An ethics fight over a hepatitis B trial in newborns, a critical report card on federal health policy, and new money and data in aging research.
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A US-funded trial would delay the hepatitis B birth dose for half of 14,000 Guinea-Bissau newborns; four Danish ethics committee members have resigned. story 2 ↓
Lifestyle explains about a fifth of the wealth–health gap, while dog and mouse studies link aging to jumping genes and worn-out immune cells. story 1 ↓
A Protect Our Care report says Kennedy's HHS rolled back chemical safety reviews, cancelled research grants and weakened a mercury rule. story 3 ↓
Internist Adam Cifu explains why patients quietly stop coming, from insurance churn to death, and why doctors rarely learn the reason. story 4 ↓
The new Second Century Foundation launches with an investor memo on longevity biotech, a map of research funding and a free lifespan simulator. story 5 ↓
The Justice Department told health care executives at the STAT Summit it is stepping up fraud investigations: "Don't be another Theranos."
1/5Fight Aging!· Reason· Oct 18
Aging research roundup: lifestyle explains about a fifth of the wealth–health gap
In a 20-year study of 33,541 older Chinese adults, healthy habits accounted for only 16–21% of poorer people's higher death risk. Other new studies, mostly in animals, focus on cell cleanup and DNA control.
Why it matters · It separates the few results with human or large-cohort data from the many mouse studies and reviews, so you can judge how far each one is from patients.
Know this first
Context from the editor, not the article · 31 sec
1 · Senescent cells
Cells that permanently stop dividing after damage or too many divisions. They release inflammatory signals called the SASP. The young immune system clears them. In old age they build up and harm tissue, which makes them a major target for anti-aging drugs.
2 · Epigenetic clocks
With age, chemical tags called methyl groups are added to or lost from DNA in predictable places. Measuring those tags gives a 'biological age'. If someone's clock age runs ahead of their real age, that usually predicts worse health.
3 · Evidence tiers here
Fight Aging! is an advocacy blog, run by Reason, that summarizes papers. Most items this week are mouse studies or literature reviews. Only the Chinese cohort and the brain-imaging study involve humans, and both are observational.
2/5Science-Based Medicine· Jonathan Howard· Oct 15
Neurologist compares a planned hepatitis B vaccine trial in Guinea-Bissau to Tuskegee
Danish researchers plan a CDC-funded trial that would withhold the proven hepatitis B birth vaccine from 7,000 newborns in Guinea-Bissau for six weeks. Neurologist Jonathan Howard argues this repeats the central wrong of Tuskegee.
Why it matters · Officials who champion this trial are also cutting US vaccine recommendations. Its design shows how a demand to re-test a proven vaccine can put children at real risk.
Know this first
Context from the editor, not the article · 28 sec
1 · The Tuskegee syphilis study
From 1932 to 1972 the US Public Health Service followed about 400 Black men with syphilis and withheld treatment, even after penicillin became standard. More than 100 died. A leak to the press ended it.
2 · Hepatitis B in newborns
About 90% of babies infected at birth develop chronic hepatitis B, and 25–40% of them later die early of cirrhosis or liver cancer. A vaccine dose in the first day of life prevents most of these infections.
3 · When placebo arms are ethical
Research ethics generally forbid randomizing people away from a proven effective treatment. Withholding it from a control group is accepted only when it is genuinely uncertain which arm is better, a condition called equipoise.
3/5Food Politics (Marion Nestle)· Marion· Oct 16
Advocacy report says Trump and Kennedy broke "Make America Healthy Again" promises
Nutrition scholar Marion Nestle points readers to a report from the advocacy group Protect Our Care. It argues the Trump administration has weakened chemical, pesticide and pollution protections despite Robert F. Kennedy Jr.'s "Make America Healthy Again" pledges.
Why it matters · Federal decisions on chemical safety reviews, mercury limits and environmental-health research funding affect what people are exposed to, and what scientists are able to study, for years.
Know this first
Context from the editor, not the article · 25 sec
1 · What MAHA is
Make America Healthy Again (MAHA) is the movement around Robert F. Kennedy Jr., now US Health Secretary. It promised to curb food additives, pesticides and industrial chemicals it blames for chronic disease, especially in children.
2 · The MAHA Commission
Created by executive order in 2025 and chaired by Kennedy, the commission brings together cabinet officials, among them Environmental Protection Agency head Lee Zeldin, to set federal policy on chronic disease.
3 · Who is speaking
Marion Nestle is a nutrition professor emerita at New York University who writes the Food Politics blog. Protect Our Care is a progressive health-policy advocacy group, not a neutral research body.
4/5Sensible Medicine· Adam Cifu, MD· Oct 16
An internist on patients who quietly stop coming
Chicago internist Adam Cifu updates a 2023 essay about his "ghost patient panel": people who left his practice without telling him. He argues that their silence leaves doctors badly misjudging how satisfied patients are. It's reflection, not research.
Why it matters · Whether a patient keeps the same doctor over time affects their care. This essay shows how insurance churn and lack of feedback quietly break that continuity, and why doctors rarely notice.
Know this first
Context from the editor, not the article · 27 sec
1 · What a patient panel is
In primary care, a doctor's panel is the group of patients they're responsible for over time. Continuity, meaning seeing the same doctor year after year, is widely valued, and observational studies link it to better outcomes.
2 · Why US patients switch doctors
Most working-age Americans get insurance through their jobs or Medicaid, so a new job or a change in eligibility can push a patient out of a doctor's network. Medicare, which starts at 65, is far more stable.
3 · Electronic health records
An electronic health record (EHR) is the software that holds patients' charts. It can produce automatic lists such as "My Patients". Those lists often still include people who stopped coming long ago.
5/5Fight Aging!· Reason· Oct 13
New nonprofit, Second Century Foundation, launches to push money toward aging research
A new US charity, Second Century Foundation, says it will fund longevity work that government grants and venture capital skip. So far it has produced advocacy and analysis tools, not research results.
Why it matters · How money flows into aging research decides which therapies ever reach trials, and new groups are trying to change that flow.
Know this first
Context from the editor, not the article · 28 sec
1 · Treating aging itself
Geroscience is the idea that slowing the biology of aging would delay many diseases at once, like heart disease, cancer and dementia. Regulators don't currently recognize aging as a disease, which makes drug trials and funding harder.
2 · Two main funding channels
Most US biomedical research is paid for by NIH grants, which reward work that leads to publications, or by venture capital, which expects a company sale or stock listing in roughly 7–10 years. Work that fits neither model often goes unfunded.
3 · Fight Aging! as a source
Fight Aging! is a long-running advocacy blog written by "Reason," who openly supports more spending on aging research. This post is mostly a quoted launch announcement with a short, approving introduction.
This week's Fight Aging! newsletter covers 15 papers. Only a few involve people, and those are observational. Here they are, roughly from strongest evidence to weakest.
Lifestyle explains only part of the wealth gap
A 20-year study followed 33,541 Chinese adults aged 65 or older. Compared with people of high socioeconomic status (SES: education, finances, occupation), those with low SES had a 1 of 1.25 for death. That means about 25% higher risk at any point in time. Their hazard ratio for "unhealthy ageing" (decline in physical, cognitive, mental, vision or hearing function) was 1.46.
A 2 estimates how much of a link runs through a third factor. It found that four healthy habits (not smoking, no heavy drinking, staying active, a healthy diet) explained only 20.5% of the mortality gap and 16.4% of the unhealthy-ageing gap. Comparing the healthiest and least healthy lifestyles at 65, the gain in life expectancy was 3.18 years for low-SES people and 5.65 for high-SES people. The gain in healthy years was 1.40 versus 3.90. Habits help at every level, but less for poorer people. This is observational data, and Reason notes that pollution, infections and access to care are other likely causes.
Big dogs, faster epigenetic aging
Researchers used the 3, a study of pet dogs, to analyze DNA methylation tags in 894 dogs. They built "4" with a median error of 0.82 years, and dogs with older-than-expected clock ages died sooner. Larger dogs lost methylation 31% faster at 5. These are self-copying DNA left over from ancient viruses, normally kept silent, which can cause inflammation when active. The effect was largest in young 6, the most active family.
Why old immune cells miss senescent cells
Senescent cells are damaged cells that stop dividing and release inflammatory signals. A mouse study looked at 7, a cleanup system in which a chaperone protein brings tagged proteins into the 8 to be broken down. In aged senescent cells, CMA declines and their signals then suppress CMA in 9, the immune cells that should engulf them. Blocking macrophage CMA led to more senescent cells. A CMA-activating drug reduced senescent cells in old mice and lessened lung fibrosis.
The rest
Blocking a microRNA, miR-128-3p, restored muscle in aged mice. Elenae Therapeutics is developing the approach.
Brain scans of more than 1,100 people show Alzheimer's and normal aging change brain connectivity along separate axes.
Reviews covered the gut microbiome (centenarians have more Akkermansia), vascular aging, stem-cell microRNAs and bone-joint disease. All are hypothesis-stage.
This week's Fight Aging! newsletter, written by the blog's founder Reason, summarizes 15 recent papers. Few of them say anything about patients yet. Two use human data, both observational. One draws on almost 900 pet dogs. The rest are mouse experiments or literature reviews. Below they are sorted by how strong the evidence is.
How much of the wealth–longevity gap is lifestyle?
Researchers followed 33,541 adults aged 65 or older across 23 Chinese provinces for 20 years. They used latent class analysis, a statistical way of sorting people into groups, to place participants into low, medium or high socioeconomic status (SES) based on education, finances and occupation. Each person got a lifestyle score built from four habits: never smoking, no heavy drinking, regular physical and leisure activity, and a healthy diet.
People with low SES did worse than those with high SES. Their 1 for death from any cause was 1.25, meaning about 25% higher risk at any given time after adjustment. For "unhealthy ageing" (decline in physical, cognitive, mental, visual or hearing function) the hazard ratio was 1.46.
The authors then ran a 2. This method estimates how much of the link between two things (here SES and health) passes through a third (lifestyle). Lifestyle accounted for 20.5% of the SES gap in mortality and 16.4% of the gap in unhealthy ageing. Most of the gap, then, comes from something else. Reason lists air pollution, chronic infections and access to medical care as candidates. He also warns that studies of this kind rarely settle questions of cause.
The life-expectancy results stand out. At age 65, comparing the healthiest lifestyle group with the least healthy within each SES level:
SES
Extra total life expectancy
Extra healthy life expectancy
Low
3.18 years
1.40 years
Medium
3.76 years
2.73 years
High
5.65 years
3.90 years
Good habits are linked to longer life at every income level. But the payoff is smaller for poorer people, especially in healthy years. The study is observational: people who keep good habits differ in other ways too, and habits were self-reported.
Big dogs age faster epigenetically
Large dog breeds live much shorter lives than small ones. Using the 3, a long-running study of pet dogs, researchers produced 1,640 methylomes from 894 dogs. A methylome is a map of methylation tags across the genome. From these they built DNA-methylation age predictors, or "4", with a median error of 0.82 years. Dogs whose clock age was higher than their real age were more likely to die, which suggests the clock measures real biological variation.
Larger dogs, males and younger dogs showed faster epigenetic aging. The clearest size effect was in 5 (TEs). These are DNA stretches, left over from ancient viral infections, that can copy themselves around the genome and are normally kept silent by methylation. With age, TEs lose methylation in all dogs. In larger dogs that loss was 31% stronger. The effect was largest in young 6, the most recently evolved and most active family of copying elements. Reason links this to a separate review in the same issue. It argues that active TEs make virus-like products that set off innate immune alarms and type I interferon inflammation. Proposed ways to suppress them include nucleoside reverse transcriptase inhibitors (a class of HIV drugs), 7 and epigenetic drugs.
Why old immune cells stop clearing senescent cells
A mouse paper looks at 8, one of the cell's selective cleanup systems. Here is how it works. A chaperone protein, HSC70, recognizes a short tag (the KFERQ-like motif) on a protein that is due for disposal. It brings that protein to a receptor, LAMP2A, on the 9, the cell's recycling compartment. LAMP2A molecules then join into a channel that pulls the protein inside to be broken down. CMA weakens with age in most tissues.
The authors found that senescent cells lacking CMA look like aged senescent cells. Their secreted signals (the SASP) push neighboring cells into senescence. They also suppress CMA in 10, the immune cells that engulf debris, and this impairs the macrophages' ability to swallow senescent cells. Blocking CMA only in macrophages led to more senescent cells in mice and slowed their clearance during wound healing. A CMA-activating drug lowered senescent-cell burden in aged mice and reduced disease severity in a mouse model of pulmonary fibrosis. The summary does not give effect sizes. The point is mechanistic: both the old senescent cell and the old immune cell contribute to the failure.
Other mouse results
miR-128-3p. MicroRNAs are short RNAs that turn down sets of genes. Blocking this one with an antisense oligonucleotide (a short synthetic strand that binds it) restored muscle mass and function in aged mice. It also improved heart function after heart attack in mice and reduced muscle damage in mouse and pig models of Duchenne muscular dystrophy. Elenae Therapeutics is developing it, starting with heart indications. Reason notes that interest in preventing muscle loss on GLP-1 drugs is drawing funding into this area.
Dental pulp stem cell secretome. These are the factors secreted by stem cells from teeth. In a mouse stroke model they reduced infarct size and improved motor coordination and memory.
New geroprotectors. A screen in worms found that some age-linked gene-expression changes are adaptive. It identified seven new lifespan-extending compounds. Reason expects most such hits to trigger the same stress responses as known compounds.
Human brain imaging
In two cohorts, BioFINDER-2 (973 people) and the Alzheimer's Disease Neuroimaging Initiative (129), normal aging and Alzheimer's changed functional connectivity along different, orthogonal axes. Functional connectivity is how closely activity in different brain regions rises and falls together. Alzheimer's changes ran along a sensory–association axis and normal aging along a representation–executive axis. So Alzheimer's is not simply faster brain aging.
Reviews worth knowing about
A systematic review of 41 gut-microbiome studies, 58.5% of which used 16S rRNA sequencing (a cheap genus-level census). Centenarians consistently had more Akkermansia, Alistipes and Parabacteroides.
A review of 37 animal studies on microRNAs derived from mesenchymal stem cells in Parkinson's, Alzheimer's and stroke. Reason notes that human trials of these cell therapies have given mixed results.
A vascular-aging review. It notes that the senolytic combination dasatinib plus quercetin improved blood-vessel dilation in aged mice. Reason argues that regulators still need large trials before cheap senolytics can be used.
A review proposing immune aging as a shared driver of osteoporosis and osteoarthritis. Its own authors say the evidence is not yet enough to call it causal.
Also new: the Second Century Foundation, a nonprofit that plans to fund longevity work that neither the NIH nor venture capital will back.
Remember
Healthy habits were linked to 1.4 extra healthy years for low-SES older adults, versus 3.9 for high-SES.
Big dogs lost silencing marks on self-copying DNA 31% faster with age than small dogs.
In mice, failure to clear senescent cells comes from both the aged senescent cells and the aged macrophages.
A man in a light blue shirt draws blood from a man in a hat, a school bus behind them.
A trial funded by the US 1 (Centers for Disease Control and Prevention) would withhold the hepatitis B vaccine from half of 14,000 newborns in Guinea-Bissau for their first six weeks. Jonathan Howard, a neurologist and psychiatrist, argues in Science-Based Medicine that this repeats the central wrong of the 2: withholding a proven treatment for the sake of research. This is an opinion piece built on news reports and published reviews.
A proven vaccine
The case for the birth dose rests on decades of data. About 90% of babies born to infected mothers become infected, and 25–40% of them later die early of cirrhosis or liver cancer. The US has recommended the vaccine for every newborn since 1991. Since then, mother-to-child transmission has fallen 94–98%. The dose is given at birth because screening is patchy: only 82–86% of pregnant people are tested, so millions of infants a year are born to mothers who were never screened. A review of trials, cohort studies and safety surveillance found the vaccine safe at all ages.
The trial
Researchers from the University of Southern Denmark would test mothers before birth and enroll only babies whose mothers test negative. Critics, including infectious-disease physician Paul Offit, say that does not make the trial safe. About half of childhood infections in earlier research happened after birth, through household contact, and the test misses about 5% of infections. Offit argues the trial could never be approved in the US.
Stig Børsen Hansen, one of two reviewers who presented the study to the Danish ethics committee, resigned after it was approved. "You are now enrolling newborns in a lottery to test a hypothesis," he said. Three other members also quit. After several reversals, Guinea-Bissau's health authorities are now refusing to take part.
The researchers
The lead investigators, Christine Stabell Benn and Peter Aaby of the Bandim Health Project, have long claimed that vaccines have "non-specific" effects beyond their target disease. Robert F. Kennedy Jr., the US health secretary, praises their work. Danish authorities are investigating the pair over alleged misconduct. One paper reports that it could not find primary-outcome results for 10 of their trials. A Danish review found that their randomized trials did not demonstrate the effects they claimed. Benn disputes the criticism.
The cost comparison
The CDC budgeted $1.6 million for the study. Vaccinating every newborn in Guinea-Bissau would cost about $13,200 a year.
Howard does not set out the researchers' own case for the trial, and the revised protocol is not public.
Jonathan Howard, a neurologist and psychiatrist, writes in Science-Based Medicine about a trial planned for Guinea-Bissau. Half of the newborns enrolled would not get the hepatitis B vaccine for their first six weeks. Howard argues that the trial repeats the core wrong of the 1: holding back a proven treatment for a serious infection for the sake of "research." He also argues that the people who normalized the "2" (MAHA) movement around US health secretary Robert F. Kennedy Jr. share the blame for it. This is an opinion piece. Its factual claims come mostly from news reports and published reviews that Howard quotes.
Why the birth dose exists
Howard bases his case on the vaccine's track record, which goes back decades. The first hepatitis B vaccine, Heptavax, was made from blood plasma and approved by the FDA (Food and Drug Administration) in 1981. Recombinant vaccines, which are produced in yeast, followed: Recombivax HB in 1986 and Engerix-B in 1989. At first the US gave the vaccine only to high-risk groups. That approach did not reduce overall infection rates, partly because 35–65% of mothers who tested positive for 3 (hepatitis B surface antigen, the marker of infection) had no identifiable risk factor.
Babies are the main concern. About 90% of infants born to infected mothers become infected themselves, and an estimated 25–40% of them die early in adulthood of cirrhosis or hepatocellular carcinoma, a type of liver cancer. In 1991 the 4 (Centers for Disease Control and Prevention) and the American Academy of Pediatrics recommended the vaccine for every newborn. Since then, mother-to-child ("5") transmission in the US has fallen by 94–98%.
The dose is given at birth, without waiting for the mother's test result, because prenatal screening misses many infections. The review Howard quotes says only 82–86% of pregnant people are screened, and only 35% of those who test positive get all the recommended follow-up care. That leaves 2.9–3.1 million infants a year born to mothers who were never screened, and the universal birth dose covers them. A review of randomized trials, cohort studies, national vaccine-safety surveillance and 6 analyses (a standard method for rating the strength of evidence) found the vaccine safe and well tolerated at all ages.
The proposed trial
Reporting by Melody Schreiber, which Howard quotes, describes the design. Researchers from the University of Southern Denmark would enroll 14,000 infants in Guinea-Bissau, a country where hepatitis B is very common. Half would get the vaccine at birth. The other half would get nothing for six weeks. The trial was revised so that mothers are now tested before delivery. Babies of mothers who test positive are vaccinated and left out of the trial, and only babies of mothers who test negative can be enrolled. The revised protocol has not been made public. The CDC planned to spend $1.6 million on the study.
Critics say testing the mothers first does not close the gap, for two reasons:
Infections after birth. In earlier research, about half of children who caught hepatitis B did so after birth, from people around them. Paul Offit, an infectious-disease physician at Children's Hospital of Philadelphia, notes that the virus can survive on surfaces for up to seven days and can spread through shared washcloths, toothbrushes and nail clippers.
False negatives. The test misses about 5% of infections, so some infected mothers would be wrongly cleared.
Here is an illustrative calculation, not one from the article. With 7,000 unvaccinated babies and a 5% false-negative rate, even a small share of mothers who are actually infected would mean that some of those babies are born to infected mothers and left unprotected during the period when infection is most likely to become lifelong.
Stig Børsen Hansen helped found the Danish ethics committee and was one of two reviewers who presented the study to it. He resigned after the committee voted to approve. "You are now enrolling newborns in a lottery to test a hypothesis," he said. Any infections in the control group would happen "by design." Three other committee members also resigned. Offit argues that the trial could never be approved in the US and asks whether "children in Africa are more expendable." Other experts have called it "neo-colonialist" and "horribly unethical."
Guinea-Bissau's health minister, Quinhin Nantote, said earlier this year that the trial was suspended after international criticism, then approved it. According to Howard's latest update, Guinea-Bissau's health authorities are now refusing to take part. The trial's status has changed several times, including within the past week.
The researchers
The lead investigators, Christine Stabell Benn and Peter Aaby, run the Bandim Health Project. For decades it has studied "7" in West Africa: the idea that vaccines also protect against, or cause, illnesses other than the one they target. Kennedy has praised this work and says it shows "catastrophic injuries" from vaccines "hiding in plain sight."
Howard cites three problems with the group:
An official investigation. Danish authorities are investigating Benn and Aaby over allegations of falsification and scientific misconduct in earlier vaccine research.
Missing results. A paper in the journal Vaccine reports that the authors could not find complete data on the 8, the results a trial is designed to measure, for 10 of the group's studies, which together enrolled tens of thousands of children. Epidemiologist Evan Mayo-Wilson called failing to report primary results "a red flag." Benn says the paper is "substantially flawed."
What it costs to just vaccinate
Kamal Delawalla, chief executive of the nonprofit Stand Up for Science, estimates that buying vaccine through Unicef and Gavi (an international vaccine-purchasing alliance) to cover every newborn in Guinea-Bissau would cost about $13,200 a year. That is less than 1% of the trial's $1.6 million budget. The shot itself costs about 20 cents.
What the piece leaves open
Howard does not lay out the researchers' own case for the trial. He mentions only their claims that it is "ethical, feasible, practical" and that many physicians misunderstand trial ethics. He also does not say what result they expect or what outcome the trial would measure. Readers would need the protocol to judge the scientific question, and it is not public. Howard's strongest point is the standard rule of research ethics: when an intervention is proven to work, randomizing infants away from it needs real uncertainty about which arm is better, and decades of data leave little room for that.
Remember
Only babies of mothers who test negative would be enrolled, but about half of childhood infections in earlier research were caught after birth.
Four Danish ethics committee members resigned after the committee approved the trial.
The lead researchers are under a Danish misconduct investigation and have reported no primary-outcome results for 10 trials.
Marion Nestle, a nutrition scholar who writes the Food Politics blog, is recommending a new report from 1, a progressive health advocacy group. The report is called MAHA Betrayed. It argues that President Trump and Health Secretary Robert F. Kennedy Jr. have abandoned the promises of 2, the movement that pledged to take on the food, agriculture and chemical industries.
What the report claims
The report says that a year into Kennedy's tenure, "cancer-linked chemicals [are] back on the market," food safety agencies have been cut back, grocery prices are higher, and even the movement's founders feel sidelined. It groups its complaints into chemicals, pesticides and what it calls 3, meaning regulators serving the industries they oversee. It says women are especially affected.
Nestle quotes one section as an example. It claims that:
The 4 dropped plans to publish a MAHA agenda.
The 5 stopped accepting submissions to its flagship environmental-health journal and withdrew research grants.
EPA scientists were pressured to change safety reviews of chemicals in household cleaners and cosmetics so the risks looked smaller than the data showed.
At a chemicals summit, Kennedy praised an Oregon State University microplastics study. An hour earlier, the researcher had learned that EPA had cancelled the grant paying for it.
Mercury
The report puts weight on mercury. As an environmental lawyer, Kennedy sued over mercury pollution and has said that mercury-contaminated fish gave him "word retrieval and memory problems." EPA announced its rollback of mercury emissions rules the day after the first meeting of the 6, the cabinet-level body that Kennedy and EPA Administrator Lee Zeldin both sit on. Kennedy has not objected in public.
The report also cites earlier work by Protect Our Care and Climate Power. That work counts 31 pollution protections the administration has eliminated. It says that together they were expected to deliver $275 billion a year in benefits and prevent 30,000 deaths a year.
How much weight to give it
This is advocacy, not a study. Nestle's post doesn't say where the $275 billion and 30,000-death figures come from. Estimates like these usually come from the government's own 7, which rest on modelling assumptions. The claim that scientists were pressured is the report's allegation, and the post doesn't detail the evidence behind it. Nestle, who has long criticised industry influence on food policy, calls the list of broken promises "long, alas." The post itself is only a pointer: the documentation is in the full report.
Marion Nestle is a nutrition professor emerita at New York University who has written for decades about industry influence on food policy. On her Food Politics blog this weekend she recommends MAHA Betrayed: Trump, RFK Jr. Keep Selling Out Movement to Corporate Polluters and Poison Peddlers, a report from the advocacy group 1. She calls it "the most complete analysis yet" of how the Trump administration has handled its 2 promises, and "a devastating report card."
Her post is short. It quotes the report and links to it, so most of what follows is the report's case as she presents it, not independent findings.
The promise and the charge
MAHA is the movement built around Robert F. Kennedy Jr., now Secretary of Health and Human Services. Its central claim is that chronic disease, especially in children, is driven partly by food additives, pesticides and industrial chemicals that regulators have allowed. Kennedy's appeal to the movement rested on a promise to confront what the report calls "Big Food, Big Ag, and Big Chemical."
Protect Our Care is a progressive health-policy group. It argues that the administration has instead delivered "a steady diet of broken promises, corporate quid pro quos, and foodborne illnesses." By its account, a year into Kennedy's tenure, "cancer-linked chemicals [are] back on the market, food safety agencies [are] gutted, families [are] paying more for groceries," and even MAHA's founders wonder whether they have been "put out to political pasture." The report sorts its charges into chemicals, pesticides and 3, meaning regulators acting in the interest of the industries they oversee. It singles out effects on women, though Nestle's excerpt doesn't explain that part.
The example Nestle quotes
Nestle reproduces one section, headed "Kennedy Stays Silent While EPA Betrays MAHA on Toxic Chemicals." It makes four claims:
Mercury as the sharpest contrast
The report spends the most time on mercury because of Kennedy's own history with it. Mercury is a neurotoxin. Coal-fired power plants emit it, it builds up in fish, and people mostly take it in by eating seafood. As an environmental attorney, Kennedy sued over mercury pollution. He has said that eating mercury-tainted fish gave him "word retrieval and memory problems."
EPA announced a rollback of its mercury emissions rules the day after the 6 held its first meeting. The commission is a cabinet-level body that Kennedy and EPA Administrator Lee Zeldin both sit on. The report's point is that Kennedy said nothing about the rollback. It doesn't claim he endorsed it.
The report also cites earlier work by Climate Power and Protect Our Care. That work says the administration has eliminated 31 pollution protections that together were set to deliver $275 billion a year in benefits and prevent 30,000 deaths a year.
Reading the numbers carefully
Readers who care about evidence should keep a few caveats in mind:
The source has a side. Protect Our Care campaigns politically on health care and environmental policy. Its report is a prosecution brief, not a neutral review.
The big numbers come from models. Nestle's post doesn't say how the $275 billion and 30,000 figures were calculated. Estimates of avoided deaths from pollution rules usually come from agency cost-benefit analyses. These convert projected drops in pollution, mostly fine particles, into predicted deaths using exposure-response relationships from observational studies. They are informed projections, not deaths anyone counted. Adding up 31 separate rules also risks double counting where the rules overlap.
Some claims are allegations. The pressure on EPA scientists is stated as fact in the report. The post doesn't show the evidence behind it, such as documents, whistleblower accounts or inspector-general findings.
Some claims are easy to check. Cancelled grants, a closed journal submission system and a rule rollback leave public records. The microplastics anecdote, by contrast, shows irony more than it shows policy.
What's left open
Nestle's post doesn't cover the report's pesticide or food-safety sections in detail. It doesn't explain the "cancer-linked chemicals back on the market" claim or the grocery-price argument, and it includes no response from the administration. She closes simply: "Take a look at the report. The list is long, alas." Anyone wanting to weigh the case properly will have to go to the report itself, and ideally check the agency records it cites.
Remember
The report says EPA dropped a MAHA agenda and cancelled grants, and that NIH closed an environmental-health journal to submissions.
EPA rolled back mercury rules the day after the MAHA Commission first met, and Kennedy, once an anti-mercury litigator, stayed silent.
The 30,000-deaths-a-year figure is a modelled estimate from advocacy groups, not a count of observed deaths.
Adam Cifu, an internist who writes for Sensible Medicine, has republished an updated version of a 2023 essay about his "ghost patient panel." These are people who stopped seeing him without saying so. It's a personal reflection, not a study, and it has no data. It is a clear account of how little feedback doctors get.
The lists a doctor keeps
His electronic health record (1), the software that holds patient charts, keeps an automatic "My Patients" list. He also keeps two lists of his own:
"INR": patients on the blood thinner 2, who need a clotting test called the 3 every few months.
"Enigmas": puzzling cases he wants to follow.
A third list, the patients he's worried about, lives only in his head. The ghost panel is a fourth list: people who moved, lost insurance, fired him or died without him knowing. A patient joins it only when he happens to notice they're gone.
RP
One example is RP, an 87-year-old retired diesel engineer. He had diabetes, sleep apnea, high blood pressure and 4, an irregular heart rhythm. He was still grieving his wife, who had died of pancreatic cancer. At his last visit they mostly talked about Cifu's new diesel car. Five years later a similar car passed by, and Cifu realised RP had never come back. RP was on 5, so insurance probably wasn't the reason. Cifu suspects death or a move closer to his children. Learning of deaths late, he writes, brings sorrow and guilt.
Why patients leave silently
Insurance churn. Most patients who lose coverage leave without a word. Some come back at 65 when Medicare begins.
Dissatisfaction. Cifu argues doctors overestimate patient satisfaction for three reasons. Nearly all their feedback comes from patients who stayed. The power imbalance keeps patients quiet. And good pay makes doctors feel valued "sometimes beyond our true worth."
Death, often discovered months or years later.
He gives an example from his own care. A surgeon he calls excellent said "You must have injured this" about trauma at Cifu's wound. Cifu felt blamed, and said nothing.
The limits
Cifu believes the ghost panel could teach him a lot about what he does well and where he fails. But he doesn't suggest how to find out who is on it or why they left, and he doesn't estimate how many there are. Read it as a description of a blind spot, not a fix for one.
Adam Cifu, an internist who writes for the newsletter Sensible Medicine, has republished an updated version of a June 2023 essay. He says he almost never reposts, but this piece "kind of haunts" him. Whenever he filters his electronic health record (1), the software that holds patient charts, for "my patients," it turns up names of people who no longer are. This is a personal essay with no data and no study. Its value is the questions it raises about continuity of care and how little feedback doctors get.
The panels a doctor keeps
Cifu describes several lists. The EHR automatically keeps a "My Patients" list covering everyone in his practice. He also built two lists himself:
"INR": patients on 2, a blood thinner. Their 3 (INR), a blood test of how long blood takes to clot, has to be checked every few months to keep the dose safe.
"Enigmas": patients whose symptoms puzzled him and a colleague, and whose workups he wants to follow.
A third list lives only in his head: the patients he is worried about. He says he can only list all of them at about 4 a.m.
The fourth is what he calls the ghost patient panel. It holds people who left without telling him, because they moved, lost or changed insurance, fired him, or died. Nobody can ever fully know who is on it. A patient joins it only when Cifu happens to notice they're gone, which might be at his daughter's track meet or while he's writing up another patient's visit.
One example: RP
At his last visit, RP was 87. He had diabetes, obstructive sleep apnea, high blood pressure, 4 (an irregular heart rhythm) and restless legs syndrome. Cifu writes that his worst problem was grief: his wife, also Cifu's patient, had died of pancreatic cancer after years of illness. RP was a retired diesel engineer, and the two spent that last visit talking about Cifu's new diesel Volkswagen Jetta. Five years later, a similar car went by and Cifu realised RP had never come back.
RP was on 5, so an insurance change is unlikely to explain it. Cifu guesses he died or moved closer to his children. Cifu describes this kind of relationship as one where he was close to the patient but not to the family, so nobody thought to tell him. He says realising a death months or years late leaves him with sorrow and guilt.
Three reasons patients vanish
Insurance instability. A few patients tell Cifu when an insurance change is forcing them out. Most assume nothing can be done and leave quietly. Some come back at 65 when Medicare starts, which he compares to Voldemort reclaiming a body. The essay doesn't put numbers on this. It reflects a well-known feature of US coverage: job-based and Medicaid coverage changes often, and Medicare doesn't.
Dissatisfaction. Some patients fired him. Cifu admits that no doctor suits every patient, and that "even when I provide the care a patient needs, I often don't provide the care that he wants." He gives three reasons doctors overestimate how satisfied patients are:
6. Nearly all his feedback comes from patients who stayed. The unhappy ones are, by definition, gone.
Power imbalance. Most patients won't tell a doctor what they really think.
Pay. Doctors are well paid, and he argues that can make them feel valued "sometimes beyond our true worth."
Death. As with RP, this is the reason he dreads most, and often the one he learns about last.
The view from the other chair
Cifu illustrates the feedback gap with his own minor surgery. He calls the surgeon exceptional in every way. But at the post-operative check, the surgeon saw trauma at the wound and said, "You must have injured this." Cifu, who calls himself an "obsessively adherent perfectionist," was stung. He says "there seems to have been some trauma here" would have landed better. He said nothing, and he's sure the surgeon never knew. The point: even a doctor who is a patient, and who knows the system from inside, stayed silent.
What it does and doesn't show
The essay argues that the ghost panel holds information about a doctor's strengths and failures, and about how families care for older relatives. Cifu believes he could learn a lot if he knew "the whos and whys." But he offers no way to find out: no exit surveys, no EHR flags for patients who've gone quiet, no estimate of how many there are. Those tools exist in some health systems, but the essay doesn't discuss them. Read it as an honest account of a blind spot. The patients most likely to tell a doctor something useful are the ones the doctor never hears from.
Remember
Doctors mostly hear from patients who stayed, so they likely overestimate how satisfied patients are.
US insurance churn quietly breaks up doctor relationships; Medicare at 65 sometimes brings patients back.
Even a doctor who was himself a patient kept quiet about being offended, which shows how rarely patients complain to doctors.
A new US nonprofit, the Second Century Foundation, has launched with the goal of speeding up research on human longevity. The news comes through Fight Aging!, a pro-longevity advocacy blog whose author, Reason, welcomes any new group pushing for more aging-research money. This is an announcement, not a study. There are no results to report.
The pitch
The foundation is a 1, a US charity that mainly runs its own programs instead of giving grants to others. Its argument is about money. The 2 (National Institutes of Health), the main US government funder of medical research, pays for work that leads to publications. Venture capital pays for work that can produce an "3" (a company sale or stock-market listing) within about ten years. The founders say a lot of the work longevity needs fits neither model, and they want to fill that gap. They don't say how big their budget is or name specific projects of that kind.
What it has built so far
An investor memo making "the financial case for longevity biotech." It covers routes to a stock listing or acquisition and how to pitch Wall Street. It also offers a framework for estimating a therapy's 4 (net present value: future earnings converted into today's money) and a list of areas the authors consider over- or underfunded.
A map of where the money goes, cataloguing longevity spending by universities, companies and government, broken down by organization and approach.
A free, open-source longevity simulator that runs in the browser and models how future treatments might change lifespan and (years lived in good health).
The headline claim
The simulator is built to show that slowing aging by 20% would add far more healthy life than curing cancer. The direction is backed by established demographic research. Eliminating all cancer adds only about three years to life expectancy at birth, because other age-related diseases soon take its place. Slowing aging itself would delay all of them at once.
The caveat is large. No therapy has been shown to slow human aging by 20%, or by any measured amount. The simulator shows what would follow if such a drug existed. It isn't evidence that one is coming. The post also doesn't explain the model's assumptions.
Bottom line
This is a new advocacy and analysis group, and two of its three outputs are aimed at investors. It has potentially useful public tools, but nothing yet changes things for patients.
The advocacy blog Fight Aging! has announced the launch of the Second Century Foundation, a new US nonprofit that wants to speed up research on human longevity. The post mostly quotes the foundation's own launch text. Reason, the blog's author, adds a short introduction welcoming another organization to the cause. Nothing here is a study, a trial or a result. It is an announcement of intentions and tools, and it should be read that way.
The gap the foundation says it fills
The founders describe themselves as pursuing "our childhood dream of a world where no one has to suffer or die from aging." The foundation is set up as a 1. That is a US tax-exempt charity that mainly runs its own programs rather than handing out grants to others.
Its central argument is about funding. In its words, much of the work needed for longevity breakthroughs "isn't fundable today. If it doesn't lead to a publication, the 2 won't fund it. If it doesn't enable an 3 in ten years, venture capital can't fund it." The NIH (National Institutes of Health) is the main US government funder of biomedical research. An "exit" is the moment investors get their money back, usually when a company is acquired or lists on the stock market.
The complaint is a familiar one. Infrastructure, datasets, replication studies and long-horizon programs tend to fall between academic grants and startup money. The foundation doesn't name specific projects of that kind that it plans to fund, and it doesn't say how large its budget is.
Reason's framing is that aging carries vast human and fiscal costs, and that current spending on aging research falls far short of what those costs justify. That is his view as an advocate. The post doesn't quantify it.
What it is actually doing so far
The foundation lists three projects.
1. An investor memo. The memo is aimed at for-profit investors and company operators and makes "the financial case for longevity biotech." It promises to cover:
routes to an 4 (initial public offering) or a merger or acquisition;
the main funding sources, and how to pitch the field to Wall Street;
a framework for estimating a therapy's 5 (net present value), meaning its expected future earnings discounted back to today's money;
areas the authors consider overfunded relative to their financial and lifespan return, and areas where they think the return is highest.
The post doesn't say which areas fall into which group.
2. A map of capital flows. This is meant to be a catalogue of longevity spending across universities, industry and government, broken down by organization and scientific approach. The stated aims are to point out underfunded areas "relative to their promise" and to connect "top talent" with funders. If it is done well and made public, a spending map like this could help outsiders. The field's funding is scattered across philanthropists, a few heavily financed companies and NIH institutes, and it is hard to see as a whole.
3. A longevity simulator. This is a free, open-source tool that runs in a web browser and models how future medicine might change 6 (years lived in good health) and lifespan. The foundation uses it to back a headline claim: slowing aging by 20% would give you a longer, healthier life than curing cancer, "by a huge margin."
Weighing the simulator claim
The direction of that claim matches well-established demographic work. Eliminating a single major cause of death adds surprisingly little to life expectancy, because people who are spared one age-related disease soon face another. Classic estimates put the gain from eliminating all cancer at roughly three years of life expectancy at birth.
Slowing the underlying aging process would, in principle, push back all of those diseases at the same time. An illustrative analogy: curing cancer removes one hurdle on a track that keeps getting steeper. Slowing aging flattens the whole track.
The catch is that the comparison depends on a hypothetical. No intervention has yet been shown to slow human aging by 20%, or by any measured amount. Evidence for aging-slowing drugs in people is still limited to early trials and observational data. The simulator shows what would follow if such a therapy existed. It is not evidence that one is close. The post also doesn't describe the model's assumptions, such as how "slowing aging by 20%" is defined or how mortality is modeled. Readers would need to check the open-source code to judge it.
What's left open
The announcement leaves basic questions unanswered: who the founders are, how much money the foundation has, how it chooses projects, and whether it will fund laboratory research or mostly do analysis and advocacy. Two of its three outputs are aimed at drawing in investors, which fits Reason's stated goal of getting "more capital into the longevity industry." Whether that produces better science or just more startups is a separate question. The foundation is also asking students to start longevity clubs, research projects or companies.
For now this is a new voice in longevity advocacy with some potentially useful public tools. It is not a development that changes anything for patients.
Remember
The foundation's case rests on a funding gap: work that's too unpublishable for NIH grants and too slow for venture capital.
Two of its three first outputs are aimed at investors, not at doing lab research.
The 'slow aging beats curing cancer' claim holds in theory, but no therapy has shown it can slow human aging.
No demonstrated effects. A Danish review led by Henrik Støvring concluded that the group's randomized trials did not demonstrate non-specific effects for the measles, tuberculosis (BCG), diphtheria, tetanus or whooping cough vaccines.
A shelved agenda. The 4 shut down plans to release a MAHA agenda, even though MAHA leaders had spoken out about air and water pollutants.
Research cut off. The 5 stopped accepting submissions to its "flagship journal on environmental health" and withdrew research grants. The report doesn't name the journal. The best-known candidate is Environmental Health Perspectives, published by NIH's environmental health institute, but that is an inference.
Altered safety reviews. EPA scientists were allegedly pressured to rewrite risk assessments for chemicals in household cleaners and cosmetics so the risks looked less serious than the data showed. The report argues these are exactly the products MAHA's core supporters were promised would be regulated.
An awkward moment. At a chemicals summit, Kennedy praised an Oregon State University researcher's microplastics study from the podium. An hour earlier, she had learned that EPA had ended the grant funding that work.
