Archives for category: Health

This is one of the saddest stories I have read in a long time. Georgia has one of the most draconian abortion laws in the nation. Because of that law, a woman who is brain-dead will be kept “alive” until she gives birth. She is nine weeks pregnant. The baby will be removed when it reaches 32 weeks. One of those Bible-thumpers should offer to adopt the baby. Lots of Bible-thumpers or the State Legislature should pay the outrageous bills that will pile up.

Robyn Pennacchia of the Wonkette wrote about this horrendous case:

Adriana Smith of Atlanta, Georgia, has been brain dead for more than 90 days.

Back in February, Smith — a registered nurse at Emory University Hospital — started experiencing intense headaches and went to get checked out at a local hospital, because she knew “enough to know something was wrong.”

“They gave her some medication, but they didn’t do any tests. No CT scan,” Smith’s mother, April Newkirk, told 11Alive news. “If they had done that or kept her overnight, they would have caught it. It could have been prevented.”

The next morning, Smith’s boyfriend discovered her gasping for air and gurgling on what he believed was blood. She went back to the hospital, where they finally did a CT scan and discovered multiple blood clots in her brain. Unfortunately, they were too late and Smith was declared brain dead as they prepared to go into surgery.

This would have been a horrific enough scenario under normal circumstances, but Smith was also nine weeks pregnant … and in Georgia. Georgia has one of the worst maternal mortality rates in the nation, 33.9 deaths per 100,000 live births — 48.6 per 100,000 for Black women and 22.7 for white and Hispanic women. Part of that is because women like Adriana Smith are ignored when they tell doctors that something is wrong. 

Georgia also has a “Heartbeat Law” that bans abortion after fetal pole cardiac activity is detected (but before there is even an actual heart).

Because of Georgia’s garbage abortion ban, Smith now has to be kept on life support until the fetus is 32 weeks along and can be removed. Like, they are literally using her dead body as an incubator for a fetus. 

Please, take a moment to scream into a nearby throw pillow, if you need it. 

Via 11Alive:

Under Georgia’s heartbeat law, abortion is banned once cardiac activity is detected — typically around six weeks into pregnancy. The law includes limited exceptions for rape, incest, or if the mother’s life is in danger. But in Adriana’s case, the law created a legal gray area.

Because she is brain dead — no longer considered at risk herself — her medical team is legally required to maintain life support until the fetus reaches viability. 

The family said doctors told them they are not legally allowed to consider other options. […]

Now, due to the state abortion ban, Smith is being kept on life support.

“She’s been breathing through machines for more than 90 days,” Newkirk said. “It’s torture for me. I see my daughter breathing, but she’s not there. And her son — I bring him to see her.”

Newkirk said it’s been heartbreaking seeing her grandson believe his mother is “just sleeping.”

It would be bad enough if the state were just forcing the family to keep Smith “alive” on life support in order to be an incubator for the fetus, but they’re also requiring them to pay for it. While it’s not exactly easy to track down exact costs, an ICU bed in a Georgia non-profit hospital costs, on average, $2,402 a day on its own, without any additional treatment. According to a report from the Agency for Health Care Research and Quality, mechanical ventilation costs, on average, “$3,900 per day after the fourth day.” So that’s $6302 a day just for the basics. Then there’s everything else on top of that. 

And health insurance doesn’t cover life support when there’s no chance of survival or improvement. 

So we’re already at $1.6 million before even getting into the cost of the baby’s care. The average stay in the NICU for a baby born at 32 weeks is 36 days, and a NICU stay can cost $3,000 to $20,000 a day. That is more likely to be covered by health insurance — though it is not actually clear if the baby would be covered by Smith’s health insurance if she’s dead, or for how long. And that’s just in the beginning. It is hard to imagine that a kid born in those circumstances would not have some pretty serious health issues down the road. 

This family is fucked. 


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I am going to need to point out, for the 80 bajillionth time, that the people who love the idea of forcing a woman to give birth against their will (or while braindead) are almost universally against universal health care. Especially the ones who are going around crying about “birth rates.” 

I’m not saying it would make anything okay, it wouldn’t, but the very fact that these absolute pieces of shit want to force people to give birth against their will and pay for the privilege as well is galling. In this case, the state wants to force this family to pay possibly $1.6 million or more to keep a brain dead woman alive so that she can give birth to a fetus that was only nine weeks along when she died. 

Perhaps it’s crass to think of money, given the fact that keeping a woman on life support just to incubate a fetus is appalling enough on its own. And it is. But a nearly two million dollar surcharge is a hell of an added insult to injury. 

In 2000, the contagious disease measles was officially eradicated in the United States. However, since the rise of anti-vaccine anxieties during the COVID pandemic, a growing number of parents have refused to let their children be vaccinated.

Texas is the center of a measles outbreak. 702 children have measles; 95% had not been vaccinated. Two have died, neither of them had been vaccinated. The national number is certainly larger.

The Houston Chronicle reported:

The measles outbreak that started in the South Plains region of Texas surpassed 700 cases on Tuesday, according to health officials.

The latest update from the Texas Department of State Health Services shows the state has seen 702 cases of measles since the outbreak began spreading in late January. The outbreak, which has also spread to New Mexico and Oklahoma, is the largest in the United States since measles was declared eliminated in the country in 2000.

Two children, an 8-year-old girl and a 6-year-old girl, died after contracting the virus, and 91 people have been hospitalized. Neither child who died had received the measles, mumps and rubella vaccine, and they did not have any underlying medical conditions, according to the DSHS.

Roughly two-thirds of cases in Texas have been in children and teens. More than 95% have been in individuals who are unvaccinated, or whose vaccination status is unknown.

Arkansas is deep-red, so of course the Legislature banned abortion. Supporters of abortion rights gathered enough signatures to put the issue to the voters, but the politicians knocked their referendum off the ballot. But the issue has not gone away.

I thought readers might like to read about the persistence of abortion right supporters.

The Arkansas Times is a dissident website that keeps readers informed about events like this one. If you want to know what Governor Sarah Huckabee Sanders is doing, this is a great source.

Austin Gelder wrote about the annual planned parenthood Garden Party:

For proof of the sorry state of reproductive rights in Arkansas, consider that for the second year in a row, no protesters even bothered to show at the annual Planned Parenthood Garden Party.

It’s been a brutal run here since the U.S. Supreme Court’s Dobbs decision of 2022 whipped away the national right to abortion access,  pulling the trigger on an Arkansas law primed to ban virtually all abortions in the state as soon as our blood-red state government officials could get away with it.

Since then, the annual Planned Parenthood fundraiser still goes on. But the protesters who used to hoist their placards of bloody, dismembered fetus parts in view of the wine sippers and bidders at the silent auction tables aren’t a problem anymore. Transgender people and immigrants have displaced abortion care providers as the right’s new bogeyman, leaving reproductive rights advocates to regroup in peace.

Anti-abortion groups tout Arkansas as the “most pro-life state in the nation.” To the crowd at the Planned Parenthood Garden Party in Little Rock Wednesday night, other superlatives – worst maternal mortality rate in the country, vying with Mississippi for the highest rate of teen pregnancy, among the worst states for child well-being – are more apt. 

Planned Parenthood Great Plains Executive Director Emily Wales was in town for a party nonetheless. And while she didn’t sugarcoat the status report, it wasn’t quite as bitter as you might expect. 

“Arkansas has paved the way for some pretty awful policies, not just for abortion access, but also excluding us from the Medicaid program and then continuing to pass anti-abortion billswhen there is really no abortion that is accessible for people,” Wales said. “That is not about health care, it’s about messaging and fear.”  

Arkansas’s consolation prize for winning this race to the bottom is that we’re down here pioneering tips and tricks to share with other states who find themselves shut off from access to necessary medical care. A decade ago, then-Gov. Asa Hutchinson blocked Planned Parenthood clinics in Arkansas from collecting Medicaid reimbursements for non-abortion services. (Federal reimbursements for abortions generally were banned even before the Supreme Court overturned Roe v. Wade.) Now, Planned Parenthood affiliates in other states are facing similar threats, and the Trump administration maintains a chokehold on the Title X federal funding that once helped cover the cost of family planning consultations, prescriptions and procedures.  

“I don’t want to lean into our trauma or say that we’re resilient, because we’ve always been under attack,” Wales said. “But we have learned lessons about how to adapt and change and meet the moment. And right now, we have sister affiliates in Planned Parenthood who are trying to figure out what happens if they lose Medicaid, or if their Title X funding that was recently cut for many Planned Parenthoods doesn’t come back, what do they do? And for places like Arkansas, we are now in the position of advising other Planned Parenthoods on how you keep your doors open.”

Doesn’t seem like much to brag about until you consider that Arkansas’s two Planned Parenthood clinics – one in Little Rock and one in Rogers – are seeing increasing numbers of patients each year, even with the state’s abortion ban in place. The number of patients served by Planned Parenthood in Arkansas rose nearly 45% from July 2023 to July 2024. Turns out they really do provide lots of other medical services after all!

Iffy weather necessitated a change of venue for this year’s garden party, from the grounds of a historic home in the Quawpaw Quarter to the decidedly less garden-themed Next Level Events in the Union Station basement. The regulars showed up anyway, their numbers weighted toward people old enough to have a glimmer of memory of the pre-Roe days, but a three-dozen-strong corps of young volunteers organized the nametag table and passed out hors d’oeuvres. 

Speakers skipped those apologetic qualifiers that used to precede seemingly every statement about abortion. None of that tired and defensive, “Nobody likes abortion, but …” anymore.

Instead, speakers leaned into the freedom that comes with having little to lose. The din of a chatty, tipsy crowd packed into a subterranean space helped, too. “I feel like I could say anything and you wouldn’t know,” Wales said. “I could be wildly offensive about, perhaps, the current administration, and no one would ever know.”

Other speakers laughed about the time Lori Williams, longtime clinical director at Little Rock Family Planning Services and the night’s winner of the Brownie Ledbetter Award, helped torpedo a 2013 bill to require ultrasounds for abortion access at six weeks by pulling out an alarmingly phallic vaginal ultrasound probe during a legislative committee hearing. 

Sarah Thompson, a leader with Grandmothers for Reproductive Rights and winner of this year’s Christina Mullinax Persistent Spirit Award, lamented progress made and lost.

“When I needed abortion care in Arkansas, I had to leave the state, and it was a long time ago. And now young women still have to leave the state to obtain abortion care,” Thompson said. “I’ll never stop doing this work. It’s part of who I am for the rest of my life.” (It should be noted that many Arkansas women still do access abortion services without leaving the state thanks to the prevalence of mail-order medication for early term abortions — though many Republicans want to put a stop to that as well.)

Arkansas is part of Planned Parenthood of Great Plains, a consortium that includes Oklahoma, Kansas and Missouri. Abortion is legal in Kansas, and last year, Missouri voters reinstated abortion rights, although state lawmakers there are angling to repeal them again. That kind of heartache is familiar to the 100,000+ Arkansans who signed a petition to give the state a chance to vote on reinstating abortion rights in 2024, only to see that opportunity smothered by dubious legal shenanigans.

“Care in Arkansas does not look the way we want it to, and eventually it will return to what it needs to be, but we’re going to keep working on that,” Wales said. “Until then, we will be creative and thoughtful, and we are not about to be intimidated by what’s happening at the federal level, because we are really, really good at undermining authority.”

Jonathan V. Last writes for and edits one of the liveliest and most informative sites on the Internet: The Bulwark. That is home base for a significant number of Republican Never Trumpers. In this post, he explains that Robert F. Kennedy Jr. is not only unqualified in medical issues but his ignorance puts all of us in danger.

America has never been healthier. Going backwards is going to mean more people getting sick and dying.

(Composite / Photos: GettyImages / Shutterstock)

1. The Past Sucked

I had a great conversation with Your Local Epidemiologist, Katelyn Jetelina, yesterday. It’s here if you missed it.

As she was explaining the state of play with measles outbreaks and falling vaccination rates, I asked her if there was any analog to this moment in the history of public health. She couldn’t think of one.

What America’s new public health establishment—by which I don’t mean actual public health experts but their dilettante conspiracist bosses—is doing is choosing to move the country backwards. Less medical research, a pull-back on life-saving vaccines, turning away from science and embracing folk medicine.

Our new health establishment is explicit about wanting to go backwards. It’s right there on the hat: Make America Healthy Again.

Again.

Meaning: America used to be “healthy” and now is not.

I’m sorry, I know we’re supposed to meet people where they are and give them a loving truth sandwich, but this is the stupidest fucking thing I’ve ever heard.

Does anyone remember what “health” looked like in America a generation or two ago? Half the country smoked. People dropped dead at 50 on the reg. Child birth was dangerous. Seatbelts were suss. Drug use was off the charts.

Dangerous communicable diseases were still around. Cancer was a death sentence. AIDS looked like an unstoppable tsunami.

Food? Do remember what grocery stores looked like in 1980? Aisles of canned vegetables, processed foods, and frozen TV dinners. Fresh produce? Good luck. That section of the Acme was a shoebox.

But that’s all anecdotal. Let’s look at the data. Because it shows—absolutely, unequivocally—that this is the healthiest period in American history.


Let’s start with the dumbest possible metric: life expectancy.

We’ve had a slight downtick in the last year or two largely driven by COVID. You know why a lot of people died from COVID? Because they refused to follow public health advice during the pandemic and then refused to get vaccinated once we had vaccines in hand. So it was precisely the MAHA idiocy that moved our life expectancy backward.

Let’s zoom out and look at America compared to the rest of the developed world:

You want to “Make America Healthy Again”? Get the fucking COVID vaccine like everyone else in the civilized world did.


How about infant mortality? That’s another excellent marker of health in a society. Oh, look—it’s incredibly low: 5.61 deaths per 1,000 live births. This is up slightly from 2020 because, again, COVID. But it’s still a historic low.

When do you think the golden, “healthy” past was? In 1980, the infant mortality rate was more than double what it is today (12.0). In 1960 it was more double that number (25.9).

Real problems do exist. For instance: Access to healthcare for African-American women. The black infant mortality rate is double that of white Americans and the maternal mortality rate for African-American women has been rising sharply for a generation.

These statistics are absolutely shameful. Yet you don’t hear a lot about them from the beef-tallow crowd, do you?


How about infectious diseases? In 1900 half of all deaths in America were from communicable diseases. Through medical advances—especially vaccines—we got that number down to about 5 percent—until COVID. All by itself COVID accounted for 12 percent of all deaths in the United States in 2021.

So again: If you want America to be healthy you’d do exactly the opposite of what the Trump administration is doing and urge everyone to get vaccinated.


And while we’re talking about healthy habits: Americans don’t smoke like they used to.

Also, forty years ago less than a fifth of people in cars used seatbelts. Today that number is well over 90 percent.


2. The Big C

Let’s talk about cancer. You ever feel like, “Man, people are getting cancer like crazy these days?”

Here’s what happened. There was a huge spike in the incidence of cancer diagnoses from 1975 to 1995. Why? Two things.

First, people were living longer and you have to die of something. Since people weren’t dying from polio, measles, and communicable diseases, they were living long enough to get cancer.

Second, medical science developed more tools to detect cancer. Inventing effective tests and screenings means finding more incidences. Donald Trump knows this.

So when you look at this graph the solid lines are cancer incidences. You see that they go up, and then down. But I want you to look at the dotted lines:

The dotted lines are the cancer mortality rates. And what you see is that in the early 1990s, people started surviving cancer at higher rates even as the incidences of cancer increased. And from 1995 to 2000, as the cancer incidence rate peaked, the mortality rate fell off a cliff.

Why?

Because better tests = more cancer diagnoses = earlier interventions + therapeutic advances = much higher survival rates.


The pattern we see with cancer incidence describes a lot of our health challenges today. Why do so many people get dementia or Alzheimer’s now? Because they’re surviving cancer and—again—something is going to get us eventually.

Why so many autism diagnoses? Because 40 years ago doctors didn’t understand what they were seeing in kids who had ASD. Now they do. Once medical science understands what it’s looking at, you’re going to get more diagnoses. This isn’t hard to understand.

Look: There are some things that have legitimately gotten worse over time. The incidence of Type 2 diabetes has increased dramatically since 1950. Some of this is linked to increasing obesity.

What’s the answer? Diet and exercise, which you may recall Michelle Obama talking a lot about (and getting ridiculed by Republicans for her trouble). Semaglutide drugs show tremendous potential for helping curb obesity and reduce the incidence of diabetes.

You may be surprised to hear that MAHA does not like this class of pharmaceuticals.


So what’s going on here? Why does the “Make America Healthy Again” movement romanticize the health outcomes of the past (which were worse) and misunderstand the health outcomes of the present (which are significantly better along the most important vectors and continue to improve over time)?

Why do people like RFK Jr. oppose medical practices that create better outcomes (vaccines; the Ozempic-class drugs)?

I don’t know. Maybe you have a theory and can discuss it in the comments.

But at the end of the day, the “why” doesn’t matter. What matters is the results. And the results are going to be bad.


3. Worse Than Fraud

Buildings used to catch on fire all the time in America. It was a serious problem. That’s why cities had as many fire stations as churches.

Over time, we cut way down on the number of fires. We switched construction materials. We came up with safer mechanisms for delivering gas and electricity. We developed best-practices and enshrined them in building codes. The big thing was the invention of the sprinkler system.

The result was that even as the total number of buildings in America kept growing, the annual number of structure fires kept going down. Dramatically.

Imagine a movement that looked at this data and decided America didn’t need sprinkler systems anymore.

Modern building costs are too high. There’s too much red tape. We spend billions on sprinkler systems every year that are never used. Let’s go back to the old ways. Make Buildings Great Again.

After all, we don’t have to worry about fires anymore.

The MAHA movement is like that. Except that while trying to get rid of sprinkler systems and building codes, they are also walking around carelessly tossing lit matches.

These people aren’t just frauds. They’re arsonists. And right now they run the U.S. government, the CDC, the NIH, and the fire department, too.

After Trump introduced Elon Musk and his so-called “Department of Government Efficiency,” several Republican-controlled states created their own DOGE operations. Like the one Musk launched, these were non-governmental, unelected, unaccountable cost-cutters, set loose to apply a chainsaw to state government.

John Thompson reports on what happened in Oklahoma.

CBS’s Sixty Minutes recently reported on the danger of H5N1 bird flu spinning out of control. It cited Dr. Kamran Khan who explained why “We are really at risk of this virus evolving into one that has pandemic potential.” Another expert agreed that “this flu could make Covid look like a walk in the park.”

This frightening reporting comes as the DOGE–OK seeks to cut nearly $150 million for programs that provide immunization services, pathogens surveillance, and emerging infectious diseases prevention, and provide Epidemiology and Laboratory Capacity for Prevention of Control of Emerging Infectious Diseases.

And this is only one reason for looking into the DOGE–OK process.

Anyone paying attention to Elon Musk’s leadership of the Trump administration’s DOGE campaign to cut federal programs has reason the fear the DOGE campaigns launched in 26 states. After all, as the Economic Policy Institute (EPI) explains, when Governor Kevin Stitt opened Oklahoma’s DOGE-OK, he called for a reduction in our personal income and corporate tax rates, thus making the state’s tax code even more regressive.

The EPI further explained that Stitt selected Marc Nuttle, “who was the ‘chief strategist’ behind Oklahoma’s 2001 so-called right-to-work referendum—a policy designed to disempower workers and lower wages (and contrary to proponents’ claims, it did not bolster job growth in the state).” The executive order empowered Nuttle to lead efforts of a newly formed agency to study the state budget.

Moreover, the EPI explains:

DOGE-OK is itself duplicative since the Office of the State Auditor and Inspector is constitutionally mandated to “examine the state and all county treasurers’ books, accounts, and cash on hand, stipulating that [the office] shall perform other duties as may be prescribed by law.” Similar to DOGE-OK, the auditor reviews staffing levels, assesses state spending, and issues public reports to promote transparency.

The DOGE-OK report now explains:

Once DOGE-OK ideas are received, they are analyzed and vetted with the appropriate group. If validated, ideas are added to the DOGE-OK website. 

But, when I studied the report, I found no sign of hard evidence to back its claims. For instance, they didn’t explain their methodology, and offered no cost/benefit analyses. DOGE didn’t explain what “groups” it considered to be “appropriate,” and what data was used to analyze and vet, and validate their ideas.  

Since the first DOGE headlines focused on $157 million in supposedly “wasteful health grants” by the federal government, I focused on Medicaid and Department of Health cuts.

These proposed cuts are especially disturbing because, as Shiloh Kantz, the executive director of the nonpartisan Oklahoma Policy Institute, explained, “Oklahoma already ranks among the worst in health outcomes.”

First, DOGE-OK claimed that $60 million per year would be saved if the state, not the federal government, performed eligibility checks on children. And, they cited two drugs that received accelerated approval without working, costing $42 million. But, they did not mention the number and the benefits of the other drugs, like the Covid vaccine, that received accelerated approval.

Also, DOGE-OK inexplicably said that easing the prescription drug cost cap would improve prices. And they recommended repeal of staffing requirements for Long-Term Care facilities in order to save $76 million annually, without mentioning harm to elderly patients due to under-staffing.

DOGE-OK also said that three Oklahoma State Department of Health programs should be cut by almost $150 million because their funding exceeded the amount necessary.  As already mentioned, in the wake of Covid pandemic, and as measles and bird flu spread, these programs provide immunization services, pathogens surveillance, and emerging infectious diseases prevention, etc. So, how did DOGE reach the conclusion that the full funding of those programs is no longer necessary?  

Then, DOGE-OK said that 7 programs should have cuts because of “duplication,” with partners doing the same or similar work. They said $2.2 million would be saved by getting rid of the team efforts necessary to improve health.

And Sex Education should be cut by $236,000 because of its low Return on Investment.

Again, I saw no evidence behind their recommendations for $157,606,300 in overall health care reductions. Neither did they address financial costs of implementing their ideas. And, there is no evidence that DOGE seriously considered the costs in terms of the lives that would be damaged or lost.

Given the history of the Trump/Musk DOGE, none of the DOGE–OK should be a surprise. When Gov. Stitt selected Nuttle, a true-believer in Milton Friedman, to run the project, Stitt said, “With his help, we’ll leave state government leaner than we found it.”

Is that the proper way to launch a supposedly balanced and evidence-driven investigation of such complex and crucial policy approaches?

Stitt’s news release previewed Nuttle’s methodology: “use his knowledge of the inner workings of government to comb through agency budgets, legislative appropriations, and contracts.”

So, to paraphrase the DOGE-OK report’s description of its methodology, its proposals would be “analyzed and vetted” by what they see as the “appropriate group.”

In other words, Oklahomans were never promised an open, balanced, evidence-based DOGE process for making our state better. But the same is also true for Musk’s federal DOGE chainsaw.

Since Trump invited Elon Musk and his DOGE team to cut the federal budget, the federal government has been subject to a bloodbath of firings, layoffs, and closed agencies. Some of the most shocking budget cuts have focused on scientific research. Reckless cuts have been imposed on the National Science Foundation and on every part of the Department of Health and Human Services, where the Secretary–conspiracy theorist Robert F. Kennedy Jr.–is crushing genuine research and prioritizing his obsession with vaccines as the cause of autism, which has been debunked.

Trump has blocked the payment of millions of dollars to universities that fund basic science research. He is using those blocks to force universities to stop DEI programs.

We can understand why Kennedy wants to destroy science: it has an annoying tendency to undercut his pet conspiracy theories. No matter what science says, he will continue to warn the public that vaccines are dangerous, that fluoridating water is dangerous, and anything that contradicts his ideology is fake, regardless of how many scientists disagree. WHO you gonna believe? The addled RFK Jr. or the world’s top scientists? Or Ghostbusters?

But we do not know why Trump put the nation’s public health agencies into the hands of a man who does not respect science.

Why does Trump want more children to die of measles? Why does he allow Elon Musk to shut down agencies like USAID that have saved millions of lives? Why he is cancelling grants to universities for basic scientific research? Why does he want to stop the work of scientists who are seeking cures for cancer, tuberculosis, AIDS, and other lethal diseases? I don’t know.

Frankly, the cuts are coming so fast that I can’t keep track of them all. I hope soon to find a comprehensive summary of the destruction of federally-funded scientific research.

In the meanwhile, this is the best overview I have seen.

Alan Burdick of the New York Times wrote this story about Trump’s rampage against scientific research:

Late yesterday, Sethuraman Panchanathan, whom President Trump hired to run the National Science Foundation five years ago, quit. He didn’t say why, but it was clear enough: Last weekend, Trump cut more than 400 active research awards from the N.S.F., and he is pressing Congress to halve the agency’s $9 billion budget.

The Trump administration has targeted the American scientific enterprise, an engine of research and innovation that has thrummed for decades. It has slashed or frozen budgets at the National Institutes of Health, the National Science Foundation, the Centers for Disease Control and Prevention and NASA. It has fired or defunded thousands of researchers.

The chaos is confusing: Isn’t science a force for good? Hasn’t it contained disease? Won’t it help us in the competition with China? Doesn’t it attract the kind of immigrants the president says he wants? In this edition of the newsletter, we break out our macroscope to make sense of the turmoil.

American research thrives under a patronage system that funnels congressionally approved dollars to universities, national labs and institutes. This knowledge factory employs tens of thousands of researchers, draws talent from around the world and generates scientific breakthroughs and Nobel Prizes.

It’s a slow-moving system, because science moves slowly. Discoveries are often indirect and iterative, involving collaboration among researchers who need years of subsidized education to become expert. Startups and corporations, which need quick returns on their investment, typically can’t wait as long or risk as much money.

Science is capital. By some measures, every dollar spent on research returns at least $5 to the economy.

President Trump is less patient. He has defunded university studies on AIDS, pediatric cancer and solar physics. (Two prominent researchers are compiling lists of lost N.I.H. grants and N.S.F. awards.) The administration has also laid off thousands of federal scientists, including meteorologists at the National Weather Service; pandemic-preparedness experts at the C.D.C.; black-lung researchers at the National Institute for Occupational Safety and Health. A next-generation space observatory, already built with $3.5 billion over a decade, awaits a launch that now may never happen.

Administration officials offer various reasons for the crackdown: cost-cutting, government efficiency, “defending women from gender ideology extremism.” Many grants were eliminated because they contain words, including climate, diversity, disability, trans or women. Some drew the administration’s ire because the applications included D.E.I. statements required by the previous administration.

It doesn’t take a telescope to see where this leads. American leaders have historically seen science as an investment in the future. Will this administration foreclose it? One-third of America’s Nobel Prize winners have been foreign-born, but an immigration crackdown has swept up scientists like Kseniia Petrova, a Russian who studied aging at Harvard and now sits in a Louisiana detention center. Australian academics have stopped attending conferences in the U.S. for fear of being detained, The Guardian has reported.

Now some American scientists are looking for the exits. France, Canada and other countries are courting our researchers. In a recent poll by the journal Nature, more than 1,200 American scientists said they were considering working abroad. The journal’s job-search platform saw 32 percent more applications for positions overseas between January and March 2025 than during the same period a year earlier.

These are mechanical threats to science — who gets money, what they work on. But there is a more existential worry. The Trump administration is trying to change what counts as science.

One effort aims at what science should show — and at achieving results agreeable to the administration. The health secretary, Robert F. Kennedy Jr., wants to reopen research into a long-debunked link between vaccines and autism. He doesn’t want to study vaccine hesitancy. The National Science Foundation says it will no longer fund “research with the goal of combating ‘misinformation,’ ‘disinformation,’ and ‘malinformation’ that could be used to infringe on the constitutionally protected speech rights of American citizens.” A Justice Department official has accused prominent medical journals of political bias for not airing “competing viewpoints.”

Another gambit is to suppress or avoid politically off-message results, even if the message isn’t yet clear. The government has expunged public data sets on air quality, earthquake intensity and seabed geology. Why cut the budget by erasing records? Perhaps the data would point toward efforts (pollution reduction? seabed mining limits?) that officials might one day need to undertake. We pursue knowledge in order to act: to prevent things, to improve things. But action is expensive, at a moment when the Trump administration wants the government to do as little as possible. Perhaps it’s best to not even know.

One sure way to shut down knowledge is to question who can gather it. The administration is painting scientists with the same liberal brush it has applied to academics more broadly — what Project 2025 describes as “the ‘enlightened,’ highly educated managerial elite.” The N.I.H. is controlled by “a small group of highly paid and unaccountable insiders,” the Project 2025 authors write. The regulatory work of the Environmental Protection Agency “should embrace so-called citizen science” and be left “for the public to identify scientific flaws and research misconduct.”

In science, as in a democracy, there’s plenty of room for skepticism and debate. That’s what makes it work. But at some point, calls for “further research” become disingenuous efforts to obscure inconvenient facts. It’s an old playbook, exploited in the 1960s by the tobacco industry and more recently by fossil-fuel companies.

Now it’s being weaponized by the government against science generally. Facts are elite, facts are fungible, facts are false. And once nothing is true, anything can be true.

One of Trump’s major goals during his campaign was to strip any rights from transgender people and make them invisible. He and Defense Secretary Pete Hegseth agree that trans men and women should not serve in the military and should not receive gender-affirming care to support their transition to a different gender identity. Trump signed an executive order ousting them from the military.

However, federal judges have blocked their plans. Not only will they continue to serve but the Pentagon will continue to provide gender-affirming care for them.

Politico reported:

The Pentagon will resume gender-affirming care for transgender service members, according to a memo obtained by POLITICO, an embarrassing setback to Defense Secretary Pete Hegseth’s efforts to restrict their participation.

The memo says the Defense Department is returning to the Biden-era medical policy for transgender service members due to a court order that struck down Hegseth’s restrictions as unconstitutional. The administration is appealing the move, but a federal appeals court in California denied the department’s effort to halt the policy while its challenge is pending.

As a result, the administration is barred from removing transgender service members or restricting their medical care, a priority of President Donald Trump and Hegseth. The administration insisted its restrictions were geared toward people experiencing medical challenges related to “gender dysphoria,” but two federal judges said in March that the policy was a thinly veiled ban on transgender people that violated the Constitution.

The Trump administration on Thursday asked the Supreme Court to allow the Pentagon to ban transgender servicemembers while legal battles continue to play out.

Both judges ordered the military to refrain from forcing out more than 1,000 transgender troops and to resume providing for their medical care, including surgical procedures and voice and hormone therapy. The memo is the latest move by the Pentagon to comply with those orders.

But it presents another headache for Hegseth, who has made culture war issues — such as changing recruitment standards and reinstating the ban — a key piece of his effort to make the military more lethal. Hegseth has emphasized this theme as he’s sought to defend himself amid multiple scandals, including texting sensitive details of military operations in Yemen to multiple Signal group chats and a vicious brawlbetween his top advisers.

“Service members and all other covered beneficiaries 19 years of age or older may receive appropriate care for their diagnosis of [gender dysphoria], including mental health care and counseling and newly initiated or ongoing cross-sex hormone therapy,” Dr. Stephen Ferrara, the Pentagon’s acting assistant secretary of Defense for health affairs, said in a memo dated April 21.

Trump signed a long-expected order banning transgender people from serving in the military at the outset of the administration, just as he had done in 2017. But LGBTQ+ advocacy groups quickly pounced, calling the order discriminatory.

So far, the courts have rejected the Pentagon’s arguments that including transgender troops reduces the military’s ability to fight. U.S. District Judge Benjamin Settle ruled in March that there is no evidence that transgender troops harm military readiness, and ordered the Pentagon to return to the status quo.

A three-judge panel of the D.C. Circuit Court of Appeals on Tuesday became the first appellate court to hear arguments on Trump’s transgender military policy but gave little indication of how it might rule.

Defense officials acknowledged in a March memo sent to Pentagon leadership that the agency would comply with the court order, but did not detail the steps the department would take to follow it. Hegseth has openly attacked one of the judges, U.S. District Judge Ana Reyes, for her order, labeling her “Commander Reyes” in a pejorative post on X.

Trump’s war on our federal government continues unabated. Among his least noticed targets is data collection. If we don’t collect data, we don’t know where to focus our efforts and where we are succeeding or failing. Trump is not smart enough to figure this out on his own. Someone put this malevolent plan in action on his behalf. We know he is destroying our government, firing essential personnel, closing down Congressionally authorized agencies by eliminating their staff. But we don’t yet know why. He is not cutting waste, fraud, and abuse. He is literally disabling every department. Is he the Manchurian Candidate or is it Musk? The attack on data collection appears to be a direct hit on knowledge.

Alec MacGillis of Pro Publica wrote this report:

More children ages 1 to 4 die of drowning than any other cause of death. Nearly a quarter of adults received mental health treatment in 2023, an increase of 3.4 million from the prior year. The number of migrants from Mexico and northern Central American countries stopped by the U.S. Border Patrol was surpassed in 2022 by the number of migrants from other nations.

We know these things because the federal government collects, organizes and shares the data behind them. Every year, year after year, workers in agencies that many of us have never heard of have been amassing the statistics that undergird decision-making at all levels of government and inform the judgments of business leaders, school administrators and medical providers nationwide.

The survival of that data is now in doubt, as a result of the Department of Government Efficiency’s comprehensive assault on the federal bureaucracy.

Reaction to those cuts has focused understandably on the hundreds of thousands of civil servants who have lost their jobs or are on the verge of doing so and the harm that millions of people could suffer as a result of the shuttering of aid programs. Overlooked amid the turmoil is the fact that many of DOGE’s cuts have been targeted at a very specific aspect of the federal government: its collection and sharing of data. In agency after agency, the government is losing its capacity to measure how American society is functioning, making it much harder for elected officials or others to gauge the nature and scale of the problems we are facing and the effectiveness of solutions being deployed against them.

The data collection efforts that have been shut down or are at risk of being curtailed are staggering in their breadth. In some cases, datasets from past years now sit orphaned, their caretakers banished and their future uncertain; in others, past data has vanished for the time being, and it’s unclear if and when it will reappear. Here are just a few examples:

The Department of Health and Human Services, now led by Robert F. Kennedy Jr., laid off the 17-person team in charge of the National Survey on Drug Use and Health, which for more than five decades has tracked trends in substance abuse and mental health disorders. The department’s Administration for Children and Families is weeks behind on the annual update of the Adoption and Foster Care Analysis and Reporting System, the nationwide database of child welfare cases, after layoffs effectively wiped out the team that compiles that information. And the department has placed on leave the team that oversees the Pregnancy Risk Assessment Monitoring System, a collection of survey responses from women before and after giving birth that has become a crucial tool in trying to address the country’s disconcertingly high rate of maternal mortality.

The Centers for Disease Control and Prevention has eviscerated divisions that oversee the WISQARS database on accidental deaths and injuries — everything from fatal shootings to poisonings to car accidents — and the team that maintains AtlasPlus, an interactive tool for tracking HIV and other sexually transmitted diseases.

The Environmental Protection Agency is planning to stop requiring oil refineries, power plants and other industrial facilities to measure and report their greenhouse-gas emissions, as they have done since 2010, making it difficult to know whether any of the policies meant to slow climate change and reduce disaster are effective. The EPA has also taken down EJScreen, a mapping tool on its website that allowed people to see how much industrial pollution occurs in their community and how that compares with other places or previous years.

The Office of Homeland Security Statistics has yet to update its monthly tallies on deportations and other indices of immigration enforcement, making it difficult to judge President Donald Trump’s triumphant claims of a crackdown; the last available numbers are from November 2024, in the final months of President Joe Biden’s tenure. (“While we have submitted reports and data files for clearance, the reporting and data file posting are delayed while they are under the new administration’s review,” Jim Scheye, director of operations and reporting in the statistics unit, told ProPublica.)

And, in a particularly concrete example of ceasing to measure, deep cutbacks at the National Weather Service are forcing it to reduce weather balloon launches, which gather a vast repository of second-by-second data on everything from temperature to humidity to atmospheric pressure in order to improve forecasting.

Looked at one way, the war on measurement has an obvious potential motivation: making it harder for critics to gauge fallout resulting from Trump administration layoffs, deregulation or other shifts in policy. In some cases, the data now being jettisoned is geared around concepts or presumptions that the administration fundamentally rejects: EJScreen, for instance, stands for “environmental justice” — the effort to ensure that communities don’t suffer disproportionately from pollution and other environmental harms. (An EPA spokesperson said the agency is “working to diligently implement President Trump’s executive orders, including the ‘Ending Radical and Wasteful Government DEI Programs and Preferencing.’” The spokesperson added: “The EPA will continue to uphold its mission to protect human health and the environment” in Trump’s second term.) The White House press office did not respond to a request for comment.

Laura Lindberg, a Rutgers public health professor, lamented the threatened pregnancy-risk data at the annual conference of the Population Association of America in Washington last week. In an interview, she said the administration’s cancellation of data collection efforts reminded her of recent actions at the state level, such as Florida’s withdrawal in 2022 from the CDC’s Youth Risk Behavior Survey after the state passed its law discouraging classroom discussion of sexual orientation. (The state’s education secretary said the survey was “inflammatory” and “sexualized.”) Discontinuing the survey made it harder to discern whether the law had adverse mental health effects among Florida teens. “States have taken on policies that would harm people and then are saying, ‘We don’t want to collect data about the impact of the policies,’” Lindbergsaid. “Burying your head in the sand is not going to be a way to keep the country healthy.” (HHS did not respond to a request for comment.)

Making the halt on data gathering more confounding, though, is the fact that, in some areas, the information at risk of being lost has been buttressing some of the administration’s own claims. For instance, Trump and Vice President JD Vance have repeatedly cited, as an argument for tougher border enforcement, the past decade’s surge in fentanyl addiction — a trend that has been definitively captured by the national drug use survey that is now imperiled. That survey’s mental health components have also undergirded research on the threat being posed to the nation’s young people by smartphones and social media, which many conservatives have taken up as a cudgel against Big Tech.

Or take education. The administration and its conservative allies have been able to argue that Democratic-led states kept schools closed too long during the pandemic because there was nationwide data — the National Assessment of Educational Progress, aka the Nation’s Report Card — that showed greater drops in student achievement in districts that stayed closed longer. But now NAEP is likely to be reduced in scope as part of crippling layoffs at the Department of Education’s National Center for Education Statistics, which has been slashed from nearly 100 employees to only three, casting into doubt the future not only of NAEP but also of a wide array of long-running longitudinal evaluations and the department’s detailed tallies of nationwide K-12 and higher education enrollment. The department did not respond to a request for comment but released a statement on Thursday saying the next round of NAEP assessments would still be held next year.

Dan Goldhaber, an education researcher at the University of Washington, cast the self- defeating nature of the administration’s war on educational assessment in blunt terms: “The irony here is that if you look at some of the statements around the Department of Education, it’s, ‘We’ve invested X billion in the department and yet achievement has fallen off a cliff.’ But the only reason we know that is because of the NAEP data collection effort!”

Shelly Burns, a mathematical statistician who worked at NCES for about 35 years before her entire team was laid off in March, made a similar point about falling student achievement. “How does the country know that? They know it because we collected it. And we didn’t spin it. We didn’t say, ‘Biden is president, so let’s make it look good,’” she said. “Their new idea about how to make education great again — how will you know if it worked if you don’t have independent data collection?”

“Reality has a well-known liberal bias,” Stephen Colbert liked to quip, and there have been plenty of liberal commentators who have, over the years, taken that drollery at face value, suggesting that the numbers all point one way in the nation’s political debates. In fact, in plenty of areas, they don’t.

It’s worth noting that Project 2025’s lengthy blueprint for the Trump administration makes no explicit recommendation to undo the government’s data-collection efforts. The blueprint is chock full of references to data-based decision-making, and in some areas, such as immigration enforcement, it urges the next administration to collect and share more data than its predecessors had.

But when an administration is making such a concerted effort to stifle assessments of government and society at large, it is hard not to conclude that it lacks confidence in the efficacy of its current national overhaul. As one dataset after another falls by the wayside, the nation’s policymakers are losing their ability to make evidence-based decisions, and the public is losing the ability to hold them accountable for their results. Even if a future administration seeks to resurrect some of the curtailed efforts, the 2025-29 hiatus will make trends harder to identify and understand.

Who knows if the country will be able to rebuild that measurement capacity in the future. For now, the loss is incalculable.

Jesse CoburnEli HagerAbrahm LustgartenMark OlaldeJennifer Smith Richards and Lisa Song contributed reporting.

Today is a good day to reflect on hypocrisy. The Trump administration is deeply entwined with two groups: evangelical Christians and Elon Musk’s DOGE team. The White House has frequent prayer meetings, issues proclamations written by evangelical leaders, and even has offices in the Weat Wing for Trump’s spiritual advisors.

Meanwhile, Trump empowered DOGE to ransack every federal agency, fire staff by the tens of thousands, and shutter agencies that were established by Congress. Many fear that Medicaid, Medicare, and Social Security will suffer deep cuts.

The result will be not “efficiency,” but inefficiency. Worse, people will die if they cannot afford to pay for health care and do not get their Social Security because their local or regional office has been closed and they do not have a cell phone or computer.

The prime example of DOGE slaughter of an agency that has saved millions of lives is USAID. Foreign aid has had bipartisan support for decades. It brings food, medicine, and medical clinics to desperately poor people around the globe. American farmers supply the grains that are exported and lose billions of dollars.

But most important, millions of people will die because of the cutoff of drugs and food.

This is rank cruelty. This is obscene. This is a crime.

What do the evangelicals who surround Trump say about this? Clearly they influence his words but not his deeds. Jesus spoke about love, compassion, healing the sick, feeding the hungry, welcoming the stranger. What do they say about withdrawing drugs and food from millions of the needy and poor?

Today is a good day to ask, What would Jesus do?

David Remnick, editor of The New Yorker, interviewed Dr. Atul Gawande about his work at USAID. He was especially interested in learning Dr. Gawande’s views about the likely consequences of the evisceration of USAID.

Remnick writes:

It is hard to calculate all the good that Atul Gawande has done in the world. After training as a surgeon at Harvard, he taught medicine inside the hospital and in the classroom. A contributor to The New Yorker since 1998, he has published widely on issues of public health. His 2007 article in the magazine and the book that emerged from it, “The Checklist Manifesto: How to Get Things Right,” have been sources of clarity and truth in the debate over health-care costs. In 2014, he published “Being Mortal: Medicine and What Matters in the End,” a vivid, poetic, compassionate narrative that presents unforgettable descriptions of the ways the body ages and our end-of-life choices.

Gawande’s work on public health was influential in the Clinton and Obama Administrations, and, starting in November, 2020, he served on President Joe Biden’s covid-19 Advisory Board. In July, 2021, Biden nominated him as the assistant administrator for the Bureau of Global Health at the U.S. Agency for International Development, where he worked to limit disease outbreaks overseas. Gawande, who is fifty-nine, resigned the position on the day of Donald Trump’s return to the Presidency.

When we spoke recently for The New Yorker Radio Hour, Gawande, usually a wry, high-spirited presence, was in a grave mood. There were flashes of anger and despair in his voice. He was, after all, watching Trump and Elon Musk dismantle, gleefully, a global health agency that had only lately been for him a source of devotion and inspiration. As a surgeon, Gawande had long been in a position to save one life at a time. More recently, and all too briefly, he was part of a vast collective responsible for untold good around the world. And now, as he made plain, that collective has been deliberately cast into chaos, even ruins. The cost in human lives is sure to be immense. Our conversation has been edited for clarity and length.

President Biden appointed you as the assistant administrator for global health at U.S.A.I.D., a job that you’ve described as the greatest job in medicine. You stepped down on Trump’s Inauguration Day, and he immediately began targeting U.S.A.I.D. with an executive order that halted all foreign aid. Did you know, or did you intuit, that Trump would act the way he has?

I had no idea. In the previous Trump Administration, they had embraced what they themselves called the “normals.” They had a head of U.S.A.I.D. who was devoted to the idea of development and soft power in the world. They had their own wrinkle on it, which I didn’t disagree with. They called it “the journey to self-reliance,” and they wanted to invest in Africa, in Asia, in Latin America, to enable stronger economies, more capacity—and we weren’t doing enough of that. I actually continued much of the work that had occurred during that time.

Tell me a little bit about what you were in charge of and what good was being done in the world.

I had twenty-five thousand people, between D.C. and sixty-five countries around the world, working on advancing health and protecting Americans from diseases and outbreaks abroad. The aim was to work with countries to build their systems so that we protected global health security and improved global outcomes—from reducing H.I.V./aids and other infectious diseases like malaria and T.B., to strengthening primary health-care systems, so that those countries would move on from depending on aid from donors. In three years, we documented saving more than 1.2 million lives after covid alone.

Let’s pause on that. Your part of U.S.A.I.D. was responsible, demonstrably, for saving 1.2 million lives—from what?

So, covid was the first global reduction in life expectancy in seventy years, and it disrupted the ability across the world to deliver basic health services, which includes H.I.V./aids [medications], but also included childhood immunizations, and managing diarrhea and pneumonia. Part of my target was to reduce the percentage of deaths in any given country that occur before the age of fifty. The teams would focus on the top three to five killers. In some places, that would be H.I.V.; in some places that would be T.B. Safe childbirth was a huge part of the work. And immunizations: forty per cent of the gains in survival for children under five in the past fifty years in the world came from vaccines alone. So vaccines were a big part of the work as well.

What was the case against this kind of work? It just seems like an absolute good.

One case is that it could have been more efficient, right? Americans imagine that huge sums of money go to this work. Polls show that they think that a quarter of our spending goes to foreign aid. In fact, on a budget for our global health work that is less than half the budget of the hospital where I did surgery here in Boston, we reached hundreds of millions of people, with programs that saved lives by the millions. That’s why I describe it as the best job in medicine that people have never heard of. It is at a level of scale I could never imagine experiencing. So the case against it—I woke up one day to find Elon Musk tweeting that this was a criminal enterprise, that this was money laundering, that this was corruption.

Where would he get this idea? Where does this mythology come from?

Well, what’s hard to parse is: What is just willful ignorance? Not just ignorance—it’s lying, right? For example, there’s a statistic that they push that only ten per cent of U.S.A.I.D.’s dollars actually got to recipients in the world. Now, this is a willful distortion of a statistic that says that only ten per cent of U.S.A.I.D.’s funding went to local organizations as opposed to multinational organizations and others. There’s a legitimate criticism to be made that that percentage should be higher, that more local organizations should get the funds. I did a lot of work that raised those numbers considerably, got it to thirty per cent, but that was not the debate they were having. They’re claiming that the money’s not actually reaching people and that corruption is taking it away, when, in fact, the reach—the ability to get to enormous numbers of people—has been a best buy in health and in humanitarian assistance for a long time.

Now the over-all agency, as I understand it, had about ten thousand people working for it. How many are working at U.S.A.I.D. now?

Actually, the number was about thirteen thousand. And the over-all number now—it’s hard to estimate because people are being turned on and off like a light switch—

Turned on and off, meaning their computers are shut down?

Yeah, and they’re being terminated and then getting unterminated—like, “Oops, sorry, we let the Ebola team go.” You heard Elon Musk say something to that effect in the Oval Office. “But we’ve brought them back, don’t worry.” It’s a moving target, but this is what I’d say: more than eighty per cent of the contracts have been terminated, representing the work that is done by U.S.A.I.D. and the for-profit and not-for-profit organizations they work with, like Catholic Relief Services and the like. And more than eighty per cent of the staff has been put on administrative leave, terminated, or dismissed in one way or the other.

So it’s been obliterated.

It has been dismantled. It is dying. I mean, at this point, it’s six weeks in. Twenty million people with H.I.V., for example—including five hundred thousand children—who had received medicines that keep them alive have now been cut off for six weeks.

A lot of people are going to die as a result of this. Am I wrong?

The internal estimates are that more than a hundred and sixty thousand people will die from malaria per year, from the abandonment of these programs, if they’re not restored. We’re talking about twenty million people dependent on H.I.V. medicines—and you have to calculate how many you think will get back on, and how many will die in a year. But you’re talking hundreds of thousands in Year One at a minimum. But then on immunization side, you’re talking about more than a million estimated deaths.

I’m sorry, Atul. I have to stop my cool journalistic questioning and say: This is nothing short of outrageous. How is it possible that this is happening? Obviously, these facts are filtering up to Elon Musk, to Donald Trump, and to the Administration at large. And they don’t care?

The logic is to deny the reality, either because they simply don’t want to believe it—that they’re so steeped in the idea that government officials are corrupt and lazy and unable to deliver anything, and that a group of young twentysomething engineers will fix it all—or they are indifferent. And when Musk waves around the chainsaw—we are seeing what surgery on the U.S. government with a chainsaw looks like at U.S.A.I.D. And it’s just the beginning of the playbook. This was the soft target. This is affecting people abroad—it’s tens of thousands of jobs at home, so there’s harm here; there’s disease that will get here, etc. But this was the easy target. Now it’s being brought to the N.I.H., to the C.D.C., to critical parts of not only the health enterprise but other important functions of government.

So the National Institutes of Health, the Centers for Disease Control and Prevention, and other such bureaucracies that do equal medical good will also get slammed?

Are being slammed. So here’s the playbook: you take the Treasury’s payment system—doge and Musk took over the information system for the Treasury and the payments in the government; you take over the H.R. software, so you can turn people’s badges and computer access on and off at will; you take over the buildings—they cancelled the leases, so you don’t have buildings. U.S.A.I.D.—the headquarters was given to the Customs and Border Protection folks. And then you’ve got it all, right? And then he’s got X, which feeds right into Fox News, and you’ve got control of the media as well. It’s a brilliant playbook.

But from the outside, at least, Atul, and maybe from your vantage point as well: this looks like absolute chaos. I’ve been reading this week that staff posted overseas are stranded, fired without a plane ticket home. From the inside, what does it look like?

One example: U.S.A.I.D. staff in the Congo had to flee for their lives and watch on television as their own home was destroyed and their kids’ belongings attacked. And then when they called for help and backup, they could not get it. I spoke to staff involved in one woman’s case, a pregnant woman in her third trimester, in a conflict zone. They have maternity leave just like everybody else there. But because the contracts had been turned off, they couldn’t get a flight out, and were not guaranteed safe passage, and couldn’t get care for her complications, and ended up having to get cared for locally without the setup to address her needs. One person said to me, as she’s enduring these things, “My government is attacking me. We ought to be ashamed. Our entire system of checks and balances has failed us.”

What’s been the reaction in these countries, in the governments, and among the people? The sense of abandonment must be intense on all sides.

There are broadly three areas. The biggest part of U.S.A.I.D. is the fema for disasters abroad. It’s called the Bureau for Humanitarian Assistance, and they bring earthquake response; wildfire response; response in conflicts, in famines. These are the people who suit up, and get assistance, and stabilize places where things are going wrong.

The Global Health Bureau, which I led, is the second-largest part of the agency, and that does work around diseases and health threats, as well as advancing health systems in low- and middle-income countries around the world. There’s coöperation on solving global problems, like stopping pandemics, and addressing measles outbreaks, and so on.

The third is advancing countries’ economies, freedom, and democracy. John F. Kennedy, when he formed U.S.A.I.D. in 1961, said that it was to counter the adversaries of freedom and to provide compassionate support for the development of the world. U.S.A.I.D. has kept Ukraine’s health system going and gave vital support to keep their energy infrastructure going, as Russia attacked it. In Haiti, this is the response team that has sought to stabilize what’s become a gang-controlled part of the country. Our health teams kept almost half of the primary health-care system for the population going. So around the world: stopping fentanyl flow, bringing in independent media. All of that has been wiped out completely. And in many cases, the people behind that work—most of the people we’re working with, local partners to keep these things going—are now being attacked. Those partners are now being attacked, in country after country.

What you’re describing is both human compassion and, a phrase you used earlier in our conversation, “soft power.” Describe what that is. Why is it so important to the United States and to the world? What will squandering it—what will destroying it—mean?

The tools of foreign policy, as I’ve learned, are defense, diplomacy, and development. And the development part is the soft power. We’re not sending troops into Asia and Africa and Latin America. We’re sending hundreds of thousands of civilians without uniforms, who are there to represent the United States, and to pursue common goals together—whether it’s stemming the tide of fentanyl coming across the border, addressing climate disasters, protecting the world from disease. And that soft power is a reflection of our values, what we stand for—our strong belief in freedom, self-determination, and advancement of people’s economies; bringing more stability and peace to the world. That is the fundamental nature of soft power: that we are not—what Trump is currently trying to create—a world of simply “Might makes right, and you do what we tell you,” because that does not create stability. It creates chaos and destruction.

An immoral universe in which everybody’s on their own.

That’s right. An amoral universe.

Who is standing up, if anyone, in the Administration? What about Secretary of State Marco Rubio, whom you mentioned. What’s his role in all of this? Back in January, he issued a waiver to allow for lifesaving services to continue. That doesn’t seem to have been at all effective.

It hasn’t happened. He has issued a waiver that said that the subset of work that is directly lifesaving—through humanitarian assistance, disaster relief, and so on, and the health work that I used to lead—will continue; we don’t want these lives to be lost. And yet it hasn’t been implemented. It’s clear that he’s not in control of the mechanisms that make these things happen. doge does not approve the payments going out, and has not approved the payments going out, to sustain that work.

The federal courts have ruled that the freeze was likely illegal and unconstitutional, and imposed a temporary restraining order saying that it should not be implemented, that it had to be lifted—the payment freeze. Instead, they doubled down. And Marco Rubio signed on to this, tweeted about it earlier this week—that over eighty per cent of all contracts have now been terminated. And the remaining ones—they have not even made a significant dent in making back payments that are owed for work done even before Trump was inaugurated.

There’s always been skepticism, particularly on the right, about foreign aid. I remember Jesse Helms, of North Carolina, would always rail about the cost of foreign aid and how it was useless, in his view, in many senses. I am sure that in your time in office, you must have dealt with officials who were skeptical of the mission. What kind of complaints were you getting from senators and congressmen and the like, even before the Trump Administration took over in January?

It was a minority. I’ll just start by saying: the support for foreign-aid work has been recognized and supported by Republicans and Democrats for decades. But there’s been a consistent—it was a minority—that had felt that the U.S. shouldn’t be involved abroad. That’s part of an isolationist view, that extending this work is just charity; it’s not in U.S. interests and it’s not necessary for the protection of Americans. The argument is that we should be spending it at home.

They’re partly playing into the populist view that huge portions of the budget are going abroad, when that’s not been the case. But it’s also understandable that when people are suffering at home, when there are significant needs here, it can be hard to make connections to why we need to fight to stop problems abroad before they get here.

And yet we only recently endured the covid epidemic, which by all accounts did not begin at home, and spread all over the world. Why was covid not convincing as a manifestation of how a greater international role could help?

Certainly that didn’t convince anybody that that was able to be controlled abroad—

Because it wasn’t.

Because it wasn’t, right. And covid did drive a significant distrust in the public-health apparatus itself because of the suffering that people endured through that entire emergency. But I would say the larger picture is—every part of government spending has its critics. One of the fascinating things about the foreign-aid budget, which has been the least popular part of the budget, is that U.S.A.I.D. was mostly never heard of. Now it has high name recognition, and has majority support for continuing its programs, whether it’s keeping energy infrastructure alive in Ukraine, stabilizing conflicts—whether it’s Haiti or other parts of the world—to keep refugees from swarming more borders, or the work of purely compassionate humanitarian assistance and health aid that reduces the over-all death rates from diseases that may yet harm us. So it’s been a significant jump in support for this work, out of awareness now of what it is, and how much less it turns out to cost.

So it took this disaster to raise awareness.

That’s human nature, right? Loss aversion. When you lose it is when you realize its value.

Atul, there’s been a measles outbreak in West Texas and New Mexico, and R.F.K., Jr.—who’s now leading the Department of Health and Human Services—has advised some people, at least, to use cod-liver oil. We have this multilayered catastrophe that you’ve been describing. Where could the United States be, in a couple of years, from a health perspective? What worries you the most?

Measles is a good example. There’s actually now been a second death. We hadn’t had a child death from measles in the United States in years. We are now back up, globally, to more than a hundred thousand child deaths. I was on the phone with officials at the World Health Organization—the U.S. had chosen measles as a major area that it wanted to support. It provided eighty per cent of the support in that area, and let other countries take other components of W.H.O.’s work. So now, that money has been pulled from measles programs around the world. And having a Secretary of Health who has done more to undermine confidence in measles vaccines than anybody in the world means that that’s a singular disease that can be breaking out, and we’ll see many more child deaths that result from that.

The over-all picture, the deeper concern I have, is that as a country we’re abandoning the idea that we can come together collectively with other nations to do good in the world. People describe Trump as transactional, but this is a predatory view of the world. It is one in which you not only don’t want to participate in coöperation; you want to destroy the coöperation. There is a deep desire to make the W.H.O. ineffective in working with other nations; to make other U.N. organizations ineffective in doing their work. They already struggled with efficiency and being effective in certain domains, and yet they continue to have been very important in global health emergencies, responding and tracking outbreaks. . . .

We have a flu vaccine because there are parts of the world where flu breaks out, like China, that don’t share data with us. But they share it with the W.H.O., and the result is that we have a flu vaccine that’s tuned to the diseases coming our way by the fall. I don’t know how we’ll get a flu vaccine this fall. Either we’ll get it because people are, under the table, communicating with the W.H.O. to get the information, and the W.H.O is going to share it, even though the U.S. is no longer paying, or we’re going to work with other countries and be dependent on them for our flu vaccine. This is not a good answer.

I must ask you this, more generally: You’re watching a President of the United States begin to side with Russia over Ukraine. You’re watching the dismantlement of our foreign-aid budget, and both its compassion and its effectiveness. Just the other day, we saw a Columbia University graduate—you may agree with him, disagree with him on his politics, but who has a green card—and ice officers went to his apartment and arrested him, and presumably will deport him. It’s an assault on the First Amendment. You’re seeing universities being defunded—starting with Columbia, but it’ll hardly be the last, etc. What in your view motivates Donald Trump to behave in this way? What’s the vision that pulls this all together?

What I see happening on the health side is reflective of everything you just said. There is a fundamental desire to remove and destroy independent sources of knowledge, of power, of decision-making. So not only is U.S.A.I.D. dismantled but there’s thousands of people fired—from the National Institutes of Health, the C.D.C., the Food and Drug Administration—and a fundamental restructuring of decision-making so that political judgment drives decision-making over N.I.H. grants, which have been centralized and pulled away from the individual institutes. So the discoveries that lead to innovations in the world—that work has a political layer now. F.D.A. approvals—now wanting a political review. C.D.C. guidance—now wanting a political review. These organizations were all created by Congress to be shielded from that, so that we could have a professional, science-driven set of decisions, and not the political flavor of the moment.

Donald Trump’s preference, which he’s expressed in those actions and many others, is that his whims, just like King Henry VIII’s, should count. King Henry VIII remade an entire religion around who he wanted to marry. And this is the kind of world that Trump is wanting to create—one of loyalty trumping any other considerations. So the inspectors general who do audits over the corruption that they seem to be so upset about—they’ve been removed. Any independent judgment in society that would trump the political whims of the leader. . . . The challenge is—and I think is the source of hope for me—that a desire for chaos, for acceding to destruction, for accepting subjugation, is not a stable equilibrium. It’s not successful in delivering the goods for people, under any line of thinking.

In the end, professionally organized bureaucracies—that need to have political oversight, need to have some controls in place, but a balance that allows decision-making to happen—those have been a key engine of the prosperity of the country. Their destruction will have repercussions that I think will make the Administration very unpopular, and likely cause a backlash that balances things out. I hope we get beyond getting to the status quo ante of a stalemate between these two lines of thinking—one that advances the world through incremental collective action that’s driven around checks and balances as we advance the world ever forward, and one in which a strongman can have his way and simply look for who he can dominate.

Right now, Robert F. Kennedy, Jr., is the head of H.H.S. His targets include not only vaccine manufacturers but the pharma industry writ large. But he’s talked a lot, too, about unhealthy food in the American diet—to some extent, he’s not wrong. Do you see any upside in his role in pushing this so-called Make America Healthy Again idea?

Of course there is good. I mean, we as a country have chronic illness that is importantly tied to our nutritional habits, our exercise, and so on. But for all our unhealthiness, we’ve also had an engine of health that has enabled the top one per cent in America to have a ninety-year life expectancy today. Our job is to enable that capacity for public health and health-care delivery to get to everybody alive, I would argue, and certainly to get it to all Americans.

What’s ignored is that half the country can’t afford having a primary-care doctor and don’t have adequate public health in their communities. If R.F.K., Jr., were taking that on, more power to him. Every indication from his history is that this is an effort to highlight some important things. But how much of it’s going to actually be evidence-driven? He’s had some crazy theories about what’s going to advance chronic illness and address health.

I’d say the second thing is the utter incompetence in running things and making things work. They’ve utterly destabilized the National Institutes of Health, the Centers for Disease Control, the F.D.A.

Explain that destabilization—what it looks like from inside and what effects it’ll have.

One small example: doge has declared that all kinds of buildings are not necessary anymore. That includes the headquarters of the Department of Health and Human Services. They’re saying, “Oh, everybody has to show up for work now, but you won’t have a building to work in anymore.”

No. 2 on the list is F.D.A. specialized centers around the country. There’s a laboratory in St. Louis where they have specialized equipment for testing food and drugs for safety. And so that whole capability—to insure that your foods and your medications are able to be tested for whether they have contaminants, whether they are counterfeit—that’s a basic part of good nutrition, good medicine, that could be pulled away.

Whether it’s maintaining the building infrastructure, maintaining the staff who are being purged sort of randomly left and right, or treating them not like they’re slaves but actually bringing good work out of everybody, by good management—that is what’s not happening.

I have the feeling that you, even in a short time, loved being in the federal government. What I hear in our conversation is a sense of tragedy that is not only public but that is felt very intimately by you.

I did not expect that going into government would be as meaningful to me as it was. I went into government because it was the covid crisis and I was offered an opportunity to lead the international component of the response. We got seven hundred million vaccines out to the world. But what I found was a group of people who could achieve scale like I’d never seen. It is mission-driven. None of these people went into it for the money; it’s not like they’ve had any power—

I assume all of them could have made more money elsewhere.

Absolutely. And many of them spent their lives as Foreign Service officers living in difficult places in the world. I remember that Kyiv was under attack about eight weeks after I was sworn in. I thought I was going to be working on covid, but this thing was erupting. First of all, our health team, along with the rest of the mission and Embassy in Kyiv, had to flee for safety. But within a week they were already saying, “We have T.B. breaking out, we have potential polio cases. How are we going to respond?” And my critical role was to say, “What’s going to kill people the most? Right now, Russia has shut down the medical supply chain, and so nearly a hundred per cent of the pharmacies just closed. Two hundred and fifty thousand H.I.V. patients can’t get their meds. A million heart patients can’t get their meds. Let’s get the pharmacies open.” And, by the way, they’ve attacked the oxygen factories and put the hospitals under cyberattack and their electronic systems aren’t functioning.

And this team, in four weeks, moved the entire hospital record system to the cloud, allowing protection against cyberattacks; got oxygen systems back online; and was able to get fifty per cent of the pharmacies open in about a month, and ultimately got eighty per cent of the pharmacies open. That is just incredible.

Yes, are there some people that I had to deal with who were overly bureaucratic? Did I have to address some people who were not performing? Absolutely. Did I have to drive efficiency?

As in any work . . .

In every place you have to do that. But this was America at its best, and I was so proud to be part of that. And what frustrated me, in that job, was that I had to speak for the U.S. government. I couldn’t write for you during that time.

Believe me, I know!

I couldn’t tell the story. I’ve got a book I’m working on now in which I hope to be able to unpack all of this. It is, I think, a sad part of my leadership, that I didn’t also get to communicate what we do—partly because U.S.A.I.D. is restricted, in certain ways, from telling its story within the U.S. borders.

If you had the opportunity to tell Elon Musk and Donald Trump what you’ve been telling me for the past hour, or if they read a long report from you about lives saved, good works done, the benefits of soft power to the United States and to the world and so on—do you think it would have any effect at all?

Zero. There’s a different world view at play here. It is that power is what matters, not impact; not the over-all maximum good that you can do. And having power—wielding it in ways that can dominate the weak and partner with your friends—is the mode of existence. (When I say “partner with friends,” I mean partner with people like Putin who think the same way that you do.) It’s two entirely different world views.

But this is not just an event. This is not just something that happened. This is a process, and its absence will make things worse and worse and have repercussions, including the loss of many, many, maybe countless, lives. Is it irreparable? Is this damage done and done forever?

This damage has created effects that will be forever. Let’s say they turned everything back on again, and said, “Whoops, I’m sorry.” I had a discussion with a minister of health just today, and he said, “I’ve never been treated so much like a second-class human being.” He was so grateful for what America did. “And for decades, America was there. I never imagined America could be indifferent, could simply abandon people in the midst of treatments, in the midst of clinical trials, in the midst of partnership—and not even talk to me, not even have a discussion so that we could plan together: O.K., you are going to have big cuts to make. We will work together and figure out how to solve it.”

That’s not what happened. He will never trust the U.S. again. We are entering a different state of relations. We are seeing lots of other countries stand up around the world—our friends, Canada, Mexico. But African countries, too, Europe. Everybody’s taking on the lesson that America cannot be trusted. That has enormous costs.

It’s tragic and outrageous, no?

That is beautifully put. What I say is—I’m a little stronger. It’s shameful and evil. ♦︎

What is Elon Musk’s agenda? His DOGE teams are wreaking havoc across the federal government. His claims of saving “billions” are making government inefficient. Thousands of researchers, scientists, and essential personnel have been fired. Is he working to destroy our government? Or is he settting up a scenario of failure as a prelude to privatization?

The Washington Post reported on chaos at the Social Security Administratuin:

Retirees and disabled people are facing chronic website outages and other access problems as they attempt to log in to their online Social Security accounts, even as they are being directed to do more of their business with the agency online.

The website has crashed repeatedly in recent weeks, with outages lasting anywhere from 20 minutes to almost a day, according to six current and former officials with knowledge of the issues. Even when the site is back online, many customers have not been able to sign in to their accounts — or have logged in only to find information missing. For others, access to the system has been slow, requiring repeated tries to get in.

The problems come as the Trump administration’s cost-cutting team, led by Elon Musk, has imposed a downsizing that’s led to7,000 job cuts and is preparing to push out thousands more employees at an agency that serves 73 million Americans. The new demands from Musk’s U.S. DOGE Service include a 50 percent cut to the technology division responsible for the website and other electronic access.

Many of the network outages appear to be caused by an expanded fraud check system imposed by the DOGE team, current and former officials said. The technology staff did not test the new software against a high volume of users to see if the servers could handle the rush, these officials said.

The technology issues have been particularly alarming for some of the most vulnerable Social Security customers. For almost two days last week, for example, many of the 7.4 million adults and children receiving monthly benefits under the anti-poverty program known as Supplemental Security Income, or SSI, confronted a jarring message that claimed they were “currently not receiving payments,” agency officials acknowledged in an internal email to staff.

The error messages set off widespread panic until recipients discovered that their monthly checks had still been deposited in their bank accounts. Another breakdown disabled the SSI system for much of the day on Friday, prompting claims staff to cancel appointments because they could not enter new disability claims in the system and blocking some already receiving benefits from gaining access to their accounts.

“Social Security’s response has been, ‘Oops,’” said Darcy Milburn, director of Social Security and health-care policy at the Arc, a national nonprofit that advocates for people with disabilities. The group fielded dozens of calls last week from nervous clients who saw the inaccurate message and assumed their monthly check, usually paid on the first of the month, would not arrive.

“It’s woefully insufficient when we’re talking about a government agency that’s holding someone’s lifeline in their hands,” Milburn said.

The disruptions are occurring as acting commissioner Leland Dudek and the DOGE team move to lay off large swaths of the workforce in a new phase of downsizing. Thousands of employees already have been pushed out — many in customer-facing roles, others with expertise in the agency’s cumbersome technology systems. At least 800 of the 3,000 employees left in the division that manages all of the Social Security databases face layoffs, a senior official said on Friday. The newly named chief information officer, Scott Coulter, a Musk-aligned private equity analyst, has demanded a cut of 50 percent, the official said.

The network outages are one in a cascade of blows to customer service that also have hobbled phone systems and field office operations as the workforce shrinks.

A surge in visitors to the website is overwhelming the computer system as customers — nervous that the rapid changes at the agency will compromise their benefits — download their benefit and earnings statements and attempt to file claims. President Donald Trump has said that his administration will not reduce Social Security benefits.

The chaos could accelerate starting April 14, when new identification measures are set to take effect that will require millions of customers applying for benefits to authenticate their identity online, part of the administration’s campaign to root out allegedly fraudulent claims.

“We’re just spiking like crazy,” said one senior official, who, like others in this article, spoke on the condition of anonymity because they were not authorized to speak publicly about agency operations. “It’s people who are terrified that DOGE is messing with our systems. It’s the sheer massive volume of freaked-out people.”

The Social Security press office said in a statement that officials are “actively investigating the root cause” of the incidents, which they called “brief disruptions” averaging about 20 minutes each with the exception of the SSI error message. But on several occasions, including during an outage last Monday, customers were shut out of the website for hours. The system was back online last Monday after two hours, but lingering issues lasted through the afternoon while all backlogged queries were processed, current and former officials said. And a system upgrade on a Saturday in late March took several hours longer than anticipated and knocked out the network.

Three times in a recent 10-day stretch, the online systems the field office staff rely on to serve the public have crashed, said one employee in an Indiana office.

The downed programs included tools employees use to schedule visits, to see who has booked an appointment and to check who has arrived, the employee said. It is unheard-of for the system to fail this often, and each outage has led to chaos, they said.

Suddenly forced offline as they were taking claims, the staff members scribbled down clients’ information, then had to wait until later to load it into the computer, doubling or tripling the amount of time and work involved, the employee said.

In other instances, managers or security guards improvised a solution after the online scheduling system failed, the employee said. They walked out to the reception area, wrote down numbers on paper slips and started handing them out to people waiting in line.

The network crashes appear to be caused by an expansion initiated by the Trump team of an existing contract with a credit-reporting agency that tracks names, addresses and other personal information to verify customers’ identities. The enhanced fraud checks are now done earlier in the claims process and have resulted in a boost to the volume of customers who must pass the checks.

But the technology staff did not test the software against a high volume of users to see if the servers could handle the rush, current and former officials said. Connectivity issues and bugs with the expanded system have caused the portal that manages log-ins and authentication for many Social Security applications to go down, officials said.

At a weekly operations meeting on March 28 that was made public last week, Wayne Lemon, deputy chief information officer for infrastructure and IT operations, acknowledged the network crashes and said, “While they’ve been brief, we prefer no outages.” He said the outages were under investigation and may involve “challenges we’ve experienced with a number of partners.” Part of the problem may be that the outages have occurred during “high volume use of the network.”

“Is there a spike in demand or something in the environment causing the issues?” Lemon said.

Customers, meanwhile, are growing more frustrated.………..

What readers are saying

The comments express strong concerns about the recent IT staff cuts and website outages at the Social Security Administration, suggesting these actions are deliberate attempts to undermine the system. Many commenters believe this is part of a broader strategy to privatize Social Security.