Samizdat for Science

How can we prevent our suicidal patients from killing themselves? That's an important question for a primary-care physician like me. I am often in the position of trying to assess—in 15 minutes or less—which patients need urgent treatment. The type of guidance that might help me can be found in a paper that was published in 2022 on PSNet, the Patient Safety Network, a federally funded initiative. 'Few considerations are more critical,' the authors wrote, 'than identifying a person at risk for taking their own life.'
On January 31, however, the authors of that paper received a notice that their peer-reviewed article had been struck from the PSNet website. Apparently, it violated Executive Order 14168, 'Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,' signed by Donald Trump on his first day in office.
In addition to being a physician, I happen to be a woman, so I was curious why women needed defending from an analysis of how health professionals might better help suicidal patients. In the paper, the authors reminded clinicians to keep in mind which patient groups are known to be at higher risk, citing peer-reviewed data: ' High risk groups include male sex, being young, veterans, Indigenous tribes, lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ).' The acknowledgment of transgender people, however peripheral, was apparently enough to invite the ax.
The memo came out on a Wednesday, and agencies had until 5 p.m. on Friday to scrub their websites—as well as their agencies, grants, contracts, and personnel—of anything that might 'promote or inculcate gender ideology.' As a result, hundreds of government websites were shorn of articles, pages, and data sets about transgender issues, along with information on contraception, HIV, and abortion.
Much of the information that was stripped came from the CDC website, but even pages on the Census Bureau and the National Park Service sites came down. The tech-news publication 404 Media has estimated that more than 2,000 data sets have disappeared from government websites since Trump took office.
Coupled with other recent actions— pulling out of the World Health Organization, muzzling communications from government health agencies, stopping funding for overseas programs that treat HIV and malaria, drastically cutting NIH research funding —the Trump administration is signaling its contempt for evidence-based science and doing so in a way that demonstrates its sweeping disregard for human health and life.
Federal agencies and employees may be required, for the moment, to follow these guidelines. But the path for nongovernmental medical and scientific organizations is clear: Every hospital, university, professional medical organization, residency program, scientific organization, and nursing and medical school needs to insist that these data remain accessible to the public.
The science and health-care communities must also work together to make available all of the expunged data. This is beginning to happen: Individual researchers, doctors, students, and self-declared data hoarders have been racing to download as much of these crucial data as possible. Efforts such as the Internet Archive, the Library Innovation Lab Team, the End of Term Archive, and other groups to archive and host public data can prevent the erasure of years of scientific progress, and, by preserving this information, create a kind of scientific samizdat.
As of yet, major medical and scientific organizations have not formally stepped into the void. Doctors for America has filed a lawsuit over the expunged data, claiming that the actions were unlawful and endanger the lives of Americans. But bigger groups such as the American Medical Association and the American Association for the Advancement of Science remain on the sidelines.
A week after the initial purge, the agency that hosts PSNet was informed that the paper could be reposted on condition that the words transgender and LGBTQ be removed. The senior author rightly refused, stating that the researchers would remove those terms only if the Trump administration could cite verified data demonstrating that LGBTQ and trans communities did not have a higher risk of suicide. In that case, they would issue a correction. The fact the government would interfere with scientific work at this level at all is startlingly authoritarian.
The Trump administration may feel that winning the election grants it the authority to alter science to its liking. It may even get nongovernmental institutions to temporarily parrot the party line by threatening to withhold funding. But the scientific community needs to stand its ground. Doctors and nurses have a particular responsibility, because we have sworn oaths to put patient welfare first. As Dr. Steven H. Woolf succinctly put it in a recent editorial: 'We must draw the line when the science is clear that a policy will increase the risk of disease, complications, or premature death.'
The legal challenges to Trump's executive orders are piling up, though it will take time for these actions to grind through the courts. Fortunately, the medical and scientific communities need no such delay to determine our course of action. Commitment to patients and to scientific inquiry is our unequivocal guiding principle.

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Shifting views and misdirection: How Trump decided to strike Iran

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Advertisement While the 'two weeks' statement bought the president more time for last-minute diplomacy, military officials said that ruse and the head fake with the B-2s also had the effect of cleaning up a mess -- the telegraphing of the attack -- that was partly of the president's making. Asked to comment on the details of this article, Leavitt said the president and his team 'successfully accomplished one of the most complex and historic military operations of all time' regarding Iran's nuclear sites. She added that 'many presidents have talked about this, but only President Trump had the guts to do it.' A shifting tune Trump had spent the early months of his administration warning Israeli Prime Minister Benjamin Netanyahu against a strike on Iran. But by the morning of Friday, June 13, hours after the first Israeli attacks, Trump had changed his tune. He marveled to advisers about what he said was a brilliant Israeli military operation, which involved a series of precision strikes that killed key figures in Iran's military leadership and blasted away strategic weapons sites. Trump took calls on his cellphone from reporters and began hailing the operation as 'excellent' and 'very successful' and hinting that he had much more to do with it than people realized. Later that day, Trump asked an ally how the Israeli strikes were 'playing.' He said that 'everyone' was telling him he needed to get more involved, including potentially dropping 30,000-pound GBU-57 bombs on Fordo, the Iranian uranium-enrichment facility buried underneath a mountain south of Tehran. The next day, the president told another adviser he was leaning toward using those 'bunker buster' bombs on Fordo, while taking pride in both the bomb's destructive power and the fact that the United States is the only country that has the bomb in its arsenal. The adviser left the conversation convinced that Trump had already decided to bomb Iran's nuclear sites. Advertisement At the same time, the president's team was closely monitoring how their most prominent supporters were reacting on social media and on television to the prospect of the United States joining the war in a more visible way. They paid close attention to the statements of Tucker Carlson, the influential podcaster and former Fox News host, who was vehemently opposed to the United States joining Israel in taking on Iran. Trump became infuriated by some of Carlson's commentary and started complaining about him publicly and privately. Political advisers to Trump had been swapping notes on various public and private polls examining the popularity of military action against Iran, noting that American support for an operation depended in part on how pollsters asked the question. While polls showed that an overwhelming majority of Americans did not want the United States to go to war with Iran, most Americans also did not want Iran to obtain a nuclear weapon. The president was closely monitoring Fox News, which was airing wall-to-wall praise of Israel's military operation and featuring guests urging Trump to get more involved. Several Trump advisers lamented the fact that Carlson was no longer on Fox, which meant that Trump was not hearing much of the other side of the debate. Deliberations among administration officials about a possible American strike on Iran were in full swing by Sunday night, June 15, when Trump left for Canada for the G7 meeting. Trump seemed to his advisers to be inching closer to approving a strike, even as he told them that Israel would be foolish to try to assassinate Ayatollah Ali Khamenei, Iran's supreme leader. Advertisement Moreover, he said, if the United States were to strike Iran, the goal should be to decimate its nuclear facilities, not to bring down its government. The 'biggest threat to Opsec' By then, a small group of top military officials at the Pentagon and U.S. Central Command in Tampa, Florida, had already begun refining attack plans on the Fordo facility and other Iranian nuclear sites that military planners had drawn up years ago. The planning was led by Gen. Michael Erik Kurilla, the Centcom commander, and Gen. Dan Caine, the chair of the Joint Chiefs. B-2 stealth bombers, based at Whiteman Air Force Base in Missouri, are the only warplanes capable of delivering the GBU-57 bombs without detection by Iranian radar. B-2 bomber pilots have done extensive rehearsals for extended-range missions like the one before them -- crossing the Atlantic Ocean and the Mediterranean Sea, refueling multiple times before syncing up with fighter jets for the final flight leg into Iran. But even as the military planning was being conducted in secrecy, each of Trump's social media posts seemed to be telling the world what was coming. The president, said one military official, was the 'biggest threat to opsec,' or operational security, that the planning faced. To build confusion into the attack plan, military officials decided to have two groups of B-2 bombers leave Missouri around the same time. One group would fly westbound, toward Guam, with transponders on that could be tracked by commercial satellite companies. Another group of seven bombers, carrying a full payload of bombs and with their transponders off, flew east toward Iran, undetected. Advertisement During a news conference Sunday, hours after the U.S. strike, Caine called the Guam feint a 'decoy.' Shaping the conversation By Tuesday, June 17, Trump had largely made up his mind to strike Iran. But he took his coercive diplomacy to a new level, issuing menacing threats over social media. 'We now have complete and total control of the skies over Iran,' he posted on Truth Social, adding, 'We know exactly where the so-called 'Supreme Leader' is hiding. He is an easy target, but is safe there -- We are not going to take him out (kill!), at least not for now.' He demanded, in all-caps, 'UNCONDITIONAL SURRENDER!' By this point, several people in the anti-interventionist camp of Trump's advisers realized they most likely could not prevent the president from hitting the Iranian nuclear facilities. So, they turned their focus on trying to ensure the American war did not spiral into an expansive 'regime change' war. That day, June 17, Vice President JD Vance posted a long series of posts on social media that many within the anti-interventionist camp interpreted as him seeding the ground for a potential U.S. military operation and preemptively defending the president's likely decision. 'He may decide he needs to take further action to end Iranian enrichment. That decision ultimately belongs to the president,' Vance wrote in the widely shared post. 'And of course, people are right to be worried about foreign entanglement after the last 25 years of idiotic foreign policy. But I believe the president has earned some trust on this issue.' Prominent activists began working to shape the conversation for what was likely to come after the bombing: a debate about whether or not to engage in a war intended to bring about new leadership in Iran. 'Regime change has quickly become the newly stated goal of this operation,' wrote influential activist Charlie Kirk, in a social media post two days before the U.S. strikes. 'America should learn its lesson and not involve itself in a regime change war.' Even as Trump was posting his own hawkish statements, he was becoming annoyed as he watched pundits on television telegraph his likely strike against Fordo. He was infuriated when The Wall Street Journal reported that he had already given a green light to putting the pieces of the operation in place but had not given the final order. On Thursday, Trump was joined for lunch at the White House by Bannon, one of the most prominent critics of U.S. involvement in Israel's war with Iran. Some wishful thinkers in the anti-interventionist camp interpreted the meeting as a sign that Trump was getting cold feet. Leavitt reinforced that sentiment when she delivered Trump's statement, not long after Bannon arrived at the White House, indicating that he had given himself up to two weeks to make a decision, a time frame he often invoked for decisions on complex issues when he had no clear plan. But Trump had already dictated Leavitt's statement before he met with Bannon. It was a calculated misdirection intended to buy some breathing room for the president while suggesting that no attack was imminent. 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Hours after the American aircraft had departed Iranian airspace, Trump gave a triumphant speech at the White House saying that the mission had 'completely and totally obliterated ' Iran's nuclear capabilities. He suggested that the war could end with this one-off mission if Iran would give up its nuclear program and negotiate. By Sunday afternoon, however, U.S. officials had tempered the optimism of the night before, saying that Iran's nuclear facilities might have been severely damaged, but not entirely destroyed. Vance acknowledged that there are questions about the whereabouts of Iran's stock of near-bomb-grade uranium. He and Secretary of State Marco Rubio stressed that a regime change in Tehran -- which could mean a protracted U.S. engagement -- was not the goal. But Trump, whose operation was the subject of praise in news coverage not just from allies but some of his critics, had already moved on, hinting in a Truth Social post that his goals could be shifting. 'It's not politically correct to use the term, 'Regime Change,'' he wrote, 'but if the current Iranian Regime is unable to MAKE IRAN GREAT AGAIN, why wouldn't there be a Regime change???' This article originally appeared in

Boston Globe

22 minutes ago

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GOP tax bill would ease regulations on gun silencers and some rifles and shotguns

Advertisement Republicans who have long supported the changes, along with the gun industry, say the tax infringes on Second Amendment rights. They say silencers are mostly used by hunters and target shooters for sport. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up 'Burdensome regulations and unconstitutional taxes shouldn't stand in the way of protecting American gun owners' hearing,' said Clyde, who owns two gun stores in Georgia and often wears a pin shaped like an assault rifle on his suit lapel. Democrats are fighting to stop the provision, which was unveiled days after two Minnesota state legislators were shot in their homes, as the bill speeds through the Senate. They argue that loosening regulations on silencers could make it easier for criminals and active shooters to conceal their weapons. Advertisement 'Parents don't want silencers on their streets, police don't want silencers on their streets,' said Senate Democratic leader Chuck Schumer, D-N.Y. The gun language has broad support among Republicans and has received little attention as House Speaker Mike Johnson, R-La., and Senate Majority Leader John Thune, R-S.D., work to settle differences within the party on cuts to Medicaid and energy tax credits, among other issues. But it is just one of hundreds of policy and spending items included to entice members to vote for the legislation that could have broad implications if the bill is enacted within weeks, as Trump wants. Inclusion of the provision is also a sharp turn from the climate in Washington just three years ago when Democrats, like Republicans now, controlled Congress and the White House and pushed through bipartisan gun legislation. 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John Cornyn, who was one of the lead negotiators on the bipartisan gun bill in 2022 but is now facing a primary challenge from the right in his bid for reelection next year. Advertisement If the gun provisions remain in the larger legislation and it is passed, silencers and the short-barrel rifles and shotguns would lose an extra layer of regulation that they are subject to under the National Firearms Act, passed in the 1930s in response to concerns about mafia violence. They would still be subject to the same regulations that apply to most other guns — and that includes possible loopholes that allow some gun buyers to avoid background checks when guns are sold privately or online. Larry Keane of the National Shooting Sports Foundation, who supports the legislation, says changes are aimed at helping target shooters and hunters protect their hearing. He argues that the use of silencers in violent crimes is rare. 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CNN

23 minutes ago

• CNN

Trump floats Iran ‘regime change' even as the true impact of US strikes is far from clear

President Donald Trump's onslaught of Iran's nuclear plants was the most violent moment of his two terms and America's 46-year showdown with the Islamic Republic. Flush with the spoils of battle, he already seems to be toying with the idea of regime change. But the reality of whether Trump truly destroyed Iran's nuclear ambitions and the consequences of his aggression are far more ambiguous than his bullish claims of victory would suggest. The president insisted Sunday that the damage to three nuclear sites struck by the US was 'monumental.' He posted on social media that 'the hits were hard and accurate.' Round-the-world raids by B-2 stealth bombers out of Missouri using never-before-deployed 'bunker-busting' bombs demonstrated the unique reach of the US military and its continued potency despite Trump administration chaos at the Pentagon. If Trump's order eradicated Iran's nuclear program, or set it back years or decades, he could claim a legacy achievement that lifted an existential threat to Israel. If Iranian power is neutered, the Middle East could be transformed. The president effectively tried to bomb Iran to the negotiating table and to an effective surrender of its capacity to enrich uranium. But it's a long shot whether humiliation by an enemy Tehran regards as the 'Great Satan' will convince it to sue for peace. And questions are mounting over whether the strikes over the weekend truly 'obliterated' all of Iran's nuclear infrastructure as Trump claims. And the president has still not shared the intelligence that convinced him that Iran was 'a few weeks away' from building a nuclear weapon — even though US spy agencies assessed it had not yet decided to do so. It is now vital to establish whether Iran salvaged any enriched nuclear material or even relocated it ahead of the US strikes. If it did, Trump's bid to eliminate its path to a weapon could instead catalyze a race by Tehran to build a rudimentary device that would leave the world a far more dangerous place. 'Anybody who says that they have any idea whatsoever about whether these raids did anything other than create a big boom and a lot of dust has no idea what they're talking about,' Rep. Jim Himes, the top Democrat on the House Intelligence Committee, told CNN's Kasie Hunt on 'State of the Union' on Sunday. In the meantime, everyone is waiting on Iran's military revenge, with the Middle East on alert for new turmoil — and Americans potentially in the firing line. Tehran's decisions will be fateful. A slide into yet another open-ended Middle East war is not inevitable. But history shows that American attempts to reshape the region almost always fail to capitalize on 'shock and awe' openings. Amir-Saeid Iravani, the Islamic Republic's envoy to the United Nations, said on Sunday that 'the timing, nature and the scale of Iran's proportionate response will be decided by its armed forces.' There's growing uncertainty, meanwhile, about the president's intentions. Vice President JD Vance insisted on Sunday that the US wasn't at war with Iran or seeking to topple its leaders. But Trump on Sunday evening raised the possibility of mission creep, asking on Truth Social, 'Why wouldn't there be a Regime change???' That was likely music to the ears of Israeli Prime Minister Benjamin Netanyahu. The situation inside Iran's leadership remains opaque. The country was already in a period of transition as the long rule of Supreme Leader Ayatollah Ali Khamenei enters its sunset. But Israel's dismantling of Iran's regional power by crushing its proxies in Gaza and Lebanon, and now America's blow against its nuclear aspirations, could foment unpredictable political forces. It's unlikely that any loosening of the clerical regime's control would result in the more benign leadership that the US and Israel would prefer, and which millions of more moderate Iranians crave. Instead, political upheaval could bring even greater domestic repression. And any signs of state collapse in a nation twice the size of Iraq could send shockwaves throughout the region and across the globe. America's latest plunge back into the Middle East is already having profound political reverberations back home. Top Republicans heaped praise on what they see as Trump's strength, clarity and daring. But despite his deep bond with his base, some influential right-wing influencers fear he could be driving the MAGA movement into a quagmire. And a president with autocratic instincts who is severely straining the rule of law and the Constitution and is using his power to punish his perceived enemies has now led the US into a potential new conflict on a hunch without making any case to the public and after ignoring Congress's power to declare war. This cascade of uncertainties in the aftermath of Trump's strikes underline that he gave up total control of this new crisis as soon as US bunker busters dropped on the Fordow nuclear plant. The resolution of this clash with Iran — a seat of civilization laced with historic, sectarian, religious and political fault lines and a resentment of perceived US colonialism — is unlikely to be as clean as the decision to send a squadron of B-2 bombers around the globe to enforce the impulses of an American strongman. The next move probably belongs to Iran. Depending on the state of its military after days of pounding Israeli airstrikes, Tehran has options. It could target vast US military bases and assets in the region. It might close the Strait of Hormuz to spark a global energy crisis. It could send missiles into the oil fields of US allies. It might try to stage terror attacks against US interests in the region, or even in the American homeland. Each of these options comes with high risks. It may be counterproductive, for instance, for Tehran to close shipping lanes that would slow its own oil exports to China and Russia, its nominal allies. But each of these steps could also draw Trump deeper into a direct confrontation with Iran and a full-scale war — showing the limits of his ability to control a cycle of escalation. Vance told ABC News' 'This Week' that if Iran gave up its nuclear program 'peacefully' then it would find a willing partner in the US, but if it hit back against US troops, it would be met with 'overwhelming force.' But a president who vowed to avoid new wars sounds increasingly warlike. In his social media post announcing the strikes on Saturday, Trump called on Iran to negotiate with the US over the complete end of its nuclear program. But his subsequent address to the nation was far more belligerent, warning, 'There will be either peace, or there will be tragedy for Iran, far greater than we have witnessed over the last eight days. Remember, there are many targets left.' The possibility of deepening hostilities therefore seems acute. This is not least because a regime that defined itself for nearly half a century through antipathy to the US may perceive an existential need to show strength. Still, a resort to all-out warfare by Iran could offer an opening for the US or Israel to move toward a regime decapitation strategy — despite the grave risks of turning Iran into a failed state. The exact state of Iran's remaining nuclear capability will be a top issue in the coming days. Gen. Dan Caine, the chairman of the Joint Chiefs of Staff, was noticeably far less bullish in immediate assessments of the results of Saturday's raids than Trump or Defense Secretary Pete Hegseth. New battle damage assessments carried out by surveillance and other forms of intelligence could decide whether Trump may order follow-up raids that could further exacerbate tensions. Early independent examinations of the aftermath of the strikes suggest that the damage to one of the three key sites — Isfahan, which was targeted by US cruise missiles — was restricted to aboveground structures. Unlike the other two Iranian facilities targeted in the operation, B-2 bombers did not drop massive 'bunker-buster' bombs on the Isfahan facility, multiple sources told CNN. 'This is an incomplete strike,' said Jeffrey Lewis, a weapons expert and professor at the Middlebury Institute of International Studies who has closely reviewed commercial satellite imagery of the strike sites. 'If this is all there is, here's what left: the entire stockpile of 60% uranium, which was stored at Isfahan in tunnels that are untouched.' Himes warned that Iran could have moved some enriched uranium out of Fordow before the strikes. 'You have got the possibility — and I will stress possibility here — that there's a lot of highly enriched uranium sitting underneath a hornet-mad regime that has decided that the only way we're going to forestall this in the future is to actually sprint towards a nuclear weapon,' Himes said. If that is the case, Trump will have created a threat to the US and Israel that will rumble on for years to come. 'I think the more interesting thing other than retaliation, is reconstitution,' Richard Haass, president emeritus of the Council on Foreign Relations, told CNN's Fareed Zakaria. 'What lessons did the Iranians draw? It's quite possible they will decide that this never would have happened had they had nuclear weapons. So I think it's possible their retaliation is relatively modest. And what they really want to do is put themselves on a trajectory where some years down the road, when there's another crisis, they're in a different position.' 'So, this may not be quite as neat as we think. This could actually play out not just over weeks and months, but over many years.' Washington, meanwhile, is already buzzing with a familiar spectacle of officials, experts and pundits all making logical cases for why Trump was right to act, why the mission succeeded and how Iran could best serve its interests with a restrained response. But as the long list of lost US wars in the late 20th century and 21st century attests, things are almost never so simple.