\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 In a highly unusual White House news conference this week, President Donald Trump \u2014 without evidence \u2014 boldly blamed the painkiller Tylenol and a string of childhood vaccines for causing a recent rise in autism. That came just days after the newly reconstituted Advisory Committee on Immunization Practices, now populated with vaccine skeptics and opponents, voted to change long-standing recommendations. <\/p>\n Podcast host Julie Rovner interviews Demetre Daskalakis, who until last month was the head of the Centers for Disease Control and Prevention\u2019s National Center for Immunization and Respiratory Diseases, about the reaction to these unprecedented actions.<\/p>\n Meanwhile, as the government approaches a likely shutdown, with Congress at a standoff over funding for the new fiscal year that starts Oct. 1, the Trump administration is ordering federal agencies not to just furlough workers but to fire them if their jobs do not align with the president\u2019s priorities.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, and Sandhya Raman of CQ Roll Call.<\/p>\n \t\t\t \tAnna Edney \t\t\t \t\t\t \t\t\t \t\t\t \tSandhya Raman \t\t\t \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read this week that they think you should read, too:<\/p>\n Julie Rovner:<\/strong> NBC News\u2019 \u201cRFK Jr. Has the Federal Vaccine Court in His Sights. Attacking It Could Threaten Vaccine Production in the U.S.<\/a>,\u201d by Liz Szabo.<\/p>\n Anna Edney:<\/strong> The Washington Post\u2019s \u201cDo State Abortion Laws Affect Women\u2019s Recruiting? That\u2019s Up to Athletes<\/a>,\u201d by Kevin B. Blackistone.<\/p>\n Sandhya Raman:<\/strong> ProPublica\u2019s \u201cPsychiatric Hospitals Turn Away Patients Who Need Urgent Care. The Facilities Face Few Consequences<\/a>,\u201d by Eli Cahan.<\/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: Public Health Further Politicized Under the Threat of More Firings<\/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, Sept. 25, at 10 a.m. As always, news happens fast, and things might\u2019ve changed by the time you hear this, so here we go.\u00a0<\/p>\n Today, we are joined via videoconference by Sandhya Raman of CQ Roll Call.\u00a0<\/p>\n Sandhya Raman: <\/strong>Good morning.\u00a0<\/p>\n Rovner: <\/strong>And Anna Edney of Bloomberg News.\u00a0<\/p>\n Anna Edney:<\/strong> Hey, everybody.\u00a0<\/p>\n Rovner:<\/strong> So we\u2019re going to do something a little different today. I got a chance to speak on Wednesday with Dr. Demetre Daskalakis, the former head of the Centers for Disease Control and Prevention\u2019s National Center for Immunization and Respiratory Diseases. I asked him to respond to the White House announcement on autism and last week\u2019s rather muddled meeting of the Advisory Committee on Immunization Practices. So we\u2019ll play that interview first, and then we\u2019ll come back for our panel discussion. Here\u2019s the interview.\u00a0<\/p>\n I am so pleased to welcome Dr. Demetre Daskalakis to the podcast. Until last month, Dr. Daskalakis was the head of the Centers for Disease Control and Prevention\u2019s National Center for Immunization and Respiratory Diseases in Atlanta. He quit, along with three other senior career CDC officials, after Health and Human Services Secretary Robert F. Kennedy Jr. fired their boss, Susan Monarez, for refusing to approve in advance changes to the childhood vaccine schedule. Dr. Daskalakis, thank you so much for joining us.\u00a0<\/p>\n Demetre Daskalakis:<\/strong> Thank you so much for having me.\u00a0<\/p>\n Rovner: <\/strong>So, for those who haven\u2019t been plugged into the public health doings over the past month, remind us what exactly your job was at CDC and why you felt you needed to resign following the dismissal of Dr. Monarez.\u00a0<\/p>\n Daskalakis:<\/strong> So CDC is made up of centers, and so I ran one of the centers, called the National Center for Immunization and Respiratory Diseases. CDC\u2019s not known for its pithy titles. So what that is is the center that is responsible for a lot of what you think about when you think about vaccines and vaccine-preventable diseases. That includes the resources that go out to local jurisdictions.\u00a0<\/p>\n Rovner:<\/strong> And when Dr. Monarez was fired, what did that signal to you?\u00a0<\/p>\n Daskalakis:<\/strong> Yeah. I think the last eight months had been hard. I think that we had other things that happened before Dr. Monarez\u2019s resignation. I think we saw the Advisory Committee on Immunization Practices be zombified into something that was not science, we saw recommendations around covid vaccine come out on Twitter rather than through any scientific process. So those were the things that were on the way. But as ACIP was made zombified \u2014 and what I mean by that was CDC has nothing to do with it, these folks who have been installed, who are frankly anti-vaxxers for the most part, they\u2019re the ones that are driving the agenda, the membership, all of it \u2014 so it wasn\u2019t really doing anything of scientific consequence anymore.\u00a0<\/p>\n But when Dr. Monarez was there, we had a scientific leader whose job it was to really be a diplomat to Secretary Kennedy and Health and Human Services, but also to really make sure that the science is what leads the policy. And so, when I saw that organization, the Advisory Committee on Immunization Practices, become some strange ideology machine, and then also saw that I wouldn\u2019t have a scientific leader at CDC who would be able to defend the science, the game was over for me, because I couldn\u2019t see any way that we would be leading with science. Instead, I could only see ideology. I read RFK\u2019s books, and I know what\u2019s coming, which is the dismantling of vaccines for the United States.\u00a0<\/p>\n Rovner:<\/strong> So can you talk a little bit about how the career scientists and doctors at the CDC normally interact with the political appointees at the agency and the political folks at the top of HHS, and how that was so different in this administration?\u00a0<\/p>\n Daskalakis:<\/strong> Yeah. I worked with \u2014 now that would be \u2014 four CDC directors and two secretaries of health. And so, the way that we normally interacted as career scientists was that we would produce materials; if there were questions, we would create memos and other materials to be able to present to our politicals around those issues. We would be responsive to any issues that they wanted to talk about. So for instance, if somebody said, \u201cI want to talk about the birth dose of hepatitis B vaccine,\u201d we would create briefing materials and opportunities for the politicals, both at HHS and CDC, to be able to have time with career scientists to really learn about the story. And that\u2019s not what\u2019s happened in this newest regime.\u00a0<\/p>\n Now, let me be clear, Dr. Monarez did ask for briefings, and she did get them, so that is not the person I\u2019m talking about. Above that, the secretary had never been briefed by anyone from the National Center of Immunization and Respiratory Diseases while I was there, so he never heard about measles, never heard about bird flu, didn\u2019t hear about covid, though he made decisions about covid, didn\u2019t hear about any of the things that we normally brief about. Didn\u2019t hear anything about seasonal flu, RSV, and covid. We had been briefing folks on a monthly basis, because this was the epidemic that we have every year. So to say that there\u2019s a glitch in the matrix is an understatement. This is an extremely atypical environment, where the head of people\u2019s health for America doesn\u2019t talk to people who know the science.\u00a0<\/p>\n Rovner:<\/strong> So I want to ask you about the ACIP meeting, but since then, we\u2019ve had the White House announcement on the causes of autism and a potential new treatment for it. Can you give us your take on that entire event, both the press conference announcing it and the documentation, such as it was, that was provided afterwards? I have to say, I watched all of the covid press conferences with President [Donald] Trump in 2020, and this made even my eyes cross a little bit.\u00a0<\/p>\n Daskalakis:<\/strong> So let\u2019s rehash what happened with the acetaminophen and autism issue. So they took one study and elevated that study and did this Orwellian doublespeak around it, where they said that it showed that there was a link, quote, \u201clink,\u201d between acetaminophen and autism. The study didn\u2019t show that; the study showed that there was an association, and so an association does not mean cause. And so, my example that I use is when you are meeting people who have lung cancer and you ask them if they have matches in their pocket, they very often do. It\u2019s not the matches that cause the lung cancer, it\u2019s the tobacco; it\u2019s the smoking.\u00a0<\/p>\n So very similarly, there\u2019s an association with acetaminophen, that\u2019s the matchbook. Autism is a spectrum and it\u2019s not a disorder or a disability for some people, it\u2019s just part of their normal neurocognitive story, but it\u2019s like the equivalent in my analogy of lung cancer. And so, there\u2019s something in between there that we don\u2019t really see, and that could be genetics and other environmental exposures. So they put all of their eggs in one basket that should make nobody feel comfortable that they have the answer for autism because they found an association that people kind of already knew about and made an announcement, mainly because the secretary promised a September announcement. And so, science can\u2019t be rushed, this was a rush job, and I don\u2019t like my policy fast and loose, and that\u2019s what you\u2019re seeing, fast-and-loose policy.\u00a0<\/p>\n They also talked about leucovorin, which is a drug that I think many people use or know about, usually used in cancer chemotherapies that involve some kind of antifolate, so it is a rescue. So if people are getting a medicine that makes their folate low, the folinic acid is kind of like super folate that really replaces the deficiency. And so, they made big statements about this being a potential treatment for autism, but then subsequently in the writing that they put out, they were very focused on a very specific circumstance of people who have some sort of cerebral folate deficiency.\u00a0<\/p>\n So that\u2019s the big picture. They announced a bunch of stuff, and it didn\u2019t go through any process, we don\u2019t know the quality of the data, the entirety of the data was not reviewed in any systematic way, and then announcements were made without any process of actually demonstrating what work was done to get there. We\u2019ve all been in math class \u2014 the answer to an equation isn\u2019t just 25, you have to show the work to get there, and so it\u2019s like they just said, \u201cThe answer is 25.\u201d\u00a0<\/p>\n Rovner:<\/strong> And in this case, this could cause all kinds of actual consequences for people, particularly for pregnant women who have pain or fever.\u00a0<\/p>\n Daskalakis:<\/strong> Which is associated with poor outcome for the pregnant woman, as well as for the fetus or the child after they\u2019re born. So there\u2019s that reality, that it\u2019s not inconsequential, and then you have someone saying, \u201cAvoid it, don\u2019t do it, at all costs, don\u2019t do it,\u201d and then what the FDA puts out that says, \u201cShould use judiciously.\u201d\u00a0<\/p>\n So I\u2019m going to answer the second part of your question, what did I think of the press conference? I\u2019m going to be honest, I don\u2019t blame the president for anything that he said. I blame RFK Jr. and the other people on that stage. Their job is to make sure that their principal knows what they\u2019re talking about, and so they have failed their job because what happened was we had a principal who was talking about things that were, I think, beyond his scope. And then also, we thought we were just talking acetaminophen, and then all of a sudden, in a non sequitur, we heard about the vaccine schedule for kids with some very strange places that we visited, including the notion that hepatitis B is a sexually transmitted infection, and rather than the birth dose that prevents vertical transmission, mother to child, as well as household transmission, we should wait until age 12, which will manifest itself as liver cancer, liver transplant, and cirrhosis for a lot of children, especially those who maybe are at higher risk because of their social circumstance.\u00a0<\/p>\n So that\u2019s what I thought. I was, like, poor guy, he\u2019s being briefed by people who don\u2019t know anything, and so maybe they should take care of him.\u00a0<\/p>\n Rovner:<\/strong> All right. Well, I want to also ask you about your reaction to the Advisory Committee on Immunization Practices\u2019 meeting last week, where the committee voted to change recommendations for both the measles-mumps-rubella and chickenpox vaccines and the covid vaccine. At the end, it felt like everyone was confused, including the members of the committee. What stood out to you about that meeting?\u00a0<\/p>\n Daskalakis:<\/strong> I felt like an oracle, because in my resignation letter, I told you this was going to happen, and it\u2019s exactly what I thought. And so, what happened was they did no process and just did stuff. And so, let me just give you what normal is, because that\u2019s really important, and then I\u2019ll walk you through each one and tell you why they were abnormal.\u00a0<\/p>\n So generally speaking, something happens, and there\u2019s a question related to vaccine policy, there\u2019s a new vaccine, there\u2019s new data around safety, something happens. And that\u2019s elevated either by ACIP members, CDC, or the working groups that live within the ACIP that do all the work on the side before the meeting. So that question comes to the work group, and the CDC folks work really hard and poll all the data in the world about the question. They in effect work to do what is, for lack of a better word, a meta-analysis, a study of studies, and they go through a process called GRADE, where they look at all the data and say, \u201cThis is good data, this is OK data, there\u2019s bias,\u201d really to contextualize all of the data. They then put that onto a clear table that tells you what\u2019s happening. Now, they did that for a couple of things.\u00a0<\/p>\n The next thing is that there are long discussions. They\u2019re long because they\u2019re complicated, and they go through something that\u2019s called an Evidence to Recommendations Framework. Now, that\u2019s jargony, but what it means is that there\u2019s this process where they ask, \u201cIs this an important public health question? What are the implications for equity? Do the risks and the benefits \u2026 what is the equation there? Is there more harm or more good? Is this something that is going to improve the health of people? And is this cost-effective?\u201d There\u2019s a lot of domains, but they go through it really methodically because they want to get all of the domains that are needed for decisions. Once they do that, they produce a recommendation. That is taken to ACIP and it\u2019s discussed. And then they vote.\u00a0<\/p>\n So what happened was that they didn\u2019t do it, because RFK Jr., I know this from the inside, said, \u201cI want on the agenda hepatitis B birth dose and MMRV.\u201d What you saw there was politicization of the committee, ideology dominating, conspiracy theories being elevated to the level of data, and then decisions being made based on that. So if the data\u2019s no good, if the foundation of the house is rotten, that house shouldn\u2019t be standing, so that\u2019s what we saw.\u00a0<\/p>\n And I want to go back to that hepatitis B thing. So they may go and do something that\u2019s more process. But one of the reasons that I left was that CDC is not allowed to dictate who is on the work group anymore. So if they stack the work group with people that are anti-vax people, who are naysayers, who are not basing conversations on data, but on the anecdote or unvetted studies, it won\u2019t matter, because that process will also be rotten if there\u2019s not a diversity of opinion and scientific expertise on the work group. So that\u2019s what happened at ACIP.\u00a0<\/p>\n Rovner:<\/strong> So following some pretty unusual public health actions just in the week since you\u2019ve resigned, what\u2019s your biggest concern about public health going forward?\u00a0<\/p>\n Daskalakis:<\/strong> So I think that there\u2019s a couple of things that happened that I didn\u2019t talk about yet that are very concerning. I\u2019ll tell you that the book that I picked up to start reading when I finished my time at CDC was [George] Orwell\u2019s \u201c1984,\u201d and the reason that I picked it up was because really soon after I left, I have nothing to do with stopping it or starting it, but just saying temporally speaking, CDC changed their webpage, that was the \u201cAbout CDC\u201d webpage, into, in effect, what is a manifesto as opposed to a description of an agency that is supposed to be balanced and scientific. So it really, in effect, speaks about compliance to ideology as the principal motivator for what CDC is and will do. There were other things wrong with that document, but we don\u2019t have the time to go into that one.\u00a0<\/p>\n And so, I feel like \u2014 first chapter of \u201c1984\u201d that talks about ministries that are using doublespeak to be able to say what they do, I think we are now living it. And so that\u2019s my fear, that everything that\u2019s going to be coming out of CDC is going to be colored by ideology, or that data is going to be released from CDC without scientists able to explain it so that it can be used for other means or that will allow folks who are more ideologically motivated to be able to make conclusions based on inadequate analyses. So that\u2019s what I\u2019m worried about.\u00a0<\/p>\n Rovner:<\/strong> So how do we proceed from here, both public health professionals and Americans who are just looking for health guidance?\u00a0<\/p>\n Daskalakis:<\/strong> Yeah. I think we\u2019re at a dark time, but I also think that there\u2019s going to be light in the darkness, it just may not be today. So the first thing is trauma-informed care, your feelings are valid: This is not normal, something not good is going on, and it\u2019s hard to figure out who to trust. And so, my recommendation to people is, and I know that this is a hard one because not everybody has access to care, is if you do have access to care, you really need to lean into your doctors \u2014 doctors, nurses, nurse practitioners, physician assistants, pharmacists \u2014 taken widely and broadly, health care professionals. So even if you don\u2019t have a primary care doctor, you have a pharmacist, and so go to that pharmacist and talk to them. It\u2019s not as good as having one word for the land, as had been standard for CDC, but in this environment, I think you need to go with people that you trust.\u00a0<\/p>\n I\u2019ll also say one of the things that should be a red flag for everybody out there is \u2014 I\u2019m a doctor, I take care of patients \u2014 and I do actually believe that the relationship between a clinician, a health care provider, whoever they are, and their patient is very sacred. And so, whenever you hear anyone in the world trying to destabilize that relationship, saying that, \u201cDoctors don\u2019t know what they\u2019re talking about, don\u2019t listen to the pediatricians,\u201d that is not someone you should be taking medical advice from, because they\u2019re actually at their core trying to get you to not listen to the people who are your best allies and advocates in the health space.\u00a0<\/p>\n Rovner:<\/strong> Dr. Demetre Daskalakis, thank you so much for joining us.\u00a0<\/p>\n Daskalakis:<\/strong> My pleasure.\u00a0<\/p>\n Rovner:<\/strong> OK. We are back with our panel, and I want to ask both of you about your reactions to the ACIP meeting and the autism announcement. But let\u2019s turn first to the breaking news about the potential government shutdown that\u2019s less than a week away. Last night, the Office of Management and Budget, which traditionally sets the rules for who stays on the job in a shutdown and who doesn\u2019t, issued a memo of the sort I\u2019ve never seen before. Rather than directing agencies to prioritize which activities are needed to preserve, quote, \u201clife and property,\u201d and thus who\u2019s required to work without pay for the duration and who gets furloughed until funding is restored, this memo basically says if the activity doesn\u2019t have another source of funding and it\u2019s not within the administration\u2019s priorities, agencies should prepare to fire not furlough workers. This is obviously a big ramping up of this shutdown. I know this just happened, but what kind of reaction are you guys seeing?\u00a0<\/p>\n Raman:<\/strong> This to me just seems very, very highly unprecedented. We\u2019ve had shutdowns, we\u2019ve had near shutdowns, many of them in the past, and it has not escalated to this at any time that I\u2019ve seen.\u00a0<\/p>\n Rovner:<\/strong> Forty years, I\u2019ve been doing this 40 years, I have never seen anything quite like this. We\u2019ve had rifts and we have shutdowns, but we\u2019ve never had them combined.\u00a0<\/p>\n Raman:<\/strong> Yeah. And so, I think it\u2019ll be really interesting how the next few days play out. The Senate is in for a couple of days before we would hit the shutdown, if there\u2019s anything they can come together on. It is really difficult when you escalate to this level when they\u2019ve been trying to negotiate so far. It\u2019s hard. The House isn\u2019t supposed to come back until Oct. 6.\u00a0<\/p>\n Rovner:<\/strong> Oops.\u00a0<\/p>\n Raman:<\/strong> So if the Senate changes anything or wants to change anything compared to what the House had passed, they\u2019re stuck. Either the House has to come back in or they shut down until they come to a compromise on something. So I think from everyone that I\u2019ve been talking with over the past few weeks, it seems like we\u2019re really headed to a shutdown. It\u2019s possible they get a few Democrats to fold and go with what\u2019s there, but I think this last move, and then also President Trump saying that he was going to meet with Democrats earlier this week, and then saying, \u201cNo, I don\u2019t want to,\u201d they\u2019ve been saying there\u2019s not good-faith efforts to negotiate, so they\u2019re in a pickle at this point.\u00a0<\/p>\n Rovner:<\/strong> Let\u2019s get real: This is about not whether we\u2019re going to have a shutdown, but who gets blamed for the shutdown. Traditionally, it\u2019s been the Democrats, and the Republicans keep saying this, who say, \u201cLook, we\u2019re just having a clean extension of funding, we\u2019re just going to basically roll out the clock, kick the can down the road, so we can continue to negotiate over funding for next year. Why won\u2019t Democrats go along with that?\u201d And Democrats are responding, \u201cWell, we went along with it in March, and look at what\u2019s happened in the interim, and our base didn\u2019t like that, so we think we should fight this time.\u201d And then, you had the president agreeing to meet with Democratic leaders, but then the Republican leaders in Congress telling the president, \u201cNo, don\u2019t meet with them.\u201d It\u2019s all strategy at this point. You\u2019re nodding, Anna.\u00a0<\/p>\n Edney:<\/strong> Yeah, yeah. I was just thinking, I think a lot of times, talking about this administration, people are saying, \u201cThere\u2019s no plan.\u201d But I do see the 3D game of chess at this point, and that letter very clearly mentioned if the Democrats shut down the government, that was lobbying that into the court of the Democrats saying, \u201cThis is your fault if it happens.\u201d And I do think that the Democrats were burned last time in the sense that it seemed like they might allow a shutdown and then backtracked pretty quickly and the base just didn\u2019t like it, and I think we\u2019re seeing a lot from the, I don\u2019t know what exactly to call them, thought leaders on the more liberal side saying, \u201cJust do it, let it rip.\u201d If it shuts down, they\u2019re going to try to find a way to blame it on the Republicans.\u00a0<\/p>\n So I think it\u2019s a game of chicken at this point, but there are real consequences. These are people\u2019s jobs who aren\u2019t necessarily going to all want to come back to the government if things suddenly, it works out. These are activities that we rely on for everyday life that will be hurt.\u00a0<\/p>\n Rovner:<\/strong> Yeah. We\u2019ve already seen the administration trying to hire back some of the people that they laid off earlier this year because it turns out they were needed to do important jobs. I saw House Democratic Whip Katherine Clark this morning on CNN describing this letter as, \u201cThe beatings will continue until morale improves.\u201d This really is playing with the lives of government workers who basically have come to these jobs because either they believe in them or because they usually have been stable jobs. They might, may be able to make more in the private sector, but government jobs tended to be secure, and boy, that\u2019s not what\u2019s happening right now. They don\u2019t seem to be guilty parties in all of this, and yet they\u2019re the ones who are being used as pawns.\u00a0<\/p>\n Raman:<\/strong> I think one thing that I have been thinking about in reading that OMB memo is that it says that the rifts are going to affect people that aren\u2019t also really aligned with carrying out President Trump\u2019s priorities and mission. What does that entail? Within HHS, what falls in that bucket? We have some ideas based on previous executive orders and things that he\u2019s made some remarks on, but there\u2019s plenty that we don\u2019t know.\u00a0<\/p>\n Rovner:<\/strong> They could theoretically shut down the entire NIH [National Institutes of Health] or the entire CDC, which I think Secretary Kennedy might not mind.\u00a0<\/p>\n Raman:<\/strong> How that would go about, I don\u2019t know. I think that we\u2019ll all be really looking to see what kind of contingency documents they put out. They usually put those out before, when we\u2019re in this waiting period about a shutdown, and it would definitely be very different than the ones that we\u2019ve had in the past for a department down or agencies. What that\u2019ll say, I just don\u2019t know.\u00a0<\/p>\n Rovner:<\/strong> Yeah, that\u2019s right. To be clear, the OMB memo is to the agencies saying, \u201cSend us your contingency plans.\u201d Normally, that would\u2019ve happened by now, it usually comes out a couple of weeks ahead of a potential shutdown and everything. We\u2019re playing brinksmanship here. Anna, you wanted to say something before we move on?\u00a0<\/p>\n Edney:<\/strong> Oh, I don\u2019t remember what that was. But just on the last point, I think the agencies, they usually have that contingency plan at the ready, but they can\u2019t \u2014 I don\u2019t think that this would\u2019ve been the one that they had drawn up. I think they have to tear that up and start over again. And like you mentioned, the CDC, the NIH, you can, through this mandate, possibly see how you could just wipe out an entire agency.\u00a0<\/p>\n I think on the FDA side, I just wanted to add, there are some user fees on that side that may keep the drug review side afloat, anything where they\u2019re looking at approvals and things like that is funded, at least for a while. If this devolves for months and months, that\u2019s not the case. But there are a lot of other parts where they\u2019re doing inspections and keeping the drug supply and the food supply safe that could be impacted.\u00a0<\/p>\n Rovner:<\/strong> Yeah. And we should point out that this does not affect things that have mandatory funding, like Medicare and Medicaid and Social Security, and, as you say, user fee funding, like the review activities at FDA.\u00a0<\/p>\n Well, while we\u2019re on the subject of things that are unprecedented, let\u2019s turn back to that ACIP meeting and the White House autism announcement. One of the things that ties them together is the fact that both leave the public with more confusion than clarity over what to do about vaccines and Tylenol and, once again, leaves Americans wondering who or what they can trust. What\u2019s the biggest takeaway from each of you? Anna, why don\u2019t you go first, about both the autism announcement and the ACIP meeting?\u00a0<\/p>\n Edney:<\/strong> Yeah, I think there just is a ton of confusion. I can\u2019t count how many times people are like, \u201cRemind me again, who can get a covid shot and who can\u2019t? And what are we doing with RSV now?\u201d There was a lot of talk before the ACIP meeting about hepatitis B and that even the ACIP members were confused.\u00a0<\/p>\n So I think that one thing that I think this makes crystal clear is that when I know that this administration and many of the people at the top in health care don\u2019t appreciate the medical establishment and they don\u2019t feel that it is operated in a way that is open to modernization. But you can\u2019t just break it all and then start over, these are guidelines and things that people rely on, and it has to be, I think, a much more thoughtful process than what we\u2019re seeing right now. You have a lot of people who are pregnant or have young children who are freaking out, because they\u2019re like, well, I took Tylenol for three days because I had a fever<\/em>, and I think that it creates more fear-mongering, because the guidance really isn\u2019t that different, what the FDA actually said isn\u2019t that different from what was already out there, you\u2019re just really scaring people now.\u00a0<\/p>\n Raman:<\/strong> So I think I would say something along similar lines, the mixed messaging and the confusion of that both events is pretty stark. So I think the thing that struck me with ACIP is just the second day, we have a re-vote on something that you voted on the first day, and if you watch just one, you would assume that what happened there is done, and then going back, it\u2019s just very unusual and makes it even more confusing.\u00a0<\/p>\n And I think the second thing that struck me was that we had this whole shake-up of ACIP in general to be like, we don\u2019t want conflicts of interest, we want people that are able to vote on everything<\/em>. And then, here, when we have the votes, we have someone on ACIP not be able to vote on something because they\u2019re disclosing a conflict of interest. So it struck me that we went through this whole process that was to eliminate that, and then here we are back to that, which people have been saying for a long time, it\u2019s difficult to find anyone in this space that doesn\u2019t have other things that are connected to vaccines.\u00a0<\/p>\n For the autism announcement, the thing that was really interesting to me was that this was done on the White House level rather than just HHS is having an event, it\u2019s with some agency folks there, and then them putting out information, whatever they\u2019re talking about. This was predominantly Trump speaking in a much more aggressive, this is what is what<\/em> tone, compared to the agency folks who mostly were downplaying a little bit of what he\u2019s saying. He repeatedly said, over and over again, \u201cDon\u2019t take Tylenol, don\u2019t take Tylenol, no Tylenol for pregnant women.\u201d And then, even when you look at the FDA release that came out a little bit after really downplayed it, it said that there was an association, but there wasn\u2019t a causal relationship that they had found between acetaminophen and autism in children. It goes back to that mixed messaging, where even if the majority of scientific professionals are saying that this goes against what a lot of the research that they\u2019ve been doing, you\u2019re going to be confused.\u00a0<\/p>\n Rovner:<\/strong> Yes. Another thing that seems to tie together both the ACIP meeting and the autism announcement is to basically put all medical responsibility on individuals, which many consider to be blaming the victim and increasing stigma by basically saying, \u201cWhatever you decide, whatever happens is your fault.\u201d I feel like we\u2019ve careened from maybe too much reliance on experts to too little. That was certainly the president\u2019s message at that press conference, it\u2019s like, \u201cWell, this is just common sense.\u201d It\u2019s like, I thought we were supposed to be relying on gold-standard science.\u00a0<\/p>\n Edney:<\/strong> That was a very stark point, where it was like, what do you mean you feel this? It\u2019s like, I think you\u2019re supposed to know that through research and scientific data.\u00a0<\/p>\n But I wanted to go back, you mentioned blaming the patient, I think specifically on the autism side, this is something we see with expecting mothers a lot, because I interviewed professor Emily Oster about the autism announcement, and she dives very deep into data on a lot of things parents are concerned about, and she was telling me about \u201crefrigerator moms\u201d in the 1950s, and I didn\u2019t realize this, but apparently women were blamed for different mental illnesses if they were too cold, not freezing-cold, but emotionally not available for their children enough, and so they must be causing their schizophrenia and there was a big link to that. And that continues, they\u2019re telling the women, \u201cIf you have a fever or enough pain that you would consider popping a Tylenol, then that\u2019s on you, just either deal with it or be responsible for the fate of your child.\u201d\u00a0<\/p>\n I think that\u2019s what the medical establishment has been trying to avoid, is giving women options, and there are a lot of reasons you need to take care of that fever or you need to take care of that pain, and some of them have to do with the health of the child, the baby that they\u2019re carrying, so \u2026\u00a0<\/p>\n Rovner:<\/strong> Right, fever is also a potential cause of problems.\u00a0<\/p>\n Edney:<\/strong> Exactly.\u00a0<\/p>\n Rovner:<\/strong> All right. Well, in a health-related story that doesn\u2019t seem like a health-related story, the Trump administration late last week announced a new $100,000 application fee for H-1B visas. Now, those are usually associated with tech workers, but it turns out that an awful lot of medical professionals, particularly doctors from other countries, use them to come here to fill residency positions that American medical school graduates don\u2019t fill \u2014 often low-paying primary care slots in rural areas. And, according to reporting from your colleagues at Bloomberg<\/a>, it seems that medical personnel might be exempt from this new fee, but it\u2019s not clear how many hoops hospitals might have to jump through to get those exemptions. At best, it doesn\u2019t feel like this was very thoroughly thought through, particularly for an administration that says that rural health is a priority.\u00a0<\/p>\n Edney:<\/strong> Right, yes. I think they may have been a little surprised by the amount of pushback from the hospital and doctor associations, saying, \u201cWe really rely on these to get doctors to rural areas.\u201d And they almost immediately tried to massage that and say, \u201cOh, well, they could be included in exemptions.\u201d But that\u2019s all we know, \u201ccan be included\u201d is not extremely reassuring. It\u2019s not saying, \u201cWe\u2019re giving you a blanket waiver for doctors,\u201d or anything like that, and nobody knows, like you said, the hoops they might have to jump through. I would say it\u2019s a start, and maybe they\u2019re thinking about it, more aware of it, at this point.\u00a0<\/p>\n Rovner:<\/strong> Sandhya, is there any pushback from Congress? Can the president even do this?\u00a0<\/p>\n Raman:<\/strong> I think the pushback I\u2019ve seen has been broader, not just on how this is going to affect hospitals that clearly cannot afford this in the same way that maybe some of the Big Tech companies may be able to. But I will be really interested when they come back just how lawmakers might look at this, because hospitals are the biggest employer in so many congressional districts, that if they\u2019re pushing back, I could see people that normally don\u2019t push back on this kind of thing saying, \u201cIf the biggest employer in my district is going to tank because of this,\u201d it rises up as an issue for them.\u00a0<\/p>\n Rovner:<\/strong> On the other hand, we haven\u2019t seen a lot of pushback from Congress for things that we expected to see pushback on, so I guess we\u2019ll have to watch that space.\u00a0<\/p>\n Raman:<\/strong> Yeah.\u00a0<\/p>\n Rovner:<\/strong> Well, finally this week, there\u2019s good news and bad news on drug prices, which President Trump has vowed to reduce by, and I looked this up to get the quote correct, 1,400% to 1,500%. He said it many other ways, by the way. The idea of his, quote, \u201cmost-favored-nation\u201d executive order that he issued last spring is to get drugmakers to lower U.S. prices to those charged in other countries that have price controls that we don\u2019t have. Well, Trump is getting half of what he wanted, according to Axios<\/a>. Several large drugmakers say they\u2019re going to equalize what they charge here and overseas, but not by lowering prices for Americans, rather by raising them for Europeans and others. On the other hand, there\u2019s still a few more days until the Sept. 29 deadline for them to do this. Anna, are you hearing anything new on this?\u00a0<\/p>\n Edney:<\/strong> I haven\u2019t heard anything new. I think we just saw, like you mentioned, what Bristol Myers Squibb did, which was a newer schizophrenia drug they raised, they said they were going to introduce that in the U.K. [United Kingdom] at the same price in the U.S., extremely convenient for the pharmaceutical companies to be able to have this reason to raise prices elsewhere. But then, of course, they can find reasons not to bring them down so far in the U.S., and we\u2019ve seen \u2014 the only other company I can think of was Eli Lilly did this earlier this summer, saying they would do the same for their drug Mounjaro, and there was maybe some hoarding that started because people in Europe don\u2019t want to pay the higher price.\u00a0<\/p>\n Rovner:<\/strong> Mounjaro being a diabetes drug that is also the weight loss drug.\u00a0<\/p>\n Edney:<\/strong> Right, right, yeah, so the weight loss drugs have seen a lot of ups and downs. But you\u2019re right, there\u2019s only a few days left, and it\u2019s interesting that it hasn\u2019t leaked \u2026 any kind of plan that the pharmaceutical companies are talking about or anything like that. Sometimes, I feel like because this administration is operating more by telling people through letters and demanding it at the podium rather than doing actual regulations \u2014 remember, the most-favored-nation policy did not work out well after challenged in court the first administration. So I think they\u2019re often happy to get half of what they asked for in a way. But this could be tough, because it lets Trump say, \u201cWe\u2019re no longer carrying all the water,\u201d but it doesn\u2019t let him say, \u201cWe decreased prices for the American people.\u201d So we\u2019ll have to see \u2026\u00a0<\/p>\n Rovner:<\/strong> By 1,400% to 1,500%.\u00a0<\/p>\n Edney:<\/strong> Right, right, get those economists to figure that out. But we\u2019ll just have to see what\u2019s going on even \u2026 so much. The shutdown may take all his fire.\u00a0<\/p>\n Rovner:<\/strong> Yeah. This is one of those issues that is bipartisan, that it is popular on Capitol Hill, and that lawmakers keep saying they\u2019re going to do something about, but so far, we\u2019re not seeing it, are we?\u00a0<\/p>\n Raman:<\/strong> I think that there\u2019s so much that they have on their plate right now and just so much that they have been at odds with each other right now, it\u2019s something that would\u2019ve gotten more attention in normal times, has just gotten really delayed at this point.\u00a0<\/p>\n Rovner:<\/strong> These are definitely not normal times.\u00a0<\/p>\n Raman:<\/strong> Yep.\u00a0<\/p>\n Rovner:<\/strong> All right. Well, that is the news for this week. Now, it\u2019s time for our extra-credit segment. That\u2019s where we each recognize a 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. Anna, why don\u2019t you go first this week?\u00a0<\/p>\n Edney:<\/strong> Sure. So mine is in The Washington Post, and it\u2019s: \u201cDo State Abortion Laws Affect Women\u2019s Recruiting? That\u2019s Up to Athletes<\/a>.\u201d It was a really interesting look at basically how women athletes, specifically in basketball, and they discuss others lower down, are choosing college based on abortion laws \u2014 the states where they have less restrictive abortion laws, or more abortion rights, I guess I should say \u2014 then they\u2019re tending to go there. And then, you have the schools more in the South, where they\u2019re more restrictive, where they\u2019re choosing not to go there for the four years of their college life. And it was something that I think was just a really interesting look at a topic that has been on everyone\u2019s mind, but with so much going on, not exactly focusing on it. And it talks about other trends in college admissions and things too. So something to think about.\u00a0<\/p>\n Rovner:<\/strong> Yeah. I know we\u2019ve talked a lot about health workers avoiding states with abortion restrictions. This is the first time I\u2019ve seen this link to younger women and sports and college, and we\u2019ll see whether some of the states react to that. Sandhya?\u00a0<\/p>\n Raman:<\/strong> My extra credit is called \u201cPsychiatric Hospitals [Turn Away Patients Who Need Urgent Care. The Facilities Face Few Consequences<\/a>],\u201d and it\u2019s in ProPublica by Eli Cahan. And I think what drew me to this is EMTALA [the Emergency Medical Treatment and Labor Act] has been one of those things where we have<\/em> been thinking about it a lot in terms of abortion, when we\u2019ve seen it in the news in the last few years, it\u2019s been very abortion-focused. But this story looks at a psychiatric hospital in Colorado that got taken to task for not providing stabilizing care to patients at risk for suicide, and CMS [the Centers for Medicare & Medicaid Services] didn\u2019t penalize them in reducing funding or imposing any penalties. It\u2019s part of a broader thing, where over 90 psychiatric hospitals have violated EMTALA in the past 15 years. I don\u2019t want to give away the whole thing of the story, but it goes more into this.\u00a0<\/p>\n Rovner:<\/strong> Yeah, it\u2019s a really good story. All right. My extra credit this week is from NBC News by my friend and former colleague Liz Szabo, and it\u2019s called \u201cRFK Jr. Has the Federal Vaccine Court in His Sights. Attacking It Could Threaten Vaccine Production in the U.S.<\/a>\u201d It\u2019s a really good roundup about what\u2019s likely to be the HHS secretary\u2019s next target: the program that compensates the very small number of Americans who are injured or killed by vaccine side effects. There are risks to all vaccines, although they are very much outweighed by the benefits, and this program was created by Congress during the Reagan administration to compensate those who have suffered from those rare adverse reactions.\u00a0<\/p>\n The program was created to keep vaccine manufacturing alive in the United States because product liability suits were threatening to shut it down entirely, while the program also makes it easier for those who are injured to receive compensation. The program is far from perfect and it could use some revisions, which Congress has tried and failed to do over the last couple of decades. But it seems clear that that\u2019s not what Secretary Kennedy has in mind. It\u2019s a great preview of what the next likely battle is going to be in the vaccine wars.\u00a0<\/p>\n OK, that is this week\u2019s show. Thanks this week to our editor, Stephanie Stapleton, and our producer-engineer, Francis Ying. If you enjoy the podcast, you can subscribe wherever 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, or you can find me on X, @jrovner<\/a>, or on Bluesky, @julierovner<\/a>. Where are you folks these days? Sandhya?\u00a0<\/p>\n Raman:<\/strong> At X<\/a> and on Bluesky<\/a>: @SandhyaWrites.\u00a0<\/p>\n Rovner:<\/strong> Anna?\u00a0<\/p>\n Edney:<\/strong> Same places, @annaedney<\/a> or @annaedney<\/a>.\u00a0<\/p>\n Rovner:<\/strong> We will be back in your feed next week. Until then, be healthy.\u00a0<\/p>\n \tFrancis Ying \tStephanie Stapleton To hear all our podcasts,\u00a0click here<\/a>.<\/em><\/p>\n And subscribe to KFF Health News\u2019 \u201cWhat the Health?\u201d on\u00a0Spotify<\/a>,\u00a0Apple Podcasts<\/a>,\u00a0Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n
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