Defending US health: Who's stepping up—and who's MIA?
A report card on the various organizations behind the legal actions against the Trump administration, and those quietly sitting it out.
Every destructive action the Trump administration takes against our nation’s medical and public health infrastructure seems to unfold like a three-act play:
Act I: The administration announces something horrible, either by executive order or memo.
Act II: Experts and stakeholders decry the treachery, and panic ensues while everyone sorts out just how bad the news is, and what to do next.
Act III: An organization or group files a lawsuit to stop the latest madness. Within hours or days, a judge issues a ruling that temporarily puts things back to normal.
The second and third acts have been opportunities for organizations, advocacy groups, associations, and other stakeholders to step up. Or not. Some actors in the health and medical spaces have been effective in the early days of the Trump administration and they deserve credit. Today’s issue of Inside Medicine is a rundown and review of some of the major stories we’ve been following as they’ve developed over the last few weeks, where things stand now, and some news and updates tucked in…
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Federal Research Grant Freeze.
The American Public Health Association (APHA) filed a lawsuit seeking to block the Trump administration’s federal grant freeze. It won. The APHA also said—in news that came out of an interview I conducted with the organization’s executive director Dr. Georges C. Benjamin—that it would not bend to censorship demands made by the Trump administration. Grade: A.
A group of states subsequently filed a motion requesting that the Trump administration actually abide by the ruling. That’s headed for a legal showdown (for more, see below).
Cap on NIH “indirect costs” funding (the 15% debacle).
Twenty-two states filed a lawsuit seeking to block the NIH’s decree that it would summarily change all existing grants to researchers at institutes of higher education so that the “indirect costs” would be capped at 15%. (To review what that’s all about and why it matters, please refer to these two prior Inside Medicine issues where we discussed this.) They won. Those states get an A.
Meanwhile, the American Association of Medical Colleges filed a similar action. It also won. Grade: A.
However, where were the major universities that would be affected? Grade: C. (I’m holding back on giving them a D or an F, because I believe they are trying to determine how best to survive this moment. I don’t think their silence is great, but there are many considerations they have to balance).
Data suppression and censorship at HHS, CDC, FDA.
Doctors For America (DFA), an organization of 27,000 physicians, filed a lawsuit seeking to block the Trump administration’s widespread censorship of public health data and resources, including its obsessive proscription of content that includes what the administration calls “gender ideology”. The DFA won (a welcome development yesterday). Grade A.
It’s unclear whether the CDC is complying (or will comply) with the order. Some resources that had been taken down during the administration’s brazen data blackout and were offline as recently as Monday were back online on Tuesday, including manuscripts in the CDC’s journal Preventing Chronic Disease (which was first reported here in Inside Medicine). Another resource, the CDC’s Youth Risk Behavior Surveillance System (YRBSS), was back online Tuesday, including questionnaires that looked conspicuously unchanged from prior iterations. But it’s unclear whether these restored websites reflected prompt adherence to the judge’s restraining order or, as reported in Inside Medicine, a slow communications thaw already in progress.
USAID—and our foreign aid in general.
The Trump administration has done its best to destroy USAID (the United States Agency for International Development), an agency whose work has saved millions of lives around the world in recent decades. The administration’s campaign to ruin USAID is both cruel and horrifying. A number of organizations including the Global Health Council and the American Bar Association filed a civil action trying to stop what it calls “an unlawful and unconstitutional exercise of executive power that has created chaos in the funding and administration of the United States Agency for International Development (USAID) and other federal foreign-assistance programs, causing grievous irreparable harm to Plaintiffs and other grantees, contractors, and partners.”
Global Health Council gets an A. For this and its forceful statement published on Monday entitled, “The ABA supports the rule of law,” the ABA, however, gets an A+.
(As an aside, a judge already issued a temporary restraining order blocking the Trump administration from summarily placing 2,200 USAID workers on paid leave—a move that would grind many key projects to a halt.)
However, as above with the grant freeze, the Trump administration appears to be ignoring judicial restraining orders, meaning that despite supposedly allowing delivery of HIV medications through PEPFAR (our global HIV/AIDS relief program that has saved 25 million lives since President George W. Bush unveiled it), the reality is that very little aid is being delivered. “It may turn to a trickle,” I was told yesterday.
Meanwhile, the Trump administration took time out of its busy schedule to put black tape over the USAID signs in Washington last week, before kicking the agency off its lease on Monday.
Milquetoast messaging on other topics.
Other key organizations have been disappointingly less active, though some more than others:
The American Medical Association has spoken very little, but said in a statement that it was gearing up for a fight over Medicaid. Grade: C (with grade inflation for picking its battles/playing the long game).
The American Academy of Pediatrics posted a pro-forma pro-vaccine message after RFK Jr.’s nomination as HHS secretary moved forward. Along with the AMA, the AAP did not formally oppose RFK Jr.’s nomination. I get that they’re playing the long game and have to work with whomever is confirmed, but it’s still jarring. Grade: C (with grade inflation for picking its battles).
As for my own field, the American College of Emergency Physicians issued a statement in support of our nation’s health and biomedical research infrastructure, but didn’t get into the specifics. Unlike communiques from the AMA and AAP, ACEP all but explicitly asked the Trump administration to kindly stand down from its seemingly relentless campaign to harm or diminish our health and medical research institutions, specifically naming HHS, CDC, NIH, and the Centers for Medicare and Medicaid Services. So, there was some talk there—not as forceful as I’d like to see—but no action. Grade: B (again, with grade inflation for picking its battles/playing the long game).
We need these organizations to step up. Let’s applaud and support the ones that have taken the risk of standing up for our interests, and urge the so-far less courageous ones to take their turn.
Legal showdowns are coming.
One First, a newsletter written by my friend Georgetown Law Professor Steve Vladeck, has an important summary of the brewing showdown between the White House and the judicial branch. In particular, a recent column broke down the implications of Vice President J.D. Vance’s recent tweet that seemed to suggest the Trump administration believes the judicial branch lacks legitimate authority to intervene against it.
This concerned me. Fortunately, Steve’s informed (and scholarly) view is less dire:
[C]alling a judicial decision “illegal” certainly sounds like a basis for refusing to abide by it—especially if one believes…that such rulings are “a violation of the separation of powers.” The proper remedy, of course, is to appeal a decision you believe is wrong. And if the Supreme Court, the federal court of last resort, reaches the “wrong” decision, there are legal ways to seek to overturn it; refusing to follow it isn’t one of them.
Still, it feels like the administration and the courts are on a collision course over the future of US health infrastructure—which itself seems to be a testing ground for the Trump administration’s overall crusade to destroy most of the frickin’ federal government.
Confession: I spend my time careening between two extremes. One moment, I fear we are death spiraling towards an authoritarian system run by ruthless and vindictive oligarchs, hellbent on dismantling the separation of powers upon which our democracy has successfully flourished for generations. The next, I retain faith that our institutions truly are strong enough to rise with the occasion and restore forbearance and reason.
Why I maintain a modicum of optimism: I am no legal scholar, but it has always felt to me as though Chief Justice Roberts has held the legitimacy and prestige of the United States Supreme Court (and the judicial branch in general) above all else—that is, except the Constitution itself. I cannot help but wonder if the institutional clout that Chief Justice Roberts has been jealously guarding and nursing over the past two decades was always meant to be an insurance policy for a crisis like this—to be expended not on these one-off cases that we civilians may rise to be passionate about, but rather, on something loftier: the fate of the nation.
As I’ve said before, my message to the lawyers is this: You save the nation while my medical colleagues and I save the lives of everyone having heart attacks along the way. We’re in this together.
That’s what we know for now. If you have information about any of the unfolding stories we are following, please email me or find me on Signal.
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Wow! This is exactly what I have been yearning for! This provides credible information that can be used to guide support. I am less optimistic & as a result my anxiety is through the roof! This helps me maintain a more balanced view.
Thank you! My blood pressure thanks you!
This is very alarming this constitutional crisis affecting 50 states, hundreds of millions of people, citizens. People are losing their jobs and lives because of extremist decision making ~ and the international deaths due to the cessation of USAID, beyond heartbreaking. A trickle of life sustaining supplies, meds ? 😢🥺😳☹️Teenagers, families, young adults losing sleep nightly over a blossoming constitutional crisis and imminent oligarchy etc … My daughter says peers are crying in school over the politics ~ the racism, uncertainty, loss of LGBTQ rights, the potential loss of education and opportunities for university etc, high costs, sudden economic decline, imperialism of Oligarchs and blatant extreme right dictatorial actions, usurping Congressional checks and balances ~ Congress people having to rally and protest , E with kid in Oval Office stating misinformation…laughing joking etc acting unstable and bizarre -weird WHAT A ROLE MODEL for young people who are worried about their futures ~ these dictatoresque leaders who want to harm the health structure and health systems of millions of people and the environment. Like WHAT on Earth ?! Our teens and young adults in our communities see this for the truly bizarre unstable political situation this is and they’re vocal. They want a stable normal future for themselves and the people of the planet. They want Bird Flu to not upend anything. They want abortion access and bodily autonomy <human rights. They want better covid vaccines and treatments, long covid research. They want primary care doctors, functioning hospitals and they don’t want cancer from environmental toxins and crappy water, air. They want a good nurturing safe environment so we adults need to keep speaking up. Nobody wants Measles or TB or HIV or Drug Resistant Pneumonia or any pathogens or extra viruses because the system failed in a politically weird time. They want ER to be accessible and function ~ no strange government or corporate take overs ~ with D O G E being given ultra power about healthcare funding etc / society is very concerned and our families and communities want stability of healthcare funding and day to day life. Society is very aware of what’s at risk. We need news media to be independent and factual during this unsettling time. Call 📞 Congress regarding concerns ~ activism is key sharing opinions with leadership ~