The CDC After Trump's & RFKJr's Friday Afternoon Massacre

There is a must-read NY Times op-ed in today's paper:

• The signers are 9 former CDC directors (permanent or acting). 
• They served during every Republican and Democrat administration from Jimmy Carter to Donald Trump.
• Their service as CDC directors goes back to 1977 -- collectively that represents over 100 years at the CDC.
• Despite their differences, they agree (as their title puts it) that "Kennedy Is Endangering Every American’s Health".

I hope the link works (it's supposed to be a free "share" that I get as a subscriber), but if not, here are a few highlights:

• What the health and human services secretary, Robert F. Kennedy Jr., has done to the C.D.C. and to our nation’s public health system over the past several months — culminating in his decision to fire Susan Monarez as C.D.C. director days ago — is unlike anything we had ever seen at the agency and unlike anything our country had ever experienced.
• Mr. Kennedy has fired thousands of federal health workers and severely weakened programs designed to protect Americans from cancer, heart attacks, strokes, lead poisoning, injury, violence and more. 
• Amid the largest measles outbreak in the United States in a generation, he’s focused on unproven treatments while downplaying vaccines. 
• He canceled investments in promising medical research that will leave us ill prepared for future health emergencies. 
• He replaced experts on federal health advisory committees with unqualified individuals who share his dangerous and unscientific views. 
• He announced the end of U.S. support for global vaccination programs that protect millions of children and keep Americans safe, citing flawed research and making inaccurate statements. 
• And he championed federal legislation that will cause millions of people with health insurance through Medicaid to lose their coverage. 
• Firing Dr. Monarez — which led to the resignations of top C.D.C. officials — adds considerable fuel to this raging fire.
• When Mr. Kennedy administered the oath of office to Dr. Monarez on July 31, he called her “a public health expert with unimpeachable scientific credentials.” But when she refused weeks later to rubber-stamp his dangerous and unfounded vaccine recommendations or heed his demand to fire senior C.D.C. staff members, he decided she was expendable.
• These are not typical requests from a health secretary to a C.D.C. director. Not even close. None of us would have agreed to the secretary’s demands, and we applaud Dr. Monarez for standing up for the agency and the health of our communities.

The entire op-ed is worth reading and sharing with friends, family, and colleagues. We live in dangerous times. But if Kennedy's moves as HHS Secretary go unchecked, they're going to get a lot more so.

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.

U.S. Preventive Services Task Force: Now You See It, Soon You Won't

At the end of June, in Kennedy v. Braidwood Management, Inc., the Supreme Court reversed District Judge Reed O'Connor and the Fifth Circuit Court of Appeals, holding (6-3) that the 17 volunteer members of the U.S. Preventive Services Task Force (USPSTF) are "inferior officers" of the United States. If the Court had held the members to be principal officers under the Appointments Clause of the Constitution, Art. II, §2, cl. 2, they would have to have been appointed by the President “with the Advice and Consent of the Senate,”  not by the Secretary of HHS. Invalidating the method of their appointment would presumably have left the USPSTF without any members. 

Fortunately, that didn't happen. The USPSTF is responsible for creating the lists of services that health insurers must cover without collecting copays or deductibles from their insureds under the Affordable Care Act. In effect, then, this litigation was yet another attempt to eviscerate a basic part of Obamacare. And the Court, yet again, resisted the invitation to do so.

The victory, however, may be short-lived. The majority opinion by Justice Kavanaugh made it very clear that, because the task force's members were "inferior officers," the Secretary of HHS -- and not the President -- could not only appoint members but also remove them:

[B]ecause the Secretary of HHS appoints the Task Force members, he also has the authority to remove the Task Force members at will. . . . When a statute empowers a department head to appoint an officer, the default presumption is that the officer holds his position “at the will and discretion of the head of the department,” even if “no power to remove is expressly given". . . . The Secretary of HHS has the power to appoint (and has appointed) the Task Force members. And no statute restricts removal of Task Force members. Therefore, “there can be no doubt” that the Secretary may remove Task Force members at will. 

This was an important part of the Court's conclusion that members of the task force are "inferior officers" and were, therefore, properly appointed by the Secretary. 

This "win," however, leads directly to headlines in the past few days that RFK, Jr. is ready to fire all of the current members of the task force, apparently because they are too "woke." (Reuters, WSJ, NBC, Daily Beast). Can he really do that? Of course he can; the Court said so in June. And it would be an exercise of the same removal power that led to his removal of all 17 members of the Advisory Committee on Immunization Practice on June 8, replacing them with, among others, vaccine skeptics.

The "wokeness" of the USPSTF was the subject of an opinion piece in The American Conservative. The author singles out three initiatives of the USPSTF: (1) increasing awareness of systemic racism in clinical medicine, (2) being attentive to issues of sex and gender in clinical settings, and (3) including "preventive prophylaxis for HIV, commonly known as PrEP, for individuals at risk of infection with that disease. As the author explains: 

This population consists almost entirely of sexually active gay men, which has led a number of Christian employers who provide insurance to protest that the ACA (and its instrument, the USPSTF) are requiring them to subsidize activities they oppose on moral and religious grounds.

The author describes these initiatives as "sinister . . . abuses" that should be eliminated from medical practice. Some of the reporting on RFK, Jr.'s plan indicate that he is bothered by the task force's "wokeness" and cite this article as one source of his concerns.

Different health outcomes for racial minorities, women, gay persons, and transgendered individuals are well-established. Firing task force members won't make the issues go away. But President Trump knew exactly what he was doing when he put his man in charge of HHS.

An excellent piece by Yale Law School's Abbe Gluck teases out further implications of the Supreme Court's opinion: "Braidwood is an opinion that, to the relief of many, saves the ACA once again. But it leaves open critical questions about the future of respect for scientific expertise and how those questions will inevitably be litigated."