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      ‘The science of fluoride is starting to evolve’: behind the risks and benefits of the mineral

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      A national conversation about fluoride’s health benefits exploded this fall after a federal toxicology report, court ruling and independent scientific review all called for updated risk-benefit analysis.Fluoride, a naturally occurring mineral in some regions, has been added to community water supplies since the mid-20th century when studies found exposure dramatically reduced tooth decay.The controversy, heightened by description of the mineral as “industrial waste” by Robert F Kennedy Jr, Donald Trump’s pick to lead the US health department, highlights questions some towns are now wrestling with: should the mineral’s well-established protective effects against tooth decay be prioritized lest Americans, and especially children, be subject to unnecessary pain and shame from an unhealthy smile? Or should the possibility of neurodevelopment effects be prioritized, even as studies continue?“Fluoride is the perfect example of helping people without them even having to do anything,” said Dr Sreenivas Koka, the former dean of the University of Mississippi Medical Center’s school of dentistry. The state is a “dental desert”, where there is only one dentist for every 2,120 residents. “Fluoride in the water – all you have to do is drink water and you’ll get the benefit.”Fluoride is added to about 72% of community water supplies in the US, according to the Centers for Disease Control and Prevention (CDC). The CDC again endorsed the practice in a scientific statement this May, saying it found no “convincing scientific evidence linking community water fluoridation with any potential adverse health effect or systemic disorder such as an increased risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low intelligence, renal disorders, Alzheimer disease, or allergic reactions”.Still, controversy over water fluoridation recently made headlines after two high-profile reports and a federal court ruling. The US National Toxicology Program set off a firestorm in August when it published a systematic review that found with “moderate confidence” that children exposed to fluoride levels twice those recommended for drinking water (1.5mg per liter versus the recommended 0.7mg per liter) “are consistently associated with lower IQ in children”.Then, in October, a new Cochrane Review lowered the estimated impact of fluoride, citing the widespread use of fluoride in toothpaste beginning in 1975.“Studies conducted in 1975 or earlier showed a clear and important effect on prevention of tooth decay in children,” Cochrane Review researchers wrote. “However, due to the increased availability of fluoride in toothpaste since 1975, it is unlikely that we will see this effect in all populations today.”The public debate comes as the National Institutes of Health (NIH), the world’s largest publicly funded research agency, is both a key funder of research advancing society’s understanding of fluoride’s non-dental health effects and an agency squarely in Trump’s crosshairs.The agency is one of the top targets for cuts and restructuring. Paradoxically, that could mean that critics such as Kennedy cut research on fluoride, even as the NIH funds research into potential detriments. The incoming administration has not made proposals on how to improve oral health in the US.Fluoride’s health benefits were investigated in the early 20th century, when a Colorado Springs dentist questioned why town residents had brown, mottled and decay-resistant teeth – now known as fluorosis.It was later found that fluoride naturally occurred at high levels in Colorado Springs, causing the cosmetic defects. Its decay-resistant properties were confirmed in a landmark 1945 study in Grand Rapids, Michigan, which found children in Grand Rapids were 60% less likely to develop dental caries (better known as cavities) with fluoride added to water.By 1999, the CDC hailed water fluoridation as one of public health’s greatest victories, alongside seat belts and vaccination. That view was buttressed by a 2015 Cochrane Review, considered the gold standard, that found fluoridating water at 0.7mg per liter led to a nearly 26% reduction in tooth decay, a figure still cited by the American Dental Association (ADA) and American Academy of Pediatrics (AAP) today.The need for preventive oral health solutions is profound in the US – more than 68 million people lack dental insurance and about one in four adults said in a survey they have avoided the dentist because of cost.In addition, school children lose an estimated average of 34m school hours each year due to unexpected dental visits; 2 million Americans visit the emergency room each year because of tooth pain; half a million travel abroad for cheaper care and one in five American seniors lack a single natural tooth. Lack of dental access is so common in some areas, doctors in prison frequently have patients who have never seen one.“One of the things I routinely ask young people in juvenile jail is: ‘Do you have a doctor? Do you have a dentist?’” said Dr Fred Rottnek, former medical director of St Louis county jails in Missouri and now a professor of community medicine at Saint Louis University School of Medicine. “A lot of them have never reported going to the dentist.”Modern inquiry into fluoride’s non-dental health effects began to pick up pace in 2015, when the National Toxicology Program (NTP) requested a systematic review on fluoride’s impact on neurodevelopment. By 2019, toxicology researcher Bruce Lanphear, of Simon Fraser University in Canada, co-authored a study finding fluoride exposure was associated with decreased IQ, which would later be incorporated into the NTP’s systematic review.“That gives you an indication that the science of fluoride is starting to evolve – it wasn’t set in stone 70 years ago,” he said.Lanphear, and a small group of like-minded toxicology researchers, argue now is the time for us to “pause and have an independent scientific committee look at all this new evidence” as “we have a lot of new science specifically about fluoride and the developing brain,” he said.Critics were buttressed again when a federal court ruled in September that the Environmental Protection Agency (EPA) needed to evaluate fluoride under the Toxic Substances Control Act.But physicians, dentists and mainstream professional associations from the American Dental Association to the American Academy of Pediatrics stand by recommendations for fluoridated water.While some towns step away from fluoride, communities such as Buffalo, New York, are restarting programs.“This is a shame if we don’t take advantage of what we know from the science,” said Koka about the preventive effects of fluoride. “Are there challenges to doing it right? Yes, but should they be so strong they overcome trying at all? That’s a tragedy.”The CDC has also refined guidance about fluoridation in recent years. In 2015, its water fluoridation recommendations went down to 0.7mg per liter of water, from 0.7 to 1.0mg per liter dependent on climate. Later, the CDC issued a 2019 report that advised parents of children younger than two to speak with their dentist about fluoridated toothpaste, and reminded parents of children younger than three to use only a “grain of rice”-sized “smear”.As critics argue that federal agencies’ recommendation lag behind, the US government’s National Institutes of Health (NIH) has become one of the chief funders of research into fluoride’s potential impacts on IQ.“Getting funding from the NIH shows they are interested in this important question,” said Christine Till, an assistant professor at York University in Canada and a co-investigator with Lanphear, whose grant studying tooth dentin and neurodevelopment in Canada was funded by the NIH, but turned down by the Canadian government.Others, such as Ashley Malin, epidemiology professor at University of Florida, and Dana Goin, assistant professor of epidemiology at Columbia University, have also received NIH funding to research fluoride’s non-dental health effects. Malin is studying fluoride’s impact on children’s sleep and Goin is investigating reproductive health effects.“There is a lot of ongoing work in this area, particularly in the US,” said Goin. “Hopefully, the results from these studies will help determine whether EPA drinking water regulations and CDC recommendations for water fluoridation are adequately balancing improvements in dental health from fluoridation versus any potential negative effects.”Goin’s current funding builds on her previous work, which found water fluoridation was not associated with small-for-gestational age or preterm births. She is now exploring whether fluoride is associated with gestational diabetes.Malin added that it’s a sign of “progress” that the studies can be discussed: “Over a decade ago, to even ask the question of whether optimally fluoridated, or the concentration in drinking water, could be impacting neurodevelopment was quite controversial.” More

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      We must defend elective abortions, not just the most politically palatable cases | Moira Donegan

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      A Kentucky woman known by the pseudonym Mary Poe recently filed a lawsuit against her state, seeking an abortion for what was once a banal reason: because she wanted one.Poe, who was about seven weeks pregnant at the time of the lawsuit’s filing, has since had an abortion out of state. But her attorneys argue that she still has standing to sue to overturn Kentucky’s two abortion bans – a six-week ban and a separate total ban – arguing that the laws violate the state constitution. This much, at least, is typical: lawsuits challenging abortion bans have sprung up across the country since Dobbs, with women and their families seeking to overturn bans, expand exceptions, or get some compensation from the state for the graphic, distressing, disabling or deadly outcomes that the bans have made them suffer.The US supreme court justices who voted to overturn Roe in Dobbs cited the surge in activist litigation around abortion – a product of conservative investment in anti-choice legal shops – as part of their reason for doing so. Surely this must be a contentious, controversial issue that the federal bench is ill equipped to resolve, the judges from the conservative legal movement reasoned – because look how many complaints the conservative legal movement has filed against it!This rationale was always disingenuous, but it has also been proved flatly wrong: Dobbs has not got the courts out of the abortion business. Instead, lawsuits over abortion have exploded. The anti-choice camp has pounced, seeking to further restrict abortion by banning pills; targeting reproductive rights advocates, abortion funds and sexual health educators; claiming rights for fetuses or embryos; or by asserting that men who father pregnancies have a right to keep women from terminating them.But the pro-abortion rights side has been busy with litigation, too. Women who have been put at great health risk or made to suffer terrible, painful complications as a result of bans brought a class-action lawsuit in Texas. Bans have been challenged over and over again – on religious liberty grounds, on the grounds of state constitutional provisions securing the right to make individual healthcare decisions, under a federal law that guarantees emergency room treatment for patients needing stabilizing care, and under state constitutional clauses guaranteeing liberty, due process and privacy.The Kentucky lawsuit is part of this latter camp. Mary Poe has cited Kentucky’s constitutional guarantees of individual rights to both privacy and self-determination, which she says have been violated by the bans. “I feel overwhelmed and frustrated that I cannot access abortion care here in my own state,” she said in a statement delivered via her lawyers at the American Civil Liberties Union. “I am bringing this case to ensure that other Kentuckians will not have to go through what I am going through, and instead will be able to get the healthcare they need in our community.”This kind of desire for an abortion – the dignified simplicity of it – has been missing from much of the post-Dobbs abortion rights discourse. After the ruling, as trigger bans shot into effect across the country, clinics shuttered their doors, and scared women tried to discern their options, there was no shortage of tragic stories highlighting the brutality, indignity and gendered bigotry of the laws. But as the dust settled and members of the Democratic party, the major reproductive rights advocacy groups and the liberal legal movement surveyed the national scene, a consensus emerged that the face of the mainstream pro-choice movement would be the patient who experienced a medical emergency.Women who had suffered horrific medical complications became lucid, moving and highly sought after tellers of their own stories, explaining how abortion bans has risked their health: Amanda Zurawski, for example, was denied an emergency abortion at 18 weeks, subsequently went into septic shock twice, and one of her fallopian tubes was so scarred that it is now permanently closed, inhibiting her future fertility. Kate Cox was denied an abortion after discovering that her fetus has trisomy 18, a rare genetic condition which is incompatible with life, and which, because of Cox’s own medical history, also endangered her fertility and life.During her presidential run, Kamala Harris ran an ad featuring a woman identified only as Ondrea, who suffered a miscarriage at 16 weeks and was denied the standard care due to her state’s abortion ban. She developed sepsis and almost died. The ad features a shot of Ondrea in a bathroom, staring at her body in a mirror wearing only a sports bra. Her belly bears the scars of the emergency surgery that eventually saved her life – the surgery that she never would have had to have if it weren’t for the ban.It does not diminish these women’s bravery, their suffering, or the wrongness of what was done to them to say that they are only one small fraction of those who need abortions in America. These are married, middle-class women with wanted pregnancies; Zurawski and Cox are both white. Cox has spoken movingly about her hopes to meet her future child, a girl; in the ad that features Ondrea, she and her husband hold a baby blanket. These are women whose suffering at the hands of abortion bans has nothing to do with a refusal or distaste for heterosexual, married, middle-class life. Their suffering can be made visible precisely because they are so acceptable.Not so with Mary Poe. Poe may well be married, middle-class and white; from her statement, in which she talks about the difficulty of finding childcare, we can infer that she, like most abortion patients, is already a mother. But Poe is not suffering a physical emergency; she is not enduring any pain or medical misfortune that she can use to purchase social license. She is not, in other words, a woman whose claim to an abortion is based on a plea for mercy. She is merely a woman who seeks to be in control of her own life, one who believes that things like privacy and self-determination apply to her, too.“I have decided that ending my pregnancy is the best decision for me and my family,” Poe writes in her public statement. “This is a personal decision, a decision I believe should be mine alone, not made by anyone else.”This was not always a radical proposition. But in the post-Dobbs world, it has sadly become one.

      Moira Donegan is a Guardian US columnist More

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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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      in US Politics

      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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