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

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

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

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

      Moira Donegan is a Guardian US columnist More

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

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

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      Incoming Trump presidency threatens millions of Americans’ healthcare plans

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

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

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

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

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      How a rightwing machine stopped Arkansas’s ballot to roll back one of the strictest abortion bans

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      Theresa Lee was 22 weeks pregnant last year when her doctor confirmed the news: she had no amniotic fluid and the baby she was expecting, who she had named Cielle, was not growing.In many states across the US, Lee would have been advised that terminating the doomed pregnancy was an option, and possibly the safest course to protect her own life.But in the state of Arkansas, Lee was told she had just one choice: wait it out.A doctor who had confirmed the diagnosis was apologetic but insistent: the state’s laws meant he could be fined or jailed if he performed an abortion. In the wake of the US supreme court’s 2022 decision to overturn Roe v Wade, Arkansas activated a so-called trigger law that made all abortion illegal except if a woman was in an acute medical emergency and facing death. There are no other exceptions: not for rape victims, minors or fatal fetal anomalies.For the next five weeks, on a weekly basis, doctors knew Lee – already a mother to one-year-old Camille at the time – was at risk because she had placenta previa, which could cause bleeding and death. But she returned regularly to her OB-GYN’s office to be scanned, waiting to hear if Cielle’s fetal heartbeat had stopped.“I was having to prepare for if I passed. Me and my husband had to have a lot of really tough conversations about all the outcomes, just to prepare in case I wasn’t going to be there for my husband and my daughter,” she said.Lee never seriously considered leaving the state to get an abortion because the cost seemed exorbitant, childcare would be an issue, and she was uncertain about whether she could face criminal charges once she came home. None of her doctors ever suggested it, either.“I would have had an abortion, 100%. I am very much a realist. I knew she was going to pass. Having to carry her week after week and knowing she was going to pass, it was a horrific waiting game,” she said.Once Cielle stopped moving, and no fetal heartbeat was detected, she traveled three hours to the UAMS hospital in Little Rock from her home in Fort Smith because doctors thought delivering at the larger hospital would be safer in case of complications.There, she was induced and delivered a stillbirth. Luckily, the labor proceeded without any incident.“When I came in they had blood ready just in case. I remember seeing it out of the corner of my eye,” Lee said.The delivery room seemed prepared especially for women like Lee. She saw signs on the wall that said her baby was in heaven.When she was told the cost of transferring Cielle’s remains back home would be more than $1,000, she opted to take her in her car by herself. She held the casket in her arms the whole way.A chance for changeVoters in 10 states will cast ballots next week to expand their state’s abortion protections or maintain the status quo. Arkansans won’t be among them.But for seven weeks this summer, it looked like Arkansas voters would have an opportunity to change the state’s constitution to roll back one of the strictest abortion bans in the country.There are few places in the US where it is more dangerous to be a pregnant woman than in Arkansas. The state had the worst maternal mortality rate in the country, according to data collected by the CDC from 2018-2021. It showed that about 44 mothers die for every 100,000 live births. An Arkansas maternal mortality review board, which reviews such data, found that 95% of pregnancy-related deaths in that period were considered preventable. The Guardian’s reporting has not identified specific cases in which the state’s ban on abortion has led directly to a death, but abortion rights advocates believe the risks are high.In July, a dedicated network of about 800 grassroots organizers in Arkansas had collected the necessary signatures to get a measure on the 5 November ballot that – if passed – would have changed Arkansas’s constitution to protect the right to abortion for any reason up to 18 weeks of pregnancy. It also would have legalized exceptions for abortion after 18 weeks, including in cases involving rape, incest, fatal fetal anomalies, and life and health of the mother.It would have saved a woman like Lee from facing potentially fatal outcomes, and emotional and financial distress.View image in fullscreenThe measure did not provide the same rights that existed under Roe – which protected abortion until viability, or around 24 weeks – a fact that organizers said kept national organizations like Planned Parenthood and the ACLU from getting involved in the effort. But organizers believed that it was a measure that even conservative voters would support. After all, voters in neighboring Kansas, another Republican stronghold, overwhelmingly voted to protect abortion rights when its ballot was put to voters in a referendum in 2022.To the dismay and shock of the grassroots organizers, however, the Arkansas initiative was ultimately quashed before it ever reached voters. A paperwork error by organizers prompted a legal challenge by Arkansas’s secretary of state, John Thurston, who rejected the abortion amendment. On 22 August, the Arkansas supreme court upheld his decision.For Arkansas women, there is no end in sight.A Guardian investigation into the ballot’s demise tells a more complicated story than just a bureaucratic screw-up, revealing a confluence of rightwing actors working in parallel to ensure it never got to voters: a reclusive donor who has helped shape the anti-abortion movement across the US; the inner circle of the Arkansas governor, Sarah Huckabee Sanders, who has proclaimed Arkansas “the most pro-life state in the country”; and judges who are supposed to be non-partisan but are deeply aligned with the state’s Republican party.“Everyone knew there was going to be a pretty organized and well-funded effort to keep it off the ballot, said Ashley Hudson, a rising Democratic star who represents west Little Rock in the Arkansas state legislature. “Is it collusion, directly? I don’t know. But I think there are a lot of people with aligned interests.”Changing the rulesThe atmosphere was euphoric on 5 July 2024 when grassroots organizers and activists marched into the domed capitol building in Little Rock armed with dozens of boxes of signed petitions. They had accomplished the seemingly impossible: collecting more than 100,000 signatures across 50 counties in Arkansas in support of getting the abortion rights measure on November’s ballot.For grassroots organizers like Kristin Stuart, the effort had been all consuming. Stuart had previously worked as an escort at Little Rock’s only surgical abortion clinic, helping patients get through the throng of protesters who were usually assembled outside. The clinic no longer performs abortions but is used as resource center for women looking for financial support or information about how to get abortion pills from out of state.She was motivated to try to change the state’s constitution because she believed the ban was deeply unjust. Stuart was particularly incensed by circumstances that are especially dire for poor women and children in Arkansas, like the fact that it remains the only state in the nation that has not expanded postpartum Medicaid coverage to give poor women health insurance for a year after they give birth.“There was a small group of us that worked it like it was a full time job,” she said. The campaign, led by Arkansans for Limited Government (AFLG), divided the state into 50 clusters. There were cluster leaders and county leaders. Volunteers were trained three times a week. For a signature to be valid, they needed a person’s name, address, birth date, the date they signed and city. They also had to make sure the signer was a registered voter.“We knew we had to be perfect. We knew we had to do everything correctly, because they would be looking for anything to disqualify it,” Stuart said.They sometimes faced harassment, including protesters who could be “loud and mean and scary” who tried to stop people from signing, Stuart said. There were moles in chat and message groups where hundreds of volunteers were communicating. Sometimes the locations where canvassers were planning to collect signatures would be published ahead of time by Arkansas Right to Life, the state’s leading anti-abortion group. Organizers had to adjust the ways they communicated to adapt.But what volunteers discovered, said Lauren Cowles, was that there were “blue dots” in even the reddest counties of the state.View image in fullscreen“We found people who were desperate to connect. There are a lot of people out there who believe women should have the right to choose,” Cowles said. Voters were also being educated. Many did not understand that the total ban did not include any exceptions, including for rape.“There were many months when I did not believe we could get enough signatures. The last few weeks before the deadline, we saw such a surge of urgency,” Stuart said.Hudson, the Democratic legislator, believes the Republican effort to stop the measure from succeeding began in 2023, when Republicans first proposed an amendment to the Arkansas constitution that would make it significantly more difficult to get a constitutional amendment on the ballot. Instead of calling for signatures to be collected from at least 15 counties, as is stated in the Arkansas constitution, Republicans wanted to increase the number to 50 counties. Voters rejected the proposal in a referendum. But the Republican legislature passed a law to that effect anyway.“That was done in anticipation of a ballot like this,” says Hudson. It was a difficult challenge but organizers got the signatures they needed. In a move that would later prove to be a fatal flaw, leaders hired paid canvassers in the final weeks of the campaign to help get the petitions over the line.The chicken tycoonRonnie Cameron, a poultry billionaire from Arkansas, is one of the most important rightwing power players you’ve never heard of. While Republican megadonors like Harlan Crow, Charles Koch and Dick Uihlein have become well known as big conservative donors, Cameron, a conservative evangelical Christian, has shied away from the spotlight, even as he has donated tens of millions of dollars to anti-abortion causes nationwide.According to public records, Cameron was the largest single donor in the fight against the abortion amendment, giving about $465,000 to groups that fought the initiative. This included $250,000 to a group called Stronger Arkansas, which was formed to fight the petition as well as a separate ballot initiative that would have increased rights to medical marijuana.Stronger Arkansas was run by Chris Caldwell, a consultant who is Sanders’s closest political adviser and served as her campaign manager in 2022. Two other officials with close ties to Sanders served as vice-chair and treasurer of the group.View image in fullscreenCameron, the chairman of the chicken company Mountaire Farms, also donated about $215,000 to Family Council Action Committee 2024, a group formed by Jerry Cox, the conservative head of the Arkansas Family Council, which is staunchly anti-abortion. The conservative advocacy group was accused in June 2024 of using intimidation tactics when it published a list of names of paid canvassers who were working on the abortion petition. The names were obtained after the Family Council obtained them via a freedom of information request.AFLG said in a statement at the time that the publication of canvassers’ names put its team at great risk for harassment, stalking and other dangers.“The Family Council’s tactics are ugly, transparently menacing, and unworthy of Arkansas. We won’t be intimidated,” it said.In a 2020 New Yorker report by the investigative journalist Jane Mayer, Cameron was described as a reclusive businessman who had donated $3m to organizations supporting Trump’s candidacy in 2016. The report found that Trump had weakened federal oversight of the poultry industry even as he accepted millions of dollars in donations from Cameron and other industry figures. Cameron, whose grandfather founded Mountaire, also served on Trump’s advisory board on the pandemic’s economic impact.Cameron and his wife, Nina, reportedly attend Fellowship Bible church, which the New Yorker called a hub of social conservatism that lists condemnation of homosexuality as a key belief. Cameron also founded the Jesus Fund, and is a funder of both that private group and another called the Jesus Fund Foundation. According to public records, the Jesus Fund has donated $159m over the last decade to the National Christian Foundation, a highly influential multibillion-dollar charity that is considered the largest single funder of the anti-abortion movement.View image in fullscreenAccording to Opensecrets, Cameron and his wife are considered the 28th largest contributors to outside spending groups in this election cycle. One of the biggest beneficiaries of the couple’s donations is the Arkansas Republican senator Tom Cotton, who has called for fetuses to be given constitutional rights. Cameron also donated $1m to the pro-Trump Super Pac Make America Great Again Inc in July.Nina Cameron was reached by the Guardian at her home but she declined to answer questions about her political activity.A spokesperson for Mountaire did not respond to the Guardian’s request for comment. A spokesperson for the Family Council did not respond to a request for comment.A staple and a photocopyFive days after grassroots activists celebrated their milestone on 5 July, reality hit.Thurston, Arkansas’s secretary of state, who had participated in the state’s March for Life, an anti-abortion rally on state grounds, and had won the endorsement of Arkansas Right to Life in 2022, challenged the legality of the petition. In a claim that would be hotly contested, Thurston said AFLG had not submitted the documents that were required to name the paid canvassers and confirm they had been properly trained. He rendered 14,143 signatures they had collected in the final stretch invalid, leaving the final count at 88,000. They were a few thousand short of the 90,704 they needed under Arkansas’s legal requirements. Thurston offered no “cure period” for organizers to fix the issue. Abortion was off the ballot.Thurston seemed to be quibbling over a staple and a photocopy: AFLG had already submitted the required paperwork related to training a week earlier, but it should have stapled a copy of it to the petition it submitted on the due date.Privately, some grassroots organizers seethed at what they saw as an unforgivable mistake by AFLG leaders following a grueling campaign. Others say that even if the paperwork had been perfect, Thurston would have found another issue to challenge.In legal briefs and statements, AFLG argued that the 2016 secretary of state had counted signatures for other ballot measures even after those organizers failed to submit some paperwork. Thurston’s personal views on abortion, they said, meant he was discriminating against them. They also claimed that they had been verbally assured by Thurston’s assistant director of elections, Josh Bridges, that their paperwork was in order.Sarah Huckabee Sanders seized on the decision. In a post on X, the governor posted a photograph of Thurston’s letter and wrote “the far left pro-abortion crowd in Arkansas showed they are both immoral and incompetent”.Then the matter went to court.The judgesJudges in Arkansas are supposed to be non-partisan. But when Sanders announced in June 2023 that Cody Hiland, a former US attorney who served as the head of the Arkansas Republican party, would be appointed to the state’s supreme court following a vacancy, she boasted that her pick would give Arkansas a “conservative majority” for the first time.“I know it will have the same effect on our state as it has had on our country,” she said at the time, in a reference to the US supreme court.View image in fullscreenHiland would become one of four justices to strike down the abortion amendment on 22 August. The majority decision, written by the justice Rhonda Wood – who counts Ron Cameron’s Mountaire as one of the largest individual donors to her election campaign and had months earlier been endorsed by Arkansas’s state Republican party – found that Thurston had “correctly refused” to count the signatures by paid canvassers because the organizers had failed to file the necessary training certificate.The August ruling faced strong criticism, including from an unlikely source: a Washington DC lawyer named Adam Unikowsky, a parter in the supreme court practice at Jenner & Block, and former law clerk to the late conservative supreme court justice Antonin Scalia.“The Arkansas Supreme Court’s decision is wrong,” Unikowsky wrote in a lengthy post on his legal newsletter. The majority’s decision, Unikowsky wrote, said that the allegedly missing paperwork had to be stapled to the organizers petition. Except, he said, Arkansas law does not say that.The three dissenting judges made the point in their dissent, saying Thurston had “made up out of whole cloth” that such a requirement existed. The dissenting judges said the majority’s endorsement of Thurston’s rationale was inexplicable.View image in fullscreenWhen AFLG argued that it had relied on Thurston’s office’s alleged verbal assurance that their paperwork was in order, the court rejected the argument in their majority opinion saying his comments did not change the law.Unikowsky also argued that Arkansas law made it clear that AFLG should have been offered time to correct its mistake. “Taking a step back, I have to dwell on the injustice of it all. Arkansans are being disenfranchised,” he wrote. He also noted that conservative groups who had made similar errors in their own ballot initiatives had not faced pushback.Sanders celebrated the supreme court’s ruling. “Proud I helped build the first conservative supreme court majority in the history of Arkansas and today that court upheld the rule of law, and with it, the right to life,” she said.The governor has long made touting the state’s so-called “pro-life” stance a priority. In March 2023 she signed a bill to create a “monument to the unborn” near the Arkansas state capitol.Shortly after the judges’ made their decision, the Pike county Republican committee issued a flyer for a political event in October. It featured a picture of Wood, the justice, alongside Thurston. They were both scheduled to appear at the Republican event. Wood reportedly “panicked” over the flyer and had the Republicans remove her picture but still planned to attend.Organizers say they will probably try again in 2026. Sanders will also be up for re-election that year.‘There is no way we can stay here’Looking back, Danielle – an Arkansas resident – realized she had eloped and closed on a house in Little Rock in June 2022, in the same week that Roe fell. A native of Philadelphia, Danielle (who asked the Guardian not to use her last name) and her husband, a doctor, moved to Arkansas so that he could work in underserved communities.They tried to conceive for months before turning to IVF. Danielle quit her job and commuted back and forth to Texas to receive treatment – her options were limited in Arkansas – and ultimately got pregnant. She was 18 weeks pregnant when a routine scan revealed that there was no fluid around the fetus, which also had no kidneys and no stomach. The pregnancy was not viable, even though the fetus had a heartbeat.When she was told by her doctor in Arkansas that her only option after the Dobbs decision was carrying the pregnancy to term, she and her husband knew they needed to find another solution. Even her IVF doctor in Texas urgently advised her to terminate the pregnancy. If she ended up needing a C-section during labor, it would take a long time before she would be physically ready to try again, he said.View image in fullscreen“My husband and I scrambled and got the earliest appointment in the closest place we could, which was in Illinois,” Danielle says. It was a six-and-a-half-hour drive and a two-day medical procedure. They stayed in a hotel for two nights.Danielle knows she was relatively fortunate to have the means to leave the state, unlike many women in Arkansas who lack resources. She and her husband also understood her life was at risk, even though it was never made explicitly clear. Her local hospital had only offered “palliative care” for the fetus, which meant scans every two-three weeks to check on its fetal heartbeat – not the kind of care Danielle knew she would need to avoid the risk of becoming sick and septic.After terminating her pregnancy in April 2024 and returning to Arkansas, Danielle got involved in the grassroots effort to collect signatures for the abortion ballot initiative. She remembers how one protester called her a “murderer” for collecting signatures. The person doing the shouting was an anesthesiologist she recognized who had attended one of her husband’s lectures and worked at the UAMS hospital in Little Rock.She went to the statehouse when the signatures were turned in, full of hope. She was photographed by a friend that day holding a sign that read: “I deserved better.”“We felt so accomplished when we turned those in. I was so excited. I felt very triumphant. We did this in a state where it’s really hard to do,” she said.When the supreme court of Arkansas ruled against them, Danielle knew she would have to leave. Then she became pregnant again with the one IVF-created embryo she had left.View image in fullscreen“I said there is no way we can stay here and my husband agreed. It’s not a safe place for me to be,” she told the Guardian. “We cannot raise a daughter here.”There were things about life in Arkansas – like their nice home – that she loved. But now they are moving back to Philadelphia.“I think I was naive moving from a big city where I never would have thought twice about what I could do with my own body. It’s a shame. It’s so sad.”Theresa Lee, the woman who was forced to deliver a stillbirth, echoed Danielle’s disappointment. “You want to believe that we as citizens have a chance at voting for what we believe in, but with the precedent set by the supreme court in the state of Arkansas, it’s clear we don’t,” she said.“I do not desire to have another pregnancy in Arkansas. I don’t feel safe and I don’t feel cared for as a woman in our state. What happened to me can happen to any woman and it has. Arkansas is a dangerous place to be pregnant.” More

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      ‘One death is too many’: abortion bans usher in US maternal mortality crisis

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      In Louisiana, doctors will no longer be able to carry a lifesaving medication with them during pregnancy emergencies. In Texas, the infant mortality rate is soaring. In Idaho, pregnant people drive hours just to give birth. And in Oklahoma and Georgia, women are bleeding out in hospital parking lots and facing dangerous infections before they can find care – and sometimes, that care comes too late.The limitations and outright bans on abortion that have taken hold in half of the US in the wake of the Dobbs decision have wreaked enormous changes to the reproductive health landscape.The restrictions put a growing burden on the health and wellbeing of patients and providers, even as more Americans find it difficult to find and access care.“The United States is, and has been for quite some time, in the midst of a maternal and infant mortality crisis,” said Dr Jamila Perritt, a board-certified obstetrician and gynecologist and president of Physicians for Reproductive Health.Banning access to reproductive healthcare, including abortion care, is “directly causing an increase in morbidity and mortality in our community”, she said. “We have really robust evidence that shows us that when people have sought abortion care and are unable to obtain it, their psychological, social, physical and emotional health is harmed.”Maternal and infant mortality will probably increase because of the restrictions – especially if national limitations, like enforcement of the Comstock Act, are put into place.“I expect in the next few years, we’re going to start to see the infant mortality, pre-term birth, maternal mortality, and maternal morbidity numbers rise for everyone, and particularly for folks from racially marginalized and low-socioeconomic communities,” said Rachel Hardeman, professor of reproductive health and founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota.Calculating mortality is often a complicated and controversial endeavor. When maternal mortality dropped in 2022, anti-abortion advocates credited the success to the Dobbs decision.But that’s not the case, according to new research in Jama Network Open.Maternal deaths surged during the first two years of the pandemic, when Covid, a deadly illness during pregnancy, accounted for one-quarter of all maternal deaths. But in 2022, that rate dropped to levels similar to pre-pandemic levels, from 32.9 deaths per 100,000 live births in 2021 to 22.3 in 2022.That rate is still higher than maternal mortality rates in peer nations, and research indicates it will increase if officials clamp down on abortion nationally – which, with the Comstock Act, would require no additional anti-abortion legislation or bans.Right now, “people can still travel to other states, but once there’s a federal ban, that won’t be an option any more,” says Amanda Jean Stevenson, co-author of the new Jama research and a sociologist at the University of Colorado Boulder. “And there could be this very different set of outcomes when people’s options are gone.”In the United States, more than 80% of pregnancy-related deaths and more than 60% of infant deaths in the first week are preventable – and those figures were estimated before the Dobbs decision.Because of abortion restrictions, there are already significant challenges to accessing reproductive healthcare – and it’s not just abortion care.In Louisiana, misoprostol – a drug used for medication abortion and other lifesaving purposes – will be labeled a controlled substance beginning on 1 October. One of its uses is keeping patients from bleeding out after childbirth, which is the No 1 cause of postpartum mortality.Yet physicians cannot keep controlled substances in their emergency carts, and they fear they won’t have enough time to fill prescriptions for patients when minutes and even seconds make the difference between life and death.In the year following Texas’s abortion ban, child mortality shot up by 12.9% – compared with a 1.8% increase in the rest of the country, according to a recent study. Congenital anomalies are the leading cause of infant death in the US – but while they went down by 3.1% in the rest of the country, they went up by 22.9% in Texas.“That study was chilling. That is a huge change,” Stevenson said.It echoed previous research finding that states with the most restrictive abortion laws saw 16% more infant deaths between 2014 and 2018.The trauma and costs of carrying to term pregnancies that are incompatible with life inflict an incalculable toll on families and providers.States are closing obstetric units and losing experienced providers who worry about not being able to offer lifesaving care as patients die on the table in front of them, and facing jail time if they provide care.More than two-thirds (68%) of obstetricians and gynecologists say the Dobbs decision has made it harder for them to respond to pregnancy-related emergencies, according to the non-partisan health research organization KFF. They also believe it has worsened mortality in pregnancy while increasing racial and ethnic inequities, and fewer doctors are now interested in entering the field.In 2022, soon after the Dobbs decision, medical residency applications dropped for states with bans.More than half of doctors surveyed in states with bans and limitations said they were very concerned about legal repercussions to providing the standard of care in pregnancy.“That can just exacerbate already pretty large gaps in the workforce,” said Usha Ranji, associate director for women’s health policy at KFF.In the past two years, more than 100 hospitals have closed their obstetric units entirely, according to a new March of Dimes report. More than one-third of US counties are now maternity care deserts, with no obstetricians or places to give birth. North Dakota, South Dakota, Alaska, Oklahoma and Nebraska have the least access to maternity care.The majority of rural hospitals (57%) no longer deliver babies, with more than 100 of the rural hospitals ending labor and delivery services in the past five years.“We’ve created policy and legislation to limit access to abortions and also have closed the exact places that people need to go to get care if they are pregnant,” Hardeman said. That puts pressure on neighboring states that still provide care, she said.“Where you live matters for your health. And I think that the Dobbs decision and the fall of Roe have demonstrated that in a very real and very obvious way, because there are literally places in this country where there is essentially no access to reproductive healthcare,” she said.“It started out in rural spaces, but more and more, there’s reports popping up of labor and delivery units closing in, like, urban Chicago.”In states with restrictions on abortion, women of color and pregnant people from low-income communities often suffer the most, said Hardeman. “Taking away access to reproductive healthcare is exacerbating those disparities.”Black women die because of pregnancy at twice the national rate, and three times more than white women, according to the US Centers for Disease Control and Prevention.“The fact that black women and birthing people are dying at three to four times greater risk than white women is shameful – and it’s preventable,” Perritt said.It’s important to shore up protections for reproductive health for all Americans before health complications and mortality rise even more, she said. “One death is too much. One is too many.” More

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      Kamala Harris should launch a national campaign to end the US diabetes epidemic | Neil Barsky

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      Before addressing the political opportunity in front of the vice-president, let us first confront the sacred cow in the room.Contrary to recent claims by Donald Trump, JD Vance and Ted Cruz, Kamala Harris loves a good cheeseburger; she positively does not want to take our red meat away. She has cited sugars and sodas as major culprits in our poor health. Moreover, the Biden-Harris administration has demonstrated that it is unafraid to challenge the stranglehold the pharmaceutical industry has over insulin prices, and the cost that industry charges Medicare patients for drugs.Next, let’s dispense with the false narrative that Trump and his acolyte Robert F Kennedy Jr, have the capacity to “make America healthy again.” As part of RFK Jr’s recent endorsement, Trump vowed to appoint “a panel of top experts, working with Bobby, to investigate what is causing the decades-long increase in chronic health problems …” Kennedy, whose anti-vaccine work is more likely to make America have measles again, has recently become the darling of many metabolic health advocates for his series of half-truths about America’s obesity epidemic.Let’s not be fooled. To paraphrase Harris, these are not serious people, and the consequences of putting America’s healthcare in their hands would be deadly.I happen to live with type 2 diabetes, and have spent the past year chronicling the ways one of the country’s most lethal, expensive and ubiquitous diseases is actually reversible through a diet low in carbohydrates – the macronutrient that diabetics like me cannot safely metabolize without the help of drug therapies. Nutrition in America has become quite politically polarizing, as shaky science often collides with ideology, leaving us at a loss to know why we get fat, why we get sick, and even whether red meat causes diabetes (it doesn’t). Our healthcare budget is $4tn a year, yet our life expectancy is only 48th in the world, and we seem to be getting heavier and sicker. Something is terribly wrong.In this abyss lies a golden opportunity for presidential candidate Harris to present a healthcare agenda that would save thousands of lives, billions of dollars, as well as her appeal to voters in conservative states. She can do what no president has ever had the courage to do before: launch a national campaign to reverse America’s diabetes epidemic and, in the process, improve our metabolic health. She might even declare the destructive disease a national emergency.This initiative would be both good policy and good politics, and it is not as quixotic as it might first sound. Type 2 diabetes is a condition where the hormone insulin does not naturally function properly, leading to high blood sugars, and leaving its victims at risk of cardiovascular, kidney, eye and other disease. Currently, 38 million American adults have diabetes, while another nearly 100 million more have pre-diabetes – or more than a third of adult Americans. At $420bn per year, it is one of America’s costliest diseases, accounting for over 10% of the country’s $4tn annual healthcare budget. It kills over 100,000 Americans annually, more than die of opiate overdoses.And while it is true that people of color are more likely to get diabetes than white people, it is also the case that, like the opiate crisis, diabetes is a color-blind disease that has disproportionately ravaged red state America. In fact, 14 of the 15 states with the highest diabetes mortality rates voted Republican in 2020. And 14 of the 15 states with the lowest mortality rates voted Democratic in 2020.What form should a Harris initiative take? Here are my personal recommendations, based on my own experience with the disease, and a year’s worth of interviewing well over 100 researchers, clinicians, advocates and patients. Frankly, it is baffling that this disease – which is killing us widely, breaking our budget and reversible through diet – is not yet a matter of national urgency.1. First, she should announce her intention to appoint a diabetes czar whose job, among other things, would be to solve this puzzle – over the past quarter-century, America’s pharmaceutical and medical technology industry have made extraordinary strides developing various forms of insulin and other drugs, continuous glucose monitors and test strips. So why have seven times more Americans been diagnosed with diabetes than in 1980? Eventually commonsense solutions would emerge, such as restricting cereal companies’ ability to market their sugary treats to children.Not only would the czar be empowered to confront things like the scandalous $1bn-plus in sugar subsidies provided by US taxpayers, she would explore common-sense treatments for treating diabetes that are diet and lifestyle-focused. (A good place to start would be the excellent 2024 book Turn Around Diabetes, written by endocrinologist Roshani Sanghani.)2. We must defund, disqualify and otherwise delegitimize the American Diabetes Association (ADA). As I have written, the ADA has become a virtual branch of big pharma and big food. Yet it sets standards of care for clinicians and de-emphasizes mountains of evidence that the low-carbohydrate diet is a powerful tool in reversing the disease. Frankly, it is mind-boggling that the world’s most powerful diabetes-fighting organization (2023 revenue: $145m) has so utterly failed to stem the disease, but still sets standards of care, controls research dollars and dictates the diabetes narrative in this country.Late last year, the ADA was sued by its former director of nutrition. She claimed she was fired for refusing to include the artificial sweetener Splenda, whose parent company donated $1m to the ADA, in the ADA’s list of approved recipes. It is one of American healthcare’s great tragedies that the ADA and the plaintiff, Elizabeth Hanna, settled before the facts of the inner workings of the ADA were brought to light in a trial. In any case, the complaint is a stinging indictment of the organization and should be read by every clinician interested in learning how corporate donations have corrupted the organization’s nutrition guidance.3. Perhaps most urgently, the federal government, including the National Institutes of Health, should expand its research budget to include researchers treating patients with low-carbohydrate and ketogenic diets. Over the past two decades, there has been an explosion of courageous clinicians who prescribe the low-carbohydrate diet to their patients, as well as at least two startups – Virta Health and OwnaHealth – with promising results treating diabetes and obesity with low-carbohydrate diets.But because their research does not include the search for the next blockbuster drug, researchers often cannot access ADA, NIH and big pharma research dollars. They don’t get prominent spots in pharma-funded conferences. This is an enormous impediment to the low-carbohydrate diet becoming part of the medical mainstream and in my opinion is responsible for the persistence of the diabetes plague.4. We should give platforms to people who actually have diabetes, especially those who have reversed their condition by taking control of their diet. Of all the misconceptions I uncovered in my reporting on diabetes, the most common was that the low-carb diet was too difficult for patients, particularly low-income patients, to maintain. Of course, resisting bread, sweets, rice and starches is not easy, but it is made far more difficult by the utter lack of a national consensus that these are the foods responsible for diabetes and obesity. Stopping smoking is hard too, but once it became a national imperative, usage plummeted. In my experience, when patients are told the truth (“Stop eating carbs or your disease will progress and you may die”), they can change their behavior. And they feel empowered.Take the case of Jemia Keshwani, a 40-year-old LaGrange, Georgia, woman who has had diabetes for 25 years, and who narrowly escaped amputation of her right foot after her doctor prescribed a low-carbohydrate diet. She has lost 120lb (54kg) and no longer shoots insulin into her belly four times a day. “I didn’t understand you could change things around if you eat the right foods,” she said. “You know how sometimes you feel helpless? Now I don’t feel that way.”Or the case of Ajala Efem, a 47-year old Bronx woman, who, according to a recent article in Medscape, lost nearly 30lbs and got off 15 medications after her Bronx-based healthcare provider, OwnaHealth, prescribed a low-carb diet.“I went from being sick to feeling so great,” she told her endocrinologist. “My feet aren’t hurting; I’m not in pain; I’m eating as much as I want, and I really enjoy my food so much.”This past March, Harris asked an audience in Las Vegas how many people had family members living with diabetes. “A sea of hands went up,” she wrote on her Facebook page.Harris clearly understands the diabetes scourge and needs only a gentle push to make it a priority. So here is one final word of affectionate advice. The next time she attends a state fair, she might consider having one of those cheeseburgers she loves. It’s delicious, nutritious and will make a great photo op.Just lose the ketchup and bun.

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