s Donald Trump prepares to take the oath of office, we at STAT are preparing, too. Here’s what we’re watching for as the new administration tackles big questions in health, medicine, and science.
Will the NIH squash research on fetal tissue?
I’m looking for quick action by the Trump administration on embryonic stem cell research, possibly by executive order.
In his first executive order, President Obama overturned President George W. Bush’s 2001 policy barring the National Institutes of Health from funding any research on embryonic stem cells except on cell lines that had already been created. Trump could easily reverse the Obama policy. That would affect the roughly $180 million per year the NIH spends on human embryonic stem cell research. (The cells all come from donated embryos created by IVF).
I’m also watching what Trump will do about fetal tissue research — that is, on tissue donated by women who have had abortions.
That was the subject of the incendiary Planned Parenthood ambush video in 2015 and the congressional hearings that followed. The Republican Party platform says Congress should “make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research.” NIH spends about $76 million per year funding human fetal tissue research. Will those projects continue?
— Sharon Begley
Will Trump help opioid addicts get treatment?
When it comes to the opioid epidemic, Trump has promised an aggressive response that is a mix of old-school “war on drugs” bluster and promises of more money for prevention and treatment.
I will be watching to see if he makes good on pledges to expand drug courts and mandated treatment while also removing barriers to medication-assisted therapies.
At the same time, will his vow to lock up more drug kingpins make a dent in the opioid trade, or will it result in the jailing of street addicts selling smaller amounts to support their habits? Will he be willing to challenge China, which recently has pushed back on charges that labs there are supplying North America with much of the deadly fentanyl flooding the country?
And will a wall along the Mexican border do anything to slow the flow of heroin and fentanyl northward?
— David Armstrong
Will he create an initiative to conquer death?
Trump is inheriting several major science projects, like Vice President Joe Biden’s cancer moonshot. Those projects are already funded by Congress and have broad bipartisan support. Will he keep them going?
His pick to direct the NIH — whether he keeps Francis Collins on permanently or goes with an unconventional choice — could tell us a lot.
Trump may also strike off in an all new direction. After all, nobody has bigger ideas for science than Silicon Valley billionaire Peter Thiel, a known immortality seeker who has Trump’s ear. Every administration ends up putting their stamp on medical science by setting some audacious goals. I’ll be watching to see which ones Trump picks.
— Dylan Scott
Will immigrants be too afraid to seek medical care?
I’m already hearing from clinicians who work with asylum-seekers, refugees, and migrants that Trump’s inauguration is stirring anxiety in their patients. That’s showing up when patients come to community health clinics for care — but some worry it may also deter them from showing up for medical care at all.
Trump has said he will create a “special deportation task force” to remove the estimated 11 million undocumented immigrants in the US, and has vowed to reverse Obama’s Deferred Action for Childhood Arrivals, which allowed hundreds of thousands of children who arrived in the United States without immigration papers to stay.
I’ll be checking in with clinics that serve immigrants to monitor the impact of both the president’s rhetoric and potential policy changes.
— Eric Boodman
Will a Trump tweet drag down a biopharma stock?
Biopharma is afraid of the Trump tweet. So I will be watching Twitter.
All it could take is one egregious price hike, one merger designed to reduce corporate taxes, or one big round of job cuts, and the likes of Pfizer and Biogen might suffer the fates of Boeing and Lockheed Martin — watching their stock price plummet after an angry blast from the tweeter-in-chief.
Last week, Trump’s seemingly off-hand remark that drug makers are getting away with murder sent the Nasdaq biotech index down more than 3 percent. It rebounded, but investors are wary.
This month, EvercoreISI asked more than 300 biotech investors about the biggest political risks facing the industry, and about 32 percent responded with “Twitter,” second only to drug pricing reform. Their industry — and their money — is at risk every time the president-elect opens up the app.
— Damian Garde
Will more states charge poor residents for Medicaid?
Medicare gets a lot of headlines, but I’ll be watching what happens to Medicaid and the 70 million Americans the program helps cover.
If Obamacare is repealed and replaced, what will happen to the 11 million low-income people who gained coverage?
Trump has been coy on the details of his plan, but Republicans want to convert federal Medicaid funding into block grants or per capita allotments. That could usher in a whole lot of changes. More states may move toward models like the one Indiana developed (with the help of Seema Verma, Trump’s pick to head up Medicaid and Medicare). It charges recipients premiums and can lock some out of coverage. I’ll be keeping track of state policy proposals.
— Andrew Joseph
Will the Supreme Court make abortion illegal?
I’ll be watching Trump’s nominee to the Supreme Court. He’s promised to appoint an anti-abortion justice to the seat left open after Justice Antonin Scalia’s death nearly a year ago. And he has said he would like to see the court overturn Roe V. Wade,the landmark 1973 decision that determined women have a constitutional right to receive an abortion.
The court has a long record of defending Roe against challenges. And Trump’s first pick for the court isn’t likely to change that, because five sitting justices still support Roe and have voted to block state regulations that place an “undue burden” on women seeking abortion.
But three of the five justices in the majority — Ruth Bader Ginsburg, Stephen Breyer, and Anthony Kennedy — are in their late 70s or early 80s. Trump may well have a chance to nominate a second anti-abortion justice during his term, shifting the balance on the court.
— Megan Thielking
Will Trump promote the Precision Medicine Initiative?
I’ll be keeping an eye on Trump’s pick to fill the position of chief data scientist, which Obama created in the Office of Science and Technology Policy.
DJ Patil — who previously worked at RelateIQ, LinkedIn, Skype, eBay, PayPal and the Department of Defense — has held the position since February 2015. Among his priorities was the Precision Medicine Initiative, which aims to recruit at least a million volunteers from across the US to have their health data monitored and medical histories studies. Enrollment is expected to begin this year.
The question: Will Trump appoint someone who’s committed to recruiting those volunteers and getting this massive research project off the ground?
— Kate Sheridan
Will women retain access to free contraception?
Early warnings from Donald Trump’s presidential campaign suggested tough times ahead for women’s health.
The Affordable Care Act blocked insurance companies from charging women more than men. It also prevented them from making pregnancy a preexisting condition. Its contraception mandate required most insurers to offer a range of family-planning methods with no co-pay.
I’ll be watching to see how well the replacement to the ACA protects women’s health.
— Pat Skerrett
Will California challenge Trump on key issues?
California is not likely to secede from the Union soon. But it may well step up to challenge Trump policies on health and science.
If Trump’s EPA tries to interfere with the state’s tough auto emissions rules, enacted in hopes of slowing climate change and reducing pollution, l’d expect strong push back from state legislators, Governor Jerry Brown, and new state Attorney General Xavier Becerra.
California will also likely use state legislation and court fights to counter anticipated Trump moves to slash funding for Planned Parenthood. Then there’s medical research. In 2004, California voters approved $3 billion for stem cell research after Bush banned much federal funding for that work. If Trump again cuts federal spending on such projects, will state voters step into the breach?
— Charles Piller
Will improvements in patient care slow down?
Patient advocacy groups are, of course, most focused on the repeal and replacement of Obamacare, but they’ve got other worries, too.
Will changes in (or cuts to) Medicare and Medicaid imperil impoverished patients? What about those with mental illness and substance abuse disorders?
Will Trump eliminate — or slash funding for — the Agency for Healthcare Research and Quality within the Department of Health and Human Services? You might not have heard of it, but AHRQ is responsible for many health care delivery advances, like reducing the number of hospital-acquired infections. I’ll be watching what happens to this agency and checking in with patients and their advocates.
— Bob Tedeschi
Will Trump stoke unjustified fears about vaccines?
There are more unknowns than knowns when it comes to the new administration’s views on public health.
But Trump has raised anxiety in the science community by publicly voicing concerns about the number of vaccines children get and by meeting with leading anti-vaccine figures, such as Robert F. Kennedy Jr. and Andrew Wakefield, whose discredited research lost him his medical license but put him at the center of the movement.
He’s also floated the idea of creating a vaccine safety panel. That could undermine the integrity of the Advisory Committee on Immunization Practices, which reports to the Centers for Disease Control and Prevention. ACIP next meets in late February and it will be interesting to see if there’s any any clarity by then on whether Trump will challenge the way US vaccine policy is set.
How will we know? I’ll be watching for early morning tweets on @realdonaldtrump.
— Helen Branswell
Will medical malpractice lawsuits be curbed?
I’ll be watching the looming battle over medical malpractice lawsuits.
The issue, which doctors and their lobbyists call “tort reform,” is dear to the heart of Tom Price, the Georgia physician-turned-congressman who is Trump’s nominee for Secretary of Health and Human Services. Price contends there is a malpractice crisis that’s raising the cost of health care, though numerous academic studies refute that.
Price’s Obamacare replacement bill would have created state administrative tribunals to hear cases of alleged malpractice in lieu of jury trials — a prospect that is fiercely opposed by the American Association for Justice, which represents plaintiffs’ lawyers. It’ll be interesting to see how this fight plays out.
— Sheila Kaplan