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      Former CDC official ‘only sees harm’ to public health under RFK Jr’s leadership

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      The former immunizations director of the Centers for Disease Control and Prevention has warned of the future of American health under the leadership of Donald Trump’s health secretary, Robert F Kennedy Jr.In an interview on Sunday with ABC, Demetre Daskalakis – who resigned this week in protest over the White House’s firing of CDC director Susan Monarez – said: “From my vantage point as a doctor who’s taken the Hippocratic Oath, I only see harm coming.”He went on to add: “I may be wrong, but based on what I’m seeing, based on what I’ve heard with the new members of the Advisory Committee for Immunization Practices, or ACIP, they’re really moving in an ideological direction where they want to see the undoing of vaccination.”Daskalakis’s interview comes amid growing chaos across US health agencies and rare bipartisan pushback towards the White House’s firing of Monarez, which came amid steep budget cuts to the CDC’s work as well as growing concerns of political interference.There have also been growing public calls for Kennedy to resign, particularly as he has continued to make questionable medical and health claims – and be lambasted in response by experts and lawmakers alike.Explaining his resignation, Daskalakis said: “I didn’t think that we were going to be able to present science in a way free of ideology, that the firewall between science and ideology has completely broken down. And not having a scientific leader at CDC meant that we wouldn’t be able to have the necessary diplomacy and connection with HHS to be able to really execute on good public health.”Daskalakis also criticized Kennedy’s recent changes to the childhood Covid-19 vaccine schedule, noting that the vaccine is currently approved only for people aged 65 and older, as well as for children and adults with underlying health conditions.“That’s not what the data shows. Six months old to two years old, their underlying condition is youth. 53% of those children hospitalized last season had no underlying conditions. The data say that in that age range, you should be vaccinating your child. I understand that not everybody does it, but they have limited access by narrowing that recommendation. Insurance may not cover it,” Daskalakis said.He also cast doubt on Jim O’Neill, the new CDC chief who was a top aide to Kennedy and has no training in medicine or infectious disease science.In response to whether or not he trusts O’Neill saying that he is in favor of vaccines, Daskalakis said: “Honestly, I really want to trust it … But based on the very first post that I’ve seen from him on X where he says that CDC scientists manipulated data to be able to follow an ideology or an agenda in the childhood schedule, makes me think that I know what leader he serves, and that leader is one that does not believe in vaccination.”In a Saturday op-ed for the New York Times, Vermont senator Bernie Sanders accused Kennedy of “endangering the health of the American people now and into the future”, adding: “He must resign.”Since he assumed leadership over the health department, Kennedy – a longtime anti-vaccine advocate – has fired health agency workers and entertained conspiracy theories. Last week, more than 750 current and former employees at US health agencies signed a letter in which they criticized Kennedy as an “existential threat to public health”.The health agency workers went on to accuse the health secretary of being “complicit in dismantling America’s public health infrastructure and endangering the nation’s health by repeatedly spreading inaccurate health information”.The letter comes after a deadly shooting at the CDC headquarters in Atlanta earlier this month, when a 30-year-old gunman fired more than 180 rounds into the buildings, killing a police officer before dying from a self-inflicted gunshot wound. The shooter had been struggling with mental health issues and was influenced by misinformation that led him to believe the Covid-19 vaccine was making him sick, according to the gunman’s father. More

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      RFK Jr says he’ll ‘fix’ a vaccine program – by canceling compensation for people with vaccine injuries

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      While unrest and new vaccine restrictions have kept US health agencies in headlines, there’s one vaccine program in particular that Robert F Kennedy Jr, secretary of the US Department of Health and Human Services (HHS), recently vowed to “fix”, which experts say could further upend the vaccine industry and prevent people experiencing rare side effects from vaccines from getting financial help.While some changes to the National Vaccine Injury Compensation Program (VICP), which compensates people who suffer very rare side effects from vaccination, must come from Congress, Kennedy could take several actions to reshape or affect the program’s operations.Kennedy “seems to be pursuing two opposite theories” on changing VICP, said Anna Kirkland, a professor at the University of Michigan and author of Vaccine Court.“Make it easier and compensate more, versus blow it all up. And then maybe there’s a third way of, foment skepticism, undercut recommendations,” she said.The moves represent the latest battle in “the war on vaccines that he’s been waging for decades”, Art Caplan, head of the division of medical ethics at New York University’s Grossman School of Medicine said. Kennedy, an anti-vaccine activist for about two decades, has reported more than $2.4m in income for referring vaccine-related cases to a law firm, for instance.Making major changes to the program may open up vaccine makers to more litigation, making it difficult for them to keep existing vaccines on the market or to produce new ones.In 1980, there were 18 companies in the US producing vaccines; a decade later, there were four. Congress passed a law in 1986 leading to the establishment of the VICP to prevent further instability in the vaccine market.By making changes to the program, Kennedy “can scare the manufacturers”, and the market is “pretty fragile”, said Caplan.Dorit Reiss, professor of law at University of California College of the Law, San Francisco, said that “VICP was adopted … because manufacturers were leaving the market over litigation” and that “this would mean manufacturers will pull out of the market and we’ll have less vaccine accessible”.There aren’t many vaccine makers left in the US. Most vaccines are not very lucrative – either for the manufacturers or the doctors who administer them. Most routine vaccines are covered under the VICP.Caplan said any vaccines could be vulnerable and these actions have major consequences for uptake even if vaccines remain on the market.“The biggest problem is still undermining trust in mainstream science,” Caplan said.Changing or even eliminating the program would also likely make it more difficult for patients to have their cases addressed. Yet a bill that would abolish the VICP entirely, introduced by the representative Paul Gosar, a Republican from Arizona, is gaining traction in anti-vaccine circles.Reiss noted that “undoing VICP might mean there’s no vaccines available”.A website about Gosar’s bill features a quote from Kennedy: “If we want safe and effective vaccines, we need to end the liability shield.”HHS did not respond to the Guardian’s questions on whether Kennedy knows about this use of his quotation, or what his plan to “fix” the compensation program involves.There are several actions Kennedy can take to “make vaccine availability much more difficult”, Caplan said.Kennedy has mentioned two concrete plans: adding discovery to existing compensation claims, and removing the backlog of claims. The program rules already allow discovery at the discretion of the adjudicators, called special masters. Adding special masters could help speed up claim processing, but the number of special masters was set by Congress, not HHS.In addition, the special masters answer to the US Department of Justice (DoJ), not HHS – though they represent the secretary in claims.“The first thing [Kennedy] said he was doing was working with Pam Bondi at DoJ,” Kirkland said. “Bondi could certainly direct her own employees to stop contesting a lot of things, and just let as much as possible go through, because they represent the secretary against the petitioners. So they could certainly change the softer ways that they operate, try to be easier, try to be faster.”In that case, Kennedy could ask the special masters to concede – effectively approving automatically – any claims about, for instance, diagnoses of autism or allergies after vaccination, Reiss said.One way to argue that a vaccine caused severe side effects under VICP is to present in a causation hearing a preponderance of evidence demonstrating it’s more than 50% likely – a metric known as “50% and a feather” – that the vaccine is the cause of a side effect.But “there doesn’t have to be existing literature that shows this connection. If you have a credible expert with a convincing theory, that’s enough” under VICP, Reiss said.Reiss noted that the “program was intentionally and consciously designed to make it easy to compensate”.“It increases vaccine trust when we have a quick, generous compensation program – when we can tell people: ‘Look, if the worst happens, if you’re the one in the million where things actually go wrong, you can be quickly and generously compensated, whereas if you instead get a vaccine-preventable disease, you don’t have any compensation.’ I think that can help trust. It’s also the right thing to do,” she said.The other way to settle a claim is the table of injuries, which lists the vaccines included in ACIP [the Advisory Committee on Immunization Practices], potential injuries and time periods.“If the injury occurs within that time, then causation is presumed,” Reiss said.Kennedy could change the table, adding more or different side effects. This would require publishing public notice and accepting comments. If a new injury is added to the table, cases are allowed to be submitted for the past eight years, rather than the usual three years.The table is “the one that’s the most straightforwardly under his control”, Kirkland said. The last time a government agency tried to change the table, it failed. “That’s got to mean something,” she added.If the ACIP no longer recommends a routine vaccine, it may be removed from the table. Claims would then need to go through the regular court system.There is a higher bar in the regular courts, where claimants have to show fault, demonstrating a defective product or negligence, for instance. The rules of evidence are stricter. Claimants also have to hire a lawyer and pay the lawyer costs and the experts.With the private US healthcare market, “if you don’t win your case, you’re going to then get stuck with gigantic medical bills”, Caplan said.In a country like the US, where the burden is on the individual to pay their medical bills, VICP is a safety net for people having medical events after vaccination, he said.Many of the claims now handled under VICP are for relatively low amounts of money that law firms – especially the rare firms with the expertise to take on large pharmaceutical companies – might not find worthwhile in representing.There are aspects of VICP that need reform, Reiss said. The program needs more special masters, the caps on payments need to be updated from original levels set in the 1980s, and the statute of limitations should be expanded beyond three years – especially because it is difficult to diagnose side effects in young children in that amount of time, she said.“The statute of limitations, special masters and caps need to be changed, and there have been efforts to do that,” she said. “They just, I think, didn’t get enough attention, and that’s probably not what he’s focusing on.” More

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      Publications aimed at LGBTQ+ audiences face discrimination from advertisers, editors warn

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      Publications aimed at LGBTQ+ and other diverse audiences are facing “good old-fashioned discrimination” as advertisers avoid them after political attacks on diversity and inclusion campaigns, editors have said.Senior figures at publications aimed at the gay community and other minority groups said a previous “gold rush” to work with such titles was over.There has been a backlash in the US over corporate diversity, equity, and inclusion (DEI) efforts in the past 18 months, which has led to some big names rolling back their plans.Tag Warner, the chief executive of Gay Times, said his publication, which had been growing digitally in the US, had lost 80% of its advertisers in the past year. It has also lost in excess of £5m in expected advertiser revenue.Warner, who has led the outlet since 2019, said his title’s growth had been accompanied by an enthusiasm from brands to embrace LGBTQ+ audiences. He blames an anti-DEI drive in the US for the dramatic shift.“I know that media and marketing is also going through a challenging year anyway, but when we’re thinking about other organisations that don’t talk to diverse themes, they’re not nearly as impacted as we are,” he said. “This is just good old-fashioned discrimination. Because discrimination doesn’t have to make business sense. Discrimination doesn’t have to be logical. Discrimination is discrimination.“We’re really experiencing the impact of what happens when voices that are pressuring organisations to give in to less inclusive perspectives start winning. Then it creates this massive behavioural shift in brands and organisations.”Nafisa Bakkar, the co-founder of Amaliah, a publication aimed at “amplifying the voices of Muslim women”, said there had been a “change in mood” among brands and advertisers. “There was this DNI [diversity and inclusion] gold rush,” she said. “It is, I would say, well and truly over.“We work with a lot of UK advertisers, but I would say that the US has a lot more emphasis on what they would call ‘brand safety’, which I think is a code word for ‘we don’t want to rock the boat’. I would say there is a lot more focus on this element.”Ibrahim Kamara, the founder of the youth platform GUAP, which has a large black and ethnically diverse audience, said he had detected a “relative difference” from 2020 in approaches from brands.He and others cited the economic pressures on advertisers generally in recent years. However, he said the “hype and the PR around wanting to support and connect with diverse audiences” had also subsided.“The thing that most people within these kind of spaces can probably agree on is that the energy and the PR is very different now,” he said. “It was almost a badge of honour to be able to say that you’re supporting certain communities. Now, I’ve seen that lots of the diversity and inclusion people that were hired around that period have probably lost their jobs. It doesn’t have the same PR effect any more.”Warner said the anti-DEI impact pre-dated the return of Donald Trump to the White House. Figures such as the conservative pundit Robby Starbuck have been engaged in a long-running anti-DEI campaign, pressuring firms to drop their diversity efforts. However, Warner said Trump’s arrival “gave everyone, I think, permission to be honest about it”.Not all publications in the sector have been hit in the same way as Gay Times. Companies with business models less reliant on US advertising, as well as some big players with long-established relationships, said they had managed to negotiate the changing political environment.“Brands are nervous, that’s for sure, or careful – or a combination of both,” said Darren Styles, the managing director of Stream Publishing, which publishes Attitude magazine. “They’re aware it can be a lightning rod for a vocal minority. But our experience is that most people are holding their ground, if not doubling down.”Styles also said he was not complacent, however, given the rise of Nigel Farage’s Reform party in the UK and its lack of historical support for the LGBTQ+ community.“I’m not incautious about the future,” he said. “Who knows what next year will bring, because that narrative is not going away. Obviously, there’s the rise of Reform in the polls.“[Farage] is quite clearly not an ally to our community and he’s expressed disdain in the past at the awards we’ve given out to people in the trans community. So it is a worry as political momentum gains around there. But I think broadly, consumers in the UK are a bit more capable of thinking for themselves.”Mark Berryhill, the chief executive of equalpride, which publishes prominent US titles like Out and The Advocate, said some brands and agencies “may have been a little bit more cautious than they have been in the past”. However, he said it had so far meant deals had taken longer to be completed, in a tough economic climate.He said the political headwinds made it more important to highlight that working with such titles was simply a sound business decision. “We’ve tried to do a better job in this political climate of just selling the importance of our buying power,” he said. “Everybody’s cautious and I don’t think it’s just LGBTQ. I think they’re cautious in general right now with their work with minority owned companies.“The one thing that maybe this whole controversy has helped us with a little bit is to really make brands realise it’s a business decision. It’s not just a charity or something you should do because you feel guilty.“You should do it because it’s the right thing to support LGBTQ journalism. We’re small. We need to get the word out. We have important stories to tell. But it’s also a good business decision. The more we show that side, certain brands will come along.” More

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      A report tied Iowa’s water pollution to agriculture. Then the money to promote it mysteriously disappeared

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      When a team of scientists embarked two years ago on a $1m landmark study of Iowa’s persistent water-quality problems, they knew that the findings would be important to share. High cancer rates amid the state’s inability to stem the tide of pollutants flowing into rivers and lakes was a growing public concern.But now, after the completed study pointed to agricultural pollution as a significant source of the key US farm state’s water problems, public officials have quietly stripped funding from plans to promote the study findings, according to sources involved in the project.The report, the results of two years of data analysis, has been highly controversial in Iowa because of the large amount of evidence it cites linking water pollution – and resulting human and environmental health risks – to the state’s economically and politically powerful farm industry.Supporters of the report said the agricultural industry and allied public officials have tried to downplay the findings for months, and they fear this move is another impediment to change.‘Zeroed out’When the report was finalized earlier this year, there was a little more than $400,000 left in the budget, with some of that money earmarked for communications and “public awareness” work, travel and other costs associated with promoting the findings, records show.Jennifer Terry, the project lead on the water report, had planned in-person meetings with scientists and community groups to focus on recommendations made in the report.But those funds were recently “zeroed out” with no explanation, according to email communications.Funding for the water report and related public outreach came from Polk county, Iowa’s most populous county and home to the state capital city of Des Moines. County leadership has changed since the report was commissioned.“The intent was that at the conclusion of the report to make sure it was seen widely in a public education effort,” said former Polk county administrator John Norris, who led support for the water report in 2023. “That was a big part of the value of it – that the public learns from it.”Norris, who agreed to leave office earlier this year as part of a legal settlement with the county, said he hoped the county would use some of the money in some way for water-quality work.Frank Marasco, who replaced Norris, did not respond to a request for comment. Neither did Polk county spokesperson Jon Cahill. Terry also declined to comment.The water report, authored by a team of 16 scientists, focuses on pollution patterns in two “essential” rivers fed from a watershed running from southern Minnesota through the central part of Iowa to Des Moines. The rivers are the primary source of drinking water for roughly 600,000 people and considered important recreational state assets, but they’re commonly laden with harmful contaminants that include phosphorus and nitrogen, bacteria from animal and human waste, pesticides and other chemicals.This summer, nitrate levels in key drinking-water sources were measured in quantities far higher than is allowed under federal safety standards.Much, though not all, of the contamination is tied to agriculture, according to the report. Among multiple recommendations, the report calls for the top US corn-growing state to diversify into production of crops that require fewer chemical inputs, and for limits on the density of livestock.The water report comes alongside growing concerns about the prevalence of cancer across the state. For the last few years, Iowa has had the second-highest rate of cancer in the nation, and is one of only two US states where cancer is increasing. Pesticides and nitrates both are scientifically shown to cause cancers.Kerri Johannsen, senior director of policy and programs at the Iowa Environmental Council, said all allocated funds should be fully utilized to educate the public.“People in Polk county and across the state are facing a water crisis but we cannot begin to make progress until all Iowans, including decision-makers, understand the urgency of this moment,” she said.“The importance of accessible, transparent public education and awareness cannot be understated,” Johannsen added. “The current resources available for addressing our water issues are a drop in the bucket, and our elected officials have a responsibility to do everything they can to find a way forward for the sake of the health of the people of this state.”Feds add to worriesThe issues over how to address water-quality problems in Iowa, which has nearly 87,000 farms and ranks first in the nation for corn, pork and egg production, comes as the Trump administration and Republican allies in Congress are moving to dismantle regulations aimed at protecting water quality, including those that work to limit discharges of pesticides and other farm-related chemicals into waterways.One chief concern for environmental advocates is the Permit Act, which is actually a package of more than a dozen bills that would streamline permitting requirements. The legislation would cut protections for many waterways, limit requirements for updated pollution-control measures and exempt pesticide spraying and agricultural runoff from permitting and accountability, according to the advocacy group Beyond Pesticides.If the measures become law, it will make it that much harder for Iowans to clean up their waterways.In another blow to efforts to address the state’s water-quality problems, the Environmental Protection Agency (EPA) recently reversed a decision made under the Biden administration that found additional areas of four Iowa rivers should be designated as impaired.When waters are classified as impaired, it triggers stricter regulatory measures to limit pollutants entering the waterways and other enhanced measures aimed at reducing the inflow of harmful contaminants.The reversal angered environmental groups across the state as well as the utility providers tasked with cleaning up the water. But farm groups, including the Iowa Farm Bureau, which had opposed the impairment designations, cheered the news.News of the reversal broke the same week that the EPA administrator, Lee Zeldin, visited Iowa to meet with farmers and others and attend the Iowa state fair to serve as a grill master at the Iowa Pork Producers Association tent.When asked what drove the decision to reverse the impairment decision, an EPA spokesperson said only that the agency had been tracking the levels of nitrates this spring and summer in the waterways and is “ensuring that all of the information and data collected by the cities, universities, and other groups is provided to the Iowa Department of Natural Resources for evaluation”.The agency is “not currently aware” of any “exceedances” of nitrates at public water systems “using surface waterbodies in Iowa”, the spokesperson said. The agency is working with state officials to “understand and resolve the issues forming the basis for EPA’s reconsideration of its 2024 decision”.Adam Shriver, director of wellness and nutrition policy at the Harkin Institute at Drake University, said the recent events are disheartening.“I think it shows just how far we still have left to go,” Shriver said. “The farm bureau opposed the initial impairment designation and was taking a victory lap with the recent EPA announcement. As long as they continue to get whatever they want from every level of government while other stakeholders are ignored, public health is going to suffer.”This story is co-published with the New Lede, a journalism project of the Environmental Working Group More

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      CDC chief ‘targeted’ for refusing to ‘rubber-stamp unscientific, reckless directives’, lawyers say – as it happened

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      Susan Monarez was removed from her position as director of the Centers for Disease Control and Prevention on Wednesday without being told why she was fired, her lawyers said in a statement.“First it was independent advisory committees and career experts. Then it was the dismissal of seasoned scientists. Now, Secretary Kennedy and HHS have set their sights on weaponizing public health for political gain and putting millions of American lives at risk”, her lawyers, Mark Zaid and Abbe David Lowell, said in a statement posted on social media.“When CDC Director Susan Monarez refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts, she chose protecting the public over serving a political agenda. For that, she has been targeted. Dr. Monarez has neither resigned nor received notification from the White House that she has been fired, and as a person of integrity and devoted to science, she will not resign.”“This is not about one official,” the lawyers added. “It is about the systematic dismantling of public health institutions, the silencing of experts, and the dangerous politicization of science. The attack on Dr. Monarez is a warning to every American: our evidence-based systems are being undermined from within.”The Department of Health and Human Services offered no explanation when it announced in an unsigned social media post that Monarez, who was confirmed by the Senate as CDC director and sworn in by Kennedy just last month, was no longer in charge of the public health agency.Sources “who spoke anonymously for fear of retribution”, told the New York Times reports that Monarez had objected to sweeping changes to the panel of experts who advise the agency on vaccine policy made by Donald Trump’s anti-vaccine health secretary Robert F Kennedy Jr.An administration official also told the Times that Kennedy had summoned Monarez to his office on Monday and demanded that she resign. After she refused to do so, she called Dr Bill Cassidy, the Republican chairman of the Senate health committee. Kennedy then accused Monarez of “being a leaker” and said that she would be fired.Hours before Monarez left the agency, Kennedy hailed decisions by the Food and Drug Administration on Wednesday revoking the emergency use authorization for the Covid-19 vaccines manufactured by Pfizer, Moderna and Novavax that CDC experts estimate saved 3.2 million lives in the United States.Vaccines from the three manufacturers are now authorized by the FDA only for people who are 65 and older, or younger people with an underlying medical condition that puts them at risk for severe disease.Even those that qualify for the vaccines will only be able to get them in the US if the advisory panel, reshaped by Kennedy to include Covid vaccine opponents, votes to approve them.This concludes our live coverage of the second Trump administration for the day, but we will be back at it on Thursday morning. Here are the latest developments:

      The leadership of the US Centers for Disease Control and Prevention was thrown into chaos after the health department announced the Senate-confirmed CDC director, Susan Monarez, was no longer in charge, but her lawyers said she refused to resign and had not been fired.

      First it was independent advisory committees and career experts. Then it was the dismissal of seasoned scientists. Now, Robert F Kennedy Jr and HHS have set their sights on “weaponizing public health for political gain” and “putting millions of American lives at risk”, lawyers for Monarez said in a statement. “When CDC Director Susan Monarez refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts, she chose protecting the public over serving a political agenda. For that, she has been targeted. Dr. Monarez has neither resigned nor received notification from the White House that she has been fired, and as a person of integrity and devoted to science, she will not resign.”

      At least three CDC senior officials resigned after Monarez was ousted. One squarely blamed Robert F Kennedy Jr’s leadership.

      “I am not able to serve in this role any longer because of the ongoing weaponization of public health,” Dr Demetre Daskalakis, who resigned as director of the National Center for Immunization and Respiratory Diseases told colleagues.

      Public health experts are sounding the alarm about the chaos at the CDC, as at least three senior leaders resigned following the ouster of the apparent ouster of the CDC director.

      As a Senate-confirmed official, only the president has the authority to fire her, and, for once, Donald Trump has been strangely silent as this drams unfolded. But the White House press office issued a statement saying that Monarez had been removed, not by Trump but by “the White House”.
      While differences over vaccines appear to have been central to the rift between the ousted CDC director, Susan Monarez, and Robert F Kennedy Jr, the health secretary, Monarez also stood out from her bosses by mourning for the officer who died defending the agency’s campus in Atlanta from a gunman who was driven by misinformation about the Covid-19 vaccine.While Monarez publicly mourned David Rose, who, as our colleague George Chidi wrote, was murdered by a lie, others in the CDC were distressed that Kennedy said little, and Trump nothing about the attack on their campus.The confusion over whether or not Susan Monarez is still the director of the Centers for Disease Control and Prevention, after the health department said she was not, and her lawyers said she has not resigned or been fired, partly stems from the fact that Monarez was confirmed by the Senate last month.As a Senate-confirmed official, only the president has the authority to fire her, and, for once, Donald Trump has been strangely silent as this drama unfolded on Wednesday night.But the White House press office has just issued a statement saying that Monarez has been removed, not by Trump but by “the White House”.“As her attorney’s statement makes abundantly clear, Susan Monarez is not aligned with the President’s agenda of Making America Healthy Again” the White House deputy press secretary, Kush Desai, said in a statement to the Guardian. “Since Susan Monarez refused to resign despite informing HHS leadership of her intent to do so, the White House has terminated Monarez from her position with the CDC.”As Aaron Fritschner, an aide to Don Beyer, a Democratic congressman, observed: “Don’t think ‘the White House’ has the power to terminate the Director of the CDC. The President does, but they didn’t say that he did, which is curious.”Public health experts are sounding the alarm about the chaos at the CDC, as at least three senior leaders resigned following the apparent ouster of the CDC director.“What’s happening at the CDC should frighten every American Regardless of whether you are MAGA, MAHA, neither, or don’t give a damn about labels or politics. It’s unclear whether the CDC director—confirmed just weeks ago—has been fired or not. Absolute shitshow,” Dr Craig Spencer, an emergency medicine doctor and professor at Brown University School of Public Health posted. “And incredible career professionals resigned tonight, sounding a massive alarm,” he added. “This is pure chaos that leaves the country unprepared. Imagine cases of Ebola in the U.S. right now? We would be an absolute mess.”“RFK, Jr is increasingly becoming a liability for the White House,” Dr Jonathan Reiner, a cardiologist and professor of medicine at George Washington University, observed. “I doubt the president feels good about RFK’s incessant attack on his COVID vaccine triumph and he’s likely not going to be pleased that the HHS Sec is usurping the role of the President in hiring/firing senate confirmed officials.”“There is a wholesale destruction of leadership at the CDC. The newly confirmed Director is out,” Dr Ashish Jha, the Biden administration’s coronavirus response coordinator, wrote. “Most of the top leaders who run key centers have resigned en masse. Total implosion. All because of [Secretary Kennedy’s] leadership. What a complete disaster.”Dr Demetre Daskalakis, who resigned on Wednesday from his position as the director of the National Center for Immunization and Respiratory Diseases at the CDC, just posted his full, blistering resignation letter on Instagram.In the letter, the veteran public health official blames the views and erratic leadership of Robert F Kennedy Jr, the health secretary, for making it impossible for him to continue.“I am unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health. The recent change in the adult and children’s immunization schedule threaten the lives of the youngest Americans and pregnant people,” Daskalakis wrote, in reference to the decision in May, for the CDC to remove its recommendation of the Covid-19 vaccine for healthy children and pregnant women.He added that the data to support this change was never shared with the CDC and that a public information sheet on the change, “written to support the Secretary’s directive” was circulated by the health department “without input from CDC subject matter experts”.Daskalakis also called out Kennedy’s fondness for “social media posts announcing major policy changes” without consulting CDC experts in advance. “Having to retrofit analyses and policy actions to match inadequately thought-out announcements in poorly scripted videos or page long X posts should not be how organizations responsible for the health of people should function,” he wrote.“The intentional eroding of trust in low-risk vaccines favoring natural infection and unproven remedies will bring us to a pre-vaccine era where only the strong will survive and many if not all will suffer,” he added. “I believe in nutrition and exercise. I believe in making our food supply healthier, and I also believe in using vaccines to prevent death and disability. Eugenics plays prominently in the rhetoric being generated and is derivative of a legacy that good medicine and science should continue to shun.”“The recent shooting at CDC is not why I am resigning,” Daskalakis wrote, drawing attention to the gunman who fired hundreds of rounds into CDC buildings who was motivated by unfounded theories about injuries from the Covid-19 vaccine that Kennedy has promoted.“My grandfather, who I am named after, stood up to fascist forces in Greece and lost his life doing so. I am resigning to make him and his legacy proud. I am resigning because of the cowardice of a leader that cannot admit that HIS and his minions’ words over decades created an environment where violence like this can occur. I reject his and his colleagues’ thoughts and prayers, and advise they direct those to people that they have not actively harmed,” Daskalakis wrote.“For decades, I have been a trusted voice for the LGBTQ community when it comes to critical health topics,” the doctor, who formerly led HIV/AIDS prevention at the CDC, and once dressed in drag to administer meningitis vaccines, added. “I must also cite the recklessness of the administration in their efforts to erase transgender populations, cease critical domestic and international HIV programming, and terminate key research to support equity as part of my decision.”Susan Monarez was removed from her position as director of the Centers for Disease Control and Prevention on Wednesday without being told why she was fired, her lawyers said in a statement.“First it was independent advisory committees and career experts. Then it was the dismissal of seasoned scientists. Now, Secretary Kennedy and HHS have set their sights on weaponizing public health for political gain and putting millions of American lives at risk”, her lawyers, Mark Zaid and Abbe David Lowell, said in a statement posted on social media.“When CDC Director Susan Monarez refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts, she chose protecting the public over serving a political agenda. For that, she has been targeted. Dr. Monarez has neither resigned nor received notification from the White House that she has been fired, and as a person of integrity and devoted to science, she will not resign.”“This is not about one official,” the lawyers added. “It is about the systematic dismantling of public health institutions, the silencing of experts, and the dangerous politicization of science. The attack on Dr. Monarez is a warning to every American: our evidence-based systems are being undermined from within.”The Department of Health and Human Services offered no explanation when it announced in an unsigned social media post that Monarez, who was confirmed by the Senate as CDC director and sworn in by Kennedy just last month, was no longer in charge of the public health agency.Sources “who spoke anonymously for fear of retribution”, told the New York Times reports that Monarez had objected to sweeping changes to the panel of experts who advise the agency on vaccine policy made by Donald Trump’s anti-vaccine health secretary Robert F Kennedy Jr.An administration official also told the Times that Kennedy had summoned Monarez to his office on Monday and demanded that she resign. After she refused to do so, she called Dr Bill Cassidy, the Republican chairman of the Senate health committee. Kennedy then accused Monarez of “being a leaker” and said that she would be fired.Hours before Monarez left the agency, Kennedy hailed decisions by the Food and Drug Administration on Wednesday revoking the emergency use authorization for the Covid-19 vaccines manufactured by Pfizer, Moderna and Novavax that CDC experts estimate saved 3.2 million lives in the United States.Vaccines from the three manufacturers are now authorized by the FDA only for people who are 65 and older, or younger people with an underlying medical condition that puts them at risk for severe disease.Even those that qualify for the vaccines will only be able to get them in the US if the advisory panel, reshaped by Kennedy to include Covid vaccine opponents, votes to approve them.Inside Medicine, a newsletter written by Jeremy Faust, a public health researcher and emergency medicine physician, just published the full text of email statements three CDC leaders who resigned on Wednesday sent to their colleagues to explain their reasons for leaving the US public health agency after its new director abruptly departed.The most explosive charge came from Dr Demetre Daskalakis, who stepped down as the director of the National Center for Immunization and Respiratory Diseases. “I am not able to serve in this role any longer because of the ongoing weaponizing of public health. You are the best team I have ever worked with, and you continue to shine despite this dark cloud over the agency and our profession,” Daskalakis wrote. “Please take care of yourself and your teams and make the right decisions for yourselves.”“For the good of the nation and the world, the science at CDC should never be censored or subject to political pauses or interpretations,” Dr Deb Houry, the agency’s chief medical officer, wrote. “Vaccines save lives – this is an indisputable, well-established, scientific fact. Informed consent and shared decision-making must focus not only on the risks but also on the true, life-saving benefits that vaccines provide to individuals and communities. It is, of course, important to question, analyze, and review research and surveillance, but this must be done by experts with the right skills and experience, without bias, and considering the full weight of scientific evidence. Recently, the overstating of risks and the rise of misinformation have cost lives, as demonstrated by the highest number of US measles cases in 30 years and the violent attack on our agency.”Houry’s statement seemed like a clear response to recent statements and actions to limit access to vaccines by the anti-vaccine health secretary, Robert F Kennedy Jr.Dr Daniel Jernigan, who resigned as director of the premiere US center for the study of emerging and zoonotic infectious diseases, told colleagues: “I believe strongly in the mission of public health and the leadership that CDC has given for almost 80 years; however, given the current context in the Department, I feel it is best for me to offer my resignation.”Jernigan, whose center included the CDC’s Immunization Safety Office, testified to Congress last year that the CDC estimates that the vaccination of children born between 1994 and 2021 “will prevent 472 million illnesses and 29.8 million hospitalizations, help avoid 1,052,000 deaths, and save nearly $2.2 trillion in total societal costs”.He also pointed to research that, as of November 2022, Covid-19 vaccines had “saved more than 3.2 million lives in the United States, prevented more than 18.5 million hospitalizations, and averted over $1.15 trillion in healthcare costs”.“I am not able to serve in this role any longer because of the ongoing weaponization of public health,” Dr Demetre Daskalakis, who resigned on Wednesday from his position as the director of the National Center for Immunization and Respiratory Diseases at the CDC told colleagues in an email obtained by STAT, a health news site.Those concerns were echoed by another departing CDC leader, Dr Deb Houry, the chief medical officer, who wrote that “ongoing changes prevent me from continuing in my job as a leader of the agency” adding that science should “never be censored or subject to political interpretations”.The two CDC leaders, and their colleague Daniel Jernigan, who ran the Center for Emerging Zoonotic Infectious Diseases, quit the agency after the abrupt departure of Susan Monarez, the Senate-confirmed director of the CDC.US officials announced on Wednesday the departure of the director of the nation’s top public health agency, after less than one month in the job.“Susan Monarez is no longer director of the Centers for Disease Control and Prevention. We thank her for her dedicated service to the American people,” the US Department of Health and Human Services wrote in a statement posted on social media.HHS officials did not explain why Monarez is no longer with the agency. Before the announcement was made, Monarez told the Associated Press: “I can’t comment.”Three senior officials at the Centers for Disease Control and Prevention resigned on Wednesday after the new CDC director Susan Monarez, abruptly left the agency.Shortly after the US Department of Health and Human Services, HHS, announced on social media that Monarez “is no longer director of the Centers for Disease Control and Prevention”, at least three CDC leaders resigned: Dr Debra Houry, the chief medical officer; Dr Daniel Jernigan, the director of the National Center for Emerging and Zoonotic Infectious Diseases; and Dr Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases.There was no immediate explanation for why any of the senior leaders have left the top US public health agency. Monarez was sworn in just four weeks ago. More

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      View image in fullscreenFor Erica L and her husband, in-vitro fertilization was the “nuclear option”.After two years of trying to conceive, Erica and her husband had no idea why they could not have a baby. Doctors said only that they had “unexplained infertility”, a non-diagnosis of a diagnosis that is given to an estimated 15% of people trying to conceive. Erica was not ideologically opposed to trying IVF, but felt daunted by the price and unpredictability.Then Erica stumbled across a clinic that specialized in “restorative reproductive medicine”, or RRM. The clinic did bloodwork on Erica and her husband and urged them to eat well-balanced foods and take supplements, as well as prioritize exercise and sleep. Erica also started tracking her temperature and menstrual cycle in intense detail.“We wanted to do everything that we could to try to have a baby as naturally as possible,” said Erica, who asked that her full last name not be published. “There’s a lot of invasive things that I just wasn’t comfortable with.”Restorative reproductive medicine is a decades-old name for a constellation of therapies that are meant to revive the “natural” fertility of people trying to conceive. Often, RRM entails prescriptions for hormones, supplements and lifestyle changes – such as adopting a better diet – as well as closely analyzing one’s menstrual cycle. Its practitioners also sometimes use aggressive surgeries to root out endometriosis, a common and chronic condition that occurs when tissue that is similar to uterine tissue grows outside of the uterus. And, critically, RRM practitioners avoid the use of assisted reproductive technology such as IVF.Top Republicans, rightwing organizations and even White House officials have recently begun to rally behind RRM, seizing on its promise to enhance fertility without resorting to IVF. Many anti-abortion conservatives revile IVF because it can create unused embryos – a practice they see as unethical, if not murderous, as they believe life begins at conception.Yet IVF remains staggeringly popular, to the point that Donald Trump pledged to make it free in the wake of a 2024 Alabama supreme court decision that imperiled the procedure. Now, conservatives are trying to pare back that commitment – and some fertility doctors, including ones who offer RRM, worry that the right is co-opting RRM as a Trojan horse in order to sell a fertility agenda to voters while undermining IVF.Backed by several high-profile anti-abortion groups, Republicans in Congress have repeatedly introduced legislation to bolster government-funded research and education on RRM. In March, the Heritage Foundation – the influential thinktank behind the notorious Project 2025 – released a 63-page report that endorsed RRM and slammed IVF.Then, in July, the Department of Health and Human Services posted a notice soliciting applications for a $1.5m grant to fund an “infertility training center” that would expand access to resources for “holistic infertility treatments” rather than assisted reproductive technology. In August, the Washington Post reported that the Trump administration is backing away from the president’s campaign promises about IVF, although a White House spokesperson rebutted that claim.View image in fullscreenDr Kaylen Silverberg is a reproductive endocrinologist who has advised administration officials, including Trump’s chief of staff Susie Wiles, about IVF. During his discussions with officials, Silverberg said he was asked about RRM.“I’ve been doing this for 31 years, and I’d never even heard the term,” said Silverberg, who is also advisory board chair of the advocacy group Americans for IVF. “So I started doing research about it. I realized that restorative reproductive medicine is just a pseudonym for a basic infertility evaluation.”Silverberg’s view is shared by many mainstream fertility doctors and organizations, who say that the difference between their work and RRM is less scientific than ideological. In their view, RRM is a rebranded version of everyday fertility medicine, minus IVF.RRM, with its focus on optimizing the body’s “natural” rhythms, is tapping into a growing interest in holistic health and wellness – one that is being increasingly politicized and expertly leveraged by the “Make America Healthy Again” (Maha) movement.But support for RRM alone, Silverberg said, cannot fulfill Trump’s campaign promises. “The problem is going to be if – and this is a big if – anybody tries to limit expansion of fertility access and care and coverage to restorative reproductive medicine.”‘There is another option’RRM is not a monolith. Some of its leading organizations and adherents take no position on IVF and reject the idea that RRM is ideologically driven or a new name for old medicine. Instead, they are drawn to RRM’s stance that infertility is not itself a disease but a symptom of something else that has gone wrong.Established in 2000, the International Institute for Restorative Reproductive Medicine (IIRRM), the preeminent group championing RRM, maintains a registry of RRM clinicians and collects data about its techniques’ efficacy.Dr Monica Minjeur, who was trained in family medicine and serves as the US director of communications and development for the International Institute for Restorative Reproductive Medicine, said RRM is “not an anti-IVF movement”. As far as Minjeur knows, no one in Congress has approached the institute to discuss RRM.“We will never say: ‘IVF should go away.’ We just mostly want people to realize: ‘Hey, there is another option,’ because so many couples are told IVF is your only option,” said Minjeur, who added that she is a Democrat.View image in fullscreenSome RRM advocates and groups do oppose IVF and have long aligned themselves with conservative causes such as the anti-abortion movement. One of the most well-known RRM techniques is NaPro Technology, which usually involves such tactics as cervical mucus tracking and has been pioneered by the anti-abortion Saint Paul VI Institute since the 1980s, when the Vatican condemned IVF. The institute’s website presents NaPro Technology as an alternative to IVF, which it calls “a highly abortive technology that often forces women to make abortion-related decisions”.In June, a new thinktank, the Maha Institute, held a roundtable discussion about women’s health and fertility. In her introduction to the discussion, Maureen Ferguson, a commissioner for the US Commission on International Religious Freedom with longstanding ties to the anti-abortion movement, sang RRM’s praises.“Traditional women’s health and fertility care has relied heavily on big pharma bandaids and workarounds that circumvent a women’s reproductive system,” Ferguson said. “Women of all political stripes appreciate healthcare that works in harmony with their body and restores health.”IIRRM wants to harness Maha advocates’ enthusiasm but is wary of being equated with the movement, according to Minjeur and Dr Tracey Parnell, the institute’s global director of communications and development. They described RRM and Maha as two sides of a Venn diagram.“We want to bring increased health to women and men and families,” Minjeur said of Maha. “Beyond that, there are definitely a fair amount of differences.”Parnell added: “We really truly are open to quite broad collaboration without being co-opted.”The rise of wellness cultureThe Make America Healthy Again movement is perhaps the best illustration of a broader push within American conservatism to incorporate the historically leftwing language of holistic health and “natural” treatments – in short, “wellness” – to advocate for traditionally rightwing aims, such as convincing women to have big families.This push started to gain steam in the years after the Covid pandemic, as trust in mainstream medicine started to falter: a survey of nearly half a million US adults found that trust in physicians and hospitals declined from roughly 72% to just 40% between April 2020 – the month after the pandemic broke out – and January 2024. As trust eroded, the wellness industry exploded. Between 2019 and 2023, it grew from $5.3tn to $6.32tn, according to the Global Wellness Institute, which defines wellness as the ongoing and individual pursuit of “optimal holistic health and wellbeing”.“Wellness” can encapsulate a wide range of activities, from undeniably healthy behaviors (such as exercising and eating nutritious foods) to practices that may be dangerous (such as drinking raw milk). These activities are yoked together by a deceptively simple ethos, according to Amy Larocca, author of the book How to Be Well: Navigating Our Self-Care Epidemic, One Dubious Cure at a Time.“In wellness, things that are natural are superior to things that are not,” Larocca explained.Wellness’s sales pitch can be particularly appealing to Americans, given the astronomical costs of traditional healthcare in the US. A single IVF cycle can run tens of thousands of dollars and most states do not require insurers to cover it. By contrast, countries such as Denmark and Sweden cover vast swathes of fertility treatments, including IVF.RRM treatments tend to cost far less than IVF, and may soon get even cheaper. In June, Arkansas’s Republican-dominated state legislature became the first in the country to pass a law requiring state insurance to cover RRM therapies.But critics say there is little quality evidence that RRM is more effective at helping people have babies than mainstream fertility medicine. The American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine and the Society of Gynecologic Surgeons are worried that other states may follow Arkansas’s lead; last week, the medical organizations sent a letter to urging the National Governors Association to reject pro-RRM legislation.Women’s health and infertility are especially ripe breeding groups for wellness because mainstream medicine routinely fails to take either seriously. Between 2013 and 2023, just 8.8% of research funded by the National Institutes of Health focused on women’s health. Women are also more likely to have their medical concerns dismissed. When women and people of color show up at emergency rooms with signs of chest pain, they usually wait longer; women are also less likely to be admitted.‘Many sobbing women’A year after Erica started working with the restorative reproductive medicine clinic, the clinic told her: “We’re really concerned that you’re not pregnant yet. You should be pregnant.”The RRM specialists suggested that Erica might have endometriosis, which affects about one in 10 women and girls worldwide and is believed to be a leading cause of infertility.It is also profoundly understudied. In 2023, a mere 0.06% of the NIH’s $47bn budget was earmarked for endometriosis research. Because many doctors dismiss the symptoms of endometriosis or lack the expertise to recognize it, it generally takes between five and 11 years to get a diagnosis.Erica went ahead with a surgery to diagnose and remove endometriosis tissue. RRM practitioners have suggested that the condition can be treated by a “one-and-done surgery” – as one RRM surgeon put it in the Heritage Foundation report – that aggressively excises endometriosis tissue.A month later, Erica got pregnant. Erica estimated that she and her husband spent, in total, about $2,500 on RRM.“We definitely wouldn’t have our daughter without them,” she said of RRM specialists.View image in fullscreenMany of RRM’s prescriptions are common sense: if you are trying to get pregnant, it can be helpful to take a holistic view of your health and know as much about your menstrual cycle as possible. But mainstream reproductive endocrinologists are skeptical of RRM’s position that infertility itself is not a disease, which runs counter to the World Health Organization’s definition of infertility. They also suspect that RRM may over-rely on surgery to treat endometriosis. One recent review of infertility treatments published in the New England Journal of Medicine found that while surgery can help mild cases of endometriosis, doctors should use IVF when it is severe. When treated with IVF, almost 40% of women under 35 who have endometriosis get pregnant within a single cycle, the review found.“We do a lot of surgery and other treatment options that can optimize a woman’s fertility. But in the end, there are many diagnoses that cannot be solved with those elements alone and need a very effective tool like IVF,” said Dr Rachel Weinerman, a reproductive endocrinologist and associate professor at Case Western Reserve University’s school of medicine. “You need to have a whole toolbox available to decide what is the right tool for that specific patient.”Dr Eve Feinberg, a reproductive endocrinologist at Northwestern University’s Feinberg school of medicine, first heard of RRM when she started treating patients who had tried it. If patients stick with RRM and defer the use of assisted reproductive technology for too long, Feinberg warned, some may become so old that they lose their chance to have biological children.“I’ve had many sobbing women in my office who really missed out on their fertility window by trying endless numbers of years of this method, who weren’t given the truth and weren’t given a chance to explore other methods because they were misled and they were told that this would work for them,” she said. “I counsel my patients that IVF has limitations. It doesn’t work for every patient. I didn’t feel like these women were adequately counseled in that way.”In an extensive memo it shared with the Guardian, IIRRM rejected many of the critiques of RRM as unfounded, including the idea that it over-relies on surgery. Physicians who provide IVF too often default to it, the institute contended, adding that it would welcome more research comparing RRM to conventional medicine.As someone who eats a mostly plant-based diet, runs religiously and avoids makeup, Feinberg considers herself to be more “natural” than most. She understands the appeal of the wellness-style language that surrounds RRM.“It’s being marketed as being holistic. It’s being marketed as being natural and ethical,” Feinberg said. But, she continued: “I think RRM plays into this fallacy that we can understand everything and we can fix everything. 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      How Baltimore’s violent crime rate hit an all-time low: ‘This is not magic. It’s hard work’

      by

      The end of violence in Baltimore is a litany of stories that weren’t told in 90-second clips on the evening news, about shootings that didn’t happen.The untold stories sound different, said Sean Wees: “The guys had guns pointed at each other. We got in between.”One summer afternoon, two years ago, two men emerged from a corner store at Patapsco Avenue and Fifth Street, steps from Wees’s office at Safe Streets, in Baltimore’s Brooklyn neighborhood.“They had a little face-off in the store,” Wees said. “Words were exchanged when they stepped out the store.”A woman in the neighborhood saw what was about to go down and banged on the door of Safe Streets, a longstanding city-run violence-prevention program and a fixture in Baltimore. Wees knows his community, and knew one of the men well – a guy with a high potential for violence. A shooter. The other guy was new, Wees said.The neighborhood was still reeling from a mass shooting that June. Safe Streets had de-escalated five fights at a Brooklyn Day block party, but weren’t on the scene when a gunfight started there late that night. Two people died, 28 were injured and Wees was on edge.He and his co-worker Corey Winfield rushed outside to find both men shouting at each other with guns drawn.View image in fullscreen“We stood in between,” Wees said. “Corey was talking to one, and I was talking to a guy that was from the community.” Wees and Winfield carefully talked them back from the cliff.“That’s why having that rapport and being very active in your community is real important with this work,” Wees said. “Because if you don’t have that rapport, you’re not going to get them to put away those guns, because you don’t know what this man is thinking. You don’t know if he had that respect for you, enough to not blow your brains out along with the next man.”Violent crime in America’s big cities has been receding from pandemic highs for about two years. But even in comparison, Baltimore’s improvement is breathtaking: fewer people have been killed in the city over the last seven months than in any similar period in the last 50 years.As of 15 August, the running 365-day total for murders in Baltimore stood at 165 dead. Assuming the city remains on that pace, its murder rate would finish below 30 per 100,000 residents for the first time since 1986. If it remains on the pace set since 1 January, it would finish 2025 at 143 murders, a rate of about 25 per 100,000, last seen in Baltimore in 1978.It confounds Baltimore’s bloody legacy. An army of social workers, violence interventionists, prosecutors, community leaders, and even cops all pulling in the same direction for once has made David Simon’s stories from The Wire or Donald Trump’s exasperating trash talk less relevant.But this metropolitan renaissance is born of agony.Before Ahmaud Arbery or Breonna Taylor or George Floyd, there was Freddie Gray, rattled to death in the back of a Baltimore police department van.“We had, if you will, a head start with our uprising in 2015,” said Dr Lawrence Brown, a Baltimore historian and health equity researcher.View image in fullscreenGray’s death in April 2015 of spinal injuries set off an earthquake of protests against police brutality across the country, with none as consequential or long-lasting as those at the epicenter. Protests in Baltimore turned into riots.“Since 2015, there’s been here in Baltimore this acknowledgement that equity needs to be a priority,” Brown said. The riots were as much about the conditions of poverty that led to Gray’s death – people losing their homes in foreclosure to water bills, for example – as they were about police brutality, Brown noted.But the heavy-handed response by cops to the protests and failures to hold police accountable for misconduct eviscerated the relationship between the Baltimore police and the public. Baltimore’s state attorney Marilyn Mosby laid murder charges on the officers involved, and Baltimore’s police union closed ranks in response, eviscerating the relationship between police and politicians. And a series of scandals at city hall and the state attorney’s office – and the failure of Mosby’s charges to result in convictions – eviscerated the relationship between politicians and the public.Violence skyrocketed.Three months after Gray’s death, Baltimore’s homicide count set a 42-year record high. Baltimore’s mayor canned the police chief, then abandoned her re-election bid. In the previous year, 211 people had been killed in Baltimore, about 33.8 per 100,000 residents. That was high at the time relative to other large US cities, but reflected incremental improvement by Baltimore’s historical standards. After Freddie Gray’s death turned the city upside down, the count rose to 344 in 2015 – a 63% increase and a multi-decade high – bucking a long national trend of declining violent crime. The rate at which police made arrests in homicide cases cratered.View image in fullscreenThe gun trace taskforce (GTTF) scandal in 2017 exacerbated problems.Baltimore’s police culture revolved around statistics-driven measures of productivity, which Baltimore street cops often achieved by busting whoever happened to be convenient without concern about the quality of an arrest or the real criminality of a suspect, according to an internal report in the wake of the scandal.The GTTF had a reputation for aggressively pursuing arrests and putting up big numbers, insulating it from internal scrutiny. But a federal investigation revealed that the taskforce had long abandoned its mission to track down the source of illegal guns and had instead become a criminal gang prowling the street to rob drug dealers. Its officers planted guns and drugs on suspects and fabricated testimony to cover their tracks. More than a dozen police officers went to federal prison.Baltimore had tried more than one way to attack violent crime, from zero-tolerance “broken windows” policing to relying on neighborhood crime statistics to motivate police officers into making more arrests. Efforts to get guns off the street backfired spectacularly from political interference, incompetence and, with the GTTF, corruption.The scandal destroyed whatever public faith in Baltimore’s police department remained. By 2017, Baltimore’s homicide rate had risen to the highest of any large city in the US.“We had a police unit that was committing crimes. They were contributing to the crime,” Brown said. This history makes it hard to attribute the city’s current gains to police work, he added: “Who do I give credit to? Police are the lowest on my scales. It may be 5%. In some cases, at least with that gun trace taskforce, it’s negative.”Snake-bitten, adrift and in a state of profound civic despair, Baltimore’s leaders came to a fundamental consensus: reducing violence had to take priority over everything else. It was defining the city and was the only thing voters cared about.The first time Brandon Scott saw someone get shot in Park Heights, he wasn’t quite seven years old.Scott, a former city council member, had long been a keen observer of violence-prevention strategy before becoming mayor in 2020. An academic consensus looking at research done in Chicago and elsewhere about violence had long suggested that a dollar spent on policing reduced violence less than a dollar spent on intervention. But political leaders find it hard to justify cuts to police budgets under the best of circumstances. And Baltimore in 2021 did not have the best of circumstances.Scott had been mayor of Baltimore for about three months when the American Rescue Plan Act (Arpa) passed in Congress, giving him an option to supercharge his violence-prevention strategy without a massive political battle. The $1.9tn economic stimulus package passed in March 2021, sending $1,400 checks to taxpayers, paying unemployment benefits at a higher rate and granting money to cities to recover from the pandemic however they saw fit. Using Arpa money, the city could fund the new data-driven project without using the police budget, sidestepping the thorny “defund the police” rhetoric that had hamstrung previous efforts around the country.“When we said we were going to reduce violence by 15% from one year to the next, folks laughed at me,” Scott said. “Folks said that we couldn’t do it this way. The only way that we could do it is we went back to zero-tolerance policing, which actually didn’t do it in the first place.”Against a Baltimore police budget topping half a billion dollars – the largest police budget per capita of any large city in the US – Baltimore’s political establishment gave its new millennial mayor room to experiment with $50m in Washington’s money.View image in fullscreenTrust was in short supply after years of scandal. The first step was to get everyone on board – the cops, the hospitals, the jails, the schools, the social services teams, the state government and the feds. Scott appointed Richard Worley as the city’s new police commissioner in June 2023; Worley was a life-long Baltimore officer picked in part to bring the rank and file in line with Scott’s antiviolence program. Scott emphasizes partnerships as an important part of the plan’s successes.Other federal grants, from the Bipartisan Safer Communities Act, emerged in 2022 to help support the network of non-profits needed for the plan. The funding came from the first federal gun-control legislation enacted in 28 years, with the support of 15 Senate Republicans and $250m over five years for community violence-intervention programs under the Department of Justice.Baltimore’s approach is tailored and personalized. The social worker who knocks on someone’s door carries a letter written for that person from the mayor, with an offer of help – and a threat.“We focus on the individuals and groups that are most likely to be a victim or perpetrator of that gun violence, and we go to them,” Scott said. “They actually get a letter from me. And if they don’t do that – if they don’t take us up on that help to operate their lives in a different way, to not put themselves at risk of being a victim or perpetrator or get involved in illegal and violent activity, then we remove them through our law enforcement partnership with the police department that obviously works at my direction, or with our attorney general, our state’s attorney and our federal law enforcement partners, and we’re holding people accountable.”Crime charts start showing the decline in September 2022, when the comprehensive plan had been up and running for about a year, Scott said. About three out of four people offered services by the program accepted them, and the city today has less violence than at any point in his life, he said.“Of the folks that we’ve been able to work with through our partners … 95.7% of them have not been re-victimized, and 97.7% of them have not recidivated,” Scott said. “You’re talking about, in any city, a very relatively small group of people who are at the highest risk. For us to be intensely focusing on them, and to have that few of them become victims again, or recidivate into their previous life, is very impressive.”No one got killed in Baltimore last week. Also, the local paper’s reporters are quitting in droves. Surely, this is a coincidence.Summers bleed Baltimore. School is out. People congregate. Tempers flare. But between 27 July and 2 August, the homicide line of the Baltimore police department’s weekly crime report posted a shutout.Baltimore’s strategy revolves around focused deterrence. Take the kind of targeting advertisers use to put an ad up on your phone for mouthwash on a day you forgot to brush your teeth, and apply it to murder. Only, instead of an ad, someone at high risk for violence gets a case worker knocking on their door.“We’re talking about young people at elevated risk,” said Kurtis Palermo, who runs the youth violence-prevention non-profit Roca in Baltimore. “We’re not talking about the young person who says F-you to his teacher, or tells Mom, Dad, Grandma they don’t want to do XYZ. We’re talking about kids who literally have probably two tracks: jail and death.”Palermo knocks on doors while a cop is carrying the mayor’s letter. As often as not, he has to knock on a door a dozen times before he finds his charge.The process often begins after a shooting. Case workers at local hospitals treating gunshot victims will take note of a patient’s history and their friends and family. The data is combined with school records, police records, social services records and whatever else might be relevant; then the violence-prevention team will have a quick meeting. When they determine someone has enough risk factors, they intervene.View image in fullscreen“It could be anything from information that is gleaned on jail calls, video evidence, you know, whatever it is, and then the connections to other people,” said Terence Nash, chief of the group violence-reduction strategy (GVRS) in the mayor’s office of neighborhood safety and engagement.About 570,000 people live in Baltimore. If 200 people are murdered in the city in a year, the average person’s risk would be about one in 2,850. But almost all the violence is concentrated among a tiny, impoverished and identifiable subset of that 570,000: 2% or less of the city, Nash said. If 80% of 200 murders are in this cluster, then most people are facing a murder risk of a bit less than 14,000 to one, while the high-risk cluster’s odds are about one in 71.There’s no single factor that is perfectly predictive, Nash said. But as connections accumulate with other people at risk for violence, a threshold is crossed. The process is epidemiological, treating violence like an infection to track.Two types of people are most vulnerable, Nash said: people in their early 20s who are feuding over trivial matters, “someone looked at somebody wrong, somebody bumped into somebody”; and older people in the drug game, “more around violence that has to do with their criminal enterprise, and so it’s much more calculated”.Critically, it’s not every young person with an Instagram beef, and not every Sandtown neighborhood street dealer that rises to their attention. The risk factors create a reasonable, articulable – and legally defensible – basis for contact. The team looks at each person individually, and crafts an approach for each one, Nash said.“This is not magic. It’s hard work,” Nash said. “It takes attention to detail.”Jaylen was in a hospital bed recovering from a gunshot wound when a life coach with Youth Advocate Programs (YAP) approached him. Jaylen had, he said, been in the wrong part of West Baltimore at the wrong time. He wasn’t especially receptive at first to a life coach, of all things, he said.“I thought there was a catch,” the 20-year-old said. “I thought I’d have to pay them back in the future.”Jaylen couldn’t say much about his life or where he was: people might still want to hurt him. But it took a couple of months of outreach for the offer of help from Teshombae Harvell, Jaylen’s life coach, to look real. It took consistency.“It’s about the follow-up,” Harvell said. “Today they might say get the F out of here. Tomorrow, they could be wanting services, because something tragic happened where they need change.”When someone gets shot, Jaylen expects someone to retaliate, he said: “Back and forth, back and forth. It’s never-ending.”What Harvell offered – what no one had offered in a credible way before – was a plan for the future, and perhaps the realization that he had a future. Jaylen had thought about killing someone before, he said. He felt as if the prospect of surviving long enough to have a legit life wasn’t worth considering.Now he has a driver’s license and wants to become a plumber. Helping fix some of Baltimore’s stubborn oversupply of abandoned houses would be a living, and ironically would be paying back the city for its help.“The only way programs like YAP or GVRS are going to be successful is for people to buy in,” said Harvell. “They can’t be spectators on the outside, looking in, wondering if it’s going to be a success or a failure.”Brandon Scott’s approach offers benefits to get people out of the street and off a violent path: housing, victim assistance, drug treatment, mental health services, job training.“There’s the carrot and stick,” said Ivan Bates. “We’re the stick.”Bates had a pretty good track record of getting drug dealers off the hook before winning election as Baltimore’s state’s attorney – what most places call the district attorney and chief prosecutor. Baltimore’s history of light prosecutions for handgun cases is a legacy of questionable policing practices – weakly supported cases landing in court – and a negative view of mass incarceration by prosecutors.“I was the one who was beating the brakes off the state,” Bates said. “Look, my law partner and I went 25, 26 straight jury trials against Baltimore city prosecutors representing some pretty rough people, you know. And when I come and say that the street – the criminal elements – do not respect that approach, I’m not saying it because I read in a book. I’m saying it because I lived it.”After defeating Mosby and assuming office in January 2023, Bates immediately reversed her policy of non-prosecution for low-level offenses like drug possession, prostitution and trespassing. He successfully lobbied the Maryland legislature to increase the penalty for illegal gun possession from three years to five years. And he started putting people in prison.View image in fullscreenIn Mosby’s last two years in office, 2,186 people faced felony gun charges. Mosby dismissed about 34% and another 30% received plea bargains, mostly without imprisonment. In Bates’s first two years, the number of cases increased a bit, to 2,443. Bates only dismissed 19% of the cases, and only 10% received plea agreements. The rest were convicted – an increase of about 1,000 people sent to prison – which includes a 70% increase in homicide convictions.“Everybody has a plan. The mayor had his plan. The police department, they have their plan,” Bates said. “And when I came and I ran for office, I had my plan. The plans have to work together as one.”Bates is quick to attribute the city’s reduction in violence to a team effort. For example, without victim assistance – which is supported by a federal grant – prosecutions that would have fallen apart in previous years concluded in convictions because witnesses could be found to appear in court. Police now are actually focused on removing illegal guns from the street, he said.It also requires people to have an out. Without a path off the street, people on the edge in Baltimore will do what they must to survive, he said.He rejects the suggestion that his approach is a return to mass incarceration. Prosecution is not zero tolerance and it is not indifferent to a defendant’s conditions.“We have focused on violent repeat offenders, not the first-time kid,” Bates said. “Remember, 5,000-6,000 individuals are doing this type of behavior. So, we’re not here to go back to mass incarceration.”But he’s sensitive to how this approach plays out in five years.“My No 1 worry is, when individuals come home, we have to have something for them,” he said. “Did we actually prepare them to come home? … Look, I believe everybody pays a debt to society. We move on, and then we as a society put them in a place that they can win. And if we didn’t, then we’re going to see these numbers bounce back up.”Sean Wees from Safe Streets said stopping a shooting might come down to noticing that a kid on a street corner has holes in his shoes.“So we asked the little kid, are you hungry?” Wees said. “That could lead to a conversation where you find out this kid is not eating. But we have the resources, or if we don’t have them at that time, we find the resources to help this family out. And now that key individual, that target individual, is the father of that child … We fed his child now, we’ve started to build a rapport with this guy, because he’s going to be appreciative of the work that we just did. That’s how this works.”View image in fullscreenOne might think that the thing that prevents expanding the work is personnel. Very few people have the street credibility, the devotion and the nerve to be successful. But Wees said the constraint is actually money.“I love this work, because I’m always trying to save an individual life,” he said. “I’m good with this work. The time and the money don’t match right now, but guess what? I still do this work … You get more money, people will put in more time.”For the first time in forever, Charm City’s leaders are all pulling in the same direction, and crime is falling through the floor. They’ve placated violence in inventive and predictable ways. They are, of course, justifiably concerned that Donald Trump will undo their successes on Republican “screw cities” general principles.Trump closed the White House office of gun violence prevention on the first day he took office. Three months later, the Department of Justice cut the $300m allocated to community violence-intervention grants in half, including many in Baltimore. The cuts were part of a larger $811m culling across the office of justice programs, Reuters reported. Funding for gun-violence victims’ services, conflict mediation, social workers, hospital-based programs: gone.Scott blasted the cuts to the program’s partners as dangerous and reckless.“You’re talking about an administration who has said for years that they want to drive down crime in these cities,” he said. “The truth is no one cares if the mayor is a Republican or Democrat in any city when it comes to gun violence.”The youth antiviolence organization Roca had three grants terminated, one in Baltimore with about $1m left unspent. The termination letter said the grant did not align with its priorities including “directly supporting certain law enforcement operations, combating violent crime, protecting American children, and supporting American victims of trafficking and sexual assault”.As applied to Roca, the rationale is absurd. But they could see it coming, said Dwight Robson, a Roca executive.“Initially, it was a huge blow. We were estimating that we were going to serve roughly 60 fewer young people a year,” Robson said. After an outcry, funders outside the federal government, including the city itself, started to step in, who “made it clear that they don’t want to lose momentum” in Baltimore.Support in other places, like Boston, is fleeting, in part because they’ve done their job too well, Robson said: “Boston is the safest big city in America. And you know, the homicides and crime just aren’t on people’s radars to the degree that it is in Baltimore.”Roca has appealed the decision to cut their grant, and a coalition of non-profits is suing the Trump administration, arguing that the cuts were made unlawfully.The real threat posed by the cuts is continuity, said Stefanie Mavronis, director of the mayor’s office of neighborhood safety and engagement (Monse). The violence-intervention plan has worked in part because it has been consistent. People are so used to the presence of Monse staffers around crime scenes and in high-violence neighborhoods that some people have come to expect a knock on the door after a shooting.View image in fullscreenIf Monse’s partners start disappearing, and if they can’t back up promises of help made to victims – or shooters – then things may fall apart, she said.“We’ve got to make the investment in the service side of things,” Mavronis said. “We can’t just make empty promises to folks who we are telling we have the services for you to change your life.”Baltimore’s leaders, both in city hall and in the streets, have been putting their reputations and capital on the line, in some cases risking their lives.Budget cuts while they’re winning makes it look like they want Baltimore to lose. The exasperation is plain.“We have the lowest amount of violence that we’ve seen in my lifetime, and I’m 41 years old,” Scott said. “If everyone says that they agree that this is the top issue, that we have to make sure that more people are not becoming a victim of these things, why change it? Why disrupt the apple cart, if the apple cart is producing the best results that we’ve seen in a generation?” More

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      Why the US is burning $10m worth of birth control | Moira Donegan

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      There are few better metaphors for the receding status of American women than one offered up by the Trump administration at a medical waste disposal facility outside Paris this week: rather than distribute nearly $10m worth of birth control, which had been purchased by USAID and was destined to be given to women in low-income countries, primarily in Africa, the Americans decided to burn it.The incinerated contraceptives included 900,000 birth control implants, 2m doses of injectable long-acting birth control, 2m packs of contraceptive pills and 50,000 IUDs. The medicine is just the latest in the far-reaching fallout from cuts made by the so-called “department of government efficiency,” or Doge, a project in which Elon Musk and a group of his very young, overwhelmingly male acolytes unilaterally slashed congressionally appropriated funding to government programs they did not like. The cuts have been devastating for non-profits that work to improve women’s health and safety worldwide. Sarah Shaw, an associate director at the global family planning group MSI Reproductive Choices, says that the cuts will put women at risk as they strain their health with unplanned pregnancies and seek out illegal abortions; other women who are denied access to birth control will lose out on the opportunities for education, professional development or remunerative work that can help them escape abuse, rise out of poverty, pursue their talents and ambitions and better provide for the children they already have.When MSI attempted to buy the contraceptives, the administration would only accept full price, which the organization couldn’t afford, she said. Several non-profits, including MSI, had offered to pay to ship and repackage the supplies, according to another representative. But the Trump administration refused, partially due to federal rules the prohibit the US from providing such goods to groups that perform, provide referrals for or offer education about abortions. In addition to the cost of purchasing the contraceptives, American taxpayers will now be on the hook for about $167,000 for the cost of burning them.It’s just the latest in a series of signs that the Trump administration is turning against the provision of birth control, particularly the safe, effective and woman-controlled hormonal methods that have been a cornerstone of healthcare policy for decades and which were a precondition of women’s advancement in work and education over the past 60 years.In April, the Trump administration abruptly announced that it was suspending a large swath of the domestic service grants distributed under Title X, the program meant to help low-income Americans access birth control, STD treatment and other sexual and reproductive healthcare. Of the 86 Title X grants awarded for fiscal year 2024, nearly 25% were “temporarily withheld”, mostly based on highly suspect allegations that the grant-receiving institutions – including 13 Planned Parenthood affiliates – had failed to comply with Trump executive orders banning things like DEI programs. Eight states now receive zero Title X dollars: California, Hawaii, Maine, Missouri, Mississippi, Montana, Tennessee and Utah. Alaska, Minnesota and Pennsylvania have also lost most of their contraception funding.The domestic cuts – along with the exclusion of Planned Parenthood clinics from Medicaid reimbursements – mean that American women, too, are now facing dramatically greater obstacles to accessing birth control. Clinics that relied on Title X funding are now set to close: 11 Planned Parenthood clinics already have, including in Democratically controlled states like California. Planned Parenthood says that cumulatively, the cuts could lead the organization to close about 200 of its 600 clinics nationwide – a devastating cut to abortion providers in particular that will make a wide range of reproductive services inaccessible to women regardless of where they live.But the Trump administration is not merely forcing these programs for women’s health and dignity go up in flames. They are redirecting them to better suit their preferred cultural outcome: one in which women’s lives, ambitions and talents are all subordinated to the task of childbearing. The New York Times reported last month that the White House is redirecting Title X funds that once went to birth control to instead fund an “infertility training center” and programs in something called “restorative reproductive medicine”. If Title X’s original aim was to help American women control their fertility so as to build healthier families and to enable them to pursue other aims – like learning or work – in the new administration’s version, the program exists mainly to encourage women to have more children. But the switch should not be seen as a genuine investment in infertility, an often devastating condition with which many Americans struggle. Because the new Title X priorities do not, by and large, direct more money to IVF. Trump promised, on the campaign trail, to make IVF free. But the procedure, which has opponents on the Christian right, is not included in the administration’s new priority of “restorative” reproductive medicine, a practice that avoids controversial fertility treatments; instead, doctors seek the “root cause” of a woman’s infertility, which may involve telling them they can conceive with proper diet and exercise.In government, money allocation is a statement of values. With its dramatic cuts to contraceptive funding at home and abroad, the Trump administration is making its values clear. It does not value women’s health; it does not value their dignity, their control over their own lives, their aspirations, their earning potential, their desire to be freed from ignorance, or poverty, or the abuse they suffer under the hands of husbands and fathers. It does not value their ability to control their own bodies, and by extension, it does not value their ability to enter the public sphere. It does not value their dreams, their gifts, their hard work or invention or aspiration to anything other than making babies. American women, like women everywhere, depend on birth control to live lives of freedom and to pursue their dreams. But because of the Trump administration, those dreams are going up in smoke.

      Moira Donegan is a Guardian US columnist More