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      Key takeaways: RFK Jr’s ‘Maha’ report on chronic disease in children

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      Donald Trump’s health secretary and long-time vaccine skeptic, Robert F Kennedy Jr, presented a highly anticipated report on children’s health this week.The “Maha commission” report, referring to the “Make America healthy again” movement, was required by a presidential executive order in February. The report focuses on chronic disease among children.The 68-page report broadly summarizes five areas affecting children’s health, with a focus on ultra-processed foods, environmental chemical exposure, lack of physical activity, “overmedicalization”, and “capture” of regulatory agencies.It notably omits some of the most common causes of chronic disease and death in children, insinuates there could be harms where there is lack of evidence, and avoids discussing how Republicans have already changed the health system in ways researchers believe are harmful.Art Caplan, a professor of bioethics at New York University’s Grossman School of Medicine, told the Guardian that the report has “interesting ideas about health and children’s health and crackpot fringe tin-hat-wearing nonsense – it’s got it all”.Here are five of the key takeaways from the report.1. The report ignores some common dangers to childrenThe most common causes of death among children are car crashes and firearm accidents. The report ignores these issues, as well as behaviors that often start in adolescence and lead to chronic disease in adulthood, such as smoking and alcohol use. It also criticizes water fluoridation, without mentioning its protective effects against cavities.Also, absent from the report is a discussion of how the administration has already changed the health department in ways that advocates argue will benefit industry and could exacerbate chronic disease.For instance, Kennedy eliminated two smoking prevention offices at the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) in what one former regulator told Stat was “the greatest gift to the tobacco industry in the last half century”. He also eliminated a world-leading sexually transmitted infection laboratory.In another example, one of the nation’s leading researchers of ultra-processed foods quit his “dream job” after facing what he described as censorship from the administration (the health department reportedly asked him to return). In a similar vein, the Trump administration cut a program that delivered local whole foods to schools soon after taking office, in spite of Kennedy calling for healthier school meals.2. The report focuses on issues key to Kennedy’s view of healthThe report is roughly broken up into five sections focusing on ultra-processed foods, environmental chemical exposures, children’s mental health, “overmedicalization” and “corporate capture” of regulators by the industries they are supposed to oversee.Kennedy has harped on many of the issues listed in the report for months in public appearances and even though his defunct presidential campaign – especially including ultra-processed foods and obesity. Although some of these concerns may find bipartisan support – such as the focus on “forever chemicals” such as Pfas – it also pushes into areas where the science is unsettled.For instance, the report mentions that high levels of fluoride are potentially associated with reduced IQ, but does not mention its well-established protective effects against cavities – the most common chronic condition in children, according to the National Institute of Dental and Craniofacial Research.Similarly, the report argues that the childhood vaccine schedule is causing concern among parents for,“their possible role in the growing childhood chronic disease crisis” – without citing evidence that vaccines are linked to any specific chronic disease.3. It’s likely to face diverse pushback – and create new alliancesEven before the report was published, congressional lawmakers were being bombarded by calls from agricultural and chemical lobbyists wary of how the report would criticize their products – and indeed it did.One of the report’s sections questions whether “crop protection tools” including “pesticides, herbicides and insecticides” could harm human health. It then specifically name-drops glyphosate, the key ingredient in Roundup, and atrazine, a common herbicide. That is sure to make for strange political bedfellows and consternation within the Republican party. Similarly, the report cites synthetic dyes and ultra-processed foods are potentially harmful.Chemicals and food additives have been issues of concern for decades on the left. However, the Maha movement has also catalyzed opposition to them on the right.4. The report’s authors are not namedThe commission’s members are made up of the heads of intersecting agencies, including Kennedy at the Department of Health and Human Services, and the heads of the departments of agriculture, housing, education, veterans affairs and the Environmental Protection Agency, among others.However, the exact authors of the report are unknown. This contrasts with Kennedy’s repeated promise at his confirmation hearing that his health department would practice “radical transparency”.The work of the “Maha” commission was reportedly spearheaded by senior Kennedy adviser Calley Means, a former food lobbyist and healthcare entrepreneur who rose to prominence as a Maha truth-teller. Means co-wrote a bestselling book with his sister, current US surgeon general nominee Casey Means, which blames many of America’s ills on sedentary lifestyle and poor diet.5. Changing any of the issues identified is likely to be toughOne of the key issues the report identifies is the influence of food, pharmaceutical and chemical companies on American policy. They are monied and powerful.As a result, getting real change through Congress is certain to be tough – especially in an administration devoted to reducing regulations. More

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      Forget the DEI hires – meet Trump’s latest WTF hire | Arwa Mahdawi

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      The US health secretary doesn’t think you should really listen to him when it comes to health issues. During an appearance before House and Senate committees this week, Robert F Kennedy Jr, famous for his unconventional views about medicine and his revelation that a parasite ate part of his brain, seemed to think it was strange that lawmakers were asking him about vaccines.“What I would say is my opinions about vaccines are irrelevant,” Kennedy said when pressed on whether he would vaccinate his child for measles. “I don’t want to seem like I’m being evasive, but I don’t think people should be taking advice, medical advice, from me.” The US health secretary repeated his refrain about not wanting to give advice a number of other times.I, on the other hand, am desperate to dole out a bit of advice. Namely: it would probably be a good idea if a few people who actually knew what they were talking about were brought into the US government. I know, I know. Look at me being a crazy idealist! Still, at the very least, it might be wise to at least ensure that the people who are in charge of health issues know a thing or two about medicine.Alas, judging by some of Donald Trump’s latest appointments, it would seem that I am asking far too much. See, for example, Dr Casey Means, who was nominated for US surgeon general last week. Means has got “Dr” in front of her name, which sounds promising, but she’s more of an influencer than a practitioner. Though she trained as a surgeon at Stanford, she never completed her medical residency afterward. Why? She says it’s because she was disillusioned with traditional medicine, but a former colleague told the Los Angeles Times that it was due to anxiety. Means also doesn’t have an active medical license. In short: she wouldn’t be able to get a job as a doctor at your local hospital but she’s being considered for the role of “the nation’s doctor”. As for experience working in government? She doesn’t have any of that, either.What Means does have, Trump announced in a recent social media post, are “impeccable ‘MAHA’ credentials”. That’s the “Make America healthy again” movement: a movement that is preoccupied with some very valid issues (processed food, corruption in the health industry) but mired in conspiracist thinking. Means has been on TV a lot to talk about Maha obsessions such as removing fluoride from drinking water. She also makes money from dietary supplements that she promotes on social media and has co-authored a book with her brother that claims “almost every chronic health symptom that Western medicine addresses is the result of our cells being beleaguered by how we’ve come to live”. Which, of course, isn’t completely false but has been accused of being overly simplistic. Means’s brother, by the way, is also a prominent adviser to Kennedy.So are all the Maha crowd rejoicing in the streets at the idea of Means becoming surgeon general? Not quite. Her nomination has actually sparked Maha infighting. Some Maha voices think Means is not extreme enough, particularly when it comes to the Covid shot. These people seem to want a surgeon general who declares Covid was a hoax and bans vaccines altogether.The far-right conspiracy theorist Laura Loomer, meanwhile, who seems to have become one of Trump’s most influential albeit unofficial advisers, isn’t happy with Means because she thinks she’s unserious. Writing on Twitter/X, Loomer said Means “PRAYS TO INANIMATE OBJECTS, COMMUNICATES WITH SPIRIT MEDIUMS, USES SHROOMS AS ‘PLANT MEDICINE’ AND TALKS TO TREES! SHE ALSO DOESN’T EVEN HAVE AN ACTIVE MEDICAL LICENSE.”Loomer isn’t the only one a little worried about Means’s enthusiasm for psychedelic drugs including magic mushrooms – which the prospective surgeon general once suggested in a newsletter helped her find a romantic partner. Psilocybin, a psychedelic compound found in certain mushrooms, is currently listed as a schedule I drug, defined as a substance “with no currently accepted medical use and a high potential for abuse”.Means should probably be a little worried about what Loomer thinks, as Loomer may have played a part in ousting Trump’s original pick for the position. That was Janette Nesheiwat, a former Fox News medical contributor and the sister-in-law of Mike Waltz, the former national security adviser. On X this month, Loomer called Nesheiwat “a pro-Covid vaccine nepo appointee” who “didn’t go to medical school in the US”. (Nesheiwat has said that she got a degree from the University of Arkansas School of Medicine, but it would seem that she actually earned her medical degree from a school in Sint Maarten.)Will Loomer topple Means before her confirmation (which hasn’t been scheduled yet) as well? I don’t know but I can tell you that if she does, it’s unlikely that her successor will be any more qualified. The Trump administration, as we all know, has been waging war on diversity, equity and inclusion (DEI). If you’re a (non-Trump-loving) woman or a minority, it doesn’t seem to matter how many qualifications you have, you’re automatically considered a “DEI hire” and looked upon with suspicion. Many prominent people in the Trump administration, meanwhile, seem to be WTF hires. They are there because they’re white, Trumpy and often in the family of someone influential (or they have been on Fox News). Whether we get Means or not, you can be sure that whoever is confirmed as the nation’s top doctor will be completely unqualified to treat the US’s Trump-induced ailments.

      Arwa Mahdawi is a Guardian columnist More

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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