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    Six former US surgeons general warn RFK Jr is ‘endangering nation’s health’

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    Six former US surgeons general – the top medical posting in Washington – warned in an opinion column published on Tuesday that policy changes enacted by the health and human services (HHS) secretary, Robert F Kennedy Jr, are “endangering the health of the nation”.The surgeons general – Jerome Adams, Richard Carmona, Joycelyn Elders, Vivek Murthy, Antonia Novello and David Satcher – who served under both Republican and Democrat administrations, identified changes in vaccine policy, medical research funding, a shift in priorities from rationality to ideology, plunging morale, and changes to staffing as areas of concern.Referring to their oaths of office, both Hippocratic as physicians and as public servants, the former officials wrote in the Washington Post that they felt “compelled to speak with one voice to say that the actions of Health and Human Services Secretary Robert F. Kennedy Jr. are endangering the health of the nation”.“Never before have we issued a joint public warning like this. But the profound, immediate and unprecedented threat that Kennedy’s policies and positions pose to the nation’s health cannot be ignored,” they said, adding that they could not ignore the “profound, immediate and unprecedented threat” of his policies.Under a “Make America Healthy Again” (Maha) agenda, Kennedy has accelerated vaccine policy changes despite opposition from scientists, including narrowing eligibility for Covid-19 vaccine shots and dismissing members of a vaccine advisory panel.He has cut federal funding for mRNA vaccine research for respiratory illnesses and instituted a review of vaccine recommendations. Kennedy also sought the dismissal of Dr Susan Monarez, former head of the US Centers for Disease Control and Prevention (CDC).Monarez testified before Congress last month that her firing by Donald Trump came after refusing a request from Kennedy to dismiss CDC vaccine experts “without cause”.Kennedy said in June that waning public trust in US healthcare and conflicts of interest between the medical establishment and the pharmaceutical industry are behind a mission to put “the restoration of public trust above any pro- or anti-vaccine agenda”.“The public must know that unbiased science guides the recommendations from our health agencies. This will ensure the American people receive the safest vaccines possible,” he said.The surgeons general pushed back on that characterization in their letter, noting that they had uniformly “watched with increasing alarm as the foundations of our nation’s public health system have been undermined.“Science and expertise have taken a back seat to ideology and misinformation. Morale has plummeted in our health agencies, and talent is fleeing at a time when we face rising threats – from resurgent infectious diseases to worsening chronic illnesses,” they said.They accused Kennedy of failing to ground public healthcare policy in science, pointing out that Kennedy “has spent decades advancing dangerous and discredited claims about vaccines” and referred to the recent measles outbreak in parts of the US.“Secretary Kennedy is entitled to his views,” the authors concluded. “But he is not entitled to put people’s health at risk. He has rejected science, misled the public and compromised the health of Americans.”Last week, two psychiatric organizations – the Southern California Psychiatric Society and a grassroots startup, the Committee to Protect Public Mental Health – called for Kennedy’s removal as health secretary in a statement, arguing that the HHS had “been damaged in ways that directly endanger lives, degrade scientific integrity, and obstruct effective treatment for mental health and substance use disorders”.The groups pointed to Kennedy’s restructuring of the agency including changes to the substance abuse and mental health services administration (Samhsa), which the secretary plans to place under the control of a new entity, titled the Administration for a Healthy America (AHA).Emily Hilliard, a spokesperson for the federal health department, said in a statement to NPR that “Secretary Kennedy remains firmly committed to delivering on President Trump’s promise to Make America Healthy Again by dismantling the failed status quo, restoring public trust in health institutions, and ensuring the transparency, accountability, and decision-making power the American people voted for.” More

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      Trump’s H-1B visa fee is a death sentence for US healthcare | Eram Alam

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      The Trump administration announced last week that every new H-1B visa will now cost $100,000. Framed as a crackdown on Silicon Valley, the policy will devastate American hospitals. Its real casualties will be poor and rural Americans in need of medical care, but with no one left to provide it.One in four US physicians is foreign-trained. Many enter through the H-1B program, disproportionately staffing rural and underserved hospitals where American graduates rarely go. In some facilities, every single doctor is an immigrant. These are the physicians who deliver babies in Mississippi Delta towns, staff emergency rooms in the Dakotas, and run primary care clinics in the Bronx. By raising visa costs from a few thousand dollars to $100,000, the administration is functionally cutting off their pipeline.The consequences will be immediate and severe. In this year’s residency match, international graduates filled more than 6,600 positions, with the vast majority in internal medicine and family medicine – the unglamorous workhorses of primary care. American graduates consistently avoid these specialties, preferring higher-paying and more prestigious fields. Without immigrant physicians, safety-net hospitals will be unable to fill residency slots, rural areas will lose their only steady doctors, and wait times for basic care will stretch our even further than they already are. The result will not be new jobs for Americans; it will be shuttered clinics and lives lost.The administration claims that cutting off immigrant doctors will catalyze domestic production of physicians. But training a doctor takes at least a decade, and requires investments in medical education that both major US political parties have consistently refused to make. Since the 1960s, Congress has chosen not to expand medical school and residency capacity in line with population growth, instead treating immigrant doctors as a convenient – and far cheaper – stopgap.When Medicare was created in 1965, lawmakers agreed to fund graduate medical education precisely because hospitals argued they could not sustain the high cost of residency training on their own. But funding was capped in the 1990s, and despite repeated warnings about looming shortages, Congress has failed to lift those limits. Today, the Association of American Medical Colleges projects a shortfall of up to 86,000 physicians by 2036. That crisis is not the product of immigration policy. It is the predictable result of decades of underinvestment in training the workforce Americans need.As I show in my forthcoming book, the Care of Foreigners: How Immigrant Physicians Changed US Healthcare, the US has always yoked the fate of immigrant physicians to the health of American patients. After the second world war, when new public insurance programs like Medicare and Medicaid expanded access to care, lawmakers turned to foreign doctors to fill the gaps. The 1965 Hart-Celler Act, passed the same year as Medicare, was explicitly designed to recruit highly trained professionals from abroad. Within a decade, tens of thousands of physicians – overwhelmingly from India and other postcolonial nations – were staffing hospitals across the United States.This arrangement was hailed as mutually beneficial: the US got the doctors it needed, and immigrant physicians got training and opportunity. But the costs were exported. Countries like India, with far fewer doctors per capita and vastly greater health burdens, lost tens of thousands of their best-trained clinicians. American lawmakers knew it. In 1967, Senator Walter Mondale called it a “national disgrace” that the US was siphoning lifesaving workers from countries “where thousands die daily of disease” in order to staff American hospitals. Yet the practice persisted, institutionalized as a structural feature of US healthcare.What Donald Trump’s new policy does is break even with this pragmatic, longstanding “America-first” tradition with which the country has long prioritized its own convenience over an honest accounting of its effects on the poorer nations from which it continually extracts value. Instead of using immigration policy to stabilize the system, it weaponizes it for exclusion. The $100,000 fee is not simply a labor market reform. It is a political message: immigrant doctors are expendable, and so are the patients they serve.The American Medical Association, the American Hospital Association, and 53 leading medical societies have already urged the administration to exempt physicians from the new fee. But carving out exceptions misses the point. Relying on temporary waivers and emergency visas has always been a precarious way to run a healthcare system. Immigrant physicians are not a contingency plan. They are the backbone of American medicine – and they deserve stability, not discretionary exemptions subject to the whims of Kristi Noem, the homeland security secretary.The deeper crisis at play is not immigration at all. It is America’s refusal to build a sustainable pipeline with which to ensure care for its citizens. For 60 years, policymakers have papered over severe underinvestment in medical education and poor rural and urban communities by exploiting immigrant labor. Now, instead of repairing that rotten foundation, the administration is simply dynamiting the patchwork that has kept the system functional. Wealthy hospitals in big cities may find ways to absorb the costs. Rural and safety-net hospitals cannot. Patients in those communities – disproportionately poor, rural, and minority – will be the ones left sacrificed in service of Trump’s indulgence for dramatic, nonsensical proclamations without accounting for their very real consequences for American communities.The lesson of this moment should not be that immigrant doctors need another exception. It is that Americans cannot afford to keep treating healthcare labor as a disposable commodity, imported when convenient and scapegoated when politically expedient. What we need is structural reform: expanding medical school and residency capacity, investing in primary care, and ensuring that immigrant doctors who already sustain the system have a predictable, efficient and permanent route to practice.Immigrant physicians have long been America’s safety net. To slam the door on them now, without fixing the underlying shortages, is more than shortsighted. It is a policy of exclusion disguised as reform – and it will cost lives. America first, in this case, will make Americans die.

      Eram Alam is a historian of medicine and migration in the department of the history of science at Harvard University. She is the author of the Care of Foreigners: How Immigrant Physicians Changed US Healthcare, forthcoming from Johns Hopkins University Press in October 2025 More

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      California nurses decry Ice presence at hospitals: ‘Interfering with patient care’

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      Dianne Sposito, a 69-year-old nurse, is laser-focused on providing care to anyone who enters the UCLA emergency room in southern California, where she works.That task was made difficult though one week in June, she said, when a federal immigration agent blocked her from treating an immigrant who was screaming just a few feet in front of her in the hospital.Sposito, a nurse with more than 40 years of experience, said her hospital is among many that have faced hostile encounters with Immigration and Customs Enforcement (Ice) agents amid the Trump administration’s escalating immigration crackdown.The nurse said that the Ice agent – wearing a mask, sunglasses and hat without any clear identification – brought a woman already in custody to the hospital. The patient was screaming and trying to get off the gurney, and when Sposito tried to assess her, the agent blocked her and told her not to touch the patient.“I’ve worked with police officers for years, and I’ve never seen anything like this,” Sposito said. “It was very frightful because the person behind him is screaming, yelling, and I don’t know what’s going on with her.”The man confirmed he was an Ice agent, and when Sposito asked for his name, badge, and warrant, he refused to give her his identification and insisted he didn’t need a warrant. The situation escalated until the charge nurse called hospital administration, who stepped in to handle it.“They’re interfering with patient care,” Sposito said.After the incident, Sposito said that hospital administration held a meeting and clarified that Ice agents are only allowed in public areas, not ER rooms and that staff should call hospital administration immediately if agents are present.But for Sposito, the guidelines fall short, as the hostility is unlike anything she has seen in over two decades as a nurse, she said..“[The agent] would not show me anything. You don’t know who these people are. I found it extremely harrowing, and the fact that they were blocking me from a patient – that patient could be dying.”Since the Trump administration has stepped up its arrest of immigrants at the start of the summer, nurses are seeing an increase in Ice presence at hospitals, with agents bringing in patients to facilities, said Mary Turner, president of National Nurses United, the largest organization of registered nurses in the country.“The presence of Ice agents is very disruptive and creates an unsafe and fearful environment for patients, nurses and other staff,” Turner said. “Immigrants are our patients and our colleagues.”While there’s no national data tracking Ice activity in hospitals, several regional unions have said they’ve seen an increase.“We’ve heard from members recently about Ice agents or Ice contractors being inside hospitals, which never occurred prior to this year, ,” said Sal Rosselli, president emeritus of the National Union of Healthcare Workers.Turner said nurses have reported that agents sometimes prevent patients from contacting family or friends and that Ice agents have listened in on conversations between patients and healthcare workers, actions that violate HIPAA, the federal law protecting patient privacy.In addition, Turner said, nurses have reported concerns that patients taken away by Ice will not receive the care they need. “Hospitals are supposed to discharge a patient with instructions for the patient and/or whoever will be caring for them as they convalesce,” Turner said.The increased presence of immigration agents at hospitals comes after Donald Trump issued an executive order overturning the long-standing status of hospitals, healthcare facilities and schools as “sensitive locations”, where immigration enforcement was limited.Nurses, in California and other states across the nation, said they fear the new policy, in addition to deterring care at medical facilities, will deter sick people from seeking care when they need it.“Allowing Ice undue access to hospitals, clinics, nursing homes and other healthcare institutions is both deeply immoral and contrary to public health,” said George Gresham, president of the 1199SEIU United Healthcare Workers East, and Patricia Kane, the executive director of the New York State Nurses Association in a statement. “We must never be put into positions where we are expected to assist, or be disrupted by, federal agents as they sweep into our institutions and attempt to detain patients or their loved ones.”Policies on immigration enforcement vary across healthcare facilities. In California, county-run public healthcare systems are required to adopt the policies laid out by the state’s attorney general, which limit information sharing with immigration authorities, require facilities to inform patients of their rights and set protocols for staff to register, document and report immigration officers’ visits. However, other healthcare entities are only encouraged to do so. Each facility develops its own policies based on relevant state or federal laws and regulations.Among the most high-profile cases of Ice presence in hospitals in California occurred outside of Los Angeles in July. Ming Tanigawa-Lau, a staff attorney at the Immigrant Defenders Law Center, represents Milagro Solis Portillo, a 36-year-old Salvadorian woman who was detained by Ice outside her home in Sherman Oaks and hospitalized that same day at Glendale Memorial, where detention officers kept watch in the lobby around the clock..Solis Portillo was then forcibly removed from Glendale Memorial against her doctor’s orders and transferred to Anaheim Global Medical center, another regional hospital, according to her lawyer. Once there, Ice agents barred her from receiving visitors, denied her access to family and her attorney, prevented private conversations with doctors and interrupted a monitored phone call with Tanigawa-Lau.“I repeatedly asked Ice to tell me which law or which policy they were referring to that allowed them to deny visits, and especially access to her attorney, and they never responded to me,” Tanigawa-Lau said.Ice officers sat by Solis Portillo’s bed and often spoke directly to medical staff on her behalf, according to Tanigawa-Lau. This level of surveillance violated both patient confidentiality and detainee rights, interfering with her care and traumatizing her, Tanigawa-Lau said.Since then, Solis Portillo was moved between facilities, from the Los Angeles processing center to a federal prison and eventually out of state to a jail in Clark county, Indiana.In a statement, Glendale Memorial said “the hospital cannot legally restrict law enforcement or security personnel from being present in public areas which include the hospital lobby/waiting area”.“Ice does not conduct enforcement operations at hospitals nor interfere with medical care of any illegal alien,” said DHS assistant secretary, Tricia McLaughlin. “It is a longstanding practice to provide comprehensive medical care from the moment an alien enters Ice custody. This includes access to medical appointments and 24-hour emergency care.”The federal government has aggressively responded to healthcare workers challenging the presence of immigration agents at medical facilities. In August the US Department of Justice charged two staff members at the Ontario Advanced Surgical center in San Bernardino county in California, accusing them of assaulting federal agents.The charges stem from events on 8 July, when Ice agents chased three men at the facility. One of the men, an immigrant from Honduras, fled on foot to evade law enforcement and was briefly captured in the center’s parking lot, and then he broke free and ran inside, according to the indictment. There,the government said, two employees at the center, tried to protect the man and remove federal agents from the building.“The staff attempted to obstruct the arrest by locking the door, blocking law enforcement vehicles from moving, and even called the cops claiming there was a ‘kidnapping’,” said McLaughlin. The Department of Justice referred questions about the case to DHS.The immigrant was eventually taken into custody, and the health care workers, Jesus Ortega and Danielle Nadine Davila were charged with “assaulting and interfering with United States immigration officers attempting to lawfully detain” an immigrant.Oliver Cleary, who represents Davila, said a video shows that Ice’s claim that Davila assaulted the agent is false.“They’re saying that because she placed her body in between them, that that qualifies as a strike,” Cleary said. “The case law clearly requires it to be a physical force strike, and that you can tell that didn’t happen.”The trial is slated to start on 6 October. More

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      Vinay Prasad returns to FDA days after leaving under pressure from Laura Loomer

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      Vinay Prasad is returning to his role overseeing vaccine, gene therapy and blood product regulation at the US Food and Drug Administration (FDA) a little more than a week after he left the agency.“At the FDA’s request, Dr Vinay Prasad is resuming leadership of the Center for Biologics Evaluation and Research,” Department Health and Human Services spokesperson Andrew Nixon said in a statement to Reuters.Prasad left the agency on 30 July after just a few months as director of the center.Endpoints News, which covers the biotech industry, first reported the return of Prasad.Prasad, an oncologist who was a fierce critic of US Covid-19 vaccine and mask mandates, was named the center’s director by the FDA’s commissioner, Marty Makary, in May.Criticism of Prasad’s tenure intensified around the agency’s handling of a gene therapy for Duchenne muscular dystrophy (DMD) from Sarepta Therapeutics.The FDA-approved therapy played a role in the death of two teens who had advanced DMD. After a third death in a separate experimental gene therapy from the company, the FDA asked Sarepta on 18 July to stop all shipments of the approved DMD therapy, saying it had safety concerns.The FDA changed course on Sarepta on 28 July and said shipments to the main group of patients for the drug could restart.Laura Loomer, a far-right influencer and conspiracy theorist with outsized sway over Donald Trump, had called Prasad a “progressive leftist saboteur” who was undermining the agency’s work.Two days before Prasad stepped down last month, Loomer had released misleadingly edited audio to suggest that that Prasad had admitted sticking pins in a Trump voodoo doll, when the full audio made it clear that he was talking about the kind of thing an imagined liberal Trump-hater would do.Loomer reacted to the news of Prasad’s return on Saturday by renewing her attacks on him in a social media post in which she promised to produce “exposes of officials within HHS and FDA” in the weeks ahead. “There are several Senate Confirmation hearings coming up and I have multiple oppo books ready for distribution!” she wrote.Prasad was a physician who joined the agency from the University of California, San Francisco. He has had stints at the National Cancer Institute and the National Institutes of Health.The FDA and other health agencies have seen multiple shake-ups in recent months under the leadership of health secretary Robert F Kennedy Jr. More

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      VA hospitals remove politics and marital status from guidelines protecting patients from discrimination

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      The Department of Veterans Affairs has imposed new guidelines on VA hospitals nationwide that remove language that explicitly prohibited doctors from discriminating against patients based on their political beliefs or marital status.The new rules, obtained by the Guardian, also apply to psychologists, dentists and a host of other occupations. They have already gone into effect in at least some VA medical centers.Under federal law, eligible veterans must be given hospital care and services, and the revised VA hospital rules still instruct medical staff that they cannot discriminate against veterans on the basis of race, color, religion and sex. But language within VA hospital bylaws requiring healthcare professionals to care for veterans regardless of their politics and marital status has been explicitly eliminated from these bylaws, raising questions about whether individual workers could now be free to decline to care for patients based on personal characteristics not expressly protected by federal law.Explicit protections for VA doctors and other medical staff based on their marital status, political party affiliation or union activity have also been removed, documents reviewed by the Guardian show.The changes also affect chiropractors, certified nurse practitioners, optometrists, podiatrists, licensed clinical social workers and speech therapists.In making the changes, VA officials cite Donald Trump’s 30 January executive order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”. The primary purpose of the executive order was to strip most government protections from transgender people. The VA has since ceased providing most gender-affirming care and forbidden a long list of words, including “gender affirming” and “transgender”, from clinical settings.The Department of Veterans Affairs is the nation’s largest integrated hospital system, with more than 170 hospitals and more than 1,000 clinics. It employs 26,000 doctors and serves 9 million patients annually.In an emailed response to questions, the VA press secretary, Peter Kasperowicz, did not dispute that language requiring medical staff to treat patients without discriminating on the basis of politics and marital status had been removed from the bylaws , but he said “all eligible veterans will always be welcome at VA and will always receive the benefits and services they’ve earned under the law”.He said the rule changes were nothing more than “a formality”, but confirmed that they were made to comply with Trump’s executive order. Kasperowicz also said the revisions were necessary to “ensure VA policy comports with federal law”. He did not say which federal law or laws required these changes.The VA said federal laws and a 2013 policy directive that prohibits discrimination on the basis of marital status or political affiliation would not allow patients within the categories removed from its bylaws to be excluded from treatment or allow discrimination against medical professionals.“Under no circumstances whatsoever would VA ever deny appropriate care to any eligible veterans or appropriate employment to any qualified potential employees,” a VA representative said.Until the recent changes, VA hospitals’ bylaws said that medical staff could not discriminate against patients “on the basis of race, age, color, sex, religion, national origin, politics, marital status or disability in any employment matter”. Now, several of those items – including “national origin,” “politics” and “marital status” – have been removed from that list.Similarly, the bylaw on “decisions regarding medical staff membership” no longer forbids VA hospitals from discriminating against candidates for staff positions based on national origin, sexual orientation, marital status, membership in a labor organization or “lawful political party affiliation”.Medical experts said the implications of rule changes uncovered by the Guardian could be far-reaching.They “seem to open the door to discrimination on the basis of anything that is not legally protected”, said Dr Kenneth Kizer, the VA’s top healthcare official during the Clinton administration. He said the changes open up the possibility that doctors could refuse to treat veterans based on their “reason for seeking care – including allegations of rape and sexual assault – current or past political party affiliation or political activity, and personal behavior such as alcohol or marijuana use”.Dr Arthur Caplan, founding head of the division of medical ethics at New York University’s Grossman School of Medicine, called the new rules “extremely disturbing and unethical”.skip past newsletter promotionafter newsletter promotion“It seems on its face an effort to exert political control over the VA medical staff,” he said. “What we typically tell people in healthcare is: ‘You keep your politics at home and take care of your patients.’” Caplan said the rules opened the door to doctors questioning patients about whether they attended a Trump rally or declining to provide healthcare to a veteran because they wore a button critical of JD Vance or voiced support for gay rights.“Those views aren’t relevant to caring for patients. So why would we put anyone at risk of losing care that way?” Caplan said.During the 2024 presidential campaign and throughout the early months of his second term, Trump repeatedly made threats against a host of people whom he saw as his political antagonists, including senators, judges and then president Joe Biden. He called journalists and Democrats “the enemy within”.In interviews, veterans said the impact of the new policy would probably fall hardest on female veterans, LGBTQ+ veterans and those who live in rural areas where there are fewer doctors overall. “I’m lucky. I have my choice of three clinics,” said Tia Christopher, a navy veteran who reported being raped in service in 2000.Based in Pittsburgh, Pennsylvania, Christopher advocates on behalf of military sexual trauma survivors throughout the country. Under the new policy, some may have to register at a hospital in another region and travel more than a hundred miles to see a doctor. It “could have a huge ripple effect”, she said.As concerned as they were about the new policies themselves, medical experts were equally worried about the way they came about. Sources at multiple VA hospitals, speaking on condition of anonymity because of fear of retaliation, told the Guardian that the rule changes were imposed without consultation with the system’s doctors – a characterization the VA’s Kasperowicz did not dispute.Such a move would run counter to standards established by the Joint Commission, a non-profit organization that accredits hospitals. Kasperowicz said the agency worked with the Joint Commission “to ensure these changes would have no impact on VA’s accreditation”.At its annual convention in Chicago this week, the American Medical Association’s 733-member policymaking body passed a resolution reaffirming “its commitment to medical staff self-governance … and urges all healthcare institutions, including the US Department of Veterans Affairs, to ensure that any amendments to medical staff bylaws are subject to approval by medical staff in accordance with Joint Commission standards”.The changes are part of a larger attack on the independence of medicine and science by the Trump administration, Caplan said, which has included restrictions and cuts at the National Institutes of Health and the Centers for Disease Control and Prevention, where the secretary of the Department of Health and Human Services, Robert F Kennedy Jr, last week fired every member of a key panel that advises the government on vaccines. The Guardian has earlier reported on a VA edict forbidding agency researchers from publishing in scientific journals without clearance from the agency’s political appointees. More

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      FDA suspends milk quality-control testing program after Trump layoffs

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      The Food and Drug Administration is suspending a quality-control program for testing fluid milk and other dairy products due to reduced capacity in its food safety and nutrition division, according to an internal email seen by Reuters.The suspension is another disruption to the nation’s food-safety programs after the termination and departure of 20,000 employees of the Department of Health and Human Services, which includes the FDA, as part of Donald Trump’s effort to shrink the federal workforce.The FDA this month also suspended existing and developing programs that ensured accurate testing for bird flu in milk and cheese and pathogens like the parasite Cyclospora in other food products.Effective Monday, the agency suspended its proficiency testing program for grade “A” raw milk and finished products, according to the email sent in the morning from the FDA’s division of dairy safety and addressed to “Network Laboratories”.Grade “A” milk, or fluid milk, meets the highest sanitary standards.The testing program was suspended because FDA’s Moffett Center Proficiency Testing Laboratory, part of its division overseeing food safety, “is no longer able to provide laboratory support for proficiency testing and data analysis”, the email said.An HHS spokesperson said the laboratory had already been set to be decommissioned before the staff cuts and that though proficiency testing would be paused during the transition to a new laboratory, dairy product testing would continue.The Trump administration has proposed cutting $40bn from the agency.skip past newsletter promotionafter newsletter promotionThe FDA’s proficiency testing programs ensure consistency and accuracy across the nation’s network of food safety laboratories. Laboratories also rely on those quality-control tests to meet standards for accreditation.“The FDA is actively evaluating alternative approaches for the upcoming fiscal year and will keep all participating laboratories informed as new information becomes available,” the email said. More

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      My child has autism. Trump and RFK Jr linking it to vaccines scares parents like me

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      It was a moment when Donald Trump’s larger-than-life presence on the global stage became unexpectedly personal.Near the end of his one-hour, 40-minute speech to a joint session of Congress on 4 March, the US president diverted from his favoured themes of a new golden age of American greatness and grievances against his adversaries to address a more unlikely topic: autism.The president drew his audience’s attention to Robert F Kennedy Jr, his controversial, newly confirmed choice as health secretary, and charged him with one overarching responsibility.“Not long ago, you can’t even believe these numbers – one in 10,000 children had autism,” Trump intoned. “Now it’s one in 36. There’s something wrong. One in 36 think of that. So we’re going to find out what it is. And there’s nobody better than Bobby.“Good luck. It’s a very important job.”It was not the first time that Trump had waded into the controversy swirling around autism – a neurodivergent condition affecting an estimated 75 million people worldwide. Nor was it the first occasion that he had touted Kennedy’s credentials as being able to tackle it.But the high symbolism of the setting brought home to me, a watching journalist, with sobering clarity that a life-changing decision, taken for the most pressing of family reasons, had taken on unforeseen contours.Just over two years ago, my wife and I had moved to the United States so that we could better address the needs of our son, who had been diagnosed with autism just before his third birthday. We had gradually despaired of finding a practical solution in the Czech capital of Prague, where we previously lived, and where state-of-the-art therapeutic remedies were still fledgling works in progress.America, by contrast, seemed to be a land of possibility and innovative approaches and to offer a more amenable environment to our circumstances – and had the added attraction that we all held US citizenship.In the period since our arrival, we found progress uneven, but engaged an outstanding therapist who made up for our difficulties navigating the Maryland state education system. I shifted my career from one centered in Europe, to covering US politics – and the second Trump administration.Now here – in the highest shrine of US democracy – was the graphically vivid figure of Trump digressing from his usual weaving script to elevate the very topic that had brought us to America’s shores to a national priority.It was not, to put it mildly, exactly what we had envisioned.The uptick in the autism trend Trump cited was exaggerated; while the most recent US autism statistics, recorded in 2020, did indeed record one in 36 children in the US having received a diagnosis of autism, the jump was less dramatic than he described – comparing with a rate of one in 150 in 2000, according to the Centers for Disease Control and Prevention (CDC).Nevertheless, the undoubted spike in instances of the condition meant that his proclaimed zeal to find a cause resonated with many, us included.The catch lay in his choice of Kennedy, who has declared that autism is caused by vaccines – a scientifically baseless theory which Trump himself has previously indulged – as the lead figure in a national crusade to discover a cause.I spoke with other parents of children with autism, who used a range of pejorative adjectives to deride this conviction; among them “dangerous”, “scary”, “batshit crazy”, “despicable” and “disgusting”.Kennedy’s views carry weight which, experts fear, will be lent still greater authority by his new health portfolio. The CDC is reportedly now planning a large study into potential connections between vaccines and autism.“Were I the father of a child with autism, I would be really angry at the anti-vaccine community for taking this story hostage and for diverting resources and attention away from the real cause, or causes, of autism,” said Paul Offit, a pediatrician specialising in immunology and author of the 2008 book Autism’s False Prophets, which rebutted the alleged links between the condition and vaccines.“There’s financial or emotional burdens that make it hard enough for parents, but to have this offered as a reason for why a child has autism is just spurious and in some ways malicious, because I think it puts the burden on the parent.”Belief in the alleged connection between vaccinations and autism gained traction after a 1998 study conducted by a British physician, Andrew Wakefield, and published in the Lancet asserted a causal link with the measles, mumps and rubella (MMR) vaccine. The paper ignited a firestorm of controversy in Britain, with the then prime minister, Tony Blair, pressured to say whether his baby son had been administered the MMR shot.But research underpinning the finding was later debunked as fraudulent, leading to the Lancet retracting the paper and Wakefield being struck off the UK medical register. Multiple subsequent studies have found no connection between the vaccine and autism.Despite the countervailing evidence, suspicions persisted – fuelled in no small part by Kennedy himself, who has shown himself unmoved in the face of challenge.My personal interest in Kennedy and his views on vaccines was piqued after hearing a 2023 podcast interview with the New Yorker. He was adamant under questioning from the magazine’s editor-in-chief, David Remnick, who – disclosing himself as the parent of a child with “quite severe” autism – asked if he had second thoughts about “slinging around theories … that don’t have any great credibility among scientists”.“I’ve read the science on autism and I can tell you … If it didn’t come from the vaccines, then where is it coming from?” Kennedy responded.Scientists say there are multiple potential answers to that question, including genetics, drugs taken during pregnancy, age of conception – albeit none giving a definitive explanation.skip past newsletter promotionafter newsletter promotion“When you hear about autism and its causes, the first thing people think is vaccines, which is the one thing you can say it’s not,” Offit said.Caught in the crossfire of this conflict between science and dogma are parents struggling to cope with a condition whose manifestations can be maddening, challenging and bewildering.Autism is a wide spectrum condition and children with it come in a surprising variety of types. Some – like my son – are functional, verbal and teachable, with aspects of high intelligence; others are non-verbal and may have severe intellectual disabilities; many others may fall somewhere in between.“If you’ve met one child with autism, you’ve met one child with autism,” goes the refrain among many specialists.Common to all, however, are atypical behaviours that for the parents, are life-changing and force them to make painful adaptations, sometimes at high financial cost.A complaint frequently heard about Kennedy’s views is that they heap stigmatisation on their children and unwarranted blame on the parents.“It puts a stigma on our children that their parents did something wrong when they were pregnant with them, and thus it’s the parents fault,” said Davina Kleid, 38, an executive assistant in a real estate development company in Maryland, whose nine-year-old daughter has autism.Kleid feared Kennedy’s views have the potential to unleash an eventual crackdown conjuring scenes resembling The Handmaid’s Tale, Margaret Atwood’s novel dystopian novel depicting a bleak patriarchal future and female subjugation.“Who knows? Maybe I could be arrested for having a child on the spectrum, because they’re going to say that I did something to purposely cause her to have this condition,” she said. “There’s nothing wrong with my child. It’s how she was born. I’m not ashamed of it, and I don’t think anyone should be ashamed of it.”Madeline, a publisher from Maryland who requested that her real name not be disclosed, said Kennedy’s views amounted to a disparagement of her 24-year-old son, who was born at the height of the MMR controversy arising from the Wakefield paper but who showed signs of developmental delay before being vaccinated.“It is just insulting that people would think that it would be better to get measles or mumps or pertussis or whooping cough than to have autism,” she said. “And RFK Jr has said as much. It’s like this is worse than getting these terrible, life-threatening diseases.”Lux Blakthorne, 33, a professional gardener living in Chester county, Pennsylvania, said fears for the future over her non-verbal, nine-year-old autistic son, Kai, had prompted her to make plans to emigrate to Germany, the country of her ex-husband’s birth and where she said provisions for autism had made great strides.The breaking point, she said, would be cuts to Medicaid, the public healthcare system that Kennedy oversees and which pays for Kai’s daily needs including education at a special private facility.An added factor is a recent White House executive order banning puberty blocking medication for those under 18, a measure aimed at stymying gender-affirming care for transgender youth but which, Blakthorne says, would prevent her trying to mitigate harmful autism-related behaviour that is likely to be exacerbated by the onset of puberty.“I think RFK sees disabilities as a problem that needs to be fixed,” said Blakthorne. “He has a dangerous belief system, and it’s not science- or fact-based.”Yet amid the negativity, the Autism Science Foundation, a research group, says Kennedy has a unique opportunity to discover its causes.“Many of us in the autism community give RFK credit for wanting to study the causes of autism,” said Alison Singer, the foundation’s president and the mother of a daughter with autism.“What would be very positive is if as health secretary, he can declare profound autism as a national public health emergency,” she said.“That would open up a variety of actions he could take, like making additional grants, entering into new contracts [and] really focusing funding on investigating the causes of autism, treatments and prevention.” More

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      ‘We’re on the edge of chaos’: families with trans kids fight for care as bans take hold

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      Aryn Kavanaugh was sitting in her living room in South Carolina when her 17-year-old daughter came into the room and said: “I’m really scared. I think people are gonna die.” Katherine, who is using her middle name for her protection, told Kavanaugh that she thought transgender youth may be the target of violence due to the hate generated by Donald Trump’s recent action.On 28 January, Trump issued an executive order to ban access to gender-affirming care for youth under 19 years old. It directed federal agencies to deny funding to institutions that offer gender-affirming medical care including hormones and puberty blockers.“She just felt like the world was crumbling around her. So we talked it out and tried to stay super positive,” said Kavanaugh, a parent of two trans children. “I think she really feels like we’re on the edge of chaos.”In a victory for trans kids and their families, a federal judge in Maryland blocked the ban on 4 March. The preliminary injunction extended a mid-February restraining order that blocked Trump’s directive and will remain in effect until further order from the US district court for the district of Maryland. In the meantime, the order prohibits the government from withholding federal funding to healthcare facilities that provide treatment to trans youth.Still, the executive order sent parents, children and medical providers into a tailspin as they deciphered its impacts. Some hospitals immediately canceled appointments and turned away new patients to adhere to the directive. In early February, Katherine was dropped as a patient at Virginia Commonwealth University, where she received gender-affirming care after South Carolina banned hormone therapy, surgery and puberty blockers for trans youth last year. Some parents say that their children’s mental health severely declined in the weeks following the executive order. And as a result, families have gone to great lengths to ensure that their trans kids continue to receive care, including considering moving abroad or stocking up on puberty suppressants.“We have seen dozens of families affected across the United States, in many, many states that have been left and abandoned without care that they need,” said Omar Gonzalez-Pagan, senior counsel and healthcare strategist at the LGBTQ+ civil rights organization Lambda Legal. “This is an unlawful executive order because it seeks to override the congressional mandate to condition federal financial assistance on non-discrimination, and this order seeks to require discrimination as a condition of federal funding.”The pause follows a lawsuit filed on 4 February by civil rights organizations including Lambda Legal and the American Civil Liberties Union (ACLU) on behalf of transgender youth. ACLU staff told the Guardian that they anticipated that the preliminary injunction would remain through the court proceedings.Some hospitals that stopped providing care to trans youth after the January directive, such as Children’s Hospital Los Angeles and Children’s Hospital of Richmond, lifted limits on surgeries or hormonal therapy in late February. Kavanaugh said she was “relieved and hopeful” about the preliminary injunction, though it does not roll back South Carolina’s ban on trans youth healthcare, which was signed into law last year.Her 18-year-old trans son Parker and Katherine received treatment at Medical University of South Carolina and then a private clinic in the state for several years until Henry McMaster, the governor of South Carolina, signed into law a ban on gender-affirming care for trans minors in May 2024. Parker is now old enough to receive his care in South Carolina, but the state ban means that the family has had to drive more than five hours each way to Virginia Commonwealth University for Katherine’s doctors’ appointments and medicine every few months.Being dropped as a patient due to the federal ban “puts us in a really tough spot because we’re already having to find care outside of South Carolina. And so that just limits our options,” Kavanaugh said. Katherine’s doctors connected her to a private medical practice in Fairfax, Virginia, that does not receive federal funding, so they were able to avoid a lapse in her care. While the change in providers did not cost more money, it stretched their commute to more than seven hours.In late February, Katherine’s puberty-blocker treatment at Virginia Commonwealth University resumed. In a statement, the hospital said that patients would continue medications, but that surgeries would remain suspended. Trans kids’ treatment remains in limbo as federal challenges wind through the court.‘A psychological toll’Studies have shown that gender-affirming medical care greatly improves trans people’s mental health and quality of life. A 2022 report published in the journal JAMA Network Open analyzed data from a study of 104 transgender and non-binary youth from ages 13 to 20 who received hormonal therapy or puberty blockers at the Seattle Children’s Gender Clinic for a year. Researchers found that 60% of participants reported lower rates of depression and 73% had less odds of suicidal ideation and self harm after receiving gender-affirming hormones and puberty blockers.Black transgender people, who experience the intersecting stigma of being gender diverse and racial minorities, are at even greater risk of poor mental health. A 2022 national survey of 33,993 LGBTQ+ young people by the Trevor Project, a non-profit, found that one in four Black transgender and nonbinary youth attempted suicide in the past year, more than double the rate of their cisgender counterparts.“It’s already difficult to access healthcare and treatment. It’s additionally difficult for folks who belong to other marginalized communities, especially families and children of color, as well as folks who are on various forms of state-funded insurance and may have difficulty selecting their providers to begin with,” Harper Seldin, a senior staff attorney at the ACLU, told the Guardian.“There is already a subset of gender clinics in this country who provide this care. When you lay over on top of that insurance and access based on family means, it’s particularly devastating for families who can’t just pick up and go somewhere else – to another city, state or other country – to get care.”While her trans daughter’s care hasn’t been directly affected by the executive order, Sarah, a Texas mother who asked that her last name not be used to protect her daughter’s privacy, said that her daughter Raven was devastated by the president’s directive. Raven, a 16-year-old Black trans girl in Texas who is using a pseudonym, dropped out of school last month due to her declining mental health, exacerbated by the federal ban. Sarah said that Raven had rarely got out of bed, and when she did, she would show her mom news reports of murdered Black trans girls and women.“She has told me that she’s afraid of being killed if she leaves the house,” Sarah said. “She really only will leave the house with me. But that’s very few and far between, because she’s just incredibly depressed.”Since dropping out of school, Sarah said that Raven’s depression and anxiety significantly decreased, and she plans to start GED test preparation classes over the summer.In November 2024, the LGBTQ+ non-profit Human Rights Campaign Foundation released a report that showed that half of the 36 transgender people killed in the last 12 months were Black trans women. That reality has made it terrifying for Raven to live as a Black trans girl, Sarah said.Raven’s medical providers have increased her antidepressants dosage, and she now checks in with her psychiatrist every three weeks. Since last year, Raven has had to fly to Colorado every six months to receive gender-affirming care due to a Texas ban on treatment for minors. She has received grants from the non-profit Campaign on Southern Equality to fund the travel for medical treatment, which has helped defer some of the exorbitant costs of seeking out-of-state care.Sarah said that she has researched living in other nations and would be willing to order medicine from Canada if Raven could no longer get medical treatment in Colorado. Gender-affirming care has drastically improved Raven’s life. “She feels more herself,” Sarah said. “If she didn’t have it, I don’t think she would choose to stay alive.”Navigating medical care restrictions has caused anxiety for parents who are shouldering the burden of the policies’ twists and turns for their children. A Georgia-based parent, Peter Isbister, said that he had chosen not to share the news of the executive order with his 11-year-old trans son Lev, who is using a pseudonym out of fear of harassment: “It’s taken a psychological toll on his parents, not on him.”An endocrinologist is currently monitoring Lev’s hormone levels to determine when he will be put on puberty blockers. Isbister, an attorney and founder of the peer support network Metro Atlanta TransParent, has to contend with the federal executive order and a looming ban on puberty blockers for minors in Georgia.“If the bill passes in Georgia, then we as a family are going to really have to study up more seriously on how it works to be an out-of-state person to get care in California, New Mexico, Massachusetts or wherever,” Isbister said. “And the more states that restrict access to care, the harder that’s going to be.”As a result of the federal and state policies, Isbister said that he has talked with an immigration attorney about acquiring Canadian citizenship for his son. But at least for now, Lev’s clinic continues to provide him care.While Isbister was “heartened” by the judge’s injunction on the executive order, he said that it is “wrenching and in my view unjust that my ability to provide my kid healthcare should be an issue for our federal courts”. More

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      Trump picks Brooke Rollins to lead Department of Agriculture

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      Donald Trump has chosen Brooke Rollins, president of the America First Policy Institute, to be agriculture secretary.“As our next Secretary of Agriculture, Brooke will spearhead the effort to protect American Farmers, who are truly the backbone of our Country,” the US president-elect said in a statement.Trump’s nomination of Rollins marks the completion of his top cabinet picks for his incoming administration.If confirmed by the Senate, Rollins would lead a 100,000-person agency with offices in every county in the country, whose remit includes farm and nutrition programs, forestry, home and farm lending, food safety, rural development, agricultural research, trade and more. It had a budget of $437.2bn in 2024.The nominee’s agenda would carry implications for American diets and wallets, both urban and rural. Department of Agriculture officials and staff negotiate trade deals, guide dietary recommendations, inspect meat, fight wildfires and support rural broadband, among other activities.“Brooke’s commitment to support the American Farmer, defense of American Food Self-Sufficiency, and the restoration of Agriculture-dependent American Small Towns is second to none,” Trump said in the statement.In response to her nomination, Rollins wrote on X: “Thank you, Mr. President, for the opportunity to serve as the next U.S. Secretary of Agriculture. It will be the honor of my life to fight for America’s farmers and our Nation’s agricultural communities. This is big stuff for a small-town ag girl from Glen Rose, TX — truly the American Dream at its greatest.”She added: “Who’s ready to make agriculture great again!”The America First Policy Institute is a right-leaning thinktank whose personnel have worked closely with Trump’s campaign to help shape policy for his incoming administration. Rollins chaired the Domestic Policy Council during Trump’s first term.As agriculture secretary, Rollins would advise the administration on how and whether to implement clean fuel-tax credits for biofuels at a time when the sector is hoping to grow through the production of sustainable aviation fuel.The nominee would also guide next year’s renegotiation of the US-Mexico-Canada trade deal, in the shadow of disputes over Mexico’s attempt to bar imports of genetically modified corn and Canada’s dairy import quotas.Trump has said he again plans to institute sweeping tariffs that are likely to affect the farm sector.He was considering offering the role to the former US senator Kelly Loeffler, a staunch ally whom he chose to co-chair his inaugural committee, CNN reported on Friday.In a separate announcement on Saturday, Trump urged Randy Fine, a former gambling industry executive and current Florida state senator, to run in a special election to represent the state’s sixth congressional district in the House of Representatives.Trump’s endorsement of Fine comes after he named Mike Waltz, Florida’s current sixth congressional district representative, to serve as his national security adviser.Writing on Truth Social, Trump called Fine “an incredible voice for MAGA”.“Should he decide to enter this Race, Randy Fine has my Complete and Total Endorsement. RUN, RANDY, RUN!” Trump added. More