human services

A group of Democratic state governors has launched a new alliance aimed at coordinating their public health efforts.

They’re framing it as a way to share data, messages about threats, emergency preparedness and public health policy — and as a rebuke to President Trump’s administration, which they say isn’t doing its job in public health.

“At a time when the federal government is telling the states, ‘you’re on your own,’ governors are banding together,” Maryland Governor Wes Moore said in a statement.

The formation of the group touches off a new chapter in a partisan battle over public health measures that has been heightened by Health Secretary Robert F. Kennedy Jr.’s advisers declining to recommend COVID-19 vaccinations, instead leaving the choice to the individual.

Andrew Nixon, a spokesperson for the U.S. Department of Health and Human Services, said in an email that Democratic governors who imposed school closures and mask mandates, including for toddlers, at the height of the pandemic, are the ones who “destroyed public trust in public health.”

“The Trump Administration and Secretary Kennedy are rebuilding that trust by grounding every policy in rigorous evidence and Gold Standard Science – not the failed politics of the pandemic,” Nixon said.

The initial members are all Democrats

The Governors Public Health Alliance bills itself as a “nonpartisan coordinating hub,” but the initial members are all Democrats — the governors of 14 states plus Guam.

Among them are governors of the most populous blue states, California and New York, and several governors who are considered possible 2028 presidential candidates, including California’s Gavin Newsom, Illinois’ JB Pritzker and Maryland’s Moore.

The idea of banding together for public health isn’t new for Democratic governors. They formed regional groups to address the pandemic during Trump’s first term and launched new ones in recent months amid uncertainty on federal vaccine policy. States have also taken steps to preserve access to COVID-19 vaccines.

The new alliance isn’t intended to supplant those efforts, or the coordination already done by the Association of State and Territorial Health Officials, its organizers say.

A former CDC director is among the advisers

Dr. Mandy Cohen, who was CDC director under former President Biden and before that the head of the North Carolina Department of Health and Human Services, is part of a bipartisan group of advisers to the alliance.

“The CDC did provide an important backstop for expertise and support,” she said. “And I think now with some of that gone, it’s important for states to make sure that they are sharing best practices, and that they are coordinating, because the problems have not gone away. The health threats have not gone away.”

Other efforts have also sprung up to try to fill roles that the CDC performed before the ouster of a director, along with other restructuring and downsizing.

The Governors Public Health Alliance has support from GovAct, a nonprofit, nonpartisan donor-funded initiative that also has projects aimed at protecting democracy and another partisan hot-button issue, reproductive freedom.

Mulvihill and Stobbe write for the Associated Press.

It’s not my habit to preface my columns with “trigger alerts,” so this is a first:

If talking about circumcision makes you cringe, feel free to move along.

If, on the other hand, you wish to understand what Robert F. Kennedy Jr. was talking about during a White House meeting Oct. 9 when he tried to connect circumcision with autism, follow along with me.

The offhand reference to circumcision’s possible role in autism by Kennedy, Trump’s secretary of Health and Human Services, is part and parcel of Kennedy’s documented assault on science-based medicine.

His campaign encompasses attacks on COVID-19 vaccines, which have been shown over the years to have saved millions of people from death, hospitalization or long-term disability; his firing members of professional advisory boards at his agency and replacing them with anti-vaccine activists; his promotion of unproven “cures” for vaccine-preventable diseases; and his inaction in the face of a nationwide surge in cases of measles, a disease that was declared eliminated in the U.S. in 2000.

Let’s pause for a few words about the broader consequences of the erosion of our public health infrastructure. It not only exposes Americans to more disease and more serious disease, but has profound economic effects.

That’s true worldwide, but especially in the U.S., which spends much more per capita on healthcare than other developed countries, for lower results. Undermining the existing system for partisan ends won’t make the picture look any lovelier.

“The U.S. health disadvantage threatens the country’s global competitiveness and national security, as well as the hopes and prospects of future generations,” according to a 2021 paper from the Department of Health and Human Services, the agency that Kennedy now leads.

“U.S. employers depend on a healthy workforce to maximize productivity and minimize healthcare costs,” the paper stated. “Population health also affects the consumer market, whereby the demand for nonessential products and services suffers when families are struggling with illnesses and much of their disposable income is required for medical expenses.”

The chaos imposed on our public health system under the Trump administration only intensifies the damage.

On Friday, hundreds of employees at Kennedy’s agency, including the Centers for Disease Control and Prevention, abruptly received layoff notices. Some were hastily informed that their firings were erroneous, but the experience rattled the CDC, an agency tasked with overseeing the national response to seasonal respiratory illnesses at a time when those illnesses typically spike.

“The damage is beyond repair,” Demetre Daskalakis, who resigned as director of the National Center for Immunization and Respiratory Diseases, a unit of the National Institutes of Health, over conflicts with Kennedy, told CNN. “Crippling CDC, even as a ploy to create political pressure to end the government shutdown, means America is even less prepared for outbreaks and infectious disease security threats.”

That brings us back to Kennedy’s preoccupation with autism. He has claimed that the autism rate is on the rise due to “environmental toxins” such as childhood vaccinations and the use of Tylenol — or acetaminophen, its generic name — by mothers during pregnancy.

As I’ve reported, however, the roots of the increase in reported autism rates in recent decades are well understood: They have much to do with a broader definition of autism, which is widely described today as “autism spectrum disorder,” and with improved access to screening and diagnostic services by formerly overlooked groups such as Blacks, Hispanics and other nonwhite cohorts.

Kennedy’s comment about circumcision came during a White House Cabinet meeting. At first, he and Trump traded misconceptions they had previously aired about Tylenol use by pregnant women — Trump asserting that “obviously,” the rise in autism rates is “artificially induced” and adding, “I would say don’t take Tylenol if you’re pregnant, and … when the baby is born don’t give it Tylenol.”

That advice dismayed physicians, who say that fevers during pregnancy are a greater risk for the unborn and that acetaminophen is safer than alternative fever-reducing medicines.

Kennedy then injected circumcision into the discussion. “There’s two studies that show children who were circumcised early have double the rate of autism,” he said. “It’s highly likely because they were given Tylenol.”

Unsurprisingly, Kennedy’s remark got extensive play in the news media, prompting him to try walking it back via a tweet on X. Rather than accept responsibility for his confusing words, he responded with Bondi-esque truculence, writing: “As usual, the mainstream media attacks me for something I didn’t say in order to distract from the truth of what I did say.”

He even took arms against the Murdoch-owned New York Post, which posted its story with the headline, “RFK Jr. says Tylenol after circumcisions linked to autism,” and proceeded to debunk the claim.

In trying to clarify his point, however, Kennedy dug himself a deeper hole. According to his tweet, the two studies he was referring to at the cabinet meeting were a Danish study from 2015 and a non-peer-reviewed preprint posted online in August, which refers to the Danish paper. Kennedy mischaracterizes both.

Contrary to Kennedy’s implication, the Danish study did not address the use of acetaminophen (called “paracetamol” in the paper) in connection with circumcision. The reason, its authors wrote, was that “we had no data available on analgesics or possible local anesthetics used during ritual circumcisions in our cohort, so we were unable to address the paracetamol hypothesis directly.”

They did note, however, that the acetaminophen theory had only “limited empirical support.” In other words, evidence was lacking. Anyway, the Danish study was criticized — in the same journal that had published it — for its reliance on a very small sample of children.

As for the preprint, contrary to Kennedy’s description, it did not identify the Danish paper as offering “the most compelling ‘standalone’ evidence” for an autism-acetaminophen link. That language referred to three studies, one of which was the Danish paper. Of the other papers, one was based on later interviews with parents. The other was a study of the effects of acetaminophen on 10-day-old mice, not human children.

I asked Kennedy’s agency to clarify his claim and to explain the discrepancies between his words and the papers themselves, but received no reply.

To summarize, Robert F. Kennedy Jr., the nation’s top federal healthcare official, conjured up a connection between circumcision and autism via a relationship between circumcision and Tylenol that is unsupported by the research he cited. Indeed, the Danish paper describes the idea that boys undergoing circumcision invariably are given acetaminophen for pain as “a questionable assumption.”

In searching for empirical support for the acetaminophen theory, moreover, the Danish paper cited a 2010 paper funded by NIH that cautioned: “No evidence is presented here that acetaminophen in any way causes autism. … This hypothesis is largely based on multiple lines of often weak evidence.” Anyway, the paper was focused on a possible link between acetaminophen use and asthma, not autism.

Sadly, this sort of mischaracterization of research described as “a rigorous scientific framework” (RFK Jr.’s words) isn’t surprising coming from today’s Department of Health and Human Services. This is the agency, it may be recalled, that in May issued an “assessment” of the health of America’s children that cited at least seven sources that did not exist.

Nothing can stop unwary parents from relying on the judgment of Donald Trump or Robert F. Kennedy Jr. to make healthcare decisions for their infants and children. But they should be warned: They do so at their own and their offsprings’ risk.

WASHINGTON — The Trump administration is planning to remove nearly 700 Guatemalan children who had come to the U.S. without their parents, according to a letter sent Friday by Sen. Ron Wyden of Oregon, and the Central American country said it was ready to take them in.

The removals would violate the Office of Refugee Resettlement’s “child welfare mandate and this country’s long-established obligation to these children,” Wyden told Angie Salazar, acting director of the office within the Department of Health and Human Services that is responsible for migrant children who arrive in the U.S. alone.

“This move threatens to separate children from their families, lawyers, and support systems, to thrust them back into the very conditions they are seeking refuge from, and to disappear vulnerable children beyond the reach of American law and oversight,” the Democratic senator wrote, asking for the deportation plans to be terminated.

It is another step in the Trump administration’s sweeping immigration enforcement efforts, which include plans to surge officers to Chicago for an immigration crackdown, ramping up deportations and ending protections for people who have had permission to live and work in the United States.

Guatemalan Foreign Affairs Minister Carlos Martínez said Friday that the government has told the U.S. it is willing to receive hundreds of Guatemalan minors who arrived unaccompanied to the United States and are being held in U.S. facilities.

Guatemala is particularly concerned about minors who could age out of the facilities for children and be sent to adult detention centers, he said. The exact number of children to be returned remains in flux, but they are currently discussing a little over 600. He said no date has been set yet for their return.

That would be almost double what Guatemala previously agreed to. The head of the country’s immigration service said last month that the government was looking to repatriate 341 unaccompanied minors who were being held in U.S. facilities.

“The idea is to bring them back before they reach 18 years old so that they are not taken to an adult detention center,” Guatemala Immigration Institute Director Danilo Rivera said at the time. He said it would be done at Guatemala’s expense and would be a form of voluntary return.

The plan was announced by President Bernardo Arévalo, who said then that the government had a moral and legal obligation to advocate for the children. His comments came days after U.S. Homeland Security Secretary Kristi Noem visited Guatemala.

The White House and the Department of Health and Human Services did not immediately respond to requests for comment on the latest move, which was first reported by CNN.

Quoting unidentified whistleblowers, Wyden’s letter said children who do not have a parent or legal guardian as a sponsor or who don’t have an asylum case already underway “will be forcibly removed from the country.”

The idea of repatriating such a large number of children to their home country also raised concerns with activists who work with children navigating the immigration process.

“We are outraged by the Trump administration’s renewed assault on the rights of immigrant children,” said Lindsay Toczylowski, president and CEO of Immigrant Defenders Law Center. “We are not fooled by their attempt to mask these efforts as mere ‘repatriations.’ This is yet another calculated attempt to sever what little due process remains in the immigration system.”

Santana, Seitz and Gonzalez write for the Associated Press. Gonzalez reported from McAllen, Texas. AP writers Sonia Pérez D. in Guatemala City and Tim Sullivan in Minneapolis contributed to this report.

Regulation of psilocybin — the “magic” substance in psychedelic mushrooms — has been a hot-button issue for Californians in recent years, but repeated attempts by state lawmakers to allow medical use of the substance have floundered.

Now it seems change may come at the federal level.

The U.S. Department of Health and Human Services is weighing a petition sent earlier this month by the Drug Enforcement Administration to review the scientific evidence and consider easing restrictions.

Psilocybin is currently classified as a Schedule I narcotic, the most restrictive category under federal law, reserved for drugs “with a high potential for abuse” and “no currently accepted medical use.” The DEA is considering moving psilocybin into the less restrictive Schedule II tier, which includes drugs that are considered addictive or dangerous — including fentanyl and cocaine — but also have medical value.

Past efforts to allow for therapeutic use of psilocybin have largely stalled in the face of official intransigence and lack of political will, including in California, where state lawmakers’ efforts to decriminalize psilocybin and other psychedelic substances have failed multiple times.

Despite strict prohibition under both state and federal law, psilocybin is widely available and growing in popularity for both recreational and therapeutic purposes.

Illegal cannabis dispensaries across Southern California openly sell actual psilocybin mushrooms, as well as dodgy chocolates and gummies that often purport to contain the substance but instead contain only synthetic versions. In recent decades, a growing body of research has found that psilocybin can be beneficial in treating mental health conditions including depression, anxiety and substance use disorder.

The issue of psychedelic access is high on the agenda of Robert F. Kennedy Jr., Trump’s controversial and conspiracy-minded secretary of Health and Human Services. Kennedy has signaled support in the past for expanding access to some hallucinogens in medical settings for treatment of mental health disorders.

Kennedy’s agency directed all inquiries to the DEA, which said in an email that it is “unable to comment on or confirm scheduling actions.”

The DEA sent the psilocybin petition after a drawn-out legal battle led by Dr. Sunil Aggarwal. For about five years, Aggarwal, co-director of the Advanced Integrative Medical Science Institute in Seattle, has been seeking a means to legally obtain and administer psilocybin to ailing and aging patients for care during the final phases of their lives.

Kathryn L. Tucker, a lawyer for Aggarwal, wrote a letter to the DEA this month that said he “continues to provide care to patients with advanced and terminal cancer who could benefit greatly from psilocybin assisted therapy, enabling them to experience a more peaceful dying process.”

“The science supports movement to schedule II; such placement will enable access under Right to Try laws, which contemplate early access to promising new drugs for those with life-threatening conditions,” Tucker wrote.

Aggarwal filed a lawsuit after his 2020 petition to reschedule psilocybin was denied. A federal panel dismissed the suit, but the move toward rescheduling continues now that the DEA has officially forwarded his petition to the Department of Health and Human Services.

But some researchers and other experts caution against moving too fast to expand access.

Dr. Steven Locke, a former Harvard Medical School psychiatry professor, wrote in an email that the question of whether psilocybin has any medical applications “remains controversial.” A past president of the American Psychosomatic Society, Locke has studied rare conditions such as Hallucinogen Persisting Perception Disorder, which cause symptoms akin to long-lasting “bad trips” in a small percentage of people who use psilocybin mushrooms and other psychedelics.

“There is little evidence from good-quality studies to support claims for the efficacy of the use of psilocybin for the treatment of any medical disorders,” said Locke. “The reclassification should be contingent on a careful review.”

McALLEN, Texas — A federal judge ruled Friday to deny the Trump administration’s request to end a policy in place for nearly three decades that is meant to protect immigrant children in federal custody.

U.S. District Judge Dolly Gee in Los Angeles issued her ruling a week after holding a hearing with the federal government and legal advocates representing immigrant children in custody.

Gee called last week’s hearing “deja vu” after reminding the court of the federal government’s attempt to terminate the Flores settlement agreement in 2019 under the first Trump administration. She repeated the sentiment in Friday’s order.

“There is nothing new under the sun regarding the facts or the law. The Court therefore could deny Defendants’ motion on that basis alone,” Gee wrote, referring to the government’s appeal to a law it argued kept the court from enforcing the agreement.

In the most recent attempt, the government argued it had made substantial changes since the agreement was formalized in 1997, creating standards and policies governing the custody of immigrant children that conform to legislation and the agreement.

Gee acknowledged that the government made some improved conditions of confinement, but wrote, “These improvements are direct evidence that the FSA is serving its intended purpose, but to suggest that the agreement should be abandoned because some progress has been made is nonsensical.”

Attorneys representing the federal government told the court the agreement gets in the way of their efforts to expand detention space for families, even though President Trump’s tax and spending bill provided billions to build new immigration facilities.

Tiberius Davis, one of the government attorneys, said the bill gives the government authority to hold families in detention indefinitely. “But currently under the Flores settlement agreement, that’s essentially void,” he said last week.

The Flores agreement, named for a teenage plaintiff, was the result of more than a decade of litigation between attorneys representing the rights of migrant children and the U.S. government over widespread allegations of mistreatment in the 1980s.

The agreement set standards for how licensed shelters must provide food, water, adult supervision, emergency medical services, toilets, sinks, temperature control and ventilation. It also limited how long U.S. Customs and Border Protection could detain child immigrants to 72 hours. The U.S. Department of Health and Human Services then takes custody of the children.

The Biden administration successfully pushed to partially end the agreement last year. Gee ruled that special court supervision may end when Health and Human Services takes custody, but she carved out exceptions for certain types of facilities for children with more acute needs.

In arguing against the Trump administration’s effort to completely end the agreement, advocates said the government was holding children beyond the time limits. In May, CBP held 46 children for more than a week, including six children held for over two weeks and four children held for 19 days, according to data revealed in a court filing. In March and April, CPB reported that it had 213 children in custody for more than 72 hours. That included 14 children, including toddlers, who were held for over 20 days in April.

The federal government is looking to expand its immigration detention space, including by building more centers like one in Florida dubbed “Alligator Alcatraz,” where a lawsuit alleges detainees’ constitutional rights are being violated.

Gee still has not ruled on the request by legal advocates for the immigrant children to expand independent monitoring of the treatment of children held in U.S. Customs and Border Protection facilities. Currently, the agreement allows for third-party inspections at facilities in the El Paso and Rio Grande Valley regions, but plaintiffs submitted evidence showing long detention times at border facilities that violate the agreement’s terms.

Gonzalez writes for the Associated Press.

WASHINGTON — The Supreme Court cleared the way Tuesday for the Trump administration to lay off tens of thousands of federal employees and downsize their agencies without seeking the approval of Congress.

In an 8-1 vote, the justices lifted an order from a federal judge in San Francisco who blocked mass layoffs at more than 20 departments and agencies.

The court has sided regularly with President Trump and his broad view of executive power on matters involving federal agencies.

In a brief order, the court said “the Government is likely to succeed on its argument that the Executive Order and Memorandum are lawful,” referring to the plans to reduce staffing. But it said it was not ruling on specific layoffs.

Justice Sonia Sotomayor concurred with the decision on the grounds that it was narrow and temporary.

Dissenting alone, Justice Ketanji Brown Jackson said the court should not have intervened.

“Under our Constitution, Congress has the power to establish administrative agencies and detail their functions,” she wrote.

Since mid-April, the court has handed down a series of temporary orders that cleared the way for Trump’s planned cutbacks in funding and staffing at federal agencies.

Litigation will continue in the lower courts, but the justices are not likely to reverse course and rule next year that they made a mistake in allowing the staffing cutbacks to proceed.

The layoff case posed the question of whether Congress or the president had the authority to downsize agencies.

U.S. District Judge Susan Illston in San Francisco said Congress, not the president, creates federal agencies and decides on their size and their duties.

“Agencies may not conduct large-scale reorganizations and reductions in force in blatant disregard of Congress’s mandates, and a president may not initiate large-scale executive branch reorganization without partnering with Congress,” she said on May 22.

Her order barred more than 20 departments and agencies from carrying out mass layoffs in response to an executive order from Trump.

They included the departments of Commerce, Energy, Health and Human Services, Housing and Urban Development, Interior, Labor, State, Treasury, Transportation and Veterans Affairs as well as the Environmental Protection Agency, the General Services Administration and the National Science Foundation.

She said the planned layoffs are large. The Health and Human Services department plans to cut 8,000 to 10,000 employees and the Energy Department 8,500. The Veterans Administration had planned to lay off 83,000 employees but said recently it will reduce that number to about 30,000.

Labor unions had sued to stop the layoffs as illegal.

Illson agreed that the agencies were not acting on their own to trim their staffs. Rather, Trump’s Office of Management and Budget under Russ Vought was leading the reorganization and restructuring of dozen of agencies. She said only Congress can reorganize agencies.

The U.S. 9th Circuit Court of Appeals, by a 2-1 vote, turned down the administration’s appeal of the judge’s order.

Appealing to the Supreme Court, Trump’s lawyers insisted the president had the full authority to fire tens of thousands of employees.

“The Constitution does not erect a presumption against presidential control of agency staffing,” Solicitor Gen. D. John Sauer said in his appeal, “and the President does not need special permission from Congress.”

He said federal law allows agencies to reduce their staffs.

“Neither Congress nor the Executive Branch has ever intended to make federal bureaucrats a class with lifetime employment, whether there was work for them to do or not,” Sauer wrote.