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    Hear me out: RFK could be a transformational health secretary | Neil Barsky

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    Among the cast of characters poised to join the Trump administration, no one is as exasperating, polarizing or potentially dangerous as Robert F Kennedy Jr. But in a twist that is emblematic of our times, no single nominee has the potential to do as much good for the American people.Bear with me. RFK Jr has been rightly pilloried for promoting a litany of theories linking vaccines with autism, chemicals in the water supply to gender identity, how people contract Aids and saying the Covid-19 vaccine, which in fact stemmed the deadliest pandemic of our lifetimes, was itself “the deadliest vaccine ever made”. He claimed Covid-19 was meant to target certain ethnic groups, Black people and Caucasians, while sparing Asians and Jewish people.In normal times, these notions would be disqualifying. Spouting unfounded scientific claims is corrosive to a functioning democracy. It weakens the bonds of trust in our public institutions, and feeds the rightwing narrative that all government is illegitimate. This is why, writing in the Guardian this September, I dismissed the prospect of RFK Jr, saying his “anti-vaccine work is more likely to make America have measles again”.But these are not normal times. RFK Jr is Donald Trump’s pick to run our country’s health and human services department. He will have a massive impact on our broken, expensive and largely ineffectual delivery of healthcare services. How shall we deal with this?On one hand, RFK Jr’s anti-vaccine views are beyond the pale. To obtain Senate approval, I think he will have to repudiate the unproven assertion that the Covid-19 vaccine was harmful, and embrace the scientific reality that vaccines for measles, smallpox, coronavirus and other contagious diseases are in fact modern medical miracles that spared the lives hundreds of millions of people. And here is where I will part company with many of my Trump-fighting friends: should RFK Jr be able to abandon his numerous conspiracy theories about vaccines, he can be the most transformative health secretary in our country’s history.This is because RFK Jr has articulated what our Democratic and Republican leaders have largely ignored: our healthcare system is a national disgrace hiding in plain sight. He recognizes the inordinate control the pharmaceutical and food industries over healthcare policy, and the revolving door that exists among congressional staffers, pharmaceutical lobbyists and corporate executives. In testimony during hearings chaired by the Republican senator Ron Johnson this past September, Kennedy offered a lucid analysis of what is making America metabolically sick; he railed against big pharma and big food, and drew links between the damage done by ultraprocessed foods such as seed oils and sugars to our health, as well as the efforts of the food industry to come up with chemicals that make these foods addictive.He advocates banning pharmaceutical advertising on television, and wants to clamp down on the corporate ties to federal agencies such as the Food and Drug Administration and National Institute of Health. (To my knowledge, he has not spoken out against the egregious cost of life-saving drugs or unequal access to medical treatment, but hopefully he will get around to that as well.)We spend $4tn on healthcare annually, and lead the world in spending more than $12,000 per person, 50% more than Switzerland, which is the second biggest spender per capita. American doctors dominate the Nobel prizes for medicine, and our medical schools are considered the best in the world. Yet we appear incapable of stemming the epidemic of chronic diseases. A staggering 73% of us are obese or overweight and more than 38 million people suffer from diabetes.This issue hits home for me, as I was diagnosed with severe type 2 diabetes in 2021, and – after receiving terrible medical advice to rely on insulin and metformin – reversed my condition by adopting a diet low in carbohydrates. This year, I published a “follow the money” series for the Guardian, Death By Diabetes, in which I highlighted the heavy influence of big pharma and big food on the American Diabetes Association (ADA). The ADA is a so-called patient advocacy group that sets the standard of care for diabetes treatment in this country, and yet it accepts money from food companies such as the makers of Splenda and Idaho potatoes – two products which have been found to increase people’s risk of getting diabetes.I subsequently wrote about amputations, and the reality that African Americans with diabetes are four times more likely to endure that grim procedure than white people. I view nutrition and metabolic health as a matter of racial and economic equity. I am clear-eyed, I think, of the serious risks to public health that RFK Jr’s unfounded anti-vaccine views pose. But so long as we still have a voice and can find a drop of hope in these terrible times, I think we should try to tilt policy toward the public good where we can. To that end, here is the game plan I believe RFK Jr should pursue.

    Lose the conspiracies and stick to the science. RFK Jr is right, and there is more than ample research to focus on the deleterious impact of sugars and seed oils. Following the money has always been a valuable strategy. Let’s start there.

    Lean on the vast ecosystem of committed researchers, clinicians and writers who have devoted their career to promoting metabolic health, even while knowing they would forfeit access to government and pharmaceutical grants. Many of these mavericks come from top medical schools, but they are a decided minority on their faculties. They include clinicians such as Georgia Ede, Mariela Glandt, Tony Hampton, Eric Westman, scientists such as Benjamin Bikman, Ravi Kampala, Cate Shanahan, and writers such as Gary Taubes, Nina Teicholz and Casey Means. These are heroic people who, in getting to know them and reading their work, I have found to be intellectually honest health practitioners.

    Appoint a diabetes czar to come up with proposals to once and for all fix this deadly and utterly reversible disease. I choose this particularly chronic ailment because it is ubiquitous, ruinously expensive, a disease that disproportionately afflicts the poor, is closely connected to our obesity epidemic, and utterly reversible through diet. Wouldn’t it be amazing if we could finally reverse type 2 diabetes in our lifetime?

    Increase federal funding of nutrition studies. The FDA and NIH historically have tilted the research scales in favor of studies that might produce the next blockbuster drug. In reality, we still do not understand why we get fat and why we have seen an increase in chronic (non-contagious) diseases such as diabetes, Alzheimer’s and Crohn’s.

    Severely regulate the ability of cereal companies to market their sugary wares to children, and the ability of pharmaceutical companies to barrage the rest of us with advertisements. Will a Republican-controlled Congress allow for more government regulation – even if it saves lives?
    RFK Jr’s ascent represents a tricky issue for people like myself who strongly supported the election of Kamala Harris. Healthcare is far from the only issue I am committed to, and I am disgusted by the Trump administration’s plans to deport millions of undocumented people, its attack on democratic institutions, and possible abandonment of Ukraine and the Nato alliance. While I disagreed with Liz Cheney about many, if not most, issues, I also embraced her apostasy when it came to the election – I adhere to the approach of not interrupting people you disagree with while they are doing the right thing.After writing something unkind about RFK Jr in the days leading up to the election, I received a private note from Jan Baszucki, a prominent metabolic health advocate I have come to admire over the past year. “With all due respect,” she wrote. “I am a big fan of your reporting on type 2 diabetes. But your comments about RFK Jr … are not helpful to the cause of metabolic health, which is only on the national agenda because he put it there.”Leading up to the election, I believed RFK Jr was fair game. I was, and remain, particularly concerned that his fringe ideas about vaccines and poisons would get conflated with his excellent perspective on metabolic health, and hurt the cause. Now I think we should be constructive where we can advance the public good.The larger question hanging over RFK Jr’s term as HHS secretary is whether Donald Trump will back him up when he takes on the pharmaceutical and food industries. The US’s health is not an issue the president-elect has evinced an interest in in the past. And his embrace of corporate executives such as Tesla’s Elon Musk suggests crony capitalism could be the dominant theme of the second Trump administration. But if we know anything about what makes Trump tick, we know that he responds to positive reinforcement.After all, it was the criminal justice advocates such as Van Jones and Trump’s son-in-law Jared Kushner who coaxed him into supporting the First Step Act, a significant piece of criminal justice reform (and one which Trump now forswears). As founder of the Marshall Project, the non-profit journalism organization that covers the US criminal justice system, I believe criminal justice reform should also be a matter of national urgency, yet at the time, I was ambivalent about efforts to work with the administration. In retrospect, whatever harm Trump might have otherwise inflicted, I would say we are a better country for the First Step Act.We are in a similar dilemma with respect to healthcare today: the system is ruinously expensive and inhumane. If there is someone in the administration who wants to make things better, let’s not interrupt him.

    Neil Barsky, a former Wall Street Journal reporter and investment manager, is the founder of the Marshall Project More

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      Ex-CDC acting director calls RFK Jr’s false vaccine theories ‘cruel’

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      The former acting director of the US Centers for Disease Control and Prevention has criticized Robert F Kennedy Jr’s nomination by Donald Trump as secretary of the country’s health and human services (HHS), calling his false vaccine theories “cruel”.In a new interview on ABC, Richard Besser, who led the CDC during Barack Obama’s administration, called Kennedy’s push to falsely link vaccines to autism a “cruel thing to do”, adding, “There are things we do for our own health, but there are things we do that are good for ourselves, our families and our communities and vaccination falls into that category.”“Having someone who denies that in that role is extremely dangerous,” Besser said about Kennedy.“We need to, as a nation, address chronic diseases in children and one of the dangerous things about RFK Jr is that there are bits of things he says that are true and they’re mixed in … It makes it really hard to sort out what things you should follow because they’re based on fact and which things are not,” he continued.Besser went on to say that experts should address chronic diseases – including autism – but to “keep [on] lifting the idea [that] that has something to do with vaccinations is really a cruel thing to do”.In a separate interview on Sunday, Deborah Birx, the former White House coronavirus response coordinator under Trump’s administration, said that Kennedy will require a team that has “really come out of the industry” in order to manage the HHS.“I think the most important thing is what team he would bring with him, because you’re talking about really a large … corporation with a highly diverse group, which you have to really bring together and, frankly, eliminate some of the duplication set between these agencies to really become more cost effective,” said Birx.“Having a management person at his side, a chief of staff, perhaps that has really come out of industry that would know how to bring and look and bring those individuals together that are running the other agencies because … HHS is probably one of our most complicated departments,” she added.Birx also agreed that there is no scientific evidence that vaccines cause autism, saying: “I’m actually excited that in a Senate hearing he would bring forward his data and the questions that come from the senators would bring forth their data.”“That hearing would be a way for Americans to really see the data that you’re talking about, that we can’t see that causation right now,” she said.skip past newsletter promotionafter newsletter promotionKennedy has previously said that “there’s no vaccine that is safe and effective.” However, following Trump’s re-election, Kennedy said that he “won’t take away anybody’s vaccines”.His nomination has been widely criticized by health experts who condemned him as a “clear and present danger” to public health. More

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      The appointment of Robert F Kennedy has horrified public health experts. Here are his three most dangerous ideas | Devi Sridhar

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      The announcement that Donald Trump has appointed Robert F Kennedy as the US secretary of health and human services has sent shock waves through the health and scientific community. Kennedy ran as an independent presidential candidate before bowing out and supporting Trump’s run in exchange for an influential position, so we have a pretty good idea of his positions on public health.The main goal Kennedy has trumpeted recently is to “Make America healthy again”. At face value, it’s a noble aim. That’s the essence of public health: how to reduce risk factors for disease and mortality at a population level and improve the quality of health and wellbeing. But behind this slogan comes a darker, conspiracy-laden agenda. As someone who has spent a lot of time researching global public health, these are the positions I believe could be the most dangerous.Anti-vaxxer viewsKennedy is well known as a prominent anti-vaxxer. He has claimed that vaccines can cause autism, and also said that “there’s no vaccine that is safe and effective”. He called the Covid-19 vaccine the “deadliest vaccine ever made”. None of these claims are true: repeat studies have shown that the MMR vaccine does not cause autism, we have numerous safe and effective vaccines against childhood killers such as whooping cough and measles, and the Covid-19 vaccines have saved millions of lives globally.Much of what he is saying is what people want to hear: being anti-vax is increasingly a way to build a fanbase. I have seen this as a scientist: if you talk about childhood vaccinations, you get daily abuse. If you talk about the dangers of vaccines, you can end up with a cult following, as Russell Brand and Andrew Wakefield have. It’s not even clear that Kennedy personally believes what he’s saying: guests invited to a holiday party at his home in December 2021 were told to be vaccinated or tested for Covid-19 (he blamed his wife).The big question is about how much harm he can do in the next few years as the man who oversees health agencies in the US. Will he roll back budgetary allocations for vaccination campaigns? Eliminate research into new vaccines? With avian flu continuing to spread in mammals and birds, will he support the stockpiling and rollout of H5N1 vaccines if necessary in a future outbreak or pandemic? If his appointment is approved, experts say that vaccines will be “the first issue on the table”.The “benefits” of raw milkSimilarly, he has tweeted about the benefits of raw milk, which has become a bizarre Maga talking point generally. Raw milk consumption is a risk factor for a number of dangerous illnesses from E coli to salmonella, but is even more worrying with the widespread infection of dairy herds in the US. While pasteurisation has been shown to kill the H5N1 virus in milk and prevent its ability to infect, raw milk retains its pathogens. This year, 24 cats who drank raw milk on a farm become infected by avian flu; 12 died and 12 suffered from blindness, difficulty breathing and other serious health problems. This is when we need federal agencies to regulate what is being sold to the public and ensure clear communication of the health risks. Instead, raw milk demand has gone up, with some vendors claiming that “customers [are] asking for H5N1 milk because they want immunity from it”. (There’s a certain irony in the logic behind vaccination – training our immune system in how to respond to a pathogen – being used in this situation.)Anti-pharmaceutical conspiracy theoriesPart of the problem of the “Make America healthy again” campaign is that it contains nuggets of truth within a larger false narrative. We know that the prices charged by “big pharma” in the US are a problem – but instead of thinking this is a conspiracy to medicate the public when that’s not in their best interests, it’s worth reflecting on how the UK has managed to negotiate more reasonable prices. This is where government can have real power: ensuring fair prices for healthcare providers and individuals, and going after the extraordinary profit margins of pharmaceutical companies. But instead of taking this on – for instance, Trump could have negotiated Covid-19 vaccine prices in his first presidency – it is easier to demonise all pharma companies. Many of them of course play a valuable role in trialling and bringing drugs and vaccines to market. They just need to be regulated.Taking on these ideas will be a challenge when their proponent is leading US health policy. How do you try to engage with those who believe things that are simply not true? It’s hard: a recent Nature study found that the more time you spend on the internet trying to validate what is true and not true, you more you go down the rabbit hole of false information. Those who believe outlandish theories are generally people who think of themselves as more intelligent than the average person, have a lot of time to do their own research on the internet, and are convinced that everyone else is being duped.The US has a big health problem. Life expectancy is going dramatically backwards, Covid-19 killed a huge number of working-age Americans and trust in the federal government is at 23%. But the solution, if we look to healthier countries such as Denmark and South Korea, involves basic public health interventions, access to affordable medical care and trust in government. And not drinking raw milk.

      Prof Devi Sridhar is chair of global public health at the University of Edinburgh

      Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please click here. More

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      US overdose deaths decreased in 2023 – will Trump continue this trend?

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      The Biden administration saw unprecedented levels of US opioid overdose fatalities, but those deaths are now declining faster than they have in decades – progress a second Trump administration could continue or threaten, experts say.The number of overdose deaths in the US declined for the first time in five years in 2023, and have continued to decline more rapidly this year, according to provisional data.Some of the decline may have resulted from Biden administration efforts to expand access to harm-reduction services, especially the overdose-reversal drug naloxone, which received over-the-counter approval for the first time last year. Public health experts worry that the second Trump administration will gut access to healthcare, including addiction treatment.The president-elect’s legacy on opioids is complicated. When Trump first took office, he inherited a rapidly escalating overdose crisis. Opioid overdose deaths more than doubled during the Obama administration,according to data from the Centers for Disease Control and Prevention. The three most recent presidential administrations have all failed to quell escalating opioid overdose deaths, which nearly doubled again during the Trump and Biden administrations, dipping slightly in 2018 but overall jumping by 62% during Trump’s first term in 2020. Under Biden, deaths increased by 19% from 2020 to 2022, to 81,806, before declining by 2% last year.At times, the Trump administration seemed to work against itself when it came to the crisis. For example, Trump repeatedly attempted to gut funding for the Office of National Drug Control Policy, although Congress blocked his efforts. Similarly, Trump was frequently in disputes with Congress over attempts to repeal elements of the Affordable Care Act and its expansions to Medicaid, which funds treatment for 40% of adults with opioid use disorder.Still, experts contacted by the Guardian within and outside the first Trump administration credit the president-elect for putting unprecedented focus on the crisis.Trump signed an executive order in 2017 forming the Presidential Commission on Combating Drug Addiction and the Opioid Crisis. Bertha Madras, a professor in Harvard’s psychiatry department who served on the commission, said it wasn’t until Trump “established the commission that a significant integrated national response materialized”.Adm Brett Giroir, who served as an assistant secretary in Trump’s Department of Health and Human Services, says that he was given the authority to head up an unofficial “opioids cabinet … which met every week at the White House under Kellyanne Conway to make sure every department was working on this crisis”.Others praise Trump for supporting harm-reduction efforts, despite past opposition from his party.“President Trump publicly supported syringe services programs, a first for a Republican president,” said Jerome Adams, who served as surgeon general under Trump. Indeed, the Trump administration in some ways paved the way for the Biden administration’s response to the crisis. Access to naloxone expanded significantly under Trump, and even more under Biden.But despite these efforts, the number of US overdose deaths climbed for the majority of Trump’s first term. Giroir and Madras both attribute the huge overdose spike in 2020 to the Covid-19 pandemic, which overwhelmed the healthcare system and increased depression and suicide.Andrew Kolodny, medical director for the Opioid Policy Research Collaborative at Brandeis University, says the administration should have done more.“The first time around, President Trump did an excellent job of calling attention to the opioid crisis and designating it as a public health emergency,” he conceded, but he also said the then president failed to take sufficient action or establish a long-term plan.While the Trump administration allocated unprecedented amounts of funding to combat the crisis, Kolodny said the impact was limited, because states were usually given funds in the form of one- or two-year grants.“That’s not really adequate for building out a treatment system that doesn’t exist yet,” Kolodny said. “If you were to hire a whole bunch of staff, what would you do if you don’t get that appropriation the next year? Do you lay everybody off?”skip past newsletter promotionafter newsletter promotionExperts disagree on whether the administration spent too much of that funding on law and border enforcement, rather than treatment. Giroir supported harm-reduction and treatment expansion during his time under Trump, and is proud of his efforts to remove red tape and increase access to the opioid-cessation drug buprenorphine. Still, he says, “enforcement has to dominate the discussion”, because treatment is less effective than preventing addiction in the first place.Other experts say that criminalization only exacerbates the crisis.“Under Trump’s previous administration, they federally criminalized all fentanyl-related substances in 2018 – and overdose deaths increased from 67,367 that year to 70,630 and 93,331 in 2019 and 2020 respectively,” said Kassandra Frederique, executive director of the Drug Policy Alliance.Kolodny didn’t necessarily agree that criminalization drove the overdose increases, but he did say “the balance should be different” when it comes to prioritizing treatment over law enforcement. He said the best way to immediately reduce the overdose death count would be to make treatment “basically free” and overall easier to access than fentanyl.“[People with opioid use disorder] are not out there using fentanyl because it’s so much fun. If they don’t use, they’re gonna be very, very sick … People can really feel like they’re gonna die,” he said.It’s hard to predict how Trump will tackle the overdose crisis the second time around. He avoided the topic during his recent presidential campaign, and instead focused on inaccurate talking points about immigrants trafficking drugs across the border. He also falsely claimed he had never wanted to repeal the Affordable Care Act. But a Republican-controlled Congress could cut ACA subsidies and Medicaid.Frederique worries that Trump will continue prioritizing drug arrests during his second term, but said during his first term “he also dedicated billions of dollars toward research, education, prevention and treatment. We are committed to supporting the Trump administration’s previous efforts to advocate for health approaches such as increasing access to treatment and naloxone.” More

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      RFK Jr could have disastrous global impact on public health, experts fear

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      The appointment of a US health secretary with anti-vaccine views could cause deaths and have profound consequences around the world, global health experts fear.Robert F Kennedy Jr, Donald Trump’s pick for the position, has a history of spreading misinformation on vaccines and questioning the science of HIV and Aids.His nomination has been greeted with bemusement and alarm. One global health activist, speaking on background, said the move was akin to making the disgraced doctor Andrew Wakefield, who falsely claimed that the MMR vaccine caused autism, the UK’s health secretary.Prof Sir Simon Wessely, a regius professor of psychiatry at King’s College London, said of the move: “That sound that you just heard was my jaw dropping, hitting the floor and rolling out of the door.”Prof Sir Andrew Pollard, the director of the Oxford Vaccine Group, said there was real concern that Kennedy might use the platform “to pursue the same anti-science positions on life-saving public health interventions that he has advanced previously”.He added: “If this makes families hesitate to immunise against the deadly diseases that threaten children, the consequence will be fatal for some.”Prof Beate Kampmann, of the London School of Hygiene & Tropical Medicine, said the measles vaccine had averted more than 60m deaths worldwide in the last 25 years.“Progress will be rapidly lost in societies where vaccine hesitancy is promoted – as I fear will be the case in the US if Kennedy is appointed,” she said. Beyond US shores, the influence “could swing either way”, she said. “My worry is that polarisation on the topic will further increase.”The US is a huge force in global health as the largest funder and the home to many big pharmaceutical companies and leading health research institutes. The decisions of its regulators, such as the Food and Drug Administration, are closely watched by their equivalents elsewhere.Some of those institutions are likely to be disrupted by Kennedy’s pledge to “clear out corruption” at US health agencies and potentially eliminate entire departments. But the impact of a Trump administration on global health will be broader than any policies pursued by Kennedy alone. Trump could reinstate plans to withdraw from the World Health Organization and is almost certain to cut funding to UNFPA, the United Nations sexual and reproductive health agency that works in many poorer countries.As under all Republican presidents since Ronald Reagan, NGOs expect there to be a “global gag rule” banning recipients of US health funding from performing or promoting abortions anywhere in the world, which will potentially expand to cover even recipients of humanitarian aid.Kennedy’s stance on vaccination is being watched warily. Globally, routine vaccination coverage has yet to return to pre-pandemic levels. Lower immunisation rates led to a 20% annual increase in measles cases in 2023.Kennedy has previously made common cause with anti-vaccine groups overseas. In June 2019 he visited Samoa, where the measles vaccine was being blamed for the deaths of two babies a year earlier. It later emerged that the deaths had been caused by incorrect preparation of the vaccine mixture.Immunisation rates halved to 31% and not long after his visit a measles outbreak ended up infecting more than 57,000 people and killed 83, including children. Even as the outbreak raged, Kennedy wrote to the Samoan prime minister suggesting it might have been caused “by a defective vaccine” rather than inadequate coverage. Kennedy said previously he bore no responsibility for the outcome.His nomination was greeted with cautious civility in Berlin, where Kennedy made a name for himself as a coronavirus sceptic during the pandemic. The health minister, Karl Lauterbach, a qualified doctor, offered his congratulations but couched it in language that made his scepticism clear. “Here’s to a constructive collaboration. Will certainly not be just easy. But the choice of the voters is to be respected,” he wrote on X.Kennedy managed to enter Germany in 2020 despite tight travel restrictions in order to address coronavirus sceptics at a rally in the capital. He became a hero of the so-called Querdenker anti-coronavirus conspiracy theorist group, speaking to a demonstration attended by about 18,000 people.Kennedy drew parallels between his presence in Berlin, as a “fighter against totalitarianism”, and his uncle John F Kennedy’s appearance there in June 1963 during the cold war when he said the city had previously been a front against totalitarianism.On Friday, individuals and groups linked to the Querdenker movement welcomed the appointment, with some claiming Kennedy would “save the rest of the world”.The Hartmannbund association of German doctors voiced its concern about the overall effect a Trump presidency could have on Germany’s healthcare system. Its chair, Klaus Reinhardt, warned of the potential impact of any trade war between the US and Europe on the supply of medicines, saying issues over tariffs could greatly increase health costs and the individual contributions currently required by Germany’s health insurers.Scientific leaders say another pandemic is inevitable and that while during the Covid-19 pandemic Trump’s Operation Warp Speed aided the development, approval and mass manufacture of vaccines in record times, similar US leadership under Kennedy appears less likely.On other issues, experts are waiting for more detail on Kennedy’s plans. He has pledged to tackle chronic diseases and address the issue of overly processed foods. Leadership in those areas could be welcome in a world where diabetes rates have doubled in the past three decades.Many global health activists said they would agree with Kennedy that big pharma has questions to answer, but that companies should not be falsely accused of making vaccines that harm people; rather, they should be asked why so much of the world does not have access to affordable medicines. More

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      Make no mistake: this Trump presidency will continue to attack abortion rights | Moira Donegan

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      Abortion rights initiatives were on the ballot in 10 states on Tuesday, and won in seven of them. One of the losers was prop 4, Florida’s abortion rights measure, which received a whopping 57% of the vote but failed to meet the state’s unusually high 60% threshold, meaning that the state’s six-week ban will remain in place. Asked about the Florida abortion rights proposition ahead of the election, Trump said that when he went to cast his ballot near Palm Beach, he would vote against it.It has always been a little hard to believe that Donald Trump personally hates abortion, even if it is abundantly clear how little he thinks of women. Trump, after all, has claimed to have numerous conflicting positions on abortion rights throughout his life. And his brand of masculinity is boorish, vulgar, and above all, sexually entitled – far from the priggish, repressed moralism of more classical anti-abortion figures like Mike Pence.Maybe this is why, though Trump appointed three of the six justices who overturned Roe v Wade and has boasted about his role in ending the right to an abortion, many voters seem to not quite believe that he will continue to suppress the procedure further in his coming second term. Abortion rights measures won in several states that Trump carried on Tuesday – including Arizona, Nevada, Montana and Missouri, all states that Trump won. A lot of people, it seems, voted for abortion rights in their own states, and then also voted for Donald Trump – who, make no mistake, will move to restrict abortion access nationwide when he returns to the White House next year.Trump, of course, has insisted that this will not happen – which on its own might be a decent indication that it will. But there is evidence that the new Trump administration will pursue a broad agenda restricting women’s rights, including nationwide attacks on abortion access, even beyond that offered by Trump’s habitual pattern of self-serving dishonesty.Republicans have won control of the Senate and are likely to capture the House of Representatives; if they do, they may well advance legislation to ban abortion nationwide. (And to pass it: there is no reason to believe that a Republican governing trifecta will preserve the filibuster.) A bill like this would probably not be termed a “ban” by its sponsors: Republicans, wary of the public disapproval of abortion bans, have started calling their new abortion restrictions by chillingly imprecise euphemisms, such as “standard” or even “protection”. But the effect of the laws are the same: to outlaw abortions. This could take the form of a gestational limit, or of the federal recognition of fetal personhood. Trump may well sign such legislation into law, eliminating abortion rights even in Democratic-controlled states and those that have recently passed abortion rights referendums with the stroke of a pen.But Republicans do not even need to manage to pass a bill through Congress to make abortion much more difficult to get. Trump can simply restrict abortion through federal agencies. He will soon be in control of the FDA, for example, which regulates the abortion drug mifepristone, part of a two-drug regimen that now accounts for most abortions in the United States. Mifepristone is a safe, effective drug that allows abortions to be performed in the privacy of patients’ homes, with little of the expensive clinical involvement and overhead that makes surgical abortions more time-intensive and costly for providers and patients alike.Naturally, the anti-abortion movement hates it. Since Dobbs, a coalition of anti-choice groups and Republican attorneys general have been suing the FDA, seeking to overturn the agency’s 2000 approval of the drug. Trump will be able to rescind access to it almost immediately, taking the drug off the legal US market. If he gives the anti-choice movement what they want, he may also direct the FDA to revoke approval of the most reliable forms of female-controlled contraception, like Plan B, IUDs, and certain birth control pills, which the anti-choice movement falsely claims cause abortions.Trump is likely to also revive enforcement of the Comstock Act, a long-dormant 1873 law that bans the shipment of anything that could be used to induce an abortion through the US mail. The Comstock Act has not been enforced in decades – parts of it were repealed in the 20th century, and other sections were long rendered moot by supreme court precedents like Roe and Casey – and would have the effect of criminalizing much abortion care. Since Dobbs, several Democratic-controlled states have passed what are called shield laws, which protect doctors who mail abortion drugs from states where the procedure is legal into states that have bans. This mail-order abortion operation is, for now, technically legal: it has preserved women’s independence and dignity and no doubt saved thousands of lives.But when the Comstock Act is enforced, much of this sector of abortion provision will disappear. Combined with the revocation of FDA approval for mifepristone, this will inevitably mean that many women seeking abortions will turn to black market surgical abortion providers, and suffer the risks attendant to such procedures. A return to pre-Roe levels of abortion ban-related mortality could probably follow.Trump is also likely to reverse the Biden administration’s guidance on Emtala, the Emergency Medical Treatment and Active Labor Act, a federal law that requires emergency rooms to provide stabilizing care to all patients facing health crises. Emtala has been the subject of much post-Dobbs litigation, as states like Idaho and Texas have sought to argue that their abortion bans supersede the federal law, thus requiring hospitals in their states to withhold emergency abortions from women in medical emergencies who will suffer or die without them. The US supreme court declined to decide the issue last summer; a Trump administration may help to resolve it for them.This is all just what Trump could do on his own in his first years back in office. But the impact of a Trump term on American women’s access to abortion will be felt long after Trump himself is no longer with us. Trump will probably appoint at least two supreme court justices to lifetime seats in his coming term; he will also fill an unknown number of vacancies on the lower federal courts, whose judges also serve for life. These judges are all likely to be anti-abortion zealots, as are the federal bureaucrats Trump will bring in to staff agencies such as the FDA, CDC and Department of Health and Human Services.We are already living in an era when abortion access is restricted more than it has been in decades. Now, it will be restricted more. We may well never have as much reproductive freedom as we do now ever again.American women are well advised to prepare for this, to not wait for the Trump administration to restrict the tools they use to control their own bodies. Sterilization and long-acting birth control remain accessible, for now; women who want these should move quickly to get them. Plan B and abortion pills can both be purchased ahead of time and kept on hand in the privacy of a medicine cabinet; such purchases may provide security and peace of mind to those staring down the barrel of another Trump term. Abortion, as we know, will never be eliminated; it can only be less safe, and less dignified. But there are few things as strong as women’s determination to control their own lives. That determination is certainly stronger than the law.

      Moira Donegan is a Guardian US columnist More

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      Wisconsin supreme court seems hostile to 1849 abortion ban in oral arguments

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      During heated oral arguments on Monday morning, the Wisconsin supreme court appeared poised to find an 1849 law banning most abortions cannot be enforced.The legal status of abortion in Wisconsin has been contested since the US supreme court overturned Roe v Wade and ended the right to abortion nationwide, triggering bans across the country – including in Wisconsin, where a 175-year-old ban immediately went into effect.Democrats in Wisconsin have seized on abortion as a campaign issue, with Justice Janet Protasiewicz expressing her support for abortion rights and winning a seat on the court in spring 2023. Protasiewicz’s election to the court helped flip the ideological balance on the bench, which is now controlled by a narrow liberal majority.It is highly unlikely the liberal-controlled court will uphold the ban.The 1849 statute, which was nullified by Roe v Wade and then reanimated when the landmark decision was overturned, declares that ending “the life of an unborn child” is a felony, except when required to save the life of the mother. In July 2023, a Dane county judge ruled that the 1849 ban applies only to feticide and not “consensual” abortion, citing a previous ruling that interpreted the statute as an anti-feticide law, and in September, providers including Planned Parenthood resumed offering abortion care.The Sheboygan county district attorney Joel Urmanski appealed the ruling, which is now before the Wisconsin supreme court.“The position of the circuit court below … is ultimately indefensible,” said Matthew Thome, an attorney representing Urmanski, during his opening argument. Thome argued that the 1849 law should be interpreted to “prohibit consensual abortions from conception until birth, subject to an exception when it is necessary to save the life of the mother”.Justice Jill Karofsky interrogated Urmanski’s interpretation of the law, asking if it would provide exceptions for rape, incest, the health of the mother, or fetal abnormalities.“Just to be clear, a 12-year-old girl who was sexually assaulted by her father and as a result, became pregnant, under your interpretation … she would be forced to carry her pregnancy to term?” asked Karofsky. She noted that the “penalty for aborting after a sexual assault would be more severe than the penalty for the sexual assault”.In response to a question about the medical consequences of a ban, Thome responded that he was unsure, given that he is “not a doctor”.“I fear that what you are asking this court to do is to sign the death warrants of women and children and pregnant people in this state, because under your interpretation, they could all be denied life saving medical care, while the medical professionals who are charged with taking care of them are forced to sit idly by,” said Karofsky.The court weighed the question of whether laws that were passed regulating abortion while Roe was in effect “impliedly repealed” the 1849 ban and rendered it unenforceable.“All of those statues” passed after 1973 and before it was overturned, “just go to the dust pile?” asked Karofsky.Justice Brian Hagedorn, a conservative-leaning judge, argued, of the 1849 ban, that “the law is still there”, adding that “the judiciary doesn’t get to edit laws, the judiciary doesn’t get to rewrite them, we didn’t delete it, we prevented its enforcement”.The assistant attorney general Hannah Jurss disagreed, arguing that “there is nothing in the text of these statutes that says in the event that Roe is overturned we somehow go back to the old law and throw out all of the new ones,” drawing a distinction between Wisconsin’s more than a century old law and “trigger” laws passed in certain states that were specifically designed to go into effect after Roe v Wade was overturned.A separate case, which the Wisconsin supreme court has also agreed to hear, would decide whether the right to abortion is protected under the state’s constitution – possibly opening the door to challenge other laws regulating abortion in the state. More

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      Incoming Trump presidency threatens millions of Americans’ healthcare plans

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      Millions of Americans are at risk of losing health coverage in 2025 under Donald Trump’s forthcoming administration.More than 20 million Americans rely on the individual private health insurance market for healthcare, private insurance which is subsidized by the federal government.These subsidies, programs that help lower the cost of health insurance premiums, increased the amount of assistance available to people who want to buy health insurance through the Affordable Care Act, dubbed Obamacare as a signature piece of legislation during Barack Obama’s administration.This specific subsidy program resulted from the Biden administration’s 2021 American Rescue Plan and is set to expire at the end of 2025.“The consequences of more people going uninsured are really significant, not just at an individual level with more medical debt and less healthy outcomes, but also has ripple effects for providers,” Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University, said.Read more of the Guardian’s 2024 US election coverage

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      “Premiums go up for the people who do have health insurance; for the people without health insurance, it’s financially devastating. The result is medical debt, garnished wages and liens on people’s homes because they can’t pay off their bills,” she said.The American Rescue Plan not only added additional subsidies, but also broadened the eligibility requirements, extending them to many more people in the US middle class.It was announced earlier this year by the Biden-Harris administration that 21.3 million people selected an Affordable Care Act health insurance marketplace plan during the 2024 0pen enrollment period.With Republicans now having won control of the presidency, the Senate and possibly the House, it is highly likely that Congress will not vote to extend the coverage next year.President-elect Trump said during the presidential debate with his Democratic rival, Kamala Harris, that he had “concepts of a plan” to replace the Affordable Care Act but has yet to reveal them. He previously attempted to replace the ACA in favor of the American Health Care Act, a bill to repeal subsidies and regulations, which failed in the Senate in 2017.The subsidies helped Obamacare enrollment nearly double during Biden’s term, a record high. The enrollment was highest in southern Republican-voting states. The Congressional Budget Office (CBO) reports that the share of people without health insurance reached an all-time low of 7.2% in 2023.“The 2021 boosts [in subsidies] helped millions of people afford health insurance,” Corlette said. “It’s led to the lowest uninsured rate we’ve seen in this country and helped boost financial security for millions of families.”Last month, the Republican House speaker, Mike Johnson, took a stance against the ACA at an event in Pennsylvania, telling a crowd there would be “massive” healthcare changes in America if Donald Trump won the election.The CBO estimates nearly 4 million people will lose their coverage in 2026 if the subsidies are not extended because they won’t be able to afford the rising cost of healthcare plans. Lower-income Americans would still receive some federal assistance, while those it the middle class would lose it altogether.Despite the 2021 subsidies having extended coverage to more than 20 million people, the ACA remains a flawed option for healthcare coverage and has been a major factor in driving medical debt.For 2025, the out-of-pocket limit for a marketplace plan cannot be more than $9,200 for an individual and $18,400 for a family, according to the Department of Health and Human Services. These prices represent the legal limit that insurers can have people spend on their plans.But policy experts insist that the ACA’s imperfect system is still preferable to millions of Americans going without health insurance.Read more of the Guardian’s 2024 US election coverage

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      Trump’s queasy prescription to ‘make America healthy again’ takes shape

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      From assertions that America’s highest-profile vaccine critic would lead health agencies to new promises for “massive reform” of Obamacare, the chaotic last week of Donald Trump’s presidential campaign will probably serve as a preview of what “Make America healthy again” could mean should the former president regain power.The jumble of proposals echoed conservative policy documents, channeled the residual anger of the post-pandemic anti-vaccine movement and alarmed experts who help set the nation’s health policies.“My first reaction is that a Trump administration would be the most anti-public health, anti-science administration in history,” said Lawrence Gostin, a global health law professor at Georgetown Law School.“In my mind, health is very much on the ballot,” he said.Over the last week of the campaign, Trump said he would let the nation’s foremost vaccine skeptic “go wild” at the nation’s food and drug agencies and refused to rule out banning certain vaccines. The Republican House speaker, Mike Johnson, also promised “massive reform” of Obamacare should Trump win.Vaccines are among society’s most effective public health interventions, saving an estimated 154 million lives worldwide over 50 years, according to a study in the Lancet. Obamacare has grown in popularity even among Republicans.“It reminds me of the chaos of the first administration, right in the midst of the pandemic,” said Gostin, referring to a time when Trump floated bogus treatments for Covid from injecting disinfectant to ivermectin to hydroxychloroquine – all debunked and often actively harmful.“But it’s far worse,” continued Gostin, “because while Trump at least was surrounded by credible scientists like Tony Fauci, I don’t think there will be any similar restraint in the next Trump administration.”The official Republican party platform is short on details, but blames immigrants for high healthcare prices, and says the party will “commit” to lowering healthcare prices through “choice” and “transparency”. It also pledges to “protect” Medicare from Democrats, who it claims plan to allow “tens of millions of new illegal immigrants” to enroll in the program.Voters in both parties cite healthcare costs as their top health-related issue. However, transparency measures would probably only result in a 1% reduction in healthcare prices over 10 years, according to the Congressional Budget Office. “Choice” is often a euphemism for reducing health insurance regulations, which would allow Americans to buy plans that cover fewer services.Undocumented migrants are not eligible to enroll in Medicare, and the Democratic presidential candidate, Kamala Harris, backed away from a policy that would have provided government-backed healthcare to all residents of the US, regardless of immigration status.A detailed look at how Trump’s supporters might attempt to change US health policy is found in the conservative playbook Project 2025. There, health policy proposals are dominated by calls to restrict abortion and diminish the role of scientific research.In it, the Department of Health and Human Services (HHS) should be known as the “Department of Life”, approval for medication abortion should be withdrawn, and health policy should promote “fatherhood” and the “nuclear family” and stop research that amounts to “woke transgender activism”.HHS should stop focusing on “LGBTQ+ equity” and end policies that are “subsidizing single-motherhood, disincentivizing work, and penalizing marriage”. Its sub-agencies, such as the Centers for Disease Control and Prevention, should be split in two with the power to make policy recommendations severely curtailed. The “incestuous relationship” between government researchers and vaccine manufacturers should end, the plan says.As voters head to the polls, the people who might institute these policies have also come into focus. Robert F Kennedy Jr, the former independent candidate and staunch vaccine critic, said he had been “promised” a role helming the nation’s health agencies by Trump.“The key, which President Trump has promised me, is control of the public health agencies,” said Kennedy on a Zoom call with supporters, according to ABC News. Those agencies include “HHS and its sub-agencies, CDC, Food and Drug Administration, [National Institutes of Health] and a few others. And also the [United States Department of Agriculture], which is, you know, key to making America healthy”.skip past newsletter promotionafter newsletter promotionKennedy ended his presidential run and endorsed Trump in August after a conspiracy theory-fueled campaign that revealed he had health issues related to a brain worm, once sawed the head off a whale and dumped a dead bear in Central Park.Dr Joseph Ladapo has been floated as a potential pick for the head of HHS. The Harvard University-educated Florida surgeon general warned state residents against using Covid-19 vaccines and allowed unvaccinated children to go to school during a measles outbreak.Although ideas floated by Trump’s supporters may be easily disproved, health researchers and policy experts said they take the threat of their influence deadly serious, with the last week highlighting how legitimate concerns about the power of pharmaceutical and chemical companies can be exploited.“I think we leaned into a libertarian left hook,” said Dr Paul Offit, director of the vaccine education center at Children’s Hospital of Philadelphia and a member of an advisory committee on vaccines for the US Food and Drug Administration (FDA).Offit said he worried vaccine mandates primed some Americans to believe vaccine misinformation, and even though he supported them, worried they may “have done more harm than good”.Another research advocate who spoke anonymously to Science magazine said: “We’re all in a state of panic … I don’t know anybody who isn’t worried about this.”Soon, the nation will know the extent to which such messages resonated with voters.“I’m surprised that anti-vaccine rhetoric is considered to be convincing enough to get you elected,” said Offit. “I’m surprised that such a significant portion of the population would be compelled by that.”Read more of the Guardian’s 2024 US election coverage

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