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    Indiana passes law threatening non-profit status of expensive hospitals

    Indiana’s governor, Mike Braun, has signed a landmark bill that would strip charity hospitals of their non-profit status if they continue to charge high prices.The legislation, the first of its kind in the United States, followed uproar across the state after a Guardian series in October that investigated how one major Indiana non-profit hospital system bought up its competition, then hiked its prices, leaving businesses and patients struggling to pay their medical costs.In the wake of the Guardian investigation, Braun, then the Republican gubernatorial candidate, and his Democratic rival both criticized the hospital system, Parkview Health, for its high prices, and lawmakers vowed to take action against the non-profit chain, which charged some of the highest prices in the country despite being based in Fort Wayne, Indiana, the US’s most affordable metro area.Braun signed the legislation into law on Tuesday. It comes at a time of growing concern across the US about healthcare costs and medical debt.To implement the law, the Indiana office of management and budget will first study prices across the state and come up with a price benchmark for non-profit hospitals in consultation with the legislature, according to the bill’s author, Martin Carbaugh, a Republican representative who represents a district that includes Fort Wayne. Non-profit hospitals will then have until 2029 to get their prices under that average, though Carbaugh hopes some will lower their prices before then as they negotiate with insurers.“We’ll start to see the downward pressure put on them right away,” he said. “The hospitals know they can’t just go for broke and raise costs, only to have to lower it again in 2029.”According to data compiled by Hoosiers for Affordable Healthcare, an Indiana advocacy group, the legislation could result in average price reductions as large as 40% for Parkview, and similarly sized cuts for other large state hospital systems.“It’s gonna be beneficial to everybody,” said Doug Allen, a small business owner who has struggled to keep up with Parkview’s healthcare costs for his employees. “Maybe people won’t be hurting so bad. Maybe they won’t think twice before coming to the hospital. Almost everybody around here is on a payment plan with Parkview. Everybody owes money to Parkview.”Parkview Health did not respond to requests for comment but has previously said it is committed to lowering healthcare costs.In a statement, the Indiana Hospital Association said it was “concerned by the potential loss of non-profit status for hospitals based on meeting an unknown statewide average commercial price in the future. This does not take into consideration the uncertainty of rising cost pressures such as tariffs, inflation, and other significant economic factors that will further threaten the financial stability of Indiana’s health care ecosystem.”The group added that it looks forward to “continuing our work with legislators and Gov Braun’s administration on future solutions that strike the right balance of lowering costs while maintaining access for Hoosier patients”.The US spends far more on healthcare than other large, wealthy countries, a trend that has been exacerbated by decades of hospital consolidation limiting competition in the healthcare sector. Carbaugh said he was aware of how high healthcare prices are across the country and said Indiana’s legislation might be a model for other states too.“It’s great to be a leader,” he said. “I’m happy to be part of leading that charge.” More

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    Protecting democracy is not enough: five things Americans must fight for | Huck Gutman

    A recent dinner was peaceable until it was just about over, when a friend’s son spoke up in praise of a middle-of-the-road columnist and how his opposition to Donald Trump’s attack on democracy revealed that we were all on the progressive left now.“Not true,” I responded with more vehemence than I expected. “Wanting democratic norms is not sufficient; it is merely a precondition for meaningful change.” Making sure the US’s plumbing was secure did not mean that anything of importance would pass through the pipes.There has been a great outcry about the erosion of democratic practices during these first hundred days of the second Trump presidency. Many Americans, probably a solid majority, are appalled at the attack on our courts and judges, at the willful ignoring of habeas corpus, at the intrusion of unelected figures – not just Elon Musk, but his whole “department of government efficiency” (Doge) team – into the privacy of American lives, at the undoing of the independence of agencies intended to protect the public.But protecting democracy is not enough. It is a rearguard action, one that fights against incursions that would transform the United States into an oligarchic state serving special interests. It does not address the needs of the larger public. Fighting for procedures and not substance is insufficient.Those who fight for the future of our nation need to fight not just against threats, but for a just and equitable future. Too often the well-deserved plaudits for those who fight against do not extend to articulating a program of what the American nation needs, in addition to democratic institutions.Here are five specific suggestions for what we should be fighting for. Without these reforms, defenses of democracy ring hollow, elevating a defense of form while denying any attention to substance.First, the nation needs a new minimum wage, a living wage, not the residue of 1938 legislation called the Fair Labor Standards Act. No one can live on $7.25 an hour, which translates to about $15,000 a year.Second, Americans deserve healthcare as a right. A Medicare for All system would extend healthcare to every person. Its cost would be more than offset by eliminating the 25% of healthcare spending that goes for overhead in our private-insurance-dominated system. Cutting $1tn of needless bureaucratic expenses and bill-keeping would ensure that we have the money to provide healthcare to everyone.Third, Americans should find it easy to join unions if they wish. The decline in unionization is a major reason why, as the wealthy get ever wealthier, wages have been flat or declining for almost 50 years. As it stands, the table is tilted toward management. Corporations regulate all employee concerns, from wages to healthcare to retirement benefits, leaving workers little to no chance to say what they actually want. We must level that playing field so that workers together can fight for their needs.Fourth, we need to increase taxes on the wealthy. There is no reason that Warren Buffett, as he has said, should pay a lower tax rate than his secretary. Increasing the marginal tax rate for the highest earners, limiting the exorbitant pass-throughs of the inheritance tax, and ending the unhealthy practice of taxing paper gains in wealth, or capital gains, less than the money earned by workers would diminish the federal deficit and at the same time fund many needed services to Americans. Removing the cap on income subject to social security taxes would ensure the solvency of the nation’s pension program for generations.Fifth, we should reverse the deeply damaging Citizens United decision, which enabled the wealthy and their special interests to buy elections. Currently, money and not votes determines the priorities of the United States. If the supreme court does not reverse this decision, a constitutional amendment limiting contributions – one person, one vote, with a low limit on individual contributions and no contributions by corporations – would fix this loophole, which has corrupted all of American politics.skip past newsletter promotionafter newsletter promotionThere is, rightly, much concern about the undemocratic moves made by the Trump administration. But unless we demand changes in what the United States does, unless we do more than just defending the practices of democracy, our society will remain dysfunctional. Those who focus only on the process of maintaining the pipes required for quenching our thirst, without giving us actual water to drink, are fighting only a small part of the battle.What’s giving me hope nowWe need to fight for democracy, but we also need to fight for the achievable goals democracy can bring us, particularly economic justice for all Americans. Raising wages, providing healthcare to all, fostering unions, taxing the wealthy and corporations, preventing big money from buying elections: these are the things the renewal of democracy can and should bring us.

    Huck Gutman is a former chief of staff to Senator Bernie Sanders and an emeritus professor at the University of Vermont More

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

    Donald Trump has tapped Dr Casey Means, a wellness influencer with close ties to Robert F Kennedy Jr, the US health secretary, as nominee for surgeon general after withdrawing his initial pick for the influential health post.The US president said in a social media post on Wednesday that Means has “impeccable ‘MAHA’ credentials” – referring to the “make America healthy again” slogan – and that she will work to eradicate chronic disease and improve the health and wellbeing of Americans.“Her academic achievements, together with her life’s work, are absolutely outstanding,” Trump said. “Dr Casey Means has the potential to be one of the finest Surgeon Generals in United States History.”The news signals Trump’s withdrawal of his original pick for the post: Janette Nesheiwat, a former Fox News medical contributor. It marks at least the second health-related pick from Trump to be pulled from Senate consideration. Nesheiwat had been scheduled to appear before the Senate health, education, labor and pensions committee on Thursday for her confirmation hearing.Means and her brother, former lobbyist Calley Means, served as key advisers to Kennedy’s longshot 2024 presidential bid and helped broker his endorsement of Trump last summer. The pair made appearances with some of Trump’s biggest supporters, winning praise from conservative pundit Tucker Carlson and podcaster Joe Rogan. Calley Means is currently a White House adviser who appears frequently on television to promote restrictions on Snap benefits, removing fluoride from drinking water and other Maha agenda items.Casey Means has no government experience and dropped out of her surgical residency program, saying she became disillusioned with traditional medicine. She founded a health tech company, Levels, that helps users track blood sugar and other metrics. She also makes money from dietary supplements, creams, teas and other products sponsored on her social media accounts.In interviews and articles, Means and her brother describe a dizzying web of influences to blame for the nation’s health problems, including corrupt food conglomerates that have hooked Americans on unhealthy diets, leaving them reliant on daily medications from the pharmaceutical industry to manage obesity, diabetes and other chronic conditions.Few health experts would dispute that the US diet – full of processed foods – is a contributor to obesity and related problems. But Means goes further, linking changes in diet and lifestyle to a raft of conditions including infertility, Alzheimer’s, depression and erectile dysfunction.“Almost every chronic health symptom that Western medicine addresses is the result of our cells being beleaguered by how we’ve come to live,” Means said in a 2024 book co-written with her brother.Food experts say it’s overly simplistic to declare that all processed foods are harmful, since the designation covers an estimated 60% of US foods, including products as diverse as granola, peanut butter and potato chips.“They are not all created equal,” said Gabby Headrick, a nutrition researcher at George Washington University’s school of public health. “It is much more complicated than just pointing the finger at ultra-processed foods as the driver of chronic disease in the United States.”Means has mostly steered clear of Kennedy’s debunked views on vaccines. But on her website, she has called for more investigation into their safety and recommends making it easier for patients to sue drugmakers in the event of vaccine injuries. Since the late 1980s, federal law has shielded those companies from legal liability to encourage development of vaccines without the threat of costly personal injury lawsuits.She trained as a surgeon at Stanford University but has built an online following by criticizing the medical establishment and promoting natural foods and lifestyle changes to reverse obesity, diabetes and other chronic diseases.If confirmed as surgeon general, Means would be tasked with helping promote Kennedy’s sprawling Maha agenda, which calls for removing thousands of additives and chemicals from US foods, rooting out conflicts of interest at federal agencies and incentivizing healthier foods in school lunches and other nutrition programs.Nesheiwat, Trump’s first pick, is a medical director for an urgent care company in New York and has appeared regularly on Fox News to offer medical expertise and insights. She is a vocal supporter of Trump and shares photos of them together on social media. Nesheiwat is also the sister-in-law of former national security adviser Mike Waltz, who has been nominated to be Trump’s ambassador to the United Nations.Nesheiwat also recently came under criticism from Laura Loomer, a far-right ally of Trump who was instrumental in ousting several members of Trump’s national security council. Loomer posted on Twitter/X earlier this week that “we can’t have a pro-COVID vaccine nepo appointee who is currently embroiled in a medical malpractice case and who didn’t go to medical school in the US” as the surgeon general.Independent freelance journalist Anthony Clark reported last month that Nesheiwat earned her medical degree from the American University of the Caribbean School of Medicine in St Maarten, despite saying that she has a degree from the University of Arkansas School of Medicine.The surgeon general, considered the nation’s doctor, oversees 6,000 US Public Health Service Corps members and can issue advisories that warn of public health threats.In March, the White House pulled from consideration the nomination of former Florida Republican Dave Weldon to lead the Centers for Disease Control and Prevention. His skepticism on vaccines had raised concerns from key Republican senators, and he withdrew after being told by the White House that he did not have enough support to be confirmed.The withdrawal was first reported by Bloomberg News. More

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    Trump is dismantling a key worker safety group. It’s another betrayal of the working class | Devan Hawkins

    As Donald Trump announced his tariffs in the White House Rose Garden last month, he proclaimed: “We’re standing up for the American worker.” While it remains to be seen what impact these tariffs will have on American workers, his words were belied by the fact that just a day before this announcement, hundreds of workers at the National Institute for Occupational Safety and Health (Niosh) – an organization that has stood up for US workers since 1970 – discovered that they had been laid off.Niosh was founded as part of the Occupational Health and Safety Act with the purpose of “developing and establishing recommended occupational safety and health standards”. The organization has been on the frontline of protecting worker health and safety ever since. Its work has focused on understanding the risks faced by millions of workers throughout the country who put their safety on the line every day to perform their jobs. For example, Niosh’s Fire Fighter Fatality Investigation and Prevention Program investigates fatalities to understand their circumstances and make recommendations, ensuring that more of these workers, who risk their lives for others daily, can be safer in the line of duty.Far from being a caricature of a federal body firmly entrenched in the Beltway, Niosh’s work is spread across the country. One of Niosh’s most notable sites is its Morgantown, West Virginia, facility. Located in the heart of coal country for decades, it has focused on studying the health impacts of coalmining – particularly black lung disease – which has seen notable increases in recent years. Nearly 200 workers were fired from the Morgantown location, which will severely hamper this work. (Some were temporarily rehired.)Niosh also supports surveillance programs run out of 23 states. These state-based programs focus on the unique needs of the workforce in those areas. For several years, I was fortunate to have been an epidemiologist with such a program in Massachusetts, where my colleagues and I focused on understanding and preventing health challenges ranging from bloodborne pathogen exposure among healthcare workers, to asthma risk among cleaners, to fatalities in the construction industry.Since its founding, Niosh has been a nimble organization, adapting to and studying new and emerging threats. The World Trade Center Health Program, which is administered by Niosh, was created to study the health impacts of responding to those terrorist attacks – ranging from traumatic injuries and respiratory disease to cancer and mental health – while providing support for those responders.In a similar way to its response to the September 11 attacks, in the grip of the epidemic of opioids and suicides that have cost tens of thousands of lives over the past two decades, Niosh has sought to understand the workplace component of these challenges. These efforts have helped to shed light on the pathway linking occupational injuries to a high risk of drug overdoses among workers in certain occupations, particularly in the construction industry, and contribute to efforts to prevent these deaths.During the Covid-19 pandemic, Niosh studied the risks faced by frontline workers. The pandemic also highlighted one of Niosh’s most essential functions: air filtration ratings. Niosh tests, approves and certifies respirators to ensure that workers are protected from airborne risks ranging from silica dust to lead.Niosh also supports the future of occupational safety and health workers. Niosh traineeship programs across the country provide support to students studying occupational health and safety. I was fortunate to be supported by such a program when I was in graduate school. Throughout the country, hospital employee safety departments, union workplace safety committees, and community occupational health and safety advocacy organizations are staffed by others like myself who received this support.Now is the worst possible time for Niosh to be dismantled. Traditional workplace hazards still remain. In 2023, the last year with available data, there were 5,283 fatal occupational injuries – one every 99 minutes. Violent injuries at work are a growing concern, particularly among healthcare workers. Increasing temperatures caused by climate change place many vulnerable workers at high risk for illness, injury and death, while extreme weather events, such as the wildfires that devastated southern California earlier this year, threaten the health and safety of emergency workers. Emerging technologies such as artificial intelligence are changing the nature of work, presenting new dynamics and hazards.We need Niosh to study these emerging threats and safeguard workers.It remains to be seen what will happen to the remainder of the organization and the programs supported by Niosh throughout the country. Regardless of what occurs, we should support the current and former workers of the organization and carry forward its mission, just as Niosh workers have advocated for the health and safety of workers across this country since the organization’s inception.

    Devan Hawkins is a writer and researcher from Massachusetts. He is the author of the book Worthy and Unworthy: How the Media Reports on Friends and Foes More

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

    Since Robert F Kennedy Jr assumed control of the US health department in February, with a mandate to “[lower] chronic disease rates and [end] childhood chronic disease”, he has moved quickly to remake the US’s federal health infrastructure. But the Trump administration’s actions on medical research are already threatening that goal – and could end medical progress in this country for good.Kennedy’s office oversees the National Institutes of Health, the control center of disease research in the United States. Kennedy’s agency has killed almost 800 active projects, according to Nature, affecting medical research into HIV/Aids, diabetes, women’s health, heart disease, cancer, Alzheimer’s and more. The administration wants to cut the NIH’s budget up to 40% while consolidating its 27 agencies – separated by disease area – into just eight. Elon Musk’s Doge has been reviewing previously awarded grant funding, reportedly requiring researchers to explain how they are using their grants to advance the Trump administration’s political goals. (Audio obtained by the Washington Post suggests this “Defend the Spend” initiative may be a smokescreen, with one NIH official admitting: “All funding is on hold.”) Separately, Donald Trump has aggressively targeted universities such as Harvard and Columbia over alleged antisemitism and diversity initiatives, using federal contracts that fund research as leverage. And just recently, the NIH passed a new rule banning any university from receiving future federal grants if the universities use DEI programs or boycott Israeli firms.Medical research is a wonkish issue usually kept far away from political discussions. Even popular initiatives like former presidents Barack Obama and Joe Biden’s cancer moonshot require long-term vision in a political landscape rarely concerned with anything beyond the day’s news. But in recent years, public and private investments in medical research have seeded a wave of potential cures across major disease areas. Now, just as that wave is about to crest, RFK Jr and the Trump administration’s incursion against the NIH threatens to ensure these cures are never finished.For me, the promise of those cures is personal. At three days old, I was diagnosed with a rare version of the most common type of birth defect: congenital heart disease. CHD affects one in every 100 babies born in the US and is the leading cause of birth defect-related deaths. Congenital heart problems can range from a small hole in the heart to being born with only one ventricle. Many defects are underdiagnosed, and chances are good that you know somebody who lives with one. Even JD Vance does: his relative was born with Ebstein’s anomaly, a deformity of the tricuspid valve that has resulted in her now needing a heart transplant at the age of 12.When I was six weeks old, doctors performed the first in a series of three surgeries aimed at correcting the circulation of blood within my heart and between the other organs of my body. The final surgery in that sequence had first been described in medical journals in 1971, and crucial refinements had been made only a few years before I was brought under the knife.Before the surgery’s advent, the prognosis was grim. Many children like me died before their first birthday. Of congenital patients in the 1950s, “half died before the age of twenty”, writes cardiologist Sandeep Jauhar in his book Heart: A History. “In short, they were cardiac cripples, their existence doomed.” But after the surgery, more of us started living into adulthood. Today, most of these patients live at least another 30 years after the operation. My survival past infancy was an accident of history, the product of being born at the right moment in the lifespan of medical research. “Don’t worry,” my first surgeon told my parents when I was a child. “He’s going to long outlive you both.”But my future and the future of others like me is not guaranteed. As I grew up, my doctors acknowledged that the surgery was merely palliative, not curative – a stopgap, medicine’s way of buying me some time. With medicine advancing so quickly, though, we could hope that new solutions would be brought into existence by the time I needed them. In the decades since, we have come to understand the surgery’s long-term consequences: likely progressive damage across organ systems, leading to the need for heart or multi-organ transplants in most patients by the age of 40. Last year, shortly after turning 31, I was formally diagnosed with cardiac cirrhosis and informed that I will need a combined heart-liver transplant within the decade. The time that those early developments bought me seems to be running out.In recent years, as the patient population has grown, more of us have been able to advocate for the need for new solutions. Private foundations have started pouring tens of millions of dollars into research aimed at discovering new treatments and identifying the root causes of birth heart defects so they can be prevented. These foundations have also begun correcting an imbalance in funding – historically, pediatric cancer has received five times the amount of funding that CHD does, despite similar prevalence and mortality rates.I volunteer on the patient board of one such organization, a privately funded non-profit aimed at curing heart defects like mine. With the help of researchers and hospital systems across the country, the organization has been making remarkable progress in a short period of time. But this work relies on the infrastructure of university labs. Even before Kennedy took office, the Trump administration ordered that the NIH change how grant funding is allocated by limiting what are known as “indirect costs”, which go beyond the direct needs of a given study. But often, these costs go into funds that help universities keep their labs running: things like building operations and upgrades, legal compliance and paying researchers. Even with this support, university labs struggle to keep the lights on, and researchers are constantly fighting to secure and retain funding. (The order has since been paused by a federal judge and is the subject of continuing litigation.)Some insist the US shouldn’t be funding research with taxpayer dollars at all. Instead, they would leave the task to pharmaceutical companies and biotech firms. But this fundamentally misunderstands the reality: in the decade leading up to 2020, researchers found, government funding played a role in the development of every new pharmaceutical drug; these drugs are then sold back to patients at a premium. The research that for-profit companies do fund is narrowly focused on things that are guaranteed to make money, or to advance discoveries begun in the public sector. For example, the new blockbuster medication category of GLP-1s – Ozempic, Wegovy, Mounjaro – would not exist without a discovery that was first made by an NIH scientist. When people debate the American healthcare system, they often point to the innovations and cutting-edge treatments we’ve pioneered to support the idea that our system, while flawed, is the best in the world. That impression of a world-class system is due almost entirely to the quality and breadth of our university research infrastructure and our medical schools.Private non-profits, like the one I volunteer with, already fund a large amount of medical research. If more university labs start closing, there will be nowhere for this money to go or for this research to be performed. As Dr Kimryn Rathmell, former director of the National Cancer Institute, told the AP: “Discoveries are going to be delayed, if they ever happen.” The result will be both patients and the government spending even more money on emergency and palliative healthcare. That will only benefit the healthcare profiteers Kennedy claims to be going after: pharmaceutical companies, hospital systems and healthcare entrepreneurs such as Brad Smith, who, by some accounts, has been leading Doge’s firings within HHS.My disease isn’t the only one that will be affected by these cuts. Ongoing research has indicated that targeted mRNA vaccines may show promise in preventing or treating Aids and certain types of cancers. The technology is also being studied for its ability to treat cystic fibrosis, heart failure, sickle cell anemia and other genetic birth defects. But scientists working in these areas through the NIH have already been instructed to strike mention of mRNA vaccines from grant applications and materials, perhaps owing to Kennedy’s hostility towards vaccines and his repeated lies about mRNA technology.If the proposed funding cuts and changes at the NIH are allowed to proceed, Kennedy’s mandate to lower chronic disease rates will fail, and his failure will be obvious. We will see it in rising rates of cancer, birth defects, diabetes and other chronic illnesses. We will see it in the exodus of medical experts to other countries, and the collapse of the researcher pipeline in US universities. We will see the quality of our supposed world-class medical system crash as treatments stagnate. We will pay for this cruelty in blood and lives and lost generations.In truth, today’s congenital heart research has arrived too late to save my own life. My future is at the whim of our broken transplant system, itself already showing signs of strain under Kennedy. But I continue championing the work being done because of the hope that future children won’t be consigned to the same fate. The only thing that will have made the suffering I’ve faced worth it is if I’m a part of the last generation to do so.

    Jameson Rich is a writer and film-maker from Massachusetts who covers healthcare and culture More

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    Trump to continue Biden’s court defense of abortion drug mifepristone

    Donald Trump’s administration on Monday pushed forward in defending US rules easing access to the abortion drug mifepristone from a legal challenge that began during Democratic former president Joe Biden’s administration.The US Department of Justice in a brief filed in Texas federal court urged a judge to dismiss the lawsuit by three Republican-led states on procedural grounds.While the filing does not discuss the merits of the states’ case, it suggests the Trump administration is in no rush to drop the government’s defense of mifepristone, used in more than 60% of US abortions.Missouri, Kansas and Idaho claim the US Food and Drug Administration acted improperly when it eased restrictions on mifepristone, including by allowing it to be prescribed by telemedicine and dispensed by mail.The justice department and the office of Missouri’s attorney general, Andrew Bailey, did not immediately respond to requests for comment.Trump said while campaigning last year that he did not plan to ban or restrict access to mifepristone. Robert F Kennedy Jr, the health and human services secretary, told Fox News in February that Trump has asked for a study on the safety of abortion pills and has not made a decision on whether to tighten restrictions on them.Last year, the US supreme court rejected a bid by anti-abortion groups and doctors to restrict access to the drug, finding that they lacked legal standing to challenge the FDA regulations.Those plaintiffs dropped their case after the high court ruling, but US district judge Matthew Kacsmaryk, a Trump appointee, allowed the states to intervene and continue to pursue the lawsuit.The US justice department moved to dismiss their claims days before Trump took office in January.In Monday’s filing, government lawyers repeated their arguments that Texas is not the proper venue for the lawsuit and that the states lack standing to sue because they are not being harmed by the challenged regulations.“Regardless of the merits of the States’ claims, the States cannot proceed in this Court,” they wrote.The three states are challenging FDA actions that loosened restrictions on the drug in 2016 and 2021, including allowing for medication abortions at up to 10 weeks of pregnancy instead of seven, and for mail delivery of the drug without first seeing a clinician in person. The original plaintiffs initially had sought to reverse FDA approval of mifepristone, but that aspect was rebuffed by a lower court.The Republican-led states have argued they have standing to sue because their Medicaid health insurance programs will likely have to pay to treat patients who have suffered complications from using mifepristone.They have also said they should be allowed to remain in Texas even without the original plaintiffs because it would be inefficient to send the case to another court after two years of litigation. More

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

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

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    The United States is witnessing the return of psychiatric imprisonment | Jordyn Jensen

    Across the country, a troubling trend is accelerating: the return of institutionalization – rebranded, repackaged and framed as “modern mental health care”. From Governor Kathy Hochul’s push to expand involuntary commitment in New York to Robert F Kennedy Jr’s proposal for “wellness farms” under his Make America Healthy Again (Maha) initiative, policymakers are reviving the logics of confinement under the guise of care.These proposals may differ in form, but they share a common function: expanding the state’s power to surveil, detain and “treat” marginalized people deemed disruptive or deviant. Far from offering real support, they reflect a deep investment in carceral control – particularly over disabled, unhoused, racialized and LGBTQIA+ communities. Communities that have often seen how the framing of institutionalization as “treatment” obscures both its violent history and its ongoing legacy. In doing so, these policies erase community-based solutions, undermine autonomy, and reinforce the very systems of confinement they claim to move beyond.Take Hochul’s proposal, which seeks to lower the threshold for involuntary psychiatric hospitalization in New York. Under her plan, individuals could be detained not because they pose an imminent danger, but because they are deemed unable to meet their basic needs due to a perceived “mental illness”. This vague and subjective standard opens the door to sweeping state control over unhoused people, disabled peopleand others struggling to survive amid systemic neglect. Hochul also proposes expanding the authority to initiate forced treatment to a broader range of professionals – including psychiatric nurse practitioners – and would require practitioners to factor in a person’s history, in effect pathologizing prior distress as grounds for future detention.This is not a fringe proposal. It builds on a growing wave of reinstitutionalization efforts nationwide. In 2022, New York City’s mayor, Eric Adams, directed police and EMTs to forcibly hospitalize people deemed “mentally ill”, even without signs of imminent danger. In California, Governor Gavin Newsom’s Care courts compel people into court-ordered “treatment”.Now, these efforts are being turbocharged at the federal level. RFK Jr’s Maha initiative proposes labor-based “wellness farms” as a response to homelessness and addiction – an idea that eerily echoes the institutional farms of the 20th century, where disabled people and people of color were confined, surveilled and exploited under the guise of rehabilitation.Just recently, the US Department of Health and Human Services (HHS) announced a sweeping restructuring that will dismantle critical agencies and consolidate power under a new “Administration for a Healthy America” (AHA). Aligned with RFK Jr’s Maha initiative and Donald Trump’s “department of government efficiency” directive, the plan merges the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA) and other agencies into a centralized structure ostensibly focused on combating chronic illness. But through this restructuring – and the mass firing of HHS employees – the federal government is gutting the specialized infrastructure that supports mental health, disability services and low-income communities.The restructuring is already under way: 20,000 jobs have been eliminated, regional offices slashed, and the Administration for Community Living (ACL) dissolved its vital programs for older adults and disabled people scattered across other agencies with little clarity or accountability. This is not administrative streamlining; it is a calculated dismantling of protections and supports, cloaked in the rhetoric of efficiency and reform. SAMHSA – a pillar of the country’s behavioral health system, responsible for coordinating addiction services, crisis response and community mental health care – is being gutted, threatening programs such as the 988 crisis line and opioid treatment access. These moves reflect not just austerity, but a broader governmental strategy of manufactured confusion. By dissolving the very institutions tasked with upholding the rights and needs of disabled and low-income people, the federal government is laying the groundwork for a more expansive – and less accountable – system of carceral “care”.This new era of psychiatric control is being marketed as a moral imperative. Supporters insist there is a humanitarian duty to intervene – to “help” people who are suffering. But coercion is not care. Decades of research show that involuntary (forced) psychiatric interventions often lead to trauma, mistrust, and poorer health outcomes. Forced hospitalization has been linked to increased suicide risk and long-term disengagement from mental health care. Most critically, it diverts attention from the actual drivers of distress: poverty, housing instability, criminalization, systemic racism and a broken healthcare system.The claim that we simply need more psychiatric beds is a distraction. What we need is a complete paradigm shift – away from coercion and toward collective care. Proven alternatives already exist: housing-first initiatives, non-police and peer-led crisis response teams, harm reduction programs, and voluntary, community-based mental health services. These models prioritize dignity, autonomy and support over surveillance, control and confinement.As Liat Ben-Moshe argues, prisons did not simply replace asylums; rather, the two systems coexist and evolve, working in tandem to surveil, contain and control marginalized populations. Today, reinstitutionalization is returning under a more therapeutic facade: “wellness farms”, court diversion programs, expanded involuntary commitment. The language has changed, but the logic remains the same.This moment demands resistance. We must reject the idea that locking people up is a form of care. These proposals must be named for what they are: state-sanctioned strategies of containment, rooted in ableism, racism and the fear of nonconformity.Real public health does not rely on force. It does not require confining people or pathologizing poverty. It means meeting people’s needs – through housing, community care, healthcare and support systems that are voluntary, accessible and liberatory.As budget negotiations in New York continue to drag on – with expansions to involuntary commitment still on the table – and as RFK Jr advances carceral care proposals at the federal level, we face a critical choice: will we continue the long history of institutional violence, or will we build something better – something rooted in justice, autonomy and collective wellbeing?The future of mental health care – and of human dignity itself – depends on our answer.

    Jordyn Jensen is the executive director of the Center for Racial and Disability Justice at Northwestern Pritzker School of Law More