Health Care/Joan Retsinas

The Glumness of Trump-World

Trump et al see bête noires everywhere. Where some of us try to look upon the world with optimism, hoping that an arc of progress is inching up, the Trumpalytes see disaster.

Consider the migrants who are risking death to come here. Our streets are not paved in gold; most soon recognize that our social safety net is porous, and they will fall through. Yet they come. They pick our crops. They work in our factories. The clean our offices. They landscape our yards. At the same time, they marry, start families, often buy homes. Some drive Ubers on the side; some open restaurants (the immigrants have expanded our nation’s culinary palate). If they don’t achieve whatever American dream they imagined, their children might. And because they fear the “knock on the door” of ICE, many stay semi-hidden, all the while paying taxes. (Of course, some immigrants rob, murder, embezzle - a lower percentage than native-born miscreants.)

Many Americans acknowledge the value of immigrants (and remember that virtually all of us came from immigrant stock). Yet the Trumpalytes consider them a scourge on a nativist America. Instead of feeling fortunate to have these workers, the Trumpalytes want to expel those without sufficient documentation, regardless of the misery to them, and to us. (I suspect that they will relax their xenophobia to let the foreign-born scientists, physicians and engineers in our midst stay.)

Consider vaccines. Most of us, with an eye to the past, see them as wondrous: polio, tetanus, whooping cough, measles, typhoid, smallpox, influenza. We Americans are still dying — no Ponce de Leon fountain on site — but we are not likely to die of those diseases. Other vaccines have helped. Shingles, COVID, RSV … maybe not 100% effective all the time, but they have tamped down the large outbreaks. Side effects? Yes. Permanent side effects? No strong evidence supports the claim, and most people, weighing the risks, will opt for the vaccine. Yet the incoming health czar, Robert Kennedy, has fueled doubt: can we forego vaccines? Can we stop those mandates for school and work vaccination? Where most of the world has welcomed vaccines as a weapon against the Grim Reaper, particularly the one that comes for children, the Trump acolytes focus only on possible harm, broadcast on social media, not supported by peer review studies, yet fueling the skepticism that will fuel outbreaks of disease.

Fluoride deserves mention. Most of the country fluoridates the water; most children show fewer cavities, maybe stronger bones; most everybody accepts that fluoride, considered a nutrient not a drug, when added to the water supply helps. But instead of looking at the benefits of fluoride, the Trump team screams “No.” We should stop. Again, no strong peer-reviewed studies of danger. But they see harm instead of benefits. And in a zero sum world of public policy, where so many other problems loom, the Trumpalytes focus on fluoride.

On to food additives. Maybe we should all grow food in organic gardens,, or purchase from organic farms. Most of us, though, shop in supermarkets, where additives keep food edible long past expiration dates. Some additives are harmful; some are not; some are helpful (folic acid is added to cereals) some are essential to the stuff we have grown accustomed to. A blanket “no” to additives is not helpful. Nor is a blanket “no” to ultra-processed food. I agree: all those calorie-laden, nutrient-poor snacks, sodas (including the “diet” ones), cookies, chips contribute to the nation’s epidemic of obesity. But Robert Kennedy cannot eliminate “Bad Food” when the country — as well as the incoming President — are hooked. Maybe positive reinforcements — like public schools that offer sports, that serve healthy meals — would help more.

The oversight of pharmaceuticals does merit scrutiny. The combination of scientific wisdom and sheer greed gave us the opiate epidemic. Opiates relieve pain; but the companies knew the addictive power. That didn’t deter the companies, the pharmacies, and the physicians from pushing these drugs onto people desperate for relief, not just from chronic pain but from the numbing miasma of unemployment and poverty. Today weight loss drugs are emerging as the goose that laid the golden egg,. A lot of obese, or almost obese Americans. A quick fix, subsidized by insurance, touted by advertisements. Yet red flags are popping up: people buying directly on-line; compounding pharmacies that whip up the pills; pressure to prescribe to younger and younger patients, in spite of pediatricians’ warnings about bone development. Hormone replacement therapy was another golden egg: every menopausal woman a possible patient, until the FDA issued cautions.

So I hope the incoming FDA head looks closely at what is approved, how it is marketed. At the same time, we don’t need a wholesale shakeup. The FDA has given us drugs for cholesterol, high blood pressure, anemia, infections … The pipeline for launching a new drug is lengthy, with a regimen of clinical trials. If Robert Kennedy wants to allow psychedelics et al, let those media-favorites go through that regimen.

Finally, health insurance. Thanks to President Barack Obama and Speaker of the House Nancy Pelosi millions of Americans have affordable comprehensive coverage. Any dramatic shake-up will take us back, way back, to that era when so many Americans were uninsured, or under-insured. The Affordable Care Act has gaps. Let’s improve it, starting with expanding Medicaid in those states that said “no.” We shelve this Act at our peril

In the spirit of Thanksgiving, which is supposed to last at least a few months, many Americans have sat down to give thanks for what works in this country. If only the Trump acolytes, ever angry, could do the same.

Joan Retsinas is a sociologist in Providence, R.I., who writes about health care. Email joan.retsinas@gmail.com.

From The Progressive Populist, January 1-15, 2025

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