This week in public hell—um, health. May 23, 2025.
Relax, President Biden got the right cancer screening. Plus, the new MAHA report on children has major problems, DOGE usurped scientists at NIH, and what the House voted to cut from Medicaid.
It’s been a busy week. I was in Washington D.C. visiting some colleagues, and then I spent a chunk of time writing a piece about the FDA’s new Covid-19 vaccine framework. But I need more information before I can publish that, and sometimes good, careful, and accurate work takes time. Meanwhile, much happened this week, and I wanted to catch you up on my takes from some of the major stories. Let’s dive in…
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Did President Biden get the right prostate cancer screening?
Everyone lost their collective heads over President Biden’s Stage IV prostate cancer diagnosis.
“How could his doctors have not screened him?” Easy. They followed the best guidelines we have. The guidelines clearly state that for a man of his age, screening for cancer by prostate-specific antigen (PSA) blood testing should not be done after age 70, because the harms of biopsies and over-treatment clearly outweigh the benefit of discovering what are mostly clinically insignificant cancers.
Could he have had cancer for years and not known it? Maybe, but it’s not likely, despite what some pundits said. A prostate cancer imaging specialist, Dr. Cheryl DeWitt, wrote on Threads:
1. Every Gleason 9 tumor like Biden’s I’ve seen has been much larger and aggressive than the Gleason 6, 7 and 8 tumors at initial prostate MRI, often with spread outside the prostate and into the local and distant lymph nodes as well as the bones. This tells me they grow quickly and often are not caught between PSA checks…maybe as fast as 6 months to a year.
2. Yes, most prostate cancers take years to grow and metastasize, but most of these are lower grade tumors, not Gleason 9 in my experience.
3. Biden did not receive prostate cancer screening at his last checkup in February 2024. Reasons for this could vary, but often men over 70 are not screened, particularly those with a life expectancy under 10 years. It’s often a discussion between the physician and patient. For all we know, Biden could’ve turned down the testing even if offered.
4. He could live 5-10+ years with this diagnosis, but he’s 82, so that’s unlikely based on his age alone. Something else like a heart attack or stroke could get him before his prostate cancer does.
5. There are so many facts we don’t know about his case, but so far, it doesn’t set off any medical negligence red flags for me. So let’s stop with the comments about his doctors messing up and the conspiracy theories that he was running for President while knowing he had stage 4 cancer.”
Bottom line: There was a lot of hand-wringing on this news cycle, and I think some people reacted and reached conclusions before interrogating the facts. Some knee-jerk reactions came from corners that didn't surprise me (ahem. Donald Trump Jr.), while others, frankly, were from disappointing places who should have taken a deep breath and looked into the facts before popping off.
Open tabs: Gina Kolata’s story in The New York Times and another by Dr. Dhruv Khullar The New Yorker did nice work on this.
New MAHA document released. Infectious diseases experts respond.
The White House released a document entitled “Make Our Children Healthy Again.” Here’s a summary of what’s included. You know it’s not good when The Infectious Diseases Society of America has to issue a statement in defense of vaccines. But that’s exactly what happened. Here’s what IDSA President Dr. Tina Tan said this week:
“Many families are understandably searching for answers about the potential causes of chronic conditions affecting their children. It’s important to investigate those causes, but decades of rigorous and scientifically sound research have proven that vaccines are not among them. In fact, the benefits of vaccines far outweigh the risks and provide significant protection against vaccine-preventable diseases.
Vaccines have saved millions of lives of people of all ages and have been instrumental in protecting children from deadly diseases and, in some cases, even preventing the development of chronic illnesses like cancer. The recent measles outbreak in the U.S. — occurring mostly among unvaccinated kids — is a painful reminder of how dangerous inaccurate information can be to the health of everyone, especially infants and children.
As a pediatrician and an infectious diseases specialist, I want every child to thrive. Vaccines are one of the most powerful, safe and effective tools we have to make that possible.”
— Tina Tan, MD, FIDSA, FPIDS, FAAP — President, IDSA
This comes in the broader context of an HHS that is being run by longtime vaccine underminer Secretary Robert F. Kennedy Jr, whose statements and actions have contradicted the assurances he made to the contrary to Senator Bill Cassidy, a physician who raised doubts about the nomination but ultimately voted for the guy.
Open tab: The Neo-Anti-Vaxxers Are in Power Now, in The Atlantic.
DOGE, and not HHS scientists, directed the killing of many NIH grants.
The Trump administration has killed nearly $2.5 billion in scientific grants in just the past four months, shuttering over 1,400 funded projects midstream. That means all investment and no return on said investment.
The cuts have never made sense. The administration has been draconian in its pursuit of its goal of saving a few bucks (which these cuts don’t even do) by axing the projects that are powering our dominance in scientific research. We knew that the cuts were signed by DOGE. But now we know that many of them were specifically identified by DOGE. That is, these decisions were not made by NIH or NSF scientists. They were made by faceless bureaucrats nobody has ever heard of.
I figured they’d deny it. But when asked about it for a story in Nature, the Trump administration fessed right up.
“Spokespeople for the NIH’s parent agency, the US Department of Health and Human Services, and the White House acknowledged DOGE’s involvement in funding: “Paying so-called ‘experts’ to deliberate bad ideas for hundreds of hours is exactly the kind of waste that DOGE is eliminating,” White House spokesperson Kush Desai told Nature in a statement.” —Nature.
This is the first time I’ve seen the US federal government say that the feels of DOGE operatives—that is, Trump loyalists without any relevant scientific knowledge—should replace exceedingly rigorous analyses conducted by respected scientists who, for decades, have carefully adjudicated highly competitive federal grant applications.
They’ve stopped pretending that the cuts had a scientific basis. Now they’re questioning the scientists instead. If you recognize that from the playbook of notorious regimes of the past, you’re on to something….
House of Representatives passes Medicaid cuts. Will the Senate go along?
The House of Representatives passed its version of the 2026 budget (known as “One Big Beautiful Bill”) this week. The bill includes $700 billion in Medicaid cuts over the next ten years.
How’d they do it? Mainly by adding a work requirement, adding red tape, and by cutting funding to certain services, including key federal funding to states that allow undocumented persons to receive healthcare. (Here’s a good summary).
Let’s drill into work requirements.
Some people think it’s a hot idea to require that Medicaid beneficiaries be in the workforce (with some exemptions including pregnancy, disability/medical frailty, being a full-time student, caring for a child or other household members, and receiving substance abuse treatment). The idea—and I think it’s weird—is that absent such a requirement, some freeloaders won’t be encouraged to work.
Think about that conceit. These lawmakers are envisioning people choosing not to work because they’d get Medicaid either way? Seems doubtful to me. Well, what do the data say? Research in The New England Journal of Medicine found that after Arkansas enacted a Medicaid work requirement, two fairly predictable things happened: 1. People lost their insurance (and all the bad things that come with that). 2. There was no change in employment. Given that, what’s the point in a work requirement?
Meanwhile, an April white paper from the National Bureau of Economic Research found that expanding Medicaid (#ThanksObama) not only saved lives, but did so with investments well under the usual cost-effectiveness thresholds used to measure whether government programs are “worth it.”
So…adding a work requirement for Medicaid can be expected to do a few things:
Increase the rate of Americans without health insurance. Bad.
Cost lives. Bad.
Save very little or no money in the final analysis. (Care that is provided to uninsured people is generally more expensive and inevitably gets paid for by hikes in premiums to everyone else.) Bad.
Next up: Will the Senate go for these cuts? Republican Senator Joshua Hawley wrote an essay in the New York Times defending Medicaid against attacks by colleagues in his own party. What we don’t yet know is whether the cuts the House made might be acceptable to him and other key voters.
Hopefully, they will balk. According to the non-partisan Congressional Budget Office estimates, if passed, the “One Big Beautiful Bill Act” would cause 7.6 million US residents to lose their health insurance. Sorry, but that ain’t beautiful.
If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.
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Dr. Faust is exactly right. The outrage over President Biden’s diagnosis ignored both the science and the guidelines that protect older patients from the harms of overtesting and overtreatment. His doctors followed evidence-based medicine. The real problem is the assumption—often implied—that VIP-style deviation would have been better.
Some of the loudest criticism came from physician pundits who should know better. They engaged in post hoc reasoning, confused public disclosure with clinical timeline, and used a bad outcome as proof of bad care. That is not just wrong. It is reckless.
It also reveals the persistent myth that VIP medicine is better medicine. In reality, it often means distortion, overreach, and poor judgment shaped by optics. The idea that following guidelines was the mistake is exactly backward.
This kind of commentary erodes trust and pressures doctors to abandon individualized, evidence-based care. We need fewer hot takes and more humility. Bad outcomes do not equal bad medicine.
COVID Guidelines: We flew to SFO for a family wedding and despite our kn95 masks in the airport and on planes, I contracted my second case of COVID. I went to the CDC website to get more info on masking and recovery guidelines. I was startled to be sent to a page for all respiratory viruses. COVID doesn't deserve it's own page???? I went to Mayo and other academic sites (knowing they will be affected), and then Canadian and NHS sites. Is this our future? I needed more concrete information than I saw. (Maybe I was too sick to put it all together.) I'm "physician adjacent" so had resources most folks don't have. I stayed home day 1-10. Symptoms diminished and I had three negative tests. When I did go out, on day 10, I wore a mask. (We are a couple of hours away from the Canadian border and will go there to get whatever vaccines we, our kids, and grandkids need.)