Category Archives: General Health

RFK Jr. Ousts Entire CDC Vaccine Advisory Committee

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AP News 6/09/25: RFK Jr. ousts entire CDC vaccine advisory committee

An excerpt:

Health Secretary Robert F. Kennedy Jr. on Monday removed every member of a scientific committee that advises the Centers for Disease Control and Prevention on how to use vaccines and pledged to replace them with his own picks.

Major physicians and public health groups criticized the move to oust all 17 members of the Advisory Committee on Immunization Practices… Kennedy wrote in a Wall Street Journal opinion piece. “A clean sweep is needed to re-establish public confidence in vaccine science…”

Kennedy is going against what he told lawmakers and the public…Kennedy’s move, coupled with declining vaccination rates across the country, will help drive an increase in vaccine-preventable diseases…

Republican Sen. Bill Cassidy of Louisiana, a doctor who had expressed reservations about Kennedy’s nomination but voted to install him as the nation’s health secretary nonetheless, said he had spoken with Kennedy moments after the announcement.

“Of course, now the fear is that the ACIP will be filled up with people who know nothing about vaccines except suspicion,” Cassidy said in a social media post. “I’ve just spoken with Secretary Kennedy, and I’ll continue to talk with him to ensure this is not the case.”

RFK Jr alleges ACIP committee members are laden with conflicts of interest as the rationale for this move; however, his editorial lists little evidence of this. Just last month, HHS leaders announced that COVID vaccination was no longer recommend for pregnant women; these women and their infants in the first 6 months of life are at increased risk of COIVD deaths and complications. The pattern of undermining expertise in utilizing vaccines will have far-reaching repercussions. Unfortunately, the trajectory for public health is even more worrisome. It is likely that there will be more measures to limit vaccine availability. Though, it will be a while until the full body count will be determined.

My take: Senator Cassidy, a physician, allowed RFK Jr to lead HHS despite misgivings; this was due to political considerations rather than qualifications. This decision and his lack of action to hold him accountable are a true betrayal of his constituents and to the principle of ‘Do No Harm.’

Link to AAP Statement: AAP Statement on Changes to Advisory Committee on Immunization Practices

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It is funny that the city of Roswell highlights an award for excellence in park and recreation management on a trashcan. This type of honor, though, could be replicated for the work of the current HHS secretary.

Essential Summer Safety Tips for Preventing Drowning

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Yesterday, a ICU colleague indicated that she really does not like to work on summer holiday weekends. While she is a hard worker, what she doesn’t like is seeing kids with drowning and firework injuries. All of a sudden a happy time becomes tragic. With that in mind, here are a few tips to prevent drowning.

From Strong4Life: “Practicing water safety for kids of all ages is crucial because drowning is a leading cause of death in children from birth through the teen years. And drowning is often quick and silent.”

Also, firearm deaths are the leading cause of death in children in the U.S. and motor vehicle accidents are second. So, firearms need to be secured and drive safely on the way to the pool, lake, river or beach.

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How Putting America First is Undermining Health Outcomes Here and Globally

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CP Duggan, ZA Bhutta. NEJM 2025; DOI: 10.1056/NEJMp2503243. “Putting America First” — Undermining Health for Populations at Home and Abroad

This article initially lays out the historical context of U.S. involvement in global health dating back to aiding famine in Belgium (1917), WHO (1948), USAID (1961). Also, the CDC and NIH have played important roles following WWII. Subsequently, the commentary outlines the impact of dismantling U.S global health efforts. In the two related articles cited afterwards, it is clear that the cuts to foreign aid and other DOGE activities may result in millions of deaths and at the same time expand the federal deficit.

An excerpt:

In the initial months of the Trump administration, numerous executive orders have led to a chaotic dismantling of U.S. foreign-assistance and global health efforts. These orders have already had, and will continue to have, severe adverse effects on vulnerable populations globally. But they also have serious implications for people in the United States…

Often missing from these success stories are the financial and health-related benefits these programs have had in the United States….One of the earliest and most fundamental examples of reciprocal innovation was the discovery and implementation of oral rehydration therapy (ORT)…Widespread use of ORT has helped drive substantial reductions in childhood deaths from diarrhea and has led to a new standard of care for childhood diarrhea in high-income countries and to commercial products in the United States…

Perhaps no program epitomizes these dual advantages better than the President’s Emergency Plan for AIDS Relief (PEPFAR). Early in the HIV epidemic, the NIH promoted multinational scientific collaborations to identify the virus, develop effective treatments, and implement global prevention and treatment programs, which led to PEPFAR’s creation in 2003. PEPFAR has saved 26 million lives, and economic growth in countries with PEPFAR programs has benefited the United States and other trading partners…[and] have contributed enormously to current knowledge about HIV and AIDS.

Another essential initiative, the FIC — the NIH institute responsible for supporting research training and partnerships in global health — has …directly benefited health in the United States by advancing early cancer detection and the development of sickle cell disease therapies, point-of-care diagnostics for infectious diseases, and treatments for child malnutrition. More than three quarters of FIC grants involve a U.S. grantee or investigator, which further emphasizes the institute’s direct benefits to the U.S. economy…

Since U.S. foreign assistance accounts for about 1% of the federal budget, we are skeptical of cost-savings–based arguments for its elimination…

The Trump administration’s gutting of USAID and other foreign-assistance programs marks a break from decades of evidence-based practices that have improved lives throughout the world. In addition to pushing millions of people into poverty and leading to an estimated 160,000 or more avoidable child deaths each year,4 these reforms will undermine health and the economy in the United States…

Withdrawal from the WHO reduces the United States’ ability to influence reform and restructuring of the world’s global health coordinating body. The elimination of U.S. funding for Gavi, the Vaccine Alliance, also endangers the health of vulnerable populations internationally and in the United States…

Critical to the success of advocacy efforts will be evidence of the ways in which the withdrawal of foreign aid and global disengagement undermine health and economic well-being in the United States and threaten global health and economic security.

My take: By the time the extent of the damage is understood, it will be too late to fix what this administration has destroyed. The toll in terms of death and suffering both in the U.S. and abroad will be hard to justify and not further the aim of making ‘America First.’

Related articles:

  1. D Wallace-Wells, NY Times 5/8/25: The $200 Billion Gamble: Bill Gates’s Plan to Wind Down His Foundation “He is committing the foundation to 20 more years of generous aid, more than $200 billion in total, targeting health and human development…The news comes at a time that will seem to many as a perilous one, given the Trump administration’s recent assault on foreign aid and indeed on the idea of global generosity itself….The journal Nature suggested that an overall cessation of U.S. aid funding could result in roughly 25 million additional deaths over 15 years.”
  2. J Riedl, The Atlantic 5/8/25: The Actual Math Behind DOGE’s Cuts “As an effort to meaningfully reduce federal spending, however, DOGE remains wholly unserious…The DOGE website now claims $165 billion in savings. However, it still details only a fraction of the supposed cuts, and earlier accounting errors have given way to new ones…Even assuming that the website’s stated savings have become twice as accurate as they were in February, annual savings would reach perhaps $15 billion, or 0.2 percent of federal spending…Total federal outlays in February and March were $86 billion (or 7 percent) higher than the levels from the same months a year ago, when adjusted for timing shifts. This spending growth—approximately $500 billion at an annualized rate—continues to be driven by the three-quarters of federal spending allocated to Social Security, Medicare, Medicaid, defense, veterans’ benefits, and interest costs. These massive expenses have been untouched by DOGE’s focus on small but controversial targets such as DEI contracts and Politico subscriptions…The bad news is that the project seems quite likely to expand long-term budget deficits. Slashing IRS enforcement will embolden tax evasion and reduce revenues by hundreds of billions of dollars over the decade. Laying off Department of Education employees who ensure collection of student-loan repayments will increase the deficit. Illegally terminated federal employees are already being reinstated with full back pay, leaving the government with little to show for its trouble besides mounting legal fees…None of this is to say that DOGE has failed. Musk might not have followed through on his unfocused and evolving promises to eliminate payment errors, balance the entire budget, and implement regulatory reform. But he has successfully given the White House cover to purge and intimidate the civil service, helped Congress justify exorbitant tax cuts, rewarded MAGA voters with revenge against their perceived enemies, and granted himself the ability to access sensitive government data and possibly ensure his companies’ continued government contracts. Sure, annual budget deficits remain on track to double over the next decade. But if you thought DOGE was really about cutting costs, you were never in on the joke.”
View of the Chattahoochee River from Don While Memorial Park, Sandy Springs, Ga

Rapid Gut Microbiome Recovery: Diet Outperforms Microbial Transplant

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Briefly noted: MS Kennedy et al. Nature (2025). https://doi.org/10.1038/s41586-025-08937-9. Diet outperforms microbial transplant to drive microbiome recovery in mice

Methods:  Here we characterize the trajectory by which the gut microbiome recovers its taxonomic and functional profile after antibiotic treatment in mice on regular chow (RC) or Western Diet (WD).

Key findings: “Only mice on RC undergo a rapid successional process of recovery. Metabolic modelling indicates that a RC diet promotes the development of syntrophic cross-feeding interactions, whereas in mice on WD, a dominant taxon monopolizes readily available resources without releasing syntrophic byproducts. Intervention experiments reveal that an appropriate dietary resource environment is both necessary and sufficient for rapid and robust microbiome recovery, whereas microbial transplant is neither.”

Conclusion (from authors): “Our data challenge widespread enthusiasm for faecal microbiota transplant (FMT) as a strategy to address dysbiosis, and demonstrate that specific dietary interventions are, at a minimum, an essential prerequisite for effective FMT, and may afford a safer, more natural and less invasive alternative.”

My take: This study suggests that the best way to get a “healthy” microbiome is to eat a healthy diet rather than to try to alter with FMT. This finding likely would be the same for probiotics as well.

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Andaman Sea (Thailand)

Shingles Vaccine Linked to Lower Dementia Risk

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L Carroll. NBC News, 4/2/25: Shingles vaccine may protect against dementia, new study suggests

An excerpt:

It’s been shown that reactivation of the chickenpox virus can lead to the accumulation of aberrant proteins associated with Alzheimer’s…

The new research, published Wednesday in Nature, analyzed data from more than 280,000 older adults in Wales and found that people who received the original shingles live virus vaccine were 20% less likely to develop dementia of any type than those who were not vaccinated...

The new study was possible because of an unusual public health policy in Wales that provided a “natural experiment” to explore the potential impact of the vaccine on dementia risk. With the rollout of the vaccine on Sept. 1, 2013, in Wales, shots were offered to people who were 79 on that date but not given to people who had turned 80. That allowed the German and Stanford University researchers to compare two groups of people with similar health characteristics who differed only by one week in age...

Bolstering the case for the shingles vaccine protecting against dementia were the findings from a study published in Nature Medicine in 2024 that analyzed medical records from more than 100,000 patients. That analysis suggested the newer shingles vaccine was associated with even better protection against dementia.

Actual study:Eyting, M., Xie, M., Michalik, F. et al. . Nature (2025). https://doi.org/10.1038/s41586-025-08800-x Open Access! A natural experiment on the effect of herpes zoster vaccination on dementia

My take: Avoiding shingles is a great reason to get the vaccine. Lowering the risk of Alzheimer’s may convince more to take the shot.

For those wanting a deeper dive on this topic: Eric Topol, The Shingles Vaccine and Reduction of Dementia

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Challenges for Aspiring Physicians: Application Overload, Shadowing Issues, and Wonka Bars

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Two recent commentaries discuss some of the problems for aspiring physicians:

  • RP Walensky, LD Walensky. NEJM 2025; 392: 1251-1254. Application Overload — A Call to Reduce the Burden of Applying to Medical School
  • DB Holt, EA Elster. NEJM 2025; 392: 1249-1251. Rethinking Shadowing for Aspiring Physicians

In the first article, the authors detail the burden associated with the common-place high-volume applications to medical schools.

“The cost is approximately $150 per school for application fees, plus $345 for taking the MCAT and having the score distributed through AMCAS. These fees are waived for qualifying low-income applicants (as primarily defined by household income below 400% of the national poverty level) who apply to the AAMC Fee Assistance Program and provide the required financial documentation.2 After submitting the primary application, applicants face a flood of secondary applications, some requiring up to eight additional essays. Even when the essay prompts are similar to those from other schools, the instructions often specify different lengths. One premedical student posted on social media the findings of his review of 54 medical schools’ secondary applications: he identified 222 different prompts, which he provided to help applicants get a jumpstart on their frenzied essay writing.3..

Between 2013 and 2023, … the total number of applications and the average number of applications per student increased dramatically — by 40% (from 690,281 to 966,947) and 28% (from 14.4 to 18.4), respectively. Despite the disproportionate escalation in applications submitted, the success rate (matriculants divided by applicants) remained flat (range, 36 to 44%).”

The authors recommend limiting applications to 10 to 12 medical school applications per applicant. This would benefit students as well as faculty burdens.

“The secondary-application process also needs to be reined in. Medical schools could adopt standardized secondary essays… Under this model, a student applying to 10 schools would complete a maximum of 13 secondary essays — 3 standardized and 1 customized essay per school — rather than the current norm of 60 to 80 essays (e.g., 20 secondary applications with 3 to 4 distinct essays each).”

My take: In Charlie and the Chocolate Factory, there are only five golden tickets. If everyone buys twice as many Wonka bars, it is a lot more expensive and perhaps more time-consuming. For medical school applicants, applying to 20 or more programs does not help if almost everyone is doing this. It does disadvantage the minority who do not have the financial means or available time to complete this arduous task.

In the second commentary, the article details the problems with shadowing experiences.

“Medical school admission in the United States remains intensely competitive. In 2024, according to the Association of American Medical Colleges (AAMC), prospective students submitted an average of 18 applications apiece…Many medical school admissions committees consider shadowing a physician to be an essential clinical experience for professional identity formation, so nearly all applicants now do some shadowing: 95% of respondents to the 2024 AAMC Matriculating Student Questionnaire (MSQ) said they’d spent time observing a physician at work.1 …

Premedical students are spending more time shadowing — sometimes hundreds to thousands of hours, which often necessitate taking a “gap year” between college and medical school at a financial cost…Three quarters of medical school applicants report taking time off before medical school, 50% taking 1 to 2 years and 25% taking 3 or more years...

These additional years delay entry into the workforce and result in higher levels of debt than moving more quickly toward potential earnings as a physician; one lost year of a physician’s salary (an average of $265,000) would result in an estimated net loss of $2 million by retirement if the money were invested at a 7% return…

Although medical schools consider clinical experiences other than shadowing, a review of our own data suggests that applicants who have shadowed physicians for more than 50 hours are more likely than their peers to be admitted — and more likely to come from higher-income families.“

The authors point out that unstructured observation is of unclear benefit. A course from Stanford, that far fewer hours (11-20 hrs) was sufficient for more than 90% of students “to decide whether medicine was the right career for them….The current emphasis on shadowing not only contributes to a longer and more expensive medical education pathway but also discourages nontraditional applicants and pursuit of genuine interests in other areas that make for well-rounded physicians.”

My take: The pathway to medical school has become more time-consuming and expensive. At the same time, it is doubtful that lengthy shadowing experiences or extensive numbers of applications are benefiting aspiring students.

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Angel Oak Tree, Historical Landmark in Charleston, SC. The tree is approximately 400 years old

Longevity Gap Present Even in Wealthy Americans

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S Machado et al. NEJM 2025;392:1310-1319. Association between Wealth and Mortality in the United States and Europe

Methods: This was a longitudinal, retrospective cohort study with 73,838 adults (mean [±SD] age, 65±9.8 years), a total of 13,802 (18.7%) died during a median follow-up of 10 years.

Key findings:

  • The gap in survival between the top and bottom wealth quartiles was wider in the United States than in Europe
  • The poorest Americans appeared to have the lowest survival among all wealth groups in the study sample
  • Survival among the participants in the top wealth quartiles in northern and western Europe and southern Europe appeared to be higher than that among the wealthiest Americans
  • Survival in the wealthiest U.S. quartile appeared to be similar to that in the poorest quartile in northern and western Europe

The countries in the Survey of Health, Ageing, and Retirement in Europe (SHARE) were split into the following three groups: northern and western Europe (Austria, Belgium, Denmark, France, Germany, the Netherlands, Sweden, and Switzerland), southern Europe (Italy, Portugal, and Spain), and eastern Europe (Czech Republic, Estonia, Hungary, Poland, and Slovenia). The shaded area in Panel A indicates the difference between quartile 4 (the wealthiest) and quartile 1 (the poorest) in the Health and Retirement Study (HRS); the same shaded area was added in Panels B, C, and D for the purposes of comparison. The median duration of follow-up was 10 years in both surveys, and the mean (±SD) age at baseline was 65±9.8 years.

In their discussion, the authors note that health care access should not be a factor for wealthy Americans. However, “systematic factors may influence longevity across social strata, such as diet; environment; behavioral, cultural, and social attitudes; and opportunities for social mobility.2,28,32,33 The poorest are most vulnerable to these systemic factors, but these factors are broad and probably affect the entirety of society.”

My take: This study indicates that mortality in the United States is higher than in Europe, even at higher wealth levels.

Commentary on this article from NBC News (4/2/25): Not even wealth is saving Americans from dying at rates seen among some of the poorest Europeans

“Fifty years ago, life expectancy in the U.S. and wealthy European countries was relatively similar. That began to change around 1980. As European life expectancy steadily increased, the U.S. struggled to keep pace — and its life expectancy even began declining in 2014…The wealthiest group in northern and western Europe had mortality rates about 35% lower than the wealthiest group in the U.S.”

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U.S. Measles Outbreak Is Not Slowing

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These charts show measles data through April 7th. Some additional data through Apirl 11th is listed below.

For those interested in a deeper dive into the measles numbers, you can follow Caitlin Rivers substack. From her notes on April 11:

  • “Since my last update on Tuesday, Arkansas and Hawaii reported cases for the first time this year. At least five states have reported ten or more cases, which is very unusual. Texas continues to register the most cases, with 541 to date.”
  • “According to the CDC, 712 cases have been reported so far this year. 1 in 3 (32%) are under the age of 5, and 1 in 10 (11%) have been hospitalized.”

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