Updates on the Musk-Trump attack on US public health and biomedical science dominance.
Mass firings began over the weekend at CDC, NIH, and elsewhere. Plus details on USAID, and other stories we are watching.
Hi everyone, Just back from Dallas where I attended a meeting of the editorial board for the Annals of Emergency Medicine. We had lots of discussion about the future of medical journals, how we can attract the best science, diversify our board, expand our roster of peer reviewers, and broaden the authors and topics we publish. And, of course, there was much pontificating on where things stand with AI. It was fun to be in a room with super-smart dedicated people who love medicine and science. Fortunately, none of us are full-time employees of the US federal government, so we weren’t all summarily fired over the weekend for that infraction. But there were discussions about grants, and many who attended have been or will be affected by the oddball campaign to demolish our biomedical assets and diminish our public health protections that the Musk-Trump camp has undertaken.
So, today’s issue is an update on where things stand in the various stories we’ve been following as we enter the week.
Before we start, I wanted to share a social media post that was shared posted in response to an Inside Medicine post. It provides one of the clearest possible explanations for why Musk and Trump are dismantling our public health safety nets and ceding our global dominance in biomedical research:
While this is not the only feasible explanation for what we are seeing, it’s one that rings true to me. Now on to the updates.
But first…if you want to support work like this, please share and support Inside Medicine. Your support makes this all possible. Thank you!
Mass firings at the CDC and the NIH are underway, but not done.
As expected, dedicated employees at the CDC and NIH received termination notices over the weekend. However, NPR reported that fewer notices went out than expected, meaning that thousands of workers were in limbo over the weekend—another cruel twist in the Musk-Trump approach to destroying our public health and biomedical infrastructure.
As someone said, these are not faceless bureaucrats. These are passionate people who work to keep us safe and make our future healthier. Some of those individuals took to social media over these last few days. The #OpenToWork hashtag on LinkedIn is both the most uplifting and soul-crushing thing. On one hand, our nation includes a profoundly wonderful group of people who care about the world and work to improve it. On the other, the Musk-Trump project seems intent on punishing those people—at a minimum for no reason, or worse, because cruelty is the point.
Above are three LinkedIn posts to read. On the left, an NIH employee (who had already left). In the center, a talented CDC employee who just lost her job for no apparent reason. And on the right, an open letter from a group of former top health officials at the NIH, CMS (Centers for Medicare and Medicaid Services), FDA, CDC, and others. These give you a taste of the passion, quality, and scope of the work that the Musk-Trump project is attempting to destroy.
And here’s one more. It’s a post from someone who helps run 988, our nation’s suicide and crisis hotline, which is run by the federal government’s Substance Abuse and Mental Health Services Administration. That of course means it’s a target for firings by Musk and Trump. They’ve lost a quarter of their team.
We’ll have more to come on this, including lost jobs at Veterans Affairs and other key assets. We need to share these voices and amplify these stories. The general public has no idea what our colleagues in these agencies do. I fear that the “find out” phase of all of this FAFO is going to be very, very ugly.
USAID aid not being delivered, despite assurances.
In a brief video recorded in Cairo, Egypt and posted on Instagram by my colleague Dr. Atul Gawande (who recently served as the lead for global health for USAID for three years), we learn that essential foreign assistance normally provided by the agency is not reaching its intended recipients. This is despite Trump administration’s assurances (and a judicial temporary restraining order) to the contrary. This means that HIV drugs that keep millions of people alive are not reaching those in need, putting their lives in danger, and potentially breeding resistant strains of the virus that will eventually reach us too.
Over the weekend, a post on LinkedIn by Ben Jourdan, a development specialist in South Africa, provided details on all of the grants and contracts the Musk-Trump project has been trying to terminate. The post included a heat map showing the location of grant recipients (most of which are actually in the US, because the workers who administer programs all over the world are often based here) as well as detailed information on the 231 grants and contracts administered by USAID. (The link provides raw and searchable data.)
And yes, according to Atul and others, very little is actually happening, meaning that the Musk-Trump policy of cutting funding summarily and without warning is harming millions of humans around the planet—including heartlessly stranding US professionals in the foreign service.
Possibly good news on Indian Health Service terminations. (Not sure.)
Last week, Inside Medicine broke the news that hundreds of Indian Health Service employees were to receive termination notices from the Trump administration. This was despite earlier word that the already thinly staffed IHS would be spared.
Then, over the weekend, ICT News (Indian Country Today) reported that RFK Jr.—who is the Secretary of the United States Department of Health and Human Services—rescinded the terminations. My sources at IHS said they’d heard similar rumors before the report, but won’t know what to believe until they go back to work today and hear from their leadership.
Two tiny glimmers of hope.
Two small pieces of good news, one smaller and one potentially larger.
First, a couple of colleagues of mine told me that their NIH grant proposals that were scheduled to be judged this month were in fact processed with minimal delay. This is welcome in light of earlier news that the “study sections” that determine who receives NIH grants had been cancelled during the public health communications blackout—which remains active in some agencies but not others. One of the applications had to do with orthopedic injuries. It was not funded. The silver lining here was—and this is according to the researcher himself—that he didn’t feel that the decision was politically motivated. In fact, he’s a White male associate professor at a major Midwest university in a state that Trump carried in the election and the topic was not anything the current administration would have any objection towards funding on political grounds. But for many others I’ve been talking to, there’s a real concern over how best to frame important research that should be funded but that, for extremely superficial reasons, might strike the administration as “woke.”
Second, ABC News reported that former Vice President Mike Pence has begun speaking out against the Musk-Trump destruction in progress—and unlike other Republicans, he is sticking to a principle that the presidency should have a lighter touch. A principled stance. Will others in his party follow?
One last thing. (The extra snarky portion of our programming.)
I acknowledge that my snark has been on overdrive lately. I indulge in this because it’s cathartic and because these things have an emotional component. Accepting that is what differentiates us from the callous views of the administration’s scorched Earth approach. But I don’t want to do it at the expense of the data-driven, focused, and hopefully, incisive analyses that bring you to Inside Medicine. All to say, I know I need to strike a balance here.
That said…here's a thought I posted on Threads last night.
That’s all for now. If you have information about any of the unfolding stories we are following, please email me or find me on Signal.
Thanks for reading, sharing, speaking out, and supporting Inside Medicine! Please ask your questions in the comments and if you can’t upgrade due to financial considerations, just email me.
The recent mass firings at the CDC and NIH are not merely administrative decisions; they represent a deliberate and egregious dismantling of our nation’s public health and biomedical infrastructure. By terminating thousands of dedicated professionals, the administration is crippling our ability to respond to health crises and undermining decades of medical progress. This shortsightedness not only jeopardizes current research and disease prevention efforts but also endangers the health and safety of all Americans.
Compounding the recklessness of these actions is the haphazard manner in which they are being executed. Reports have surfaced of termination emails riddled with errors, including incorrect names and nonsensical, cut-and-paste sentences. Some letters even cite poor performance reviews that never occurred. This chaotic process reflects a profound disrespect for the professionals who have dedicated their careers to public service and raises serious questions about the competence of those overseeing these terminations.
In this challenging climate, I extend profound gratitude to Dr. Faust and others who courageously speak out against these reckless actions. Their unwavering commitment to defending public health, despite the administration’s propensity to target dissenters, exemplifies the resilience and dedication necessary to safeguard our nation’s well-being.
You are justifiably angry at the reckless disregard for human life. I cannot believe that Mike Pence is someone I'm going to be rooting for but that's where we are. Thank you for all your insight.