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    RFK Jr and his grandchildren swam in DC creek contaminated by sewage

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    The US health secretary, Robert F Kennedy Jr, has revealed that he went swimming with his children in a Washington DC creek that authorities have said is toxic due to contamination by an upstream, ageing sewer system.The “Make America healthy again” crusader attracted attention for the Mother’s Day dip in Dumbarton Oaks Park with his grandchildren Bobcat and Cassius, which he posted about on X. He was also accompanied by relatives Amaryllis, Bobby, Kick and Jackson.Rock Creek, which runs through the federal park, is described as unsafe for swimming or wading because it acts as a runoff for excess sewage and storm water during rain storms.Studies of streams in the nation’s capital have revealed “chronic elevated levels of Escherichia coli (E coli) contamination that exceeded DC’s surface water quality standards”, according to one published in 2021.The District of Columbia banned swimming in all waterways in 1971, citing “extraordinarily high levels of pollutants from human and animal waste containing bacteria such as salmonella and hepatitis, and viruses”.Separately, the National Park Service has said: “Rock Creek has high levels of bacteria and other infectious pathogens that make swimming, wading, and other contact with the water a hazard to human (and pet) health. All District waterways are subject to a swim ban – this means wading, too!”Part of the issue is that the District’s combined sewer system was developed before 1900, and – like New York City sewage and rain systems – is designed to combine to ease runoff, bypassing water treatment plants.In Washington, according to Open Data DC: “Release of this excess flow is necessary to prevent flooding in homes, basements, businesses, and streets. [Combined sewer overflows] are discharged to the Anacostia River, Rock Creek, Potomac River or tributary waters at CSO outfalls during most moderate rain events.”Kennedy, an avid outdoorsman, had not responded to a request for comment as of publication time, and has not posted on social media about it.In an interview with Fox News on Sunday, Kennedy described himself as a “renegade”. Joined by other appointees to the federal health agency – including the TV doctor Mehmet Oz, Marty Makary and Jay Bhattacharya – he said: “The entire leadership of this agency are renegades who are, you know, who are juggernauts against convention and who are trying to look for truth, no matter what the cost.”On Sunday, Kennedy joined Donald Trump to unveil a new administration plan to lower high US prescription drug prices. He thanked the US president for standing “up to the oligarchs” and took aim at Vermont senator Bernie Sanders, who has made drug pricing a signature issue of his political platform.“It’s one of these promises that politicians make to their constituents knowing that they’ll never have to do it,” the former 2024 Democratic turned independent presidential candidate said.Sanders later scoffed at the administration’s plan, saying it “will be thrown out by the courts”.Kennedy is known for taking risks of a biological kind. He admitted to transporting a roadkill bear cub to New York’s Central Park, and his daughter Kick described a childhood adventure when her father transported a rotting whale head on top of their car from Nantucket to their Westchester home.Had Kennedy’s foray into the polluted creek produced ill effects, the probable treatment for E coli poisoning would not necessarily have benefited much from the administration’s drug cost reduction plan. Common antibiotics used to treat E coli infections are typically priced $10 to $30 for a course of treatment. More

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      Illinois governor is first in US to block federal access to personal data on autism

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      Illinois governor, JB Pritzker, has signed a first-in-the-nation executive order to block the federal government from collecting personal health data related to autism, a direct rebuke to the Trump administration.Pritzker, a Democrat who has been one of the more vocal critics of Donald Trump’s second administration, signed the order last week, saying he wanted to protect “dignity, privacy, and the freedom to live without fear of surveillance or discrimination”.It came two days after the US Health and Human Services secretary, Robert F Kennedy Jr, announced a plan to use data maintained by the National Institutes of Health, and claims submitted for Medicare and Medicaid coverage, to determine the causes of autism. While the agency did not release details of the plan, Kennedy promised it would follow “applicable privacy laws to protect Americans’ sensitive health information”.Prior to his rise to health secretary, Kennedy joined anti-vaccine advocates in claiming childhood vaccines are responsible for autism, but studies by the US Centers for Disease Control and Prevention and others have ruled that out.Pritzker’s executive order bans state agencies from disclosing “personally identifiable autism-related data” outside of state government unless the person or their guardian gives consent, it’s required by legal action, it’s necessary to provide services such as employment or housing or is otherwise required by law. State contractors, vendors and grant recipients are also covered.“We are taking steps to ensure that our state remains a leader in protecting the rights of individuals with autism and all people with disabilities,” Pritzker said.Andy Shih, chief science officer for Autism Speaks, a national advocacy group funding research and services, said he’s unaware of a similar declaration elsewhere. And while Kennedy promises to abide by privacy guidelines, Shih said with advances in computational power and algorithmic thinking, what’s private data today might not be tomorrow.Government investigators could use some techniques to get more information than what is previously disclosed. In the wrong hands, it could be used against patients to deny them constitutionally protected rights.“There’s always that concern,” Shih said. “Being proactive to protect privacy, which is something we value as a society, this should be applauded.”Kennedy has previously said he wants to be able to announce by September some of the causes of autism, a complex brain disorder better known as autism spectrum disorder because it affects people differently. For some people, profound autism means being nonverbal or having intellectual disabilities, while milder cases might mean difficulty with social and emotional skills.Experts say Kennedy’s planned database isn’t appropriate to uncover autism’s causes in part because there’s no information about genetics. However, Shih noted that the Department of Health and Human Services’s announcement was about creating a platform to help understand a range of chronic illnesses, which he said could be useful.Shih added that linking data sets is a proven way of studying issues of health. He pointed to a study published earlier this year in the Journal of the American Medical Association that found dementia in significantly higher numbers among autistic adults over age 65 than the general population. It was achieved by linking numerical identifiers from two different data sets. More

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      Casey Means: influencer, RFK Jr favorite – and Trump’s pick for surgeon general

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      Donald Trump nominated Casey Means, a wellness influencer and medical doctor with an inactive license for US surgeon general this week – the president’s second nominee to serve as “the nation’s doctor”.Trump abruptly withdrew his first nominee, Dr Janette Nesheiwat, before her Senate confirmation hearing, amid criticism from the right and confusion about her medical credentials.His new nominee, Means, is a 37-year-old Los Angeles-based medical entrepreneur who shot to prominence in right-leaning wellness circles by criticizing mainstream medicine and advocating for a healthier food supply.In a social media post, Trump said that Means “has impeccable ‘Maha’ credentials”.Means’s nomination is a testament to the influence of health secretary Robert F Kennedy Jr in the administration. Just a day after Trump nominated Means, he told reporters: “I don’t know her. I listened to the recommendation of Bobby.”Kennedy is the figurehead of “Make America healthy again” (Maha), a loosely defined wellness movement embraced by the right alongside vaccine skepticism, new food politics and criticism of the medical establishment.Means’s brother, self-described former food lobbyist Calley Means, already works for the administration. He serves as a senior adviser to Kennedy and as one of the secretary’s leading online mudslingers.However, major hurdles remain for Means’s nomination – including her inactive medical license and criticism from the same rightwing forces that helped tank Trump’s first nominee.“We should not toss out the window everything Casey is saying, but I would proceed with caution given her training,” said Gabby Headrick, as assistant professor and director of nutrition programs at George Washington University’s Milken School of Public Health.“Typically and historically, the person appointed to that role and confirmed is someone who has an active medical license, someone who has completed residency, and has held a leadership role in a medical institution. Casey Means does not have the resumé … She also is not trained in nutrition.”Means also faces opposition from the far right. Activist Laura Loomer, who was critical of Trump’s first nominee, is skeptical of Means – calling her “unfit” for surgeon general and promoting events with Means’s critics.Loomer previously described Nesheiwat as “a pro-Covid vaccine nepo appointee who is currently embroiled in a medical malpractice case”. Covid vaccines and the technology that underpins them have become a target of right-leaning politicians.Similarly, anti-vaccine activists have sought to reassure the “medical freedom” base of Means’s bone fides. The anti-vaccine activist John Leake argued in a newsletter: “I have not seen any evidence that Casey Means is serving the vaccine cartel with her stated objective of scrutinizing the food supply.”Means describes herself as a “medical doctor, New York Times bestselling author, tech entrepreneur … aspiring regenerative gardener, and outdoor enthusiast who lives in a state of awe for the miracle and mystery of existence and consciousness”.She and her brother wrote a bestselling book called Good Energy: the Surprising Connection Between Metabolism and Limitless Health. The pair shot to fame on the political right around the time that Kennedy dropped out of the race and endorsed Trump. They began appearing at Maha events, on former Fox News host Tucker Carlson’s podcast, on The Joe Rogan Show and on HBO’s Real Time with Bill Maher.Casey Means’s public statements about how Americans should be wary about microplastics and agricultural chemicals and the importance of organic produce could easily serve as liberal dinner-party chatter. They also show how Maha has adopted concerns once considered the dominion of the left.“The thing that is so imperative for people to understand is that the reasons we’re having surgery, the reasons why we’re getting sick, the reasons American competitiveness is plummeting, the reasons why our kids are chronically ill … are all from preventable issues,” Means told Carlson.Means has adopted more inflammatory aspects of Kennedy’s agenda – including questioning the value of vaccines and criticizing Ozempic, the blockbuster GLP-1 drug.“I bet that one vaccine probably isn’t causing autism. But what about the 20 that they’re getting before 18 months?” she said on Rogan’s podcast.Nutrition experts such as Headrick have applauded Good Energy for its effort to elevate disease prevention. But Means ignores the “root causes” of chronic conditions, she says.“Not once in this book does Casey Means point out that millions of Americans do not have access to a full-service grocery store,” said Headrick.Means graduated from Stanford University in 2014 with a medical degree, and attended residency at Oregon Health & Science University the next year, but she left in 2018 before the five-year program finished. She said she left because she became disillusioned with medicine, while professors and former classmates said it was due to stress and anxiety, per the Los Angeles Times. Her medical license lapsed in 2024, according to the Oregon medical board.By 2019, she and a few others founded Levels, a business based around selling continuous glucose monitors and a subscription health tracking app. The devices, once available only to diabetics, have become popular in the “bio-hacking” movement. Such apps also collect reams of data on their customers, a valuable asset.“I am terrified about any company having this granular a look at my life and my medical information,” said Albert Fox Cahn, the executive director of the Surveillance Technology Oversight Project.“This should be someone committed to protecting [and] promoting public health, and I’m terrified to see this administration double down on its willingness to treat health as just another commodity.”One of her co-founders is Sam Corcos, who has become a key figure in the Elon Musk-led “department of government efficiency” inside the Internal Revenue Service. The unofficial department helped eliminate more than 280,000 federal workers, including nearly a quarter of the federal health workforce. The company’s backers have also included Trump advisers.Similarly, Calley Means has also invested in health technology. He co-founded TrueMed, a business that helps people purchase wellness devices – including Levels glucose monitors – through taxpayer-subsidized health savings accounts (HSAs) and flexible spending accounts (FSAs). About one in five Americans has access to an HSA, according to the American Bankers Association. Republicans have proposed expanding the accounts for decades.Although Means’s lack of a medical license would normally be disqualifying, health law experts said they would not rule out the administration attempting an end-run around the requirement.“A medical license requires that the individual maintains her medical knowledge through mandatory continuing medical education,” Gostin told NPR. “She is not licensed and therefore should be ineligible to become surgeon general of the United States.” More

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      Trump health cuts create ‘real danger’ around disease outbreaks, workers warn

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      Mass terminations and billions of dollars’ worth of cuts at the Department of Health and Human Services (HHS) have gutted key programs – from child support services to HIV treatment abroad – and created a “real danger” that disease outbreaks will be missed, according to former workers.Workers at the HHS, now led by Robert F Kennedy Jr, and in public health warned in interviews that chaotic, flawed and sweeping reductions would have broad, negative effects across the US and beyond.While Donald Trump’s administration is cutting the HHS workforce from 82,000 to 62,000 through firings and buyouts, grant cuts by Elon Musk’s so-called “department of government efficiency” (Doge) have also had a stark impact on state governments – and resulted in firings at state public health agencies.At the South Carolina department of public health, for example, more than 70 staff were laid off in March due to funding cuts.“Disease surveillance is how we know when something unusual is happening with people’s health, like when there are more food-poisoning cases than usual, or a virus starts spreading in a community,” an epidemiologist at the department, whose role was eliminated, said. “It’s the system that lets us spot patterns, find outbreaks early, and respond before more people get sick.”“When you lose public health staff, you lose time, you lose accuracy, you lose responsiveness, and ultimately that affects people’s health,” they added. “Without us, outbreaks can fly under the radar, and the response can be delayed or disorganized. That’s the real danger when these roles get cut.View image in fullscreen“It’s invisible work, until it’s not. You may not think about it day to day, but it’s protecting your drinking water, your food, your kids’ schools and your community.”A spokesperson for South Carolina’s public health department declined to comment on specifics, but noted employees hired through grants are temporary. “When funding for grants is no longer available, their employment may end, as happened with some temporary grant employees who were funded by these grants,” they said.In Washington, the HHS has been cut harder by Doge than any other federal department. Hundreds of grants to state, local and tribal governments, as well as to research institutions, have been eliminated, worth over $6.8bn in unpaid obligations.The HHS receives about a quarter of all federal spending, with the majority disbursed to states for health programs and services such as Medicare and Medicaid, the insurance programs; medical research; and food and drug safety. Trump’s budget proposal calls for cutting the department’s discretionary spending by 26.2%, or $33.3bn.RFK Jr, who has a history of promoting conspiracy theories and medical misinformation, was nominated by Trump and approved by the Senate along party lines, with Mitch McConnell the sole Republican dissenter.Following a reduction in force of 10,000 employees on 1 April, Kennedy Jr claimed 20% of the firings were in error and that those workers would be reinstated, though that has not happened.An HHS spokesperson blamed any such errors on data-collection issues, and did not comment on any other aspects of the Guardian’s reporting.Aids relief program ‘dismantled’At the Centers for Disease Control and Prevention, an operating division of the HHS, employees working on maternal and child health at the President’s Emergency Plan for Aids Relief (Pepfar) program were shocked to be included in the reduction in force, as earlier in the administration their work had received a waiver for parts of the program from federal funding freezes.All federal experts on HIV prevention in children overseas were fired as part of the reduction in force.“Our concern initially was that it was a mistake with the name. We hoped around that time it came out that there were 20% errors, that we would be included,” said an epidemiologist who was included in the reduction in force, but requested to remain anonymous as they are currently on administrative leave. They also noted that they were in the middle of planning and delivering a new pediatric HIV treatment medication set to be dispersed this year, and that that work was now at risk.View image in fullscreenThey said 22 epidemiologists in the branch of their CDC division had been fired. Pepfar was created in 2003 by George W Bush to prevent mother-to-child HIV transmission and credited with saving 26 million lives.“We were very shocked on April 1 that we were put immediately on admin leave,” said another epidemiologist affected by the reduction in force at the CDC. “We really feel our branch being cut was a mistake. The state department had said services were a priority and needed to continue, but then we were cut by HHS.”They noted HIV treatment had already stopped in regions of countries that had been reliant on USAID programs, such as Zambia.“It is one of the most successful global health programs in history, data driven with high levels of accountability and the dollars spent achieve impact. Our concern now is, yes, they are continuing Pepfar in name, but they are dismantling all the systems and structure that allowed it to succeed,” they added. “The US made a huge investment in this program in 20 years and a lot of it is now undone. We’ve now disrupted those systems that could have reduced and eventually removed US investment in these programs.”‘Long-term impact’ on US familiesInside the HHS, the Administration for Children and Families is responsible for enforcing court-ordered child-support payments. For every dollar it receives in federal funding, ACF says it is able to collect $5 in child support.A child-support specialist with the HHS, who requested to remain anonymous for fear of retaliation, said reductions in force at the department have increased workloads on those who were not fired by multiple times, making it so state and tribal agencies have no way of ensuring they are compliant with federal requirements.“The regional staff with direct oversight of the program are gone,” they said. “There are entire regions that have two staff members managing a quarter of the work for the program with no management, no support, no knowledge of the program.”After the Trump administration took office, the agency was under an unofficial stop-work order, where staff were not permitted to provide guidance or support to grantees or even answer phones, until late February, the specialist said. A reduction in force followed on 1 April, when, the child-support specialist claimed, about half the ACF staff working on child support were fired.Their department is responsible for overseeing child-support programs at state, tribal and local levels. States “could very well lose millions of dollars in funding” if ACF does not provide key training and assistance and the states do not have qualified staff, the specialist cautioned. “And that is the long-term impact to vulnerable children and families in the country.”They added: “The entire function of the program is to give economic stability to children and families, so that they do not depend on any other government program, or their reliance on these programs is lower, because the children are supported by both parents.”‘A living hell’At the Centers for Medicare and Medicaid Services, also within the HHS, one of 300 workers terminated as part of a reduction in force claimed it had been illegal, and had not followed any proper procedures. The National Treasury Employees Union has filed a grievance over how the firings were carried out, including incorrect information on notices.They explained that, on 1 April, they received a generic letter informing them of an intent of reduction in force. Hours later, they were locked out of their government logins. “We started emailing the management that was left, trying to get clarification on what our status was. Nobody could give us an answer,” the worker said.On 7 April, they discovered through their paystub that they had been placed on administrative leave, despite never receiving a notice. They didn’t receive an RIF notice until weeks later, after requesting it.“Based on my tenure, and as a disabled veteran, I should at least have a chance of reassignment,” they said. “I’m not mad about losing my job. It happens. I’ve been laid off. The first time was in the private sector, and it was way more humane, more empathetic, and I was given different offers.“This, on the other hand, is unbridled hate. This administration has gone out of their way to make it a living hell for all of its public servants.” More

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

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

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      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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      Private firms are trying to fill research gaps, but their ‘puny’ budgets are no match for federal funds

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      The federal government has slashed research since Donald Trump took office – hacking away at the National Institutes of Health (NIH) and its grants, staff and long-held partnerships with academia.Now, some private companies said they want to pick up strands of research that might have otherwise been funded by the federal government. The effort has stoked little optimism among experts, who caution that private efforts cannot remotely replicate the breadth, depth or public service provided by federal funding.“We can’t wait four years to do any women’s health research,” said Priyanka Jain, co-founder and the CEO of the startup Evvy. The company sells at-home vaginal microbiome tests – a product the company argues can help women better understand common conditions such as bacterial vaginosis.Jain said Evvy is funding a small trial to identify biomarkers, or physical indicators, of how the vaginal microbiome can impact in vitro fertilization (IVF) success rates.“There are companies like Evvy raising venture dollars and doing the work the government is not doing,” said Jain. “Women step up and actually solve this problem.”In contrast, health policy insiders such as Sean Tipton, the chief policy officer at the American Society for Reproductive Medicine, said the many small projects that hope to keep research alive cannot remotely match the retreat of federal government research.“It is absolutely not realistic to think that the resources of the federal government can be replaced through some combination of philanthropic and for-profit entities trying to fill the gap,” said Tipton.The NIH is the world’s largest public funder of biomedical and behavioral research. When Trump took office, the agency had a $48bn budget and funded projects into nearly every area of medicine imaginable – including administration bugbears such as fluoride and vaccine safety.In the first few months of the administration, the health secretary Robert F Kennedy Jr and billionaire Elon Musk’s unofficial “department of government efficiency” have fired 1,300 NIH employees, canceled $2bn in grants, and slowed new grant approval by nearly one-third, pumping $2.3bn less into research.View image in fullscreenA leaked budget proposal would further shrink the NIH by 40% – or tens of billions less that will not go into research. HHS has also canceled more than $11bn in state grants and frozen billions in grants slated for research at Ivy league colleges such as Harvard University. In the latest move, the National Science Foundation, which finances basic research in areas such as astronomy and quantum computing, canceled $2bn more in funding.“In the research space, my organization is proud because we’re now spending in excess of $3m a year on research grants – that is literally a rounding error compared to what the federal government spends,” Tipton said. “We’re very proud of that, and worked very hard to get it up to that level, and that level is puny and inadequate.”The federal government’s backing of scientific research has been fundamental to modern drug discovery. NIH research contributed to 354 of 356 of the drugs approved by the US Food and Drug Administration (FDA) between 2010-2019, a JAMA Health Forum study found.That money has gone to advance blockbuster drugs such as Wegovy and Ozempic – first identified by an NIH-funded researcher and isolated from gila monster saliva by Veterans Affairs researchers – and to the hundreds lesser known FDA-approved treatments.“Tell taxpayers we’re studying gila monsters in a lab – they’ll laugh you out of town, but the first GLP-1 was exenatide, which is a gila monster protein,” said Dr Fred Ledley, the author of the JAMA Health Forum study. Ledley’s favorite example of basic research comes from worms – publicly funded studies of their intestinal development led to the discovery of a trigger of cell death, which now underpins nearly one-third of the new cancer drugs on the market.His research found that for every “first in class” innovative drug brought to market, the NIH funded roughly $1.4bn in research. If government investment was calculated as industry calculates its investment – to include failure and the cost of capital – it is closer to $2.8bn in public funding, or about the equivalent of what industry spends to bring an innovative drug to market.Without NIH’s basic research, there is little hope that the private market will pick up the tab, said Ledley.“It’s too expensive for them,” Ledley said. “What you’ll see industry do is develop more ‘me too’ drugs,’” and “incremental tweaking … This is not what the public wants”.“The public wants something to treat Alzheimer’s with, they want something to prevent diabetes in the first place, and they desperately need better treatments for cancer and heart disease – still the number one killer,” said Ledley.Another indicator of the low likelihood of the industry picking up basic research is in job listings. Since 1 January, listings for research and development positions have fallen 25% based on a “before times” baseline of January 2020 baseline, according to data from job hiring site Indeed. Instead, the private health sector is dominated by demand for services – such as nurses and surgeons.“The government can step in and correct that kind of market failure when something is going to be positive for the society but not necessarily profitable in the market,” said economist Allison Shrivastava, an economist with Indeed. “A lot of this research falls into that category.”Put another way by the Democratic US senator Patty Murray at a recent press conference: “Our public health folks who go out and track measles or track whooping cough or track a new pandemic aren’t going to work for a private company … There isn’t a profit-making course in this.”“In last year’s world we were hoping to get funding” from the federal government for her company’s study, said Jain. She noted that women’s health research has been especially hard-hit by cuts, a victim of “diversity, equity and inclusion” cancellations.“I personally don’t think we should have to raise venture capital money to do this study – that is not the typical use of venture capital money,” said Jain. “Our hope is we survive another four years and the tides turn.” More

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      ‘A ruthless agenda’: charting 100 days of Trump’s onslaught on the environment

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      Donald Trump has never been mistaken for an environmentalist, having long called the climate crisis a “giant hoax” and repeatedly lauding the supposed virtues of fossil fuels.But the US president’s onslaught upon the natural world in this administration’s first 100 days has surprised even those who closely charted his first term, in which he rolled back environmental rules and tore the US from the Paris climate agreement.This time, the mantra “drill, baby, drill” has been used to justify a hyperactive series of actions to reverse rules designed to protect clean air and water, open up vast tracts of land, ocean and even the seabed to mining, fire federal scientists en masse and downgrade the federal response to the disasters that stem from a warming world.Trump’s Environmental Protection Agency (EPA) is attempting to roll back toxic regulations that were calculated to save an estimated 200,000 Americans’ lives in the years ahead, his Department of the Interior is looking to shrink national monuments and his scientific agencies are degrading the basic data collection required for climate assessments and even weather forecasts.This burst of activity faces a barrage of legal action, with the courts already taking a dim view of the administration’s attempts to skirt usual practice in its haste to deregulate. Even with a rightwing-dominated supreme court, many of these executive orders are expected to founder.However, the US must accelerate efforts to cut emissions if climate goals are to be met, half of Americans still have to endure unsafe air and endangered species and public lands face pressure from a changing climate. The next few years will see little remedy to these growing problems from the White House.“The pace of announcements may slow at some point but the pressure on our regulatory system and our democracy will not only continue, but ramp up,” said Michael Burger, a climate law expert at Columbia University.“The result will be fewer environmental protections and more people suffering the public health consequences of more pollution. It’s that straightforward.” Oliver MilmanHistoric rollbacks of environmental regulations What has the administration done:

      Taken more than 140 actions to roll back environmental rules and push for greater use of fossil fuels.

      Set about rewriting regulations that limit pollution from cars, trucks and power plants.

      Officially reconsidering whether greenhouse gases actually cause harm to public health.

      Legally targeted states that have their own laws on tackling the climate crisis.

      Speeded up environmental reviews of drilling projects, from years to just a few weeks.

      Winding back water efficiency standards for showers and toilets and halting a phase-out of plastic straws
      View image in fullscreenAnalysis and reaction: When campaigning for president, Donald Trump promised to torch environmental regulations if fossil fuel companies were able to donate enough money to propel him to the White House. He has set about fulfilling this pledge in dizzying fashion.By the Guardian’s count, Trump’s administration has taken more than 140 actions to weaken or rescind environmental rules and to escalate the use of fossil fuels in his first 100 days – more than all of the rollbacks of his entire first term.The drumbeat of this effort, largely via a blizzard of executive orders and agency memos, to eviscerate rules designed to protect Americans’ air, water and a livable climate, has been relentless. “What we’ve seen in this first 100 days is unprecedented – the deregulatory ambition of this administration is mind-blowing,” said Burger of Columbia University.In a single day in March, Trump’s EPA launched 31 different actions to refashion pollution laws for cars, trucks and power plants and even re-evaluate whether greenhouse gases harm public health – a key finding that underpins US climate laws. It was a “dagger to the heart of the climate religion”, according to Lee Zeldin, the EPA administrator.Zeldin has repeatedly touted the EPA’s record during the first 100 days, with the agency publishing a list of 100 environmental actions, including the cleanup of toxic waste and the testing of chemicals.But the administration has also sought to ease restrictions upon coal plants dumping their toxic ash and mercury and to scale back a plan to prevent states from wafting their pollution to their neighbors. Consideration of the climate crisis has been removed from federal spending decisions and disaster recovery, pipeline safety standards are to be relaxed and environmental permit approvals speeded up from years to just weeks.Places of refuge for nature and carbon storage, such as oceans and national forests, will be opened up for the extraction of fish and timber while endangered species laws are set to be upended and, if the administration gets its way, essentially neutered.Not content with the reorientation of the federal government’s response to the climate crisis, Trump has ordered his Department of Justice to target states that have their own climate laws. He has also ordered the expiration of environment and energy regulations across 25 different laws, usually a responsibility of Congress.Trump has even used the power of his office to attend to his own fixations around shower water pressure, which he considers too weak, and paper straws, which he dislikes compared with the plastic alternative. “There doesn’t seem to be any strategy to this but I feel like I have policy whiplash,” said Gina McCarthy, who was Joe Biden’s top climate adviser.“We see an administration that doesn’t care about these things and is all about the whims of President Trump. Executive orders are not laws, though, and we spend a great deal of time focusing on them when most of them are highly illegal and won’t go anywhere.” Oliver MilmanTrump’s ‘drill, baby, drill’ agendaWhat the administration has done:

      Trump signed executive orders to ease restrictions on fossil fuel extraction and exports, pledging to “unleash American energy”.

      He tapped fossil fuel-supporting appointees to head up crucial federal agencies, including Chris Wright, a former fracking CEO, for energy secretary; Doug Burgum, former Republican governor of North Dakota – the third largest oil and natural gas producer in the country – to lead the interior department (DOI); and Lee Zeldin, a former Republican congressperson to head the EPA.

      Trump offered the fossil fuel industry – which lavished record levels of donations on him and Congress – an exemption from the tariffs he presented in April (and which he placed on pause shortly thereafter).
      Analysis and reaction: Aru Shiney-Ajay, executive director of the youth-led environmental justice group Sunrise Movement said: “Donald Trump’s actions on climate are part of a ruthless agenda to prop up big oil and reward the billionaires bankrolling his campaigns. Big oil’s bribe paid off.”Trump’s loyalty to the fossil fuel industry has not, however, shielded fossil fuel companies from the fallout of his erratic policymaking. The domestic oil industry is currently facing the some of the lowest prices for crude it has seen in years. The Dow Jones’s US Oil and Gas Index, which tracks 42 fossil fuel companies, plummeted by more than 15% since Trump announced the tariffs on 2 April, sinking to its lowest level since 2022, before a slow, partial rebound.View image in fullscreenMeanwhile, Trump’s tariffs have already begun driving up the costs of oil production, with new taxes on steel and aluminum inflating the costs of building fossil fuel infrastructure. And his calls to “drill, baby, drill” have raised concerns about oil demand, since an increase in supply could push down prices, thereby limiting profit.Though the oil industry has publicly praised Trump, they have quietly showed they are anxious about the economic implications of his policies. In a recent anonymized survey by the Federal Reserve Bank of Dallas, for instance, fossil fuel executives brazenly criticized Trump. “The administration’s chaos is a disaster for the commodity markets,” one oil boss said. “‘Drill, baby, drill’ is nothing short of a myth and populist rallying cry. Tariff policy is impossible for us to predict and doesn’t have a clear goal. We want more stability.”At a major Texas oil and gas conference in May, fossil fuel top brass echoed these criticisms.Though the Trump administration has not ended the chaos created by its policies, it has given big oil other gifts. In recent weeks, for instance, Trump signed an executive order instructing the Department of Justice to “stop the enforcement” of state climate laws forcing polluting companies to pay for climate damages, and also targeting dozens of lawsuits that accuse big oil of intentionally covering up the climate risks of their products. Dharna NoorHollowing out agencies including Noaa, Fema and DOIWhat has the administration done

      Sweeping cuts to federal agencies on the forefront of the climate crisis, including the National Oceanic and Atmospheric Administration (Noaa), the Federal Emergency Management Agency (Fema), the DOI and the Department of Agriculture (USDA), and widespread firings of climate scientists and regulation experts.

      Withdrawal from contracts and canceled grant funding; datasets pulled from public-facing websites; funding for regional climate centers suspended.

      National Climate Assessment contract canceled; hundreds of experts dismissed.

      Executive order to expedite deep-sea mining for minerals.

      Plans to dismantle a key Fema disaster preparedness program.

      Weather balloon launches stopped due to staff shortages.

      Censorship of climate-related words, flagged in studies, contracts and agency documents/websites.

      Plans to drain funding for climate, weather and ocean laboratories.
      Analysis and reaction: Trump wasted no time before he unleashed an all-out assault on environmental science, gutting the federal agencies positioned on the frontlines of the climate crisis, firing hundreds of researchers, staffers and forecasters and pulling public access to critical resources and data.Vital work to understand, prepare and respond to changes caused by global heating has slowed or stopped as teams try to navigate the chaos, while the threat of more severe budget cuts and political crackdowns lingers. The moves largely bypassed input or oversight from Congress as Trump used executive orders and actions undertaken by the billionaire Elon Musk-led “department of government efficiency”, even on budget issues typically governed by the legislative branch.View image in fullscreenThousands of federal workers were culled from the ranks across the country’s premier scientific agencies – including at Noaa and Nasa – and in roles across the government that typically facilitate regulatory process or research. Many of those fired were probationary employees, a classification applied to the first year, or sometimes two, in a position.The widespread firings were challenged in court, forcing the administration to rehire workers and put them on administrative leave, only to fire them again when legally in the clear. In the end, at least 121,000 federal workers were fired, leaving significant holes in their wake.Thousands more workers have opted to take offers of early retirement or voluntary separations. At Noaa alone, roughly 27,000 years of collective experience was lost, according to Craig McLean, the former director of Noaa research.“We lost our promising new talent in the probationary firings and now we’ve lost our institutional knowledge,” a Noaa employee said of the resignations, asking for anonymity out of fear of retribution.While the losses are expected to have a profound effect on the American public, the impact will be felt globally too.Among the hundreds of positions lost were workers who track El Niño-La Niña weather patterns around the world, people who model severe storm risks, and scientists contributing to global understanding of what could happen as the world warms.“I want to emphasize that this blunt smashing of federal agencies is limiting the ability of our nation to respond not only now, but in the future,” said Dr Gretchen Goldman, president of the Union of Concerned Scientists. “It’s dismantling the very infrastructure by which we collect data, foster expertise and collaboration, and have the people and processes in place to take action.”Already, the staff shortages have hampered data collection and field offices have had to stop deploying tools that gather essential intel.“The effects may not be obvious until there is a major tornado outbreak, or a hurricane landfall downwind, that doesn’t go so well,” said climate scientist Daniel Swain, who spoke about the gravity of this issue during a recent broadcast on YouTube. But, he said, the actions taken in the first 100 days were just the beginning.“What we have seen so far is just the tip of the iceberg,” he said, noting recently leaked budget documents that outline the president’s plans to continue gutting climate science-focused federal work. If the administration has its way, he said, “it would probably spell the end of most publicly funded climate research in the United States”. Gabrielle CanonPublic lands targetedWhat has the administration done

      Rescinded protections for hundreds of millions of acres of federal waters.

      Initiated major changes to National Environmental Policy Act (Nepa) regulations that require federal projects consider environmental impacts and enable public oversight/comment, severely reducing the often years-long environmental impact process to 28 days.

      Ordered the end of American Climate Corps jobs that create climate and public lands-supporting positions.

      Plans to fast-track controversial deep-sea mining and accelerating approvals for mining, drilling, and fossil fuels extraction on public lands..

      Proposed rolling back protections in the Endangered Species Act.

      Plans to rescind Bureau of Land Management rules that protect millions of acres in Alaska and across the US west; planned repeal of BLM Public Lands Rule.

      Emergency situation determination issued by the USDA to open logging on more than 100m acres of national forests and an executive orders to increase and accelerate logging on federal lands. And revoked a Biden order that protected old-growth forests.

      Joint taskforce between DOI and the Department of Housing and Urban Development to examine federal lands for housing development as the administration pushes for the sell-off of public lands.
      Analysis and reaction: Trump may be one of the very few Americans who doesn’t cherish the country’s public lands. Voter support for these roughly 640m acres – forests and deserts, parks and monuments among them – is stalwart and one of the few issues bridged by an otherwise vast political divide.But even with broad popularity and a rapidly escalating interest in outdoor recreation that’s fueled both local economies and international tourism, the administration has made it a priority to shrink land management agencies, reduce protections once governed by them and possibly even diminish the holdings of lands under federal jurisdiction.View image in fullscreenThousands of employees were fired or took deals to leave, and agencies are struggling to hire seasonal employees who typically run operations during the busiest seasons. Still, more cuts are being planned as Trump seeks to reshape the federal government. Reports found the Department of Interior has plans to cull roughly 25% of its workforce, and employees at the US Forest Service are bracing for a broad reduction in force that has yet to be detailed. The National Park Service alone has suffered a 13% reduction in staff already.Sweeping firings left behind gaping holes in an already short-staffed workforce at parks and forests, leaving some departments with workforce levels typically seen during government shutdowns according to some experts.Toilets, trash and overgrown trails may become a common feature in highly trafficked areas, along with increasing risks of trampled conservation areas, a lack of capacity for the study of threatened plants and animals, and lost support that ensures safety measures are followed. Visitation has surged in recent years, adding new strains on ageing infrastructure and more opportunities for injuries and wildlife conflicts, as dangers from extreme conditions fueled by the climate crisis continue to mount.“Scientists who should be doing their job tracking the wildlife and the ecosystems in these parks, are being told they have to take restroom cleaning shifts,” said Aaron Weiss, the deputy director for the Center for Western Priorities. “That’s incredibly important in parks,” he added, “but we shouldn’t be assigning those jobs to scientists because Doge has fired all the custodial staff.”It’s not just about recreation, though. The administration has also made moves to open the country’s holdings of conservation areas, protected habitats and wilderness to extraction and development. There have been a series of orders from the administration that call for increased logging, fossil fuels leases, and mining as Trump pushes for expanding industry access.Ben Vizzachero, a federal worker who initially lost his job during the federal firing spree but who was later brought into his position said the outlook still remained bleak for US public lands. “The Trump administration is waging a campaign of bullying and harassment, trying to shrink the federal workforce by any means,” he said, noting that removing regulators and regulations will “open lands for mining, logging, drilling, and other destruction”.These sweeping changes and the threats to public lands come as they continue to be widely supported and cherished by the American people. “The fight to protect our public lands is embedded within the fight for our democracy itself.” Gabrielle CanonCancelling environmental justice schemes, and hitting US farmers What has the administration done

      Trump immediately rescinded a slew of executive orders that directed federal agencies to prioritize tackling environmental racism and other injustices – including one dating back more than 30 years.

      A separate executive order focused on ending government-sponsored diversity, equity and inclusion (DEI) initiatives and so-called “illegal DEI” efforts in the private sector also targeted environmental justice by wrongly conflating the two. This called for the closures of all environmental justice offices and positions in the federal government – including the office of environmental justice and external civil rights which was created to support EPA efforts to help improve access to clean water, air and land in communities disproportionately affected by environmental pollution, as well as enforce federal civil rights laws.

      Mass layoffs in the EPA, USDA and health and human services department which will disproportionately hit access to adequate, clean and affordable food, water, air and energy for low-income and rural communities.

      Freezing the Biden-era Greenhouse Gas Reduction Fund – more than $20bn of competitive grants available to states, cities, tribes and other eligible groups to reduce greenhouse gas emissions and air pollution, particularly in areas most affected by climate crisis and excluded from mainstream finance.

      Terminating climate and conservation grants to US farmers including the Biden-era five-year $3.2bn real-life study into the effectiveness of conservation practices such as cover cropping for commodity farms.
      View image in fullscreenAnalysis and reaction: From day one of Trump 2.0, the president has revealed his intention to willfully conflate environmental justice – efforts to acknowledge and correct decades of harm caused by placing polluting factories, landfills, fossil fuel infrastructure and highways in low-income and Indigenous people and communities of color – with what he and his allies believe to be woke, anti-white DEI policies that proliferated in response to the BLM movement.Citing Trump’s crusade against DEI, the justice department terminated a two-year investigation into a petrochemical plant in LePlace, Louisiana, accused of emitting extraordinarily high levels of the cancer-causing chemical chloroprene into the majority Black community. Then, in an unprecedented move, his justice department terminated a 2023 landmark settlement with the state of Alabama requiring health authorities to provide the majority-Black Lowndes county with basic sewage and sanitation services – which an earlier investigation found had been denied for decades due to environmental racism. Several other consent decrees involving egregious polluters are feared to be under threat.Not to be outdone, Robert F Kennedy Jr, secretary of the Department of Health and Human Services (HHS), dismantled the office and fired the entire staff at the Low Income Home Energy Assistance Program (Liheap). States were still waiting for about $380m to be disbursed this year, when the bipartisan program that helps low-income Americans struggling to pay energy bills so they don’t die from the extreme heat or cold was disbanded. In a leaked HHS budget for 2026 seen by the Guardian, Liheap was terminated – which unless revived will increase heat and cold deaths in the richest country in the world.The $20bn Greenhouse Gas Reduction Fund, and the portal, has been frozen on and off since February, causing chaos and uncertainty for recipients as this makes its way through the courts. The money was appropriated by Congress through the 2022 Inflation Reduction Act and finalized before the election, and it is widely agreed (outside Trump world) that the fund cannot legally be cancelled without legislation. The fear is that the Republican-majority Congress will succeed in pushing this through in the continuing resolution for the 2025 budget, which should be passed in May.“The administration is trying to make it so difficult that people will give up, but our quest for environmental justice [has been waged] for 40 years and we will not stop now,” said one veteran environmental justice leader who asked not to be named in fear that his organization, a recipient of the fund, would be targeted. “The climate crisis is real; environmental racism is real. Those are the facts.” Nina LakhaniTearing up US global climate pledgesWhat has the administration done

      Pulled out of the 2015 Paris accords, which the Biden administration rejoined in 2021 – four years after Trump first withdrew the US from the global climate mitigation pact.

      Withdrew the US from the loss and damage fund – a global agreement under which the developed countries most responsible for the climate crisis pledged to partly compensate developing countries for irreversible harms caused by global heating.

      The EPA missed the annual 15 April deadline to submit data on US greenhouse gas emissions to the United Nations – the first time in 30 years.
      Analysis and reaction: The US is currently the second biggest greenhouse gas emitter, so withdrawing from the Paris agreement and its legally binding commitment to reduce emissions will further weaken global efforts to slow global heating – with catastrophic consequences for communities vulnerable to climate shocks in the US and globally. It takes a year for the withdrawal to go into effect, but missing the 15 April emissions reporting deadline, which never happened even during Trump’s first term, has raised suspicion that this administration is willing to violate international rules and could be preparing to exit from the entire UNFCCC.View image in fullscreenAnother major concern is climate finance. As the world’s biggest economy (and worst historical polluter), the US has been a major, albeit inadequate, contributor to global climate funds to help developing countries that are not responsible for global heating in their climate mitigation and adaptation efforts. It has already pulled out of the loss and damage fund, adopted at the Cop28 UN summit in 2023 after years of diplomatic and grassroots advocacy – and despite US efforts to block it. The US has long obstructed progress on global climate action and had pledged a measly $17.5m (£13.5m) to the fund; the cynical move to withdraw from loss and damage efforts – while bolstering fossil fuel production – was widely condemned by the global south.Harjeet Singh, a climate activist and founding director of the India-based Satat Sampada Climate Foundation, said: “As the largest historical emitter, the United States bears a significant share of the blame for the climate adversities affecting vulnerable populations worldwide. The decision by the Trump administration exemplifies a longstanding pattern of obstruction by the US government in securing necessary finance for addressing climate impacts, [and] undermines global efforts to deliver climate justice.” Nina Lakhani More

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      The uniting theme of Trump’s presidency? Ineptitude | Robert Reich

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      Some Democrats fear they’re playing into Donald Trump’s hands by fighting his mass deportations rather than focusing on his failures on bread-and-butter issues like the cost of living.But it’s not either-or. The theme that unites Trump’s inept handling of deportations, his trampling on human and civil rights, his rejection of the rule of law, his dictatorial centralization of power, and his utterly inept handling of the economy is the ineptness itself.In his first term, not only did his advisers and cabinet officials put guardrails around his crazier tendencies, but they also provided his first administration a degree of stability and focus. Now, it’s mayhem.A sampling from recent weeks:1. The Pete Hegseth disaster. The defense secretary didn’t just mistakenly share the military’s plans with the editor of the Atlantic; we now know he shared them with a second Signal group, including his wife, brother and personal lawyer.He’s a walking disaster. John Ullyot, who resigned last week as Pentagon spokesperson, penned an op-ed in Politico that began: “It’s been a month of total chaos at the Pentagon.” Last Friday, Hegseth fired three of his senior staffers. His chief of staff is leaving. As Ullyot wrote, it’s “very likely” that “even bigger bombshell stories” will come soon. The defense department “is in disarray under Hegseth’s leadership”.It’s not just the defense department. Much of the federal government is in disarray.2. The Harvard debacle. A Trump official is now claiming that a letter full of demands about university policy sent to Harvard on 11 April was “unauthorized”. What does this even mean?As Harvard pointed out, the letter “was signed by three federal officials, placed on official letterhead, was sent from the email inbox of a senior federal official and was sent on April 11 as promised. Recipients of such correspondence from the US government – even when it contains sweeping demands that are astonishing in their overreach – do not question its authenticity or seriousness.”Even though it was “unauthorized”, the Trump regime is standing by the letter, which has now prompted Harvard to sue.3. The tariff travesty. No sooner had Trump imposed “retaliatory” tariffs on almost all of the US’s trading partners – based on a formula that has made no sense to anyone – than the US stock and bond markets began crashing.To stop the selloff, Trump declared a 90-day pause on the retaliatory tariffs but raised his tariffs on China to 145% – causing markets to plummet once again.Presumably to stem the impending economic crisis, he declared an exemption to the China tariffs for smartphones and computer equipment. By doing so, Trump essentially admitted what he had before denied: that importers and consumers bear the cost of tariffs.Now, Trump is saying that even his China tariffs aren’t really real. Following warnings from Walmart, Target and Home Depot that the tariffs would spike prices, Trump termed the tariffs he imposed on China “very high” and promised they “will come down substantially. But it won’t be zero.”Markets soared on the news. But where in the world are we heading?4. The attack on the Fed chair fiasco. When Trump renewed his attacks on Jerome H Powell, the chair of the Federal Reserve – calling him “a major loser” and demanding that the Fed cut interest rates – Trump unnerved already anxious investors who understand the importance of the Fed’s independence and feared that a politicized Fed wouldn’t be able to credibly fight inflation.Then, in another about-face, Trump said on Wednesday he had “no intention” of firing Powell, which also helped lift markets.An economy needs predictability. Investors won’t invest, consumers won’t buy, and producers won’t produce if everything continues to change. But Trump doesn’t think ahead. He responds only to immediate threats and problems.Who’s profiting from all this tumult? Anyone with inside knowledge of what Trump is about to do: most likely, Trump and his family.5. The Kilmar Ábrego García calamity. After the Trump regime admitted an “administrative error” in sending Ábrego García to a brutal Salvadoran torture prison, in violation of a federal court order, Trump then virtually ignored a 9-0 supreme court order to facilitate his return.To the contrary, with cameras rolling in the Oval Office, Trump embraced Nayib Bukele – who governs El Salvador in a permanent state of emergency and has himself imprisoned 83,000 people in brutal dungeons, mostly without due process. Trump then speculated about using Bukele’s prisons for “homegrown” (ie, American-born) criminals or dissidents.Meanwhile, after the Trump regime deported another group of immigrants to the Salvadoran prison under a rarely invoked 18th-century wartime law, the supreme court blocked it from deporting any more people under the measure.6. Ice’s blunderbuss. Further illustrating the chaos of the Trump regime, immigration officials have been detaining US citizens. One American was held by Immigration and Customs Enforcement (Ice) in Arizona for 10 days until his relatives produced papers proving his citizenship, because, according to his girlfriend’s aunt, Ice didn’t believe he was American.Last week, the Trump regime abruptly took action to restore the legal status of thousands of international students who had been told in recent weeks that their right to study in the United States had been rescinded, but officials reserved the right to terminate their legal status at any time. What?Freedom depends on the rule of law. The rule of law depends on predictability. Just like Trump’s wildly inconsistent economic policies, his policies on immigration are threatening everyone.7. Musk’s ‘Doge’ disaster. Musk’s claims of government savings have been shown to be ludicrously exaggerated.skip past newsletter promotionafter newsletter promotionRemember the claim that taxpayers funded $50m in condoms in Gaza? This was supposed to be the first big “gotcha” from the so-called “department of government efficiency” (Doge), but as we know now, it was a lie. The US government buys condoms for about 5 cents apiece, which means $50m would buy 1bn condoms or roughly 467 for every resident of Gaza. Besides, according to a federal 2024 report, the US Agency for International Development (USAID) didn’t provide or fund any condoms in the entire Middle East in the 2021, 2022 or 2023 fiscal years.Then there have been the frantic callbacks of fired federal workers, such as up to 350 employees at the National Nuclear Security Administration who work on sensitive jobs such as reassembling warheads. Four days after Doge fired them, the agency’s acting director rescinded the firings and asked them back. Similar callbacks have occurred throughout the government.Trump and Musk are threatening the safety and security of Americans – for almost no real savings.8. Measles mayhem. As measles breaks out across the country, sickening hundreds and killing at least two children so far, Trump’s secretary for health and human services, Robert F Kennedy Jr, continues to claim that the measles vaccine “causes deaths every year … and all the illnesses that measles itself causes, encephalitis and blindness, et cetera”.In fact, the measles vaccine is safe, and its risks are lower than the risks of complications from measles. Most people who get the measles vaccine have no serious problems from it, the CDC says. There have been no documented deaths from the vaccine in healthy, non-immunocompromised people, according to the Infectious Diseases Society of America.Kennedy also says: “We’re always going to have measles, no matter what happens, as the [measles] vaccine wanes very quickly.” In fact, the measles vaccine is highly protective and lasts a lifetime for most people. Two doses of the vaccine are 97% effective against the virus, according to the CDC and medical experts worldwide. The US saw 3m to 4m cases a year before the vaccine. Today it’s typically fewer than 200.9. Student debt snafu. After a five-year pause on penalizing borrowers for not making student loan payments, the Trump regime is about to require households to resume payments. This could cause credit scores to plunge and slow the economy.Many of the households required to resume paying on their student loans are also struggling with credit card debt at near-record interest rates and high-rate mortgages they thought they would be able to refinance at a lower rate but haven’t. Instead of increasing education department staffing to handle a work surge and clarifying the often shifting rules of its many repayment programs, the Trump regime has done the opposite and cut staff.10. Who’s in charge? In the span of a single week, the IRS had three different leaders. Three days after Gary Shapley was named acting commissioner, it was announced that the deputy treasury secretary, Michael Faulkender, would replace Shapley. That was the same day, not incidentally, that the IRS cut access to the agency for Doge’s top representative.What happened? The treasury secretary, Scott Bessent, told Trump that Musk had evaded him to install Shapley.Meanwhile, the Trump regime is cutting the IRS in half – starting with 6,700 layoffs and gutting the division that audits people with excessive wealth. These are the people meant to keep billionaires accountable. Without them, the federal government will not take in billions of dollars owed.At the same time, the trade adviser Peter Navarro has entered into a public spat with Musk, accusing him of not being a “car manufacturer” but a “car assembler” because Tesla relies on parts from around the world. This prompted Musk to call Navarro a “moron” and “dumber than a sack of bricks” in a post on X, later posting that he wanted to “apologize to bricks”.The state department has been torn apart by the firing of Peter Marocco, the official who was dismantling USAID, by Marco Rubio, the secretary of state. Career officials charged that Marocco, a Maga loyalist, was destroying the agency; Trump’s Maga followers view Marocco’s firing as a sign that Rubio is part of the establishment they want to destroy.Worse yet, Trump has fired more than a half-dozen national security officials after meeting with the far-right agitator Lara Loomer, who was granted access to the Oval Office and gave Trump a list of officials she deemed disloyal.Bottom line: no one is in charge. Trump is holding court but has the attention span of a fruit fly. This is causing chaos across the federal government, as rival sycophants compete for his limited attention.Incompetence is everywhere. The regime can’t keep military secrets. It can’t maintain financial stability. It can’t protect children from measles. It cannot protect America.While we need to continue to resist Trump’s authoritarianism, we also need to highlight his utter inability to govern America.

      Robert Reich, a former US secretary of labor, is a professor of public policy emeritus at the University of California, Berkeley. He is a Guardian US columnist. His newsletter is at robertreich.substack.com More