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    Trump nominates Dr Casey Means, influencer close to RFK Jr, for surgeon general

    Donald Trump has tapped Dr Casey Means, a wellness influencer with close ties to Robert F Kennedy Jr, the US health secretary, as nominee for surgeon general after withdrawing his initial pick for the influential health post.The US president said in a social media post on Wednesday that Means has “impeccable ‘MAHA’ credentials” – referring to the “make America healthy again” slogan – and that she will work to eradicate chronic disease and improve the health and wellbeing of Americans.“Her academic achievements, together with her life’s work, are absolutely outstanding,” Trump said. “Dr Casey Means has the potential to be one of the finest Surgeon Generals in United States History.”The news signals Trump’s withdrawal of his original pick for the post: Janette Nesheiwat, a former Fox News medical contributor. It marks at least the second health-related pick from Trump to be pulled from Senate consideration. Nesheiwat had been scheduled to appear before the Senate health, education, labor and pensions committee on Thursday for her confirmation hearing.Means and her brother, former lobbyist Calley Means, served as key advisers to Kennedy’s longshot 2024 presidential bid and helped broker his endorsement of Trump last summer. The pair made appearances with some of Trump’s biggest supporters, winning praise from conservative pundit Tucker Carlson and podcaster Joe Rogan. Calley Means is currently a White House adviser who appears frequently on television to promote restrictions on Snap benefits, removing fluoride from drinking water and other Maha agenda items.Casey Means has no government experience and dropped out of her surgical residency program, saying she became disillusioned with traditional medicine. She founded a health tech company, Levels, that helps users track blood sugar and other metrics. She also makes money from dietary supplements, creams, teas and other products sponsored on her social media accounts.In interviews and articles, Means and her brother describe a dizzying web of influences to blame for the nation’s health problems, including corrupt food conglomerates that have hooked Americans on unhealthy diets, leaving them reliant on daily medications from the pharmaceutical industry to manage obesity, diabetes and other chronic conditions.Few health experts would dispute that the US diet – full of processed foods – is a contributor to obesity and related problems. But Means goes further, linking changes in diet and lifestyle to a raft of conditions including infertility, Alzheimer’s, depression and erectile dysfunction.“Almost every chronic health symptom that Western medicine addresses is the result of our cells being beleaguered by how we’ve come to live,” Means said in a 2024 book co-written with her brother.Food experts say it’s overly simplistic to declare that all processed foods are harmful, since the designation covers an estimated 60% of US foods, including products as diverse as granola, peanut butter and potato chips.“They are not all created equal,” said Gabby Headrick, a nutrition researcher at George Washington University’s school of public health. “It is much more complicated than just pointing the finger at ultra-processed foods as the driver of chronic disease in the United States.”Means has mostly steered clear of Kennedy’s debunked views on vaccines. But on her website, she has called for more investigation into their safety and recommends making it easier for patients to sue drugmakers in the event of vaccine injuries. Since the late 1980s, federal law has shielded those companies from legal liability to encourage development of vaccines without the threat of costly personal injury lawsuits.She trained as a surgeon at Stanford University but has built an online following by criticizing the medical establishment and promoting natural foods and lifestyle changes to reverse obesity, diabetes and other chronic diseases.If confirmed as surgeon general, Means would be tasked with helping promote Kennedy’s sprawling Maha agenda, which calls for removing thousands of additives and chemicals from US foods, rooting out conflicts of interest at federal agencies and incentivizing healthier foods in school lunches and other nutrition programs.Nesheiwat, Trump’s first pick, is a medical director for an urgent care company in New York and has appeared regularly on Fox News to offer medical expertise and insights. She is a vocal supporter of Trump and shares photos of them together on social media. Nesheiwat is also the sister-in-law of former national security adviser Mike Waltz, who has been nominated to be Trump’s ambassador to the United Nations.Nesheiwat also recently came under criticism from Laura Loomer, a far-right ally of Trump who was instrumental in ousting several members of Trump’s national security council. Loomer posted on Twitter/X earlier this week that “we can’t have a pro-COVID vaccine nepo appointee who is currently embroiled in a medical malpractice case and who didn’t go to medical school in the US” as the surgeon general.Independent freelance journalist Anthony Clark reported last month that Nesheiwat earned her medical degree from the American University of the Caribbean School of Medicine in St Maarten, despite saying that she has a degree from the University of Arkansas School of Medicine.The surgeon general, considered the nation’s doctor, oversees 6,000 US Public Health Service Corps members and can issue advisories that warn of public health threats.In March, the White House pulled from consideration the nomination of former Florida Republican Dave Weldon to lead the Centers for Disease Control and Prevention. His skepticism on vaccines had raised concerns from key Republican senators, and he withdrew after being told by the White House that he did not have enough support to be confirmed.The withdrawal was first reported by Bloomberg News. More

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    The Trump administration is defending abortion pill access in court. What?

    The Trump administration on Monday asked a federal court to dismiss a lawsuit that takes aim at the abortion pill mifepristone – a move that stunned many observers for what seemed a defense of the drug by a president who has overseen the most dramatic rollback of abortion rights in modern US history.At first blush, it may seem a victory for abortion access – but experts worry that, in reality, the move preserves the administration’s ability to play coy about any future plans to attack abortion rights.When Donald Trump first returned to the White House earlier this year, US anti-abortion activists had high hopes for the man who helped orchestrate the downfall of Roe v Wade. They thought he might use a 19th-century anti-vice law to effectively ban abortion nationwide. Failing that, they imagined that he might use the power of the Food and Drug Administration to roll back access to mifepristone or even yank it from the market entirely.Instead, over the last few months, the Trump administration has attempted to dodge the issue entirely. The Monday request, to a Texas judge who has become a reliable vote for abortion opponents, continued that pattern.The lawsuit seeks to roll back several FDA regulatory changes that have, over the last decade, considerably expanded access to mifepristone, one of two drugs typically used in US medication abortions. It revives a lawsuit that led to a stinging 9-0 defeat for abortion rights opponents when the court ruled the lawsuit’s plaintiffs, a group of anti-abortion doctors, did not have the legal standing to sue in the first place.Rather than let the matter die, the Republican attorneys general of Idaho, Kansas and Missouri moved to take over the case as its new plaintiffs. Judge Matthew Kacsmaryk of the US district court for the northern district of Texas, where the case is being heard, agreed to let the attorneys general move forward.However, in its Monday filing, the Trump administration argued that there is no reason why the case should proceed in Texas.“At bottom, the states cannot keep alive a lawsuit in which the original plaintiffs were held to lack standing, those plaintiffs have now voluntarily dismissed their claims, and the states’ own claims have no connection to this district,” the administration wrote.Abortion rights supporters have long pointed to one reason why the case was filed in Texas: Kacsmaryk. A Trump appointee with a track record of abortion opposition, Kacsmaryk once took the unprecedented step of ruling to reverse the FDA’s 2000 approval of mifepristone, which would lead to its removal from the market.Nicole Huberfeld, a health law professor at Boston University’s School of Public Health, found it “a little funny” that the Trump administration’s filing seemed to call out its own side for judge-shopping.It is possible that Trump, who was never exactly a true believer in the anti-abortion movement, has now soured on it. While the movement helped propel him to the White House in 2016, it became something of an albatross for him in 2024, as outrage over Roe’s collapse led abortion rights to become one of the election’s top issues.Yet Huberfeld found the filing more notable for what it did not say: namely, it shied away from revealing the Trump administration’s plans for mifepristone. She believes the administration may try to change mifepristone access through the FDA, and that the legal reasoning in Monday’s filing could be used against a future lawsuit by blue states against new restrictions.“They’re basically saying that the states don’t get to just challenge FDA policy because they want to,” Huberfeld said. “Which, in my view, is a set-up for anticipating that blue states may try to challenge any changes on mifepristone rules.”FDA Commissioner Martin Makary could, for example, move to reverse regulations that permit people to dispense abortion pills through telehealth – which accounts for about a fifth of all US abortions – or eliminate mifepristone’s approval. Project 2025, the notorious playbook of policy proposals authored by the conservative thinktank the Heritage Foundation, urged the FDA to do exactly that.Last month, Makary told the Semafor World Economy Summit that he had “no plans to take action” on mifepristone. However, he added: “There is an ongoing set of data that is coming into the FDA on mifepristone. So if the data suggests something or tells us that there’s a real signal, we can’t promise we’re not going to act on that data.”Decades of studies, conducted in more than a dozen countries, have found that mifepristone is safe and effective. However, anti-abortion groups have repeatedly pushed studies that claimed to find that mifepristone is dangerous. (Some of those studies have been retracted.)“My guess is that the Trump administration is trying to walk the fine line of not looking like it’s threatening access to mifepristone while also, potentially, through the FDA trying to limit access to mifepristone,” Huberfeld said. “In other words, I don’t think the FDA’s actually going to be hands-off.” More

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    ‘Social care will collapse’: Independent readers react to family visa crackdown

    A government crackdown on visas for overseas care workers has sparked fierce debate among Independent readers, with many warning it could tip an already fragile care system into outright collapse.New visa rules introduced by the Labour government in March 2025 have made it harder for foreign care workers to come to the UK, including preventing them from bringing children or dependents and requiring a minimum salary of £25,000. As a result, applications for Britain’s health and care worker visa have plunged by 70 per cent in a year, from 129,000 to just 26,000, at a time when more than 100,000 vacancies remain across England’s care sector.Charities such as Age UK warn that overseas staff have been “keeping many services afloat” and say care home closures could pile yet more pressure onto NHS hospitals already struggling to cope.Our readers are divided over how to respond to the growing crisis. Some argue Britain must urgently attract more overseas workers to plug critical gaps, as an ageing population and declining birth rate leave fewer working-age people to provide care. Others believe it is time to reform the benefits system, train unemployed British workers for these roles, and ensure carers, whether foreign or domestic, are paid properly and treated with respect.While views differ, few dispute the scale of the challenge facing social care today. Without decisive action, many warn that the consequences for the NHS, care homes, and vulnerable people could be dire.Here’s what you had to say:The government must be honest about care gapsWe are living in challenging times and the Government needs to speak honestly about them – and dismiss the harbingers of chaos and turmoil who are trying their hardest to get into power so they can suck us all dry. The fact is that we have more elderly than younger workers, and the birth rate has been in decline for some years. There are huge job gaps in the NHS and care homes. This has enormous implications. If we don’t have enough care workers, more elderly people and people with disabilities, and chronic health conditions will end up in the hospital, meaning that people waiting for treatment or surgery will have to wait longer. There will also be an impact on healthcare workers, such as nursing staff, which will make things worse. It is pretty annoying that political parties use issues such as net migration (which receives a pretty negative reaction) and unemployment figures as political footballs to stir up the ire of the ‘hard-working taxpayer’. The plain fact is we need more people of working age to pick up the slack. If people from other countries want to come here to work and build their lives, why not? If we don’t go down this route, we are going to end up in a much worse situation than we are already in. Some countries allow asylum seekers to work while they go through their application procedure. We should do the same where possible. That way, there won’t be such pressure on the government purse. Meanwhile, housebuilding is a number one priority. The lack of social housing is not caused by immigrants; it was caused by the policies of Margaret Thatcher, and that loophole of selling off social housing at giveaway prices must be closed. If more people are paying taxes, there will be more money to spend.Brodric11Social care will simply collapse in some partsIn some parts of the country, on this basis, social care will simply collapse. I have a small home care company as a client. They have a few foreign workers, and sorting out work visas is bureaucratic and expensive. Fortunately, they manage mostly with home-grown workers. On top of dealing with the hike in employers’ NI and above-inflation National Living Wage rise, the sector will struggle and reach a crisis point. This sector has required action for years, but political dithering and division have just made matters worse.49ninerDon’t get ill, don’t get oldSpeaking as a former NHS nurse and hospital care manager, this will completely compound the existing bed, A&E, and health logistics crisis. This isn’t a Labour Government, but hey, at least we’ve now got some local authorities that will be saved by imported MAGA policies from the new and talented Reform councillors skillfully managing local authority community care and care home funding. “Don’t get ill, don’t get old.” — Neil KinnockHerbaciousThe care my mother received was second to noneMy mother was diagnosed with terminal cancer a few years ago and died within three months of that diagnosis, as per the specialist’s prognosis. As she grew weaker, my sister (who gets paid a fair bit more than the minimum wage) tried to help my mother by moving her to be more comfortable. This resulted in my mother suffering a fractured leg, which had been weakened by cancer spreading into it. This meant that after a month of being diagnosed with three months to live, my mother was in sheer agony thanks to my sister trying to help her. For readers with empathy, you can imagine the trauma and guilt my sister felt. The NHS patched her up and she returned to die in her own home as per her wishes. The care she received from her six-person rota of African caregivers was second to none. These people were experts. Highly trained and nothing but utterly professional from start to finish. If anyone thinks for a second that I, or anyone related to me, would allow some otherwise unemployable person within a mile of my mother at this point, they have another thing coming. I will never forget the care and attention they bestowed on my mother at the end of her life.Jim987Where’s the infrastructure?ChrisMatthewsNet migration of over 1.5 million in two years. The consensus here seems to be fine, no problem… in fact, we need more. But where’s the housing, where are the extra hospitals and GP surgeries, new schools, and improvements to transport infrastructure? An extra 7.5 million in 10 years is a heck of a lot of extra people, and already we lack the housing and services to effectively look after people. Importing millions and their families isn’t the answer. We have to find another way. In 2024, there were 1 million NEETs (not in education, employment, or training) – train them up and get them working as carers, withholding benefits if they refuse.Two choicesIs this a phase the country needs to go through to understand immigration? As services are stretched and care becomes increasingly unavailable, will people recognise we have two choices? Either we allow and facilitate immigration into these roles, or we say to those on benefits: you must work in these jobs or lose benefits. Either way, the complaints will be loud and long. AI can’t help with this! A political move to bring home the reality to the electorate, where words and discussion will not work.LongsandsPay British carers moreIt’s shameful that proud British care workers have had their salaries plundered by conniving private care shareholders for over 40 years, leading to what is effectively healthcare worker slavery today. There is no easy way to restore value for our health sector other than using the supply and demand principle. Cut supply, and the unscrupulous private shareholders will pay our British carers more for their incredible work.DynamicBritainThe toughest job I ever didI did the job for four years at the age of fifty – probably the most difficult job I have ever taken on. I had no experience at all, a few days shadowing someone, and then I was left to sink or swim. I nearly sank a few times for sure. The first six months I was in total shock at the things I had to do. It was rough for sure. But you get used to the smell and mess and just get on with it. At least you could get out at the end of a visit – they could not get away from their living hell, and for some, it was hell. Poor wages and conditions; if anything goes wrong, you get the blame. Zero support – you’re on your own. And you wonder why no one wants to do it? No respect from the rest of the public at all. Yes, despite all of that, some times were very good and I got a lot from it – but four years was enough and I joined the NHS. Never looked back after that. Not many people last long if they haven’t done it before – an hour or so, and they’re running out the door.gtvv61Why do carers earn less than supermarket staff?Maybe one of the reasons there are so many shortages in the care sector is the appalling lack of pay carers get. Most of them are on minimum wage or close to it, despite it being a high-skilled and physically demanding job. Why would people do that when they can earn more working at Tesco or Starbucks? Almost everywhere else in Europe, being a carer is considered a good profession with a salary to match. Here we pay poverty wages. And yet social care in the UK is among the most expensive in Europe, so where’s the money going? Not to pay staff, that’s for sure. Maybe the councils [Reform] run should announce a huge pay rise for all their social care staff. Private providers would have to follow suit in order not to lose staff to the council care homes. Then, more UK citizens might decide that it’s a field they’d like to go into, and staff already working in the field may stay because they can make ends meet.WellActually Visa rules should require self-sufficiencyIt is usual, notably in the EU, that visas are issued for individuals, each on their own merit. After a given period without having been a burden on the state, the visa holder or a family member can apply for their own visa under family unification rules. The most important of these is that the initial visa holder must show they can support family members in full. If the follow-on members intend to work, then they must apply for a work visa, not a family visa. I’m not sure of the UK system, but it appears a bit more ‘open door’.Jonathan MillsFamily visa rules need urgent reformIn general, family visa rules need to be changed. This comes from a husband and father divided from his family by irrational financial requirements. To all the people who see any immigrant as a threat, and not an opportunity to grow the economy, I wish they could try living my life for just one day – then they would understand how ruthless these policies are. Labour must wake up to reality and understand that families belong together.EUVisaTrain the unemployed to be carersTraining always works, so get these unemployed people into training as care workers. Oh, and increase care workers’ pay at the same time, like we’ve seen for train drivers and junior doctors. I’d rather pay more for care workers than train drivers. As the years go by, we are all getting older.KeithneathImmigrants are a benefit, not a burdenOne of the many ways in which immigrants are of benefit to us is through their work in social care. People coming to our shores are a valuable resource that we can use to our advantage. Demonising them, as Reform does, is not only wrong but misguided.BigDogSmallBrainBritain must train its own workers for care“The social care sector relies on skilled overseas workers to fill posts, stabilise services, and deliver care and support to the people who need it.” Then it looks like the Brits will have to grow and train their own to stabilise the economy and the service sector. That should be a priority. Oh, and make sure qualified people aren’t excluded due to some diversity requirement.9DiamondsWho would you want looking after your loved ones?I am in a very conflicted position. My wife is dying in a care home. She needs constant medical supervision. Most of the staff are foreign nationals. Some are engineers and lawyers whose qualifications are not recognised in this country. There is a whole army of unemployed people in this country who could do the job. But who do I want looking after her? A feckless school leaver forced into work by having their benefits withdrawn, or someone who travelled halfway across the world in search of a better life?TomHawkSpain has given an amnesty to their “illegal” migrants and people working illegally for cash. They are using the skills that the migrants already have and are training them up for shortage jobs. As a result, they will have the fastest growth in Western Europe.ListenVeryCarefullyFourteen wasted yearsSadly, this Government has decided policy by dog whistle, not from the public but from Reform, while failing ideologically to address inequality and unfairness beyond easy targets. We need workers. Europe largely provided them without bringing the cultural baggage we see today, while allowing criminals to take over refugee and asylum routes simply because most people have no alternative – yet they still fail to allow such arrivals to work while their applications are assessed over months, even years, living at taxpayers’ expense in misery or detention. Now we see student visas and worker visas targeted by fraudsters as an easier route, not for essential workers who must leave their families behind. No joined-up thinking whatsoever – and 14 wasted years failing to come up with policy solutions to the UK’s problems that were hardly invisible.TopshamThe benefits system is the real problemThe number of net foreign economic migrants (i.e., those who come to work, in the vast majority of cases with higher qualifications than required for the jobs they take) is approximately the same, if not lower, than the number of chronically unemployed and NEETs. The issue is that in the UK, if you’re one of these types who can’t be bothered to study, train or work, the Government will bend over backwards to provide for you — housing, food, and a bit of extra money on top. These migrants have nothing like that in their home countries – it’s either work or starve. Put the two things together and you’ll find the solution to the problem. The benefits system needs a complete overhaul, not the immigration system. The elephant in the room is that in the UK you can afford not to work. That’s the source of 90 per cent of the issues we have. In an ideal world, the NEETs would emigrate to other countries, and we should replace them with skilled, able, and willing migrants.AgeOfStoopidThe root problemPresumably, the reason that UK residents are not volunteering to work in care is that the wages on offer are barely enough to pay the rent. That, in turn, is because rents have been encouraged to rise through the roof, not least by housing benefit, which used to be spent mainly on building and maintaining housing. At the centre of this cost-of-living crisis, in which ever fewer vital workers can afford to live in the cities where they are required, is the fact that successive governments have been robbing the poor to give to the rich, largely through privatisation and so-called austerity.ReasonTruthAndLogicOverseas staffI work in a complex care home, and some nights all of the staff on duty are from overseas. You have to wonder why Reform voters, who would rather these people not be here, don’t apply for jobs in care homes themselves.RobSacrifices are part of working abroadWhen I went to work in Switzerland, I didn’t have the automatic right to bring my family with me straight away. I would pre-book monthly EasyJet flights – out on a Friday evening, back on a Sunday night – just to see them for the first nine months. Unfortunately, these are sacrifices you have to make in your working life.VonGenschlerLabour must stop pandering to FarageIt is time for Starmer to stop pandering to Farage and act like a socialist. People are unhappy with the Government because it is not doing enough for ordinary people. The argument that the economy was in a mess when they took over is wearing thin. It was nothing like as bad as in 1945 when Labour introduced the NHS and nationalisation. Unfortunately, Starmer and co are as much in the pockets of big business and the super-rich as the Tories and Reform. Labour must get rid of Starmer, Reeves and their policies now if they are to stand any chance of stopping Farage.AlrumSome of the comments have been edited for this article for brevity and clarity.Want to share your views? Simply register your details below. Once registered, you can comment on the day’s top stories for a chance to be featured. Alternatively, click ‘log in’ or ‘register’ in the top right corner to sign in or sign up.Make sure you adhere to our community guidelines, which can be found here. For a full guide on how to comment click here. More

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    My rare disease was getting closer to a cure. RFK Jr could undermine that | Jameson Rich

    Since Robert F Kennedy Jr assumed control of the US health department in February, with a mandate to “[lower] chronic disease rates and [end] childhood chronic disease”, he has moved quickly to remake the US’s federal health infrastructure. But the Trump administration’s actions on medical research are already threatening that goal – and could end medical progress in this country for good.Kennedy’s office oversees the National Institutes of Health, the control center of disease research in the United States. Kennedy’s agency has killed almost 800 active projects, according to Nature, affecting medical research into HIV/Aids, diabetes, women’s health, heart disease, cancer, Alzheimer’s and more. The administration wants to cut the NIH’s budget up to 40% while consolidating its 27 agencies – separated by disease area – into just eight. Elon Musk’s Doge has been reviewing previously awarded grant funding, reportedly requiring researchers to explain how they are using their grants to advance the Trump administration’s political goals. (Audio obtained by the Washington Post suggests this “Defend the Spend” initiative may be a smokescreen, with one NIH official admitting: “All funding is on hold.”) Separately, Donald Trump has aggressively targeted universities such as Harvard and Columbia over alleged antisemitism and diversity initiatives, using federal contracts that fund research as leverage. And just recently, the NIH passed a new rule banning any university from receiving future federal grants if the universities use DEI programs or boycott Israeli firms.Medical research is a wonkish issue usually kept far away from political discussions. Even popular initiatives like former presidents Barack Obama and Joe Biden’s cancer moonshot require long-term vision in a political landscape rarely concerned with anything beyond the day’s news. But in recent years, public and private investments in medical research have seeded a wave of potential cures across major disease areas. Now, just as that wave is about to crest, RFK Jr and the Trump administration’s incursion against the NIH threatens to ensure these cures are never finished.For me, the promise of those cures is personal. At three days old, I was diagnosed with a rare version of the most common type of birth defect: congenital heart disease. CHD affects one in every 100 babies born in the US and is the leading cause of birth defect-related deaths. Congenital heart problems can range from a small hole in the heart to being born with only one ventricle. Many defects are underdiagnosed, and chances are good that you know somebody who lives with one. Even JD Vance does: his relative was born with Ebstein’s anomaly, a deformity of the tricuspid valve that has resulted in her now needing a heart transplant at the age of 12.When I was six weeks old, doctors performed the first in a series of three surgeries aimed at correcting the circulation of blood within my heart and between the other organs of my body. The final surgery in that sequence had first been described in medical journals in 1971, and crucial refinements had been made only a few years before I was brought under the knife.Before the surgery’s advent, the prognosis was grim. Many children like me died before their first birthday. Of congenital patients in the 1950s, “half died before the age of twenty”, writes cardiologist Sandeep Jauhar in his book Heart: A History. “In short, they were cardiac cripples, their existence doomed.” But after the surgery, more of us started living into adulthood. Today, most of these patients live at least another 30 years after the operation. My survival past infancy was an accident of history, the product of being born at the right moment in the lifespan of medical research. “Don’t worry,” my first surgeon told my parents when I was a child. “He’s going to long outlive you both.”But my future and the future of others like me is not guaranteed. As I grew up, my doctors acknowledged that the surgery was merely palliative, not curative – a stopgap, medicine’s way of buying me some time. With medicine advancing so quickly, though, we could hope that new solutions would be brought into existence by the time I needed them. In the decades since, we have come to understand the surgery’s long-term consequences: likely progressive damage across organ systems, leading to the need for heart or multi-organ transplants in most patients by the age of 40. Last year, shortly after turning 31, I was formally diagnosed with cardiac cirrhosis and informed that I will need a combined heart-liver transplant within the decade. The time that those early developments bought me seems to be running out.In recent years, as the patient population has grown, more of us have been able to advocate for the need for new solutions. Private foundations have started pouring tens of millions of dollars into research aimed at discovering new treatments and identifying the root causes of birth heart defects so they can be prevented. These foundations have also begun correcting an imbalance in funding – historically, pediatric cancer has received five times the amount of funding that CHD does, despite similar prevalence and mortality rates.I volunteer on the patient board of one such organization, a privately funded non-profit aimed at curing heart defects like mine. With the help of researchers and hospital systems across the country, the organization has been making remarkable progress in a short period of time. But this work relies on the infrastructure of university labs. Even before Kennedy took office, the Trump administration ordered that the NIH change how grant funding is allocated by limiting what are known as “indirect costs”, which go beyond the direct needs of a given study. But often, these costs go into funds that help universities keep their labs running: things like building operations and upgrades, legal compliance and paying researchers. Even with this support, university labs struggle to keep the lights on, and researchers are constantly fighting to secure and retain funding. (The order has since been paused by a federal judge and is the subject of continuing litigation.)Some insist the US shouldn’t be funding research with taxpayer dollars at all. Instead, they would leave the task to pharmaceutical companies and biotech firms. But this fundamentally misunderstands the reality: in the decade leading up to 2020, researchers found, government funding played a role in the development of every new pharmaceutical drug; these drugs are then sold back to patients at a premium. The research that for-profit companies do fund is narrowly focused on things that are guaranteed to make money, or to advance discoveries begun in the public sector. For example, the new blockbuster medication category of GLP-1s – Ozempic, Wegovy, Mounjaro – would not exist without a discovery that was first made by an NIH scientist. When people debate the American healthcare system, they often point to the innovations and cutting-edge treatments we’ve pioneered to support the idea that our system, while flawed, is the best in the world. That impression of a world-class system is due almost entirely to the quality and breadth of our university research infrastructure and our medical schools.Private non-profits, like the one I volunteer with, already fund a large amount of medical research. If more university labs start closing, there will be nowhere for this money to go or for this research to be performed. As Dr Kimryn Rathmell, former director of the National Cancer Institute, told the AP: “Discoveries are going to be delayed, if they ever happen.” The result will be both patients and the government spending even more money on emergency and palliative healthcare. That will only benefit the healthcare profiteers Kennedy claims to be going after: pharmaceutical companies, hospital systems and healthcare entrepreneurs such as Brad Smith, who, by some accounts, has been leading Doge’s firings within HHS.My disease isn’t the only one that will be affected by these cuts. Ongoing research has indicated that targeted mRNA vaccines may show promise in preventing or treating Aids and certain types of cancers. The technology is also being studied for its ability to treat cystic fibrosis, heart failure, sickle cell anemia and other genetic birth defects. But scientists working in these areas through the NIH have already been instructed to strike mention of mRNA vaccines from grant applications and materials, perhaps owing to Kennedy’s hostility towards vaccines and his repeated lies about mRNA technology.If the proposed funding cuts and changes at the NIH are allowed to proceed, Kennedy’s mandate to lower chronic disease rates will fail, and his failure will be obvious. We will see it in rising rates of cancer, birth defects, diabetes and other chronic illnesses. We will see it in the exodus of medical experts to other countries, and the collapse of the researcher pipeline in US universities. We will see the quality of our supposed world-class medical system crash as treatments stagnate. We will pay for this cruelty in blood and lives and lost generations.In truth, today’s congenital heart research has arrived too late to save my own life. My future is at the whim of our broken transplant system, itself already showing signs of strain under Kennedy. But I continue championing the work being done because of the hope that future children won’t be consigned to the same fate. The only thing that will have made the suffering I’ve faced worth it is if I’m a part of the last generation to do so.

    Jameson Rich is a writer and film-maker from Massachusetts who covers healthcare and culture More

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    Trump to continue Biden’s court defense of abortion drug mifepristone

    Donald Trump’s administration on Monday pushed forward in defending US rules easing access to the abortion drug mifepristone from a legal challenge that began during Democratic former president Joe Biden’s administration.The US Department of Justice in a brief filed in Texas federal court urged a judge to dismiss the lawsuit by three Republican-led states on procedural grounds.While the filing does not discuss the merits of the states’ case, it suggests the Trump administration is in no rush to drop the government’s defense of mifepristone, used in more than 60% of US abortions.Missouri, Kansas and Idaho claim the US Food and Drug Administration acted improperly when it eased restrictions on mifepristone, including by allowing it to be prescribed by telemedicine and dispensed by mail.The justice department and the office of Missouri’s attorney general, Andrew Bailey, did not immediately respond to requests for comment.Trump said while campaigning last year that he did not plan to ban or restrict access to mifepristone. Robert F Kennedy Jr, the health and human services secretary, told Fox News in February that Trump has asked for a study on the safety of abortion pills and has not made a decision on whether to tighten restrictions on them.Last year, the US supreme court rejected a bid by anti-abortion groups and doctors to restrict access to the drug, finding that they lacked legal standing to challenge the FDA regulations.Those plaintiffs dropped their case after the high court ruling, but US district judge Matthew Kacsmaryk, a Trump appointee, allowed the states to intervene and continue to pursue the lawsuit.The US justice department moved to dismiss their claims days before Trump took office in January.In Monday’s filing, government lawyers repeated their arguments that Texas is not the proper venue for the lawsuit and that the states lack standing to sue because they are not being harmed by the challenged regulations.“Regardless of the merits of the States’ claims, the States cannot proceed in this Court,” they wrote.The three states are challenging FDA actions that loosened restrictions on the drug in 2016 and 2021, including allowing for medication abortions at up to 10 weeks of pregnancy instead of seven, and for mail delivery of the drug without first seeing a clinician in person. The original plaintiffs initially had sought to reverse FDA approval of mifepristone, but that aspect was rebuffed by a lower court.The Republican-led states have argued they have standing to sue because their Medicaid health insurance programs will likely have to pay to treat patients who have suffered complications from using mifepristone.They have also said they should be allowed to remain in Texas even without the original plaintiffs because it would be inefficient to send the case to another court after two years of litigation. More

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    Trump administration’s budget cuts endanger Meals on Wheels: ‘Life and death implications’

    The Trump administration’s slashes to the Department of Health and Human Services is threatening Meals on Wheels, the popular program dedicated to combatting senior hunger and isolation. Despite decades of bipartisan support, Meals on Wheels now faces attacks from Republicans whose budget blueprint paves the way for deep cuts to nutrition and other social safety-net programs as a way to pay for tax cuts for the wealthy.It’s a move anti-hunger advocates and policy experts warn could have disastrous ramifications for the millions of older Americans who rely on the program to eat each day.“It’s not hyperbolic to say that we’re going to be leaving people hungry and that this literally has life and death implications,” said Nicole Jorwic, the chief of advocacy and campaigns at Caring Across Generations, a non-profit that advocates for ageing Americans, disabled people and their caregivers. “This is not just about a nice-to-have program. These programs are necessities in the lives of seniors all over this country.”While it is still unknown exactly what will be slashed, the blueprint sets the stage for the potential elimination of the Social Services Block Grant (SSBG), a key source of funding for local Meals on Wheels programs in 37 states, and serious cuts to the Supplemental Nutrition Assistance Program (Snap) and Medicaid, which would increase food insecurity and hardship and steeply increase demand for Meals on Wheels services. The entire staff who oversaw SSBG have already been fired, according to reports.If Congress takes away SSBG funding and weakens other programs, seniors who rely on in-home deliveries or meals in community and senior centers to survive would receive less help as Meals on Wheels community providers would be forced to reduce services, add people to waitlists or turn seniors facing hunger away altogether. Some program operators who are already making tough choices about who to serve due to strained budgets and rising need have said it feels as though they are “playing God”.“We’re talking about lives here so it’s worrisome to me,” said Ellie Hollander, the president and CEO of Meals on Wheels America. “Some of our programs are already operating on razor-thin budgets and are pulling from their reserves. [If funding goes away], it could result in some programs having to close their doors.”In the US one in four Americans is over the age of 60 and nearly 13 million seniors are threatened by or experience hunger. Meals on Wheels America, a network of 5,000 community-based programs that feeds more than 2 million older Americans each year, has been a successful public-private partnership for more than 50 years. The Urban Institute estimates that the number of seniors in the US will more than double over the next 40 years.The Older Americans Act (OAA) nutrition program, which supports the health and wellbeing of seniors through nutrition services, is the network’s primary source of federal funding, covering 37% of what it takes to serve more than 250m meals each year. The exact mix of local, state, federal and private funding of Meals on Wheels’ thousands of on-the-ground community programs varies from provider to provider.Under the orders of the Elon Musk-led unofficial “department of government efficiency” (Doge) and the health and human services (HHS) secretary, Robert F Kennedy Jr, 20,000 people at HHS have lost their jobs in recent weeks, including at least 40% of the staff at the Administration for Community Living, which coordinates federal policy on ageing and disability. Since many of those staffers helped fulfill critical functions to serving older Americans through the OAA, some Meals on Wheels programs are worried about funding disbursements, reporting data and the loss of institutional knowledge and expertise.HHS has said it will reorganize the ACL into other HHS agencies, although how that would happen is unclear. The co-chairs of the Disability and Aging Collaborative, composed of 62 member organizations that focus in part on ageing and disability, said in a recent statement: “This disruptive change threatens to increase rates of institutionalization, homelessness and long-lasting economic hardships.”Since experiencing multiple strokes that left her cognitively impaired and at risk for falls, Dierdre Mayes has relied on Meals on Wheels Yolo County to deliver meals that are the 64-year-old’s primary source of nutrition. “I’m really thriving off of the meals I get,” said Mayes, a Woodland, California, resident who also receives $20 a month in food stamps, which she uses to purchase cases of water. “The best part about it is I don’t have to go anywhere to get them.” For Mayes and other homebound older Americans, the program is a lifeline.The uncertainty around Meals on Wheels’ future is causing stress for seniors who are worried about how federal cuts, layoffs and tariffs will impact their daily deliveries. The non-profit FeedMore WNY, which serves homebound older adults in New York’s Erie and Niagara counties, said they’ve been hearing from fearful older clients as word of other recent cuts circulated in the news.Catherine Shick, the public relations manager for FeedMore WNY, said they served 4,775 unique Meals on Wheels clients last year and that demand for their feeding programs increased by 16% from 2023 to 2024, a trend they expect to continue. “Any cut to any funding has a direct impact on the individuals who rely on us for food assistance and any cuts are coming at a time when we know that food insecurity is on the rise,” she said. “We need the continued support of all levels of government, as well as the community, to be able to fulfill our mission.”In addition to delivering healthy, nutritious food, Meals on Wheels drivers, who are primarily volunteers, provide a host of other valuable services: they can look for signs of cognitive or other health changes. They can also address safety hazards in the home or provide pet support services, as well as offer crucial social connections since drivers are often the only person a senior may see in a given day or week.Deliveries have been shown to help keep seniors healthy and in their own homes and communities and out of costly institutional settings. Republicans in the House and Senate have said their goal is to reduce federal spending, but experts say cutting programs that help fund organizations such as Meals on Wheels would instead increase federal spending for healthcare and long-term care expenses for older Americans.“If people can’t stay in their own homes, they’re going to be ‘high flyers’ in hospitals and admitted prematurely into nursing homes,” said Hollander, “all of which cost taxpayers billions of dollars annually versus providing Meals on Wheels for one year to a senior for the same cost of being in the hospital for one day or 10 days in a nursing home.”Experts agree that even before the cuts, Meals on Wheels has been underfunded. Advocates and researchers say OAA hasn’t kept up with the rapid growth of the senior population, rising food costs or inflation. One in three local programs already have waiting lists with many programs already feeling stretched to their limits. For more than 60% of Meals on Wheels providers across the country, federal funding represents half or more of their total revenue, underscoring the serious damage that could be done if cuts or policy changes are made in any capacity.“It feels like a continuous slew of attacks on the programs that seniors rely on to be safe, independent and healthy in their own homes,” said Jorwic of Caring Across Generations. “Everything from cuts to Meals on Wheels to cuts to Medicaid, all these things that are being proposed and actively worked on being implemented, are a real threat to the security of aging Americans.” More

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    The United States is witnessing the return of psychiatric imprisonment | Jordyn Jensen

    Across the country, a troubling trend is accelerating: the return of institutionalization – rebranded, repackaged and framed as “modern mental health care”. From Governor Kathy Hochul’s push to expand involuntary commitment in New York to Robert F Kennedy Jr’s proposal for “wellness farms” under his Make America Healthy Again (Maha) initiative, policymakers are reviving the logics of confinement under the guise of care.These proposals may differ in form, but they share a common function: expanding the state’s power to surveil, detain and “treat” marginalized people deemed disruptive or deviant. Far from offering real support, they reflect a deep investment in carceral control – particularly over disabled, unhoused, racialized and LGBTQIA+ communities. Communities that have often seen how the framing of institutionalization as “treatment” obscures both its violent history and its ongoing legacy. In doing so, these policies erase community-based solutions, undermine autonomy, and reinforce the very systems of confinement they claim to move beyond.Take Hochul’s proposal, which seeks to lower the threshold for involuntary psychiatric hospitalization in New York. Under her plan, individuals could be detained not because they pose an imminent danger, but because they are deemed unable to meet their basic needs due to a perceived “mental illness”. This vague and subjective standard opens the door to sweeping state control over unhoused people, disabled peopleand others struggling to survive amid systemic neglect. Hochul also proposes expanding the authority to initiate forced treatment to a broader range of professionals – including psychiatric nurse practitioners – and would require practitioners to factor in a person’s history, in effect pathologizing prior distress as grounds for future detention.This is not a fringe proposal. It builds on a growing wave of reinstitutionalization efforts nationwide. In 2022, New York City’s mayor, Eric Adams, directed police and EMTs to forcibly hospitalize people deemed “mentally ill”, even without signs of imminent danger. In California, Governor Gavin Newsom’s Care courts compel people into court-ordered “treatment”.Now, these efforts are being turbocharged at the federal level. RFK Jr’s Maha initiative proposes labor-based “wellness farms” as a response to homelessness and addiction – an idea that eerily echoes the institutional farms of the 20th century, where disabled people and people of color were confined, surveilled and exploited under the guise of rehabilitation.Just recently, the US Department of Health and Human Services (HHS) announced a sweeping restructuring that will dismantle critical agencies and consolidate power under a new “Administration for a Healthy America” (AHA). Aligned with RFK Jr’s Maha initiative and Donald Trump’s “department of government efficiency” directive, the plan merges the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA) and other agencies into a centralized structure ostensibly focused on combating chronic illness. But through this restructuring – and the mass firing of HHS employees – the federal government is gutting the specialized infrastructure that supports mental health, disability services and low-income communities.The restructuring is already under way: 20,000 jobs have been eliminated, regional offices slashed, and the Administration for Community Living (ACL) dissolved its vital programs for older adults and disabled people scattered across other agencies with little clarity or accountability. This is not administrative streamlining; it is a calculated dismantling of protections and supports, cloaked in the rhetoric of efficiency and reform. SAMHSA – a pillar of the country’s behavioral health system, responsible for coordinating addiction services, crisis response and community mental health care – is being gutted, threatening programs such as the 988 crisis line and opioid treatment access. These moves reflect not just austerity, but a broader governmental strategy of manufactured confusion. By dissolving the very institutions tasked with upholding the rights and needs of disabled and low-income people, the federal government is laying the groundwork for a more expansive – and less accountable – system of carceral “care”.This new era of psychiatric control is being marketed as a moral imperative. Supporters insist there is a humanitarian duty to intervene – to “help” people who are suffering. But coercion is not care. Decades of research show that involuntary (forced) psychiatric interventions often lead to trauma, mistrust, and poorer health outcomes. Forced hospitalization has been linked to increased suicide risk and long-term disengagement from mental health care. Most critically, it diverts attention from the actual drivers of distress: poverty, housing instability, criminalization, systemic racism and a broken healthcare system.The claim that we simply need more psychiatric beds is a distraction. What we need is a complete paradigm shift – away from coercion and toward collective care. Proven alternatives already exist: housing-first initiatives, non-police and peer-led crisis response teams, harm reduction programs, and voluntary, community-based mental health services. These models prioritize dignity, autonomy and support over surveillance, control and confinement.As Liat Ben-Moshe argues, prisons did not simply replace asylums; rather, the two systems coexist and evolve, working in tandem to surveil, contain and control marginalized populations. Today, reinstitutionalization is returning under a more therapeutic facade: “wellness farms”, court diversion programs, expanded involuntary commitment. The language has changed, but the logic remains the same.This moment demands resistance. We must reject the idea that locking people up is a form of care. These proposals must be named for what they are: state-sanctioned strategies of containment, rooted in ableism, racism and the fear of nonconformity.Real public health does not rely on force. It does not require confining people or pathologizing poverty. It means meeting people’s needs – through housing, community care, healthcare and support systems that are voluntary, accessible and liberatory.As budget negotiations in New York continue to drag on – with expansions to involuntary commitment still on the table – and as RFK Jr advances carceral care proposals at the federal level, we face a critical choice: will we continue the long history of institutional violence, or will we build something better – something rooted in justice, autonomy and collective wellbeing?The future of mental health care – and of human dignity itself – depends on our answer.

    Jordyn Jensen is the executive director of the Center for Racial and Disability Justice at Northwestern Pritzker School of Law More

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    How ‘revenge of the Covid contrarians’ unleashed by RFK Jr puts broader vaccine advances at risk

    The US health secretary, Robert F Kennedy Jr, entered office with a pledge to tackle the US’s chronic disease epidemic and give infectious disease a “break”. In at least one of those goals, Kennedy has been expeditious.Experts said as Kennedy makes major cuts in public health in his first weeks in office, the infrastructure built to mitigate Covid-19 has become a clear target – an aim that has the dual effect of weakening immunization efforts as the US endures the largest measles outbreak since 2000.“If his goal is to undermine public health infrastructure, he’s making strides there,” said Dorit Reiss, a University of California Law School professor whose research focuses on vaccine law. “If his goal is combating chronic diseases – he’s not doing very well.”The Department of Health and Human Services (HHS) has been characterized by upheaval since Kennedy and the billionaire Elon Musk’s unofficial “department of government efficiency” (Doge) cumulatively axed 20,000 jobs – roughly a quarter of the 82,000-person workforce.And it appears that turmoil will continue: a leaked budget memo shows the administration poised to propose a budget cut of another $40bn, or roughly one-third of the department’s discretionary spending.Amid the cuts, attacks on Covid-19 infrastructure have proven thematic, and show the administration’s hostility toward work that once mitigated the virus. That’s included attacking promising vaccine platforms and elevating once-ostracized voices to high-level roles.“The Covid-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago,” a spokesperson for HHS told the Guardian in response to questions about its strategy.“HHS is prioritizing funding projects that will deliver on President Trump’s mandate to address our chronic disease epidemic and Make America Healthy Again.”Gregg Gonsalves, a Yale University associate professor and infectious disease epidemiologist, calls this strategy the “revenge of the Covid contrarians”.“They’re not interested in the science, they’re interested in their conclusions and having the science bend to their will,” said Gonsalves. “They want to create a Potemkin village of their own making that looks like science but has nothing to do with science at all.”Among Kennedy’s changes: attacks on the promising platform that supported Covid-19 vaccine development, delayed approval of a Covid-19 vaccine, the clawing back of grants that provided local immunization support and studied vaccine safety, and elevating one-time critics of Covid-19 policy.“When the new administration came in, we were hearing even within the organization: ‘We can’t say Covid, we’re not allowed to say Covid,’” said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials (Naccho), about her members’ conversations.Freeman noted that “we kind of saw the writing on the wall a couple months ago that: ‘OK, they really don’t want anything Covid-related to be pursued any more.’ Everything Covid-related is quite honestly at risk.”In the latest change, Kennedy said this week he may remove Covid-19 shots from the childhood vaccine schedule, which would probably make the shots harder to get by limiting insurance coverage.“The recommendation for children was always dubious,” Kennedy told Fox News. Although a minority of children are vaccinated, the shots are recommended, especially for immune-compromised children.Freeman believes the desire to erase the government’s Covid legacy led to HHS’s decision to claw back $11bn in public health funds from states and localities. In effect done overnight, the clawback gave local officials only hours to lay off workers, cancel immunization clinics and even stop construction projects.“That’s why we feel like the drawback of the funding occurred: Covid,” said Freeman.A spokesperson for HHS characterized this as a savings, and said most canceled awards were for Covid-19-related work.The pullback led to the cancellation of more than 50 measles immunization clinics in Texas, where the measles outbreak has already claimed the lives of two unvaccinated children, to pilot programs such as “Text4Vax”, which sent reminders about pediatric vaccines to parents.Among the canceled grants were also programs that would seem to align with Kennedy’s rhetoric about vaccine safety – among them, a study of the safety and effectiveness of Covid-19 vaccines in pregnant women in California and global Covid-19 vaccine safety monitoring in New Zealand.“If you start to take away people from health departments – the immunizers, the educators, the clinicians – through some of these other funding cuts , it disables the program naturally,” said Freeman. “You can’t put as many shots in arms.”Larger cancelled grants included a $2.25bn grant program to reduce Covid-19’s impact on the people worst affected, which had been sent to states and localities from South Dakota to Florida and the Virgin Islands to Vermont.Under Kennedy’s watch, HHS has also taken the unusual step of delaying an expected vaccine approval, reportedly under the watch of a Kennedy political appointee.The Food and Drug Administration (FDA), which sits under the umbrella of HHS, delayed the expected 1 April approval of the Novavax Covid-19 vaccine. Novavax confirmed to the Guardian that its application remained on hold, and said it would have “no further comments”.Reiss said she doesn’t think “any vaccine that’s in the pipeline is going to go forward under Kennedy” or that “he will let any vaccine go far now”.Dr Tracy Hoeg, a political appointee, was reportedly involved in the decision. Hoeg also appeared as the FDA’s representative at a special advisory committee on immunizations in April, where she took the opportunity to question the efficacy of Moderna’s Covid-19 vaccine.An HHS spokesperson told the Guardian: “The FDA’s independent review process for the Novavax vaccine, like all vaccines, is based solely on ensuring safety and efficacy, not political considerations. Any delays are a result of scientific review, not a lack of priority. It’s important to focus on the facts rather than unfounded speculation.”Scientists have also said they fear for the future of messenger RNA (mRNA) vaccine technology – the platform that underpinned the fast development of Covid-19 vaccines and that held promise for treating and preventing a wide range of diseases.Hoeg served on Florida’s public health integrity committee, which served as a platform for Covid-19 criticism during the pandemic. At the time, it was chaired by the Florida surgeon general, Dr Joseph Ladapo, who has also sown doubt about the safety and efficacy of mRNA vaccines.Hoeg could be further buttressed by insiders such as Dr Matthew Memoli, who, Kennedy said, “is going to be running Niaid [National Institute of Allergy and Infectious Diseases]”. Memoli, whom Kennedy described as “the top flu researcher at NIH”, is known for opposition to Covid-19 vaccine mandates and declined to be vaccinated. In March, Memoli sent an email to NIH grant officials requiring any grant applications that reference mRNA technology to be reported to Kennedy’s office. He also canceled government-backed studies on vaccine hesitancy.The nominee for HHS general counsel, Michael B Stuart, is also well-known for involvement in vaccine fights. Stuart, a former West Virginia lawmaker, in 2023 proposed a bill to exempt virtual public school students from vaccine requirements and allow private schools to set their own requirements, according to Stat.“Dismantling the sort of vaccine infrastructure this country relies upon – that’s been in place for several dozens and dozens of years – only impacts the chronic disease front he’s trying to ameliorate as well,” said James Hodge, a professor of law at Arizona State University and a health law expert who said he worries about the future of vaccine advisory committees. “Acquiring infectious diseases leads to chronic conditions later.”Still, some of Kennedy’s most ardent supporters and reported informal advisers, such as the former cardiologist Peter McCullough, have argued these actions don’t go far enough.“The big threat is that we still have Covid-19 vaccines on the market,” McCullough told KFF Health News. “It’s horrendous. I would not hesitate – I would just pull it. What’s he waiting for?” McCullough did not respond to requests for comment from the Guardian. More