Trump Dismantles Healthcare in Real-Time

Science is on hold, and women are bound to suffer

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When I think of this week (okay, it’s been 5 days, but it feels like an eternity) and what it means for health, and especially women’s health, in America, the only words that come to mind are this quote from Lord of the Rings:

Let those call it the wind who will; there are fell voices on the air; and these stones are aimed at us.

For those who aren’t up to date on their Tolkien, these are words spoken by Boromir as the company of the ring attempts to make its way over a mountain pass while an evil wizard whips up the wind, snow, and flying boulders to create chaos incarnate that will either throw them off the mountain or force them to turn back and take, unbeknownst to most of the company, what proves to be a more dangerous route.

Whenever I write about something that to some people seems overtly political, I receive a few comments, both here and on Instagram, that I should focus on medicine, not politics, or that I should “stick to menopause.” But here’s the issue: health and politics are intertwined in so many ways that politics touch every post I have ever written; it’s just not always that obvious.

If you are following any health influencers who are not writing or posting videos about the concerning executive orders from this week and what’s to come, then I would guess these influencers are A) either entirely on board with Trump’s plan or B) they are not on board but are more interested in making sure that sales of books and supplements and diet programs don’t drop.

Let’s put the things that are overtly political, like abortion, off to one side and discuss how politics actually touches health care for women. Do you want good information about menopause or vaginal health or on the safety of supplements? Well, that is ALL related to politics.

I would guess that at least 75% of the medical information (maybe more) I reference here is linked in some way to the National Institutes of Health (NIH), the world's largest single public funder of medical and behavioral research. The scope of how the NIH touches our lives cannot be overstated, from discovering the exact roles of different receptors on cells to turmeric's potential (or lack of) to understanding metabolism. Pharmaceutical companies often use basic science research funded by the NIH to develop new molecules that may one day become vital medication. NIH funding keeps labs at Universities running and allows researchers to have academic careers so we can all benefit. For example, there is a clinical trial looking at Premarin and bazedoxifene for women at high risk for breast cancer. This is a really important study, and it’s funded by the NIH (through the National Cancer Institute). I have referenced SWAN (Study of Women’s Health Across the Nation) for what seems like countless times because it is invaluable. The NIH funds it.

It’s fair to complain that pharmaceutical companies, with their price gouging, take advantage of the work done by the NIH. Look, if taxpayers have paid for a chunk of the research, the government should have some say regarding prices. But remember, that’s a decision made by our government primarily due to political lobbying. The NIH gets royalties related to their work. For example, between October 2021 and September 2023, the NIH received about $710 million in royalties, and most of the money went back into research. Individual scientists are allowed to collect up to $150,000 a year in royalties, which is a way to keep talent at the NIH instead of people moving to higher-paying jobs in industry. Overall, the NIH is a net financial positive for the United States because, for every dollar spent, approximately $2.46 in economic return is generated.

Have you ever complained that women’s health is understudied? The answer is probably “yes” if you read this Substack. It took government action with the National Institutes of Health Revitalization Act of 1993 to require that government-funded research through the NIH have equal representation for women and people of color. And if you applauded Biden’s executive order from March 2024 that carved out funds for women’s health care, emphasizing midlife women, then you were happy that politics was involved with medicine.

We also have the Centers for Disease Control and Prevention (CDC), which historically has been vital for tracking the health of the country and monitoring outbreaks. How did we find out so quickly in the 1970s that super-absorbent tampons were a cause of toxic shock syndrome? The CDC. When I worked in Kansas, there was an unusual cluster of birth defects, so we called the CDC, and they sent a team to investigate to determine if this was due to pollution, another cause, or maybe just chance. If I have someone with resistant trichomonas, I collect a sample, send it to the CDC, and they test it. Hopefully, they will help me come up with a treatment regimen. The CDC also tracks many infectious diseases to better understand exposure and to monitor prevention. Is there a spike in syphilis? We know that courtesy of the CDC. Each week, the CDC issues The Morbidity and Mortality Weekly Report (MMWR), which publishes essential public health information and recommendations from the CDC and state health departments. They may address local outbreaks or more global concerns, with an eye on the risk to health in the United States. These reports may address rare diseases, emerging diseases where we don’t yet know the risk, and those that are more common.

The influence of the government on health goes far beyond research and disease tracking. Many people get health care because of Medicare, Medicaid, and the VA system, which are all branches of the government, and many others have health care because of the Affordable Health Care Act. When the American free market was left to its own devices, far fewer people had access to health care.

Politics and health are, of course, intertwined in other ways. For example, poverty and racism have significant impacts on health. And, of course, government decisions can affect the climate and pollution. Did you know that greater exposure to air pollution leads to a more significant decrease in estrogen during the menopause transition? Oh, and we know that because of the NIH-funded SWAN study.

Curtailing or Halting the Flow of Information

Governments are not always happy with scientific research. Canadians experienced this under the Harper administration, which actively interfered with how scientists communicated with the press about issues that affected the climate. It’s pretty chilling, and I urge everyone, especially my Canadian followers, to read this piece because you can expect more of this if the Conservatives get elected. Healthcare, clean air, and water are not on the Canadian Conservative agenda, but oil, gas, and coal are, so information that shows environmental harm will be “inconvenient.” This kind of interference is currently happening in Alberta, where the provincial government must review any Federal grant to ensure the findings won’t be “inconvenient” to the provincial government. Really, it’s the law. For example, if a researcher receives federal money to study the health of transgender individuals, the work might not be allowed in Alberta. This law is the end of academic freedom in Alberta.

This brings me to the United States this week. Trump has frozen the NIH, which means travel to meetings, communication with the public, awarding new grants, and hiring are all paused. Job offers that had been made were rescinded, meetings were canceled minutes before they were to start, and researchers had to cancel plans to travel to present important research findings, potentially impacting some careers. Researchers had grants up for final review, only to have those reviews canceled. While it’s not uncommon to temporarily pause some activities when a new administration takes over, the scope and breadth here are different. In addition, what has happened needs to be put in context with the quote from Robert F. Kennedy Jr, who will almost certainly be leading Health and Human Services, the department responsible for the NIH:

I’m going to go to NIH my first week and I’m going to call all the division heads and I’m going to call all the bureau chiefs and I’m going to say, we’re going to give drug development and infectious disease a break. A little break, a little bit of a break for about eight years.” These remarks echo what he told an anti-vaccine conference in November 2023, when he said, “I’m gonna say to NIH scientists, God bless you all. Thank you for [your] public service. We’re going to give infectious disease a break for about eight years.”

He also claimed that he would be firing about 600 people. And while Kennedy hasn’t been confirmed yet, his confirmation hearing has been set for next week, and he must have shared his agenda.

What Does This All Mean?

Well, it’s not good given the agendas of Project 2025 and RFK Jr. And no, RFK Jr. is not interested in health or the food supply because if he read and understood anything, he would know the NIH is deeply invested in studying the prevention of chronic diseases and that vaccines save lives and that seed oils are fine and raw milk is not.

My concern is that this freeze at the NIH is the start of something more ominous that will result in gutting important research that may be “inconvenient,” for example, the safety of contraceptives or the consequences of unsafe abortions in favor of funding junk science and unqualified investigators. There are plenty of forced birthers chomping at the bit to produce biased work about the imaginary health consequences of abortion. And what does the executive order terminating diversity, equity, inclusion, and accessibility (DEIA) mandates and programs in the Federal Government mean for health? Is this just employees and programs (bad enough), or does that include studies that address racial or gender disparities or medical programs that try to meet the needs of those affected by racial or gender disparities? There is reason to be alarmed about the latter because, according to the New York Times, a Centers for Medicare and Medicaid Services contractor was required to “halt a project collecting demographic data for the agency.”

The CDC is also frozen, and for the first time in decades, they have not released the Morbidity and Mortality Weekly Report (MMWR). It was supposed to come out on Thursday, January 23, 2025, and there is no explanation for the absence on the website.

My contact at the CDC, who I will keep anonymous, explained that it might not seem like much to put purchasing new equipment on hold until February 1, but procurement can be tricky with bio lab samples, so there could be repercussions. The employees have also been asked to name anyone involved with DEIA or risk “adverse consequences.” The travel halt might again not seem like much; science is pretty slow, right? The CDC has international sites supporting treatments or doing disease surveys, so critical work could be missed, and people and research may suffer. Some employees have had to pull out of important speaking engagements. This person felt that what was going on at the CDC was both a big deal and unprecedented, but the ramifications are unknown.

Also, if I am a PhD with a newly finished postdoc, even when the NIH or CDC starts hiring again, would I want to work where I will be under the threat of “adverse consequences” if I don’t snitch on someone, or might I just say, “Fuck it” and take a job in the pharmaceutical industry? These tactics aren't the best way to get the best and the brightest, but they are a way to get the most obedient.

We May Not Be Able Even to Track The Harm

I haven’t even touched on the Food and Drug Administration, but in addition to approving medications, the FDA tracks and investigates harm and regularly releases advisories, safety information, and recalls about supplements, medications, food, infant formulas, cosmetics, and medical devices. Their communications are now frozen as well.

Because of the FDA, we discovered that BioTe Medical had withheld information about complications with hormone pellets. Here’s what the FDA had to say:

During an inspection in 2018 of BioTE Medical, our investigators uncovered information about 4,202 adverse events that had never been reported to the agency. The adverse event information our investigators found suggested compounded hormone pellets were possibly associated with endometrial cancer, prostate cancer, strokes, heart attacks, deep vein thrombosis, cellulitis and pellet extrusion. However, because the reports lacked certain critical information, the FDA was able to attribute only a small percentage of the adverse events (61 reports), such as pellet extrusion and cellulitis, to the use of compounded hormone pellets containing testosterone. The company that collected the adverse events did not send them to us during the five years they occurred between 2013 and 2018. However, in light of this discovery, the FDA is continuing to take multiple steps to help protect patients, which we wanted to highlight today in the interest of public health.

More recently, the FDA cracked down on Daye tampons for selling an unstudied CBD-infused tampon (which I am hoping to write about soon). Is it toxic to the vagina? It could be, which is why it should be studied before the product is released, but this data doesn’t appear to exist.

And when the FDA’s gag order is lifted, will we be able to count on accurate reporting, or might some companies be able to buy their way out with a political contribution? Today, the Trump administration got rid of the FDA’s proposed ban on menthol cigarettes, a product that gets many young people addicted to smoking and that disproportionately affects the Black community. I’m looking forward to the concerned hot takes about menthol cigarettes from the celebrities and Make America Healthy Again folks who celebrated removing a red dye #3 from food despite no real evidence of harm in the doses used. Just kidding, I know they won’t say a word because it’s all performance with them. The Make America Healthy Again (MAHA) crowd needs Big Food and Big Pharma to be evil because then they can position their unstudied supplements and health plans as a positive alternative. Big Tobacco doesn’t help them make any sales, so they don’t care.

*Bangs head on the desk and cries*

Looking forward, will we be able to rely on the CDC to accurately report on outbreaks, abortion, contraception, or vaccine-related data? I know some great people who work there, but how constrained will they be, especially considering Trump has nominated Dr. Dave Weldon, a forced birther who incorrectly believes that a preservative in vaccines causes autism? For those who don’t know, it was Weldon who introduced the bill in 2005 to force Terri Schiavo to remain on life support against what her legal guardian said were her wishes. You can read more about that case here.

Many states will hopefully step in to track this data, but their budgets are likely more limited., although we can’t rely on all states. In Texas, where abortion is illegal, the maternal mortality committee that is supposed to review and track near-misses as well as maternal deaths is skipping the years 2022 and 2023 to “catch up.” Coincidentally, these are the first two years where abortion was illegal in Texas. The committee claims they have skipped years in the past to catch up, but even if there is no ulterior forced-birth political motive (and I don’t believe for a minute it is anything but a political agenda), skipping the first two years after a significant policy change is stupid from a scientific perspective because these are perhaps the MOST critical years to address. Georgia disbanded their Maternal Mortality committee altogether because of confidentiality issues after information about maternal deaths that were related to that state’s abortion ban was leaked to ProPublica. The state is rehiring individuals for the committee.

If you want to falsely convince people that your unscientific and harmful health policies are great, controlling research and the flow of information is critical.

Health is Always Political

I know many of you are here primarily for the menopause content, but it’s important to point out that all of that good data I bring you largely depends on government funding and transparency. What we have seen this week is not a typical change between administrations, and I haven't yet discussed the personhood language that was slipped into the executive order that claims there are only two biological sexes. That alone should be setting off all the alarms. I’ll tackle personhood another day, and yes, even if you are in menopause, this can affect you.

If things at the NIH, CDC, and the FDA are delayed by a couple of weeks, there are unlikely to be that many significant long-term repercussions. However, people who had accepted job offers and then had them rescinded will suffer. Alternatively, it’s also possible that everything is on hold until every grant, vaccine schedule, and CDC recommendation is reviewed to ensure it aligns with Project 2025 and RFK Jr’s fever dream of defunding infectious diseases. In that case, all bets are off. Who knows what critical research will be lost and what infectious diseases may run rampant? How many outstanding researchers and experts will leave to be replaced by people who put party over science and who are unqualified to do the work? The consequences will be catastrophic for everyone, regardless of political party, but it’s a guarantee that the repercussions will be disproportionately worse for those who need abortions and those affected by racism and gender inequalities.

Am I overreacting? People said I was about abortion, and now we don’t have the protection of Roe, and it’s illegal in 12 states and severely restricted in many more, and maternal mortality is on the rise. All I can say is prepare for the worst because hope is not a strategy.