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Tag: Health and Human Services Department

  • Trump Cuts Threaten Agency Running Meals on Wheels

    Trump Cuts Threaten Agency Running Meals on Wheels


    Every Monday, Maurine Gentis, a retired teacher, waits for a delivery from Meals on Wheels South Texas.

    “The meals help stretch my budget,” Ms. Gentis, 77, said. Living alone and in a wheelchair, she appreciates having someone look in on her regularly. The same group, a nonprofit, delivers books from the library and dry food for her cat.

    But Ms. Gentis is anxious about what lies ahead. The small government agency responsible for overseeing programs like Meals on Wheels is being dismantled as part of the Trump administration’s overhaul of the U.S. Department of Health and Human Services. Roughly half its staff has been let go in recent layoffs and all of its 10 regional offices are closed, according to several employees who lost their jobs.

    “I’m just kind of worried that the whole thing might go down the drain, too,” Ms. Gentis said.

    In President Trump’s quest to end what he termed “illegal and immoral discrimination programs,” one of his executive orders promoted cracking down on federal efforts to improve accessibility and representation for those with disabilities, with agencies flagging words like “accessible” and “disability” as potentially problematic. Certain research studies are no longer being funded, and many government health employees specializing in disability issues have been fired.

    The downsizing of the agency, the Administration for Community Living, is part of far-reaching cuts planned at the H.H.S. under the Trump administration’s proposed budget.

    While some federal funding may continue through September, the end of the government’s fiscal year, and some workers have been called back temporarily, there is significant uncertainty about the future. And some groups are reporting delays in receiving expected federal funds.

    “There’s a lot of confusion,” said Becky Yanni, the executive director of the Council on Aging in St. Johns County in Florida. She said she has been told that the most recent funding for its Meals on Wheels program and other services might be late.

    If the funding does not arrive, “in a lot of communities, you will be looking at cuts in services,” said Sandy Markwood, the chief executive officer for USAging, which represents the network of area agencies of aging.

    The community living division helps coordinate services and provide funding for older and disabled Americans so they can stay at home rather than live in a nursing home. With a budget of $2.6 billion, the unit represents a minuscule fraction of total H.H.S. spending.

    Under the reorganization introduced by Health Secretary Robert F. Kennedy Jr., the community unit’s responsibilities will be divided among other agencies, including the Centers for Medicare and Medicaid Services and the Administration for Children and Families.

    “This consolidation allows the department to better meet the current health needs of vulnerable populations across the country,” a spokeswoman for H.H.S. said in a statement. “This does not impact the important work of these critical programs as it will continue elsewhere within H.H.S.”

    So far, several programs under the unit will be eliminated under the proposed budget, including one that provides ombudsmen in nursing homes, to help ensure the safety and welfare of residents, and respite care programs, to provide a break for those caring for an older person or person with disabilities. States would also have more latitude in determining where funds should be allocated.

    In addition to meal deliveries, the community living agency supports numerous programs, including the nonprofit Centers for Independent Living, that are staffed by people with disabilities, who help older adults and others with disabilities move out of nursing homes and back into the community, and find services, like transportation and legal assistance.

    Theo W. Braddy, the executive director for the National Council on Independent Living, which represents the centers and people with disabilities, said the uncertainty has upended planning.

    “Everybody is on edge. We can’t tell them anything because we don’t know anything yet,” he said, adding that no one from the Trump administration or H.H.S. has attempted to contact the group with updates.

    Advocates say the recent cutbacks have further marginalized older Americans and those with disabilities. “The bottom line is that people in charge simply don’t care about large swaths of the American people,” said Dr. Joanne Lynne, a clinical professor of geriatrics and palliative care at George Washington University.

    “We have made living with disability and old age exceedingly unpleasant,” she said. “We are on course to make it virtually intolerable.”

    Community groups like Meals on Wheels are bracing for significant cuts. In addition to the potential loss of funding from the Administration for Community Living, Republican lawmakers are proposing reducing grants to states that use another stream of federal funding. The Trump administration and Republicans are also pushing for significant cuts to the Medicaid program, which provides heath care coverage for low-income Americans.

    “We’re concerned about a number of potential threats happening all at once,” said Josh Protas, the chief advocacy and policy officer for Meals on Wheels America, an association of the local nonprofits. About a third of the association’s local units already have waiting lists, he said, and lower funding would result in fewer meals for fewer people.

    People who are 60 or older with low incomes, and who have difficulty preparing food for themselves, typically qualify for Meals on Wheels. The demand for services is increasing as food prices rise and more people need assistance. More than two million older Americans receive food deliveries each year, and many say they would have difficulty paying for meals without the program.

    “Meals on Wheels is a godsend for me,” said Richard Beatty, a 70-year-old with poor vision and limited mobility living in Baltimore. He receives deliveries four times a week and isn’t sure how he would manage without the program.

    If there are cuts in funding, the programs would have to make hard choices about who would be eligible for deliveries. “We would have to make drastic changes to who we were serving,” said Dan Capone, the chief executive of Meals on Wheels South Texas, which serves roughly 300 people a week, including Ms. Gentis. His group also receives private donations, with federal funds accounting for some 40 percent of the budget, he said.

    The federal community unit under the ax also plays a key role in supporting disabled Americans, including older individuals.

    “So much of the work we do is about giving people dignity in their lives,” said Karen Tamley, the chief executive of Access Living, a Chicago-based center, one of 400 across the United States.

    The centers connect people with a variety of services, and offer job and skills training to young adults with disabilities. They may teach someone to drive, or help them find affordable housing.

    The Administration for Community Living has helped organizations navigate the state and local bureaucracies responsible for doling out federal funds. When Mr. Capone wanted more clarity as to how Texas was distributing the money, he got in touch with the unit’s regional office in Dallas. “We just started building that relationship with the field office, and that field office is gone,” he said.

    “It is frustrating on a practical level,” said Fay Gordon, one of the regional administrators who was let go earlier this month. “These programs are live and need direction.”

    Some groups are not waiting before starting to take steps to reduce costs. Brittany Boyd-Chisholm, the chief executive of the Center for Independent Living of Central Pennsylvania, said that more than half of her funding comes through the federal agency. She has asked all the managers, herself included, to take a cut in salary of between 5 and 10 percent and is weighing other actions. She said her center was already underfunded.

    No one has provided her with any information about future grants, and her emails have not been returned. “It makes you feel completely on your own,” Ms. Boyd-Chisholm said.

    Created under the Obama administration, the agency was intended to unify the work of three other agencies: the Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities.

    “These programs being together and working together was about efficiency and was about coordination,” said Alison Barkoff, the former acting administrator under President Biden, who stepped down last fall.

    During the first Trump administration, at the height of the pandemic, the agency worked with the department’s Office for Civil Rights to ensure hospitals and doctors had clear guidelines so that if staffing fell short they wouldn’t deny care to those with disabilities.

    “We had found common ground and issues to work on together,” said Daniel Davis, who worked for the agency’s Center of Policy and Evaluation, whose entire staff was laid off, according to former employees.



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  • Tariffs on China Aren’t Likely to Rescue U.S. Medical Gear Industry

    Tariffs on China Aren’t Likely to Rescue U.S. Medical Gear Industry


    Few domestic industries have been as devastated by the flood of cheap Chinese imports as manufacturers of face masks, exam gloves and other disposable medical gear that protects health care workers from infectious pathogens.

    The industry’s demise had calamitous consequences during the Covid pandemic, when Beijing halted exports and American hospital workers found themselves at the mercy of a deadly airborne virus that quickly filled the nation’s emergency rooms and morgues.

    But as President Trump unveiled his tariff regimen earlier this month, and Beijing retaliated with an 84 percent tax on American imports, the few remaining companies that make protective gear in the United States felt mostly unease.

    “I’m pretty freaked out,” said Lloyd Armbrust, the chief executive of Armbrust American, a pandemic-era startup that produces N95 respirator masks at a factory in Texas. “On one hand, this is the kind of medicine we need if we really are going to become independent of China. On the other hand, this is not responsible industrial policy.”

    The United States once dominated the field of personal protective equipment, or P.P.E. The virus-filtering N95 mask and the disposable nitrile glove are American inventions, but China now produces more than 90 percent of the medical gear worn by American health care workers.

    Despite bipartisan vows to end the nation’s dependency on foreign medical products — and to shore up the dozens of domestic manufacturers that sprang up during the pandemic — federal agencies have resumed their reliance on inexpensive Chinese imports. Industry experts say the country’s renewed dependence on imported medical products is especially concerning given an expanding measles outbreak, the threat of avian flu and a trade war with China that some worry could affect global supply chains.

    “It’s the same movie again and again,” said Mike Bowen, whose company, Prestige Ameritech, was one of the few domestic mask makers before the pandemic, and who repeatedly warned Congress about the risks of relying on foreign-made P.P.E.

    Mr. Bowen, who retired four years ago but maintains a stake in Prestige Ameritech, said the rise and fall of the American P.P.E. sector over the past few years was entirely predictable. “We didn’t learn a thing,” he said.

    Shocked by the images of nurses donning trash bags, John Bielamowicz, a commercial real estate broker in Texas, opened a N95 factory near Fort Worth with a friend, spending hundreds of thousands of dollars on machinery that would eventually churn out 1.2 million masks a month.

    “It just seemed like the right thing to do,” said Mr. Bielamowicz, whose company, United States Mask, was one of more than 100 start-ups that sprung up during the first terrifying year of the pandemic.

    Five years later, United States Mask and most of the other start-ups are gone. The companies were hit hard by slowing demand for P.P.E. as the pandemic retreated and as masks became a symbol of government overreach and loss of freedom for many Americans. But the death blow was seemingly preordained: the return of Chinese-made gear.

    Only five of the 107 companies created during the pandemic are still making masks and gloves, according to a review of the membership list created by the American Medical Manufacturers Association.

    Eric Axel, the association’s executive director, said the tariffs on Chinese-made protective gear, if they remained high, would give American producers a leg up. “I think it will change behavior, because people will have to adjust to the reality that you can’t buy below-market price rate stuff from China anymore,” he said.

    But other industry executives worry the escalating retaliatory moves by the United States and China could lead to supply chain disruptions and a return of P.P.E. shortages. Many say the economic uncertainty prompted by Mr. Trump’s tariff rollout will chill new investment.

    “It’s difficult to make business decisions when policies change every four years, and now every couple of days,” said Scott McGurl, a health care industry expert at the consultancy firm Grant Thornton.

    Given the ability of Chinese manufacturers, with support from their own government, to circumvent trade restrictions, many executives are unconvinced the tariffs will have a lasting impact. What’s needed, they say, are legislative and policy mandates that push government agencies and hospital networks to buy American-made masks and gloves.

    “Even with a 100 percent tariff, the Chinese mask that sells for a penny is still going to be cheaper than the American-made one that sells for eight cents,” Mr. Armbrust said.

    The silver-lining story about how altruistic entrepreneurialism rallied to meet a grave public health emergency wasn’t supposed to end this way.

    Political leaders from both sides of the aisle had vowed to never again to allow the nation to become reliant on foreign-made medical gear, and the Defense Department spent $1.3 billion helping American companies make N95 respirator masks and nitrile exam gloves in the United States.

    In 2021, Congress drafted legislation to ensure that federal agencies prioritized the purchase of domestically made medical equipment to sustain the sector through the inevitable peaks and troughs of demand.

    It is a model long embraced by the Pentagon, which spends hundreds of billions of dollars each year on contracts that sustain defense-related companies during times of war and peace.

    But the P.P.E. measure, folded into the Infrastructure Investment and Jobs Act of 2021, contained loopholes that experts say rendered it ineffective as federal agencies sought waivers to buy less expensive imports.

    When Mr. Axel of the medical manufacturer’s association recently traveled through John F. Kennedy International Airport in New York, he was flabbergasted to discover that the masks used at a federal health screening station were made in China.

    “Our national security is at risk because we’ve once again put ourselves at the mercy of adversarial, nondemocratic countries,” he said.

    Mr. Trump has not mentioned personal protective equipment since returning to office, but during his first term he often spoke about the need to wean the country off foreign-made medical gear as part of his “America first” economic policy.

    “Never again will another president inherit empty shelves,” he said in May 2020, speaking at a Pennsylvania mask facility operated by Owens & Minor. “My goal is to produce everything America needs for ourselves and then export to the world.”

    Experts say the tariffs that Mr. Trump imposed on Chinese goods during his first term did little to level the playing field, mostly because Beijing’s generous industrial policy helped Chinese companies maintain their price advantage.

    The Trump administration did not respond to requests for comment.

    For now, the vast majority of masks purchased by hospital chains, federal agencies and state governments are imported, mostly from China, and to a lesser extent, from Thailand, Vietnam and Mexico — countries that often repackage Chinese-made products to avoid the tariffs that were imposed on Beijing by the last two administrations.

    Owens & Minor, the health care logistics company that Mr. Trump singled out for praise during the pandemic, sells masks that are assembled in Mexico. The company declined to discuss its production.

    There are a few exceptions to the narrative. SafeSource Direct, one of the few companies that makes nitrile exam gloves in the United States, has been surviving, largely because of a partnership with the hospital network Ochsner Health, which buys a steady stream of them, according to Justin Hollingsworth, the chief executive of SafeSource Direct. Ochsner said its investment in SafeSource was intended to ensure its hospitals and clinics have a reliable source of medical supplies.

    Armbrust American, the other pandemic-era startup still in business, gets by on purchases from travelers who don’t trust Chinese-made masks, and on bulk purchases by the retailer Target. Mr. Armbrust said Target executives were willing to pay 50 percent more for his masks and gloves because they saw the value in having a high-quality product made on U.S. soil.

    Like most Americans, Dan Izhaky, a former wholesale distribution executive in New York, wasn’t familiar with the acronym P.P.E. when friends of his began complaining about waning supplies of masks and exam gloves at hospitals where they worked.

    Six months later, United Safety Technology, the company he created to make P.P.E., won a $96 million federal contract to build a nitrile glove factory outside Baltimore.

    The company moved quickly to outfit a massive 700,000-square-foot warehouse with machinery to produce 200 million gloves a month, but as pandemic-related supply chain issues led to spiraling costs for steel beams, computer chips and shipping containers, the company needed an additional $50 million to finish the project.

    Federal officials were unmoved, he said.

    “One or two long-term government purchase contracts would have gotten us over the finish line, but the team at H.H.S. just wasn’t interested anymore,” he said, referring to the Department of Health and Human Services.

    And by the time federal officials pulled the plug, Chinese-made nitrile gloves were becoming plentiful again — and charging 1.3 cents a glove, about half what the company was planning to charge.

    Still, Mr. Izhaky said he was cautiously optimistic Mr. Trump’s tariffs. “Things are going on the right trajectory,” he said on Friday. “I just wish they were a little bit less chaotic.”



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  • RFK Jr. Announces Ban on Food Dyes and Says ‘Sugar Is Poison’

    RFK Jr. Announces Ban on Food Dyes and Says ‘Sugar Is Poison’


    Health Secretary Robert F. Kennedy Jr. escalated his war against the food industry on Tuesday, declaring that “sugar is poison.”

    Mr. Kennedy’s comment came during a highly publicized news conference where he also asserted that he has “an understanding” with major food manufacturers to remove petroleum-based food colorings from their products by 2026.

    No one from the food industry attended the event, and none have publicly agreed to Mr. Kennedy’s demands, although the International Dairy Foods Association has pledged to eliminate artificial colors in milk, cheese and yogurt sold to schools as part of the federal lunch and breakfast programs by the start of the 2026 school year.

    However, Mr. Kennedy and his advisers said that every major food manufacturer and some fast-food companies have contacted the agency looking for guidance.

    “Four years from now, we are going to have most of these products off the market, or you will know about them when you go to the grocery store,” Mr. Kennedy said.

    Mr. Kennedy’s push to get food manufacturers to remove dyes from their products is his first effort at sweeping reform of the food industry, which he has long blamed for creating and marketing ultra-processed foods that he says are making Americans obese and contributing to a host of diseases, including diabetes and heart disease.

    He ratcheted up his campaign with the remark about sugar, lamenting that government agencies recommend “a huge amount of sugar” for children, “and it’s hurting them, and it’s addicting them, and it’s changing their taste buds.”

    The Food and Drug Administration recommends that added sugar — sugar that is not found naturally in foods, including fruit — account for no more than 10 percent of the diet for both children and adults.

    “Sugar is poison,” Mr. Kennedy said, “and Americans need to know that it’s poison.”

    Critics of Mr. Kennedy say that while his goal of making the food supply healthier is laudable, the cuts he is making to scientific research grants, coupled with significant staff reductions at agencies like the F.D.A. and the National Institutes for Health, will hinder his efforts. The very same people who police the food industry, they pointed out, are now out of jobs.

    Some have quit in frustration. The leading nutrition scientist at the N.I.H., Kevin Hall, recently resigned, saying he was being censored. Jim Jones, the chief of the F.D.A.’s food division, quit last month, saying “indiscriminate” layoffs would make it “fruitless” for him to continue.

    “I was looking forward to working to pursue the department’s agenda of improving the health of Americans by reducing diet-related chronic disease and risks from chemicals in food,” Mr. Jones wrote at the time.

    Mr. Kennedy delivered his remarks in the grand hall of the Department of Health and Human Services on a stage filled with so-called MAHA Moms — women who power his “Make America Healthy Again” movement — and their children.

    He was joined by Dr. Marty Makary, the F.D.A. commissioner; Dr. Jay Bhattacharya, the director of the National Institutes of Health, and Republican leaders of states that have signed onto his MAHA movement, including the governor of West Virginia, who recently signed legislation banning dyes in most foods.

    Dr. Makary said he expected cooperation from the food manufacturers.

    “You win more bees with honey than fire,” Dr. Makary said, adding “I believe in love, and let’s start in a friendly way and see if we can do this without any statutory or regulatory changes.”



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  • Trump Seeks to Lower Drug Prices Through Medicare and Some Imports

    Trump Seeks to Lower Drug Prices Through Medicare and Some Imports


    President Trump signed an executive order on Tuesday outlining a series of actions intended to lower drug prices, including helping states import drugs from Canada.

    The policies were more modest than proposals to reduce drug prices that Mr. Trump offered in his first term.

    And one of his new directives could increase drug prices. It calls for the Trump administration to work with Congress to change a 2022 law in a way that could defang a negotiation program meant to reduce Medicare’s spending on commonly used or costly drugs.

    Such a change has the potential to increase costs for the government, because it would most likely delay the existing timetable for some drugs to become eligible for Medicare price cuts.

    Depending on how it is structured, it could increase Medicare’s drug spending by billions of dollars compared with outlays under the current law. The negotiation program was approved by a Democratic-controlled Congress and supported by former President Joseph R. Biden Jr.

    The executive order says that changes to the Medicare price negotiation program should be “coupled with other reforms to prevent any increase in overall costs to Medicare and its beneficiaries.”

    Drug pricing experts said that with the exception of the Medicare negotiation proposal, other directives in the executive order had the potential to save money for patients and government programs. None of the actions represented major changes that would lead to huge savings.

    One provision would lower the co-payments that some people on Medicare face when they undergo treatments like chemotherapy infusions at certain clinics and at outpatient hospital sites. Another would give certain lower-income people access to heavily discounted insulin and epinephrine injections.

    Tuesday’s executive order was the most prominent move Mr. Trump’s second administration has made so far on drug pricing.

    It followed Mr. Trump’s decision to move closer to imposing tariffs on imported pharmaceuticals, which manufacturers are likely to try to pass on. That could force government programs, employers and patients to pay more for some medications and could exacerbate shortages of critical drugs.

    Some of the directives, like changing the Medicare negotiation program, would require congressional approval. The pharmaceutical industry has fiercely opposed some of the ideas in the executive order while supporting others.

    Mr. Trump has long complained that the United States pays much more than other wealthy countries for the same drugs. Notably absent from the order was a reprise of a most favored nation pricing policy, which he proposed in his first term aimed at making U.S. drug prices closer to those that peer countries pay. Like several of Mr. Trump’s first-term policies on drug prices, his most favored nation plan was halted by federal courts. Last fall, Mr. Trump‘s presidential campaign walked back the proposal.

    Here’s a breakdown of some of the most notable parts of Mr. Trump’s executive order.

    The order directs Robert F. Kennedy Jr., the health secretary, to work with Congress to address a difference in how certain types of drugs are treated in the Medicare negotiation program.

    Under the law, pills and other drugs produced through synthetic processes do not become eligible for price cuts until they have been on the market for nine years. Drugs known as biologics — created from living cells and often given as an infusion — would not be eligible for 13 years.

    Drugmakers, who unsuccessfully sued the federal government over the program, bitterly call the difference a “pill penalty.” They say it discourages them from developing medications, because they have less time to build up sales before the price cuts kick in, depriving patients of new treatments. They have lobbied for pills to be exempted from the price cuts for 13 years instead of nine.

    Lawmakers have introduced legislation that would change the law to treat the two types of drugs equally.

    The president’s order does not specify how many years each type of drug should be exempt from Medicare price cuts.

    In a statement on Tuesday, Alex Schriver, an official at the drug industry’s main lobbying group, PhRMA, said that his organization would work with the Trump administration and Congress to “advance common sense solutions that lower costs and improve access for Americans.”

    Biden officials oversaw the first round of negotiations in the program, resulting in price cuts that will go into effect in 2026. The Trump administration is overseeing negotiations this year for lower prices in 2027 for drugs including the blockbuster weight-loss medication sold as Ozempic and Wegovy.

    The White House said in a fact sheet on Tuesday that it wanted to capture more savings for the government with the Medicare negotiation program than the Biden administration did last year. That would be difficult to do if Congress reduces the time during which Medicare can obtain lower prices.

    The executive order directs the Food and Drug Administration to improve the process by which states can apply to import lower-cost drugs from Canada.

    In his first term, Mr. Trump created a pathway enabling states to pursue these imports. Under the Biden administration, the F.D.A. approved one importation program, in Florida. As of late last year, Florida had not yet begun importing drugs from Canada. The pharmaceutical industry opposes the idea because it would cut into its profits.

    If Mr. Trump follows through on imposing tariffs on pharmaceuticals, importing drugs from Canada would be unlikely to offer the same savings as in the past.

    The order calls for rules to equalize the fees doctors are paid to administer drugs to patients across settings.

    Currently, many medical practices owned by hospitals can charge higher fees to Medicare than independent practices can, even for the exact same services. Because Medicare beneficiaries are often responsible for a percentage of their medical bills, those higher costs for the visits are passed along in the form of co-payments.

    Efforts to equalize such payments broadly have been under bipartisan discussion for years in Congress but have faced opposition from hospitals, who say they require the higher payments. Legislation passed during the Obama administration addressed some of these payment differences.

    Mr. Trump directed the F.D.A. to make recommendations for streamlining approvals for generic drugs and biosimilars, which are lower-priced copycats of biologic drugs.

    The first biosimilar was approved in 2015, with dozens more approved since. There was widespread hope that biosimilars would displace patent-protected brand-name biologics, such as Humira for conditions like arthritis, that sent drug costs soaring. But patients have been slow to switch over, and savings have not materialized as quickly as many wanted.

    Mr. Trump revived an executive order from his first term directing community health clinics to provide insulin and epinephrine injections at heavily discounted prices to certain lower-income people, including the uninsured.

    The clinics balked when Mr. Trump first proposed the idea in 2020. The Biden administration soon froze the regulation, saying it created too much of an administrative burden for the clinics.



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  • The Many Ways Kennedy Is Already Undermining Vaccines

    The Many Ways Kennedy Is Already Undermining Vaccines


    During his Senate confirmation hearings to be health secretary, Robert F. Kennedy Jr. presented himself as a supporter of vaccines. But in office, he and the agencies he leads have taken far-reaching, sometimes subtle steps to undermine confidence in vaccine efficacy and safety.

    The National Institutes of Health halted funding for researchers who study vaccine hesitancy and hoped to find ways to overcome it. It also canceled programs intended to discover new vaccines to prevent future pandemics.

    The Centers for Disease Control and Prevention shelved an advertising campaign for the flu shot. Mr. Kennedy has said inaccurately that the scientists who advise the C.D.C. on vaccines have “severe, severe conflicts of interest” in promoting the products and cannot be trusted.

    The Health and Human Services Department cut billions of dollars to state health agencies, including funds needed to modernize state programs for childhood immunization. Mr. Kennedy said in a televised interview on Wednesday that he was unaware of this widely reported development.

    The Food and Drug Administration canceled an open meeting on flu vaccines with scientific advisers, later holding it behind closed doors. A top official paused the agency’s review of Novavax’s Covid vaccine. In a televised interview last week, Mr. Kennedy said falsely that similarly created vaccines don’t work against respiratory viruses.

    Some scientists said they saw a pattern: an effort to erode support for routine vaccination, and for the scientists who have long held it up as a public health goal.

    “This is a simultaneous process of increasing the likelihood that you will hear his voice and decreasing the likelihood that you’ll hear other voices,” Kathleen Hall Jamieson, director of the Annenberg Public Policy Center, said of Mr. Kennedy.

    He is “decertifying other voices of authority,” she said.

    H.H.S. disagreed that Mr. Kennedy was working against vaccines.

    “Secretary Kennedy is not anti-vaccine; he is pro-safety,” Andrew Nixon, a department spokesman, said in a statement. “His focus has always been on ensuring that vaccines are rigorously tested for efficacy and safety.”

    The statement continued, “We are taking action so that Americans get the transparency they deserve and can make informed decisions about their health.”

    After attending the funeral of an unvaccinated child who died of measles in West Texas on Sunday, Mr. Kennedy endorsed the measles vaccine on X as “the most effective way to prevent the spread of measles.”

    But he has also described vaccination as a personal choice with poorly understood risks and suggested that miracle treatments were readily available. On Sunday, he praised two local doctors on social media who have promoted dubious, potentially harmful, treatments for measles.

    Even as cases of measles in the United States have surged past 600 in 22 jurisdictions, Mr. Kennedy has claimed in a recent interview that the measles vaccine causes deaths every year (untrue); that it causes encephalitis, blindness and “all the illnesses that measles itself causes” (untrue); and that the vaccine’s effect wanes so dramatically that older adults are “essentially unvaccinated” (untrue).

    According to an email obtained by The New York Times, H.H.S. intends to revise its web pages to include statements like “The decision to vaccinate is a personal one” and “People should also be informed about the potential adverse events associated with vaccines.” (Vaccines are already administered only after patients provide informed consent, as required by law.)

    Tensions with mainstream experts came into sharp focus last week, when Dr. Peter Marks, the top vaccine regulator, resigned under pressure from the F.D.A.

    “It has become clear that truth and transparency are not desired by the secretary, but rather he wishes subservient confirmation of his misinformation and lies,” Dr. Marks said in his resignation letter.

    Mr. Kennedy’s position on vaccines has raised alarm for decades. But it has become particularly notable now, against a backdrop of rising skepticism of vaccines and worsening outbreaks of measles and bird flu, experts said.

    The M.M.R. vaccine — a combination product to prevent measles, mumps and rubella that has been available since 1971 — has long been a target of anti-vaccine campaigns because of the disproved theory that it can cause autism. Mr. Kennedy has said that he would like to revisit the issue, in part to assuage parents’ fears that the vaccines are unsafe.

    But he has hired David Geier to re-examine the data. Senator Bill Cassidy, Republican of Louisiana, a doctor and the chairman of the Senate Health Committee, has sharply criticized the decision to spend tax dollars testing a discredited hypothesis even as the administration is cutting billions for other research.

    “If we’re pissing away money over here,” he said last month, “that’s less money that we have to actually go after the true reason.”

    The refusal to accept scientific consensus is “disturbing, because then we get into very strange territory where it’s somebody’s hunch that this does or doesn’t happen, or does or doesn’t work,” said Stephen Jameson, president of the American Association of Immunologists.

    In interviews, Mr. Kennedy has downplayed risks of measles and emphasized what he sees as the benefits of infection.

    “Everybody got measles, and measles gave you protected lifetime protection against measles infection — the vaccine doesn’t do that,” he said in an interview on Fox News.

    Two doses of the M.M.R. vaccine do provide decades-long immunity. And while immunity from the infection may last a lifetime, “people also suffer the consequences of that natural infection,” Dr. Jameson said.

    One consequence was discovered just a few years ago: A measles infection can destroy the immune system’s memory of other invading pathogens, leaving the body vulnerable to them again.

    Measles kills roughly 1 in every 1,000 infected people, and 11 percent of those infected this year have been hospitalized, many of them children under 5, according to the C.D.C. Two girls, ages 6 and 8, died in West Texas.

    By contrast, side effects after vaccination are uncommon. But Mr. Kennedy has suggested that people should apprise themselves of the risks before opting for the shot.

    The phrasing implies that “if you are more fully informed, you might make a different decision,” said Dr. Jamieson, of the Annenberg center.

    Doctors have long expected health secretaries and the C.D.C. to urge widespread vaccination unequivocally amid an outbreak, and in the past they have.

    But Mr. Kennedy has spoken enthusiastically about cod liver oil, a steroid and an antibiotic that are not standard therapies. Some of those treatments may be making children more sick.

    “The messaging I’m seeing is focused on potential treatments for measles,” said Dr. Sean O’Leary, chair of the infectious disease committee for the American Academy of Pediatrics.

    At his confirmation hearing, Mr. Kennedy promised that he would not change the C.D.C.’s childhood vaccination schedule. About two weeks later, he announced a new commission that would scrutinize it.

    The schedule is based on recommendations from the Advisory Committee on Immunization Practices, a panel of medical experts who review safety and effectiveness data, potential interactions with other drugs and the ideal timing to maximize protection.

    At his confirmation hearing, Mr. Kennedy claimed that 97 percent of A.C.I.P. members had financial conflicts of interest. He has long held, without evidence, that federal regulators are compromised and are hiding information about the risks of vaccines.

    “It’s frankly false,” said Dr. O’Leary, who serves as a liaison to the committee from the pediatric academy.

    Mr. Kennedy’s statistic came from a 2009 report that found that 97 percent of disclosure forms had errors, such as missing dates or information in the wrong section.

    In fact, A.C.I.P. members are carefully screened for major conflicts of interest, and they cannot hold stocks or serve on advisory boards or speaker bureaus affiliated with vaccine manufacturers.

    On the rare occasion that members have indirect conflicts of interest — for example, if an institution at which they work receives money from a drug manufacturer — they disclose the conflict and recuse themselves from related votes.

    The committee’s votes were public and often heavily debated.

    “When I was C.D.C. director, people flew in from Korea and all over the world to observe the A.C.I.P. meetings, because they were a model of transparency,” said Dr. Thomas R. Frieden, who led the agency from 2009 to 2017.

    Mr. Kennedy has repeatedly promised greater transparency and accountability, but he has proposed ending public comment on health policies.

    His department canceled a meeting of the A.C.I.P. in February at which members were set to discuss vaccines for meningitis and flu, rescheduling it for April.

    The department also canceled a meeting to discuss the seasonal flu vaccine. Officials met later without the agency’s scientific advisers.

    “After all that conversation about how they want to be transparent, one of the first things he does is take things behind closed doors and diminish the amount of public input we’re getting,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

    At his confirmation hearing, Mr. Kennedy repeated a fringe theory that Black Americans should not receive the same vaccines as others because they “have a much stronger reaction.”

    Senator Angela Alsobrooks, Democrat of Maryland, who is Black, admonished him for his “dangerous” opinion: “Your voice would be a voice that parents would listen to.”

    Two weeks later, at a clinic for teenage mothers in Denver, a 19-year-old woman refused all vaccines for herself and her 1-year-old son — including the measles and chickenpox shots he was supposed to have that day.

    She told the pediatrician, Dr. Hana Smith, who described the incident, that she had read online that vaccines were bad for people with more melanin in their skin.

    There are reams of evidence to the contrary. Still, it quickly became clear to Dr. Smith that nothing was going to change her patient’s mind.

    “No matter how much information I can give to the contrary on it, the damage is already done,” Dr. Smith said.

    Misinformation is particularly difficult to counter, Dr. Smith said, “when it’s someone that has a leadership position, especially within the health care system.”



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  • RFK Jr. Accuses FDA of Drug Industry Influence That Barred Alternative Remedies

    RFK Jr. Accuses FDA of Drug Industry Influence That Barred Alternative Remedies


    In a speech broadcast to the Food and Drug Administration’s Maryland campus on Friday morning, Robert F. Kennedy Jr. introduced himself as the nation’s health secretary with a meandering speech touching on everything from birds of prey to pollution in Lake Erie to the C.I.A.

    Mr. Kennedy told the agency staff members, in the throes of losing 20 percent of their work force under his overhaul of the Health and Human Services Department, to boldly avoid the impulse to protect the corporations they regulate.

    The layoffs, voluntary departures and cutbacks in funding have already decimated divisions that govern oversight of tobacco, the drug approval process, testing of cow’s milk and cheese for avian flu, and food safety that monitors and protects consumers from food-borne illnesses.

    In his remarks on Friday, Mr. Kennedy blamed the F.D.A. for failing to embrace raw milk, ivermectin and stem cell treatments, views he has voiced before.

    He suggested that the reason the agency did not approve “alternative medicines” was because of its subservience to well-heeled corporations. Agency veterans have argued that alternative products often fail to pass the standards for safety and efficacy.

    He urged the staff to resist the temptation to serve a small group of wealthy companies at the cost of public health.

    “We want to break away from this so we can make our kids healthy,” he said, according to a transcript of his speech that was shared with The New York Times. At another point, he said, “the deep state is real,” a pejorative reference to the sprawling federal bureaucracy that President Trump blamed as an obstacle to achieving his goals in his first term.

    Andrew Nixon, a spokesman for the Health and Human Services Department, did not immediately respond to a request for comment on Mr. Kennedy’s remarks.

    Mr. Kennedy also called the F.D.A. “a sock puppet” for the industries it is supposed to regulate, language he has used in the past. The dynamic is rewarding “the very, very powerful incumbents in the industry,” he said at another point.

    Drugmakers have benefited from a series of efforts by the F.D.A. to speed up certain drug approvals or encourage companies to develop drugs for serious diseases that lack treatments. F.D.A. officials have said the programs are aimed at helping patients.

    The F.D.A. has faced criticism in the past few years for several high-profile drug approvals. For example, top officials overruled agency scientists or advisers when they granted approval of products for Alzheimer’s disease and Duchenne muscular dystrophy.

    Mr. Kennedy urged F.D.A. employees to speak up if their superiors greenlight products with insufficient evidence. “If your boss is making a mistake, if they’re approving something that shouldn’t be approved, we want to hear,” he said.

    Dr. Marty Makary, the new F.D.A. commissioner, introduced Mr. Kennedy at Friday’s meeting and endorsed his goals to shape a healthier food supply. He acknowledged that the cuts at the agency “have been hard on the ground” for some staff. He said the changes were “aimed at consolidating, being more efficient and creating more teamwork.”

    Mr. Kennedy and Dr. Makary were broadcast on a video aired at the agency’s White Oak campus in suburban Maryland.

    Mr. Kennedy reminisced in the speech about being a child visiting his father, Attorney General Robert F. Kennedy, at the Justice Department in Washington and watching peregrine falcons nesting in the cupola at the Old Post Office building. He also discussed his experience at the Special Olympics, where he played the role of “hugger” and coach, and the battles he waged as an environmental lawyer.

    Mr. Kennedy also complained about rules governing the agency’s food division that allow companies to certify that new ingredients are generally recognized as safe. The measure initially covered ingredients like salt or vinegar as acceptable in food with no review. In the years since, though, thousands of ingredients have been added to the food supply with no notice or testing by the agency.

    Food companies are required to provide reviews of ingredients to on-site F.D.A. inspectors, but such inspections can take place once every five years or less. Mr. Kennedy has called for an end to allowing food companies to self-certify that ingredients are safe.

    “We literally do not test chemicals before they’re added to our food,” he said, according to the transcript. “Everything is stamped by the industry as generally recognized as safe.”

    He went on to attribute the nation’s rates of diabetes to the loophole, adding that sugar also plays a role.

    The speech was reminiscent of a social media message that Mr. Kennedy posted in October, accusing the F.D.A. of waging a “war on public health.” He said the agency engaged in “aggressive suppression” of a range of unproven or unsafe products, including raw milk, chelating compounds, ivermectin and “anything else that advances human health and can’t be patented by Pharma.”

    The post went on: “If you work for the F.D.A. and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.”

    The agency is still reeling from thousands of job cuts and voluntary departures in the weeks since Mr. Kennedy was appointed health secretary. The F.D.A. employees who have left in recent weeks include staff members who examine drugs for byproducts that can cause cancer and others who work with international food safety staffs to try to stop contaminated products from entering the United States.

    Cuts in some areas were so deep that former F.D.A. officials have suggested that they could jeopardize billions of dollars in fees that the pharmaceutical industry pays to the agency to ensure the approval process for drugs is adequately staffed.

    Drugmakers have been anxious about what Mr. Kennedy’s leadership will mean for their interests. They are worried that cuts at the agency will slow down reviews of drugs, including the start of clinical trials, and will add delays to final approval.

    A public letter signed by dozens of biotech investors and executives said the industry’s leaders were “deeply concerned about the current state of the agency and its future.”

    “Some of us have already encountered regulatory difficulties that we believe are the consequences of the F.D.A.’s loss of experienced staff,” the letter said.



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  • Experts Doubt Kennedy’s Timetable for Finding the Cause of Autism

    Experts Doubt Kennedy’s Timetable for Finding the Cause of Autism


    Robert F. Kennedy Jr., the nation’s health secretary, pledged on Thursday to seek out experts globally to discover the reasons for the increasing rates of autism in the United States.

    “We’ve launched a massive testing and research effort that’s going to involve hundreds of scientists from around the world,” Mr. Kennedy announced at a cabinet meeting held by President Trump. “By September, we will know what has caused the autism epidemic and we’ll be able to eliminate those exposures.”

    “There will be no bigger news conference than that,” Mr. Trump replied.

    But scientists who have worked for decades to find a cause greeted Mr. Kennedy’s predicted timeline with skepticism.

    They said that a single answer would be hard to identify in a field of possible contributors including pesticides, air pollution and maternal diabetes.

    Dr. Philip Landrigan, a pediatrician and expert on environmental toxins, pointed to the current mass layoffs and cutbacks for research at Mr. Kennedy’s Department of Health and Human Services as one reason for doubting such quick progress.

    “Given that a great deal of research on autism and other pediatric diseases in hospitals and medical schools is currently coming to a halt because of federal funding cuts from H.H.S.,” he said, “it is very difficult for me to imagine what profound scientific breakthrough could be achieved between now and September.”

    Mr. Kennedy’s office did not offer many details on the plan. Later on Thursday, Mr. Kennedy revealed a few more clues, saying that the National Institutes of Health would lead the effort.

    He said the Centers for Disease Control and Prevention would soon release data showing that the autism diagnoses had now increased to one of every 31 children. Many scientists and doctors attributed the rise in autism rates over the last several decades in part to growing awareness of the disorder and to expanded diagnoses along a spectrum.

    “We are launching requests to scientists from all over the country and all over the world,” Mr. Kennedy said in an interview on Fox News. “Everything is on the table: our food system, our water, our air, different ways of parenting, all the kind of changes that may have triggered this epidemic.”

    In the interview, Mr. Kennedy also said an important part of the effort would be to compare autism rates in vaccinated and unvaccinated children. It’s an angle that many scientists dismiss, saying that parents who vaccinate their children are also more likely to get a diagnosis, given higher rates of interaction with health providers.

    Many scientists who have observed Mr. Kennedy’s dogged opposition to many vaccines over two decades — and his frequent attempts to tie autism to vaccines — have dismissed his claims, citing the scientific consensus that debunked any such link. Scrutiny of his pledges to begin “gold standard” research only heightened in recent weeks when David Geier, a largely discredited researcher, was hired at H.H.S. to study any potential link between vaccines and autism.

    Irva Hertz-Picciotto, director of environmental epidemiology of neurodevelopment at the University of California at Davis MIND Institute, said she had been seeking a cause for autism for 20 years.

    It’s an exciting time for the field, she said, with multiple studies beginning to point to factors that could play a role. Among the possible links are pesticide exposure through food or nearby agricultural fields; workplace exposures to solvents; fevers or infections during pregnancy; maternal diabetes; and exposure to chemicals in plastics called phthalates or to PFAS, known as “forever chemicals” for their tendency to persist in the environment.

    Some studies have found that the effect of environmental exposures can vary based on a person’s genes, “emphasizing the complexity of this syndrome.” Dr. Hertz-Picciotto said it was challenging to get funding for clinical studies that could shed light on a cause of autism, but new research could help advance the field. Those studies, though, could take years.

    That all of the research could be sorted out by September, she said, was “ludicrous.”

    Dr. Alice Kuo, the chief of pediatric medicine who cares for children and adults with autism at the University of California, Los Angeles, said she was involved in a yearslong project by the National Institutes of Health called the National Children’s Study. It followed thousands of children and parents and elicited information, including the possible causes of autism. The study was costly and ended far earlier than planned, Dr. Kuo said.

    She said an effort to do something as rigorous would take months to plan and design — and years to arrive at an answer.

    In a social media post on Thursday, Mr. Kennedy recognized the assistance of the president and the Make America Healthy Again Commission — a subgroup of the cabinet that includes Linda McMahon, the education secretary, and Russell Vought, director of the Office of Management and Budget. Like Mr. Kennedy, they are not doctors or scientists.

    “Thanks to your MAHA Commission, we’ll soon identify the root causes of the autism epidemic,” Mr. Kennedy wrote in a social media post.

    Created by an executive order in February, the commission is charged with assessing in 100 days the threat to children of food ingredients, chemicals, medications and other exposures. Within 180 days, the commission is expected to submit a strategy to the president to address its findings.



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  • All Federal Experts on H.I.V. Prevention in Children Overseas Were Dismissed

    All Federal Experts on H.I.V. Prevention in Children Overseas Were Dismissed


    The Trump administration has dismissed the few remaining health officials who oversaw care for some of the world’s most vulnerable people: more than 500,000 children and more than 600,000 pregnant women with H.I.V. in low-income countries.

    Expert teams that managed programs meant to prevent newborns from acquiring H.I.V. from their mothers and to provide treatment for infected children were eliminated last week in the chaotic reorganization of the Health and Human Services Department.

    Some of the consequences of the dismissals are only now coming to light.

    While it was known that some staff members devoted to H.I.V. prevention in other countries had been lost, The New York Times has learned that all such experts have now been terminated or are awaiting reassignment at the Centers for Disease Control and Prevention, the State Department and the U.S. Agency for International Development.

    These maternal health programs are still funded by the President’s Emergency Plan For AIDS Relief, or PEPFAR. But without personnel to manage the initiatives or to disburse the money, it’s not clear how the work will continue.

    The Health and Human Services Department did not respond to a request for comment.

    “We hope this is not a sign that treating mothers and children is no longer important in PEPFAR, and that this is a mistake that can be corrected,” said a federal health official who spoke on condition of anonymity for fear of retaliation.

    The stakes are high. Already in sub-Saharan Africa, a child under 15 dies of AIDS every seven minutes.

    On Tuesday, a study in The Lancet estimated that suspending PEPFAR could lead to about one million new H.I.V. infections by 2030 and could lead to nearly 500,000 AIDS deaths among children and the orphaning of 2.8 million more.

    After the nascent Trump administration froze all foreign aid, Secretary of State Marco Rubio issued a waiver permitting delivery of “core lifesaving medicine, medical services” and other activities funded by the United States.

    A waiver specific to PEPFAR later explicitly continued support for programs meant to prevent mother-to-child transmission of H.I.V., and to provide treatment of infected women and children.

    The paperwork allowing the aid to resume took weeks after the waiver was issued, and several organizations are only just beginning to receive federal funds required to run the programs.

    “You can dismantle something very quickly, but now you’re trying to build it back up with a fraction of the staff and potentially 5 percent of the institutional knowledge,” said a federal official who wasn’t authorized to speak to the news media and requested anonymity.

    All experts in pediatric H.I.V. were all let go in the gutting of U.S.A.I.D., leaving a single unit at the C.D.C. with the expertise to advise overseas programs. That team was lost in last week’s reorganization, along with another that handles disbursement of funds for 300 grants in more than 40 countries.

    Given the State Department waiver, those layoffs came as surprise to the federal health workers and to the organizations that rely on them.

    “We clearly understood that H.I.V. services for mothers and children would fall under” the waiver, said Dr. Anja Giphart, executive vice president of medical and scientific affairs at the Elizabeth Glaser Pediatric AIDS Foundation.

    The foundation depends on the C.D.C. for about 60 percent of its budget. “We were totally blindsided that the whole unit at C.D.C. is being terminated,” she said.

    The organization has been promised funds until September. But only a few people were authorized to use the payment system at the C.D.C.

    “Everyone is scrambling now to figure out how to pay country teams and partners,” said a C.D.C. official who requested anonymity for fear of retaliation.

    Other experts said that they were not surprised by the hollowing out of the C.D.C.’s H.I.V. teams despite the waiver.

    “What we’ve seen is that there’s no rhyme and reason to any of the actions that the administration is taking,” said Jirair Ratevosian, who served as the chief of staff for PEPFAR in the Biden administration.

    Care for children and pregnant women with H.I.V. is complex.

    Infants need an H.I.V. test different from the one used for adults, and infected babies must take a separate set of medications. They succumb quickly to complications when treatment is interrupted.

    “Especially when you think about children, time is of the essence,” Dr. Giphart said. “That seems to not really be taken into consideration with all these changes that are being made.”

    In low-income countries, pregnant women with H.I.V. usually get treatment at prenatal clinics. Without treatment, one in three pregnant women may pass H.I.V. on to her baby.

    Treatment decreases the risk of transmission to less than 1 percent. PEPFAR has prevented nearly eight million such infections in newborns since its inception, in 2003.

    The foreign aid freeze imposed in January has resulted in shortages of pediatric H.I.V. drugs in many countries and the delayed delivery of a new H.I.V. drug treatment.

    The C.D.C. experts who were let go had been helping low-income countries prepare for this transition, tracking stocks and helping to direct the medications to the places with the most urgent needs, said an official who spoke on condition of anonymity for fear of retaliation.

    “This coordination is especially critical right now because we’re in a period of immense change,” the official said.



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  • As RFK Jr. Champions Chronic Disease Prevention, Key Research Is Cut

    As RFK Jr. Champions Chronic Disease Prevention, Key Research Is Cut


    Robert F. Kennedy Jr. has spoken of an “existential threat” that he said can destroy the nation.

    “We have the highest chronic disease burden of any country in the world,” Mr. Kennedy said at a hearing in January before the Senate confirmed him as the secretary of Health and Human Services.

    And on Monday he is starting a tour in the Southwest to promote a program to combat chronic illness, emphasizing nutrition and lifestyle.

    But since Mr. Kennedy assumed his post, key grants and contracts that directly address these diseases, including obesity, diabetes and dementia, which experts agree are among the nation’s leading health problems, are being eliminated.

    These programs range in scale and expense. Researchers warn that their demise could mean lost opportunities to address an aspect of public health that Mr. Kennedy has said is his priority.

    “This is a huge mistake,” said Dr. Ezekiel Emanuel, the co-director of the Healthcare Transformation Institute at the University of Pennsylvania’s Perelman School of Medicine.

    Ever since its start in 1996, the Diabetes Prevention Program has helped doctors understand this deadly chronic disease. The condition is the nation’s most expensive, affecting 38 million Americans and incurring $306 billion in one recent year in direct costs. With about 400,000 deaths in 2021, it was the eighth leading cause of death.

    The program has been terminated, and the reason has little to do with its merits. Instead, it seems to be a matter of a lead researcher’s working in the wrong place at the wrong time.

    The program began when doctors at 27 medical centers received funding from the National Institutes of Health for a study asking whether Type 2 diabetes could be prevented. The 3,234 participants had high risk of the disease.

    The results were a huge victory. Those assigned to follow a healthy diet and exercise routine regularly reduced their chances of developing diabetes by 58 percent. Those who took metformin, a drug that lowers blood sugar, decreased their risk by 31 percent.

    The program entered a new phase, led by Dr. David M. Nathan, a diabetes expert at Harvard Medical School. Researchers followed the participants to see how they fared without the constant attention and support of a clinical trial. The researchers also examined their genetics and metabolism and looked at measures of frailty and cognitive function.

    Several years ago, the investigators had an idea. Some studies suggested that people with diabetes had a higher risk of dementia. But scientists didn’t know if it was vascular dementia or Alzheimer’s or what the precise risk factors were. The diabetes program could renew its focus on investigating this with its 1,700 aging participants.

    The group added a new principal investigator, the dementia expert Dr. Jose A. Luchsinger. For administrative reasons, including the newfound focus on dementia, the program decided its money should flow through Dr. Luchsinger’s home institution, Columbia University, rather than through Harvard or George Washington University, where a third principal investigator works.

    On March 7, the Trump administration cut $400 million in grants and contracts to Columbia, saying Jewish students were not protected from harassment during protests over the war in Gaza. The diabetes grant was among those terminated: $16 million a year that Columbia shared across 30 medical centers. The study ended abruptly.

    Asked about the termination, Andrew G. Nixon, director of communications at the Department of Health and Human Services, provided a statement from the agency’s acting general counsel saying that “anti-Semitism is clearly inconsistent with the fundamental values that should inform liberal education” and that “Columbia University’s complacency is unacceptable.”

    At the time their grant ended, the researchers had started advanced cognitive testing for evidence of dementia in patients, followed by brain imaging to look for amyloid, the hallmark of Alzheimer’s disease. They planned to complete the tests during the next two years.

    Then, Dr. Luchsinger said, the group was going to look at blood biomarkers of amyloid and other signs of dementia, including brain inflammation. For comparison, they planned to perform the same tests on participants’ blood samples from 7 and 15 years ago.

    “Very few studies have blood collected and stored going that far back,” Dr. Luchsinger said.

    Now much of the work cannot begin, and the part that had started remains incomplete.

    Another troubling question the researchers hoped to answer was whether metformin increases, decreases or has no effect on the risk of dementia.

    “This is the largest and longest study of metformin ever,” Dr. Luchsinger said. Participants assigned to take the drug in the 1990s took it for more than 20 years.

    “We thought we had the potential to put to rest this question about metformin,” Dr. Luchsinger said.

    The only ways to save the program, Dr. Nathan said, are for Mr. Kennedy to agree to restore the funding at Columbia or to transfer the grant to a principal investigator at another medical center.

    The study investigators are appealing to the diabetes caucus in Congress, hoping it can help make their case to the Health and Human Services.

    “We hope the congressmen and senators might prevail and say: ‘This is crazy. This is chronic disease. This is what you wanted to study,’” Dr. Nathan said.

    So far, there has been no change.

    Compared with the Diabetes Prevention Program, a program to train pediatricians to become scientists is tiny. But pediatric researchers say that the Pediatric Scientist Development Program helps ensure that chronic childhood diseases are included in medical research.

    It began 40 years ago when chairs of pediatric departments called for the creation of the program, which has been continually funded ever since by the National Institute of Child Health and Human Development.

    Participants are clinicians who were trained in subspecialties like endocrinology and nephrology, practiced as clinicians and were inspired to go into research to help young patients with the diseases they had seen firsthand.

    The highly competitive program pays for seven to eight pediatricians to train at university medical centers for a year, pairing them with mentors and giving them time away from the clinic to research conditions including obesity, asthma and chronic kidney disease.

    In retrospect, the program’s fate was sealed in 2021 when its leaders applied for a renewal of their grant. It seemed pro forma. This was its eighth renewal.

    This time, though, an external committee of grant reviewers told the investigators their proposal’s biggest weakness was a lack of diversity. The program needed to seek pediatricians who represented diverse ethnicities, economic backgrounds, states, types of research and pediatric specialties.

    The critique said, for example, that “attention must be given to recruiting applicants from diverse backgrounds, including from groups that have been shown to be nationally underrepresented in the biomedical, behavioral, clinical and social sciences.”

    So the program’s leaders sprinkled diversity liberally through a rewritten grant application.

    “Diversity, in its broadest sense, was all over the grant,” said Dr. Sallie Permar, professor and chairwoman of pediatrics at Weill Cornell Medical College and director of the program. “It was exactly what the reviewers appreciated when we resubmitted.”

    The grant was renewed in 2023. Now it is terminated. The reason? Diversity.

    The termination letter, from officials in the National Institute of Child Health and Human Development, said there was no point in trying to rewrite the grant request. The inclusion of diversity made the application so out of line that “no modification of the project could align the project with agency priorities.”

    Mr. Nixon, the health department spokesman, did not reply to queries about the pediatric program’s cancellation.

    Participants in the program are distraught.

    Dr. Sean Michael Cullen had been studying childhood obesity at Weill Cornell in New York. He has investigated why male mice fed a high-fat diet produced offspring that became fat, even when those offspring were fed a standard diet.

    He hoped his findings would help predict in humans which children were at risk of obesity so pediatricians could try to intervene.

    Now the funds are gone. He may seek private or philanthropic funding, but he doesn’t have any clear prospects.

    Dr. Evan Rajadhyaksha is in a similar situation. He’s a childhood kidney disease specialist at Indiana University. When he was a resident, he cared for a little girl who developed kidney disease because of a condition in which some urine washes up from the bladder into the kidneys.

    Dr. Rajadhyaksha has a hypothesis that vitamin D supplementation could protect children with this condition.

    Now, that work has to stop. Without funding, he expects to leave research and return to clinical work.

    Dr. Permar said she hadn’t given up. The program costs only $1.5 million each year, so she and her colleagues are looking for other support.

    “We are asking foundations,” she said. “We are starting to ask industry — we haven’t had industry funding before. We are asking department chairs and children’s hospitals, are they willing to fund-raise?”

    “We are literally looking under every couch cushion,” Dr. Permar said.

    “But,” she said, federal support for the program “has been the foundation and cannot be supplanted.”



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  • RFK Jr. to Kick Off MAHA Tour on Fighting Chronic Disease

    RFK Jr. to Kick Off MAHA Tour on Fighting Chronic Disease


    A day after attending the funeral of an unvaccinated child who died of measles, Health Secretary Robert F. Kennedy Jr. will kick off a tour through Southwestern states on Monday, spotlighting initiatives that emphasize nutrition and lifestyle choices as tools for combating disease.

    The Make America Healthy Again tour, which will take Mr. Kennedy through parts of Utah, Arizona and New Mexico, is intended to draw attention to some of the secretary’s common-ground interests, but the first day is scheduled to end with a highly contentious one: a news conference to highlight Utah’s new law that bans adding fluoride to public drinking water supplies.

    The tour comes as questions grow about the federal government’s response to a measles outbreak in West Texas that has spread to other states. The death of an unvaccinated 8-year-old girl there last week was the second confirmed fatality from measles in a decade in the United States. Mr. Kennedy attended the girl’s funeral on Sunday and met with her family before continuing to Utah.

    Mr. Kennedy’s staff said that over the course of three days, he planned to visit multiple health centers, including a medical school’s “teaching kitchen” to train students on managing chronic disease using dietary choices. He is scheduled to meet with leaders of Navajo Nation to discuss the cultural and logistical challenges of providing high-quality health care to tribal groups and to visit a charter school in New Mexico that “integrates healthy eating and physical fitness into its daily student life.”

    During his first months in office, Mr. Kennedy’s policies have been unfurled with great brouhaha, but the secretary himself has been relatively low profile, particularly for an official with his degree of fame. The White House has encouraged Mr. Kennedy to take a more public-facing approach to his role, but the timing of his first major push out in the country will require toeing a careful line around the most conspicuous issue on the table.

    Public health experts say the measles outbreak that has now infected nearly 500 people in West Texas is driven by low vaccination rates. Mr. Kennedy, who is famously skeptical of vaccine safety, shifted his rhetoric after the little girl’s funeral, posting on X: “The most effective way to prevent the spread of measles is the MMR vaccine.”

    It was the most definitive statement he has made endorsing vaccines as a preventive tool, but some public health experts were dismayed that he did not explicitly recommend that parents vaccinate their children and did not say the vaccines were safe. And several hours later he posted on X again, praising two doctors who are using unproven treatments to care for hundreds of children with measles.

    For months, Mr. Kennedy has emphasized that vaccination was a matter of parental choice and encouraged people to consider unproven regimens like vitamin A, which can lead to toxicity, and suggested that poor lifestyle choices were at play among victims.

    Diet and nutrition “don’t offer any benefit to prevent infection with measles whatsoever,” said Dr. Michael Mina, an epidemiologist and immunologist who has studied measles.

    Healthy foods and exercise can “help limit the consequences of many infections, including measles, but will not prevent them,” he added. “Prevention is by far the best medicine.”

    Mr. Kennedy is likely to face further questions about measles during his news conference Monday afternoon in Salt Lake City, though the event is aimed at calling attention to an entirely different issue: fluoridation of drinking water.

    Mr. Kennedy has urged states and municipalities to remove fluoride from drinking water since before the 2024 election. The American Dental Association has said that water fluoridation reduces dental decay by at least 25 percent in children and adults.

    The fluoridation debate stretches back to the 1950s, when conspiracy theories swirled around whether the practice was a Communist plot to cause brain damage. Some studies suggest that excess exposure to fluoride — at levels twice the amount recommended by the Environmental Protection Agency — could harm infants. The Centers for Disease Control and Prevention has listed fluoridation as one of the 10 great public health achievements of the 20th century.



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