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      We must defend elective abortions, not just the most politically palatable cases | Moira Donegan

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      A Kentucky woman known by the pseudonym Mary Poe recently filed a lawsuit against her state, seeking an abortion for what was once a banal reason: because she wanted one.Poe, who was about seven weeks pregnant at the time of the lawsuit’s filing, has since had an abortion out of state. But her attorneys argue that she still has standing to sue to overturn Kentucky’s two abortion bans – a six-week ban and a separate total ban – arguing that the laws violate the state constitution. This much, at least, is typical: lawsuits challenging abortion bans have sprung up across the country since Dobbs, with women and their families seeking to overturn bans, expand exceptions, or get some compensation from the state for the graphic, distressing, disabling or deadly outcomes that the bans have made them suffer.The US supreme court justices who voted to overturn Roe in Dobbs cited the surge in activist litigation around abortion – a product of conservative investment in anti-choice legal shops – as part of their reason for doing so. Surely this must be a contentious, controversial issue that the federal bench is ill equipped to resolve, the judges from the conservative legal movement reasoned – because look how many complaints the conservative legal movement has filed against it!This rationale was always disingenuous, but it has also been proved flatly wrong: Dobbs has not got the courts out of the abortion business. Instead, lawsuits over abortion have exploded. The anti-choice camp has pounced, seeking to further restrict abortion by banning pills; targeting reproductive rights advocates, abortion funds and sexual health educators; claiming rights for fetuses or embryos; or by asserting that men who father pregnancies have a right to keep women from terminating them.But the pro-abortion rights side has been busy with litigation, too. Women who have been put at great health risk or made to suffer terrible, painful complications as a result of bans brought a class-action lawsuit in Texas. Bans have been challenged over and over again – on religious liberty grounds, on the grounds of state constitutional provisions securing the right to make individual healthcare decisions, under a federal law that guarantees emergency room treatment for patients needing stabilizing care, and under state constitutional clauses guaranteeing liberty, due process and privacy.The Kentucky lawsuit is part of this latter camp. Mary Poe has cited Kentucky’s constitutional guarantees of individual rights to both privacy and self-determination, which she says have been violated by the bans. “I feel overwhelmed and frustrated that I cannot access abortion care here in my own state,” she said in a statement delivered via her lawyers at the American Civil Liberties Union. “I am bringing this case to ensure that other Kentuckians will not have to go through what I am going through, and instead will be able to get the healthcare they need in our community.”This kind of desire for an abortion – the dignified simplicity of it – has been missing from much of the post-Dobbs abortion rights discourse. After the ruling, as trigger bans shot into effect across the country, clinics shuttered their doors, and scared women tried to discern their options, there was no shortage of tragic stories highlighting the brutality, indignity and gendered bigotry of the laws. But as the dust settled and members of the Democratic party, the major reproductive rights advocacy groups and the liberal legal movement surveyed the national scene, a consensus emerged that the face of the mainstream pro-choice movement would be the patient who experienced a medical emergency.Women who had suffered horrific medical complications became lucid, moving and highly sought after tellers of their own stories, explaining how abortion bans has risked their health: Amanda Zurawski, for example, was denied an emergency abortion at 18 weeks, subsequently went into septic shock twice, and one of her fallopian tubes was so scarred that it is now permanently closed, inhibiting her future fertility. Kate Cox was denied an abortion after discovering that her fetus has trisomy 18, a rare genetic condition which is incompatible with life, and which, because of Cox’s own medical history, also endangered her fertility and life.During her presidential run, Kamala Harris ran an ad featuring a woman identified only as Ondrea, who suffered a miscarriage at 16 weeks and was denied the standard care due to her state’s abortion ban. She developed sepsis and almost died. The ad features a shot of Ondrea in a bathroom, staring at her body in a mirror wearing only a sports bra. Her belly bears the scars of the emergency surgery that eventually saved her life – the surgery that she never would have had to have if it weren’t for the ban.It does not diminish these women’s bravery, their suffering, or the wrongness of what was done to them to say that they are only one small fraction of those who need abortions in America. These are married, middle-class women with wanted pregnancies; Zurawski and Cox are both white. Cox has spoken movingly about her hopes to meet her future child, a girl; in the ad that features Ondrea, she and her husband hold a baby blanket. These are women whose suffering at the hands of abortion bans has nothing to do with a refusal or distaste for heterosexual, married, middle-class life. Their suffering can be made visible precisely because they are so acceptable.Not so with Mary Poe. Poe may well be married, middle-class and white; from her statement, in which she talks about the difficulty of finding childcare, we can infer that she, like most abortion patients, is already a mother. But Poe is not suffering a physical emergency; she is not enduring any pain or medical misfortune that she can use to purchase social license. She is not, in other words, a woman whose claim to an abortion is based on a plea for mercy. She is merely a woman who seeks to be in control of her own life, one who believes that things like privacy and self-determination apply to her, too.“I have decided that ending my pregnancy is the best decision for me and my family,” Poe writes in her public statement. “This is a personal decision, a decision I believe should be mine alone, not made by anyone else.”This was not always a radical proposition. But in the post-Dobbs world, it has sadly become one.

      Moira Donegan is a Guardian US columnist More

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      Biden must Trump-proof US democracy, activists say: ‘There is a sense of urgency’

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      The skies above the White House were cold and grey. Joe Biden greeted the championship winning Boston Celtics basketball team, quipping about his Irish ancestry and tossing a basketball into the crowd. But the US president could not resist drawing a wider lesson.“When we get knocked down, we get back up,” he said. “As my dad would say, ‘Just get up, Joe. Get up.’ Character to keep going and keep the faith, that’s the Celtic way of life. That’s sports. And that’s America.”Such events continue to be among the ceremonial duties of a “lame duck” president with waning influence. Biden has cut a diminished figure in recent months, first surrendering his chance to seek re-election, then finding himself sidelined by the doomed presidential campaign of his vice-president, Kamala Harris.But with his legacy imperiled by Donald Trump, the president is facing calls to mitigate the oncoming storm. Advocacy groups say Biden, who turned 82 this week, can still take actions during his final two months in office to accelerate spending on climate and healthcare, secure civil liberties, and Trump-proof at least some fundamentals of US democracy.Trump’s signature campaign promise was a draconian crackdown on illegal immigration. He has nominated officials including Tom Homan and Stephen Miller, architects of family separations at the southern border during his first term, and vowed to use the US military to carry out mass deportations of undocumented immigrants.The plans include mandatory detention, potentially trapping immigrants in inhumane conditions for years as they fight deportation. The American Civil Liberties Union (ACLU) is leading an opposition effort, urging Biden to halt the current expansion of Immigration and Customs Enforcement (Ice) detention facilities, especially those with records of human rights abuses.Eunice Cho, a senior staff attorney with the ACLU national prison project, said Ice detention facilities “characterised by abusive conditions, pervasive neglect and utter disregard for the dignity of people in their custody” are key to Trump’s logistical plan.Dozens of people have died in Ice detention facilities – mostly owned or operated by private prison corporations – over the past four years, according to the ACLU, and 95% were likely preventable if appropriate medical care had been provided. Yet the Biden administration has backed new Ice detention facilities in states where they did not existed before, such as Kansas, Wyoming and Missouri.“We are calling on the Biden administration to take action now, in the final days of the administration, to halt any efforts to expand immigration detention and to shut down specifically abusive facilities once and for all,” Cho told reporters on a Zoom call this week. “We don’t need to put down runway for the Trump administration to put in place these mass detention and deportation machines.”She warned: “We know that the anti-immigrant policies of a second administration are going to be far more aggressive than what we saw in the first term, and mass arrest and detention is going to become perhaps the norm to create and carry out these deportation operations unless we can do all we can to put a halt to them.”View image in fullscreenAnother crucial area for Biden to make a last stand is criminal justice. In his first term, Trump oversaw the execution of more people than the previous 10 presidents combined. Biden’s attorney general, Merrick Garland, then imposed a moratorium on federal executions in 2021.Trump has indicated his intention to resume such executions and even expand the death penalty. His nominee for attorney general, Pam Bondi, issued a public apology in 2013 while serving as Florida’s top law enforcement officer after she sought to delay the execution of a convicted killer because it conflicted with a fundraiser for her re-election campaign.Cassandra Stubbs, director of the ACLU’s capital punishment project, told reporters via Zoom that Trump said “he will work to expand the death penalty. He’s going to try to expand it to people who do not even commit killings. He’s called for expanding the death penalty to his political opponents.“But perhaps most dangerously in Project 2025 [a policy blueprint from the Heritage Foundation thinktank] – and we believe every word of it is this – he promised to try to kill everyone on death row, and the reason why we have to believe this and take it so seriously is the record that Donald Trump left where he, in a span of six months, carried out 13 executions.”The ACLU and other groups are therefore pressing Biden to commute the sentences of all individuals on federal death row to life in prison, fulfilling a campaign promise and preventing potential executions under Trump. Commuting “is really the thing that Biden can do to make it harder for Trump to restart executions”, Stubbs added.Pastor Brandi Slaughter, a board member of the pressure group Death Penalty Action, told reporters this week: “We know what the next president plans to do if any prisoners are left under a sentence of death under the Biden administration. We’ve been there, we’ve done that.”Biden has also received 8,000 petitions for clemency from federal prisoners serving non-death penalty sentences that he could either reduce or pardon. The former senator has long been criticised for his role in drawing up a 1994 crime law that led to the incarceration of thousands of Black men and women for drug offences.This week, members of Congress including Ayanna Pressley and James Clyburn led 64 colleagues in sending a letter to Biden urging him to use his clemency power “to reunite families, address longstanding injustices in our legal system and set our nation on the path toward ending mass incarceration”.They were joined at a press conference on Capitol Hill by Maria Garza, 50, from Illinois, a prison reform advocate who spent 12 years in a state prison. She said in an interview: “There is a sense of urgency because a lot of the people that are sitting waiting for clemency are people that have de facto life sentences that will die in prison if they don’t [receive clemency]. A lot of their unjust sentencing was because of the 1994 crime bill that he was the founding father of.”skip past newsletter promotionafter newsletter promotionMitzi Wall, whose 29-year-old son Jonathan is incarcerated on a seven-and-a-half-year federal cannabis charge, called on Biden to keep a campaign promise to grant clemency to more than 4,000 people in federal prison for nonviolent cannabis crimes.“We voted for President Biden,” she said. “He gave us hope and we’re asking him to do nothing more than keep his promise.”Wall, 63, from Maryland, added: “President Biden was partly responsible for writing the 1994 crime bill that thrust families into abject poverty and pain. I know he feels bad about that and he can right that wrong with the power of the pen. I’m appealing to him as a father whose son [Hunter] could very possibly be going to prison.”In other efforts to protect civil liberties, the ACLU is recommending a moratorium on all federal government purchases of Americans’ personal data without a warrant. It is also asking Congress to pass the Fourth Amendment Is Not for Sale Act to prevent potential abuse of surveillance technologies under the Trump administration.Meanwhile, Trump has pledged to rescind unspent funds in Biden’s landmark climate and healthcare law and stop clean-energy development projects. White House officials are working against the clock to dole out billions of dollars in grants for existing programmes to minimise Trump’s ability to rescind or redirect these funds. Earlier this month, the transportation secretary, Pete Buttigieg, announced more than $3.4bn in grants for infrastructure projects across the country.Wendy Schiller, a political science professor at Brown University in Providence, Rhode Island, notes that Trump will have the power of impoundment to stall the money flowing out of the government and can order rescissions to programmes funded by Congress.“The singular thing that Joe Biden can do is expedite the flow of federal dollars in all the programmes,” Schiller said.“Any money that is supposed to leave the treasury to go to schools, food safety, environmental protection – anything that is not yet distributed needs to get distributed. It’s like emptying literally the piggy bank before you go on a trip. President Biden needs to be literally getting as much money out the door in the hands of state, local and community organisations as he can.”Another priority for the White House is getting Senate confirmation of as many federal judges as possible, given the potential impact of the judiciary in challenging Trump administration policies. The Marshall Project, a non-profit news organisation, noted: “Federal judges restricted hundreds of Trump administration policies during his first term, and will likely play a significant role in determining the trajectory of his second.”Senate Republicans forced numerous procedural votes and late-night sessions this week in attempt to stall confirmations. Eventually a deal was struck that will bring Biden within striking distance of the 234 judicial confirmations that occurred in Trump’s first term – but four of Biden’s appellate court nominees will not be considered.The outgoing president could also engage with Democratic-led states and localities to bolster protections and establish “firewalls” against Trump’s agenda, particularly in areas such as immigration. These collaborations could involve reinforcing sanctuary city policies and providing resources to states that are likely to face pressure from the Trump administration.Chris Scott, former coalitions director for Harris, said: “What will be interesting is how or what can President Biden to work with states, especially where we have Democratic leadership in place, to be able to brace themselves and arm themselves with more protection. We already have places like a Michigan or Illinois where you have governors vowing to make sure that they have protections – even in the Trump presidency.”As Barack Obama discovered before handing Trump the keys to the Oval Office in 2017, however, lame duck presidents can only do so much. Trump will come into office with a flurry of executive orders, a supportive Congress and fewer guardrails than the first time around.Bill Galston, a former adviser in the Bill Clinton administration, said: “On January 20 Donald Trump will control all the instruments of government and, at that point, it’ll be up to the courts – and public opinion – to restrain him.” More

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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

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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