Tag Archives: HHS

Health And Safety

It’s hard to know whether to laugh or cry while you’re watching the Keystone Kops dismantle the federal government.

A recent article charting the decimation of HHS under RFK, Jr.–aka Mr. Brain Worm– contained the following tidbits: employees who were laid off and who wanted to pursue discrimination complaints were told to contact Anita Pinder, former director of the Office of Equal Opportunity and Civil Rights. Pinder died last year.  Then there was the report that a number of FDA staff members only discovered they were part of the sweeping reduction in force when they arrived for work one morning and their badges would no longer let them into the building.

Kennedy’s haphazard and unprecedented downsizing of the federal health workforce–the dismissal of twenty thousand workers–was evidently conducted with similar inattention to careful analysis, let alone standard procedures or pesky details. The dismissals removed what the article called “a broad swath of expertise: biomedical scientists, staff who respond to freedom of information requests and researchers who work to improve patient safety.”

Those dismissed from HHS included numerous senior leaders–individuals who represented often irreplaceable institutional memory.

At the National Institutes of Health, a nearly $48 billion biomedical research agency, at least five top leaders were put on leave. Among those offered reassignment were the infectious-disease institute director Jeanne Marrazzo, according to emails obtained by The Post and multiple people familiar with the matter, who spoke on the condition of anonymity because they were not authorized to speak publicly.

Marrazzo had succeeded Anthony S. Fauci as director of the National Institute of Allergy and Infectious Diseases, which helped lead the nation’s response to the coronavirus pandemic and later became a target of Republicans. An internal email showed that two other leaders there, H. Clifford Lane and Emily Erbelding, also lost their jobs, and the agency had no advance notice of who had been targeted for layoffs through the reduction in force, or RIF

The story was the same throughout the reckless purge of HHS. At the CDC, for example, senior leaders overseeing global health, infectious diseases, chronic disease, HIV, sexually transmitted disease, tuberculosis, outbreak forecasting and information technology were all among those notified that they would be reassigned to the Indian Health Service (a reassignment most refused). The article quoted one official for the probable effect: “The agency will not be able to function. Let’s be honest.”

The purge included some 3500 scientists working on bird flu and vaccine safety, as well as the safety of the U.S. food supply and tobacco products.

“The FDA as we’ve known it is finished, with most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed,” Robert Califf, who served as FDA commissioner under Presidents Joe Biden and Barack Obama, wrote on LinkedIn on Tuesday morning.

Forbes was among the publications warning that the cuts could have profound effects on the health and well-being of Americans. A capacity to respond to emerging new diseases that has arguably already been inadequate will be even more vastly curtailed; food and drug safety are being imperiled; and research on diseases like cancer, Alzheimers and Parkinsons (among many others) will be dramatically set back. Other cuts significantly reduced the number of caseworkers who assist Affordable Care Act consumers and Medicare beneficiaries.

The list goes on.

And what about the “savings” being touted? Will the vast majority of Americans whose health and safety are being compromised by these ill-considered dismissals at least see a financial benefit? Hardly. The Trump administration is “saving” this money in order to fund further tax reductions for the wealthy–trading the health and well-being of the many for fatter pockets for the few.

America has long been the only Western democratic country without a program of national health care. Now we face the prospect of greatly diminished public health and safety protections, in order to exempt our plutocrats from paying their fair share of taxes.

Makes me want to ask those folks with the red hats: are we great yet?

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Who Will Die?

Among the travesties being committed by a lawless and determinedly stupid administration, its assault on science–and particularly medical science– is among the acts most likely to affect all Americans negatively. Ironically, the administration’s anti-science, anti-expertise tantrum has already proved to hit devoted MAGA Neanderthals the hardest.

While there have always been medical skeptics, this expanded retreat from sound medical advice began in earnest during the pandemic, when the “give me liberty” MAGA cult refused to wear masks, continued to sponsor and attend public gatherings, and–especially– refused to get vaccinated. They died of Covid in disproportionate numbers.

In the wake of the 2020 election, there was some speculation that–at least in some deep Red congressional districts–a fall-off in Republican votes was due to that disproportionate death rate. (I’ve been unable to find confirmatory data for that speculation, but the fact that unvaccinated folks were much more likely to suffer and die has been repeatedly documented.)

The designation of MAGA folks as a cult has become widespread, and the evidence for that continues to mount. During the pandemic, followers of their massively ignorant cult leader obediently ingested bleach and Ivermectin, a medication intended for horses; today, RNK, Jr.–he of the brain worm and an assortment of bizarre conspiracy theories–is busily substituting those theories for medical science. His cuts at HHS are already imperilling public health, and are likely to make it more difficult for sane Americans to receive the vaccines that protect us from a wide variety of diseases.

The dramatic politicization of health care is likely to affect us all, but–again, ironically–it is much more likely to affect the cult’s true believers. I recently came across an article describing how the choice of a doctor has become partisan. Research published in the British Journal of Political Science finds that Americans’ trust in their personal physicians—an area that the study notes “was once a rare nonpartisan sanctuary”—has become increasingly divided along political lines, with potentially serious implications for public health.

Here–in a nutshell–is what the study found.

Trust reversal: While Republicans were slightly more trusting of their doctors a decade ago, Democrats are now 12 percentage points more likely to express “a great deal” of trust in their physicians.

Political preferences matter: Both Republicans and Democrats strongly prefer doctors who share their political affiliation, sometimes placing as much importance on political alignment as on shared race or gender.

Health implications: With Trump voters over 50 being 11 percentage points less likely to closely follow their doctor’s advice, this partisan divide could affect health outcomes and potentially widen existing mortality gaps between Republican and Democratic counties.

It hasn’t always been this way.

In 2013, Republicans actually reported slightly higher trust in their personal doctors than Democrats. By 2022, the tables had turned dramatically, with Democrats approximately 12 percentage points more likely than Republicans to report “a great deal” of trust in their physicians.

The study noted that the General Social Survey–a research instrument that tracks American attitudes– found diminished “confidence in the scientific community, education, the press, and many other institutions had already polarized along partisan lines by 2010. Medicine, however, remained stubbornly nonpartisan until 2021.”

The COVID-19 pandemic thrust public health officials into the spotlight, where they quickly became lightning rods for partisan conflict. The study found strong evidence that as medical authorities like Dr. Anthony Fauci became political targets, the distrust spilled over into Americans’ relationships with their own personal doctors….

Between 2001 and 2019, researchers observed a growing gap in death rates between Republican and Democratic counties, with people in Democratic counties living longer. If partisan divides continue to influence healthcare decisions, this gap may widen further, creating a feedback loop where political identity affects health outcomes, which then reinforce political divisions.

As the linked article concludes, if this polarization continues or increases, and Americans increasingly make critical life choices based on political identity, those choices could mean the difference between early diagnosis and late-stage disease. That makes the stakes of this particular aspect of our deepening political divisions literally matters of life and death.

If the results of the stupidity were confined to those applauding it, that would be one thing. (Admittedly, still a bad thing, but–hey, I’m not a nice human–somewhat fitting.) But we’re all likely to inhabit a far less protective world. Cuts to the FDA alone will mean slower approval of new medications, fewer food safety inspections, and lapses in new medical products. Other cuts have decimated research into diseases like HIV, Parkinsons and Alzheimers.

The cult’s dominance threatens us all.

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Theocrats At HHS

Readers from Indiana will understand why I found this recent Politico headline chilling: “How Mike Pence’s Mafia Took Over Health Care Policy.”

Pence, of course, could care less about health care, or policy of any sort that doesn’t advance his Christianist agenda. And he “serves” (or is that word “serviles”?) a President who has no discernible interest in any policy–or anything other than his own self-aggrandizement. So the fact that Pence has installed his preferred people at Health and Human Services tells us that health policy will be made on the basis of ideology, not science or evidence.

Behind the scenes, Pence has developed his own sphere of influence in an agency lower on Trump’s radar: Health and Human Services. It’s also the agency with the ability to fulfill the policy goal most closely associated with Pence over his nearly 20 year career in electoral politics: de-funding Planned Parenthood.

Numerous top leaders of the department — including Secretary Alex Azar, Surgeon General Jerome Adams and Medicaid/Medicare chief Seema Verma — have ties to Pence and Indiana. Other senior officials include Pence’s former legislative director from his days as governor and former domestic policy adviser at the White House.

“He has clearly recruited people connected to him who share his very extreme views on sexual and reproductive health care,” said Emily Stewart, the vice president of public policy at Planned Parenthood. “This has been one of the most active administrations ever on rolling back reproductive rights and there’s no way that happens unless you have people in the White House driving the effort to put out policies at such a rapid clip.”

Before the courts intervened, HHS was getting ready to implement rewritten federal policies to curb abortion and–Pence’s wet dream– cut funding to Planned Parenthood. The new regulations would also have tightened the conditions under which Title X federal family planning grants are awarded, ensuring that clinics wouldn’t even be able to refer women to entirely separate abortion providers.

And in a nod to Pence’s longterm efforts to privilege religious bigotry, the agency this month boosted “religious conscience protections” for providers who refuse to perform certain medical services, including abortion, citing religious or moral objections.

The changes to Title X are the culmination of a battle Pence waged first as a member of Congress, then as governor and now in the White House. The Title X rules, which force providers of federally funded family-planning programs to separate themselves from abortion providers, are aimed squarely at Planned Parenthood, which relies heavily on such funding. The Title X changes don’t cut off Medicaid funds from Planned Parenthood — although cutting off that big pot of money is on the GOP wish list as well.

Pence has installed a number of people at HHS who were part of his Indiana administration. As White House staff members have confirmed, from the very outset of the Trump administration, Pence had carte blanche to identify nominees he preferred  “particularly in roles Trump didn’t really care about,” as one GOP operative put it.

Even somewhat smaller projects appear to bear the vice president’s ideological imprint — for example, a recent HHS decision to grant South Carolina a waiver that allows foster care providers to reject potential families who have different religious beliefs.

These conservative and religious views have played into the administration’s foreign as well as domestic policy. Internationally, Trump and Pence have gone beyond even other Republican administrations in curbing access to abortion and contraception by expanding the so-called Mexico City policy barring U.S. foreign aid to groups that promote or provide abortion.

Trump is fixated on himself. Pence is fixated on imposing his peculiar version of Christianity  on America.

Neither they nor any of the criminals and incompetents they’ve installed as cabinet members and White House staffers care anything at all about We the People, the Constitution, or the Rule of Law.

If we don’t evict the whole crew in 2020, there may not be any going back.

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Don’t Look Behind The Curtain…

On the 12th of this month, media reported that HHS was deleting twenty years of medical guidelines from its government website.

The Trump Administration is planning to eliminate a vast trove of medical guidelines that for nearly 20 years has been a critical resource for doctors, researchers and others in the medical community.

Maintained by the Agency for Healthcare Research and Quality [AHRQ], part of the Department of Health and Human Services, the database is known as the National Guideline Clearinghouse[NGC], and it’s scheduled to “go dark,” in the words of an official there, on July 16.

Medical guidelines like those compiled by AHRQ aren’t something laypeople spend much time thinking about, but experts like Valerie King, a professor in the Department of Family Medicine and Director of Research at the Center for Evidence-based Policy at Oregon Health & Science University, said the NGC is perhaps the most important repository of evidence-based research available.

Why would the administration delete this information? Experts say it was a unique repository that got 200,000 visits a month.

Medical guidelines are best thought of as cheatsheets for the medical field, compiling the latest research in an easy-to use format. When doctors want to know when they should start insulin treatments, or how best to manage an HIV patient in unstable housing — even something as mundane as when to start an older patient on a vitamin D supplement — they look for the relevant guidelines. The documents are published by a myriad of professional and other organizations, and NGC has long been considered among the most comprehensive and reliable repositories in the world.

So what was the pressing issue that forced elimination of a well-regarded, well-used, totally unpolitical resource?

AHRQ agrees that guidelines play an important role in clinical decision making, but hard decisions had to be made about how to use the resources at our disposal,” said AHRQ spokesperson Alison Hunt in an email. The operating budget for the NGC last year was $1.2 million, Hunt said, and reductions in funding forced the agency’s hand.

Not even an archived version will remain.

It’s hard to credit the notion that fiscal restraints required the deletion. After all, our “President” is spending billions on such things as repainting Air Force One and requiring a military parade a la Third-World Dictators. Toward the end of the linked report, there’s a hint:

The NGC has a screening process designed to keep weakly supported research out. It also offers summaries of research and an interactive, searchable interface.

That gatekeeping role has sometimes made AHRQ a target. The agency was nearly eliminated shortly after its establishment, in the mid-90s, when it endorsed non-surgical interventions for back pain, a position that angered the North American Spine Society, a trade group representing spine surgeons. A subsequent campaign led to significant funding losses for AHRQ, and since then, the agency as a whole has been a perennial target for Republicans who have argued that its work is duplicated at other federal agencies.

Organizations writing the guidelines for the big drug companies are paid handsomely in order to promote the companies’ products. NGC’s process provided a vetted, evidence-based resource comparatively free of that kind of influence. Gee-I wonder why it became a target for the GOP?

In 2016, when former head of HHS Tom Price was still a Congressman, one of his aides insistently protested publication of a study that was critical of a drug manufactured by one of Price’s campaign donors. According to ProPublica, Price wanted the agency to pull the critical research down.

While Americans are transfixed and distracted by the antics of our demented (and probably traitorous) accidental President, the largely unrecognized and unseen functions of competent governance are being systematically dismantled.

Even if America survives this maniac and his cabinet of disreputable and incompetent tools, it will take generations to repair the damage.

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Is This Really What Jesus Would Do?

The administration presided over by our thrice-married, p***y-grabbing, porn-star-fornicating President has announced its latest effort to protect religiosity.

The Conscience and Religious Freedom Division has been established to restore federal enforcement of our nation’s laws that protect the fundamental and unalienable rights of conscience and religious freedom…. The creation of the new division will provide HHS with the focus it needs to more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom, the first freedom protected in the Bill of Rights.

The “religious freedom” being protected by the new division and rules is the freedom of medical practitioners to deny medical care if providing that care would be “inconsistent” with their religious beliefs.  (Did the Good Samaritan check the sexual orientation of the injured man he helped? I forgot that part of the story…)

The Administration is clearly unconcerned with the religious beliefs or health needs of women who need reproductive services like birth control. The new rules allow almost anyone who works in the health field to refuse to provide a wide array of services; adding insult to injury, there is no requirement that religiously objecting doctors refer patients elsewhere.

Planned Parenthood warns that the rule could allow a pharmacist to refuse to fill a prescription for birth control, doctors to deny hormone therapy to transgender patients, and  pediatricians to refuse to treat the child of gay parents.

An Atlantic article looked at the implications.

There are already federal laws that protect medical personnel from being required to provide abortions. In addition, nearly every state also allows health-care providers to refuse to perform abortions, and 12 states allow them to refuse to provide contraceptives. In six states, even pharmacists are allowed to refuse to fill birth-control prescriptions.

According to reproductive-rights groups, the problem is these laws often mean patients who are denied services aren’t then referred to a doctor who will provide the care. According to one poll, only 57 percent of doctors nationally believe objecting physicians must refer patients to an accommodating provider. “Only in a couple of states are patients given information and referrals,” says Elizabeth Nash of the pro-choice Guttmacher Institute.

Given the language of the new regulation, the “protection” could be extensive.

“Under the new rule, you could have translators who refuse to translate for a woman undergoing tubal ligation,” says Elizabeth Sepper, a law professor at Washington University in St. Louis.

Those crafting the new rules explain that requiring objecting physicians to refer patients to willing providers would also violate their tender religious consciences.

The proposed rule defines “referral” as providing “any information,” including a phone number or website on a pamphlet, about a health service that the provider disagrees with.

The Administration’s uber-solicitous concern for the religious sensibilities of providers is certainly not matched by any concern for patients, whose rights are far more likely to be violated even under current law.

In 2015, a lesbian couple in Michigan had a pediatrician decline to care for their six-day-old infant, Bay, because, as the doctor later explained to the couple, “after much prayer following your prenatal, I felt that I would not be able to develop the personal patient-doctor relationships that I normally do with my patients.”

Another case, also in Michigan, involved Tamesha Means, a woman who was rushed to her county’s Catholic hospital when her water broke at 18 weeks into her pregnancy. “Based on the bishops’ religious directives, the hospital sent her home twice even though Tamesha was in excruciating pain,” as the ACLU put it. The hospital staff did not tell her that she could, and probably should, end the pregnancy, according to the ACLU’s summary. Ultimately, Means returned to the hospital a third time, this time with an infection, and miscarried.

Critics of this new level of regulation point out that it is transparent political pandering; unlike the numerous cases where patients have been endangered, instances where providers have been discriminated against are vanishingly rare. As the article concluded,

“They’re setting up this office and using a lot of taxpayer dollars to solve a problem that doesn’t really exist,” Fogel says. “Health systems are already pretty good at accommodating people who have a genuine objection to participating in a service.”

Swartz agrees, saying the problem of conscientiously objecting physicians “is like voter fraud. Those instances are one in a million.”

Rare though they might be, these cases will now merit special attention by the U.S. government.

Perhaps this new division is protecting “Christian” doctors in return for that “mulligan” Evangelicals gave Trump…

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