The CDC: Of Revolving Doors and Dark Clouds and Chopping Blocks, Oh My

[UPDATE BELOW] The director of the Centers for Disease Control and Prevention, longtime government scientist Dr. Susan Monarez, was confirmed for her post by the Senate on July 29. Today, she's out. The story is still developing (The Hill), so it's unclear whether the decision was made by her immediate boss (HHS Secretary RFKJr) or by his boss DJTJr. She was the president's pick to begin with, so it's safe to say that he had to approve her dismissal and it seems likely the idea started with him, as well.

Nothing has been said so far by either HHS or the White House that would shed light on the reason for her firing. Stories have been flying around  about disquiet among CDC's rank and file employees following (1) the August 11 shooting at CDC headquarters in Atlanta that resulted in the death of a Dekalb County police officer, (2) mass layoffs at the CDC since January, (3) increased harassment of CDC employees by (among others) anti-vaxxers, and (4) chaos surrounding RFKJr's relentless dismantling of CDC's vaccine  infrastructure, including the dismissal of all members of the agency's vaccine advisory panel and defunding mRNA vaccine research.  (CBS News; NPR)

It hardly needs to be said that Dr. Monarez did not have a hand in any of these events and could hardly have turned the agency around against headwinds like these in less than a month on the job. Maybe Federal Housing Finance Agency Director Bill Pulte can unearth something wrong with her (pre-confirmation) home mortgage application, which seems to be the administration's preferred mode of political harassment these days (NBC, Aug. 27).

At this stage, it appears that the dark days at the CDC aren't going to lighten up anytime soon. And that's not good news for the rest of us.

Elections have consequences.

UPDATE (10:09pm CDT):

Late-breaking reports from the NY Times (and WaPo):

• Sources say the director was told by RFKJr to resign or be fired. The immediate issue was her refusal to support the unscientific policy against vaccines that had played out at HHS over the past 7 months.
• She was also told to fire key senior officials evidence-based policies toward vaccines differed from the Secretary's.
• Monarez refused to fire the senior officials and refused to resign.
• As of this evening:
• Monarez was fired as director of CDC. "[A]t 9:30 p.m. [EDT], a spokesman for President Trump, Kush Desai, said in an email message that Dr. Monarez had been terminated. . . .  Susan Monarez is not aligned with the President’s agenda of Making America Healthy Again,” Mr. Desai wrote. . . . "Since Susan Monarez refused to resign despite informing HHS leadership of her intent to do so, the White House has terminated Monarez from her position with the C.D.C.”
• The following senior officials have resigned:
• Dr. Debra Houry, the C.D.C.’s chief medical officer; 
• Dr. Demetre Daskalakis, who ran the center that issues vaccine recommendations; 
• Dr. Daniel Jernigan, who oversaw the center that oversees vaccine safety; and 
• Dr. Jennifer Layden, who led the office of public health data.
• Reactions to the firing and the resignations have been swift:
• Dr. Mandy Cohen, who ran the agency during the second half of the Biden administration, called the officials “exceptional leaders who have served over many decades and many administrations,” and warned that “the weakening of the C.D.C. leaves us less safe and more vulnerable as a country.”
• Dr. Anne Schuchat, the C.D.C.’s principal deputy director until her retirement in May 2021, called them “the best of the best.” “These individuals are physician-scientist public health superstars,” she said. “I think we should all be scared about the nation’s health security.”

In July, I wrote about the DOJ's decision to halt the prosecution of a Utah physician who perpetrated massive COVID-related fraud and praised the doctor's "heroism." My comment was that the DOJ had turned public-health law and policy on its head by lionizing a physician who should rightfully be regarded as a public health enemy.

Now, HHS and the White House have gone equally upside-down, this time by [1] firing a true public-health defender -- a career government scientist with an unblemished reputation for integrity -- and [2] effectively forcing out four senior CDC leaders who refused to buckle under the new administration's anti-vaccine agenda.

Elections have consequences.

Texas and Trump: Failing Grades on Abortion and Measles

A couple of recent articles show the impact of massive public-health failures on the part of both the state of Texas and the federal government.  And in both instances, public-health failures undoubtedly resulted in avoidable deaths.

1. Emergency obstetrical interventions delayed or withheld. Marin Wolf and her colleagues at the Dallas Morning News have published a series of articles ("Standard of Fear") beginning in the paper's Sunday (8/24) edition and continuing in the Monday (8/25) edition. (Warning: possible paywall.) An overview:

More than a year ago, The Dallas Morning News set out to explore how Texas’ overlapping abortion laws have altered the landscape of obstetric health care. Through more than 100 interviews with physicians and other health care professionals, researchers, advocates, legal experts, patients and family members, reporters documented deviations from the standard of care, as well as other unintended consequences.

A review of hundreds of pages of medical and death records, including the examination of more than a dozen patient cases, revealed how the laws have been sweeping in their collateral damage — with patients, families and medical providers caught in the middle.

Texas lawmakers have accomplished what they set out to do — criminalize and, thus, drastically reduce access to abortion. But in doing so, they have also derailed medical care for women trying to have children who developed heartbreaking or life-threatening problems in their pregnancies.

Many women — including those who never imagined they would want or need an abortion — have faced delays or denials of treatment. This includes patients with preexisting medical conditions that make pregnancy dangerous, ectopic pregnancies, miscarriages, the onset of labor before a fetus is viable and fetal diagnoses that are lethal or life-limiting. Others have grown too afraid of becoming pregnant in Texas — so much so that there has been an increase in surgical sterilizations.

In a state that leads the nation in maternal mortality, how can legislators possibly justify interfering with women's autonomy and making it more difficult to obtain potentially life-saving emergency obstetrical care? 

2. CDC dropped the ball on the West Texas measles outbreak. KFF News published an article this morning ("As Measles Exploded, Officials in Texas Looked to CDC Scientists. Under Trump, No One Answered.") that documents the impact of Trump-era cuts in staffing and funding at the Centers for Disease Prevention and Control. Here are some excerpts:

As measles surged in Texas early this year, the Trump administration’s actions sowed fear and confusion among CDC scientists that kept them from performing the agency’s most critical function — emergency response — when it mattered most, an investigation from KFF Health News shows.

The outbreak soon became the worst the United States has endured in over three decades. . . . 

Delays have catastrophic consequences when measles spreads in undervaccinated communities, like many in West Texas. If a person with measles is in the same room with 10 unvaccinated people, nine will be infected, researchers estimate. If those nine go about their lives in public spaces, numbers multiply exponentially.

The outbreak that unfolded in West Texas illustrates the danger the country faces under the Trump administration as vaccination rates drop, misinformation flourishes, public health budgets are cut, and science agencies are subject to political manipulation. 

And here's the kicker:

While the Trump administration stifled CDC communications, health secretary Robert F. Kennedy Jr. fueled doubt in vaccines and exaggerated the ability of vitamins to ward off disease. Suffering followed: The Texas outbreak spread to New Mexico, Oklahoma, Kansas, Colorado, and Mexico’s Chihuahua state — at minimum. Together these linked outbreaks have sickened more than 4,500 people, killed at least 16, and levied exorbitant costs on hospitals, health departments, and those paying medical bills. 

The federal-state public-health partnership was based upon indispensable monitoring data and expertise that could be mobilized in an instant to support local public-health officials working in affected communities to limit the damage of infectious disease. Instead, a bunch of no-nothings in this administration are ushering in a new Dark Age of illness and premature death. 

Elections have consequences.

Providers with Larceny in Their Heart

One of the biggest weeks of indictments, arrests, convictions, and sentencing in a long time, as announced by US HHS/OIG (Aug. 22): 

1. Three Baton Rouge Individuals Sentenced To Federal Prison In Connection With The Department Of Justice’s 2024 National Health Care Fraud Enforcement Action (August 21, 2025; U.S. Attorney's Office, Middle District of Louisiana)
2. Brooklyn Cardiologist Sentenced To 37 Months In Prison In Connection With Health Care Fraud And Bribery Scheme (August 21, 2025; U.S. Attorney's Office, Southern District of New York)
3. Memphis Woman Sentenced To Federal Prison For Scheme To Defraud Federal COVID-19 Relief Program (August 21, 2025; U.S. Attorney's Office, Western District of Tennessee)
4. AG Murrill's Medicaid Fraud Control Unit Arrests Baton Rouge Woman For Failing To Report The Physical Abuse Of A Mentally Challenged Client As Required By Law (August 21, 2025; State of Louisiana)
5. Saginaw Physician Charged With Medicaid Fraud (August 15, 2025; State of Michigan)
6. Attorney General Griffin Announces Two Convictions And One Arrest By Medicaid Fraud Control Unit (August 15, 2025; State of Arkansas)
7. 10 Medicaid Providers Facing Fraud, Theft Charges (August 15, 2025; State of Ohio)
8. AG Murrill's Medicaid Fraud Control Unit Arrests Slidell Woman For Cruel Attack On An Individual With A Disability Under Her Care (August 15, 2025; State of Louisiana)
9. Houma Woman Arrested By Louisiana Bureau Of Investigation For Falsifying Check Stubs And Underreporting Income To Defraud The Medicaid Program Of More Than $83,000 (August 15, 2025; State of Louisiana)
10. Attorney General Raúl Torrez Files Lawsuit Alleging Over $1.6 Million In Fraudulent Medicaid Claims And Identity Theft Of Children (August 14, 2025; State of New Mexico)
11. Attorney General Bonta Announces Arrest And Felony Charges Against Nursing Assistant For Alleged Sexual Assault Of Three Elderly Patients In Northern California (August 14, 2025; State of California)

US DOJ Seeks Transgender Patient and Provider Information from Leading Pediatric Hospital

DOJ has subpoenaed Children's Hospital of Philadelphia to obtain 15 categories of information, including patient names and dates of birth, addresses, and Social Security numbers. (DOJ Office of Public Affairs (rev. July 9); KFF Health News (Aug. 21); Bloomberg Law (Aug. 20); NY Times (Aug. 20)). 

The KFF articles reports that DOJ also seeks "billing documents, communication with drug manufacturers and data such as . . . emails, Zoom recordings, 'every writing or record of whatever type' doctors have made, voicemails and text messages on encrypted platforms dating to January 2020 — before hormone therapy, puberty blockers and gender transition surgery had been banned anywhere in the United States."

As reported by the Washington Post (Aug. 20):

Jacob T. Elberg, a former federal prosecutor specializing in health care fraud, said Bondi’s statement suggests the government “is using its investigative powers to target medical providers based on a disagreement about medical treatment rather than violations of the law.”

When she announced the subpoenas last month, AG Pam Bondi said DOJ was seeking to hold “medical professionals and organizations that mutilated children in the service of a warped ideology” accountable. Considering the broad professional support for supportive treatments, you have to ask whose "warped ideology" is behind the subpoenas.

The Bloomberg Law story provides a good collection of articles on the Trump administration's escalating war on transgender medicine:

• Trump Signals Gender Overhaul While Health Policy Changes Wait; Jan. 21, 2025,
• Some Hospitals Pausing Youth Transgender Care Are Skirting Law; Feb. 20, 2025
• HHS Doubts Benefit of Gender-Affirming Care for Children (2); May 1, 2025
• Trump FTC Chair Looks for Deception in Gender-Affirming Care (2); July 9, 2025
• Trump Actions on Gender Care for Minors Draw New States Lawsuit (1); Aug. 1, 2025  

Access to these pieces may be blocked, but Bloomberg Law has this 9-minute YouTube video that covers the same material.

Recall also that the Supreme Court earlier this year upheld Tennessee's broad ban on treatments for transgender minors (HealthLawBlog post here). This a tough time to be a pediatric endocrinologist, let alone a transgender minor.

Trump Administration Plans to Burn $9.7 Million in Contraceptive Medicines and Devices

According to a report in today's N.Y. Times (see also NPR and Reuters), the Trump Administration is poised to destroy nearly $10 million in birth control pills, IUDs, and hormonal implants that had already been paid for by AID. The contraceptives "were destined for clinics in the poorest countries in Africa" but were warehoused in April when AID was shut down. 

Diverting these reproductive health supplies will have a devastating effect:

Siobhan Perkins, who was the procurement adviser for the U.S.A.I.D. contraception supply chain, said the products slated for destruction were enough to prevent approximately 362,000 unintended pregnancies, 110,000 unsafe abortions and 718 maternal deaths.

Destruction of the contraceptives will cost $160,000 in transportation and incineration charges, but -- as reported by Reuters -- there's a low-cost option that, with any other administration, would be a win-win solution:

Sarah Shaw, Associate Director of Advocacy at MSI Reproductive Choices, told Reuters the non-profit organisation had volunteered to pay for the supplies to be repackaged without USAID branding and shipped to countries in need, but the offer was declined by the U.S. government.

"MSI offered to pay for repackaging, shipping and import duties but they were not open to that... We were told that the U.S. government would only sell the supplies at the full market value," said Shaw.

She did not elaborate on how much the NGO was prepared to pay, but said she felt the rejection was based on the Trump's administration's more restrictive stance on abortion and family planning.

"This is clearly not about saving money. It feels more like an ideological assault on reproductive rights, and one that is already harming women."

This decision is part of a war on women's health that is, in economic terms, stupid and, in moral terms, evil. How much lower can this crowd go?