\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n A new executive order from President Donald Trump has potentially broad implications for the future of the federal research enterprise by transferring direct funding decisions away from career professionals to political appointees.<\/p>\n And a gunman, reportedly disgruntled over covid vaccines, attacked the headquarters of the Centers for Disease Control and Prevention in Atlanta, highlighting how increasingly inflammatory rhetoric from health critics endangers the public health workforce.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of the Pink Sheet, Shefali Luthra of The 19th, and Alice Miranda Ollstein of Politico.<\/p>\n \t\t\t \tSarah Karlin-Smith \t\t\t \t\t\t \t\t\t \t\t\t \tShefali Luthra \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews Aaron Carroll, president and CEO of the health services research group AcademyHealth, about how to restore the public\u2019s trust in public health.<\/p>\n Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read this week they think you should read, too:<\/p>\n Julie Rovner:<\/strong> ProPublica\u2019s \u201cVeterans\u2019 Care at Risk Under Trump as Hundreds of Doctors and Nurses Reject Working at VA Hospitals<\/a>,\u201d by David Armstrong, Eric Umansky, and Vernal Coleman.<\/p>\n Alice Miranda Ollstein:<\/strong> The New York Times-KFF Health News\u2019 \u201cWhy Young Americans Dread Turning 26: Health Insurance Chaos<\/a>,\u201d by Elisabeth Rosenthal and Hannah Norman.<\/p>\n Sarah Karlin-Smith:<\/strong> The New York Times\u2019 \u201cThis Ohio Farm Community Is a Mecca for the \u2018MAHA Mom,\u2019<\/a>\u201d by Caroline Kitchener.<\/p>\n Shefali Luthra:<\/strong> Stat\u2019s \u201cInside the American Medical Association\u2019s Sudden Strategy Shift in Washington<\/a>,\u201d by Theresa Gaffney.<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n \t\t\t\t\tClick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: Trump Further Politicizes Science<\/strong>\t\t\t\t<\/p>\n [<\/em>Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong> Hello, and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, Aug. 14, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we are joined via videoconference by Sarah Karlin-Smith of the Pink Sheet.\u00a0<\/p>\n Sarah Karlin-Smith:<\/strong> Good morning, everybody.\u00a0<\/p>\n Rovner:<\/strong> Shefali Luthra of The 19th.\u00a0<\/p>\n Shefali Luthra:<\/strong> Hello.\u00a0<\/p>\n Rovner:<\/strong> And Alice Miranda Ollstein of Politico.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Hi.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode we\u2019ll have my interview with Aaron Carroll, president and CEO of AcademyHealth. He\u2019ll talk about how the public has lost trust in public health and how public health might win it back again. But first, this week\u2019s news.\u00a0<\/p>\n I want to start this week with a story that maybe hasn\u2019t gotten as much attention as I think it should. Last week, President [Donald] Trump issued yet another executive order, this one called \u201cImproving Oversight of Federal Grantmaking.\u201d It really should be called \u201cImplementing Political Oversight of Federal Grantmaking\u201d because that\u2019s what it does. Sarah, before we get into this, explain how federal science grants work now and the role of political appointees vis-\u00e0-vis career and outside experts.\u00a0<\/p>\n Karlin-Smith:<\/strong> I guess I would say right now there\u2019s very little political oversight. You have various scientific committees and federal experts that make the decision of how to reward the money, and it\u2019s going to be very broken down by people\u2019s areas of scientific specialty. So, and this order is really trying to put it more in the hands of political people that have a lot less scientific knowledge.\u00a0<\/p>\n Rovner:<\/strong> That\u2019s a polite way to put it.\u00a0<\/p>\n Karlin-Smith:<\/strong> I think the reason why maybe it hasn\u2019t gotten attention is this is sort of an extension of a lot of stuff they have tried to do throughout the administration, but they\u2019ve either gotten pushback from universities or other parties or through the courts. And part of what seems to be going on here is they maybe have learned some lessons about their legal failures and they are trying to see if they can kind of adjust their strategy to maybe make it more foolproof. But there\u2019s a lot of tension between how Congress has directed this federal funding to be spent and what the administration can really do to change the process around it.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I mean, I feel like until now this has been very much Congress setting the parameters and career people and outside experts making the judgments about what kind of science should be funded, right? Am I missing something here?\u00a0<\/p>\n Karlin-Smith:<\/strong> I don\u2019t think you are. I guess one thing that strikes me about this is I think that the U.S. scientific infrastructure and NIH [the National Institutes of Health] in general has not been political in the way I think other parts of our health system, our public health system in particular, have been over the years. Like, NIH, it\u2019s gone through some periods maybe in the past decade or so where the funding wasn\u2019t quite where people want it. But in general it\u2019s been a pretty bipartisan priority. People do not want to mess with this system. It\u2019s kind of a crown jewel of the U.S. that has helped spur both our universities and private industry and technology. So I think this is just a bit of a very different kind of strategy and approach from the Trump administration than we\u2019ve seen from other administrations in terms of even trying to do this.\u00a0<\/p>\n Rovner:<\/strong> It has been political in the sense of Disease Group A goes to members on Capitol Hill and say, Please fund our disease,<\/em> and then they\u2019ll put a line in the Appropriations Committee report to Please fund this disease.<\/em> But when it comes to how, what specifically the kinds of research for that disease gets funded, that\u2019s been left up to experts. So, under this order, not only will political appointees be in charge of potential funding announcement as well as grant approvals, but it also orders creation of a system to cancel ongoing grants for, quote, \u201cconvenience,\u201d meaning apparently any reason that the administration might want to invoke. That\u2019s something, as Sarah points out, that this administration has been doing since January, although various courts have pointed out kind of repeatedly that that\u2019s not legal. But this could create so much uncertainty in scientific research so as to just basically bring things to a screeching halt. I see you nodding, Alice.\u00a0<\/p>\n Ollstein:<\/strong> Yeah, I think that this is going to deter a lot of researchers from even embarking on the process, because why would you pour years of effort into writing these grants, recruiting subjects, setting up these labs when you know that the funding could be yanked at any time? That kind of uncertainty doesn\u2019t comport with the years-long stability required to really get somewhere with this kind of research. And it\u2019s no wonder that other countries right now are aggressively recruiting American scientists and American scientists are saying, Yeah, I would rather go abroad and have more stability, more of a guarantee that my research won\u2019t be messed with and won\u2019t be suddenly defunded, rather than stay here.<\/em> And that\u2019s going to be an enormous loss of knowledge here and an enormous loss of economic power over time.\u00a0<\/p>\n Karlin-Smith:<\/strong> The other thing about, in talking to some of the groups that advocate for the universities here, that they were saying even prior to this order, with some of the earlier actions, what they were hearing, what was happening is is that other countries are actually recruiting scientists to work for them or fund them, but letting them stay in the U.S. And here so they\u2019ve even come up with ways to even make it pretty easy for people to switch. But then the catch is probably that that research or IP [intellectual property] and so forth will actually belong to other countries, particularly China is one that is interested in that, in the many ways an adversary of the U.S.\u00a0<\/p>\n Rovner:<\/strong> So, yeah, because I was going to say, one of the headlines I saw this morning was of investors who were starting to hold back because of all the uncertainty about the U.S. research establishment. I mean, this is a big chunk of the economy. I mean, it feels like the Trump administration trying to punish Harvard and Columbia and other universities, but I feel like the ripple effects of this could be much bigger than even they anticipate.\u00a0<\/p>\n Ollstein:<\/strong> Well, absolutely, and I know we\u2019re going to talk a lot about trust in health science and where that\u2019s going, but I think there are two sides to people\u2019s fears about this right now. One, that good, gold-standard, important research won\u2019t get funded but also that shoddy or biased research will get funded. If you politicize that, you have both risks.\u00a0<\/p>\n Rovner:<\/strong> Yeah, that\u2019s true. Well, to segue, meanwhile, as if federal health officials aren\u2019t uncertain enough right now, a gunman shot up the headquarters of the Centers for Disease Control and Prevention in Atlanta last week, killing a law enforcement official. Reports differ, but there\u2019s evidence that the gunman, who apparently shot himself, blamed his covid vaccine for his mental health woes and wished to get back at the public health agency. To quote Jerome Adams, surgeon general in Trump\u2019s first administration, in a Stat op-ed<\/a> published over the weekend, quote: \u201cOne thing is clear: This tragedy is not an isolated event. It is a dire reflection of ever escalating threats public health workers face in a climate increasingly shaped by misinformation, politicization, and inflammatory rhetoric,\u201d close quote. And it\u2019s not just the shooting itself. Apparently the way higher HHS [Department of Health and Human Services] officials have tried to calm the nerves of CDC staff hasn\u2019t really worked very well, from what we\u2019re hearing.\u00a0<\/p>\n Karlin-Smith:<\/strong> I mean, I think there\u2019s a lot of CDC staff, and people in the public health space, blame the leadership of this current HHS for stoking these fears, and the rhetoric that they were using for a number of years prior to coming into office, for kind of creating a situation where this happened. And not only have they not really wanted to take that on head-on and talk about it or take any responsibility for it, they\u2019ve sort of fueled the flames with comments HHS Secretary Robert F. Kennedy has made since the incident on news outlets, continuing to kind of double down on the language that suggested. And of course in the past few weeks they\u2019ve made other decisions that have, I think, to people who have questioned vaccines and some of the technology that this person might\u2019ve been upset about, sort of seem to back up their concerns, unfortunately, unscientifically, like pulling back on mRNA vaccine research funding.\u00a0<\/p>\n Luthra:<\/strong> I was going to say, I think there\u2019s another point that you made, Julie, that\u2019s really important, which is looking at this in the broader context even of the past five years. And we\u2019ve seen this real escalation of threats against public health workers across the country, and that really took off in a different way with the right-stoked skepticism around the covid vaccine, which we\u2019ll talk about in a moment. But that\u2019s had consequences already, whether that is people not wanting to enter public health, people leaving the profession, and it\u2019s affecting our ability to monitor diseases, to do public health prevention, to do all those kinds of things that are becoming even more important and even more difficult as other parts of the health care safety net are being constrained.\u00a0<\/p>\n Rovner:<\/strong> Yeah. And the mantra that we keep repeating is that public health, when it works, is invisible. Well, if it\u2019s not there and it doesn\u2019t work, it\u2019s not going to be invisible anymore.\u00a0<\/p>\n Ollstein:<\/strong> Well, and also this is coming at a time when a lot of people, if they\u2019re not being straight-up laid off from these agencies, are feeling driven out in other ways by the uncertainty, by My department was cut, and then it was restored because of a lawsuit, and then it was cut again,<\/em> and thinking, Why should I put up with this, the way the administration has disparaged bureaucrats, basically?<\/em> But also these nonpartisan scientists who work for the government. And so this is coming on top of all of that. And so if someone was on the fence about, Should I stay and keep working for CDC or not?<\/em> \u2014 this certainly isn\u2019t going to convince them to stay, both the fear as well as the agency\u2019s response to the incident.\u00a0<\/p>\n Rovner:<\/strong> So HHS Secretary Kennedy was not very quick to respond to the CDC shootings, but he has been busy with other things this past week. One was an unsuccessful effort to get a prominent medical journal, the Annals of Internal Medicine, to retract a large vaccine study out of Denmark \u2014 and by \u201clarge\u201d I mean 1.2 million children \u2014 that found that cumulative aluminum exposure to children via vaccines is not a safety risk. I honestly can\u2019t remember an HHS secretary ever demanding a study be retracted because they disagreed with its finding. How unusual is this?\u00a0<\/p>\n Karlin-Smith:<\/strong> Very unusual. I mean, I think the scientific basis for what he\u2019s saying and pushing for. And the journal has already said, No, we are not retracting this<\/em>, pretty bluntly. And this adjuvant has been something people have been worried about Kennedy going after. It came up a little bit the last CDC advisory committee on vaccines.\u00a0<\/p>\n Rovner:<\/strong> Yeah, explain what aluminum adjuvant is.\u00a0<\/p>\n Karlin-Smith:<\/strong> And it\u2019s basically something they\u2019ve been putting in vaccines since I think the 1930s. And it helps basically boost your body\u2019s response to it. So it makes the vaccines better. And the last CDC advisory committee on vaccines, after Kennedy sort of overhauled the panel and put a lot of his people on there who don\u2019t really trust vaccines very much, they removed thimerosal as an adjuvant for a flu vaccine, which I think was seen as problematic but won\u2019t have huge, huge consequences, especially for the U.S. But they did\u2014\u00a0<\/p>\n Rovner:<\/strong> Because it had already been removed from most vaccines.\u00a0<\/p>\n Karlin-Smith:<\/strong> Right. But they did also sort of tease that they were going to look at this adjuvant. And when I talked to people about that, they were much more concerned about it, because it\u2019s in many more products and they don\u2019t believe there\u2019s really good alternatives for it. And it could basically be a move to push companies out of this space of making a lot of vaccines that children really need and benefit from.\u00a0<\/p>\n Rovner:<\/strong> Or make vaccines less effective.\u00a0<\/p>\n Karlin-Smith:<\/strong> Right. So they just don\u2019t have good alternatives. So, yeah, it\u2019s one thing people have been watching, is kind of the next step of where they go in vaccine politics here.\u00a0<\/p>\n Rovner:<\/strong> What they\u2019re going to go after. Well, meanwhile, the fallout continues over Kennedy\u2019s cancellation of half a billion dollars in research on mRNA vaccines, which somebody mentioned earlier. This week, an international virologist group representing more than 80 labs reaffirmed their support for the technology. Michael Osterholm, one of the nation\u2019s very top epidemiologists, said on the \u201cPBS News Hour\u201d<\/a> that this was, quote, \u201cunequivocally \u2026 the most dangerous public health decision I have ever seen made by a government body.\u201d Why are scientists reacting so strongly to this particular policy change?\u00a0<\/p>\n Karlin-Smith:<\/strong> One of the big reasons is because of how fast this technology can be used to develop vaccines and the ability for it to be helpful in a pandemic. So while we have other, older vaccine technologies, this one is really much faster in being able to update vaccines and make new vaccines. So that\u2019s a crucial public health benefit to it, and that, I think, really scares people.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I know that the flu vaccine is still made using chicken eggs, right?\u00a0<\/p>\n Karlin-Smith:<\/strong> Right. It\u2019s grown in an egg. So, right, if you think about potential of flu pandemics, bird flu comes up. That\u2019s one place where having the new mRNA technology would be really valuable. It\u2019s also being studied for all different types of diseases outside of it, the infectious disease space, and cancer. And people are really excited about that, too. At this point, it doesn\u2019t seem like the administration is as interested in cutting off that sort of funding.\u00a0<\/p>\n Rovner:<\/strong> Yeah, well, we will have to see. Well, meanwhile, over at the FDA [Food and Drug Administration], we note the return of Vinay Prasad as head of the Center for Biologics. Sarah, didn\u2019t he quit just, like, two weeks ago? What is going on over there?\u00a0<\/p>\n Karlin-Smith:<\/strong> Strange times. Yeah, I think he was gone for maybe it might\u2019ve been about 10 days. I don\u2019t even think it was two weeks. He was kind of forced out. He drew attention from some right-wing allies of Trump, particularly Laura Loomer, after he halted the shipping of a gene therapy product after some safety events, some deaths. And that caused a lot of right-wing people that hadn\u2019t really maybe paid much attention to the FDA or Prasad to look into his history. They pulled up some of his past, which was, he was probably, he was fairly Democratic and aligned with more of the left wing prior to maybe the covid pandemic. He had really strongly criticized Trump and made pretty, I mean, he\u2019s quite a character in his colorful statements. So he had talked about having a voodoo doll of Trump, and I think if you know Trump, that\u2019s not the kind of thing he\u2019s probably going to personally stand for.\u00a0<\/p>\n So it seems as if the White House pushed him out. But Martin Makary, the head of the FDA, and even HHS Secretary Kennedy seemed to eventually sort of convince the White House to let him back. And here he is. The question, I think, in a lot of people\u2019s minds is does he have to sort of modify his decision-making or regulatory philosophy now that he\u2019s brought back, whether it\u2019s to sort of appeal to these right-wingers who basically have heralded Trump as this sort of head of a right-to-try movement, and this idea that there should be a more libertarian attitude toward regulation of medicine and people should basically have more options to try things.\u00a0<\/p>\n Rovner:<\/strong> Yeah. It goes back to sort of the whole right-to-try thing and this drug for muscular dystrophy, right? Isn\u2019t that sort of what prompted the big kerfuffle?\u00a0<\/p>\n Karlin-Smith:<\/strong> Right. Right. So this Duchenne muscular dystrophy treatment has a really sort of long, complicated, controversial track record because Peter Marks, who used to have Vinay Prasad\u2019s job before him, actually overruled a lot of his scientific reviewers in approving the product. And Prasad had a long history of criticizing Marks for doing that. And then right over the past few months it came out there had been some deaths in the space, mostly in non-ambulatory people. So this is a very devastating muscle-wasting disease, and eventually most people end up wheelchair-bound. And what ended up happening right before Prasad left is they agreed to let the drug back on the market for people that are still ambulatory, where they think the safety risk is less. And it\u2019s still right now off the market for those.\u00a0<\/p>\n But yeah, it\u2019s sort of ironic because Prasad, while he\u2019s sort of repeated a lot of the anti-vaccine rhetoric of Kennedy and Makary, particularly when it comes to covid vaccines, his philosophy, and what he was known for prior to coming to the FDA, was actually having kind of stricter standards for approval than many at FDA maybe had, or he would argue. And that doesn\u2019t really align with the Trump philosophy or this libertarian, right-wing philosophy around this idea of right to try and people should have access to things if they\u2019re willing to take the risks. So that\u2019s where I think we\u2019re watching moving forward, because actually outside of the covid vaccine space where he was sort of heavy-handed, he also made a number of decisions around gene therapies besides this one in his first, short stent at the FDA that did seem, again, a little bit more anti that right-to-try philosophy.\u00a0<\/p>\n Rovner:<\/strong> Yeah. Well, we will definitely be watching that one closely. All right, moving on. We are seeing still more fallout of the big budget bill that passed earlier this summer. In rural New Hampshire, a community health center is closing at the end of October, citing Medicaid cuts, among other things. The Washington Post has a story this week<\/a> about how the Medicaid reductions could lead to a decrease in services and an increase in wait times for things like counseling and speech therapy provided at schools for children with disabilities. I know Republicans were counting on these cuts not really having much of an impact prior to next year\u2019s midterms. And they keep swearing that services won\u2019t be cut except for people who are undocumented or who refuse to work. But that\u2019s not how this is all playing out, right?\u00a0<\/p>\n Luthra:<\/strong> There\u2019s just no way that is how it can play out. And I think what we\u2019re seeing in real time is how sprawling Medicaid is. It touches so many corners of so many people\u2019s lives. There\u2019s a reason it became this really sacred-cow component of things you can and can\u2019t touch. And I think one thing that will be really interesting is, just again, as we think about something like community health centers, which Republicans also often tout as this really great model. We talk about that for family planning, especially. Oh, you can go there \u2014 you don\u2019t need your Planned Parenthood,<\/em> for instance. And what does happen when all of these places that so many people rely on are gone?\u00a0<\/p>\n And I think one thing that you pointed out, Julie, that\u2019s also so important is that many cuts may not be taking effect right away, but institutions have to make plans now. They are anticipating that that money isn\u2019t coming back. And even if we don\u2019t see some of the formal cuts having their start date until later on, it\u2019s just not possible, I think, to imagine that we won\u2019t see institutions have to adapt and scale back and see people navigate what that means.\u00a0<\/p>\n Rovner:<\/strong> Yeah. If there are 10 million more people mostly without Medicaid, all of these places like community health centers who get a lot of their funding from Medicaid are going to lose a lot of their funding. I think this just didn\u2019t carry through. I mean, we heard a lot from the hospitals, but it didn\u2019t carry through to the other providers whose livelihoods basically depend on their patients having some form of insurance. And usually that\u2019s Medicaid.\u00a0<\/p>\n Ollstein:<\/strong> Right, and even with the hospitals, Congress was pressured into creating this kind of rural hospital slush fund to prop up the places that might be most impacted by this. But if all of the people who will be going to those hospitals lose their coverage, that might not be enough to make up for the loss, not to mention all of the hospitals that aren\u2019t eligible for that money. And so I think Shefali\u2019s absolutely right. The lesson in 2017 that Medicaid is not just the poor-people program was not learned. It didn\u2019t stick. And now you\u2019re seeing people relearning that, Oh, this impacts seniors in nursing homes.<\/em> Oh, this impacts kids getting special services in schools. Oh, this impacts all of these groups that aren\u2019t the working poor.<\/em>\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think we\u2019re going to continue to see this sort of spool out as we go. Well, finally this week, a priority for the Trump administration that\u2019s shared by most of the public \u2014 cutting down on so-called ultraprocessed food. The CDC reported last week that Americans are eating fewer of their calories via ultraprocessed food, but it is still more than half of the calories consumed. And pushing for at least a partial solution is not the current FDA commissioner but a former one, David Kessler, who served under Presidents George H.W. Bush and [Bill] Clinton and has campaigned against processed food for pretty much as long as I can remember. While Trump administration officials have been urging food companies to do things voluntarily, Kessler this week filed a petition arguing that the FDA has the authority to declare certain ingredients used in ultraprocessed food as not, quote, \u201cgenerally recognized as safe.\u201d Making food companies prove these processed ingredients actually are safe could be a real tool in the fight against these foods, right? I mean, Sarah, this whole \u201cgenerally recognized as safe\u201d has been one of the big FDA loopholes over the years.\u00a0<\/p>\n Karlin-Smith:<\/strong> Right. So, basically since the 1990s, due in some degree to probably staffing shortages and so forth, FDA has kind of allowed companies to self-certify that a lot of these ingredients are considered \u201cgenerally recognized as safe.\u201d And I think now there\u2019s sort of some sense that maybe that wasn\u2019t scientifically, and health, the best idea. So, Kessler\u2019s basically saying you should give companies some cushion, maybe like 12 months or so, and say, Look, you either need to pull these ingredients out of your food or really, truly prove to us with the science that these are safe.<\/em> Then he\u2019s kind of calling Kennedy\u2019s bluff a little bit and basically being like: Look, you keep talking about this. You\u2019re really furious about the ultraprocessed food. Look, I found your regulatory hook, your legal way to do it. Now go do it.<\/em>\u00a0<\/p>\n And I think the food industry, like many other big industries in the U.S., are pretty powerful, as you said. Given the amount of food we consume with these ingredients, it\u2019s a huge \u2014 it would be probably quite difficult to make these changes in a year or so forth. But Kessler\u2019s pretty smart. He was the person that really led the regulation of tobacco at FDA. And so I think he\u2019s basically trying to say, Look, here\u2019s a strategy \u2014 now go do it<\/em>, and see if they\u2019ll really follow through on anything.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I was absolutely fascinated by this in terms of sort of calling the bluff, because that\u2019s what you were saying. On the one hand, they\u2019ve talked a big game on something that, unlike the Medicaid cuts, is popular with the public. On the other hand, they seem very loath to require the food industry to do anything.\u00a0<\/p>\n Karlin-Smith:<\/strong> Right. I mean, their main food achievement so far is getting commitments on certain food dyes, which for the most part actually aren\u2019t that used anymore. And I think even the safety concern around them is generally seen as pretty low. Now they\u2019re not really adding anything to your food other than color. So there\u2019s an argument that even if there\u2019s just even some slight hypothesis that there\u2019s the danger, you should get them out. But the theme, and we talked a lot about this a little bit last week in the podcast, is they\u2019re talking a lot more than they\u2019re actually making achievements so far in the public health space.\u00a0<\/p>\n Rovner:<\/strong> I guess you can sum this up in: It\u2019s less What color are your Froot Loops?<\/em> than Should you be eating Froot Loops at all?<\/em> Or, Should you be feeding them to your children?<\/em>\u00a0<\/p>\n Karlin-Smith:<\/strong> That\u2019s perfect.\u00a0<\/p>\n Rovner:<\/strong> Yeah. All right. Well, I\u2019ll be fascinated to see if they actually follow up on this. All right, that is this week\u2019s news. Now we\u2019ll play my interview with AcademyHealth president and CEO Aaron Carroll, and then we\u2019ll come back and do our extra credits.\u00a0<\/p>\n I am so pleased to welcome Aaron Carroll to the podcast. Aaron is president and CEO of AcademyHealth, the leading national organization for health system researchers, in addition to being a top-notch health policy expert himself. Aaron is also a pediatrician and formerly a pediatrics professor and associate dean at the Indiana University School of Medicine. Aaron Carroll, thanks so much for joining us.\u00a0<\/p>\n Aaron Carroll:<\/strong> Thanks for having me.\u00a0<\/p>\n Rovner:<\/strong> So, I wanted to talk to you mostly about your op-ed published in The Washington Post last week. We will link to it in our show notes. It\u2019s called: \u201cThis Phrase Was Meant To Increase Trust in Science. It backfired.<\/a>\u201d The phrase in question is \u201cFollow the science.\u201d Tell us why you think it backfired.\u00a0<\/p>\n Carroll:<\/strong> Well, for a couple of reasons. The biggest is that I think it to some extent conflates science and policy, and it makes it sound like that once we have science that policy naturally follows from it and that anyone who is rational will know the right answer. The problem with that is that science is sort of a set of facts, or an explanation of the world as we best understand it, but policy should take good science, and then it has to incorporate societal values, people\u2019s preferences, what I would call utility values almost, and all the trade-offs that come with policy. And so good science should inform policy, but good science is not the same as policy.\u00a0<\/p>\n I provide a number of examples. One would be like, look, we have great science that shows vaccines are unsurpassed to preventing infectious disease. We also have science that shows that eating raw or undercooked eggs can cause salmonella. The first might justify vaccine mandates in schools. The second certainly doesn\u2019t mandate banning sunny-side eggs. Just because something is true, you have to think about their differences when you come into policy. And too often we use that phrase almost as a cudgel to say: We have science, therefore this is the only policy that makes sense. And if you disagree, then you\u2019re not following science.<\/em> That\u2019s just not the case.\u00a0<\/p>\n Rovner:<\/strong> And that\u2019s pretty much what happened during the pandemic, wasn\u2019t it?\u00a0<\/p>\n Carroll:<\/strong> Yeah. I mean there were so many times where we were making the best guess, because you have science, but the science isn\u2019t terribly great and it\u2019s not really up to date. So you have to make policy decisions from that. But different people are going to make different policies, and different groups, depending upon where they\u2019re focusing, might make different policies. And that is OK. But we sort of fell into a trap where there could only be one voice, one truth. It really brooked no dissent, and it had to be sort of put out nationwide. And when there was pushback that the policy decisions didn\u2019t necessarily follow from the science, everyone didn\u2019t always react to that as well as they should have.\u00a0<\/p>\n Rovner:<\/strong> And now it\u2019s being hung around people\u2019s necks, whichever side they were on.\u00a0<\/p>\n Carroll:<\/strong> Yeah.\u00a0<\/p>\n Rovner: <\/strong>Even if the science has changed since then.\u00a0<\/p>\n Carroll:<\/strong> Yeah. I mean, I helped to run Indiana University\u2019s pandemic response, and we used to do at least a weekly webinar where we would answer questions, and all the time I would say things like: This is the best answer we have right now. That\u2019s why we\u2019re going with this. And let me explain to you why. And these are the trade-offs. We\u2019re trying to do the best by everyone. These are the pros. These are the cons. Let\u2019s talk it out. And if the data change in the future, we\u2019ll change the policy. We\u2019re doing the best we can.<\/em> But that kind of nuance, that kind of long-form answer, was too often not acceptable or not possible during the pandemic, because we wanted things to be reduced to sound bites. We wanted things reduced to easy algorithms. We wanted everyone to sort of do whatever our chosen sort of arbiter of truth said. And if people disagreed, we really accused them of disagreeing with science. And there\u2019s a real difference between science and policy.\u00a0<\/p>\n Rovner:<\/strong> So, how do we start to win back that trust?\u00a0<\/p>\n Carroll:<\/strong> I think a couple of ways. One is, I think, we have to start listening as well as we do speaking. I think too few of us actually are willing to spend time talking with people who truly disagree with us, and that\u2019s going to limit our ability to enact good policy. I like to point to the fact that there are change management experts who will argue that there are three reasons people resist change. They don\u2019t understand it, they don\u2019t like it, or they don\u2019t like you, which is really about trust. But we treat too many things as if they only fall into that first bucket. It\u2019s a knowledge dissemination problem. And if we just speak out facts louder and louder and more stridently, then everyone will come and listen to us. So if we just keep broadcasting facts over social media, then everyone\u2019s going to agree with us.\u00a0<\/p>\n It completely ignores that there\u2019s a section of people who are completely rational but don\u2019t like the change, because of trade-offs. I hated wearing a mask. It fogged up my glasses completely. I would do it, but I hated it. And every time someone lectured me on how easy it was and I should just get over it, I got angry. We\u2019ve got to be better about understanding there are trade-offs in policy, and we have to address those trade-offs. And of course there\u2019s that huge third bucket of people that don\u2019t trust us. That\u2019s only going to come from slow, honest conversation with people who disagree with us. And we don\u2019t want to do that, either. We want to shout at people over social media. We want to push people away who don\u2019t agree with us. We want to belittle them.\u00a0<\/p>\n That\u2019s a problem. In the op-ed, I talked about that, as a pediatrician, I\u2019ve been dealing with parents that don\u2019t want to do what I tell them is best for decades. I don\u2019t slap \u2019em. You have to build trust. You have to listen to them empathetically. You have to discuss the reasons why you might want to do something or not do something. And you have to build those kinds of relationships over time. It\u2019s slow. It can be tedious. But that\u2019s how you get people to change their mind, not by just shouting or belittling them. And we do that too often.\u00a0<\/p>\n Rovner:<\/strong> One thing I\u2019ve noticed over almost 40 years of doing this is that some of the best explainers of policy have been pediatricians \u2014 C. Everett Koop, David Kessler, Bill Roper, all pediatricians of one sort or another. What is it that they teach you that lets you communicate so well?\u00a0<\/p>\n Carroll:<\/strong> I trained in Seattle. People were refusing vaccines back in the \u201990s, and they weren\u2019t the same people who are refusing vaccines today. You had to learn to deal with that. I would make recommendations about how to sleep, how to eat, how to control tantrums, how to do behavior change, how to parent. And I\u2019m competing with Grandma, and I\u2019m competing with other relatives who have very wildly different opinions about how things should be done. And you have to learn how to deal with that, with people who just don\u2019t agree with you right away and who aren\u2019t swayed by data and evidence but by trust. And people get more riled up about when they\u2019re pregnant and, I think, when they have small children, than almost any other time in their lives, about they can\u2019t make a mistake, they\u2019ve got to do the right thing, and they\u2019ve got to balance competing voices who are telling them very different information. Maybe we\u2019re just better used to it or trained to it, but a lot of this stuff that we\u2019re arguing about now, a lot of pediatricians have been dealing with for a long time.\u00a0<\/p>\n Rovner:<\/strong> So, this administration, obviously, for anybody who\u2019s listened to the podcast for more than five minutes knows, is not really helping matters right now, are they?\u00a0<\/p>\n Carroll:<\/strong> I mean, we\u2019re not doing a lot of really good communication and a lot of really good listening. I think we\u2019re seeing a lot of top-down decisions that are not perhaps based on the best data and evidence, are not as justified as well as you might want to expect, and who are dismantling or removing many of the tools that we use to produce the data and evidence that can produce sound policy. No one would argue, I think, that the NIH couldn\u2019t have reform. No one could argue that the USPSTF [U.S. Preventive Services Task Force] is perfect and never needs to be touched. ACIP [The Advisory Committee on Immunization Practices] could be refined. I think there were decisions made about covid vaccines and boosters that produced hearty debate years ago, and lots of decisions on ways that some of these organizations work could be refined. But we don\u2019t want to throw out the baby with the bathwater. A lot of the infrastructure that we have in place is to make sure that things are nonpartisan, that we\u2019re relying on the best evidence, that we\u2019re doing the best job that we can to make sure that these things are not biased or partisan in any way.\u00a0<\/p>\n And a lot of the steps, I think, that are being taken to wipe away a lot of this infrastructure are not going to reinforce trust. The answer isn\u2019t to shut down discussion, which is happening too often around the country. It\u2019s to move and lean into open dialogue. We have a meeting coming up in the next few months, Health Datapalooza, which really brings together lots of people from the current administration who should be there, plus lots of people from industry, plus researchers, plus health systems, and those who provide the care, coming together and having an open dialogue, open discussion, learning to listen to each other, and learning to realize we\u2019re all really human beings and we need to be able to learn. Both ways is how we move forward. And unfortunately, we\u2019re moving in a direction that tries to shut down that kind of debate and just shouting that the other side is wrong.\u00a0<\/p>\n Rovner:<\/strong> I know AcademyHealth has been pretty outspoken about the disappearing databases at HHS in particular. I mean, what could that mean for public health? And, I mean, now it\u2019s not just databases that are being taken down but there\u2019s a concern about data being put up that\u2019s not necessarily trustworthy.\u00a0<\/p>\n Carroll:<\/strong> I mean, again, we can\u2019t improve what we can\u2019t measure, and we can\u2019t make change if we don\u2019t know where we\u2019re starting from or where we need to go. And you can make an argument, I suppose, that a lot of these data would still be available without the federal government collecting it, but no one is as good or thorough or has the mandate of law to pull a lot of these data sources together in ways that people can use. And these aren\u2019t just, like, esoteric research things. Some of these are, like, how public health officials monitor the health of their citizens. Some of these are about what clinicians might want to know to talk to their patients about what\u2019s going on in their area, or what trends are in certain diseases, or how things work. People, clinicians, patients need these data. There are \u2014 a lot of them are mandated by law, and if we don\u2019t have them up, people suffer.\u00a0<\/p>\n This isn\u2019t, again, like we\u2019re just punishing researchers or scientists. This is punishing people, and, again, at AcademyHealth, our mission is to promote the creation and use of data and evidence to improve health and health care for all. You can\u2019t do that without the data, and no one can do it if they don\u2019t trust the data. So much of this, again, is about trust, which is about transparency, which should be a nonpartisan issue. We advocated for this same kind of thing under the Biden administration when they tried to restrict Medicare data and how researchers could get and use it. And we were out in front saying: That\u2019s not OK. People need access to this data.<\/em> And that the same thing is true under the Trump administration. We want more people to have more access to the best and most trustworthy data, always.\u00a0<\/p>\n Rovner:<\/strong> Well, thank you for fighting the fight for good science and good policy. Aaron Carroll, thanks a lot.\u00a0<\/p>\n Carroll:<\/strong> Thank you.\u00a0<\/p>\n Rovner:<\/strong> OK. We\u2019re back. And now it\u2019s time for our extra-credit segment. That\u2019s where we each recognize the story we read this week we think you should read, too. Don\u2019t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. Shefali, why don\u2019t you go first this week?\u00a0<\/p>\n Luthra:<\/strong> Absolutely. My story is by Theresa Gaffney from Stat News. The headline is \u201cInside the American Medical Association\u2019s Sudden Strategy Shift in Washington<\/a>.\u201d I picked this because I knew Julie and I would both get a real kick. There\u2019s just a lot of fun in following the political trajectory of the AMA, which as we know began as this more conservative political organization, has undergone this transformation in more recent years, becoming more interested in causes, sometimes aligned with more of the political left, whether that is expanding access to health care, whether that is opposing abortion restrictions, and then had really gone quiet when we saw this big attack on a lot of medical institutions from the new administration. And this story looks at how that is starting to shift and the AMA is now trying to actually act in response to all of the things that have been happening to scientists and health care providers, and where that is coming from within the medical community and what it could mean.\u00a0<\/p>\n Rovner:<\/strong> It\u2019s a really interesting story. And Shefali\u2019s right. One of my hobbies is following the AMA\u2019s political trajectory. Alice.\u00a0<\/p>\n Ollstein:<\/strong> So I have a piece in The New York Times by some KFF stalwarts, and it\u2019s called \u201cWhy Young Americans Dread Turning 26: Health Insurance Chaos<\/a>.\u201d So, it sets up that if Congress doesn\u2019t renew the ACA [Affordable Care Act] subsidies that are expiring later this year, people are going to face an even worse cliff when they turn 26 and they have to start buying their own insurance. But the article talks about all of the ways that cliff is already worse now before that even happens, largely because there\u2019s just less regulation of plans, and so people are buying crappier plans that don\u2019t adequately cover them when they actually need them and get sick, and the process, because the navigators have been defunded, and there just isn\u2019t a lot of outreach and promotion going on under the Trump administration.\u00a0<\/p>\n People are very confused and overwhelmed by all of the options and are largely going without insurance. And I think what\u2019s important from the story is you may think: Oh, this doesn\u2019t affect me. I\u2019m not a 26-year-old. I have my insurance. I\u2019m fine.<\/em> As we learned in the past, this impacts everybody. If young and healthy people are driven out of these markets, that impacts everybody\u2019s costs and makes things more expensive for the rest of us. So definitely worth paying attention to.\u00a0<\/p>\n Rovner:<\/strong> Yeah, it\u2019s a really good piece. Sarah.\u00a0<\/p>\n Karlin-Smith:<\/strong> I took a look at a piece in The New York Times by Carolyn Kitchener, \u201cThis Ohio Farm Community Is a Mecca for the\u201d quote \u201c\u2018MAHA Mom.\u2019<\/a>\u201d And it\u2019s about what is essentially sort of a \u2014 the story kind of describes it as the idea of the 1960s, 1970s, like, hippie farm commune but kind of MAHA [\u201cMake America Healthy Again\u201d] style, and maybe a bit more luxurious. And it\u2019s essentially a look at how this community develops and operates and tries to live by some of the, quote-unquote, \u201cMAHA principles\u201d around how the foods you eat or grow. And it\u2019s kind of a fascinating look as to what they\u2019re trying to do and how they want to live their lives.\u00a0<\/p>\n Rovner:<\/strong> Yeah, it\u2019s the new age of the New Age. Fascinating. Well, my extra credit this week is from the \u201cWho Could Possibly Have Seen This Coming\u201d category. It\u2019s from ProPublica. It\u2019s called \u201cVeterans\u2019 Care at Risk Under Trump as Hundreds of Doctors and Nurses Reject Working at VA Hospitals<\/a>,\u201d by David Armstrong, Eric Umansky, and Vernal Coleman. And despite vows by Trump officials that they could cut tens of thousands of jobs at the department without harming clinical care, it turns out that the cuts are deterring clinical care workers from signing up to work at the VA [Department of Veterans Affairs] in the first place. It seems that 40% of doctors offered work at the VA in the first quarter of this year said no. That\u2019s quadruple the rate of rejection from just the year before. And between January and June, the VA lost twice as many nurses as it hired.\u00a0<\/p>\n While VA officials accused ProPublica of cherry-picking numbers, I will point out that separately this week, the VA\u2019s inspector general, in its annual report, found that every one of the VHA\u2019s [Veterans Health Administration\u2019s] 139 medical centers reported staff shortages, with those reporting, quote, \u201csevere shortages\u201d for specific jobs up 50% from the year before. So, that doesn\u2019t sound very much like cherry-picking.\u00a0<\/p>\n OK. That is this week\u2019s show. Thanks as always to our editor, Emmarie Huetteman, and our fill-in editor today, Stephanie Stapleton, and our producer-engineer, Francis Ying. If you enjoy the podcast, you can subscribe where you get your podcasts. We\u2019d appreciate it if you left us a review. That helps other people find us, too. Also, as always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org<\/a>. Or you can find me still on X, @jrovner<\/a>, or on Bluesky, @julierovner<\/a>. Where are you guys hanging these days? Shefali?\u00a0<\/p>\n Luthra:<\/strong> I\u2019m at Bluesky, @shefali<\/a>.\u00a0<\/p>\n Rovner:<\/strong> Alice.\u00a0<\/p>\n Ollstein:<\/strong> On Bluesky, @alicemiranda<\/a>, and still on X, @AliceOllstein<\/a>.\u00a0<\/p>\n Rovner:<\/strong> Sarah.\u00a0<\/p>\n Karlin-Smith:<\/strong> Bluesky<\/a>, X<\/a>, LinkedIn<\/a> \u2014 @SarahKarlin or @sarahkarlin-smith.\u00a0<\/p>\n Rovner:<\/strong> We\u2019re going to take a little bit of a summer break for the rest of the month. Next week we\u2019ll have a special episode on the 60th anniversary of Medicare and Medicaid, and the week after we\u2019ll be dark so our hardworking staff can have some time off. We\u2019ll be back in your feed with all the news on the Thursday after Labor Day. Until then, be healthy.\u00a0<\/p>\n \tFrancis Ying \tStephanie Stapleton To hear all our podcasts,\u00a0click here<\/a>.<\/em><\/p>\n
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