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    Top medical body concerned over RFK Jr’s reported plans to cut preventive health panel

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    A top US medical body has expressed “deep concern” to Robert F Kennedy Jr over news reports that the health secretary plans to overhaul a panel that determines which preventive health measures including cancer screenings should be covered by insurance companies.The letter from the the American Medical Association comes after the Wall Street Journal reported on Friday that Kennedy plans to overhaul the 40-year old US Preventive Services Task Force because he regards them as too “woke”, according to sources familiar with the matter.During his second term, Donald Trump has frequently raged against organizations and government departments that he considers too liberal – often without any evidence. The US president, and his cabinet members such as Kennedy, have also overseen huge cuts and job losses across the US government.The taskforce is made up of a 16-member panel appointed by health and human services secretaries to serve four-year terms. In addition to cancer screenings, the taskforce issues recommendations for a variety of other screenings including osteoporosis, intimate partner violence, HIV prevention, as well as depression in children.Writing in its letter to Kennedy on Sunday, the AMA defended the panel, saying: “As you know, USPSTF plays a critical, non-partisan role in guiding physicians’ efforts to prevent disease and improve the health of patients by helping to ensure access to evidence-based clinical preventive services.”“As such, we urge you to retain the previously appointed members of the USPSTF and commit to the long-standing process of regular meetings to ensure their important work can be continued without disruption,” it added.Citing Kennedy’s own slogan of “Making America healthy again,” the AMA went on to say: “USPSTF members have been selected through an open, public nomination process and are nationally recognized experts in primary care, prevention and evidence-based medicine. They serve on a volunteer basis, dedicating their time to help reduce disease and improve the health of all Americans – a mission well-aligned with the Make America Healthy Again initiative.”According to the Affordable Care Act, public and private insurance companies must cover any services recommended by the Preventive Services Task Force without cost sharing.In a statement to MedPage Today, Department of Health and Human Services spokesperson Andrew Nixon did not confirm the reports, instead saying: “No final decision has been made on how the USPSTF can better support HHS’ mandate to Make America Healthy Again.”Reports of Kennedy’s alleged decision to overhaul the taskforce come after the American Conservative published an essay earlier this month that described the taskforce as advocating for “leftwing ideological orthodoxy”.It went on to accuse the panel of being “packed with Biden administration appointees devoted to the ideological capture of medicine”, warning that the “continued occupation of an important advisory body in HHS – one that has the capacity to force private health insurers to cover services and procedures – by leftwing activists would be a grave oversight by the Trump administration”.In response to the essay, 104 health organizations, including the American Medical Association, issued a separate letter to multiple congressional health committees in which they urged the committees to “protect the integrity” of the taskforce.“The loss of trustworthiness in the rigorous and nonpartisan work of the Task Force would devastate patients, hospital systems, and payers as misinformation creates barriers to accessing lifesaving and cost effective care,” the organizations said.In June, Kennedy removed all 17 members of a US Centers for Disease Control and Prevention panel of vaccine experts. Writing in a Wall Street Journal op-ed, he accused the committee of having too many conflicts of interest.Kennedy’s decision to overhaul the immunization panel was met with widespread criticism from health experts, with the American Public Health Association executive director Georges Benjamin calling the ouster “a coup”.“It’s not how democracies work. It’s not good for the health of the nation,” Benjamin said. More

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      Democrats use new tactic to highlight Trump’s gutting of Medicaid: billboards in the rural US

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      The road to four struggling rural hospitals now hosts a political message: “If this hospital closes, blame Trump.”In a series of black-and-yellow billboards erected near the facilities, the Democratic National Committee (DNC) seeks to tell voters in deep red states “who is responsible for gutting rural healthcare”.“UNDER TRUMP’S WATCH, STILWELL GENERAL HOSPITAL IS CLOSING ITS DOORS,” one sign screams. The billboards are outside hospitals in Silex, Missouri; Columbus, Indiana; Stilwell, Oklahoma; and Missoula, Montana.The fate of rural hospitals has become a politically contentious issue for Republicans, as historic cuts pushed through by the GOP are expected to come into effect over the next decade. Donald Trump’s enormous One Big Beautiful Bill Act (OBBBA) cut more than $1tn from Medicaid, the public health insurance program for low-income and disabled Americans, insuring more than 71 million adults.“Where the real impact is going to be is on the people who just won’t get care,” said Dave Kendall, a senior fellow for health and fiscal policy at Third Way, a center-left advocacy organization.“That’s what used to happen before we had rural hospitals – they just don’t get the care because they can’t afford it, and they can’t get to the hospital.”In response to criticism, Republicans added a $50bn “rural health transformation fund” just before passage of the OBBBA. The fund is expected to cover about one-third of the losses rural areas will face, and about 70% of the losses for the four hospitals where Democrats now have nearby billboards. The rural health fund provides money through 2030, while the Medicaid cuts are not time-bound.That is already becoming a political football, as Democrats argued in a letter that the money is a “slush fund” already promised to key Republican Congress members.“We are alarmed by reports suggesting these taxpayer funds are already promised to Republican members of Congress in exchange for their votes in support of the Big, Ugly Betrayal,” wrote 16 Democratic senators in a letter to Dr Mehmet Oz, Trump’s head of Medicare and Medicaid.View image in fullscreen“In addition, the vague legislative language creating this fund will seemingly function as your personal fund to be distributed according to your political whims.”Rural hospitals have been under financial strain for more than a decade. Since 2010, 153 rural hospitals have closed or lost the inpatient services which partly define a hospital, according to the University of North Carolina Sheps Center for Health Services Research.“In states across the country, hospitals are either closing their doors or cutting critical services, and it’s Trump’s own voters who will suffer the most,” said the DNC chair, Ken Martin, in a statement announcing the billboards.The OBBBA is expected to further exacerbate those financial strains. A recent analysis by the Urban Institute found rural hospitals are likely to see an $87bn loss in the next 10 years.“We’re expecting rural hospitals to close as a result – we’ve already started to see some hospitals like, ‘OK, how are we going to survive?’” said Third Way’s Kendall.skip past newsletter promotionafter newsletter promotionA June analysis by the Sheps Center found that 338 rural hospitals, including dozens in states such as Louisiana, Kentucky and Oklahoma, could close as a result of the OBBBA. There are nearly 1,800 rural hospitals nationally, according to the Kaiser Family Foundation (KFF), a healthcare research non-profit.That perspective was buttressed by the CEO of the National Rural Health Association, Alan Morgan, who in a recent newsletter said 45% of rural hospitals are already operating at a loss.“When you remove $155bn over the next 10 years, it’s going to have an impact,” he said.In the fragmented US healthcare ecosystem, Medicaid is both the largest and poorest payer of healthcare providers. Patients benefit from largely no-cost care, but hospitals complain that Medicaid rates don’t pay for the cost of service, making institutions that disproportionately rely on Medicaid less financially stable. In rural areas, benefit-rich employer health insurance is harder to come by; therefore, more hospitals depend on Medicaid.But even though Medicaid pays less than other insurance programs, some payment is still better than none. Trump’s OBBBA cut of more than $1tn from the program over the coming decade is expected to result in nearly 12 million people losing coverage.When uninsured people get sick, they are more likely to delay care, more likely to use hospital emergency rooms and more likely to struggle to pay their bills. In turn, the institutions that serve them also suffer.“This is what Donald Trump does – screw over the people who are counting on him,” said Martin, the DNC chair. “These new DNC billboards plainly state exactly what is happening to rural hospitals under Donald Trump’s watch.” More

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      ‘We need some hope’: can a rural hospital on the brink survive Trump’s bill?

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      When her severely allergic toddler, Josie, began gasping for breath in the middle of the night, Krissy Cunningham knew there was only one place she could get to in time to save her daughter’s life.For 74 years, Pemiscot Memorial hospital has been the destination for those who encounter catastrophe in Missouri’s poorest county, a rural stretch of farms and towns in its south-eastern Bootheel region. Three stories of brown brick just off Interstate 55 in the town of Hayti, the 115-bed hospital has kept its doors open even after the county’s only Walmart closed, the ranks of boarded-up gas stations along the freeway exit grew, and the population of the surrounding towns dwindled, thanks in no small part to the destruction done by tornadoes.For many in Pemiscot county, its emergency room is the closest available without taking a 30-minute drive across the Mississippi river to Tennessee or the state line to Arkansas, a range that can make the difference between life and death for victims of shootings, overdoses or accidents on the road. In the wee hours of one spring morning, it was there that Josie received the breathing treatments and a racemic epinephrine shot that made her wheezing subside.“There is no way I would have made it to one of the farther hospitals, if it wouldn’t have been here. Her airway just would have closed off, and I probably would have been doing CPR on my daughter on the side of the road,” recalled Cunningham, a nurse who sits on the hospital’s board.View image in fullscreenYet its days of serving its community may be numbered. In May, the hospital’s administration went public with the news that after years of struggling with high rates of uninsured patients and low reimbursement rates from insurers, they may have to close. And even if they do manage to navigate out of their current crisis, Pemiscot Memorial’s leaders see a new danger on the horizon: the “big, beautiful bill” Republicans pushed through Congress earlier this month, at Donald Trump’s request.Centered around an array of tax cuts as well as funds for the president’s mass deportation plans, the bill will mandate the largest funding reduction in history to Medicaid, the federal healthcare program supporting low-income and disabled Americans. That is expected to have ripple effects nationwide, but will hit particularly hard in Pemiscot county and other rural areas, where hospitals tend to have frail margins and disproportionately rely on Medicaid to stay afloat.“If Medicaid drops, are we going to be even collecting what we’re collecting now?” asked Jonna Green, the chairwoman of Pemiscot Memorial’s board, who estimated 80% of their revenue comes from Medicaid as well as Medicare, another federal health program primarily for people 65 and older. “We need some hope.”The changes to Medicaid will phase in beginning in late 2026, and require enrollees to work, volunteer or attend school 80 hours a month, with some exceptions. States are also to face new caps on provider taxes, which they use to fund their Medicaid programs. All told, the non-partisan Congressional Budget Office forecasts that 10 million people nationwide will lose their healthcare due to the bill, which is nonetheless expected to add $3.4tn to the federal budget deficit through 2034.Trump carried Missouri, a midwestern state that has veered sharply away from the Democratic party over the past three decades, with more than 58% of the vote last November. In Pemiscot county, where census data shows more than a quarter of residents are below the poverty line and the median income is just over $40,000 a year, he was the choice of 74% of voters, and Republican lawmakers representing the county played a notable role in steering his tax and spending bill through Congress.Senator Josh Hawley publicly advocated against slashing the healthcare program, writing in the New York Times: “If Republicans want to be a working-class party – if we want to be a majority party – we must ignore calls to cut Medicaid and start delivering on America’s promise for America’s working people.” He ultimately supported the bill after a $50bn fund to help rural hospitals was included, but weeks later introduced legislation that would repeal some of the very same cuts he had just voted for.“I want to see Medicaid reductions stopped and rural hospitals fully funded permanently,” the senator said.View image in fullscreenJason Smith, whose district encompasses Pemiscot county and the rest of south-eastern Missouri, oversaw the crafting of the measure’s tax provision as chairman of the House ways and means committee, and has argued they will bring prosperity rural areas across the state. Like others in the GOP, he has said the Medicaid cuts will ferret out “waste, fraud and abuse”, and make the program more efficient.It’s a gamble for a state that has seen nine rural hospitals close since 2015, including one in a county adjacent to Pemiscot, with a further 10 at immediate risk of going under, according to data from the Center for Healthcare Quality and Payment Reform policy group.The Missouri Budget Project thinktank estimates that the bill will cost 170,000 of the state’s residents their health coverage, largely due to work requirements that will act as difficult-to-satisfy red tape for Medicaid enrollees, while the cap on provider taxes will sap $1.9bn from the state’s Medicaid program.“There’s going to be some really hard conversations over the course of the next five years, and I think that healthcare in our region will look a lot different than what it does right now,” said Karen White, CEO of Missouri Highlands Health Care, which operates federally qualified health centers providing primary and dental care across rural south-eastern Missouri. She forecasts 20% of her patients will lose Medicaid coverage through 2030.As the bill was making its way through Congress, she contacted the offices of Smith, Hawley and Missouri’s junior senator, Eric Schmitt, all politicians she had voted for, asking them to reconsider cutting Medicaid. She did not hear back.“I love democracy. I love the fact that we as citizens can make our voices heard. And they voted the way that they felt they needed to vote. Maybe … the larger constituency reached out to them with a viewpoint that was different than mine, but I made my viewpoint heard,” White said.Spokespeople for Schmitt and Smith did not respond to requests for comment. In response to emailed questions, a spokeswoman for Hawley referred to his introduction of the legislation to partially stop the Medicaid cuts.Down the road from the hospital lies Hayti Heights, where there are no businesses and deep puddles form in the potholes and ditches that line roadways after every thunderstorm. Mayor Catrina Robinson has a plan to turn things around for her 500 or so residents, which involves bringing back into service the water treatment plant that is the town’s main source of revenue. But that is unlikely to change much without Pemiscot Memorial.“Half of those people that work at the hospital, they’re my residents. So how they gonna pay their bills? How they gonna pay their water bill, how they gonna pay their light bill, how they gonna pay rent? This is their source of income. Then what will they do?” Robinson said.View image in fullscreenTrump’s bill does include an array of relief aimed at the working-class voters who broke for him in the last election, including tax cuts on tips and overtime pay and deductions aimed at senior citizens. It remains to be seen if whatever financial benefits those provisions bring to the workers of Pemiscot county will outweigh the impact of the stress the Medicaid cuts place on its healthcare system.“The tax relief of server’s tips and all that, that’s not going to change the poverty level of our area,” said Loren Clifton, the hospital’s administrative director. “People losing their healthcare insurance absolutely will make it worse.”Work can be found in the county’s corn, wheat, soybean and rice fields, at a casino in the county seat Caruthersville and at a shipyard along the banks of the Mississippi . But Green questions if those industries would stick around if the hospital goes under, and takes with it the emergency room that often serves to stabilize critical patients before transferring them elsewhere.View image in fullscreen“Our community cannot go without a hospital. Healthcare, employment, industry – it would devastate everything,” Green said.The board is exploring partnerships with other companies to help keep the hospital afloat, and has applied for a federal rural emergency hospital designation which they believe will improve their reimbursements and chances of winning grants, though that will require them to give up other services that bring in revenue. For many of its leaders, the stakes of keeping the hospital open are personal.“This is our home, born and raised, and you would never want to leave it. But I have a nine-year-old with cardiac problems. I would not feel safe living here without a hospital that I could take her to know if something happened,” said Brittany Osborne, Pemiscot Memorial’s interim CEO.One muggy Wednesday morning in July, Pemiscot’s three county commissioners, all Republicans, gathered in a small conference room in Caruthersville’s courthouse and spoke of their resolve to keep the hospital open.“It’s 50-50 right now,” commissioner Mark Cartee said of the hospital’s chances of survival. “But, as long as we have some money in the bank of the county, we’re going to keep it open. We need healthcare. We got to have a hospital.”They were comparatively sanguine about the possibility that the Medicaid work requirements would harm the facility’s finances down the line.“We got a guy around here, I guess he’s still around. He’s legally blind but he goes deer hunting every year,” commissioner Baughn Merideth said. “There’s just so much fraud … it sounds like we’re right in the middle of it.”A few blocks away, Jim Brands, owner of Hayden Pharmacy, the oldest in the county, had little doubt that there were those in the county who took advantage of Medicaid. He also believed that fewer enrollees in the program would mean less business for his pharmacy, and more hardship overall.View image in fullscreen“Just seeing this community, the situation it’s in, the poverty, we’ve got to get people to work. There are a ton of able-bodied people that could work that choose not to,” he said.“To me, there’s got to be a better way to weed out the fraud and not step on the toes of the people who need it.” More

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      Trans youth fight for care as California clinics cave to Trump: ‘How can this happen here?’

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      Eli, a 16-year-old Los Angeles student, is spending his summer juggling an internship at a natural history museum, a research project, a physics class and cheer practice – and getting ready to apply for college.But in recent weeks, he has been forced to handle a more urgent matter: figuring out how he is going to access vital medical treatments targeted by the Trump administration.Last month, Eli was stunned to get an email alerting him that Children’s hospital Los Angeles (CHLA) was shutting down its Center for Transyouth Health and Development, which had provided him critical healthcare for three years. The center, which has served transgender youth for three decades, offered Eli counseling and helped him access gender-affirming hormone therapy that he said allowed him to live as himself and flourish in school.CHLA said it was shuttering the center due to the federal government’s threats to pull funding, part of the president’s efforts to eradicate trans youth healthcare. The move has forced Eli and his mother to scramble for alternatives, taking time out of his busy summer to contact new providers and ensure he doesn’t run out of medications.California became the first sanctuary state for trans youth healthcare in 2022 and has long positioned itself as having the strongest protections for LGBTQ+ children. Now, for families like Eli’s, it feels like that safety is rapidly disappearing.View image in fullscreen“I was always worried for people in conservative states and had a lot of fear for my community as a whole. But I never thought it would directly affect me in California,” Eli said on a recent afternoon, seated with his mom at a Latino LGBTQ+ organization in Boyle Heights. “I wish people understood they’re doing so much more harm than they could possibly imagine – that so many lives will be hurt and lost and so many people torn apart.”Eli is one of nearly 3,000 patients who learned on 12 June they would be abruptly losing their healthcare at CHLA, one of the largest and most prominent centers in the nation to treat trans kids. Then, on 24 June, Stanford Medicine revealed it had also paused gender-affirming surgeries for trans minors and 18-year-olds, with reports that some families had appointments suddenly canceled and leaving other patients fearful it was the beginning of a wider crackdown on their care.Families across California told the Guardian they were exploring options to stockpile hormones, researching how to get care outside the US, growing increasingly fearful that parents could face government investigations or prosecutions, and discussing options to permanently flee the country.CHLA, in a letter to staff, said its decision to close the trans center was “profoundly difficult”, but as California’s largest pediatric safety net provider, it could not risk losing federal dollars, which makes up a majority of its funds and would affect hundreds of thousands of patients. Stanford said its disruption in services followed a review of “directives from the federal government” and was done to “protect both our providers and patients”.“This is Los Angeles – how can this be happening here?” said Emily, Eli’s mother, who is an educator; the Guardian is identifying them by only their first names to protect their privacy. “My parents left their Central American countries for a better life – fleeing poverty and civil war, and I cannot believe I’m sitting here thinking: what would be the best country for my family to flee to, as so many immigrant families have done? I never thought I might have to leave the US to protect my son.”‘This care gave me my life’Katie, a 16-year-old film student who lives two hours outside Los Angeles, started going to CHLA for gender-affirming care in 2018 when she was nine. For several years, the care involved therapy and check-ins, but no direct medical interventions. Throughout that time, Katie was consistent about her identity as a girl, which CHLA providers supported.“It was so meaningful and incredible for them to say: ‘We see you for who you are, but also you can be who you are,’” recalled Katie, who asked to go by a pseudonym to protect her privacy. “It was like, I have a future. I’ll get to have my life.”In gender-affirming care, young children may first socially transition by using new names, pronouns and clothes. When youth are persistent about their gender, doctors can consider prescribing puberty blockers, which pause puberty, and eventually hormone therapies that allow for medical transition. Trans youth surgeries are rare.View image in fullscreenThe treatment has for years been considered the standard of care in the US, endorsed by major medical groups, including the American Academy of Pediatrics and the American Medical Association, and linked to improved mental health. In recent years, Republicans have passed bans on gender-affirming care in more than 25 states, and Trump has called the treatments “chemical and surgical mutilation”. There has also been a growing international backlash against the care, including in the UK, which has banned puberty blockers for trans kids.Last month, the US supreme court upheld Tennessee’s ban on gender-affirming care for trans youth. Families and civil rights groups have argued the bans are discriminatory, as cisgender children can still receive the same treatments; cis boys with delayed puberty may be prescribed testosterone, for example, while trans boys cannot.Katie, who was eventually prescribed puberty blockers and hormones, broke down crying recounting how the care saved her. “Sometimes I think: What would my life be if I never got this?” she said. “And I just don’t see myself here. I can’t see myself at 16 if I didn’t come out and transition … Losing this now would destroy my life.”Sage Sol Pitchenik, a 16-year-old CHLA patient, who is non-binary, said the care helped them overcome debilitating depression caused by their severe gender dysphoria: “Every day, I couldn’t even get up because I just didn’t want to see myself, not even my reflection in the window. I was so terrified to look at my body.”They compared the care to the essential treatment their twin brother had earlier received at the same institution: a liver transplant. “CHLA saved my life, just like they saved my brother,” they said.Eli, who came out as trans while in middle school during pandemic lockdowns, said it was hard to return to school when he felt so uncomfortable in his body. At the start of high school, he avoided making friends: “I’m really sociable. I love talking to people and joining clubs, but I felt restricted because of how embarrassed I felt and scared of how people would react to me.”The testosterone therapy helped restore his confidence, he said, recounting “euphoric moments” of his transition: growing facial hair, his voice deepening, staying in the boys’ cabin at camp. His friends celebrated each milestone, and his mom said the positive transformation was obvious to his whole family: “It was like day and night – we are a traditional Latino Catholic family, but they were all loving and accepting, because he is such a happier kid.”View image in fullscreen‘Treating our kids as disposable’CHLA started treating trans children around 1991, and that legacy was part of its appeal for parents. “It’s not just the best place in LA to get care, it’s also one of the most important research centers in the country,” said Jesse Thorn, a radio host who has two trans daughters receiving care there.Critics of gender-affirming care have claimed that vulnerable youth are rushed into transitioning without understanding treatment consequences, and that there is not enough research to justify the care. CHLA, Thorn said, countered those claims; families have appointments and build long-term relationships with doctors, psychologists, psychiatrists and social workers. The process is slow and methodical, and the center was engaged in extensive research on the effects of treatments, he said.“The youth most in danger with the clinic closing are those with parents who aren’t sure about this care,” Thorn added. “That’s a lot of parents. They’re not hateful bigots. They’re overwhelmed and scared, and the institution means a lot.”View image in fullscreenOne LA parent, who requested anonymity to protect her trans son’s privacy, said she knew parents who traveled from Idaho to get CHLA’s care: “It really was a beacon of the entire western United States. It is a remarkable loss.”Parents told the Guardian that they were putting their children on waitlists at other clinics and beginning intake processes, but remained worried for families who have public health insurance and fewer resources.Like CHLA, Stanford has long researched and championed trans youth healthcare. The prestigious university’s recent pullback on care only affects surgeries, which are much more rare than hormone therapy and puberty blockers. But families whose care has remained intact, for now, say they are on edge.“There’s a constant feeling of not knowing what you need to prepare for,” said one mom of a 17-year-old trans boy, who said her son waited six months to first be seen by Stanford. “We all understand the pressures the doctors and institutions are under. But ceding the surgeries doesn’t mean the pressure will end. It’s just showing us our kids are seen as disposable.”Parents and advocates say they fear that other institutions could follow CHLA and Stanford, particularly as the White House significantly escalates attacks in ways that go far beyond funding threats.Fears of prosecutionTrump’s focus on California trans youth and gender-affirming care has been relentless. The president has directly attacked a 16-year-old trans track runner, with the US justice department and federal Department of Education fighting, so far unsuccessfully, to force the state’s schools to ban trans female athletes and bar trans girls from women’s facilities. Trump has threatened to withhold billions of dollars in education funding over a state law meant to prevent schools from forcibly outing LGBTQ+ youth to their parents.Perhaps most troubling for families and providers, the FBI has said it is investigating providers who “mutilate” children “under the guise of gender-affirming care”, and the DoJ said this week it had issued subpoenas to trans youth clinics and doctors.This has led to growing fears that the US will seek to prosecute and imprison clinicians, similar to efforts by some Republican states to criminally charge abortion providers. Many parents say they worry they could be targeted next.“There’s an outcry of terror,” said another LA mother of a trans child. “It feels like there is a bloodlust to jail any doctor who has ever helped an LGBTQ+ kid. There’s this realization that the world is constricting around us, and that any moment they could be coming for us.”Some families hope that California will fight back, but are wary of how committed the governor, Gavin Newsom, really is. Newsom faced widespread backlash in March when he hosted a podcast with a conservative activist and said he agreed with the suggestion that trans girls participating in sports was “deeply unfair”.California’s department of justice, meanwhile, has repeatedly emphasized that when institutions withhold gender-affirming care for trans youth, they are violating the state’s anti-discrimination laws.A spokesperson for Rob Bonta, the state’s attorney general, said Trump was “seeking to scare doctors and hospitals from providing nondiscriminatory healthcare”: “The bottom line is: this care remains legal in California … While we are concerned with the recent decisions by CHLA, right now we are focused on getting to the source of this problem – and that’s the Trump administration’s unlawful and harmful threats to providers.”A CHLA spokesperson shared a copy of its staff letter, noting that Trump’s threats to its funding came from at least five federal departments, and saying it was working with patients to identify alternative care and would “explore” reassigning affected employees to other roles. A Stanford spokesperson did not answer questions about how many patients were affected by its recent changes, but said in an email it was “committed to providing high quality, thorough and compassionate medical services for every member of our community”.Kush Desai, a White House spokesperson, said in an email that Trump has a “resounding mandate” to end “unproven, irreversible child mutilation procedures”, adding: “The administration is delivering.”Katie’s mother said she expected the state’s leaders to do more: “The quiet from the governor and others on trans rights is very unsettling. My husband and I grew up in California, went to public schools here, and always thought we’d be safe here and that the state would hold the line. It’s hard to tell right now if that’s true.”Izzy Gardon, Newsom’s spokesperson, defended the governor, saying in an email that his “record supporting the trans community is unmatched”.“Everyone wants to blame Gavin Newsom for everything. But instead of indulging in Newsom-derangement syndrome, maybe folks should look to Washington.”‘We can’t be quiet’Affected youth are increasingly speaking out. Since the news broke, protesters have organized weekly demonstrations in front of CHLA to call for the healthcare to be restored.At one recent evening rally, organized by the LA LGBT Center, families and supporters marched and chanted outside the busy hospital on Sunset Boulevard, holding signs saying “Trans joy is resistance” and “blood on your hands”, and at one point shouting: “Down with erasure, down with hate, shame on CHLA!”View image in fullscreen“We can’t be quiet any more. We’ve been polite for too long and taken so much bullshit from people who hate us,” said Sage, who spoke at an earlier rally. “I didn’t stand up just for myself or the people affected by this, but also for the trans people who came before us who still have incorrect names on their graves, who don’t have a voice.” Sage, who is now in a creative writing program, said they hoped to become a journalist.Katie, who aspires to be a television writer in LA, said she could not be silent as anti-trans advocates force families to consider fleeing: “How dare you try to drive me out of the place where I was born, where my best friends are, where the job I want to do is, where I’ve experienced my whole life? This is my home.”Eli said he didn’t feel as if he was being an activist. He was simply asking for the “bare minimum”: to be left alone and able to access basic healthcare. “Trans services like hormone therapy truly saves lives,” he said. “We just want people to be able to live their lives. I’m just asking for what is commonsense.” More

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      US posts highest annual measles case tally in 33 years amid Texas outbreak

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      The annual tally of measles cases in the US is the highest in 33 years, as an ongoing outbreak in west Texas continues to drive cases.The latest figures mean Americans will have to look back to 1992 to find a worse year with the vaccine preventable disease. The official tally very likely undercounts the scope of the outbreak, experts told the Guardian.“When you talk to people on the ground, you get the sense that this outbreak has been severely underestimated,” said Dr Paul Offit, director of the vaccine education center at the Children’s Hospital of Philadelphia. Confirmed cases appear to be the “tip of a much bigger iceberg”, he said.Measles was declared eliminated in the US in 2000. However, as the pandemic disrupted routine childhood visits to the doctors and anti-vaccine organizations saw their coffers swell during the pandemic, measles vaccination rates have fallen below a critical threshold to prevent outbreaks in some communities.As of 4 July, Johns Hopkins University’s Center for Outbreak Response Innovation counted 1,277 measles cases. The Centers for Disease Control and Prevention (CDC) reports 1,267 cases, but has not updated its data since 2 July.“The number of new cases has slowed down, but I don’t think there’s any reason to suggest this will be our last,” said Dr Peter Hotez, a vaccine expert and dean for the national school of tropical medicine at Baylor College of Medicine in Houston, Texas.He later added: “It’s a very dark epidemic that never had to happen.”The latest national tally will eclipse 2019, when unvaccinated members of New York City’s isolated orthodox Jewish community drove a large outbreak, and the nation ended the year with 1,274 confirmed measles cases.Americans will need to look back to 1992 to find a higher annual measles tally. In 1992, the CDC confirmed 2,126 cases, with the largest outbreaks in Kentucky and Texas. Texas has confirmed 753 cases in 2025, according to the state health department, opening up the possibility that Texas could exceed the 1992 annual total as well.The enormous outbreak comes as Donald Trump’s health secretary, Robert F Kennedy Jr, who once ran an influential anti-vaccine group, has injected upheaval into US vaccine policy and spread misinformation about treatments for the disease.Measles is a viral disease characterized by a top-down rash, high fever, runny nose and red, watery eyes. The virus is one of the most infectious diseases known to medicine. There is no cure for measles. The best way to prevent measles is by getting vaccinated with the measles, mumps and rubella vaccine (MMR), which is 97% effective with two doses.Although most people recover, as many as one in five infected children require hospitalization; one in 20 get pneumonia and one in 1,000 can develop encephalitis, which can lead to lifelong disability, according to the CDC. The disease can also weaken the host’s immune system and lead to more future infections. In rare cases, measles can cause an incurable degenerative brain disorder. The US has already seen three deaths from measles this year, both in otherwise healthy children.Before a measles vaccine was licensed in 1963, an estimated 3-4 million Americans were sickened each year, 48,000 were hospitalized and an estimated 400-500 died, according to the CDC. From 1994 to 2023 in the US alone, the CDC estimates the measles vaccine saved 85,000 lives and prevented 104m illnesses.Although the vaccine has been wildly successful, it has also been the target of sustained misinformation by people who have a financial stake in reduced vaccine uptake.In 1998, a British doctor hypothesized a link between the MMR and increasing autism rates. The doctor, Andrew Wakefield, was later found to have committed fraud, failed to report conflicts of interest and lost his license. The article was retracted.Reams of science has since examined and re-examined the evidence, and found no link between the MMR vaccine and autism. Still, the debunked connection has found an afterlife as a talking point for anti-vaccine groups who have attracted a vocal minority of parents. The overwhelming majority of Americans still vaccinate children against measles.Now, alongside longtime anti-vaccine talking points about autism and “medical freedom”, Hotez said a new threat was the, “very pernicious health and wellness and influencer movement that’s got a big profit motive”.Outbreaks appear to be “occurring in the same [parts] of the US that had some of the lowest Covid vaccination rates”, said Hotez, introducing the possibility that anti-vaccine sentiment is “spilling over to childhood immunizations”.In June, Kennedy unilaterally fired all 17 expert members of a CDC advisory panel on vaccines and stacked the committee with seven ideological allies. The advisory committee is a key link in the vaccine distribution pipeline.Among those allies now serving on the committee are medical professionals with fringe beliefs and known anti-vaccines advocates. In June, the group met for the first time, and said it would form a new committee to re-evaluate the childhood vaccine schedule.“We’ve not only eliminated measles, we’ve eliminated the memory of measles,” said Offit. “People don’t remember how sick this virus can make you – or how dead it can make you.” More

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      Trump expected to sign tax-and-spending bill in win for administration

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      Donald Trump is expected to sign his sweeping spending package into law on Friday during a Fourth of July picnic at the White House, setting up significant cutbacks on federal safety-net programs and increasing funds for aggressive immigration enforcement.Trump has touted the legislation’s passage as a “birthday present for America”, speaking before a crowd at a campaign-style rally in Iowa on Thursday evening, even as Democrats expressed their displeasure at the spending package.After months of deliberations, the bill passed by a single vote in the Senate and later passed the House with a 219 to 213 vote on Thursday, with only two Republicans voting against it. The sweeping legislation accomplishes what rightwingers have pushed for, for decades, as the Guardian explained this week, and provides Trump a huge legislative win.The bill, once signed into law, will significantly cut taxes, building on the 2017 tax cuts during Trump’s first term. Although temporary tax exemptions for tips, overtime pay and car loan interest are included, research from the Center on Budget and Policy Priorities shows that the bill is skewed to the rich, with the wealthiest in the US benefiting the most from the tax relief.Additionally, the law, once signed by Trump, will add new restrictions to Medicaid, which provides healthcare to low-income and disabled people, and Snap, also known as food stamps, which helps low-income people afford food. Researchers estimate that the Medicaid cutbacks will leave as many as 11.8 million people without healthcare, while 8 million people will lose their Snap benefits. Critics say that the Medicaid cuts will have massive ripple effects on healthcare nationwide.“This is highway robbery,” the Democratic senator Raphael Warnock posted on X, formerly known as Twitter. “The bill Republicans just passed steals from you to give to the rich.”Proponents of the bill say that the Medicaid and Snap changes are designed to root out waste and abuse.Additionally, the spending package will allocate $170m to immigration enforcement, a monumental amount of money that will help support the Trump administration’s push to engage in “mass deportations”.“This disgraceful, anti-immigrant budget hands the Trump administration a blank check to further ramp up its shameful efforts to terrorize American communities and separate families,” said Nicole Melaku, the executive director of the National Partnership for New Americans, an immigrants’ rights organization. “Instead of safeguarding people’s access to healthcare and wellness, the bill gives tax cuts to big corporations and funnels billions of dollars to hire more immigration agents, build more immigration jails and deny people their fair day in court.”Already, the Trump administration has engaged in widespread attacks on immigrant communities, by increasing resources to immigration enforcement operations.“This budget promises to supercharge US Immigration and Customs Enforcement arrests that disappear community members, leave children parentless and threaten constitutional and due-process rights for all of us,” said Meg McCarthy, executive director of the National Immigrant Justice Center, alegal organization.A recent Guardian analysis shows that undocumented immigrants without any criminal history have been arrested at an exponentially increasing rate, after top White House officials instructed agents to increase arrests.Trump temporarily walked back some of Ice’s aggressive immigration enforcement actions after complaints from leaders in the farming and hospitality industries: last month, the Trump administration engaged in a short-lived pause on raids at farms, restaurants and hotels. But at Thursday’s event, Trump again brought up the idea of pausing large-scale enforcement on farms.“If a farmer is willing to vouch for these people in some way, Kristi, I think we’re going to have to just say that’s going to be good, right?” Trump said to the secretary of homeland security, Kristi Noem. “We don’t want to do it where we take all of the workers off the farms.”In addition to tax cuts, restrictions on Medicaid and Snap and the aggressive supercharging of immigration enforcement, the bill seeks to end green energy incentives created under Joe Biden, seen as a further blow against efforts to combat the climate crisis.The US budget deficit will increase with this bill, leading to opposition by some Trump allies. The non-partisan congressional budget office estimates the bill will add $3.3tn to the country’s debt through 2034, leading to clashes with some rightwingers.One of the two Republicans who voted against the bill, Thomas Massie, said he opposed the spending bill “because it will significantly increase US budget deficits in the near term, negatively impacting all Americans through sustained inflation and high interest rates”.Elon Musk, the rightwing billionaire who established the federal government’s office tasked with slashing federal spending during the first few months of the Trump administration, has also publicly called out the spending bill. Days before Congress passed the bill, Musk repeated his call for the creation of a new political party to oppose the Republicans and Democrats. More

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      Trump’s Medicaid cuts are coming for rural Americans: ‘It’s going to have to hit them first’

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      When Hurricane Helene drowned western North Carolina in muck and floodwater last year, it caught folks off-guard.Now, local leaders in places like Asheville expect the Republican-led reconciliation bill – called the “big, beautiful bill” by Donald Trump – to bear down on rural America. And they wonder whether people are missing the warning signs.“It’s going to have to hit them first,” said Laurie Stradley, CEO of Impact Health in Asheville, a Medicaid-funded non-profit providing social services to some people still digging out from the flood.Medicaid is the single largest health insurance program in the US. The public program covers 71 million low-income, disabled and elderly US residents. It pays for half of all US births and the care of six in 10 nursing home residents.When Trump’s sprawling tax-and-spending bill passed on Thursday, it heralded more than $1tn in federal cuts to Medicaid, which experts worry will push Republican-led states to abandon parts of the program and leave people without access to timely healthcare.“This is an extraordinarily regressive bill,” said Joan Akler, executive director and co-founder of Georgetown University’s Center for Children and Families. “This is the largest rollback of healthcare coverage that we’ve ever seen and all in service of an agenda to drive tax cuts that will disproportionately benefit wealthy people and corporations.”Medicaid “expansion” is a key provision of Obamacare, formally called the Affordable Care Act of 2010. The expansion provides largely no-cost health insurance to people earning up to 138% of the federal poverty level, or $36,777 for a family of three. Although Obamacare has been the law for more than a decade, Medicaid expansion proved politically divisive in Republican states, and many only recently decided to accept enormous federal subsidies to cover their residents.North Carolina will lose $32bn in the next decadeThe Medicaid cuts in the bill could have particularly acute consequences in North Carolina, a politically competitive state, where experts said the bill could trigger a “kill switch” to end Medicaid expansion.“If the state spends any state dollars to implement the expansion population or expansion coverage, it triggers an automatic ending to Medicaid expansion,” said Kody Kinsley, North Carolina’s former secretary of health and an architect of the state’s Medicaid expansion.North Carolina is set to lose $32bn in federal funding in the next decade, according to an analysis by the office of the Republican senator Thom Tillis, who represents the state. He’s one of just three Senate Republicans who voted against the bill on Tuesday.North Carolina’s expansion only went into effect in December 2023, and in less than 19 months it enrolled more than 650,000 people – all of whom will lose coverage if the program ends.Those North Carolinians are only some of the 17 million people expected to lose health insurance by 2034 across the country, according to estimates from the non-partisan Congressional Budget Office. Nearly 12 million people will lose insurance because of attacks on Medicaid.“Ultimately, Medicaid being cut is going to kill people,” said Molly Zenkler, a nurse at Mission hospital in Asheville. “I deal with people getting their feet literally amputated because they don’t have access to diabetic care. This is just going to get increasingly worse.”The reconciliation bill cuts state funding through a number of provisions. On healthcare specifically, the bill attacks complex financial maneuvers states use to draw down federal funds. It also requires states to spend enormous sums – perhaps tens of millions of dollars per state – implementing work requirements, effectively adding layers of expensive red tape.Congressional Republicans in favor of the bill argue it targets “waste, fraud and abuse”. However, it is already well-known that most Medicaid beneficiaries who can work do, and that Medicaid is one of the most cost-efficient health programs in the US, according to the American Hospital Association.North Carolina is one of a dozen conservative states that wrote a “trigger” law into Medicaid expansion. Not all function like North Carolina’s – the laws are, in the words of an expert with Georgetown University’s McCourt School of Public Policy, a “lesson in federalism” – but they nevertheless underscore the difficult choices state legislators will face because of congressional Republicans’ cuts.One such program that could be on the chopping block is a pilot with Impact Health, which uses Medicaid expansion funds for social needs that affect health – an effort to reduce long-term costs. Stradley gave the example of a Medicaid-covered child with severe asthma who hit the local emergency room three times a week for breathing treatments.Impact’s program used Medicaid funds to replace moldy rugs with laminate flooring in the child’s home, and to buy a vacuum with a Hepa filter. The cost to Impact Health was about $5,000, “but now this child is going to the emergency room a couple times a year instead of a couple times a month. And so, every month we’re saving about $4,500.”The program’s knock-on effects boost the local economy: the work to replace the rug was done by a local carpenter, and the child’s mother isn’t calling out from work, increasing her job stability.“One of the ways that we talk about this program is that it’s a hand up rather than a handout,” she said. “Almost half of the folks that are recipients in our program are children … Then you look at the adults. Most of them are working multiple jobs, and those jobs don’t come with benefits, because they’re working two or three part-time jobs in order to make ends meet.”The enormity of Medicaid means large cuts to the program imperil not only patients, but the institutions that serve them – especially rural hospitals and clinics hanging on “by a thread”, according to Kinsley.One of US residents’ few rights to healthcare is in emergency departments, where hospitals are required to stabilize patients regardless of ability to pay. That makes emergency departments the go-to source for healthcare for the uninsured.An analysis released by the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill earlier this year showed that 338 rural hospitals around the country were at risk of imminent closure with the cuts to Medicaid contained in the bill.‘Hospitals will be forced to restrict services, or close’Rural states such as Kentucky are expected to be disproportionately hard-hit as well. Thirty-five of the rural hospitals at risk of closure – about 10% – are in Kentucky, even though Kentucky’s 4.5 million residents comprise about 1.3% of the US’s population. About a third of Kentucky residents are on Medicaid, according to figures from Kentucky’s cabinet for health and family services. The program benefits about 478,900 adults.The situation is similarly dire in Arizona, another battleground state, which also has a trigger law on the books. Although the reconciliation bill may not “trigger” a rollback of Medicaid expansion, it does undermine a key financing mechanism for the state’s program called a “provider tax”.“We estimate Arizona’s healthcare system would lose over $6bn over the next seven years,” said Holly Ward, a spokesperson for the Arizona Hospital and Healthcare Association, in a statement.“In other words, more than 55% of Arizona hospitals would be operating in the red,” she said. “Hospitals will be, at best, forced to restrict services such as obstetrics, behavioral healthcare and other complex services, and at worst, will close their doors altogether.”Another issue is the potential for Republicans’ cuts to drive up the cost of healthcare for Americans who are privately insured, including through employers. As hospitals fight to survive, they will try to extract as much money as possible from other sources of funding – namely, commercial insurance.In addition, rural healthcare providers worry the water will be muddied by the sheer complexity of US healthcare. Private companies have a hand in managing – and therefore branding – state Medicaid programs.“A lot of our rural voters may not even realize that what they have is Medicaid, because there are so many names for it,” said Stradley. However, the precarious situation is already worrying people whose lives have been stabilized because of Medicaid.Amanda Moynihan is a single mother of three children – ages nine, 12 and 16 – living in Kuna, Idaho. Medicaid expansion has helped her become a “functioning human in society”, she said. Routine medical care for herself and her children, along with other assistance programs, has meant the difference between grinding poverty and a shot at the middle class.Idaho, one of the most politically conservative states in the union, expanded Medicaid in 2018 with an overwhelming ballot-referendum vote of 61-39. Even if Idaho’s “trigger law” does not go into effect, the state could face similar fiscal challenges to Arizona.“Back two years ago, before I started school, I was just in fight-or-flight, just trying to pay the bills there. I didn’t ever see a future of what I could do. And then I just started with one class,” she said.Moynihan has completed an associate degree in psychology and is starting the social work bachelor’s degree program at Boise State University in the fall. For now, she’s working part time with the Idaho Commission for the Blind and Visually Impaired and planning to pick up work at a gas station because it has a college scholarship benefit.But without stability to pursue higher education, her future “would be making the minimum wage, which is about $15 an hour, barely paying rent in a low-income household”. More

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      No one wanted Trump’s devastating budget bill. Of course it passed | Moira Donegan

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      The budget reconciliation bill that passed the US House of Representatives on Thursday and was promptly to be signed into law by Donald Trump represents the particular perversity of national politics in America: seemingly no one wants it, everyone hates it, and it is widely agreed to be devastating for staggering numbers of Americans. And yet, the bill felt inevitable: it was a foregone conclusion that this massive, malignant measure was something that everyone dreaded and no one had the capacity to stop.They didn’t really even try. In the Senate, a few conservative Republicans made noise about the bill’s dramatic costs: the congressional budget office estimates that the bill will add $3.3 tn to the deficit over the coming decade, and the senator Rand Paul, a budget hawk from Kentucky, declined to vote for it for this reason. But other Republicans, who used to style themselves as fiscally responsible guardians against excessive government spending, engaged in a bit of freelance creative accounting in order to produce an estimate that falsely claimed the cost of the bill would be lower. Most of them quickly found themselves on board.Moderate Republicans, or what remain of them, also quickly quit the field. Thom Tillis, a Republican from North Carolina facing down an uncertain re-election bid, expressed concerns about the bill’s massive cuts to Medicaid, the federal low-income healthcare program on which many Americans – and many of his constituents – rely. When Donald Trump threatened to secure a primary challenge to Tillis in retaliation, the senator announced that he would not seek re-election after all; he voted against the bill, but also ended his political career. Susan Collins, of Maine – she of the perennial “concern” about the sadistic Republican agendas that she continues to support – made a rare departure from her usual formula and voted against the bill, a move that came close on the heels of polling showing her dismal approval rating among her constituents. That left just Lisa Murkowski, of Alaska, who agreed to play ball: she would vote for the bill, which she had publicly disparaged, in exchange for some money for her state. The result was that Alaska will be exempted, at least temporarily, from new rules associated with the Supplemental Nutrition Assistance Program, or Snap, which helps low-income Americans buy enough food to keep themselves alive. Republicans threw in a tax deduction for Alaskan whaling captains – of all things – and with that, her vote was secured.When the bill was sent to the House, a handful of Republicans threatened to withhold their votes over budget and Medicaid concerns. But no one believed them. They were always going to cave, abandon their stated principles and follow Trump’s orders, and they did. Trump, after all, had said that he wanted the bill passed in time for the Fourth of July; it passed on the third. He says jump, and the Congress asks: How high?They do so even when the demands that Trump makes are morally grotesque. The bill will devastate Americans. Its massive cuts to Medicaid, combined with expiring Obamacare subsidies, will result in an estimated 17 million Americans losing health coverage over the next 10 years, effectively undoing the expansion of healthcare coverage that was achieved with Barack Obama’s health law. Cuts to Snap are so profound that they cannot be made up with additional state spending; some people who are eating today because they have food assistance will go hungry in the future. There are deep cuts to federal loans and grants for college students, and a near-reversal of the Biden-era Inflation Reduction Act’s investments in green energy, with tax breaks now going to climate-damaging sectors like coal and oil instead. Because the bill creates a dramatic budget deficit, law requires that Medicare, the healthcare program for seniors, will face cuts, too.All of this is to say nothing of the downstream effects of the legislation. The steep cuts to Medicaid, in particular, will devastate America’s already fragile and partial healthcare system. Planned Parenthood is now excluded from federal Medicaid dollars, meaning that about 200 of its roughly 600 clinics will probably have to close, making abortion less accessible even in states where it is legal, and putting contraception and STD and cancer screenings out of reach for untold numbers of American women. Many rural hospitals will likely have to close, too, along with nursing homes. Those healthcare clinics that remain will have longer wait times and more crowding, and offer more expensive care. Ultimately, fewer people will be going to the doctor, and more of them will suffer and die needlessly of treatable and preventable conditions.But the bill does have winners. It has been called, among other things, the largest tax cut in the nation’s history, although the benefit is disproportionately to billionaires. The budget of Ice, Trump’s anti-immigrant secret police force, is also expanded exponentially: from $3.5bn to $48.5bn, making it the nation’s largest law enforcement agency, though still no more accountable.The bill, in other words, steals from the sick, the elderly, the hungry and the curious, and gives that plundered loot to billionaires and jackboots. It will warp American life – already sickly and impoverished by the standards of our peer nations – in cruel and enfeebling ways. It will make us sicker, poorer, more fearful, more ignorant and more endangered. It will make the rich, meanwhile, even richer.Why are Republicans voting for a bill that will hurt their own constituents? A bill that undermines their stated values and threatens their careers and will immiserate people they care about – if only themselves?One of the more confounding aspects of the Trump era is his ability to vacate what the constitution’s authors – and indeed most reasonable adults – would have assumed would be a defining feature of the contest among the branches: self-interest. Republicans will follow him anywhere, even to unpopular votes, even to self-sabotage, and frequently to the diminishment of their own branch’s relevance. Some say that now, he is leading them to a midterm defeat. Democrats made a show of their opposition to the bill – in the minority, shows are about all they can accomplish – with the minority leader Hakeem Jeffries delivering an eight-and-a-half-hour, filibuster-style speech on the floor telling the stories of Americans who will be hurt by the legislation, laying out the bill’s cruelty and recklessness. But you could also detect a hint of pleasure in his voice as he read out the testimonies of Americans who live in what the Democrats see as particularly vulnerable districts for Republicans in 2026.The bill is unpopular now, and it is likely to become much more so as the full breadth of its cuts to social services, and its impacts on Americans seeking to get healthcare, buy food, secure an environmentally livable future or go to school, become clear. Many of the politicians who ultimately voted for it criticized it sharply just days or hours before. They will be attacked about this in the midterms: the suffering that the bill will cause will be cut into television and social media ads and played incessantly on networks in what the Democrats believe are winnable districts. But it is unclear, in the end, if hurting Americans, including their own voters, really will come back to bite the Republican party. It hasn’t for a long time.

      Moira Donegan is a Guardian US columnist More

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      CDC vaccine panel to review ingredient RFK Jr has targeted for removal

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      A key vaccine advisory panel reconstituted by health secretary and vaccine skeptic Robert F Kennedy Jr is slated to discuss thimerosal-containing influenza vaccines in its first meeting – an ingredient which has been a fixation of anti-vaccine activists for decades.The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) will hold two separate votes later this month: one on “influenza vaccines” and one on influenza vaccines that contain thimerosal.Thimerosal is an ethylmercury preservative used in multi-dose vaccine vials to prevent fungi and bacteria growth. The preservative has been studied and deemed safe, but was nevertheless removed from all routine childhood vaccines in 2001 as a precaution.“I was there when we went through this the first time,” said Dr Paul Offit, director of the vaccine education center and an attending physician in the division of infectious diseases at Children’s Hospital of Philadelphia, about debates over the preservative in the early 2000s.Offit served on the ACIP panel in question from 1998 to 2003. He said the issue of thimerosal was vigorously debated and found safe then, prompting him to ask: “What’s the point?”In a short history of the thimerosal controversy published in the New England Journal of Medicine, Offit described how some parents became convinced thimerosal gave their children autism, resulting in thousands of autistic children receiving heavy metal chelation treatments each year.Studies have found no link between thimerosal and autism, according to the American Academy of Pediatrics. The National Vaccine Injury Compensation Program has also denied claims of a thimerosal-autism link. Kennedy, however, has written a book arguing against the use of thimerosal.Offit said the discussion of thimerosal appeared to geared to, “accomplish [Kennedy’s] goals of making vaccines less affordable, less accessible and more feared”, he said.“Here’s what you do know – you do know RFK Jr is an anti-vaccine, science-denying conspiracy theorist. He is devoted to this, he is a zealot, there is no middle ground with him,” said Offit. “He believes we have merely substituted infectious diseases for chronic diseases.”The panel’s advisory recommendations are critical because they result in vaccine “schedules”. These schedules are relied on by health insurers to determine which vaccines to cover and by clinicians who use them as an evidence-based guide on immunization – effectively giving the American public access to the medicines.Although the CDC does not always take the panel’s advice, the CDC typically affirms the panel’s decisions. However, the agency is currently without a leader, as Senate hearings have not yet been held for nominee and CDC career official Susan Monarez. As a result, Kennedy has signed off on some previous ACIP recommendations.Kennedy wrote a book on the preservative thimerosal in 2014 called Thimerosal: Let the Science Speak, in which he argues that “there is a broad consensus among research scientists that thimerosal is a dangerous neurotoxin that should be immediately removed from medicines”. Kennedy said in the book he is “pro-vaccine”.Until 9 June, the ACIP was an independent panel of 17 experts who served staggered terms and were rigorously vetted by career CDC staff. Kennedy broke with tradition when he fired the entire panel, claiming in a Wall Street Journal editorial that he was working to “restore public trust in vaccines”.The same week, Kennedy appointed eight new members to the committee, including medical professionals with little vaccine expertise and known vaccine skeptics.A wide spectrum of groups criticized the decision, from MomsRising, who said they were “alarmed and disgusted”, to major doctors’ groups such as the American Academy of Pediatrics, to public health leaders who described Kennedy’s actions as “a coup,” to the former members of the committee, who warned the independent panel was at “a crossroads”.The group is scheduled to meet the last week of June. Prior to Kennedy’s changes, they had been expected to discuss reducing the number of shots needed for human papilloma virus (HPV) and a meningococcal vaccine.On Wednesday, the panel released a draft agenda for its upcoming meeting. A wide range of vaccines will be discussed – including those against influenza; the tropical disease chikungunya; the measles, mumps, rubella and varicella (chickenpox) vaccine; anthrax; Covid and respiratory syncytial virus (RSV).The agenda scheduled a vote on recommendations for flu vaccines, including the multidose versions that still contain thimerosal. These vaccines are used only in adolescents and adults. The panel is also scheduled to vote on recommendations for maternal and pediatric versions of the respiratory syncytial virus (RSV).Notably, despite Kennedy’s repeated pledges of “radical transparency”, the draft agenda does not include the names of many speakers, which are listed as “TBD” (to be determined) for instance on “Covid-19 safety update”.New ACIP members have not been added to a conflict of interest tracker for ACIP members developed by the Trump administration. A spokesperson for HHS said the new members ethics agreements “will be made public” before they start work with the committee.In addition to the new draft agenda, there have also been changes to the committee’s meeting times not reflected in the Federal Register, according to Politico. The group will meet for two days instead of three, and there does not appear to be a vote scheduled on Covid vaccines. More