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Vox
13 hours ago
- Health
- Vox
Ketamine is suddenly everywhere
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. Ketamine seems to be everywhere — from the nightclub to the psychiatric clinic. Among its growing number of users is Elon Musk, who says he takes ketamine every two weeks for depression as prescribed by a doctor. He's far from alone: More and more Americans are turning to ketamine for relief for their mental health struggles. But the New York Times reported recently that Musk was taking so much ketamine during last year's presidential campaign, sometimes daily, that he reportedly told people it was causing him bladder problems, a known symptom of chronic ketamine use. Musk's reported experience with the drug — from medical to possibly abusive — provides a window into ketamine's growing popularity in the United States, and the paradox that popularity presents. Ketamine, both an anesthetic and a hallucinogen, was first synthesized in the 1960s and has long been used for surgery and veterinary medicine. More recently, it has shown remarkable effectiveness in alleviating symptoms of depression, particularly in treatment-resistant populations. Clinics administering the drug — which legally must be licensed by the government to provide intravenous infusions — are becoming more popular. The Food and Drug Administration approved the first ketamine-derived nasal spray for depression in 2019. On the other hand, as highlighted in the Times' report alleging that Musk was mixing ketamine with other drugs, more Americans appear to be using ketamine recreationally and outside of medical supervision. Chronic misuse can put people at risk of serious physical and mental health consequences, from kidney and liver damage to memory loss and paranoia. 'There is absolutely a role for ketamine to help people with depression and suicidal ideation,' said Dr. Kevin Yang, a resident physician in psychiatry at the University of California-San Diego. 'At the same time, that doesn't mean it's going to be safe and effective for everyone.' According to a study co-authored by Yang and published earlier this year, the percentage of Americans who reported using ketamine within the past year grew by 82 percent from 2015 to 2019, took a brief dip in 2020 — possibly because of the pandemic complicating people's access to the drug — and then rose another 40 percent from 2021 to 2022. The increases were similar for both people with depression and people without, suggesting that the growth is being driven by both more people seeking ketamine for clinical purposes and more people using it recreationally. The overall number of people taking ketamine is still tiny: About 0.28 percent of the population as of 2022, though this might be an undercount, as people don't always tell the truth in surveys about drug use. There is other evidence to suggest more people are taking ketamine recreationally. Yang's study found that ketamine use was rising most among white people and people with college degrees, and users reported taking it more often in combination with other recreational drugs such as ecstasy and cocaine. Ketamine drug seizures nationwide increased from 55 in 2017 to 247 in 2022, according to a 2023 study led by Joseph Palamar at New York University. Experts think most recreational ketamine is produced illicitly, but the number of legitimate ketamine prescriptions that are being diverted — i.e., lost or stolen — has been going up, a 2024 analysis by Palamar and his colleagues found, which is another possible indicator of a blossoming black market. The buzz about ketamine's popularity in Silicon Valley and its persistence in certain club cultures that first emerged in the '80s confirms its place in the counterculture. We can't know the reality behind Musk's public statements and the anonymous reporting about his ketamine use. The Times reports that people close to Musk worried that his therapeutic use of ketamine had become recreational; Musk quickly dismissed the Times's reporting. But the drug does coexist as a therapeutic and a narcotic, and the line between the two can be blurry. People should not try to self-medicate with ketamine, Yang said. Its risks need to be taken seriously. Here's what you need to know. How to think about ketamine as its popularity grows Ketamine is edging into the mainstream after years at its fringes. It has been around for decades, enjoying a boom as a party drug in the '80s and '90s. For the most part, ketamine had been viewed warily by mainstream scientists. But in 2000, the first major research was published demonstrating its value in treating depression. And increasingly over the past decade, however, ketamine has started to gain more acceptance because of its consistently impressive study results. Studies have found that for some patients, ketamine can begin to relieve their depression symptoms in a matter of hours after therapy and other medications have failed. The testimonials of patients whose depression improved quickly, such as this one published in Vox, are convincing. The benefits identified in clinical research have opened up a larger market for the substance. Johnson & Johnson developed its own ketamine-derived treatment for depression (esketamine, sold as a nasal spray called Spravato) that received FDA approval in 2019, the first of its kind. The number of monthly prescriptions for Spravato doubled from the beginning of 2023 to October 2024. People can also visit clinics to receive an IV of conventional ketamine for treatment, and that business is booming too: In 2015, there were about 60 clinics in the US dedicated to administering ketamine; today, there are between 1,200 and 1,500. For the 21 million Americans who experience major depression, this widening access could help: ketamine and esketamine do appear to have strong anti-depressive effects — as long as it is used in consultation with a doctor and under their supervision. A 2023 meta-analysis of the relevant studies found that across many clinical trials, most patients reported significant improvements in their symptoms within 24 hours. It is recommended primarily for people whose depression has not gotten better after trying other treatments or for people with severe suicide ideation, who need a rapid improvement in their symptoms to avoid a life-threatening emergency. But providers also screen potential patients for any current substance use problems for a very important reason: The risks for ketamine abuse are real. When taken outside of a clinical setting, ketamine is often consumed as a pill or a powder, either snorted or mixed with a drink, and it's easy to take too much. One recent survey found that more than half of patients who attempted to take ketamine at home for depression either intentionally or accidentally took more than the prescribed amount. Users can also develop a tolerance over time, which raises the risk that people will take stronger and stronger doses to feel the same effects. Packs of illegal ketamine are seen before a destruction ceremony to mark the 'International Day against Drug Abuse and Illicit Trafficking' in Yangon on June 26, 2023. Sai Aung Main/AFP via Getty Images Scientists have found that people who use ketamine can develop a dependency on it, especially with frequent and high-dosage use. They become irritable or anxious without the drug and experience other withdrawal symptoms. Its addictive quality, while less potent than that of nicotine or opioids, is an important difference from some other hallucinogens, such as psilocybin, that are also being used in experimental settings for mental health needs and are less likely to be habit-forming. Maintenance doses can also be necessary for ketamine therapy, and regulating any long-term use to prevent dependency is another reason medical supervision is so crucial. There is limited evidence that most people who use ketamine in a clinical setting do not end up abusing it, which is a promising sign that properly managing its use reduces the risk of therapeutic use turning into a disorder. But because ketamine's use for depression is still so new and still growing, it's an important risk to watch out for. Johnson & Johnson urges patients to be mindful of Spravato's potential for misuse. The line between genuine therapeutic use and abuse becomes clearer when a biweekly treatment at a clinic turns into a regular at-home habit, especially if that involves obtaining the drug from illicit sources whose purity is not guaranteed. Street ketamine is typically just the drug itself, produced and sold illegally. But Dr. Nabarun Dasgupta, who oversees the University of North Carolina's Street Drug Analysis Lab, told me they've noticed a recent rise in samples where ketamine is combined with other substances. On its own, ketamine overuse in the short term can cause nausea and high blood pressure, with all of the attendant risks, as well as hallucinations and 'bad trips.' Longer-term abuse can lead to problems with a person's bladder and urinary tract, which can create difficulty urinating — the kind of issues Musk described to people in private, according to the Times. People who chronically abuse ketamine can also experience paranoia, memory loss, and a shortened attention span. The potential for ketamine in a clinical environment is exciting. But its use does come with risks, and not enough people are aware of them: A recent survey from the United Kingdom found that many people there who were taking ketamine did not know that it could be addictive. It can be. Ketamine is not something to experiment with on your own. Clinics have all sorts of safety checks for their patients, Yang told me. Ketamine 'absolutely has been shown to be very effective,' he said, before adding the all-important qualifier: 'under the supervision of a clinical physician.'
Yahoo
27-05-2025
- Business
- Yahoo
The hidden elitism of RFK's MAHA movement is making America more unhealthy
Health and Human Services Secretary Robert Kennedy has a well-documented history of lying, and so it was reasonable to believe he was lying again during his January confirmation hearing when he said he is "not anti-vaccine" and promised he wasn't going to take vaccines away. Still, it's both alarming and remarkable how swiftly he's moved to take away COVID-19 boosters that have helped millions of Americans avoid becoming seriously ill from this still-novel virus. Last week, the Food and Drug Administration announced plans to deny access to the vaccine for people under 65 without an underlying health condition. This fits in with Kennedy's long-standing history of eugenics-tinged notions that disease is a good thing, falsely claiming that it strengthens the gene pool, and insinuating that it makes survivors stronger. (In reality, vaccines boost overall immunity while disease often weakens it.) But the particulars of the policy also reveal something about Kennedy's reactionary class politics, which contradict his family's history of progressivism. As Josh Marshall of Talking Points Memo noted on Bluesky, "I strongly suspect you're going to have doctors leaning forward on what constitutes a preexisting condition in this case." Which is to say, people who want the booster can get around the FDA ban by asking their doctor for a prescription. But as many folks, including myself, immediately pointed out, forcing people to go to the doctor requires time and usually money. Previously, most people could get the vaccine, often with no copay, by breezing into a pharmacy while grocery shopping. The people who don't have the time or money to go through the onerous process of a doctor's appointment are more likely to be working class or poor. Even middle-class people who can afford a copay struggle to find the time to do so. This policy is turning what was once a 10-minute process into a half-day ordeal, if you're lucky. In effect, Kennedy isn't banning the vaccine — he's just making sure that only well-to-do people like himself have "Make America Healthy Again" slogan — shortened to "MAHA" — has a lot of surface appeal. Worse, Kennedy is smart about floating attention-grabbing policy ideas, like banning artificial food dyes, that are unlikely to happen but snag a lot of headlines, misleading people into thinking he's serious about improving public health. Looking away from Kennedy's empty, lie-laden rhetoric to his actions, however, and another narrative emerges: He's taking away health care, with a special emphasis on limiting access for women, minorities, children, and working people. On the latest episode of my YouTube show, "Standing Room Only," journalist Lindsay Beyerstein and I discussed how much Kennedy is taking away. Of course, the most prominent assault from Republicans on health care is Donald Trump's new tax bill, which aims to kick over 10 million eligible people off Medicaid. The mechanism for cheating people out of their coverage is phony "work requirements." In reality, it's a paperwork requirement that uses red tape to keep eligible people from accessing benefits. 'It's going to be creating this administrative bureaucracy and devastating amount of poor people who, despite being eligible, are going to lose coverage so that Congress can fund tax cuts for the wealthiest,' MaryBeth Musumeci of George Washington University told the Washington Post. Ironically, the people most affected will often be those who work full time, because they have the least free time to navigate the paperwork labyrinth. Kennedy, who grew up in a famously progressive household, surely knows this. But he cynically joined in the lie that eligible people are "cheating" the system by penning a New York Times op-ed earlier this month that falsely claimed "able-bodied adults on welfare are not working at all" and "we don't even ask them to." Kennedy and his co-authors hope readers are picturing lazy young men who refuse to work so they can sit around playing video games. We know this because Jesse Watters rolled out the blunter form of this message on Fox News, claiming Medicaid recipients "play softball on the weekend, sell ecstasy on the side" and don't "even look for a job." As if young men don't have any need for money other than for paying their medical bills. But, as John Knefel at Media Matters explained, "92% of people on Medicaid are working, have a disability, or are performing duties — such as going to school or caregiving — that could qualify for an exemption from meeting work requirements." Those 92% are in danger of losing access because of the paperwork maze requirements. Of the other 8%, four out of five are women. And they aren't young or lazy. On average, they're 41 years old and were recently forced out of the workforce, often to care for family members, especially elderly ones. Most have only a high school degree or less, and their median annual income is $0. That's not a typo. This is a group of very poor women. This is where the GOP's traditional classism and racism meld with Kennedy's unsubtle eugenicist impulses. He speaks frequently of disabled people as if they are useless parasites. During his confirmation hearing, Kennedy said this about people with disabilities or chronic illnesses, a category which includes anyone with diabetes or asthma: "A healthy person has a thousand dreams. A sick person has only one." That was his scripted remark, and even then, he was arguing that a person with any chronic health condition, from someone in a wheelchair to someone who needs daily medication to manage depression, does not have a life worth living. Punishing for the "sin" of caring for disabled family members fits into this bleak, anti-human worldview. It will not make America healthy to let people die because they don't have the wealth to pay for health care out of pocket. Social Darwinism was a bad idea in the 1900s. It's even dumber now. We have decades of medical evidence showing that robust, functioning health care systems are how you improve public health. The entire history of public health research shows that the "rising tide" model isn't just more humane, but more effective than the "culling the herd" model. Sickness spreads, often directly through viruses or indirectly by depleting family resources, putting stress on people that degrades their health. Taking away health care from the people Kennedy thinks are the undeserving sick will not make others healthier. That's not even really the goal of the Medicaid cuts, which are about funding massive tax cuts for the rich. Pulling a few food dyes out of your snacks is no substitute for what Americans need, which is the health care support for all to live full and productive lives.
Vox
26-05-2025
- Health
- Vox
Does medicine have an over-diagnosis problem?
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. A new book argues doctors are too quickly and too confidently diagnosing their patients with too many medical problems. Corbis via Getty Images Patients in the 21st century are pretty lucky. Medical science and technology have advanced so much that we can diagnose many thousands of distinct conditions, and we can even take genetic tests that scour our DNA for signs of a disease that may not materialize for decades — offering us a peek into our own future. And with these advances, we are being diagnosed more and more. The number of people diagnosed with chronic health conditions and mental health disorders is at an all-time high — at least partly, most experts agree, because we have simply catalogued more diseases to catch. Yet we are also increasingly anxious, anxious about our health — even anxious that we're too anxious about our health. Our ability now to understand our bodies and put a name on what's wrong with them does not always provide comfort; instead, it can create new fears and impose new constraints on us. Some health care leaders, including Donald Trump's health secretary, Robert F. Kennedy Jr., argue that we are becoming over-medicalized — too ready to take a pill for something, just for the sake of taking something. The reality is nuanced because medicine is, to put it mildly, complicated. But we should in fact be careful about doling out diagnoses, says Dr. Suzanne O'Sullivan, an Irish neurologist and the author of a new book, The Age of Diagnosis: How Our Obsession With Medical Labels Is Making Us Sicker. In her book, O'Sullivan argues that our eagerness to diagnose, preemptively screen, and otherwise push these new tools to their limits is creating problems that deserve to be taken more seriously. She describes mutually reinforcing trends — the patient's insistence on certainty and the doctor's desire to avoid being blamed for missing something — that are driving clinical practice toward overdiagnosis. The phenomenon is even leading to more instances of doctors diagnosing certain cancers by 50 percent or more, due to the availability of new imaging tech that can detect even minuscule traces of abnormal cells. Overdiagnosis can cause real harm. And so O'Sullivan advocates for 'slow medicine,' in which doctors and patients take time to develop a relationship, monitor symptoms, and take a great deal of care before naming a condition — an approach that may sound quaint in an era of rapid-testing but something she says is actually more in tune with the reality that diagnosis is partly an art. 'Most diagnoses come with a huge amount of uncertainty. That covers asthma, diabetes, cancer, autism. Diagnosis is a clinical skill,' she told me in a recent interview. 'Now, the difficulty, I think, with modern medicine is a lot of people don't understand that and that they feel that the test — the blood test or the brain scan — makes the diagnosis, when actually a diagnosis is made on understanding the story in the context of the tests that are done.' There is a tension here. Slowing down could, at least in theory, risk missing an aggressive disease early at the most crucial time — when it can still be treated. And in the United States, simply getting a doctor's appointment can be more challenging than it should be. Each individual case is unique, O'Sullivan acknowledges, which is why a relationship with your own primary care doctor is so important. But she argues that, on the whole, doctors have erred too far in the other direction, toward diagnosing conditions too quickly and too confidently and creating a different set of problems for patients. During our conversation, we spoke about how to balance our tremendous new technological abilities with a more measured approach to clinical practice and how she would respond to critics who argue her advice would lead to people's health problems being missed. Our conversation has been edited for clarity and length. First, let's clarify something basic. What do you mean by overdiagnosis? How do you define it? I think of overdiagnosis as measuring the point at which a medical diagnosis ceases to be useful. A diagnosis may be right or it may be wrong, but it isn't always beneficial in a certain situation. Overdiagnosis is trying to ask when a diagnosis is genuinely a useful way of conceptualizing someone's difficulties, and when it is not. The first chapter is about Huntington's disease. Why did you start there? There's a genetic test available for Huntington's disease. If you happen to have the gene for Huntington's disease, you are destined to get Huntington's if you live long enough. If you have the genetic test, you can find out ahead of time that you have that at some point in your future. I needed people to understand the power of a diagnosis to make you sick even when you actually don't have much physically wrong with you. I tell the story of a patient named Valentina, who didn't have the gene but believed that she did because of her family history. Because of her strong belief that she had the gene, she developed all the symptoms. When we take on a medical label, when we are told that we are sick in some way, we inadvertently search ourselves for the symptoms and signs of the label that we've been given. Our bodies are very noisy engines. There's all sorts of things to notice if you are given reason to notice. The Huntington's disease community is in this incredible situation where they have the opportunity to find out they have a diagnosis 20 years before the disease starts. And in most countries, only 10 percent to 20 percent of people actually have the genetic test that will advise them of the disease. They do that because they are a community who has given a great deal of thought to what it's like to live with the label of an impending disease. Once you discover you have a positive test, it completely changes your relationship with your body. It changes how you think about your health. And once you know, you can't unknow. I spoke to loads of people with Huntington's, and they all said the same thing: that living with the hope that you are negative and that everything is okay is a way better life than living with the knowledge that you're positive and waiting for the disease to start. One of the most interesting themes in the book is this idea that people want and have come to expect concrete answers from modern medicine. Black or white: You have a disease or you don't. But you cover chronic Lyme disease, long COVID, and autism, these conditions where the boundaries are fuzzier. What problems does that create? Most diagnoses come with a huge amount of uncertainty. That covers asthma, diabetes, cancer, autism. Diagnosis is a clinical skill. It requires a good clinician to be able to put the patient's story in the context of tests and findings. Now, the difficulty, I think, with modern medicine is a lot of people don't understand that and that they feel that the test makes the diagnosis, the blood test or the brain scan, when actually a diagnosis is made on understanding the story in the context of the tests that are done. That means that diagnosis is hugely subjective. I hear a lot of stories of people going to different doctors who said I didn't have a diagnosis, but then the 11th doctor said I did have it. There is an inherent subjectivity that doctors will manage differently. I'm a doctor in a highly specialized center, and I deliberately err on the side of slight underdiagnosis. I do that because I'm aware that when I make a diagnosis of a brain disease, I am changing that person's future forever. I'm not just changing their relationship with their body. I'm also changing their mortgage payments, their insurance, their confidence in themselves, their ability to get health insurance. I'm changing their finances, their practical future. I'm changing their ability to drive. There's so many things that come with the diagnosis that people don't think about. What many, many doctors do is they err on the side of overdiagnosis because that['s an easier place for a doctor to be. Because you're never going to come back to me and say, 'Listen, I don't really believe I had asthma when I was a child.' You'll say, 'Well, listen, I had it. You treated it and now I'm better.' It protects us against someone coming back and saying we missed something. I came into this book thinking that something like cancer would very much be more of a yes or no. You either have it or you don't. And if you do, you really would want to know about it — as soon as possible. And yet, after reading your book, I felt like you had complicated that story. How do we risk overdiagnosing cancer? Within the medical community, this has been well-known for a long time, but it just doesn't leak into the general conversation. The bottom line is if you screen healthy people for an illness, any illness, be it cancer or high blood pressure, diabetes, then you will be picking up borderline cases and overtreating them. In the case of cancer, I try to remind people we've only had MRI scans in regular clinical use in doctors' offices since the 1990s. They've only been as good as they are now in the last 10 years, as sensitive at picking up things. As we get these newer tests, we're finally seeing inside the healthy body of people. What we find when we screen people for things like cancer is we find abnormal cells. But not all abnormal cells go into cancer. Lots of people live out their lives having these abnormal cells. They never spread. They never do anything. They never grow. They would never threaten health. But our difficulty as doctors is because we're so new to finding all these irregular abnormalities that when we find them, we don't know which ones will turn into malignant cancers and which ones won't. So what we do is we treat them all as if they will inevitably turn into malignant cancers. One Cochrane Review estimated that if you screen 2,000 women for breast cancer, you will save one woman's life from breast cancer and treat 10 women for breast cancer who never needed to be treated. I think sometimes we're very in love with all of our access to screening tests and scans and health checks. A lot of that care is not only unnecessary, but actually doing us harm. One estimated that if you screen 2,000 women for breast cancer, you will save one woman's life from breast cancer and treat 10 women for breast cancer who never needed to be treated. Obviously being able to better more precisely diagnose conditions and to test samples at a genetic level represents advancement in science and an improvement in our understanding of our own body. How do we encourage that kind of development while mitigating the problems that you're writing about? I work with people who've got rare brain diseases. The advancement in genetics and the ability to diagnose rare genetic conditions is amazing. I don't want to in any way detract from what a phenomenal kind of medical advancement that is. I have no doubt that going forward in 20, 30, 40 years, it will continue contributing to science and to medicine in very positive ways. How to talk to your doctor about 'slow' medicine O'Sullivan's book is not a self-help guide, but after reading it, it's easy to come up with some strategies that could help each of us bring a 'slow-medicine' sensibility to our next doctor's appointment and potentially avoid overdiagnosis. Such as: • Set expectations with your doctor. Make clear that you don't want to be quick to judgment or treatment. • Press your doctor to get a better sense of how confident they are in a diagnosis, what could change their mind, what additional steps could be taken to double-check. • If you're really worried about something, speak up. Slow medicine means being thoughtful — not ignoring what your body is telling you. But something being modern and expensive and cutting-edge doesn't mean it's always better medicine. We need to be a little bit more open with the general public about the uncertainties. We'll never understand the meaning of different genes to healthy populations if we don't test them, so we need to do the population-based testing. But we need to be careful before we begin offering genetic tests to unsuspecting members of the public who probably think we understand them a great deal better than we do. We're really on a learning curve at the moment. A little bit more clarity and honesty with the public would go a long way. How would you respond to somebody who hears we should be testing less and diagnosing less and immediately thinks, 'Well, you're just going to put my health at risk.' Listen, I don't want a diagnosis missed in myself. I don't want to be the doctor who misses things either. So I completely understand people's fear of dialing back. It's not about replacing all these tests with nothing. It's really advocating for this concept of slow, thoughtful medicine with good clinicians that we invest in good doctors, good nurses, good diagnosticians, and we don't feel the need to be compelled to jump into tests and diagnosis at that first meeting. We have time to spend with our patients and meet them again to discuss the problem. That's how you come to both a good understanding between patient and doctor. A quality diagnosis is made with time and understanding.
Vox
13-05-2025
- Health
- Vox
Trump picked a wellness influencer to be surgeon general and it's breaking MAHA brains
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. The Make America Healthy Again movement's infiltration of federal health policy took another step forward last week when President Donald Trump nominated Dr. Casey Means, a 'metabolic health evangelist' and an ally of Health Secretary Robert F. Kennedy, Jr. to be his surgeon general. If confirmed by the Senate in the coming weeks, Means will hold one of the most visible public health roles in the country, and would be set to boost Kennedy's vision for remaking the nation's approach to health and wellness. But who is Means? And where does she fit in the broader MAHA space? Like Kennedy, she is an insider turned outsider: She graduated from Stanford Medical School but dropped out of her residency program in 2019 shortly before completing it because she came to view the health care system as 'exploitative.' She's since pivoted to focus on personal wellness, challenging the health care establishment along the way. In doing so, she's found an eager audience, attracting hundreds of thousands of followers on social media. In 2019, she started a health tech company called Levels that marketed at-home glucose monitors. Means herself has pitched the devices as a general health tool not only for people with diabetes, for whom they were originally developed, but for everyone — even though research studies have found no benefit for those without the condition. Perhaps coincidentally, last month, Kennedy floated having the federal government cover the costs of such devices for some patients, rather than cover new weight-loss drugs, as one way to arrest the country's obesity crisis. Last year, Means published a bestselling book called Good Energy, co-authored with her brother Calley Means, that cemented her place as a MAHA champion who would take on the health care industrial complex. In their book, the Meanses advance a theory of 'metabolic dysfunction' — that Americans' bodies are bad at producing energy because of our poor diets and sedentary lifestyles, and which is the root cause of chronic diseases, including not only obesity and diabetes but even schizophrenia and depression. (Scientists have found that metabolism is central to the development of obesity and its associated diseases, but the underlying causes remain the subject of active research.) Good Energy paints a grand conspiracy that the food and medical industries have little motivation to prevent diseases from occurring because once a person becomes ill, they start using medical services and making money for health care providers. Experts say Means's commentary on metabolism is often overly simplistic. She can also stray into sounding more like a spiritual guru than a medical doctor, prone to talking about 'dark energy' and speculating that our brains may be more like receivers that tap into the divine. She appears to view people's ill health as a matter of spiritual disorder as much as a physical phenomenon. 'Humans are out of alignment with the Earth and depleting its life force,' she wrote last year. 'And human bodies are now exhibiting signs of blocking the flow of energy through them. This is insulin resistance. We are the Earth.' To Means's public health critics, she is both anti-science — she frequently criticizes vaccines in her weekly newsletter — and fundamentally unqualified to be, as the surgeon general is often known, America's doctor. (Her medical license actually lapsed in 2019.) 'Appointing Casey Means, a non-practicing doctor who has spent years peddling unproven 'health interventions,' means a surgeon general that will put a fringe practitioner of unproven functional medicine in charge of educating the American people about their health and disease challenges,' Arthur Caplan, a medical ethicist at New York University, told the New York Times. But Kennedy says Means is 'the perfect choice' for surgeon general — her unorthodoxy a feature, not a bug. 'Casey articulates better than any American the North Star of a country where we have eliminated diabetes, heart disease, and obesity through prioritizing metabolic health,' Kennedy wrote on X. 'Casey will help me ensure American children will be less medicated and better fed — and significantly healthier — during the next four years. She will be the best Surgeon General in American history.' The surgeon general, though not a policy-making role, has the influence to drive the national conversation on health and can draw attention to important changes in the nation's health. Vivek Murthy, President Joe Biden's surgeon general, released a widely covered report on the loneliness epidemic and called for cancer warnings on alcohol packaging during his tenure. Already Means has outlined what she'd like to see: less corporate influence in health and food, less ultraprocessed foods in the American diet, a reformed meatpacking industry, and more. Means's priorities are consistent with Kennedy's agenda, which is why it was so surprising when Means's nomination sparked outrage among some in the MAHA universe. But wait — is this the beginning of a MAHA civil war? Not in the least. But before we get into why not, here's what's going on: Means's critics have gotten a lot of attention recently by portraying her as insufficiently committed to MAHA's various goals — particularly in her opposition to vaccines — and suggested that nebulous dark forces may be at work against the movement. As journalist Helena Bottemiller Evich wrote in her newsletter Food Fix, some anti-vaccine activists have come to believe an emphasis on food wellness has overtaken vaccine safety as Kennedy's primary focus, and Means's nomination exacerbated those tensions. According to the Washington Post, one anti-vax influencer said Means's appointment showed Kennedy was actually 'powerless' within the Trump circle. 'I don't know if RFK very clearly lied to me, or what is going on,' Nicole Shanahan, who was Kennedy's vice-presidential candidate during his presidential run, posted on X. 'It has been clear in recent conversations that he is reporting to someone regularly who is controlling his decisions (and it isn't President Trump).' Shanahan, after speculating that Kennedy had come under somebody else's influence, called the Means siblings 'aggressive and artificial.' Far-right commentator and internet personality Laura Loomer called Means 'a Witch Doctor' and insisted Trump could not have selected her of his own accord. But according to Trump, he picked Means because Kennedy recommended her for the position. So while the rift is eye-catching, it is probably better understood as interpersonal rivalries spilling into the open rather than any meaningful change in direction for Kennedy or the MAHA agenda he is implementing at HHS. Kennedy has nurtured a movement in which conspiracy theories are commonplace and now that he's disappointed some of his supporters by endorsing Means, they are seeing more conspiracies. The MAHA movement encompasses everything from vaccine skepticism and elaborate theories of chronic disease to eliminating environmental toxins and eradicating corruption in the health system. Means may bring a particular focus on food and wellness to the surgeon general position, but if you look at his record so far, Kennedy has begun working aggressively across a wide range of issues. In his first few months as health secretary, Kennedy has downplayed the efficacy of the measles shot in favor of alternative treatments amid the worst outbreak in decades. He has also ridiculed vaccine mRNA technology, calling into question a future Covid-19 vaccine for children. And he has launched a vaccine safety investigation and ordered a probe into autism's causes. At the same time, Kennedy has already sought voluntary commitments from food manufacturers to remove artificial dyes from their products and tried to crack down on more additives in ultraprocessed foods. Last week, the FDA and NIH launched yet another research initiative, this one on diet-related chronic disease, that aims to understand how certain foods affect metabolism, the cornerstone of Means's theory of our modern health problems. All of this drama over Means's nomination does clarify some things about the MAHA movement: The coalition is reactive and conspiratorial, but its key figures are moving at stunning speed to remake the country's approach to health care. Tapping Means is another step in that direction; her nomination isn't a sign of MAHA fracturing — it's a sign of Kennedy doubling down. Health and Human Services Secretary Robert F. Kennedy Jr. with President Donald political potency, much like Trump's MAGA movement, is aided by its malleability: Make America Healthy Again could mean a lot of different things to different people, from hardcore anti-vaxxers to the kind of crunchy conservative wellness influencer that Means typifies. But while that ambiguity can be an asset in a campaign, it presents a challenge when governing. You have different constituencies who, while happy to be unified to win an election, are now pushing you to pick different personnel, to prioritize different issues, to frame issues in different terms.
The Guardian
10-05-2025
- Politics
- The Guardian
‘From all sides': universities in red states face attacks from DC and at home
Days after the University of Michigan president, Santa Ono, announced that he was leaving his post to lead the University of Florida, his name was quietly removed on Wednesday from a letter signed by more than 600 university presidents denouncing the Trump administration's 'unprecedented government overreach and political interference' with academic institutions. As Ono is set to become the highest-paid public university president in the country, in a state that has often been at the forefront of the rightwing battle against higher education, the reversal, first reported on by Talking Points Memo, underscored the challenges of standing up against the government's sweeping attacks on education in solidly red states. Many private colleges and universities have begun to push back against Donald Trump's federal funding cuts, bans on diversity initiatives, and targeting of foreign students, while faculty at more than 30 universities, most of them public, have passed resolutions calling for a 'mutual defence compact' – a largely symbolic pledge to support one another in the face of the government's repressive measures. But in conservative states, where local attacks on higher education were in vogue before the US president took office, faculty trying to fight back find themselves fighting on multiple fronts: against state legislators as well as against Trump. Some have persevered, although for now that resistance has been limited to statements and resolutions calling on the universities themselves to put up a more muscular response. The faculty senate at Indiana University, Bloomington, voted in favor of a defence compact last month, days before Republican legislators passed a sweeping overhaul of the state school's governance. In Georgia, Kennesaw State University became the first – and so far only – school in the US south to join the call for the solidarity pact, in part to protest the state scrapping a decades-old initiative to increase the college enrollment of Black men, which was pulled as part of the broader Trump-led crackdown on diversity initiatives. This week, faculty at the University of Miami in Ohio and at the University of Arizona – both states with Republican majority legislatures – also passed resolutions in favor of mutual alliances among universities. The resolutions are nonbinding, as faculty senates play an advisory role at most universities, and so far no administrations have responded to the call. But the idea, those behind it say, is to send a message. 'All universities in all states are under threat,' said Jim Sherman, a retired psychology professor at Indiana University, Bloomington, who proposed the resolution passed by faculty there. 'If we don't stand together and talk about what each of us is experiencing, how we're dealing with it, and what the options are, then we're standing alone, and that's much more difficult.' Paul Boxer, a psychology professor at Rutgers University in New Jersey, first came up with the plan to organize faculty in the 'Big Ten' conference, a group of 18 large, mostly public universities, to put up a united front against the Trump administration. But schools outside the conference showed an interest, and the solidarity effort quickly outgrew the consortium to include other, mostly public colleges and universities across the country. Boxer also praised other collective initiatives that have since emerged, including by a group of 'elite' universities quietly strategizing to counter the Trump administration policies, but called on more universities to publicly unite in their resistance. 'A lot of the attention has been on Harvard, and the Ivy Leagues, and the universities that Trump has name-dropped, and I'm glad that Harvard did what they did, obviously, but they're sitting on a $50bn endowment, and they can do things that we can't in a public university,' Boxer said, referring to the university's public defiance of Trump's demands and a lawsuit it filed against the administration. Large, state universities – particularly those in blue states with sympathetic legislators – had other advantages, Boxer noted, including strong connections to alumni in local government and the broader community. That is a harder case to make in Republican-controlled states – some of which, like Florida, Texas, Iowa and Utah – had essentially drawn up a blueprint for attacking diversity initiatives and academic freedom in the years leading up to Trump's election. In Indiana, the recently passed measures, which legislators attached to a budget bill at the last minute, would establish 'productivity' quotas for tenured faculty and end alumni's ability to vote for the university's board of trustees, which would fall under the full control of the state's governor, Mike Braun. 'There is a lot of anxiety,' said Sherman. 'If Indiana is any indication, red states might even be more under threat from their state legislatures than they are from the federal government.' Taking a public stance in a climate of growing repression is not easy, faculty say. In Florida, where Ono is headed, the state's Republican governor, Ron DeSantis, was an early champion of the battle against diversity initiatives and said this week that he expects the incoming president to abide by the state's mission to 'reject woke indoctrination'. In Georgia, at a statewide faculty leadership meeting this week, scholars from across the state's universities debated how to defend programmes supporting Black students, help international students facing visa revocations, and prepare to fight proposed state legislation that would impose further restrictions on diversity initiatives and criminalize the distribution of some library materials. 'Faculty want to do something, they want to respond, but they also see the inevitability of their university system and their lawmakers doing it, there's no stopping that train here in Georgia,' said Matthew Boedy, a professor at the University of North Georgia who also leads the state's American Association of University Professors conference. 'There are state-level attacks, there are federal attacks,' he said. 'We are taking it from all sides.'
