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      Hear me out: RFK could be a transformational health secretary | Neil Barsky

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      Among the cast of characters poised to join the Trump administration, no one is as exasperating, polarizing or potentially dangerous as Robert F Kennedy Jr. But in a twist that is emblematic of our times, no single nominee has the potential to do as much good for the American people.Bear with me. RFK Jr has been rightly pilloried for promoting a litany of theories linking vaccines with autism, chemicals in the water supply to gender identity, how people contract Aids and saying the Covid-19 vaccine, which in fact stemmed the deadliest pandemic of our lifetimes, was itself “the deadliest vaccine ever made”. He claimed Covid-19 was meant to target certain ethnic groups, Black people and Caucasians, while sparing Asians and Jewish people.In normal times, these notions would be disqualifying. Spouting unfounded scientific claims is corrosive to a functioning democracy. It weakens the bonds of trust in our public institutions, and feeds the rightwing narrative that all government is illegitimate. This is why, writing in the Guardian this September, I dismissed the prospect of RFK Jr, saying his “anti-vaccine work is more likely to make America have measles again”.But these are not normal times. RFK Jr is Donald Trump’s pick to run our country’s health and human services department. He will have a massive impact on our broken, expensive and largely ineffectual delivery of healthcare services. How shall we deal with this?On one hand, RFK Jr’s anti-vaccine views are beyond the pale. To obtain Senate approval, I think he will have to repudiate the unproven assertion that the Covid-19 vaccine was harmful, and embrace the scientific reality that vaccines for measles, smallpox, coronavirus and other contagious diseases are in fact modern medical miracles that spared the lives hundreds of millions of people. And here is where I will part company with many of my Trump-fighting friends: should RFK Jr be able to abandon his numerous conspiracy theories about vaccines, he can be the most transformative health secretary in our country’s history.This is because RFK Jr has articulated what our Democratic and Republican leaders have largely ignored: our healthcare system is a national disgrace hiding in plain sight. He recognizes the inordinate control the pharmaceutical and food industries over healthcare policy, and the revolving door that exists among congressional staffers, pharmaceutical lobbyists and corporate executives. In testimony during hearings chaired by the Republican senator Ron Johnson this past September, Kennedy offered a lucid analysis of what is making America metabolically sick; he railed against big pharma and big food, and drew links between the damage done by ultraprocessed foods such as seed oils and sugars to our health, as well as the efforts of the food industry to come up with chemicals that make these foods addictive.He advocates banning pharmaceutical advertising on television, and wants to clamp down on the corporate ties to federal agencies such as the Food and Drug Administration and National Institute of Health. (To my knowledge, he has not spoken out against the egregious cost of life-saving drugs or unequal access to medical treatment, but hopefully he will get around to that as well.)We spend $4tn on healthcare annually, and lead the world in spending more than $12,000 per person, 50% more than Switzerland, which is the second biggest spender per capita. American doctors dominate the Nobel prizes for medicine, and our medical schools are considered the best in the world. Yet we appear incapable of stemming the epidemic of chronic diseases. A staggering 73% of us are obese or overweight and more than 38 million people suffer from diabetes.This issue hits home for me, as I was diagnosed with severe type 2 diabetes in 2021, and – after receiving terrible medical advice to rely on insulin and metformin – reversed my condition by adopting a diet low in carbohydrates. This year, I published a “follow the money” series for the Guardian, Death By Diabetes, in which I highlighted the heavy influence of big pharma and big food on the American Diabetes Association (ADA). The ADA is a so-called patient advocacy group that sets the standard of care for diabetes treatment in this country, and yet it accepts money from food companies such as the makers of Splenda and Idaho potatoes – two products which have been found to increase people’s risk of getting diabetes.I subsequently wrote about amputations, and the reality that African Americans with diabetes are four times more likely to endure that grim procedure than white people. I view nutrition and metabolic health as a matter of racial and economic equity. I am clear-eyed, I think, of the serious risks to public health that RFK Jr’s unfounded anti-vaccine views pose. But so long as we still have a voice and can find a drop of hope in these terrible times, I think we should try to tilt policy toward the public good where we can. To that end, here is the game plan I believe RFK Jr should pursue.

      Lose the conspiracies and stick to the science. RFK Jr is right, and there is more than ample research to focus on the deleterious impact of sugars and seed oils. Following the money has always been a valuable strategy. Let’s start there.

      Lean on the vast ecosystem of committed researchers, clinicians and writers who have devoted their career to promoting metabolic health, even while knowing they would forfeit access to government and pharmaceutical grants. Many of these mavericks come from top medical schools, but they are a decided minority on their faculties. They include clinicians such as Georgia Ede, Mariela Glandt, Tony Hampton, Eric Westman, scientists such as Benjamin Bikman, Ravi Kampala, Cate Shanahan, and writers such as Gary Taubes, Nina Teicholz and Casey Means. These are heroic people who, in getting to know them and reading their work, I have found to be intellectually honest health practitioners.

      Appoint a diabetes czar to come up with proposals to once and for all fix this deadly and utterly reversible disease. I choose this particularly chronic ailment because it is ubiquitous, ruinously expensive, a disease that disproportionately afflicts the poor, is closely connected to our obesity epidemic, and utterly reversible through diet. Wouldn’t it be amazing if we could finally reverse type 2 diabetes in our lifetime?

      Increase federal funding of nutrition studies. The FDA and NIH historically have tilted the research scales in favor of studies that might produce the next blockbuster drug. In reality, we still do not understand why we get fat and why we have seen an increase in chronic (non-contagious) diseases such as diabetes, Alzheimer’s and Crohn’s.

      Severely regulate the ability of cereal companies to market their sugary wares to children, and the ability of pharmaceutical companies to barrage the rest of us with advertisements. Will a Republican-controlled Congress allow for more government regulation – even if it saves lives?
      RFK Jr’s ascent represents a tricky issue for people like myself who strongly supported the election of Kamala Harris. Healthcare is far from the only issue I am committed to, and I am disgusted by the Trump administration’s plans to deport millions of undocumented people, its attack on democratic institutions, and possible abandonment of Ukraine and the Nato alliance. While I disagreed with Liz Cheney about many, if not most, issues, I also embraced her apostasy when it came to the election – I adhere to the approach of not interrupting people you disagree with while they are doing the right thing.After writing something unkind about RFK Jr in the days leading up to the election, I received a private note from Jan Baszucki, a prominent metabolic health advocate I have come to admire over the past year. “With all due respect,” she wrote. “I am a big fan of your reporting on type 2 diabetes. But your comments about RFK Jr … are not helpful to the cause of metabolic health, which is only on the national agenda because he put it there.”Leading up to the election, I believed RFK Jr was fair game. I was, and remain, particularly concerned that his fringe ideas about vaccines and poisons would get conflated with his excellent perspective on metabolic health, and hurt the cause. Now I think we should be constructive where we can advance the public good.The larger question hanging over RFK Jr’s term as HHS secretary is whether Donald Trump will back him up when he takes on the pharmaceutical and food industries. The US’s health is not an issue the president-elect has evinced an interest in in the past. And his embrace of corporate executives such as Tesla’s Elon Musk suggests crony capitalism could be the dominant theme of the second Trump administration. But if we know anything about what makes Trump tick, we know that he responds to positive reinforcement.After all, it was the criminal justice advocates such as Van Jones and Trump’s son-in-law Jared Kushner who coaxed him into supporting the First Step Act, a significant piece of criminal justice reform (and one which Trump now forswears). As founder of the Marshall Project, the non-profit journalism organization that covers the US criminal justice system, I believe criminal justice reform should also be a matter of national urgency, yet at the time, I was ambivalent about efforts to work with the administration. In retrospect, whatever harm Trump might have otherwise inflicted, I would say we are a better country for the First Step Act.We are in a similar dilemma with respect to healthcare today: the system is ruinously expensive and inhumane. If there is someone in the administration who wants to make things better, let’s not interrupt him.

      Neil Barsky, a former Wall Street Journal reporter and investment manager, is the founder of the Marshall Project More

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      The appointment of Robert F Kennedy has horrified public health experts. Here are his three most dangerous ideas | Devi Sridhar

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      The announcement that Donald Trump has appointed Robert F Kennedy as the US secretary of health and human services has sent shock waves through the health and scientific community. Kennedy ran as an independent presidential candidate before bowing out and supporting Trump’s run in exchange for an influential position, so we have a pretty good idea of his positions on public health.The main goal Kennedy has trumpeted recently is to “Make America healthy again”. At face value, it’s a noble aim. That’s the essence of public health: how to reduce risk factors for disease and mortality at a population level and improve the quality of health and wellbeing. But behind this slogan comes a darker, conspiracy-laden agenda. As someone who has spent a lot of time researching global public health, these are the positions I believe could be the most dangerous.Anti-vaxxer viewsKennedy is well known as a prominent anti-vaxxer. He has claimed that vaccines can cause autism, and also said that “there’s no vaccine that is safe and effective”. He called the Covid-19 vaccine the “deadliest vaccine ever made”. None of these claims are true: repeat studies have shown that the MMR vaccine does not cause autism, we have numerous safe and effective vaccines against childhood killers such as whooping cough and measles, and the Covid-19 vaccines have saved millions of lives globally.Much of what he is saying is what people want to hear: being anti-vax is increasingly a way to build a fanbase. I have seen this as a scientist: if you talk about childhood vaccinations, you get daily abuse. If you talk about the dangers of vaccines, you can end up with a cult following, as Russell Brand and Andrew Wakefield have. It’s not even clear that Kennedy personally believes what he’s saying: guests invited to a holiday party at his home in December 2021 were told to be vaccinated or tested for Covid-19 (he blamed his wife).The big question is about how much harm he can do in the next few years as the man who oversees health agencies in the US. Will he roll back budgetary allocations for vaccination campaigns? Eliminate research into new vaccines? With avian flu continuing to spread in mammals and birds, will he support the stockpiling and rollout of H5N1 vaccines if necessary in a future outbreak or pandemic? If his appointment is approved, experts say that vaccines will be “the first issue on the table”.The “benefits” of raw milkSimilarly, he has tweeted about the benefits of raw milk, which has become a bizarre Maga talking point generally. Raw milk consumption is a risk factor for a number of dangerous illnesses from E coli to salmonella, but is even more worrying with the widespread infection of dairy herds in the US. While pasteurisation has been shown to kill the H5N1 virus in milk and prevent its ability to infect, raw milk retains its pathogens. This year, 24 cats who drank raw milk on a farm become infected by avian flu; 12 died and 12 suffered from blindness, difficulty breathing and other serious health problems. This is when we need federal agencies to regulate what is being sold to the public and ensure clear communication of the health risks. Instead, raw milk demand has gone up, with some vendors claiming that “customers [are] asking for H5N1 milk because they want immunity from it”. (There’s a certain irony in the logic behind vaccination – training our immune system in how to respond to a pathogen – being used in this situation.)Anti-pharmaceutical conspiracy theoriesPart of the problem of the “Make America healthy again” campaign is that it contains nuggets of truth within a larger false narrative. We know that the prices charged by “big pharma” in the US are a problem – but instead of thinking this is a conspiracy to medicate the public when that’s not in their best interests, it’s worth reflecting on how the UK has managed to negotiate more reasonable prices. This is where government can have real power: ensuring fair prices for healthcare providers and individuals, and going after the extraordinary profit margins of pharmaceutical companies. But instead of taking this on – for instance, Trump could have negotiated Covid-19 vaccine prices in his first presidency – it is easier to demonise all pharma companies. Many of them of course play a valuable role in trialling and bringing drugs and vaccines to market. They just need to be regulated.Taking on these ideas will be a challenge when their proponent is leading US health policy. How do you try to engage with those who believe things that are simply not true? It’s hard: a recent Nature study found that the more time you spend on the internet trying to validate what is true and not true, you more you go down the rabbit hole of false information. Those who believe outlandish theories are generally people who think of themselves as more intelligent than the average person, have a lot of time to do their own research on the internet, and are convinced that everyone else is being duped.The US has a big health problem. Life expectancy is going dramatically backwards, Covid-19 killed a huge number of working-age Americans and trust in the federal government is at 23%. But the solution, if we look to healthier countries such as Denmark and South Korea, involves basic public health interventions, access to affordable medical care and trust in government. And not drinking raw milk.

      Prof Devi Sridhar is chair of global public health at the University of Edinburgh

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      US overdose deaths decreased in 2023 – will Trump continue this trend?

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      The Biden administration saw unprecedented levels of US opioid overdose fatalities, but those deaths are now declining faster than they have in decades – progress a second Trump administration could continue or threaten, experts say.The number of overdose deaths in the US declined for the first time in five years in 2023, and have continued to decline more rapidly this year, according to provisional data.Some of the decline may have resulted from Biden administration efforts to expand access to harm-reduction services, especially the overdose-reversal drug naloxone, which received over-the-counter approval for the first time last year. Public health experts worry that the second Trump administration will gut access to healthcare, including addiction treatment.The president-elect’s legacy on opioids is complicated. When Trump first took office, he inherited a rapidly escalating overdose crisis. Opioid overdose deaths more than doubled during the Obama administration,according to data from the Centers for Disease Control and Prevention. The three most recent presidential administrations have all failed to quell escalating opioid overdose deaths, which nearly doubled again during the Trump and Biden administrations, dipping slightly in 2018 but overall jumping by 62% during Trump’s first term in 2020. Under Biden, deaths increased by 19% from 2020 to 2022, to 81,806, before declining by 2% last year.At times, the Trump administration seemed to work against itself when it came to the crisis. For example, Trump repeatedly attempted to gut funding for the Office of National Drug Control Policy, although Congress blocked his efforts. Similarly, Trump was frequently in disputes with Congress over attempts to repeal elements of the Affordable Care Act and its expansions to Medicaid, which funds treatment for 40% of adults with opioid use disorder.Still, experts contacted by the Guardian within and outside the first Trump administration credit the president-elect for putting unprecedented focus on the crisis.Trump signed an executive order in 2017 forming the Presidential Commission on Combating Drug Addiction and the Opioid Crisis. Bertha Madras, a professor in Harvard’s psychiatry department who served on the commission, said it wasn’t until Trump “established the commission that a significant integrated national response materialized”.Adm Brett Giroir, who served as an assistant secretary in Trump’s Department of Health and Human Services, says that he was given the authority to head up an unofficial “opioids cabinet … which met every week at the White House under Kellyanne Conway to make sure every department was working on this crisis”.Others praise Trump for supporting harm-reduction efforts, despite past opposition from his party.“President Trump publicly supported syringe services programs, a first for a Republican president,” said Jerome Adams, who served as surgeon general under Trump. Indeed, the Trump administration in some ways paved the way for the Biden administration’s response to the crisis. Access to naloxone expanded significantly under Trump, and even more under Biden.But despite these efforts, the number of US overdose deaths climbed for the majority of Trump’s first term. Giroir and Madras both attribute the huge overdose spike in 2020 to the Covid-19 pandemic, which overwhelmed the healthcare system and increased depression and suicide.Andrew Kolodny, medical director for the Opioid Policy Research Collaborative at Brandeis University, says the administration should have done more.“The first time around, President Trump did an excellent job of calling attention to the opioid crisis and designating it as a public health emergency,” he conceded, but he also said the then president failed to take sufficient action or establish a long-term plan.While the Trump administration allocated unprecedented amounts of funding to combat the crisis, Kolodny said the impact was limited, because states were usually given funds in the form of one- or two-year grants.“That’s not really adequate for building out a treatment system that doesn’t exist yet,” Kolodny said. “If you were to hire a whole bunch of staff, what would you do if you don’t get that appropriation the next year? Do you lay everybody off?”skip past newsletter promotionafter newsletter promotionExperts disagree on whether the administration spent too much of that funding on law and border enforcement, rather than treatment. Giroir supported harm-reduction and treatment expansion during his time under Trump, and is proud of his efforts to remove red tape and increase access to the opioid-cessation drug buprenorphine. Still, he says, “enforcement has to dominate the discussion”, because treatment is less effective than preventing addiction in the first place.Other experts say that criminalization only exacerbates the crisis.“Under Trump’s previous administration, they federally criminalized all fentanyl-related substances in 2018 – and overdose deaths increased from 67,367 that year to 70,630 and 93,331 in 2019 and 2020 respectively,” said Kassandra Frederique, executive director of the Drug Policy Alliance.Kolodny didn’t necessarily agree that criminalization drove the overdose increases, but he did say “the balance should be different” when it comes to prioritizing treatment over law enforcement. He said the best way to immediately reduce the overdose death count would be to make treatment “basically free” and overall easier to access than fentanyl.“[People with opioid use disorder] are not out there using fentanyl because it’s so much fun. If they don’t use, they’re gonna be very, very sick … People can really feel like they’re gonna die,” he said.It’s hard to predict how Trump will tackle the overdose crisis the second time around. He avoided the topic during his recent presidential campaign, and instead focused on inaccurate talking points about immigrants trafficking drugs across the border. He also falsely claimed he had never wanted to repeal the Affordable Care Act. But a Republican-controlled Congress could cut ACA subsidies and Medicaid.Frederique worries that Trump will continue prioritizing drug arrests during his second term, but said during his first term “he also dedicated billions of dollars toward research, education, prevention and treatment. We are committed to supporting the Trump administration’s previous efforts to advocate for health approaches such as increasing access to treatment and naloxone.” More

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      Mike Pence urges Senate Republicans to reject RFK Jr for US health secretary

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      Mike Pence, the former vice-president, urged Senate Republicans on Friday to reject Donald Trump’s choice of Robert F Kennedy Jr as health secretary – although he cited Kennedy’s support for abortion rights, while other critics are most outraged at his stance against vaccines.Pence’s comments came as public alarm mounted among Democrats and in health circles about Kennedy, while there were bipartisan warnings that another of Trump’s choices, the far-right congressman Matt Gaetz for attorney general, faces “an uphill battle” to win confirmation in the US Senate, despite Republicans winning the majority in the upper congressional chamber.Pence cited his conservative views on abortion for his opposition to Kennedy’s elevation to secretary of health and human services (HHS).“The Trump-Pence administration was unapologetically pro-life for our four years in office. There are hundreds of decisions made at HHS every day that either lead our nation toward a respect for life or away from it, and HHS under our administration always stood for life,” Pence said in a statement released by his conservative non-profit, Advancing American Freedom.“I believe the nomination of RFK Jr to serve as Secretary of HHS is an abrupt departure from the pro-life record of our administration and should be deeply concerning to millions of Pro-Life Americans who have supported the Republican Party and our nominees for decades.”Prominent medical professionals have joined leading Democrats in speaking out against Kennedy, who has embraced a multitude of debunked health-related conspiracy theories, and whose proposed elevation to the government’s top health job represents “a clear and present danger to the nation’s health” and “a catastrophe”, according to some critics.“I think this is an extraordinarily bad choice. He does not plan to lean on evidence and rigorous analysis to make decisions but instead to use his own ideas,” Dr Ashish Jha, Covid-19 coordinator for the Biden White House and dean of Brown University’s School of Public Health, told CNN.Dr Richard Besser, former acting director of the powerful US Centers for Disease Control and Prevention (CDC), told the network that Kennedy’s views criticizing childhood vaccines, including the false claim that they cause autism, were “dangerous”.“Frankly, I find it chilling. He has done so much to undermine the confidence that people have in that incredible intervention,” he said.Trump has been assembling a cabinet for his second term in office, making announcements this week from his residence in Florida, and on Thursday named Kennedy to lead HHS and its associated agencies.He praised the politician, a former independent presidential candidate and outcast from the Democratic Kennedy political dynasty, at a black-tie gala at Mar-a-Lago on Thursday night.“If you like health and if you like people that live a long time, it’s the most important position,” he said. Directly addressing Kennedy, who was in the ballroom of Trump’s Mar-a-Lago residence and private resort club, he added: “We want you to come up with things and ideas, and what you’ve been talking about for a long time.”Democrats were quick to express outrage. The California representative Robert Garcia called it “fucking insane” and described Kennedy as “a tin foil hat conspiracy theorist”.The Massachusetts representative Jake Auchincloss promised to “fight back in Washington to protect the integrity” of federal public health agencies if Kennedy is confirmed by the Senate.“RFK Jr is a conspiracist & quack who threatens the health of Americans. He’s not simply angling for more sunshine & exercise (no one disagrees with that). He seeks to overturn evidence-driven, peer-reviewed research on medicines & more,” Auchincloss posted to X.Shares in several of the world’s biggest pharmaceutical companies and vaccine manufacturers, including Moderna, AstraZeneca and GSK, plummeted on Friday in reaction to the news.Kennedy has previously said “there’s no vaccine that is safe and effective” but told NBC in a post-election interview that he “won’t take away anybody’s vaccines”.skip past newsletter promotionafter newsletter promotionTrump on Thursday nominated a vocal ally of his to be interior secretary – Doug Burgum, the Republican North Dakota governor. The role would put him in charge of national parks and public lands, and he has strong links to the fossil fuel industry, where many companies have strong appetites for government permits to drill and mine on federal land.Republicans will have a majority of at least 53-47 seats in the chamber during the next Congress, but even so, two other of Trump’s picks are already receiving bipartisan pushback: Gaetz and the former Democratic congresswoman turned Republican Tulsi Gabbard, named for director of national intelligence. Former secretary of state Hillary Clinton once described her as a “favorite of the Russians”.Gaetz resigned as a US representative for Florida on Wednesday, in effect suspending the planned release on Friday of a report by the House of Representatives ethics committee into allegations of sexual misconduct, including that he had sex with a 17-year-old girl, which he has denied. His nomination as the nation’s leading law enforcement officer was seen by some as a direct challenge by Trump to the incoming Republican Senate majority to defy his authority.“For me the message to the administration is simply that Matt Gaetz has a very long, steep hill to get across the finish line and it will require the spending of a lot of capital,” North Dakota’s Republican senator Kevin Cramer told the Washington Post.“That ethics report is clearly going to become a part of the record.”On Friday, Joni Ernst, Republican senator for Iowa, also said the report was expected to feature prominently in a confirmation hearing. “We’ll talk about it for certain, but I know he’s going to have an uphill battle [for confirmation],” she told NBC News.Other Republicans demanded the release of the report, including Washington congressman Dan Newhouse and Texas senator John Cornyn.Meanwhile former defense secretary and Republican US senator Chuck Hagel published an opinion piece in the New York Times challenging Trump’s controversial nominee for defense secretary, Pete Hegseth, as a potential “danger” to political independence, good ethics and progress towards equality in the US military. He also questioned the potential for Trump to sidestep Senate confirmations.Trump has signaled he could resort to rare recess appointments, the archaic process allowing a president to install his nominees while Congress is not in session. More

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      in UK Politics

      Sectioned patients to avoid being locked in cells in overhaul of mental health system

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      Your support helps us to tell the storyFrom reproductive rights to climate change to Big Tech, The Independent is on the ground when the story is developing. Whether it’s investigating the financials of Elon Musk’s pro-Trump PAC or producing our latest documentary, ‘The A Word’, which shines a light on the American women fighting for reproductive rights, we know how important it is to parse out the facts from the messaging.At such a critical moment in US history, we need reporters on the ground. Your donation allows us to keep sending journalists to speak to both sides of the story.The Independent is trusted by Americans across the entire political spectrum. And unlike many other quality news outlets, we choose not to lock Americans out of our reporting and analysis with paywalls. We believe quality journalism should be available to everyone, paid for by those who can afford it.Your support makes all the difference.CloseRead moreClosePatients sectioned under the Mental Health Act will have more dignity and a say over their care under proposed reforms to what has been described as an “outdated” system.Among the changes as part of the Mental Health Bill, which will come before parliament on Wednesday, police cells and prison cells will no longer be used for people experiencing a mental health crisis, with patients instead expected to be looked after within a suitable healthcare facility.In July’s King’s Speech, Labour vowed to update the Mental Health Act in a bid to shift the balance of power from the system to the patient, with the aim of putting service users at the centre of decisions about their own care.Writing exclusively for The Independent, health secretary Wes Streeting raised the story of Georgie, who was diagnosed with anorexia nervosa at 16, forced to quit school, and admitted to a mental health ward.Health secretary Wes Streeting has promised that the new bill will address a significant shift in attitudes to mental illness More

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      Trump’s queasy prescription to ‘make America healthy again’ takes shape

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      From assertions that America’s highest-profile vaccine critic would lead health agencies to new promises for “massive reform” of Obamacare, the chaotic last week of Donald Trump’s presidential campaign will probably serve as a preview of what “Make America healthy again” could mean should the former president regain power.The jumble of proposals echoed conservative policy documents, channeled the residual anger of the post-pandemic anti-vaccine movement and alarmed experts who help set the nation’s health policies.“My first reaction is that a Trump administration would be the most anti-public health, anti-science administration in history,” said Lawrence Gostin, a global health law professor at Georgetown Law School.“In my mind, health is very much on the ballot,” he said.Over the last week of the campaign, Trump said he would let the nation’s foremost vaccine skeptic “go wild” at the nation’s food and drug agencies and refused to rule out banning certain vaccines. The Republican House speaker, Mike Johnson, also promised “massive reform” of Obamacare should Trump win.Vaccines are among society’s most effective public health interventions, saving an estimated 154 million lives worldwide over 50 years, according to a study in the Lancet. Obamacare has grown in popularity even among Republicans.“It reminds me of the chaos of the first administration, right in the midst of the pandemic,” said Gostin, referring to a time when Trump floated bogus treatments for Covid from injecting disinfectant to ivermectin to hydroxychloroquine – all debunked and often actively harmful.“But it’s far worse,” continued Gostin, “because while Trump at least was surrounded by credible scientists like Tony Fauci, I don’t think there will be any similar restraint in the next Trump administration.”The official Republican party platform is short on details, but blames immigrants for high healthcare prices, and says the party will “commit” to lowering healthcare prices through “choice” and “transparency”. It also pledges to “protect” Medicare from Democrats, who it claims plan to allow “tens of millions of new illegal immigrants” to enroll in the program.Voters in both parties cite healthcare costs as their top health-related issue. However, transparency measures would probably only result in a 1% reduction in healthcare prices over 10 years, according to the Congressional Budget Office. “Choice” is often a euphemism for reducing health insurance regulations, which would allow Americans to buy plans that cover fewer services.Undocumented migrants are not eligible to enroll in Medicare, and the Democratic presidential candidate, Kamala Harris, backed away from a policy that would have provided government-backed healthcare to all residents of the US, regardless of immigration status.A detailed look at how Trump’s supporters might attempt to change US health policy is found in the conservative playbook Project 2025. There, health policy proposals are dominated by calls to restrict abortion and diminish the role of scientific research.In it, the Department of Health and Human Services (HHS) should be known as the “Department of Life”, approval for medication abortion should be withdrawn, and health policy should promote “fatherhood” and the “nuclear family” and stop research that amounts to “woke transgender activism”.HHS should stop focusing on “LGBTQ+ equity” and end policies that are “subsidizing single-motherhood, disincentivizing work, and penalizing marriage”. Its sub-agencies, such as the Centers for Disease Control and Prevention, should be split in two with the power to make policy recommendations severely curtailed. The “incestuous relationship” between government researchers and vaccine manufacturers should end, the plan says.As voters head to the polls, the people who might institute these policies have also come into focus. Robert F Kennedy Jr, the former independent candidate and staunch vaccine critic, said he had been “promised” a role helming the nation’s health agencies by Trump.“The key, which President Trump has promised me, is control of the public health agencies,” said Kennedy on a Zoom call with supporters, according to ABC News. Those agencies include “HHS and its sub-agencies, CDC, Food and Drug Administration, [National Institutes of Health] and a few others. And also the [United States Department of Agriculture], which is, you know, key to making America healthy”.skip past newsletter promotionafter newsletter promotionKennedy ended his presidential run and endorsed Trump in August after a conspiracy theory-fueled campaign that revealed he had health issues related to a brain worm, once sawed the head off a whale and dumped a dead bear in Central Park.Dr Joseph Ladapo has been floated as a potential pick for the head of HHS. The Harvard University-educated Florida surgeon general warned state residents against using Covid-19 vaccines and allowed unvaccinated children to go to school during a measles outbreak.Although ideas floated by Trump’s supporters may be easily disproved, health researchers and policy experts said they take the threat of their influence deadly serious, with the last week highlighting how legitimate concerns about the power of pharmaceutical and chemical companies can be exploited.“I think we leaned into a libertarian left hook,” said Dr Paul Offit, director of the vaccine education center at Children’s Hospital of Philadelphia and a member of an advisory committee on vaccines for the US Food and Drug Administration (FDA).Offit said he worried vaccine mandates primed some Americans to believe vaccine misinformation, and even though he supported them, worried they may “have done more harm than good”.Another research advocate who spoke anonymously to Science magazine said: “We’re all in a state of panic … I don’t know anybody who isn’t worried about this.”Soon, the nation will know the extent to which such messages resonated with voters.“I’m surprised that anti-vaccine rhetoric is considered to be convincing enough to get you elected,” said Offit. “I’m surprised that such a significant portion of the population would be compelled by that.”Read more of the Guardian’s 2024 US election coverage

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      ‘If Harris wins, it’s because of abortion’: election tests fallout from Roe reversal

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      Leslie Lemus’s top issue in the 2024 election is probably the economy. But she has a close second: “Them fucking with abortion.”Really, for the 26-year-old Arizona native, the two issues are one and the same. On Monday, she got an abortion at Camelback Family Planning, one of the last abortion clinics in Arizona, in large part because Lemus feels like she can’t financially care for a child right now.“I look at the world and it’s not very pretty. I’m not ready for that yet, to bring a child into the world right now, where the economy is not OK,” said Lemus, who said she lived paycheck to paycheck. Some months, she has to choose between making her car payments and paying off her credit card debt. “Everybody’s struggling left and right.”View image in fullscreenLemus is registered to vote in Maricopa county, which is home to 60% of the Arizona electorate and may determine whether Kamala Harris or Donald Trump wins the valuable swing state. Harris has made access to reproductive rights a key part of her policy platform – particularly as a contrast to Trump, who appointed three of the US supreme court justices who overturned Roe v Wade and who has toggled between branding himself as a champion of reproductive rights and as “the most pro-life president”.Lemus is a passionate supporter of Harris, who she calls “my homegirl”.Majorities of Americans have backed abortion access and Roe v Wade for decades, but it was rarely their top issue in the voting booth. Now that the US supreme court has overturned Roe, permitting more than a dozen states to ban almost all abortions and several more to ban it at six, 12, or – as in Arizona – 15 weeks, abortion may become the deciding issue of the 2024 election. It is now the most important issue for women under 45, like Lemus.“If Harris wins the election, it will be because of abortion and women voting for her in large part because of that issue,” said Tresa Undem, a pollster who’s been surveying people about abortion for more than two decades.On Monday, Camelback had about 40 patients to see; at least one had traveled in from Texas, which bans almost all abortions. Visitors to the lobby were greeted by a sign urging them to register to vote while they waited for their abortion. The sign advised: “The health of our democracy is in our hands.”‘That gives me hope’On Tuesday, Arizona will become one of 10 states where voters will decide whether to amend their state constitutions to add or expand abortion protections. (In one of those states, Nebraska, voters will vote on both a ballot measure that could expand abortion rights and on the nation’s sole anti-abortion measure.) Five of those states, including Arizona, have some kind of abortion ban on the books. If any of the measures supporting abortion rights pass, it would be the first time that a state has overturned a post-Roe v Wade ban.Democrats have long hoped these measures would boost turnout among their base, but the rosy polling for the measures in steadfastly red states indicates that a significant swath of voters are essentially splitting their votes by supporting both abortion rights and Republicans, the party that helped engineer Roe’s downfall. Although the measure looks likely to pass in Arizona, for example, polling suggests that Trump will win the state.View image in fullscreenJulio Morera helped collect signatures at the Arizona state fair in order to get the measure on the ballot. His group’s booth, he recalled, was set up next to a man who was hawking rightwing memorabilia adorned with eagles, guns and the slogan “Don’t Tread On Me”. When asked to sign the petition, the man demurred. “I got customers to think about,” he said.But at the very end of the fair, Morera said, the man added his signature.“That gives me hope that this is gonna pass,” Morera said. “There are quite a few people that may not be Democrats or left-leaning who would support this access to abortion.”A vote for Trump, however, may ultimately cancel out a vote for a ballot measure. If Trump wins the presidency, he will be able to skirt Congress and use a 19th-century anti-vice law known as the Comstock Act to ban the mailing of all abortion-related materials – which would result in a de facto national abortion ban and render these measures’ successes moot.Project 2025, an influential policy playbook for the next conservative administration, suggests using the Comstock Act to at least ban the mailing of abortion pills, which account for roughly two-thirds of US abortions. It also suggests rolling back privacy protections for abortion patients and reshaping the nation’s largest family planning program, which would curtail access to contraception, among a bevy of other anti-abortion policies.Harris, meanwhile, has forcefully defended abortion rights. “Over these past two years, the impact of Trump abortion bans has been devastating,” she told a rally in Texas in October. “We see the horrific reality that women and families face every single day.”For Lemus, abortion bans all come down to one thing: “Men being in control of women.”View image in fullscreenThe economy was not the only reason that Lemus sought an abortion on Monday. She is also worried about the mental toll of having a child. At 18, Lemus gave birth to a son who was born prematurely and died just a month after birth.“I was there with all the medical stuff, seeing my child in the incubator until he passed away,” she said quietly. Eight years later, Lemus is not ready to have another one.“We fought so hard to have choices,” she said. “Why do they feel like we can’t have a choice?”Read more of the Guardian’s 2024 US election coverage

      When do polls close?

      How the electoral college works

      Where is abortion on the ballot?

      Senate and House races to watch

      Lessons from the key swing states

      Trump v Harris on key issues

      What’s at stake in this election

      What to know about the US election More

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      in US Politics

      In Florida, the future of abortion might come down to men

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      When Maxwell Frost bounded on stage at a Saturday morning rally in support of Florida abortion rights, the 27-year-old congressman was quick to explain why he had shown up.“I’m so proud to be here as an ally and partner in this fight!” he yelled to the roughly hundred-strong crowd who had gathered in an Orlando church courtyard, clutching handwritten sings with messages like “abortion bans are killing us” and “womb-tang clan ain’t nothing to fuck with”.His biological mother had given him up for adoption, said Frost, who wore a black T-shirt that read “Abortion is Health Care”. “The thing that made it sacred was the fact that she had a choice,” Frost said. “I’ve had enough of people trying to use parts of all of our identities to take away freedoms from other people.”The crowd – mostly women – roared in response.In an election where women’s access to abortion has become a top issue, activists are now rushing to convince men that they also have a stake in the fight – and that, come Tuesday, they should vote accordingly.Although men support abortion rights at similar rates as women, they seem to be far less driven by the issue. Less than half of men identify as “pro-choice”, according to Gallup, and are far more likely to see the economy or immigration as their top issue. One poll of men of color found that, although more than 80% believe abortion should be legal, less than half prioritized candidates who supported abortion rights.“It’s that common misconception that abortion is a woman’s issue,” said Zach Rivera, a 24-year-old activist with Men4Choice, a national group dedicated to energizing men who support abortion rights.View image in fullscreenOver the last several weeks, Rivera has spent countless hours knocking on doors in Florida neighborhoods in support of amendment 4, a ballot measure that would enshrine abortion rights into the Florida constitution and overturn the state’s ban on the procedure past six weeks of pregnancy. Nine other states are also set to vote on similar ballot measures on election day, but amendment 4 may face the steepest odds. In order to pass, the measure must secure 60% of the vote in a state that has veered sharply to the right in recent years and whose state government has repeatedly tried to kneecap the campaign behind the amendment.Recent polling has found that support for measure hovers somewhere in the 50% range: while one poll found that 58% of Florida voters support it, another closer to 54%. In the latter poll, 55% of women supported the measure, compared to 53% of men. In an election as tight as Florida’s, nudging more men to vote yes could mean the difference between victory and defeat.As Saturday morning gave way to a humid afternoon punctuated by bursts of rain, Rivera trudged from house to house in a wealthy, blue area of Orlando, dropping off Men4Choice stickers and attempting to talk to voters about amendment 4. Numerous houses had blue “Harris/Walz” signs in their front lawns – but not a single one had a purple “Yes on 4” sign. Voters were reluctant to talk about it. “I’m friends with everyone,” one woman said.Rivera has had better luck, he said, with phone banking. In one recent conversation, Rivera described urging one reluctant man to think about his future wife and children: what if, 10 years down the line, his wife died because an abortion ban blocked her from accessing medical care? How would he reveal to his kids that he didn’t vote?“The whole point of this movement is to think about future you,” Rivera recalled telling him. The man, Rivera said, decided to vote in favor of amendment 4.At an early voting site in Tampa, 24-year-old Brandon McCray cited women’s rights as one of his greatest concerns in the 2024 elections. It helped convince him to vote for Kamala Harris. “Amendment 4 would just protect a lot of women,” he said. Banning abortion, he said, “is the biggest violation to a human right”.McCray may be a relative anomaly among his peers. Appalled by the triple-punch of Donald Trump’s victory in the 2016 election, the sexual violence exposed by the #MeToo movement in late 2017 and the 2022 overturning of Roe v Wade, young women have become the most progressive cohort ever measured in US history – but young men have inched towards the right. While 62% of young women now support Harris, 55% of young men back Donald Trump, according to recent New York Times polling. Moreover, young men’s participation in politics is falling, with young women now on track to vote, rally and donate more frequently.For many young women, the trend is so obvious that its unremarkable. “The right-leaning has more traditional values and more traditional values tends to benefit men more than it benefits women,” said Briana Valle, 22. “For obvious reasons, people are always gonna go for what benefits them.”Leila Wotruba, 22, added: “There’s a lot more at stake for women.”As a gay man, Rivera knows that he may appear to not have much at stake in the fight over abortion rights. But Rivera sees the future of the issue, especially in Florida, as a “litmus test” for other rights.“That’s what I tell people: Even if this might not be a personal issue to you overall … you are definitely next,” he said. “They are just waiting until there’s nobody left to defend you.” More