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A public health historian sizes up their records

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theconversation.com – Zachary W. Schulz, Lecturer of History, Auburn University – 2024-09-17 07:33:53

The presidential debate on Sept. 10, 2024, did not add much context to what the two candidates would do on health care beyond their own records.
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Zachary W. Schulz, Auburn University

Health care is a defining issue in the 2024 election – Democratic presidential nominee Kamala Harris and Republican contender Donald Trump have starkly different records on the issue. Rather than focusing on what they promise to do, let’s examine what their past actions reveal about their approaches to Medicare, the Affordable Care Act, public health infrastructure, drug policy and child abuse and domestic violence prevention.

As a specialist in public health history and policy, I have carefully examined both candidates’ records on American health care. With years of experience in the health care field and being a cystic fibrosis patient myself, I have developed a deep understanding of our health care system and the political dynamics that shape it.

For me, as for many other Americans, health care is more than just a political issue; it is a deeply personal one.

Medicare

During Harris’ time in the Senate, she co-sponsored the Medicare for All Act, which aimed to expand Medicare to all Americans, effectively eliminating private insurance.

At the presidential debate on Sept. 10, 2024, Harris clarified her former support of “Medicare for All” by emphasizing her prior legislative efforts to preserve and expand protections for patients’ rights and access to affordable health care.

Harris’s legislative efforts, primarily around the 2017-2020 period, reflect a commitment to broadening access to Medicare and reducing costs for seniors. During that time, Harris advocated for the Medicare program to negotiate drug prices directly with pharmaceutical companies.

Later, as vice president, Harris cast a tie-breaking vote on the 2022 Inflation Reduction Act, allowing the government to negotiate drug prices for Medicare with pharmaceutical companies.

In contrast, during Trump’s presidency, he made several attempts, some of which were successful, to cut funding for Medicare. The 2020 budget proposed by his administration included cuts to Medicare totaling more than US$800 billion over 10 years, primarily by reducing payments to providers and slowing the growth of the program.

The proposed cuts did not take effect because they required Congressional approval, which was not granted. The plan faced significant opposition due to concerns about potential negative impacts on beneficiaries.

Affordable Care Act

Harris has been a staunch defender of the Affordable Care Act, also known as the ACA or “Obamacare.” As a senator, Harris consistently voted against any efforts to repeal the ACA. She advocated for expanding its provisions, including supporting legislation that aimed to strengthen protections for people with preexisting conditions and increase funding for Medicaid expansion.

Harris’ record shows a clear commitment to ensuring broader health coverage under the ACA. And, in the recent debate, Harris noted this record and reasserted her commitment to the act.

During his presidency, Trump led multiple efforts to repeal the ACA, including the 2017 American Health Care Act, which would have significantly reduced the scope of Medicaid expansion and removed individual mandates.

Although these efforts ultimately failed in the Senate, Trump succeeded in weakening the ACA by eliminating the individual mandate penalty through the 2017 Tax Cuts and Jobs Act. In the debate against Harris, Trump reiterated his position that the Affordable Care Act “was lousy health care,” though he did not ultimately offer a replacement plan, stating only that he has “concepts of a plan.”

Donald Trump claims that as president, he had an obligation to save Obamacare, otherwise known as the Affordable Care Act, but says it is too expensive. He says he has ‘concepts of a plan’ for something to replace the ACA.

Public health infrastructure

Harris’ tenure in the Senate, from January 2017 to January 2021, shows a consistent pattern of supporting public health infrastructure. She co-sponsored several bills aimed at increasing funding for community health centers and expanding access to preventive care.

Harris also advocated for more federal funding to address public health emergencies, such as the opioid epidemic and the COVID-19 pandemic.

During Trump’s presidency, however, he made significant cuts to public health programs. The Trump administration proposed budget cuts to the Centers for Disease Control and Prevention and other public health agencies, arguing that they were necessary for fiscal responsibility. These proposals drew criticism for potentially undermining the nation’s ability to respond to public health emergencies, a concern that was underscored by the CDC’s struggles during the early days of the COVID-19 pandemic. Trump frequently has responded to these criticisms by asserting he “cut bureaucratic red tape” rather than essential services.

Drug pricing policy

Harris has also supported legislation to lower drug prices and increase transparency in the pharmaceutical industry. She co-sponsored the Drug Price Relief Act, which aimed to allow the federal government to negotiate drug prices for Medicare directly. She also supported efforts to import cheaper prescription drugs from Canada. Her record reflects a focus on reducing costs for consumers and increasing access to affordable medications.

Trump’s record on drug policy is mixed. While Trump took credit for some decreases in prescription drug prices during his presidency, his administration’s most significant regulatory changes favored pharmaceutical companies. The administration’s attempts to implement a rule allowing the importation of cheaper drugs from Canada faced significant hurdles and did not lead to immediate changes.

Trump also ended a rule that would have required pharmaceutical companies to disclose drug prices in television ads, citing concerns over its legality.

Child abuse and domestic violence

Harris has a strong record of advocating for the prevention of child abuse and domestic violence. During her time as California’s attorney general and as a senator, Harris pushed for legislation that increased funding for domestic violence prevention programs and expanded legal protections for survivors. She has consistently supported measures to enhance child welfare services and improve coordination among agencies to protect children.

Trump’s record on these issues is less defined, but his administration did sign into law the Family First Prevention Services Act, which aimed to keep more children safely at home and out of foster care by providing new resources to families. However, critics argue that the Trump administration’s broader cuts to social services and health programs could indirectly undermine efforts to combat child abuse and domestic violence. In addition, some experts suggest that Trump’s family separation policies on the southern border contributed to an increase in child trauma during his administration.The Conversation

Zachary W. Schulz, Lecturer of History, Auburn University

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What is seditious conspiracy, which is among the most serious crimes Trump pardoned?

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theconversation.com – Amy Cooter, Director of Research, Academic Development and Innovation at the Center on Terrorism, Extremism and Counterterrorism, Middlebury – 2025-01-22 15:12:00

The Jan. 6, 2021, storming of the Capitol was the result of a planned conspiracy to disrupt the government, prosecutors alleged.
AP Photo/John Minchillo

Amy Cooter, Middlebury

Several of the highest-profile figures in the Jan. 6, 2021, insurrection were charged with, and convicted of, the crime of seditious conspiracy, which is defined as the act of getting together with other people to overthrow the government. They were among the roughly 1,500 people involved in the insurrection who were pardoned or had their prison sentences commuted by Donald Trump on his first day in office.

Seditious conspiracy is a serious crime of conspiring to overthrow the government or stop its normal functioning. Historically, seditious conspiracy has been difficult to successfully prosecute.

In 2009, for example, a state judge ruled that prosecutors had failed to provide sufficient evidence for members of the Michigan Hutaree militia to go to trial on that charge. Certain militia members had been accused of plotting violence against police officers. While some members faced other charges for their actions, the judge determined that a plot against law enforcement was not sufficient to support charges of attempting to overthrow the government.

In contrast, the U.S. Department of Justice charged 18 people associated with the Jan. 6 attack on the U.S. Capitol with that crime, asserting that they had intended to “oppose by force the lawful transfer of presidential power” or had committed other actions that would undermine the entire system of government.

Of those 18, four pleaded guilty, and 10 were found guilty at trial. The remaining four were found not guilty of seditious conspiracy but were convicted of other crimes that were related to the insurrection.

Capitol entry not required

Oath Keepers militia leader Stewart Rhodes’ seditious conspiracy conviction was especially significant because, unlike some other defendants, Rhodes did not physically enter the Capitol building. He was instead in “the restricted area of Capitol grounds,” according to a Justice Department statement.

His conviction was based in part on his communications, including text messages, both before Jan. 6 and on the day itself. Prosecutors successfully argued that these communications were part of a broader conspiracy to disrupt the election certification by organizing and encouraging others to participate in more direct action.

Two men walk in front of a group of masked men with the Washington Monument in the background.
Proud Boys members Joseph Biggs, left, and Ethan Nordean, right with megaphone, walk toward the U.S. Capitol in Washington, D.C., on Jan. 6, 2021.
AP Photo/Carolyn Kaster

Militias respond to convictions – and clemency

Many observers believed successful prosecutions for these charges sent a strong message that violence against a democratically elected government was not acceptable.

Scholars of militia activity like me saw a period of relative quiet through much of Joe Biden’s presidency, which was, in part, likely due to the consequences the Jan. 6 defendants faced.

Some groups, however, continued social media discussions of their beliefs that the 2020 election had been “stolen,” as Trump continues to falsely claim, and which was used as justification by militia members for their attack. Trump himself said publicly he thought the defendants were unjustly persecuted and promised to pardon them if and when he returned to power.

The full effect that the pardons will have on militia actors and related groups in coming years is uncertain: Will the pardons send the message to all Americans that political violence is acceptable, or at least that it can be overlooked or forgiven if the right political figures are in power?The Conversation

Amy Cooter, Director of Research, Academic Development and Innovation at the Center on Terrorism, Extremism and Counterterrorism, Middlebury

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Ozempic and similar weight loss drugs may lower risk of 42 health conditions, but also pose risks

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theconversation.com – Ziyad Al-Aly, Clinical Epidemiologist, Washington University in St. Louis – 2025-01-22 14:11:00

The research shows the health effects of these drugs are significant and wide-ranging.
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Ziyad Al-Aly, Washington University in St. Louis

Several years ago, a little-known drug named Ozempic – previously used only to treat diabetes – emerged as a promising new drug for weight management.

The Food and Drug Administration’s approval of Ozempic in 2021 for weight loss treatment ushered in a new era for the class of drugs called glucagon-like peptide-1 agonists, or GLP-1.

Today, GLP-1 drugs, including Wegovy, Mounjaro and Zepbound, have become household names and key tools in the fight against obesity: 1 in 8 American adults say they have used a GLP-1 drug, and forecasts show that by 2030, 1 in 10 Americans will likely be using these medications.

Now, research from my lab and others suggests that GLP-1 drugs could help treat dozens of other ailments as well, including cognitive issues and addiction problems. However, my colleagues and I also found previously unidentified risks.

I am a physician-scientist and I direct a clinical epidemiology center focused on addressing public health’s most urgent questions. My team works to address critical knowledge gaps about COVID-19, long COVID, influenza, vaccines, effectiveness and risks of commonly used drugs, and more.

On Jan. 20, 2025, my team published a study of more than 2.4 million people that evaluated the risks and benefits of GLP-1 drugs across 175 possible health outcomes. We found that these drugs lowered risks of 42 health outcomes, nearly a quarter of the total that we analyzed. These include neurocognitive disorders such as Alzheimer’s disease and dementia, substance use and addiction disorders, clotting disorders and several other conditions.

Unfortunately, we also found that GLP-1 drugs come with significant side effects and increase the risk of 19 health conditions we studied, such as gastrointestinal issues, kidney stones and acute pancreatitis, in which the pancreas becomes inflamed and dysfunctional.

Initially, GLP-1 drugs were developed to treat diabetes.

Cognitive benefits

One of the most important health benefits we found was that the GLP-1 drugs lowered the risk of neurodegenerative disorders, including Alzheimer’s disease and dementia. These findings align with other research, including evidence from preclinical studies showing that these drugs may reduce inflammation in the brain and enhance the brain’s ability to form and strengthen connections between its cells, improving how they communicate with one another. These effects contribute to mitigating cognitive decline.

Two other key studies have shown that patients treated with a GLP-1 drug for diabetes had a lower risk of dementia.

All of these studies strongly point to a potential therapeutic use of GLP-1 drugs in treatment of the cognitive decline. Ongoing randomized trials – the gold standard for evaluating new uses of drugs – are looking at the effects of GLP-1 drugs in early Alzheimer’s disease, with results expected later in 2025.

Curbing addiction and suicidal ideation

GLP-1 drugs have also demonstrated potential in reducing risks of several substance use disorders such as those involving alcohol, tobacco, cannabis, opioids and stimulants. This may be due to the ability of these drugs to modulate reward pathways, impulse control and inflammatory processes in the brain.

The effectiveness of GLP-1 drugs in curbing addictive behavior may explain their spectacular success in treating obesity, a chronic disease state that many have suggested is indeed a food addiction disorder.

Our study demonstrated a reduced risk of suicidal thoughts and self-harm among people using GLP-1 drugs. This finding is particularly significant given earlier reports of suicidal thoughts and self-injury in people using GLP-1 drugs. In response to those reports, the European Medicines Agency conducted a review of all available data and concluded that there was no evidence of increased risk of suicidality in people using GLP-1 drugs.

Now at least two studies, including our own, show that GLP-1 drugs actually reduce the risk of suicidality.

Other benefits

In addition to the well-documented effects of GLP-1 drugs in reducing risks of adverse cardiovascular and kidney outcomes, our study shows a significant effect in reducing risk of blood clotting as well as deep vein thrombosis and pulmonary embolism.

One puzzling finding in our study is the reduced risk of infectious diseases such as pneumonia and sepsis. Our data complements another recent study that came to a similar conclusion showing that GLP-1 drugs reduced risk of cardiovascular death and death due to infectious causes, primarily COVID-19.

This is especially important since COVID-19 is regarded as a significant cardiovascular risk factor. Whether GLP-1 drugs completely offset the increased risk of cardiovascular disease associated with COVID-19 needs to be thoroughly evaluated.

GLP-1 drugs may also be useful in treating fatty liver disease and conditions ranging from asthma to chronic obstructive pulmonary disease, sleep apnea, osteoarthritis, depression and eye disorders.

Some doctors are prescribing GLP-1 drugs to help with fertility issues.

Risks and challenges

Despite their broad therapeutic potential, GLP-1 drugs are not without risks.

Gastrointestinal issues, such as nausea, vomiting, constipation and gastroesophageal reflux disease are among the most common adverse effects associated with GLP-1 drugs.

Our study also identified other risks, including low blood pressure, sleep problems, headaches, formation of kidney stones, and gall bladder disease and diseases associated with the bile ducts. We also saw increased risks of drug-induced inflammation of the kidneys and pancreas – both serious conditions that can result in long-term health problems. These findings underscore the importance of careful monitoring in people who are taking GLP-1 medications.

A significant challenge with using GLP-1 drugs is the high rates at which patients stop using them, often driven by their exorbitant cost or the emergence of adverse effects. Discontinuation can lead to rapid weight gain.

That’s a problem, because obesity is a chronic disease. GLP-1 drugs provide effective treatment but do not address the underlying causes of obesity and metabolic dysfunction. As a result, GLP-1 drugs need to be taken long term to sustain their effectiveness and prevent rebound weight gain.

In addition, many questions remain about the long-term effectiveness and risks of these drugs as well as whether there are differences between GLP-1 formulations. Addressing these questions is critical to guide clinical practice.The Conversation

Ziyad Al-Aly, Clinical Epidemiologist, Washington University in St. Louis

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Attitudes toward Christian nationalism don’t just boil down to views on race, religion and history − research suggests ‘moral foundations’ play a critical role

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theconversation.com – Kerby Goff, Associate Director of Research at the Boniuk Institute for the Study and Advancement of Religious Tolerance, Rice University – 2025-01-22 07:43:00

Christian nationalism is the belief that the United States was founded to be a Christian nation.
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Kerby Goff, Rice University; Eric Silver, Penn State, and John Iceland, Penn State

The concept of Christian nationalism has taken center stage in many Americans’ minds as either the greatest threat to democracy or its only savior.

Political scientist Eric McDaniel defines Christian nationalism as the belief that the United States was founded to be a Christian nation. “In this view,” according to McDaniel, “America can be governed only by Christians, and the country’s mission is directed by a divine hand.” Why does the idea resonate with some but alarm others?

Scholars often portray Christian nationalism as rooted in a deep-seated desire to exclude non-Christians and people of color from American society. Historians point to a persistent link between racism and Christian nationalism among white Americans throughout U.S. history.

White Christians, however, are not the only ones sympathetic to Christian nationalist ideas. Nearly 40% of Black Protestants and 55% of Hispanic Protestants agree with statements such as “being Christian is an important part of being truly American.” Interestingly, over one-third of Muslims agree that the U.S. government should promote Christian moral values but not make it the official religion.

Many who reject Christian nationalism do so because it seems to privilege those white Christian Americans who would like to make conservative Christianity the United States’ official religion. Conversely, supporters argue that the future of the U.S. depends upon loyalty to God and to staying true to the country’s Christian past. They contend that since the nation’s founding, a Christian influence in government and societal institutions such as education and health care has been and remains essential to sustaining religious, political and economic stability.

While racial, religious and political tribalism appear to influence who supports and who rejects Christian nationalism, our own research suggests there are other factors at play, specifically moral differences. We set out to understand the role that different moral values play in shaping support for and opposition to Christian nationalism.

Our study drew on the most influential social science approach to understanding moral values: moral foundations theory.

Moral differences

Moral foundations theory states that humans evolved to possess six primary moral intuitions that shape moral judgments – care for the vulnerable, fairness in how people are treated, loyalty to in-groups, respect for authority, reverence for the sacred, and the safeguarding of individual liberty.

A vast amount of research finds that liberals endorse the first two foundations, care and fairness, but score lower on the rest.

Conservatives, on the other hand, tend to score equally on all six foundations. This suggests their moral judgments often involve balancing a desire to be compassionate with a desire to safeguard the stability of the social order.

Moral foundations theory has been used extensively by social scientists to study hot-button issues such as crime control, policing, vaccine resistance, immigration, same-sex marriage, abortion and more.

For example, research finds that prioritizing care for the vulnerable, which is most pronounced among liberals, is linked to reduced acceptance of police use of force. Conservatives, who also value respect for authority, often favor “law and order” even when it involves use of force.

What our research found

A human hand inserting the Bible into a locked ballot box, placed in front of the American flag.
Researchers found that support for Christian nationalism was strongly associated with the moral foundations of loyalty, sanctity and liberty.
selimaksan/E+ via Getty images.

With moral foundations theory as our guide, we analyzed Christian nationalism using a 2021 national survey of 1,125 U.S. adults conducted by YouGov, a global opinion research organization. We measured respondents’ moral foundations with the moral foundations questionnaire, which has been used extensively by researchers across numerous academic disciplines.

To measure Christian nationalism, we asked respondents whether they agreed with six questions, such as whether the federal government should declare the United States a Christian nation, advocate Christian values, allow prayer in public schools and allow religious symbols in public spaces, to list a few.

What we found surprised us.

Support for Christian nationalism was most strongly linked to the moral foundations of loyalty, sanctity and liberty, but not to the authority foundation. We expected Christian nationalism to appeal to individuals who are enamored of authority, providing a rationale to their support for authoritarian leaders. But in our study, respect for authority did not distinguish those who supported Christian nationalism from those who opposed it.

We also found that support for Christian nationalism was linked to having a weaker fairness foundation. But it was not related to the strength of one’s care foundation.

We conclude that differences over Christian nationalism emerge not because some people care about the harm Christian nationalism could bring to non-Christian Americans, while others don’t. Rather, our findings suggest that those who support Christian nationalism do so because they are more sensitive to violations of loyalty, sanctity and liberty, and less sensitive to violations of fairness.

Our findings also revealed that support for Christian nationalism isn’t merely about racism or being ultrareligious, as critics often suggest. We accounted for endorsements of anti-Black stereotypes and religiosity. Yet, moral foundations remained the best predictors of Christian nationalist beliefs, even after taking into account these critical variables.

2 moral approaches to Christianity in the US

The Christian nationalism scale we and others have used combines several different beliefs about Christianity’s role in society. So we also examined how each of the six items in our Christian nationalism scale related to each of the six moral foundations. We found two important patterns.

A large campaign poster that says, 'Vote The Bible! Take a Stand for Morality.
Researchers found different moral values playing a role in shaping support or opposition for Christian nationalism.
Joe Sohm/Visions of America/Universal Images Group via Getty Images

First, we found that the Christian nationalist desire to bring church and state closer together was most prominent among those with strong loyalty and sanctity foundations and a weak fairness foundation. This means that people who advocate for a Christian state largely do so out of loyalty – specifically, loyalty to God – and out of a desire to adhere to God’s requirements for society, as they understand them.

In line with this, support is also linked to a desire to protect the sanctity of the nation’s Christian heritage. Those who oppose bringing church and state closer together do so out of a sense that such a union would be unfair.

Second, we found that the desire to allow prayer in schools and religious symbols in public spaces was strongest among those with pronounced liberty and sanctity moral foundations. This likely means that people who favor public religious expression, but not a union of church and state, do so because they see individual religious expression as a sacred national ideal.

All in all, our study shows that support for or opposition to Christian nationalism is not merely due to religious, political or racial identities and prejudices, as many believe, but is rather due to entrenched moral differences between the two camps.

Building solidarity through diverse moral concerns

Moral divides are not necessarily impassable. It’s possible that understanding these diverging moral concerns may help build bridges between those who are sympathetic to and those who are skeptical toward Christian nationalism.

America’s founders conceived of fairness and liberty as central to a democratic society. And these values have fueled loyalty to a robust national identity ever since.

Our research suggests that the controversy surrounding Christian nationalism is driven not by a lack of moral concern by sympathizers or critics but by their different moral priorities. We believe that understanding such differences as morally rooted can open the door for mutual understanding and productive debate.The Conversation

Kerby Goff, Associate Director of Research at the Boniuk Institute for the Study and Advancement of Religious Tolerance, Rice University; Eric Silver, Professor of Sociology & Criminology, Penn State, and John Iceland, Professor of Sociology and Demography, Penn State

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