possible working order to face the challenges ahead. And we think that’s by being honest, not by covering over mistakes or being unwilling to face up to hard questions.” More

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      in US Politics

      Trump administration eviscerates maternal and child health programs

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      Multiple maternal and child health programs have been eliminated or hollowed out as part of the Department of Health and Human Services (HHS) layoffs, prompting alarm and disbelief among advocates working to make Americans healthier.The fear and anxiety come as a full accounting of the cuts remains elusive. Federal health officials have released only broad descriptions of changes to be made, rather than a detailed accounting of the programs and departments being eviscerated.“Pediatricians, myself included, are losing sleep at night – worried about the health of the nation’s children,” said Dr Sue Kressly, president of the American Academy of Pediatrics.“The one that stands out to me is the Maternal and Child Health Bureau. There is no way to make our country healthier by eliminating expertise where it all starts, and it all starts at maternal and child health.”The health secretary, Robert F Kennedy Jr, announced HHS would eliminate 10,000 jobs as part of a restructuring plan. Together with cuts already made by Elon Musk’s unofficial “department of government efficiency”, HHS is likely to lose 20,000 workers – roughly one-quarter of its workforce.“We aren’t just reducing bureaucratic sprawl,” Kennedy said. “We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic.”Piecemeal and crowd-sourced information, which has filled the vacuum left by a lack of information from the health department, appears to show maternal health programs slated for elimination, many without an indication of whether they will be reassigned. The Guardian asked HHS to comment on the cuts but did not receive a response.The picture of cuts was further muddied on Thursday when Kennedy told reporters, according to Politico: “We’re going to do 80% cuts, but 20% of those are going to have to be reinstalled, because we’ll make mistakes.”In the aftermath of the height of the Covid-19 pandemic, there’s been much conservative criticism of public health agencies, particularly the Centers for Disease Control and Prevention (CDC). Pandemic policy continues to be an animating force within the Republican party, whose supporters are cynical about the value of federal public health programs following federal vaccine mandates.The cuts to maternal health programs may serve a second purpose for Republicans.Such programs have come under fire in some conservative states, in part because the experts involved investigate deaths that could have been prevented with abortion services – now illegal or severely restricted in nearly two dozen conservative states.As part of the restructuring, the administration announced 28 divisions would be folded into 15, including the creation of a new division, called the “Administration for a Healthy America”, or “AHA”.The administration argued the “centralization” would “improve coordination of health resources for low-income Americans and will focus on areas including, primary care, maternal and child Health, mental health, environmental health, HIV/Aids and workforce development”.Meanwhile, experts in HIV/Aids, worker health and safety, healthcare for society’s most vulnerable, and experts in maternal and child health have received “reduction in force” notices, a federal term for layoffs, or have been placed on administrative leave with the expectation of being eliminated.“It certainly appears there was a particular focus on parts of HHS that dealt with women’s or reproductive health,” said Sean Tipton, chief policy officer at the American Society for Reproductive Medicine, about the cuts.He added: “How in the world you can justify the CDC eliminating the division of maternal mortality is beyond me.”Among the divisions hard-hit was the Health Resources and Services Administration (HRSA), an operating division of HHS like the CDC, which housed the the Maternal and Child Health Bureau. HRSA lost as many as 600 workers.The CDC’s division of reproductive health, which studies maternal health, appeared to have been nearly eliminated, according to multiple reports, with some of the division’s portfolio also expected to be folded into AHA.skip past newsletter promotionafter newsletter promotionThe entire staff of a gold-standard maternal mortality survey, a program that was called the Pregnancy Risk Assessment Monitoring System, was also put on leave, Stat reported. The epidemiologist in charge of the CDC survey, Jennifer Bombard, wrote to colleagues on Tuesday: “[T]he entire CDC PRAMS team, including myself, has received the Reduction in Force (RIF) notice from HHS today.”A HRSA hotline that had fielded calls from new moms seeking mental health support was also cut, Stat reported. Layoffs at the Administration for Children and Families have jolted providers of federally backed high-quality childcare for low-income families, a program called Head Start.The CDC’s only experts on infertility were laid off, just days after Trump described himself as the “fertilization president” at an event marking Women’s History Month. The team had collected congressionally mandated statistics on fertility clinics’ success rates. Without the workers, it is unclear who at the department will help fertility clinics comply with the law.“I’m astounded, sad, perplexed,” said Barbara Collura, president of Resolve: The National Infertility Association. “Infertility impacts one in six people globally, and now we don’t have anybody at the CDC who knows anything about infertility and IVF?”A division of the CDC called the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention also appeared to be gutted, with the director Jonathan Mermin placed on administrative leave. Among the center’s many tasks, it worked to curb the spread of congenital syphilis, a debilitating disease that is on the rise in the US.The March of Dimes, an influential non-profit whose mission is to improve the health of mothers and babies, said the cuts “raise serious concerns” at a time when maternal mortality rates remain “alarmingly high”.“As an OB-GYN and public health leader, I can’t overstate the value these resources and programs – and our partners across CDC, HRSA, and NIH – have brought to families and frontline providers,” said Dr Amanda Williams, the interim chief medical Officer at the March of Dimes.“We rely on the data, research, clinical tools and partnerships built by the Division of Reproductive Health (DRH) and HRSA to protect maternal and infant health – especially in communities hit hardest.”Heads of National Institutes of Health (NIH) centers were also forced out – and, apparently, offered reassignment to the Indian Health Service to be stationed in Alaska, Montana or Oklahoma, the journal Nature reported. Such large-scale reassignments are unprecedented, according to Stat.Among those to be placed on leave was one of the federal government’s pre-eminent leaders of research, the director of the National Institute of Allergy and Infectious Diseases (NIAID) Dr Jeanne Marrazzo. Marrazzo had expertise in sexually transmitted infections and women’s reproductive tract infections – a background that gave health advocates hope of curbing the US’s sky-high STD rates. Dr Diana Bianchi, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, was also forced out.“These cuts are significant,” Kressly said. “And the policy and program changes that are made because the cuts impact real people in real communities, and I’m not just talking about the people who lost their jobs.” More

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      in UK Politics

      Chlorinated chicken: Is it bad for you and will it be sold in British supermarkets?

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      British negotiators are in “intense discussions” with the United States on closer trade ties, the chancellor has said, in an attempt to ease the impact of Donald Trump’s looming tariffs.One of the products being touted as part of the free trade deal is chlorine-washed chicken – a controversial method of cleaning farmed animals to kill bacteria.While evidence suggests the chlorine wash itself is not harmful, critics argue treating chicken with the chemical will allow for poorer hygiene earlier on in the production process.Reform UK leader Nigel Farage said he would agree to allow American chlorine-washed chicken to be sold in the UK as part of a free trade deal with the US. He said, as part of a deal, US President Trump “would want US agricultural products to be sold in Britain”.However, Liz Webster, founder of Save British Farming, told The Independent: “The British public is rightly appalled by chlorinated chicken and hormone-fed beef. We are an animal-loving nation that values high standards, and we must not trade them away.”Packs of ‘Brexit Selection Freshly Chlorinated Chicken’ sit on display at ‘Costupper’ Brexit Minimart pop-up store, set up by the People’s Vote campaign group, in November 2018 More

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      in US Politics

      Mehmet Oz confirmed by US Senate to lead Medicare and Medicaid

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      Former heart surgeon and TV pitchman Dr Mehmet Oz was confirmed on Thursday to lead the Centers for Medicare and Medicaid Services (CMS).Oz became the agency’s administrator in a party-line 53-45 vote.The 64-year-old will manage health insurance programs for roughly half the country, with oversight of Medicare, Medicaid and Affordable Care Act coverage. He steps into the new role as Congress is debating cuts to the Medicaid program, which provides coverage to millions of poor and disabled Americans.Oz has not said yet whether he would oppose such cuts to the government-funded program, instead offering a vision of promoting healthier lifestyles, integrating artificial intelligence and telehealth into the system, and rethinking rural healthcare delivery.During a hearing last month, he told senators that he did favor work requirements for Medicaid recipients, but that paperwork shouldn’t be used to reaffirm that they are working or to block people from staying enrolled.Oz, who worked for years as a respected heart surgeon at Columbia University, also noted that doctors dislike Medicaid for its relatively low payments and some don’t want to take those patients.He said that when Medicaid eligibility was expanded without improving resources for doctors, that made care options even thinner for the program’s core patients, which include children, pregnant people and people with disabilities.“We have to make some important decisions to improve the quality of care,” he said.Oz has formed a close relationship with his new boss, Robert F Kennedy Jr. He’s hosted the health secretary and his inner circle regularly at his home in Florida. He’s leaned into Kennedy’s campaign to “make America healthy again” (Maha), an effort to redesign the nation’s food supply, reject vaccine mandates and cast doubt on some long-established scientific research.The former TV show host talks often about the importance of a healthy diet, aligning closely with Kennedy’s views.skip past newsletter promotionafter newsletter promotionWhile Oz has faced some criticism for promoting unproven vitamin supplements and holistic treatments – staples of the “Maha movement” – he’s regularly encouraged Americans to get vaccinated.Oz will take over the CMS days after the agency was spared from the type of deep cuts that Kennedy ordered at other public health agencies. Thousands of staffers at the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes for Health are out of a job after mass layoffs that started on Tuesday.The CMS is expected to lose about 300 staffers, including those who worked on minority health and to shrink the cost of healthcare delivery. More