It's a MAHA world now

The ideas and innovators shaping health care

Nov 06, 2024 View in browser   By Daniel Payne, Erin Schumaker, Carmen Paun and Ruth Reader ELECTION 2024 Trump has promised Robert F. Kennedy Jr. a big health care role in his administration. | Olivier Touron/AFP via Getty Images MAGA transformed the GOP. MAHA could do the same for its health agenda. In his victory speech earlier today, President-elect Donald Trump vowed to “make America healthy again,” setting the stage for the Republican Party to reset its health agenda, finding new policy goals alongside a broader critique of the federal health bureaucracy. That could forebode conflict with the traditional GOP preference for market-based solutions and skepticism of government ones. Why it matters: Republicans have traditionally wanted to add risk pools to Obamacare to cut rates for healthy, young people; allow small businesses to team up to buy insurance; and add work requirements to Medicaid, the state-federal insurance program for low-income people. MAHA devotees, led by Robert F. Kennedy Jr., want to expose and destroy what they see as a corrupt alliance between the food and pharmaceutical industries and the agencies that regulate them to push unhealthy products for profit — arguing for strong, independent government controls. MAHA adherents emphasize policy goals out of step with the traditional Republicans, such as reducing pollution and eliminating food additives in service of reversing the “chronic disease epidemic.” “He wants to do some things, and we’re going to let him go to it,” Trump said in his victory speech of Kennedy. “Go have a good time, Bobby.” The agenda could grow well beyond environmental and agricultural rules to include new conservative health ideas broadly, with an emphasis on personal responsibility and individual choice in health care. Even so: Kennedy’s fringe views — touting the debunked claim that vaccines cause autism, suggesting a conspiracy among industry elites and government institutions to harm Americans or questioning settled science across a number of issues — have worried some Republicans and have the potential to repel them from joining the MAHA movement. And Republicans in Congress may prefer to focus on the opportunity they’ll have if they win the House as well as the Senate to enact new health policy law — even as its focus remains unclear. Some could try to tear away the MAHA slogans — increasingly popular among Trump’s base — and use them to achieve their existing policy goals. What’s next? Kennedy told National Public Radio today that Trump had directed him to root out corruption and conflicts of interest in regulatory agencies, alter the way the agencies evaluate scientific evidence, and seek cures for chronic diseases. WELCOME TO FUTURE PULSE Washington, D.C. | Samuel Corum/AFP via Getty Images This is where we explore the ideas and innovators shaping health care.  Would Donald Trump's Michigan voters have reconsidered if they'd known of Trump adviser Robert F. Kennedy Jr.'s dim view of Fruit Loops, made by Battle Creek-based WK Kellogg Co.? Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com , Ruth Reader at rreader@politico.com, or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. AROUND THE NATION The Boston Globe editorial board urged state voters to reject an initiative to legalize psychedelic drugs. | AFP via Getty Images It’s turning into a really bad year for psychedelic medicine. It suffered another loss Tuesday, when Massachusetts voters soundly rejected a ballot measure to legalize certain plant-based psychedelics for adults. The tally this morning was 57 percent opposed to 43 percent in favor, according to the Associated Press, a difference of more than 400,000 votes. Question 4 would have allowed adults 21 and older to grow, possess and use a personal amount of natural psychedelic substances, including psilocybin and psilocyn, both found in mushrooms, and mescaline, ibogaine, and dimethyltryptamine, or DMT, which are derived from plants. It also would have set up a commission and state advisory board for regulating psychedelics. Psychedelics advocates, including the CEO of Dr. Bronner’s Magic Soaps, David Bronner, who donated $1 million toward the Massachusetts campaign, believe psychedelics are a promising treatment for intractable mental health conditions like post-traumatic stress disorder, treatment-resistant depression and alcohol-use disorder. Opponents included the Massachusetts Psychiatric Society, a state branch of the American Psychiatric Association, which represents 1,500 psychiatrists in Massachusetts. Had the measure passed, it would have made Massachusetts the third state to legalize psilocybin after Oregon and Colorado, which approved their own ballot measures in 2020 and 2022. Psychedelic movement losses mount: In August, the FDA rejected drugmaker Lykos Therapeutics’ application to treat PTSD with the psychedelic drug MDMA and therapy after the agency’s outside advisers said Lykos’ regimen wasn’t effective and the company hadn’t shown that its benefits outweighed its risks. Lykos subsequently laid off 75 percent of its staff, and its top leaders left. The FDA told the company it would need to conduct an additional Phase III clinical trial to have its application reconsidered. The stringent regulatory environment put a chill on the sector. Last week, Lykos competitor Compass Pathways announced it was delaying results from its late-stage synthetic psilocybin trial and laying off 30 percent of its staff. What's next? The VA, which in addition to being the nation's largest health system serves a population with disproportionately high PTSD rates, remains bullish on psychedelic research. "The U.S. Department of Veterans Affairs must lead on this encouraging area of investigation so that we can continue to build trust with Veterans contending with these severe health conditions," Dr. Shereef Elnahal, the VA undersecretary for health, wrote on LinkedIn late last month, adding: "And we will." POLICY PUZZLE You still can't smoke that for fun in Florida, or the Dakotas. | David Ramos/Getty Images Pot went one for four on Election Day, as voters in Florida and both of the Dakotas rejected legalization, while Nebraskans approved medical marijuana. The Florida measure, Amendment 3, had a majority in support as of press time, but needed to get 60 percent for approval under state rules. It sought to expand Florida’s $2 billion medical marijuana industry by permitting the sale of products for recreational use, our Arek Sarkissian reports. The amendment failed despite more than $100 million in cash contributions. Most of that cash came from the state’s largest medical pot company, Trulieve, which became a lightning rod for attack ads launched by GOP Gov. Ron DeSantis and the Republican Party of Florida. The failed initiative marks a stark contrast to the 2016 election, when more than 71 percent of Florida voters approved marijuana for medical use. Neither of the ballot initiatives to legalize pot for recreational use in the Dakotas received 50 percent of the vote. Both states permit it for medical reasons. The District of Columbia and 24 states have legalized weed for recreational use. Nebraska voters approved a pair of medical cannabis legalization initiatives on their ballot, but their ultimate fate will still likely be decided by the courts, our Mona Zhang reports. Initiative 437 allows patients with a written recommendation from a health care provider to possess and acquire up to five ounces of cannabis. Initiative 438 creates the Nebraska Medical Cannabis Commission, which will regulate the medical cannabis program. Thirty-nine states have legal medical marijuana.   Follow us on Twitter Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker   Follow us

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