Recapping the RFK Jr. Hearings: A Live Discussion With KFF Health News Journalists

Robert F. Kennedy Jr.’s confirmation hearings for secretary of Health and Human Services are happening Jan. 29 and Jan. 30, and KFF Health News reporters will be watching as the Senate Committee on Finance and the Senate Committee on Health, Education, Labor and Pensions ask Kennedy about everything from vaccines to abortion to Medicaid. 

What are the biggest takeaways? What comes next? Tune in for a discussion with KFF Health News’ Arthur Allen, Phil Galewitz, and Julie Rovner on Thursday, Jan. 30, at 12:30 p.m. PT. 

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Trump Administration’s Halt of CDC’s Weekly Scientific Report Stalls Bird Flu Studies

The Trump administration has intervened in the release of important studies on the bird flu, as an outbreak escalates across the United States.

One of the studies would reveal whether veterinarians who treat cattle have been unknowingly infected by the bird flu virus. Another report documents cases in which people carrying the virus might have infected their pet cats.

The studies were slated to appear in the official journal of the Centers for Disease Control and Prevention, the Morbidity and Mortality Weekly Report. The distinguished journal has been published without interruption since 1952.

Its scientific reports have been swept up in an “immediate pause” on communications by federal health agencies ordered by Dorothy Fink, the acting secretary of the Department of Health and Human Services. Fink’s memo covers “any document intended for publication,” she wrote, “until it has been reviewed and approved by a presidential appointee.” It was sent on President Donald Trump’s first full day in office.

That’s concerning, former CDC officials said, because a firewall has long existed between the agency’s scientific reports and political appointees.

“MMWR is the voice of science,” said Tom Frieden, a former CDC director and the CEO of the nonprofit organization Resolve to Save Lives.

“This idea that science cannot continue until there’s a political lens over it is unprecedented,” said Anne Schuchat, a former principal deputy director at the CDC. “I hope it’s going to be very short-lived, but if it’s not short-lived, it’s censorship.”

White House officials meddled with scientific studies on covid-19 during the first Trump administration, according to interviews and emails collected in a 2022 report from congressional investigators. Still, the MMWR came out as scheduled.

“What’s happening now is quite different than what we experienced in covid, because there wasn’t a stop in the MMWR and other scientific manuscripts,” Schuchat said.

Neither the White House nor HHS officials responded to requests for comment. CDC spokesperson Melissa Dibble said, “This is a short pause to allow the new team to set up a process for review and prioritization.”

News of the interruption hit suddenly last week, just as Fred Gingrich, executive director of the American Association of Bovine Practitioners, a group for veterinarians specializing in cattle medicine, was preparing to hold a webinar with members. He planned to disclose the results of a study he helped lead, slated for publication in the MMWR later that week. Back in September, about 150 members had answered questions and donated blood for the study. Researchers at the CDC analyzed the samples for antibodies against the bird flu virus, to learn whether the veterinarians had been unknowingly infected earlier last year.

Although it would be too late to treat prior cases, the study promised to help scientists understand how the virus spreads from cows to people, what symptoms it causes, and how to prevent infection. “Our members were very excited to hear the results,” Gingrich said.

Like farmworkers, livestock veterinarians are at risk of bird flu infections. The study results could help protect them. And having fewer infections would lessen the chance of the H5N1 bird flu virus evolving within a person to spread efficiently between people — the gateway to a bird flu pandemic.

In a July 22 email obtained by KFF Health News, an epidemiologist at the Michigan health department suggests publishing a report about people who potentially spread the bird flu virus to their pet cats. The paper was accepted by the journal of the Centers for Disease Control and Prevention. But its publication is on hold because of a Trump administration order to pause communications. (Screenshot by KFF Health News)

At least 67 people have tested positive for the bird flu in the U.S., with the majority getting the virus from cows or poultry. But studies and reporting suggest many cases have gone undetected, because testing has been patchy.

Just before the webinar, Gingrich said, the CDC informed him that because of an HHS order, the agency was unable to publish the report last week or communicate its findings. “We had to cancel,” he said.

Another bird flu study slated to be published in the MMWR last week concerns the possibility that people working in Michigan’s dairy industry infected their pet cats. These cases were partly revealed last year in emails obtained by KFF Health News. In one email from July 22, an epidemiologist pushed to publish the group’s investigation to “inform others about the potential for indirect transmission to companion animals.”

Jennifer Morse, medical director at the Mid-Michigan District Health Department and a scientist on the pending study, said she got a note from a colleague last week saying that “there are delays in our publication — outside of our control.”

A close up of a black and white cow's nose with mucus running from the nostrils
Veterinarians who treat cattle await a report that could help protect them from infection with the bird flu. This photo of a runny cow nose was taken by a veterinarian working on a farm with an outbreak. (They provided it on the condition of anonymity because of concerns about reputational damage.)

A person close to the CDC, speaking on the condition of anonymity because of concerns about reprisal, expected the MMWR to be on hold at least until Feb. 6. The journal typically posts on Thursdays, and the HHS memo says the pause will last through Feb. 1.

“It’s startling,” Frieden said. He added that it would become dangerous if the reports aren’t restored. “It would be the equivalent of finding out that your local fire department has been told not to sound any fire alarms,” he said.

In addition to publishing studies, the MMWR keeps the country updated on outbreaks, poisonings, and maternal mortality, and provides surveillance data on cancer, heart disease, HIV, and other maladies. Delaying or manipulating the reports could harm Americans by stunting the ability of the U.S. government to detect and curb health threats, Frieden said.

The freeze is also a reminder of how the first Trump administration interfered with the CDC’s reports on covid, revealed in emails detailed in 2022 by congressional investigators with the House Select Subcommittee on the Coronavirus Crisis. That investigation found that political appointees at HHS altered or delayed the release of five reports and attempted to control several others in 2020.

In one instance, Paul Alexander, then a scientific adviser to HHS, criticized a July 2020 report on a coronavirus outbreak at a Georgia summer camp in an email to MMWR editors, which was disclosed in the congressional investigation. “It just sends the wrong message as written and actually reads as if to send a message of NOT to re-open,” he wrote. Although the report’s data remained the same, the CDC removed remarks on the implications of the findings for schools.

Later that year, Alexander sent an email to then-HHS spokesperson Michael Caputo citing this and another example of his sway over the reports: “Small victory but a victory nonetheless and yippee!!!”

Schuchat, who was at the CDC at the time, said she had never experienced such attempts to spin or influence the agency’s scientific reports in more than three decades with the agency. She hopes it won’t happen again. “The MMWR cannot become a political instrument,” she said.

Gingrich remains hopeful that the veterinary study will come out soon. “We’re an apolitical organization,” he said. “Maintaining open lines of communication and continuing research with our federal partners is critical as we fight this outbreak.”

Readers Offer Their Takes on the Opioid Crisis, Family Doctor Shortage, and Vaccine Policies

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.


A chronic-pain patient advocate, who has been featured previously in KFF Health News coverage, spoke out on the social platform X about our “Payback: Tracking the Opioid Settlement Cash” project:

— Bev Schechtman, Clayton, North Carolina


Rooting Out the Root Cause of the Opioid Crisis

I read with interest your detailed coverage of how states are spending billions of funds from the opioid crisis (“Payback: Tracking Opioid Cash: How Are States Spending Opioid Settlement Cash? We Built a Database of Answers,” Dec. 16). The bigger story is health advocates and policymakers need to march upstream if we are to beat the “illness industry” players in illicit drug-making, distribution, and sales on our streets.

What should not be overlooked by those interested in solving this public health crisis (legislators, health department officials, and law enforcement and court system leaders) is that such downstream efforts, even when supported by unimaginable funding, does little to prevent those pushing our citizens into the quicksand of individual, family, and community destruction and death. Certainly, such mitigating and treatment programs and services are needed, but little attention is given to rooting out the root cause of the opioid/fentanyl epidemic.

It is easy and popular to damn the corporation, but it takes courage, real work, and much risk to confront Mexico’s drug cartels, Mexico’s government officials, the Chinese Communist Party, and any of their ostensible “leaders.” Furthermore, it is embarrassing to have to confront our own public officials, from the president on down, to stop aiding and abetting this carnage!

If no serious action is taken to work on upstream causes of our opioid crisis, no amount of lifeguarding and posting of warning signs will prevent bodies from struggling in this rip current of drug addiction. The silence and omission of any action from those who have taken the oath to defend and protect the public is creating a moral hazard for all citizens. Consequently, many more people will die, with nary a word against who is pushing them to such destruction.

— Stephen Gambescia, Philadelphia


A retired assistant surgeon general and epidemiologist weighed in on X about an article on the nation’s shortage of primary care providers:

— Ali Khan, Omaha, Nebraska


Osteopaths Have Big Hand in Filling Primary Care Needs

I appreciate Felice J. Freyer’s insightful Jan. 13 article, “Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?” As an osteopathic physician and medical educator, I can confidently answer this question with a resounding “Yes!” Osteopathic medical schools have long been at the forefront of this issue by emphasizing core principles of primary care as they train future physicians, a mission embedded in our philosophy since 1874.

Osteopathic medicine is founded on four key tenets that emphasize the interconnected nature of the body, mind, and spirit and the importance of whole-person care. These tenets have guided many of this country’s nearly 150,000 DOs (doctors of osteopathic medicine) into primary care roles. More than half of DOs enter residencies in the primary care specialties of family medicine, internal medicine, and pediatrics.

As mentioned in the article, “Many medical students start out expressing interest in primary care. Then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.” This is a major part of the problem. Most Americans, more than 80%, will never be treated in a large academic medical center. Osteopathic medical schools have flipped the script.

Osteopathic medical schools, as well as some newer MD-granting schools, employ a community-based distributed education model, training students in settings such as rural clinics, community health centers, and physician offices where they will encounter underserved populations benefiting from primary care treatment. Training in underserved areas makes medical students almost three times as likely to stay in those areas to practice, and four times as likely to practice primary care in those locations.

I thank Freyer for shining a spotlight on the essential role of primary care and the contributions of osteopathic medicine. The osteopathic medical education community remains committed to working to ensure that underserved communities receive the care they deserve, and that primary care continues to thrive as the backbone of our health care system.

— Robert A. Cain, CEO and president of the American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland


A family doctor and teacher shared the article on X:

— John Frey, Grayslake, Illinois


On Immunity for Vaccine Makers

When discussing vaccination in general (“Childhood Vaccination Rates, a Rare Health Bright Spot in Struggling States, Are Slipping,” Jan. 16), please address the federal legislation surrounding this topic.

According to 42 U.S. Code § 300aa–22, vaccine producers have immunity in civil court. It reads: “No vaccine manufacturer shall be liable in a civil action for damages arising from a vaccine-related injury or death associated with the administration of a vaccine after October 1, 1988, solely due to the manufacturer’s failure to provide direct warnings to the injured party (or the injured party’s legal representative) of the potential dangers resulting from the administration of the vaccine manufactured by the manufacturer.”

And there is only one federal National Vaccine Injury Compensation Program, also known as “vaccine court,” to hear all vaccine-related injury cases involving children. And its case backlog is at least a decade long.

In everything else, when a product or service causes harm, there is accountability through the process of civil suits. What other manufacturer of a product has such legal immunity?

The issue with this is there is no true measure to create accountability with vaccine products. And vaccine makers aren’t required to display ingredient labels. So, we may be injecting our children with unknown substances, from a manufacturer who has no judicial accountability if harm results from the use of the product.

Now, what parent wants to subject their child to this? This is a big deterrent to parents vaccinating their children. Emotional appeal will not dissuade parents, but correcting this legal fallacy will.

— Alesia Wright, Tulsa, Oklahoma


An Indiana dad expressed his opinion on X:

— Steve Garbacz, Fort Wayne, Indiana


As a retired primary care physician, I was often frustrated that my management of complex medical conditions was reimbursed at lower rates due to a required treatment code (“Perspective: Removing a Splinter? Treating a Wart? If a Doctor Does It, It Can Be Billed as Surgery,” Dec. 13). Blaming the physician for the discrepancy is inappropriate. The Centers for Medicare & Medicaid Services has strict regulations on billing. We are mandated to code per the regulations. We cannot give “discounts” for procedures. To do so would be problematic in the bizarre catch-22 world of Medicare billing. We are mandated to report our services accurately using only the codes available. To do otherwise is considered fraud by Medicare. When a physician is accused of fraud, he/she is presumed guilty and pays significant financial penalties until innocence is proven. Even a murderer or thief has more rights in the judicial system.

Medicare determines the lowest reimbursement rate; the other carriers pay a higher rate based on that rate. If an individual physician accepts Medicare, he/she must accept that rate. Only a non-participating physician (not accepting Medicare) can offer a lower rate. The exception is if the service is provided at no cost. Should the patient demand the service be provided free?

I’m reminded of the plumber charging $100 to replace a washer: 10 cents for the washer and $99.90 to know how to replace it.

— Robert Sullivan, Adairsville, Georgia


On X, a New England surgeon summed up his views:

— Rafael Grossmann, Bangor, Maine

Telehealth Companies Boost Ad Spending While Taking on More Complex Medicine

Shannon Sharpe was having one of those 15-minutes-of-internet-infamy moments. Social media blew up in September after the retired Denver Broncos tight end — accidentally, he later said — broadcast some of his intimate activities online.

One of his sponsors took advantage of the moment: the telehealth company Ro, which sells a variety of prescription medicines for erectile dysfunction and hair and weight loss. The company revved up a social media campaign on the social platform X for an ad in which Sharpe boasted about his experience with the company’s erectile dysfunction medications, a company spokesperson confirmed.

The ads were more than just a passing attempt to hitch a corporate caboose to a runaway social media locomotive. A group of direct-to-consumer telehealth companies have become omnipresent across just about all media formats, seeking patients interested in their low-stigma, low-fuss, low-touch, high-convenience health products.

They’re on your favorite podcasts and in the background on the cable TV in your gym. Thirteen telehealth entities spent a combined $111 million in 2023 on television ads, more than double the sum in 2019, according to an analysis from iSpot.tv, a television ad-tracking company, provided to KFF Health News.

The ads feature high-wattage celebrities such as Jennifer Lopez as well as lesser-known influencers who are paid four figures to post a snapshot or short video to Instagram, according to interviews with marketers. Three publicly traded telehealth companies spent a total of more than $1.4 billion on advertising, sales, and marketing in 2023, according to financial reports filed with the Securities and Exchange Commission, categories that reflect the extent of their online efforts.

The companies’ advertising typically emphasizes convenience in a health care system that’s often just the opposite. They promise judgment-free birth control or care for conditions like erectile dysfunction and hair loss that have traditionally been stigmatized. As the companies expand, they’re venturing into more complex kinds of medicine, such as care for mental health conditions and obesity.

Services that telehealth companies offer, critics warn, may shortchange patients in need of close, sensitive attention. Researchers differ on telehealth services’ quality, with some saying telehealth companies offer little follow-up and inconsistent care from a revolving cast of doctors.

Still, they agree the care is fundamentally different from the traditional style. A company’s model can “kind of flip what you’re taught at medical school on its head,” said Ateev Mehrotra, a Brown University professor of public health who studies telehealth.

Typically, he said, a patient goes to the doctor with a complaint; there, the parties figure out a diagnosis and, if appropriate, a medication. By contrast, he said, telehealth companies’ advertising invites patients to make their own diagnoses, while pairing them with clinicians who, if they confirm their conditions, prescribe medicines the patients already think they want.

Under this style of medicine, the clinician is “now a screener, and you just want to make sure that that medication is safe for that patient,” Mehrotra said.

The model may work for certain kinds of care, Mehrotra said, such as birth control. He and some colleagues conducted a study in which they recruited patients with standardized backstories to patronize startups offering contraceptive medicines over the internet. Generally, the study found, the services performed well.

Harley Diamond, a patient at Nurx, a startup offering birth control prescriptions and other services, offers an example of how these companies can work well in some circumstances. After she saw an Instagram ad, she signed up to get birth control. She lives in Tennessee, a red state where it can be difficult to access contraception: Local clinics have closed and an arsonist burned down a Planned Parenthood. (The facility recently reopened.)

But when she turned to Nurx for her mental health, she found the service confounding and its convenience lacking.

The company’s app sends her frequent questionnaires about symptoms and reactions to drugs, she said. “There is no comforting face to validate you,” she wrote in an email to KFF Health News. The questions were the same each time, and she said she spoke with a new doctor in every interaction.

“It can feel like you’re having to start from scratch explaining yourself to someone new every month,” she said.

When she expressed concerns — for example, about side effects of an antidepressant she was taking — it would take “days, generally,” to hear back, with no change in her protocol, she said. Often, she said, her messages would get no response at all.

Rajani Rao, senior vice president at Nurx, said the company is “constantly working” to improve response times, “especially as we experience a high volume of patient care requests.” In mental health, the majority of Nurx’s patients experience elimination of symptoms after six months of treatment, she said.

Rao also referred to Nurx as providing an “integrated care team,” using language echoed across the industry. Ro, for example, says its care is available in the time and format of its patient’s preference and that it audits the quality of its services.

Continuous care is crucial to make sure mental health patients are on the right doses of medications and that they’re not experiencing side effects, said Reshma Ramachandran, an assistant professor of medicine at Yale who has conducted her own secret-shopper study of telehealth sites.

What’s more, research shows many mental health medications are best paired with therapy, Ramachandran said.

Ramachandran thinks frustrations like Diamond’s might be widespread, based on her team’s research. She said she’s frustrated at the “very groovy, glossy” picture painted by telehealth ads.

Ramachandran said her study is still under consideration for publication in medical journals. But she provided preliminary results to congressional offices examining the telehealth sector.

Last year, Sen. Dick Durbin, an Illinois Democrat, and former Sen. Mike Braun, an Indiana Republican, introduced legislation to regulate some telehealth advertising practices. A spokesperson for Durbin said he intends to reintroduce the bill this year.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

Led by RFK Jr., Conservatives Embrace Raw Milk. Regulators Say It’s Dangerous.

In summertime, cows wait under a canopy to be milked at Mark McAfee’s farm in Fresno, California. From his Cessna 210 Centurion propeller plane, the 63-year-old can view grazing lands of the dairy company he runs that produces products such as unpasteurized milk and cheese for almost 2,000 stores.

Federal regulators say it’s risky business. Samples of raw milk can contain bird flu virus and other pathogens linked to kidney disease, miscarriages, and death.

McAfee, founder and CEO of the Raw Farm, who also leads the Raw Milk Institute, says he plans to soon be in a position to change that message.

Robert F. Kennedy Jr., the anti-vaccine activist President Donald Trump has tapped to run the Department of Health and Human Services, recruited McAfee to apply for a job as the FDA’s raw milk standards and policy adviser, McAfee said. McAfee has already written draft proposals for possible federal certification of raw dairy farms, he said.

Virologists are alarmed. The Centers for Disease Control and Prevention recommends against unpasteurized dairy that hasn’t been heated to kill pathogens such as bird flu. Interstate raw milk sales for human consumption are banned by the FDA. A Trump administration that weakens the ban or extols raw milk, the scientists say, could lead to more foodborne illness. It could also, they say, raise the risk of the highly pathogenic H5N1 bird flu virus evolving to spread more efficiently, including between people, possibly fueling a pandemic.

“If the FDA says raw milk is now legal and the CDC comes through and says it advises drinking raw milk, that’s a recipe for mass infection,” said Angela Rasmussen, a virologist and co-editor-in-chief of the medical journal Vaccine and an adjunct professor at Stony Brook University in New York.

The raw milk controversy reflects the broader tensions President Donald Trump will confront when pursuing his second-administration agenda of rolling back regulations and injecting more consumer choice into health care.

Many policies Kennedy has said he wants to revisit — from the fluoridation of tap water to nutrition guidance to childhood vaccine requirements — are backed by scientific research and were established to protect public health. Some physician groups and Democrats are gearing up to fight initiatives they say would put people at risk.

Raw milk has gained a following among anti-regulatory conservatives who are part of a burgeoning health freedom movement.

“The health freedom movement was adopted by the tea party, and conspiracy websites gave it momentum,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who has studied the history of the anti-vaccine movement.

Once-fringe ideas are edging into the mainstream. Vaccine hesitancy is growing.

Arkansas, Utah, and Kentucky are weighing legislation that would relax or end requirements for fluoride in public water. And 30 states now allow for the sale of raw milk in some form within their borders.

While only an estimated 3% of the U.S. population consumes raw milk or cheese, efforts to try to restrict its sales have riled Republicans and provided grist for conservative podcasts.

Many conservatives denounced last year’s execution of a search warrant when Pennsylvania agriculture officials and state troopers arrived at an organic farm tucked off a two-lane road on Jan. 4, 2024. State inspectors were investigating cases of two children sickened by E. coli bacteria and sales of raw dairy from the operation owned by Amish farmer Amos Miller, according to a complaint filed by the state’s agricultural department.

Bundled in flannel shirts and winter jackets, the inspectors put orange stickers on products detaining them from sale, and they left toting product samples in large blue-and-white coolers, online videos show. The 2024 complaint against Miller alleged that he and his wife sold dairy products in violation of state law.

The farm was well known to regulators. They say in the complaint that a Florida consumer died after being sickened in 2014 with listeria bacteria found in raw dairy from Miller’s farm. The FDA said a raw milk sample from the farm indicates it was the “likely source” of the infection, based on the complaint.

Neither Miller’s farm nor his lawyer returned calls seeking comment.

The Millers’ attorney filed a preliminary objection that said “shutting down Defendants would cause inequitable harm, exceed the authority of the agency, constitute an excessive fine as well as disparate, discriminatory punishment, and contravene every essential Constitutional protection and powers reserved to the people of Pennsylvania.”

Regulators in Pennsylvania said in a press release they must protect the public, and especially children, from harm. “We cannot ignore the illnesses and further potential harm posed by distribution of these unregulated products,” the Pennsylvania agricultural department and attorney general said in a joint statement.

Unpasteurized dairy products are responsible for almost all the estimated 761 illnesses and 22 hospitalizations in the U.S. that occur annually because of dairy-related illness, according to a study published in the June 2017 issue of Emerging Infectious Diseases.

But conservatives say raiding an Amish farm is government overreach. They’re “harassing him and trying to make an example of him. Our government is really out of control,” Pennsylvania Republican Sen. Doug Mastriano said in a video he posted to Facebook.

Videos show protesters at a February 2024 hearing on Miller’s case included Amish men dressed in black with straw hats and locals waving homemade signs with slogans such as “FDA Go Away.” A court in March issued a preliminary injunction that barred Miller from marketing and selling raw dairy products within the commonwealth pending appeal, but the order did not preclude sales of raw milk to customers out of state. The case is ongoing.

With Kennedy, the raw milk debate is poised to go national. Kennedy wrote on X in October that the “FDA’s war on public health is about to end.” In the post, he pointed to the agency’s “aggressive suppression” of raw milk, as one example.

McAfee is ready. He wants to see a national raw milk ordinance, similar to one that exists for pasteurized milk, that would set minimal national standards. Farmers could attain certification through training, continuing education, and on-site pathogen testing, with one standard for farms that sell to consumers and another for retail sales.

The Trump administration didn’t return emails seeking comment.

McAfee has detailed the system he developed to ensure his raw dairy products are safe. He confirmed the process for KFF Health News: cows with yellow-tagged ears graze on grass pastures and are cleansed in washing pens before milking. The raw dairy is held back from consumer sale until it’s been tested and found clear of pathogens.

His raw dairy products, such as cheese and milk, are sold by a variety of stores, including health, organic, and natural grocery chains, according to the company website, as well as raw dairy pet products, which are not for human consumption.

He said he doesn’t believe the raw milk he sells could contain or transmit viable bird flu virus. He also said he doesn’t believe regulators’ warnings about raw milk and the virus.

“The pharmaceutical industry is trying to create a new pandemic from bird flu to get their stock back up,” said McAfee, who says he counts Kennedy as a customer. His view is not shared by leading virologists.

In December, the state of California secured a voluntary recall of all his company’s raw milk and cream products due to possible bird flu contamination.

Five indoor cats in the same household died or were euthanized in December after drinking raw milk from McAfee’s farm, and tests on four of the animals found they were infected with bird flu, according to the Los Angeles County Department of Health.

In an unrelated case, Joseph Journell, 56, said three of his four indoor cats drank McAfee’s raw milk. Two fell sick and died, he said. His third cat, a large tabby rescue named Big Boy, temporarily lost the use of his hind legs and had to use a specialized wheelchair device, he said. Urine samples from Big Boy were positive for bird flu, according to a copy of the results from Cornell University and the U.S. Department of Agriculture.

McAfee dismissed connections between the cats’ illnesses and his products, saying any potential bird flu virus would no longer be viable by the time his raw milk gets to stores. He also said he believes that any sick cats got bird flu from recalled pet food.

Journell said he has hired a lawyer to try to recover his veterinary costs but remains a staunch proponent of raw milk.

“Raw milk is good for you, just not if it has bird flu in it,” he said. “I do believe in its healing powers.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

Trump’s Funding ‘Pause’ Throws States, Health Industry Into Chaos

States and the nation’s health industry were thrown into disarray after the Trump administration ordered Monday that the government freeze nearly all federal grants at 5 p.m. ET Tuesday, a sweeping directive that at least initially appeared to include funding for Medicaid, the state-federal health insurance program that covers more than 70 million Americans.

By midmorning Tuesday, state officials around the country reported they had been shut out of a critical online portal that allows states to access federal Medicaid funding.

Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee, said on the social media site Bluesky that the portals were down in all 50 states following the Trump administration’s order.

“This is a blatant attempt to rip away health care from millions of Americans overnight and will get people killed,” he wrote.

Around midday Tuesday, as state health officials pressed the federal government for clarity, the White House Office of Management and Budget — which issued the Monday memo — put out new guidance clarifying that “mandatory programs like Medicaid” were not included in the freeze.

Karoline Leavitt, the White House press secretary, declined to confirm that Medicaid was exempt when pressed by reporters during an early afternoon briefing.

But she later said in a post on the social platform X that “no payments have been affected” by what she described as a “portal outage.”

The possibility that federal Medicaid funding would be shut off overnight spooked advocates already on edge about the program’s future. President Donald Trump vowed on the campaign trail not to seek cuts for Medicare or Social Security, the nation’s major entitlement programs serving mostly retired people. But he did not make the same promise about Medicaid, which pays for health care for primarily low-income and disabled people — approximately 1 in 5 Americans.

Separate from the freeze, congressional Republicans are discussing cutting the nearly $900 billion program, arguing costs have ballooned with enrollment, notably including the program’s expansion to cover more low-income adults. Lawmakers are also eyeing ways to save money for Trump’s other legislative priorities — in particular, extending the tax cuts from his first term that expire at the end of this year.

The federal government pays most costs for Medicaid, which is operated by states. Medicaid pays for most long-term care for Americans and for about 40% of all U.S. births, and together with the related Children’s Health Insurance Program covers about 38 million children.

Federal funding for Medicaid does not go directly to individual enrollees but to the states, which then distribute it to providers, health plans, and other entities that serve Medicaid enrollees.

State officials can access that funding through internet portals.

Joan Alker, who is executive director of the Center for Children and Families at the Georgetown McCourt School of Public Policy, said on X Tuesday that the portal lockout is “a major crisis.”

She pointed out that many states access their federal funding at the end of the month — “i.e. this week,” she wrote.

The original freeze order came in the form of a vaguely worded two-page memo from the Office of Management and Budget to all federal agencies directing them to “temporarily pause all activities related to obligation or disbursement of all Federal financial assistance.”

“This temporary pause will provide the Administration time to review agency programs and determine the best uses of the funding for those programs consistent with the law and the President’s priorities,” the memo said. The only programs explicitly noted as exceptions were Medicare and Social Security, which left it unclear how states would continue to pay doctors, hospitals, nursing homes, and private health plans to manage Medicaid.

Around the nation, health officials scrambled to make sense of the order, which was scheduled to take effect at 5 p.m. ET Tuesday. A federal judge halted the freeze shortly before its implementation, blocking the change until next week.

Even as OMB clarified that Medicaid was not included, the immediate impacts to other critical health programs were becoming clear, especially for community health centers and medical research centers.

Democrats in Congress expressed outrage at the Trump administration for pausing federal funding not only to Medicaid but also to numerous other programs, including the Supplemental Nutrition Assistance Program, also known as food stamps, the WIC nutrition program for pregnant and postpartum women and infants, and school meal programs for low-income students.

“The Trump Administration’s action last night to suspend all federal grants and loans will have a devastating impact on the health and well-being of millions of children, seniors on fixed incomes, and the most vulnerable people in our country,” Sen. Bernie Sanders (I-Vt.) said in a statement Tuesday. “It is a dangerous move towards authoritarianism and it is blatantly unconstitutional.”

The National Association of Medicaid Directors and the major nursing home associations were among those seeking clarification from the White House on Tuesday about the order’s impact on Medicaid funding.

Numerous state officials and groups said they were considering or had already filed litigation challenging the order. One lawsuit was filed Tuesday against OMB in federal court in Washington, D.C., by the National Council of Nonprofits and the American Public Health Association, seeking a temporary restraining order to “maintain the status quo until the Court has an opportunity to more fully consider the illegality of OMB’s actions.”

Attorneys general in California, New York, and four other states announced Tuesday afternoon a joint lawsuit against the Trump administration over the order, which they said had already frozen systems for Medicaid, Head Start, and even child support enforcement across multiple states.

“There is no question this policy is reckless, dangerous, illegal, and unconstitutional,” said New York Attorney General Letitia James. She added that she and other Democratic attorneys general would seek a temporary restraining order to halt the OMB policy from going into effect.

Leavitt defended the freeze during her White House briefing — the first of the new administration — saying it was critical to ensuring that federal funding was being used appropriately.

“This is a very responsible measure,” she said.

Reporting contributed by Bram Sable-Smith, Jordan Rau, Renuka Rayasam, Brett Kelman, and Christine Mai-Duc.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

Standardizing Provider Assessments Reveals Important Information About Gun and Opioid Access for Veterans at Risk of Suicide

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Social Network, Social Functioning Associated with Longer Stays in Alcohol Treatment

Newswise — When seeking treatment for alcohol use disorder, how a person is functioning in society strongly influences how long they will stay in inpatient treatment. According to a study published in Alcohol: Clinical and Experimental Research, people who are dissatisfied in their primary social role—at work or school, for example—and people with a strong social network stay in treatment longer, giving them more opportunities for therapeutic intervention. The study highlights the importance of helping people in treatment for alcohol use disorder to strengthen their social network and social role.

The purpose of the study was to examine the modifiable factors affecting how long a patient stays in inpatient treatment for alcohol use disorder. Longer duration of stay is considered to be more beneficial to patients. Researchers collected data on 800 people being admitted to a short-term inpatient facility center in greater New York City between 2022 and 2024 to treat their alcohol and substance use disorders.

Sixty-five percent of participants used alcohol as their primary substance. The average length of stay in treatment ranged from two days to 43 days. A preliminary analysis found that total well-being, symptom distress, social role, total social network size, and alcohol use severity were significant predictors of length of stay; those factors were further analyzed. The preliminary analysis did not find an association between age, sex, race, ethnicity, or substance use disorder severity and length of stay.  

Further analysis found that social role, social network size, and severity of alcohol use disorder all significantly increased length of stay. Specifically, for each additional point on the social role measure, the length of stay increased by 0.12 days. This scale measures the individual’s satisfaction with what they consider to be their primary social role, whether in a work, school, volunteer, or other setting. The higher the number on this scale, which ranges from 9 to 45, the more dysfunctional the person’s social role. Individuals generally dissatisfied with their social role may be more inclined to stay in treatment to improve their function in those roles—or may be required to do so by their school or workplace.

Each of the three additional people listed in a patient’s social network was associated with an increased length of stay in treatment of one day. This result aligns with prior studies and may be because a larger social network means more support during treatment and more motivation to stay in treatment. The study also found that for every three additional alcohol use disorder symptoms a participant reported, their length of stay increased by one day.

The authors recommend further research at other treatment facilities and note that the study findings provide important insights for clinicians who can easily incorporate the social functioning measures used in the study into intake processes and communications among treatment teams, for example, through electronic health records. They recommend that treatment aims to improve the patient’s social functioning during treatment and after discharge, for instance, through vocational rehabilitation, and that clinicians leverage patients’ social networks to support their treatment and recovery. 

Correlates of length of stay in a short-term inpatient residential addiction treatment facility. J. Bourdon, S. Verdecanna, J. Wright, N. Vadhan, M.F. Wright, J. Morgenstern

ACER-24-6126.R2

What RFK Jr. Might Face in His Nomination Hearings This Week

President Donald Trump has nominated Robert F. Kennedy Jr., an environmental lawyer with no formal medical or public health expertise, as secretary of Health and Human Sciences. Two Senate committees will question Kennedy this week on how his disproven views of science and medicine qualify him to run the $1.7 trillion, 80,000-employee federal health system.

Here are four considerations for lawmakers on the Senate Finance and Senate Health, Education, Labor and Pensions committees, which will host Kennedy for questioning on Wednesday and Thursday, respectively:

1) Kennedy’s unconventional health claims.

For decades, Kennedy has advocated for health-related ideas that are scientifically disproven or controversial. He created and was paid hundreds of thousands of dollars by Children’s Health Defense, a group that champions the false idea that vaccines cause autism and other chronic diseases and has sued to take vaccines off the market. Kennedy has said covid vaccines are the deadliest in history, antidepressants lead children to commit mass shootings, environmental contaminants may cause people to become trans, and HIV is not the only cause of AIDS. He also pushes the use of products that regulators consider dangerous, such as raw milk, and for broader use of some medicines, such as ivermectin and hydroxychloroquine, to treat conditions without FDA approval. He says public health agencies oppose their use only because of regulatory capture by big drug and food interests.

“He believes you can avoid disease if you have a healthy immune system. He sees vaccines and antibiotics as toxins,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. Top Trump health nominees — Kennedy, Marty Makary for FDA commissioner, Jay Bhattacharya for National Institutes of Health director, and former U.S. Rep. Dave Weldon for Centers for Disease Control and Prevention director — are generally disdainful of the agencies they’ll be leading, Offit said.

“They think they are going to go into office, pull back the curtain, find all this bad stuff, and reveal it to the American public,” he said.

During a measles epidemic in 2019 and 2020 that killed 83 people, mostly children, in Samoa, Kennedy, as chairman of Children’s Health Defense, warned the country’s prime minister against measles vaccination. This behavior alone “is disqualifying” for an HHS nominee, said Georges Benjamin, executive director of the American Public Health Association.

Equally problematic, in Benjamin’s view, was Kennedy’s legal effort in 2021 to get the covid vaccine pulled from the market. “He can’t say he’s not anti-vax,” Benjamin said. “He wasn’t following the evidence.”

A Kennedy spokesperson did not respond to a request for comment.

2) Kennedy’s chances appear good, despite opposition.

Kennedy’s nomination has emerged in a moment when Trump is on a roll and mistrust of public health and medical authority in the wake of the pandemic has created an opening for people with unorthodox views of science to seize the reins of the country’s health system.

After former Fox News personality Pete Hegseth was confirmed as Defense secretary last week despite his controversial qualifications for the job and stark warnings from former top military brass, many Washington observers think RFK Jr. is going to be hard to defeat. In a meeting on the Hill with Democratic senators and their aides last week, Offit said, “the feeling was that he would likely be confirmed.”

Trump has demanded that Republican senators line up behind his nominees and has so far succeeded. It’s thought that Sens. Lisa Murkowski of Alaska and Susan Collins of Maine could oppose Kennedy, based on their opposition to Hegseth. Sen. Mitch McConnell (R-Ky.), the other Hegseth “nay” vote, is a polio survivor who has not spoken publicly about Kennedy but said in December that opposing “proven cures” was dangerous. Other senators whose Kennedy votes are said to be in question include Sen. Bill Cassidy (R-La.), the HELP Committee chair, a physician who gave a lukewarm response after meeting Kennedy.

Others have reported that Sens. Cory Booker (D-N.J.), who shares Kennedy’s concern with the spread of obesity and chronic illness, and Sheldon Whitehouse (D-R.I.), who attended law school with Kennedy, might vote for him. Neither senator’s office responded to a request for comment. Advancing American Freedom, a conservative advocacy group founded by former Vice President Mike Pence, has fought Kennedy’s nomination with a major ad buy.

3) The hearings are going to be heated.

Democratic senators are coming with plenty of ammunition. Sen. Elizabeth Warren (D-Mass.) sent Kennedy a 34-page letter containing 175 questions on everything from his anti-vaccine statements and actions to his waffling positions on abortion to his stances on Medicare, drug prices, and the cause of AIDS.

While public health and medical groups did not coordinate with Pence’s conservative organization, questions about Kennedy’s earlier stance in support of abortion rights could raise hackles on the GOP side of the aisle. Although his group is far from Pence on reproductive rights, Benjamin said, “if it helps derail him, I hope some senators are listening to Pence. Any shelter in a storm.”

“The hearings are going to be very difficult for him because he’s told a web of untruths as he’s marched across the offices,” said Leslie Dach, executive chair of Protect Our Care, a Democratic-aligned advocacy group.

Public opinion reflects leeriness of Kennedy on health, though not excessively. In a poll released Tuesday by KFF, 43% of respondents said they trusted him to make the right health recommendations. About 81% of Republicans in the poll said they trusted Kennedy — almost as many as trust their own doctor.

4) What happens if Kennedy takes office.

At the NIH, FDA, and other federal health agencies, nervous scientists speak of early retirement or jumping to industry should Kennedy and his agency heads take office.

The pharmaceutical industry has kept quiet on the nomination, as has the American Medical Association. Many patient advocacy groups are worried, but wary of creating friction with an administration they can’t ignore or defeat.

Kennedy’s comments on AIDS — suggesting that gay men’s use of stimulants, rather than the HIV virus, were its cause — are troubling to Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. But “I don’t know if he’s going to get confirmed or not,” he said. “If he does, we look forward to working with him and educating him.”

At the J.P. Morgan Healthcare conference earlier this month, Emma Walmsley, CEO of GSK, a leading vaccine maker, said she’d “wait and see what the facts are” before predicting what Kennedy would do. Vaccines, she noted, are “not our biggest business.”

GSK is one of a handful of vaccine makers remaining on the U.S. market. That number could shrink further if the Trump administration and Congress undo a 1986 law that provided legal protection for vaccine makers — as Kennedy has advocated.

Virginia Tech Researchers Ask How Many Attempts It Takes to Quit Substance Abuse

Original post: Newswise - Substance Abuse Virginia Tech Researchers Ask How Many Attempts It Takes to Quit Substance Abuse

BYLINE: Leigh Anne Kelley

Relapse is common when someone is trying to quit, regardless of whether they’re giving up opioids or alcohol or cigarettes.

To better inform treatment, researchers with the Fralin Biomedical Research Institute at VTC’s Addiction Recovery Research Center wanted to better understand how the experience of quitting differed across substances. 

“When we talk about intervention for addiction, we know that we are far from the ideal model of treatment,” said Rafaela Fontes, a research scientist at the institute and first author on the study “Beyond the first try: How many quit attempts are necessary to achieve substance use cessation?”

For the study, “quitting” was based on a yes or no response to a survey question that asked whether participants still used a specific substance. Researchers noted that because substance use is a chronically relapsing disorder, the number of quit attempts reported might not be final, although for all participants across all substances, the average time in abstinence was more than seven years.

The work, scheduled for publication in the Feb. 1 issue of Drug and Alcohol Dependence, found that:

  • Substance use disorder is a chronically relapsing condition that often requires multiple quit attempts before successful abstinence.
  • The number of quit attempts varies by substance, with opioids and pain medication requiring significantly more attempts than all other substances.
  • Hallucinogens are less challenging to quit, requiring fewer attempts.
  • People who meet the criteria of having a more severe or longer history of substance use disorder might need more attempts before achieving abstinence.

“We treat addiction as an acute disorder, even though we know that it is a chronically relapsing condition,” Fontes said. “When we’re talking about addiction, we need to understand that it’s not one size fits all. There are some substances that are harder to quit than others and it’s not equally easy or equally hard for everyone. We cannot use the same strategy for everything because it might not work.”

The findings suggest that early intervention improves success and reduces relapses, according to Allison Tegge, corresponding author on the study and a research associate professor at institute.

“What makes this research stand out is that, not only did we consider the substance, but we asked additional questions to look at the individual experience in context,” Tegge said.

What they did

Researchers recruited study participants from the International Quit & Recovery Registry, a tool created to advance scientific understanding of success in overcoming addiction. Sponsored by the Fralin Biomedical Research Institute, it was developed by Professor Warren Bickel, an addiction expert who died in September. Bickel was an author and principal investigator on the substance use cessation research.

“These findings highlight the relevance of the registry and the work started by Dr. Bickel to understand addiction recovery,” Fontes said. “He was a visionary, and his registry continues to help us gain a deeper and better understanding of recovery trajectories.”

The study ultimately drew its findings from 344 registry participants who completed surveys on the substances they had used, the age of first use, the number of quit attempts, and current substance use. Only participants who reported successful abstinence from at least one substance were included.

Participants were asked which they had used 10 or more times: nicotine, alcohol, cannabis, cocaine, opioids, stimulants, prescription pain relievers, hallucinogens, anesthetics, tranquilizers, inhalants, or “other.” They also were asked about length and severity of use, based on criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

What they found

Participants reported more difficulty quitting pain medication and opioids, substances with high relapse rates and for which short-term treatment effectiveness is low. Both alcohol and stimulants had more quit attempts than cannabis, cocaine, hallucinogens, and nicotine.

Hallucinogens, which have a different clinical profile than other commonly misused substances, required fewer quit attempts. Researchers also found that tranquilizers had a substantially higher number of quit attempts than hallucinogens.

Notably, substances with a higher number of quit attempts were also those that can bring on severe physical symptoms of withdrawal, such as pain, nausea, and anxiety.

The researchers hope their work informs treatment, with a goal of avoiding high rates of relapse and readmission. “This information can help provide the necessary support for someone moving through recovery,” Tegge said.

Why it matters

The research corroborates the chronic nature of substance use disorder and expands on previous research by showing that the number of quit attempts varies depending on the substance.

Additionally, recognizing that it takes multiple attempts, and understanding how some substances may be more challenging to quit than others, is the first step. “If people in recovery knew the average number of attempts it might take to quit a particular drug, rather than see relapse as a failure they might view it as a step on the journey,” Tegge said. “Understanding that relapse is part of recovery can help people stay engaged.”

The challenges of substances’ physiological effects combined with individual circumstances allows treatment providers to create personalized plans. Knowing different factors that affect relapse can help inform interventions. 

In addition to helping inform providers, Fontes also hopes it helps people who are trying to quit. “Maybe they can see that failure is part of the process,” she said, “and think: ‘I just need to keep trying, and eventually I’m going to get there.’”

Authors

  • Rafaela Fontes, research scientist, Fralin Biomedical Research Institute at VTC
  • Allison Tegge, research associate professor, Fralin Biomedical Research Institute at VTC and Department of Basic Science Education, Virginia Tech Carilion School of Medicine
  • Roberta Freitas-Lemos, assistant professor, Fralin Biomedical Research Institute at VTC and Department of Psychology, College of Science
  • Daniel Cabral, postdoctoral associate, Fralin Biomedical Research Institute at VTC
  • Warren Bickel, professor, Fralin Biomedical Research Institute at VTC; Department of Psychology, College of Science; and psychiatry and behavioral medicine, Virginia Tech Carilion School of Medicine

DOI: 10.1016/j.drugalcdep.2024.112525

To participate in this research

  • Complete the questionnaire to see if you qualify to participate in the International Quit & Recovery Registry. Research is conducted online; the registry is worldwide.
  • If you live near Roanoke, consider participating in one of the Addiction Recovery Research Center’s studies. Complete the confidential online screening to see if you are eligible.