The Host
Julie Rovner
KFF Health News
@julierovner.bsky.social
Read Julie’s stories.
Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
Republicans remain divided over how to address the impending expiration of more generous Affordable Care Act plan tax credits, which will send premiums spiraling for millions of Americans starting in January if no further action is taken. The Trump administration floated a proposal over the weekend that included a two-year extension of the credits as well as some restrictions pushed by Republicans, but the plan was met with strong pushback on Capitol Hill and its unveiling was delayed.
Meanwhile, the Department of Education has declared that a long list of health careers are not “professions,” meaning that students pursuing those tracks — including as nurses, physical therapists, and physician assistants — will no longer be eligible for federal student loans large enough to cover their tuition.
This week’s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of the Pink Sheet, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.
Panelists
Sarah Karlin-Smith
Pink Sheet
@sarahkarlin-smith.bsky.social
Read Sarah’s stories.
Alice Miranda Ollstein
Politico
@alicemiranda.bsky.social
Read Alice’s stories.
Sandhya Raman
CQ Roll Call
@sandhyawrites.bsky.social
Read Sandhya’s stories.
Among the takeaways from this week’s episode:
- The news of Trump’s health care plan landed as Sen. Bill Cassidy of Louisiana was working on a separate GOP proposal to direct money into health savings accounts. Congressional Republicans suggested they were left out of Trump’s planning and, among other things, opposed his proposed extension of limited ACA premium tax credits.
- Health and Human Services Secretary Robert F. Kennedy Jr. has confirmed that he ordered the change to the Centers for Disease Control and Prevention website to assert the false claim that vaccines may cause autism. That development puts Republicans in a tough spot — particularly Cassidy, a physician who voted for Kennedy’s confirmation after saying he’d secured an agreement that Kennedy would not make changes to the CDC’s vaccine policy.
- Three states have revived the lawsuit challenging the approval of mifepristone, adding to the case the FDA’s recent approval of another generic version. The Supreme Court threw out the first case, ruling then that the plaintiffs — who were doctors — lacked standing to prove harm. Yet the revived case may very well end up at the Supreme Court again.
Also this week, Rovner interviews Joanne Kenen and Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health about their new book, Information Sick: How Journalism’s Decline and Misinformation’s Rise Are Harming Our Health — And What We Can Do About It.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The New Yorker’s “A Battle With My Blood,” by Tatiana Schlossberg.
Alice Miranda Ollstein: CNBC’s “Meta Halted Research Suggesting Social Media Harm, Court Filing Alleges,” by Jonathan Vanian.
Sarah Karlin-Smith: The Guardian’s “Influencers Made Millions Pushing ‘Wild’ Births — Now the Free Birth Society Is Linked To Baby Deaths Around the World,” by Sirin Kale and Lucy Osborne.
Sandhya Raman: KFF Health News’ “Kids and Teens Go Full Throttle for E-Bikes as Federal Oversight Stalls,” by Kate Ruder.
Also mentioned in this week’s podcast:
click to open the transcript
Transcript: Trump Almost Unveils a Health Plan
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Hello from KFF Health News and WAMU Public Radio in Washington, D.C., and welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping early this Thanksgiving week on Tuesday, Nov. 25, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.
Today we are joined via video conference by Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Hello.
Rovner: Sandhya Raman of CQ Roll Call.
Sandhya Raman: Good morning.
Rovner: And Sarah Karlin-Smith, the Pink Sheet.
Karlin-Smith: Hi, everybody.
Rovner: Later in this episode, we’ll have my interview with What the Health? panelist Joanne Kenen and Dr. Joshua Sharfstein, both of the Johns Hopkins Bloomberg School of Public Health, about their new book called Information Sick: How Journalism’s Decline and Misinformation’s Rise Are Harming Our Health and What We Can Do About It.
But first, this week’ news. So, for about 24 hours there, it looked like we might have an actual health care plan from President Donald Trump, but, alas, it was not to be. What we all heard about on Sunday felt like a plan with a lot of pieces that could actually be palatable to a lot of Democrats. A two-year extension of the covid-era enhanced tax credits with an income cap higher than the 400% that subsidies are about to revert to, and minimum premiums for those paying zero now. And, not surprisingly, or maybe surprisingly, Republicans on Capitol Hill, particularly those in the House who had been adamant about no extension of the premium subsidies, freaked out, to use a technical term. And now the announcement of the Trump plan has been “delayed.” But there is a deadline this time, Jan. 1, when the enhanced tax credits expire — and, before that, the second week of December, when the Senate is supposed to vote on a subsidy extension. That was the deal that got the government reopened. So where are the Republicans at this point?
Ollstein: It’s a total mess. Very few people have confidence that this will get done at all or in time to make a difference for the cost of people’s health care that has already gone up. So, House Republicans were, one, upset just process-wise. They didn’t like finding out that Trump was going to release a plan from news reports and social media. They felt left out of the loop.
Rovner: On a Sunday?
Ollstein: Congress has been left out of the loop on a lot of things in this administration, and this is yet another one. But they were also opposed to the substance of what was leaked. The few details they have, we still haven’t seen what this actual plan is, but they didn’t like that it was a two-year extension, even with these limitations that conservatives had wanted in terms of cutting off people of higher incomes from getting subsidies and requiring everyone to pay a minimum premium, which research shows will lead to a lot of people losing their insurance. And so even with those limitations, there were a lot of people upset. Meanwhile, on the Democratic side, yes, you had some people being cautiously optimistic about this plan, but then you had other Democratic ranking members in the House on the relevant health committees put out a statement saying, Anything short of a clean extension, without these conservative limitations, anything short of that was unacceptable. And so you really have both sides digging in, and I don’t really see how this gets solved.
Rovner [laughing]: Sandhya, what are you hearing?
Raman: I was going to say that in addition to the House being blindsided, I think it puts the Senate in an awkward position. Senate Republicans, they have been gearing up on an HSA [health savings account] proposal as kind of their alternative to extending the premium subsidies. And Sen. Bill Cassidy [R-La.] has said that he wants to do a hearing the week they come back from Thanksgiving to follow up on the [Senate] Finance [Committee] hearing, and this kind of pushes them in a totally different direction after just a few days ago, Trump himself had said, We don’t want to pay the insurance companies, we want the money to go to the consumers directly, kind of in line with one of the HSA proposals going around. So it caused a lot of confusion, and I think it just really further underscores … I don’t think a lot of people are confident this comes together.
Dec. 15 is when open enrollment ends, and I think that even if you look at some of the bipartisan stuff that has been floated before — even last week we had another one come out that was a little similar to the stuff being floated on Sunday that would extend open enrollment more to give them a little bit more time. But one thing that we kept hearing yesterday was just even the changes that were being floated yesterday, why they weren’t being supported by people that do want an extension is there’s such a short time crunch to implement these changes in basically a month.
Rovner: And now Republicans are talking about doing a whole new health bill, maybe using budget reconciliation so they won’t need Democratic votes. And I guess I’m the one that’s going to have to remind them that the ACA [Affordable Care Act] didn’t pass under reconciliation because there were a whole lot of things in it that they couldn’t put in a budget reconciliation bill. They used budget reconciliation to basically cut a deal between the House and the Senate after the Senate lost its 60th vote. But the original ACA passed with 60 votes. So if the Republicans think they’re going to do something really big next year with just Republican votes, they’re going to find out fairly quickly that a lot of that is not going to be allowed.
Ollstein: Just in time, as our Twitter friend says.
Rovner: Somebody pointed out that it’s been 10 years since Trump said he would have a health plan sometime in the next two weeks. Although as I say, this time two weeks is really going to be important. I feel like poor Sen. Cassidy, who we will talk about later with RFK [Robert F. Kennedy Jr.], also kind of got cut off at the knees by the president because he was all over the Sunday shows talking about his plan to give the money to consumers, which is what President Trump had been endorsing until he wasn’t. So we have no idea where the administration is at this point, right?
Ollstein: And I will say, something that in part led to the postponement and backlash and chaos this week is that folks on Capitol Hill, Republicans and Democrats, have no idea what the White House is going to do about this abortion issue that has been roiling — this whole debate where conservatives are saying that it’s a red line, they have to basically ban all plans on the individual market from covering abortion. Right now, it’s up to states: Half ban them, half don’t. Some require them, some allow them but don’t require them. And conservatives are demanding that there be sort of a blanket ban on that coverage, that any federal funding going to these plans, even if they pay for abortion with other money, they consider that a subsidization. And this has been a real sticking point. Democrats say they won’t accept any expansion of abortion restrictions in Obamacare; Republicans say they won’t accept anything without the additional restrictions, and we still don’t know where the White House is going to come down on this.
Rovner: Because, as I like to say every week, health care is really hard. All right. In big news that’s kind of lost already, Reuters is reporting that the White House has terminated DOGE, the Department of Government Efficiency, eight months early. In practice, DOGE has been dormant for many months, even before the departure of Elon Musk back to his day jobs at Tesla and SpaceX. But DOGE has left behind a lot of cuts. The nonprofit Center for Law and Social Policy has a tracker of all the funding and personnel changes made by the administration down to the program level, including at HHS [the Department of Health and Human Services]. I will post a link to it in the show notes.
But if you want a more personal look, you should go read my extra credit this week, which we can all talk about now. It’s an achingly beautiful New Yorker piece by Tatiana Schlossberg, daughter of Caroline Kennedy and granddaughter of JFK [President John F. Kennedy]. Tatiana, an environmental journalist and mother of two young children, is dying of a rare and difficult-to-treat form of leukemia. Among other things, she was undergoing rounds of ultimately unsuccessful treatment while watching huge cuts to health care research being made at the direction of her cousin RFK Jr., all the while realizing how those cuts will likely threaten the survival of patients like her. I heard a lot about this story over the weekend, and I wonder if it might have some impact reaching the public about what the HHS cuts are likely to mean going forward in a way that just the numbers being repeated haven’t.
Karlin-Smith: I think, I mean, it’s such a human connection story, and when she talks about not probably being able to live to see her kids grow up and the kind of research NIH [the National Institutes of Health] was funding that maybe would’ve given her a little bit of hope with a clinical trial that was working. One thing I thought about a lot reading this is she talks about how she’s, I guess, 34 or 35, she felt like she was young and healthy, she was very active, ate right. And one of RFK’s way of thinking, I guess, in the way of orchestrating his health goals is this idea that if you eat right and you exercise and you take certain personal responsibilities, you can avoid illness. And there are lots of kinds of illnesses that, unfortunately, you can do the best you possibly can on an individual personal level and you are not unfortunately exempt from getting, and cancers are one of them. And it’s not to say that there cannot be any role for those other things that can maybe help keep you healthy and prevent certain diseases, but it’s interesting to think about her realization around what can happen to you even if you’re trying your best to live a healthy lifestyle, and the juxtaposition of an administration that is, and their policies also, forgetting that this is not just based on what you eat and how often you exercise and so forth.
Rovner: To quote President Trump, who was talking about something else entirely, “Things happen.” It goes back to the ACA discussion. People who are young and healthy and think they don’t need health insurance because nothing bad is going to happen to them, and a certain number of people … bad things are going to happen no matter how exemplary healthily they live their lives. That’s why we have health insurance. Well, meanwhile, over at HHS, Secretary Kennedy over the weekend confirmed to The New York Times that he was personally responsible for the website changes at the Centers for Disease Control and Prevention that now say scientists “have not ruled out the possibility that infant vaccines cause autism.” Just a reminder, this was a change that Kennedy had promised HELP [Health, Education, Labor & Pensions] Committee chair and gastroenterologist Bill Cassidy he would not make in exchange for Cassidy’s vote to confirm him in the Senate. Yet Cassidy still demurred when asked on the Sunday shows if he regrets being the deciding vote to make Kennedy the secretary. I’m wondering if Cassidy is the new Susan Collins, the main moderate, who continually said during Trump’s first term that she was very, very concerned about many of the president’s policies, but still declined to vote against most of them. Has Cassidy kind of replaced her in that role?
Ollstein: I think Cassidy is really in a situation of his own. I don’t think he’s the new anything. I think he’s the first Cassidy, and maybe in the future we’ll be referring to other Cassidys. But I think given his medical background, and not just any medical background, like given his background specializing in hepatitis, which is one of the vaccines that people are most anxious will become unavailable or restricted in the future, and given his direct role in extracting promises in order to confirm RFK and now having those promises pretty blatantly stepped on and there not really being much repercussions. Also, him being up for reelection next year. I think it’s quite unique, all of those dynamics, as much as we see parallels with some other members.
Rovner: Yeah, it’s true. I’ll say Collins is a moderate because she comes from a moderate state. Cassidy’s from Louisiana, which is not a moderate state, it’s a very red state. So he does find himself in these extremely uncomfortable positions. Well, it’s not just vaccines and not just the CDC that’s turning against settled science. Over at the National Institutes of Health, reports Katherine [J.] Wu at The Atlantic, leaders have a new pandemic preparedness plan that suggests that rather than study pathogens and develop and stockpile vaccines, the country would be better off eating better and exercising. This kind of goes back to what you were just saying, Sarah. I’m not sure to where to start with this, other than I guess it’s better to be healthy than not. But as we’ve pointed out, even healthy people are susceptible to germs.
Karlin-Smith: Right. And so one thing her piece raises is that Kennedy, in particular, has sort of dismissed germ theory, which does not quite believe in the way that most scientists and people do of these roles, of these infectious organisms in disease. And while Katherine’s piece, I think very nicely, talks about there is some element of somebody who is not able to feed themselves enough of the right quantities of food may do worse with an infectious disease, but at the end of the day it’s about your immune system being exposed to these viruses and having some knowledge of how to fight them off. And so younger people, like in the 1918 flu, actually, in some cases would say we’re dying at higher rates even than older people. Obviously again, the pre-vaccine era, this is why so many children under the age of 5 died young. It wasn’t that these were all children born with particularly unhealthy lifestyles or something about them that made them more likely, it was just that their body needed to somehow learn to experience this antigen.
Rovner: We call them childhood diseases for a reason, right?
Karlin-Smith: Right. And I think Katherine Wu does a really good job of talking about the multifold strategies you need to be able to be prepared to fight a pandemic. And being so close to covid still, knowing that bird flu and different strains of bird flu are circulating, it does seem a bit concerning that people may be changing the forms of preparation that we’re preparing for rather than building up.
Rovner: Well, meanwhile over at the FDA, the sharp knives remain out among the top deputies to Commissioner Marty Makary. The latest missive comes from newly appointed drug regulator Richard Pazdur, who unlike many of his fellow center directors is actually a veteran of the agency. But Pazdur has reportedly warned that some of the new FDA efforts to speed the approval of drugs, including deals that trade faster reviews for lowered prices, could be illegal and dangerous to the public health. Sarah, what is going on over there?
Karlin-Smith: Yeah, so it’s been an untraditional year at FDA in terms of how this commissioner operates, but Makary’s what’s called this Commissioner National Priority Voucher program has rolled out in more detail over the past couple weeks. It’s designed to give companies a two-month review, which most FDA reviews tend to be in the six-[month] to one-year time frame. So two months is superfast. And the criteria for qualifying to try and get that is really vague, and it essentially at the end of the day results to the commissioner in their close circle kind of picking who they want. That’s raised a lot of questions because it’s just not clear. They have sort of a fair and established process. Makary has also suggested that if you give commitments to keep the price of the product low, or deal with Trump on his most-favored-nation pricing deal, we’ll give you this.
And FDA does not deal with drug pricing. It has no levers or authority to, if a company says, “Of course Marty, we’ll price this product at a fair price if you give us a two-month review.” They have no levers to enforce that, to determine what a fair price is, and it also raises ethical questions of Should FDA? And potentially again, legal questions, Does FDA have the authority to prioritize an application because a company makes these commitments over another application where a company doesn’t? And is that fair? Particularly, you have to think about normally FDA is prioritizing things based on how devastating the disease is or how quickly it kills things or are there other treatments? And so some of the criteria Makary is using, I think, is striking people as a bit more political in that sense.
Rovner: Yeah. Well, moving on to a segment called “Honey I Shrunk the Health Care Workforce,” you might’ve heard that the Trump administration is busy dissolving the Department of Education and transferring its responsibilities to other agencies. On its way out of existence, however, the department has determined that a long list of health care careers don’t qualify as professions, including nursing, social work, physical therapy, public health, and physician assistants. This is not just semantic, it means that people studying for these graduate degrees won’t be able to get federal student loans for anywhere near what tuition costs. And this comes at a time when the U.S. badly needs more, not fewer, of these health professionals for an aging and increasingly less healthy population. In fact, this feels like a way to make health care more, not less, expensive, since many of these professionals can do work otherwise done by higher-paid medical doctors. Am I missing something here?
Raman: I think you’re exactly right, especially as over the last few years we’ve seen in Congress them really ramping up, looking at ways to expand the pipeline of workers. You can’t create a health worker overnight. The more advanced the degree, the longer it’s going to take. And I mean, I think it’ll take a little while to see some of the effects of this if it stays in effect, because there’s going to be people that maybe won’t even consider some of these fields rather than if they’re midway through or about to enter one, if they know that it’s not going to be something that their family or themselves can afford. At the same time, as we’re going to have the population aging and we’re going to need more and more of these folks, so I think it’s a two-pronged thing that we’ll see over time.
Rovner: Yeah. And I know in my workforce studies, I’ve seen a lot of people who wanted to be doctors who ended up going to nursing school or physician assistant school because it was so much cheaper and it took less time, so it was sort of an easier career path. But this is throwing up another roadblock. It just seems like, why are they doing this? I guess nobody has yet said … I have to tell you, I’ve gotten dozens of emails from organizations representing a lot of these career professionals saying, “What are they doing here?” It seems puzzling.
Karlin-Smith: Some of these professions, like public health workers, don’t end up making the most money once you come out. So people talk about how well doctors, med school, is really expensive and they don’t make enough … but eventually you recover from that process. And in some of these professions, like public health, it really might not just make it totally unviable for people to go into the field because they don’t have that guarantee they’re going to be able to get a salary that will ensure they can repay their loans afterwards.
Rovner: Yes. Well and speaking of doctors, Yuki Noguchi over at NPR has a smart story about how the administration’s crackdown on immigration is giving international medical school graduates pause about wanting to come practice in the U.S. This is also a big deal because immigrant physicians are not only a big part of the physician workforce in general in the U.S., but in areas with the biggest doctor shortage they often make up as much as half of the doctors in practice. Since this administration is all about affordability, the combination of these two policies seems likely to create a giant shortage, yes?
Ollstein: Yeah. We’re cutting off our domestic pipeline and we’re cutting off our international pipeline, and this is coming … there are already shortages. There was so much burnout and people retiring early and people quitting during and after the pandemic, and this couldn’t come at a worse time, really. And there’s more punches than the one-two punch. People are also concerned about the high-skilled worker visa fees going up and that making it harder to bring in international medical workers for hospitals that are already struggling to pay an extra fee of tens of thousands of dollars is not really viable right now. So yeah, there’s a lot of concern.
Rovner: And it’s certainly not going to bring down medical prices, which I guess is maybe what I mean. I know that in the case of the cap on medical school tuition, the hope is to bring down tuition, is to force tuition down by not making the loans big enough. But it’s one thing to say that having unlimited loans is inflationary and allows tuition to go up; it’s another thing to say that cutting off the loans is going to make tuition go down.
Raman: Yeah, I mean it’s a complicated process when you also have, I mean, for a variety of degrees, the international students are often paying full price, and that subsidizes the cost of some other folks going. So there are many pieces of this puzzle, so it’ll be interesting to see what happens next.
Rovner: We will continue to watch this space. OK, we’re going to take a quick break. We will be right back.
So turning to the “everything that is old is new again,” now we have the return of the public charge rule, which Trump tried to rewrite during his first term to make it harder for immigrants to qualify for permanent residency, only to have it reversed by the Biden administration. Alice, remind us what this is and what Trump 2.0 is trying to do that’s different from what Trump 1.0 did.
Ollstein: Right. So this has gone back and forth, and it’s not a straight, clear-cut revival of the policy under the first Trump administration. I think in part that’s because that one was struck down in court, and so this trends of the new. So, basically, after the comment period and when things get finalized, this is giving, instead of directing all immigration officers to deny permanent residency applications to people who have used Medicaid and have used these social safety-net programs, it’s basically just leaving it up to the individual officer. And there’s language about considering the totality of circumstances, and so there’s a lot of concern in the immigration advocacy community that this will lead to discrimination and decisions made based on basically vibes of if someone seems like they might become a burden on society later, and so I expect there will be lawsuits for sure.
There is already a lot of concern, even though this hasn’t gone into effect yet, about having a chilling effect on immigrants who are perfectly eligible and can legally qualify for these programs not using them, avoiding health care, avoiding preventive care, avoiding testing and treatment for infectious diseases. And there were several studies about the impact of this policy in the first Trump administration that showed that it really took a toll on public health. And we live in a society if you pass a policy that impacts one part of the population, it’s going to impact other parts of the population. And so this is predicted to make things harder for citizens as well, both the cost of care and the spread of infectious diseases.
Rovner: All right. Well, finally this week, moving on to reproductive health. Remember that lawsuit in Texas that was filed by a group of anti-abortion doctors that wanted to reverse the FDA’s approval of the abortion pill mifepristone? Well, the doctors are no longer part of the lawsuit because the Supreme Court said they didn’t have standing to sue, and the case is no longer in Texas, but it is still around. And now the three states that are pursuing it, Missouri, Kansas, and Idaho, are adding to their suit the FDA’s recent approval of a second generic of the original abortion pill. Alice, how is this case still going? And now what happened?
Ollstein: It’s very much still going. It’s just been bouncing around, and now it’s being considered by a whole different court in a whole different state and they’re going to start the process all over again. And I wouldn’t be surprised if it made it all the way back to the Supreme Court, even though it’s already been there with different plaintiffs. So there was a lot of outrage in the anti-abortion community about the recent approval of another generic of mifepristone, even though the way that works is if it’s chemically identical to the versions that have been already approved, it kind of automatically goes through and it doesn’t really have anything to do with the other things they’re challenging. It’s just something else that they’re upset about.
Rovner: So they’re adding it to it. Well, we will watch that lawsuit too. And last, we don’t talk enough about AI [artificial intelligence] in health care, but a study caught my eye this week from the nonprofit Campaign for Accountability that found a number of chatbots, when asked about medication abortion, gave instructions to call a hotline that urged those with unplanned pregnancies to try “abortion pill reversal,” which is not a thing, although it is pushed by many anti-abortion activists. This appears to be a case where the flood of misinformation so outnumbers the real information that the chatbot thinks that the misinformation is the right answer. Quantity over quality, if you will. This feels like kind of a major flaw in using AI, not just for abortion questions, but for health information in general, given how much health misinformation is out there.
Raman: I think we’ve seen this in other types of health care, where they’ve tried to roll out some of these chatbots to help with different things, especially like mental health, and it’s backfired for different reasons because of it might promote something that it shouldn’t for that group. I think there was one at one point where it was offering dieting tips to someone with an eating disorder, just things that maybe might be applicable to someone else but not to that specific group. So there are definitely things that need to be hammered out in this.
Rovner: Yeah, I feel like we’re having sort of a real-time clinical trial of how AI works with the general public in health care, and I don’t know who is really keeping track of what it is doing.
OK. That is this week’s news. Now we will play my interview with Joanne Kenen and Joshua Sharfstein about their new book, and then we’ll come back and do our extra credits.
I am pleased to welcome to the podcast Joanne Kenen and Dr. Joshua Sharfstein, two of the three authors of the new book Information Sick: How Journalism’s Decline and Misinformation’s Rise are Harming Our Health — And What We Can Do About It. Our regular listeners all know Joanne, she’s the former health editor at Politico who now teaches at the Johns Hopkins Bloomberg School of Public Health and writes for Politico Magazine. Joshua Sharfstein, who I’ve known almost as long as I’ve known Joanne, is distinguished professor of the practice at Johns Hopkins Bloomberg School of Public Health. He’s a physician who’s worked on Capitol Hill and at the Food and Drug Administration, and also served as the city of Baltimore’s public health commissioner and the State of Maryland’s secretary of health and mental hygiene. Joanne and Josh, thank you so much for joining us.
Joanne Kenen: Thanks for having us.
Joshua Sharfstein: Great to be here.
Rovner: So first, explain the title. What does “information sick” mean?
Sharfstein: Well, “information sick” is a diagnosis. It’s a diagnosis both of individuals who are confused by information about health that they’re getting, and as a result can’t make good decisions for themselves and their families. And it’s also a diagnosis for our society, that there’s so much bad information on health out there, there’s so little good information that as a country, we’re at risk of making some bad decisions on health policy.
Rovner: So I have kind of a mea culpa. We have spent a lot of hours on this podcast talking about how public health officials should be doing a better job communicating to the public, combating mis- and disinformation, but without really addressing the other side, the decline of journalism. Joanne, how much of the problem is how information is communicated to the public by health officials, and how much is the changing ways that people are actually communicating with each other?
Kenen: That’s what our book, where they explore it, is this nexus. There’s been lots written about the decline of journalism, there’s been lots written about failures of public health communication, some of which may be overstated actually, and some of it’s clearly mistakes have been made. But the connection is something that we really explored starting in the class we taught a couple of years ago, and then putting together the book. People do not get information in the ways that we grew up getting information. Local news has really been eviscerated in large parts of the country. There’s county after county that does not have any local news, or that has something very meager. And that was trusted, it’s still trusted where it exists, that was a way people got health information. National news is polarized, with some outstanding exceptions. There’s just not a lot of policy news that people get. And people instead, particularly younger people, are getting … instead of their doctor, they’ve got their TikTok. And there’s a lot of wrong stuff. And it’s not only vaccines, it’s pretty much everything.
Rovner: So how much of the problem within the information ecosystem is information that’s just wrong because it’s being distributed by non-experts, and how much is from actual bad actors, those with either a potential monetary gain from spreading bad information or those purposely trying to sow discord?
Sharfstein: Well, one of the challenges is that there isn’t really good information because social media companies, in particular, have not been very forthcoming about what is on their site. It’s very clear that there are bad actors, as you say, including nations that are deliberately putting out information to confuse Americans, and including people who are really trying to make a quick dollar selling things that really shouldn’t be on the market. But there’s also a big gray area because sometimes information gets seeded, but people are passing it on, believing it to be true. And so it’s not all one or all the other, but the quantity of information that’s out there that is not reliable is staggering — so much so that this idea of a public health communication is, to some experts in the field, almost laughable because it will get washed away by the tidal wave of misleading information and make it very hard for people to know what to believe.
Kenen: There’s a communication media element in this, too. Because if you’re a reporter working for a little tiny newspaper that used to have maybe five or six reporters, and someone could have developed some expertise in health, you know, when you can, if you’re on a national beat doing it full-time, but you can develop some confidence in knowing what you’re talking about. If you’re now one of two reporters and you’re covering eight beats and health is one of them, and you don’t have an editor who can mentor you on health either, there’s a lot of bad reporting. And it’s what we call false equivalence a lot. If you don’t know if this source is an expert, and that source is a charlatan, or vice versa, you tend to put them both as equals. So they’re in the newspaper story or on the local news where you have somebody saying, “Vaccines are safe,” and somebody else saying, “They’re toxic, damaging, barbaric things that are going to kill us all.” So you’re getting something from a news outlet that you should be able to trust, but because of the shrinkage and lack of resources and lack of money and lack of expertise, you end up inadvertently feeding the misinformation monster.
Rovner: So yeah, some of it is deliberate, and some of it is kind of accidental because of the decline of journalism. So, luckily, your book doesn’t just lay out the problem, you also offer up some potential solutions. Joanne, can you summarize how journalism can do a better job of curing information sickness? And then, Josh, can you talk about how the health community can do its part?
Kenen: Well, I think that in journalism, if you’re a young reporter starting out and you don’t have the resources to do your job, there are some tools and resources. There’s more and more training opportunities in health, medicine, climate, other areas. So you can get some free training online, and I would urge anyone who’s starting out on this beat … and not just on the beat. I mean if you’re a business reporter or a politics reporter or a general assignment reporter, you’re a health reporter, you’re going to end up doing this. So there are a number of programs through philanthropies and universities, as well as journalism organizations, to bolster local news and bolster health reporting. So anyone who falls into that category who is listening, do it. You won’t come out with an MPH [master’s of public health], but you’ll come out with knowledge and confidence and competence.
Congress had been talking for, I don’t know, 15 years or so about tax breaks and other things to prop up journalism. It’s not going to pass now if it hasn’t passed in the last 15 years, I don’t see that happening in the current environment. The consolidation that we’re seeing in the media and TV stations is probably going to make it worse, not better. So if we tell our students, “There is a lot of free stuff out there. You can be informed without spending three hours and hundreds a day trying to read everything.” Our podcast is free, KFF is free, KFF Health News is free. There are things you can do to get quality information and quality journalists.
Rovner: And Josh, what’s the role of the public health community in this changing information environment?
Sharfstein: There’s a big role. And I would first echo Joanne’s point that there are new and emerging sources of journalism that are really important. The nonprofit sector is growing, and there are some large organizations, like KFF, there are some specific ones, like The Trace that covers gun violence. There are new outlets for specific communities that are really doing high-quality work, and we should all be supporting them. And in a sense, I’ll start there, because I think journalism and health and public health are facing a similar kind of challenge, and we should be supporting each other in addressing it.
Within the health sector, the first thing is getting the diagnosis right. That’s the right thing to do for a patient; it’s the right thing to do here. Information is not just something that is provided by a public health official or communicated by a health care official. It’s actually a determinant of health. How people get information, what that information says, is incredibly important for their health. And we have to realize that that fundamental determinant is in jeopardy right now. And then I would say that there are several things that are really important. The first is to engage, to not just say, “Well, that’s just not my job. I’m not going to learn the whole new TikTok thing.”| People have to realize where this information is coming from and do their best themselves and through partnerships to get better information out on these channels, and engage with the channels to try to find ways for the algorithms not to take people down a conspiratorial rabbit hole at every opportunity. The second thing, particularly for health care organizations, is to train clinicians so that they’re not just stunned and defenseless when people come in and say, “I’m not going to do chemotherapy. I’m instead going to do some unproven nutritional treatment instead.” And help their clinicians leverage the great relationships that they have with patients to be able to talk people down from the most severe manifestations of being information sick.
And the third element that I would highlight is that health care and public health have an opportunity, and really a responsibility, to win the battle in real life. Like, the online world is a mess. And a lot of the different techniques that we looked at, like fact-checking and debunking and pre-bunking and all these different ideas, have promise, but really have not won the situation. It’s a mess online. But in the real world, it’s possible to have networks of clinicians and faith leaders and business leaders and political leaders who are standing arm in arm and saying, “This vaccine really does matter and will keep people in our community safe.” And for health departments, this is a real opportunity to reconnect with some of those community roots and do great work literally in each other’s presence. In Baltimore here, there was a network of community health workers that played a really important role in bolstering vaccine confidence during the pandemic. It’s one of the reasons that Baltimore did quite well in terms of covid mortality. So I think that there’s a big agenda here, and of course it’s an agenda at a very difficult time for both health care and public health in 2025.
Kenen: I think that one thing that we learned about a lot as we researched this, it makes sense when we say it to people, they all nod, but understanding why information has power. There’s a lot that people researching it don’t understand yet, like why once people buy into a myth it’s so hard to get it out of their brain. But what does it do? It appeals to our fears, it appeals to our anxieties, it appeals to our resentments. Social media does not make you feel calm and serene and confident, it makes people agitated and angry. And it’s not a coincidence that there was disinformation before the pandemic and there’s disinformation after the pandemic, but the flowering and the sort of exacerbation during the pandemic, it’s partly because we were so vulnerable to it. We were feeling fear and resentment and anxiety, both about health and about the economic dislocation during the pandemic, particularly that first year. So we were really vulnerable, and people who were spreading it, the ones intentionally, in particular, really were able to sort of exploit that vulnerability that we had. There’s a lot of research. The role of AI is going to change things for good and bad. I mean, anything you write about this about disinformation is somewhat out of date tomorrow. But I think it’s useful for people to understand that what they’re being opposed to that’s so catchy and grabs them is often really bad for them.
Rovner: Yeah, well, bigger societal problem. But thank you for writing this book. Joanne Kenen and Joshua Sharfstein, thanks for joining us.
Sharfstein: Thanks so much.
Kenen: Thanks, Julie.
Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read too. Don’t worry if you miss it; we will put the links in our show notes on your phone or other mobile device. I have already done my extra credit this week. Sarah, how about you go next?
Karlin-Smith: I took a look at a piece in The Guardian called “Influencers Made Millions Pushing ‘Wild’ Births — Now the Free Birth Society Is Linked To Baby Deaths Around the World,” and it chronicles a movement started by two women using podcasts and Instagram and social media. And it’s not just a movement, I would say it was a business for them. I think The Guardian piece says they made about $13 million basically convincing people to give birth at home with no medical support at all. No midwife, nothing of the sort. And they oftentimes even seem to discourage people when they are in medical distress, or their baby is in medical distress, while birthing from going to the hospital. It has led to babies being born with various birth defects or disabilities that they would not otherwise have been born with. It has led to deaths of babies and, possibly, women.
And I think one thing that stood out to me is a lot of women the story talks about seem drawn to this movement for a couple of reasons. One is how high cost the U.S. health system is in terms of to get good midwifery care, go to a hospital, see an OB-GYN. So some people were drawn to it just because they felt like they couldn’t afford it, and this seemed like a good option. And other people were drawn to it because they had some kind of bad or traumatic experience giving birth the first time in the traditional medical system and were sort of ripe to be really taken advantage of and exploited.
Rovner: Yeah, it was quite a story. Sandhya, why don’t you go next?
Raman: So I picked “Kids and Teens Go Full Throttle for E-Bikes as Federal Oversight Stalls,” and that’s from Kate Ruder for KFF Health News. And this story looks to see are these bikes safe for kids? And that it’s a difficult thing to kind of spell out. There’s not a ton of federal regulations on e-bikes, and it’s a patchwork on the state and county level. And I learned a lot, I think, just because I didn’t realize that there’s no age for operating an e-bike at the federal level, but it’s kind of piecemeal at the state level for other types of motorized vehicles. So it looks at some of that and just kind of what the gaps are and some of the regulations that have been pulled back in recent months.
Rovner: As somebody who almost got taken out by, like, an 8-year-old on a motorized vehicle a couple of weeks ago, I very much felt this story. Alice?
Ollstein: So speaking of things that are bad for young people, this story is from CNBC reporter Jonathan Vanian. It is about through a lawsuit … so parents, school districts and state attorneys general have been suing social media companies, primarily Meta, which owns Facebook and Instagram, for negative mental health, emotional health impacts on young people. And through the discovery process in these lawsuits, they uncovered that Meta did research back in 2019 and found that people who stopped using these apps, even for just a week, experienced less depression, anxiety, loneliness, and social comparison. And they buried that finding and did not disclose it. And so this is coming out in the lawsuit. And they uncovered a quote from a Meta employee who said, “If they didn’t release the research, they risked looking like tobacco companies,” who found through their own research about the addictive and damaging properties and did not disclose them, and how that was a bad look later. So this is important to keep in mind as we all marinate our brains in it.
Rovner: That’s right. And another lawsuit that we will keep an eye on.
OK. That is this week’s show. Thanks, as always, to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever else you get your podcasts. As well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me still on X @jrovner, or on Bluesky @julierovner. Where are you folks hanging these days? Sandhya?
Raman: @SandhyaWrites on X and on Bluesky.
Rovner: Alice?
Ollstein: @alicemiranda on Bluesky, and @AliceOllstein on X.
Rovner: Sarah?
Karlin-Smith: @SarahKarlin or @sarahkarlin-smith, on X and Bluesky.
Rovner: We’ll be back in your feed next week. Until then, have a great holiday and be healthy.
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