Suggested reductions in administration of the MMR and hepatitis vaccines to children early in life are not based on science, and reduce herd immunity increasing disease prevalence. In addition, the general attitude of the administration concerning the validity of childhood vaccinations has increased the incidence of measles, especially in children kept in federal detention centers, providing further evidence that public health leadership at the federal level is absent.

As a Pediatrician and a child health advocate I have concluded that actions by the Department of Health and Human Services have endangered the general health of our country and specifically the health of our children. The American Academy of Pediatrics has consistently worked to negate detrimental government activities, and minimize the disinformation that is being spewed from the Office of the Secretary of HHS. AAP has provided consistent historical leadership to protect the interests of children. This organization is an advocacy group, not a trade group, and deserves our strong support.

Rae Brown, MD

I want to acknowledge that this is the fifth time that I have brought these facts to the attention of the public.I can also say that many of my detractors, in the starkest terms, have denied that this was even possible. Well it is possible, and the Speaker, bless his heart, has finally been led to admit what has long been denied. The GOP is going all in on cutting healthcare for children.

There is no reason for this! We can afford to provide healthcare to every American, every other industrialized nation is capable. Why should we be any different?

And once again I am going to say that children in America will be injured. Some will die because of infectious disease, poor nutrition, cancer , cardiac disease, and a variety of other modern scourges that can be treated.

It is not reasonable for the US to consider itself at this juncture to be any better than a third world country. A nation that would deny healthcare to the least of us, while millions live in abject poverty, and a few own more than half the world and flaunt it is truly disgusting.

Rae Brown, M.D.

A Voice for Children

Today the Pope speaks from beyond the grave to a President of the United States that is the antithesis of all that is good, all that is compassionate in the world. A two year old American Citizen is deported without due process, and the safety net that protects our food sources is a broken mess. The man that supports the world’s most reviled war criminal hires a clown to run the largest military in the world and a fool to guard our homeland. Today the Justice Department arrests a local judge as she tries her best to do the job that the constitution would have her do. Today we can no longer know safety, because who is really safe when an arrest warrant is provided on a whim?

Where do we turn when the delicate balance that is democracy has broken down and protects no one? When the President does not view the legal foundation of our republic to be worthy of his concern, When the congressional opposition is neutered, and the President’s Party openly abets treason on a daily basis? When the faithful stewards of countless administrations, career public servants, have been fired by the thousands, seemingly at random by a drug crazed illegal alien from South Africa.

Who is there to respond? We can’t go on like this until 26.

Who.

In the case of the President of the United States, the issues are more acute in that they control the firing codes for the US nuclear arsenal and can declare war on a whim. A recent analysis of the behavior of the President reflected many of the characteristics of a failed MSE in that the President began to spontaneously speak to the issue of invading not one, but two different countries and gave no indication that they were aware that there was no factual basis to any of the statements that they were making.

This analysis is of grave concern to the United States and the world. That a sitting President does not seem to know the difference between reality and a dream state made up in their head is the clinical definition of insanity. Patients with this level of disorganized thought would not and should not, under any circumstances, be released independently in the world at large because of the imminent risk of danger to others. This patient would never leave the healthcare facility unescorted. The risk to the world would be too great.

In the described examination, a reported discussion between the president and the Head of NATO there was a clear disconnect between the subject to be discussed and the assertions made spontaneously by the president. There was no reported intent to lead the patient to make the assertions that were made, and attempts to bring the conversation back to reality were ineffective. These findings imply that the person making the statements is involved in self talk about the reality that they perceive as opposed to that being experienced by the other persons involved. A Clear disconnect with reality.

the 25th Amendment to the Constitution of the United States was created largely to protect the citizens of the US from the harm of having a Chief Executive that cannot fulfill the requirements of the office. Clearly, a Chief Executive that blatantly and repeatedly fails a MSE would meet anyones definition of failure. This is a clear and present danger to the citizens of the United States.

Rae Brown,M.D.

A Voice for Children

rbrow120@gmail.com

Rae Brown,M.D.

A Voice for Children

Rbrow120@gmail.com

Now, I’m going to ask you to consider the world through the eyes of a child and think specifically about the implications of policy changes made and proposed.

Children develop infectious diseases with some regularity. Some of these diseases are life-threatening, and in the recent past, we have developed systems to track these diseases so that the harm caused by outbreaks can be diminished. Our experience has been that tracking allows risk reduction and saves lives. Yet the Agency that tracks these diseases has been dramatically reduced in scale.

If we were raised in the 1920s or after, there was more risk of mortality from disease, which has been diminished in the late 20th and 21st centuries because a safe and effective program of vaccination was established through scientific research funded by the federal government and monitored for the presence of risk or the lack of efficacy. Our experience has been that childhood diseases that were lethal in the first half of the 20th century were adequately controlled. Parents could take solace in the reality of at least one safety focus for children they could depend on.

However, executive fiat has eviscerated the Agency responsible for developing new vaccines, and the Agency monitoring vaccines has been similarly degraded.

Children in America have, in the past, been able to depend on education that was reasonably comparable to the best in European and Asian countries. Unless you resided in some poor states, primarily in the South, that didn’t feel everybody needed to get the best education. When that became clear, the federal government reinforced the idea that all men, women, and children are created equal and should all get a good education. Thus, the federal Department of Education was born.

But equality under law has fallen out of favor in some quarters, and the Department of Education is under attack.

Medical care is expensive in the United States, more so than in any other country in the world. Children in most countries are guaranteed health care as a right of citizenship. In the US, healthcare for children and families is an afterthought, and many families whose parents work for minimum wage must decide if they will eat or if they will pay exorbitant rates for health insurance. For these families, the Federal government, recognizing long ago the income disparities that are the reality of life in the US, developed Medicaid. This highly efficient managed care program provides basic healthcare to children, families, and people with disabilities. Problem solved, except successive Republican administrations have wanted to gut the program, and the current administration is making a supreme effort to ensure that healthcare is not a reality for impoverished citizens, child or not.

Children have diseases that are unique and sometimes deadly. Acute lymphoblastic leukemia is an example of a disease that most children did not survive in the early 20th century. Most now survive and thrive despite this diagnosis because of research funded by the National Institutes of Health. Cystic Fibrosis, a prevalent disease of early childhood, was an assassin of kids until the 1990s and beyond. At this point, because of groundbreaking research from the NIH, there is a survivable chronic illness.

Children depend on parents, and parents on jobs in a functioning economy to survive, to eat, to pay rent, to purchase clothing, and school books. What could be worse than having an economy that was the envy of the world and eliminating hundreds of thousands of jobs in the public sector for no reason, increasing the unemployment rate dramatically? Parents take most of that psychological hit, but children certainly get that their lives are now different.

From the perspective of a child advocate, many of the recent executive orders and further proposed legislation seem to be aimed at children. Others would argue the point, but the Federal responsibilities that are being hit all seem to be in areas critical to the health and safety of children. This has been a recurrent theme over the last fifty years for those of us who try to see the world through the eyes of a four-year-old. Four-year-olds don’t talk to adults that much. They do not have the world’s most powerful lobbyists. The American Academy of Pediatrics, the national organization to which I owe the most allegiance, is great, but 75000 pediatricians can’t match the volume of 100 million members of AARP.

The problem is in the title of this piece: “Generational Harm.” That is, disturbances in the fabric of society, not just now, but for years to come. An impact on a four-year-old's safety, health, education, and nutrition now reverberates through our society for 100 years. Years, and may not stop there. In 1918, hundreds of thousands died from influenza in the United States, but ten years after this epidemic, children and adults were developing serious psychological issues, such as major depression, thought to be secondary to CNS injury produced by influenza.

Influenza did not come about because of the federal government's malfeasance, yet it produced harms that were still being dealt with after the Second World War. In 2025, harms to children are being directed by the Federal Government through the Executive Branch and with the acquiescence of the Republican-led Congress. These injuries to children will reverberate through our nation for years to come, affecting multiple generations and severely limiting the potential of our children and our country.

It is past time to move on to the hard work of crafting a fundamental message to give to the American People and to the world about exactly what we will do to rectify our current situation, This message must identify clearly our best understanding of how we got to this point. It must offer specific remedies to negate the damage done and to guarantee to future generations that the hard lessons learned in the last ten years are never repeated. It must be a message of American Renewal, of America unleashed to return to the world stage as a positive force for good, as a trustworthy ally that has established guardrails against burgeoning fascism that are concrete and transparent.

The message will need to establish specific champions, and a finite timeline that assures that those brave Americans that enter the political ring henceforth will carry with them a platform backed by all the leadership of all parties to the resistance against tyrrany. We require lawyers and legislators to craft powerful legislation closing loopholes in our structure of governance that would allow a daily disregard of the rule of law. We need business men and women that can assist in. Rebuilding the American market and to reestablish overseas opportunities. We need physicians and scientists to rebuild the worlds most important and successful research organization and to encourage its growth.We need steelworkers, nurses, teachers, truck drivers, and craftsmen and women to help reestablish the cultural cauldron that drove the most successful economic machine ever encountered.

In short, we need everyone that values the American ideals to help make the message and spread it for our selves and our children. This is time of crisis but it is time of opportunity. Not since the end of the Second World War have we had a central driving force allowing us to see errors in the American Way so blatantly, while begging us to step up and become the nation that we can be.

This is the fourth in a series on the current problem and the need for immediate, specific, and dramatic action. The time is now to end the first phase of the resistance and to move to phase to of the rebuilding of America.

Rae Brown, M.D.

A Voice for Children

Rbrow120 @gmail.com

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The time has come for Universal Healthcare for every man, woman, and child in the United States. The rest of the industrialized world moved on years ago, and most countries have spent the 21st century fashioning efficient systems that negotiate prices for goods and services and support lifestyles for healthcare providers that allow truly excellent care without forcing burnout on doctors and nurses. A system like Medicare, which is efficient, auditable, and assures everyone a high standard of care, would be substantially cheaper than our current American fiasco. Speaking to European medical colleagues about our system of providing healthcare is revealing. The kindest term that I have heard used is “barbaric.” The urgency of this need cannot be overstated.

Most other countries believe that healthcare is a right, like free speech and privacy. Healthcare defines a nation because citizens who are well are productive, positive, and forward-looking. In the US, politicians have rejected the adoption of universal healthcare as an unwarranted move to a European welfare state and have decried the lack of quality in National Healthcare Systems. Time has revealed this analysis to be counterproductive to a growing economy. An evaluation of public health data for indices like longevity, infant death rates, maternal morbidity, and mortality does not support the American argument for a healthcare system that is expensive and out of the reach of more than a quarter of our citizens. European countries, advanced Asian countries, Australia, Canada, and others have developed systems for Nationalized healthcare, and they are all well-planned and rational. Industry can thrive in these countries because healthy workers are available consistently. Patients, doctors, and nurses are happier. Citizens are healthier. This would seem to be a triple win.

The value added to American society by a single mature universal healthcare system is large. Assuring healthcare for all acts as a great social equalizer. Providing healthcare to all, levels the playing field for industry, doctors and nurses can focus on keeping citizens healthy, and through negotiation with the pharmaceutical industry, the costs of breakthrough drugs are lower than currently available in the US. (Americans must wake up to the high price we pay for medications compared to the rest of the world. Taxpayers pay a large portion of the drug development cost of most drugs because scientists funded by the National Institutes of Health do the hard work and later license the drug to a pharmaceutical company. Then Americans pay the highest price for drugs in the world because we are among the few that do not negotiate, essentially double taxation!

A unified quality control system, centralized licensing of practitioners, and rational consideration of risks and liabilities throughout the nation would allow practitioners to avoid testing for testing’s sake and decrease the number of nuisance lawsuits. At present, individual states struggle with the judicial system by suggesting that there are multiple standards of medical care between states and sometimes within states. In 2025, only one medical practice standard should apply to patients in Mississippi, as in New York—the only standard for the entire country. Establishing standardized practice, which is fast becoming a reality for Medicare and Medicaid patients, would be possible through universal medical records. These records, available to practitioners online, would ensure patients get the required care on time with AI assistance, telehealth, and physician extenders. Preventive care and medical surveillance would identify illness early in the natural course of the disease. Cancer mortality would drop substantially, maternal death rates would improve, and neonatal morbidity and mortality secondary to premature birth would plummet.

But beyond the issue of expanding sick care (treatment of diseases and conditions), redirecting some of our healthcare dollars toward prevention and keeping people healthy would repay us dramatically. As an example, one of the most serious chronic diseases in America is Type 2 diabetes, which is entirely preventable. The cost of prevention is meager compared to the costs of treatment, which are insane. Examination of the incidence of heart disease, kidney failure, blindness in the elderly, and peripheral vascular disease in America and around the world provides a direct link back to obesity and Type. 2 diabetes. The benefits of prevention are not just cost-effective but also life-changing and hopeful.

In the United States, what would a program that prevented diabetes look like? A good start would be ensuring that everyone needing health insurance has it and that the program regularly includes required preventive care evaluations. These evaluations would involve comprehensive health assessments, including blood tests, BMI measurements, discussions of the risks of increased body mass, and the relationship of obesity with a subset of pathological conditions, including cancers, heart disease, and dementia. During these visits, a plan could be implemented to reduce the patient’s food intake. In many cases, that would include GLP 1 agonists, which the government could purchase in volume at a much lower price than currently available products. These medications are, in fact, so successful in producing sustained weight loss in patients, with so few side effects, that this alone would reduce the number of sick patients by several orders of magnitude.

And how do we pay for this government largesse? First, recognizing that universal healthcare could represent the salvation of our way of life, and second, by taxing products consumed daily by Americans that produce ill health: sugar, high fructose corn syrup, sugar-containing beverages, and fast food. Like the correlation between cigarettes and lung disease, these products hijack the metabolism and force fat deposition. No scientific argument currently favors a body weight above that which has been identified as the ideal body weight.

Keeping the American public well is a national security imperative in 2025. Now, the armed forces are forced to turn down nearly a quarter of all the men and women who apply because of obesity and chronic disease. High-level discussions in the Pentagon lament the poor physical condition of recruits, and some have suggested that the US would have difficulty raising an army in case of war.

In addition, type 2 diabetes now affects our children. In my former practice, I cared for many four-year-olds who were already obese. Some had developed diabetes, and a few of my sickest patients had developed chronic heart failure secondary to Metabolic Syndrome. In all my training and experience, I never could have imagined that the bane of my existence in 2020 would be obesity in four-year-olds.

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Every physician in the United States probably has ten ideas for making healthcare more effective and efficient, reducing costs, and providing more care to those without, so I am not the first to suggest a dramatic change. However, a national healthcare system available to everyone, such as “the Medicare for All” plan proposed by Bernie Sanders, would provide high-quality care at an affordable price and ultimately lower the total healthcare expenditures in the US economy. It has become very clear in the last five years that America has created the worst possible healthcare finance system in the world while believing that we have the best. This example of American belief in our exceptionalism, because we assert as fact a reality not supported by current widely held and readily available information, is a danger to our democracy. Areas of the country lag in providing adequate healthcare for men, women, and children with some regularity, similar to the situation identified in our educational system, which led to the formation of the federal Department of Education within the executive branch of government. By nationalizing our healthcare system, boys and girls enrolled in a high-quality educational program would have a better chance to excel and stay in school. Parents would survive to raise their children, and all the high-tech jobs that American industry would need to fill would have more healthy candidates - a win-win-win!

Would it be expensive? Of course, it would be costly, but it would be much cheaper than the system that we have now, a system that consumes one-fifth of the domestic economy, is relatively unaudited, and pays the highest prices for drugs globally. Nationalized universal healthcare in the US is a concept that has been delayed for much too long. If delayed further, America will continue to lag the rest of the world. The lack of healthcare for all is a headwind that the American economy does not need if we are to recover our position as a world leader in our lifetime.

Rae Brown, M.D.

A Voice for Children

Rbrow120@gmail.com

Rae Brown M.D.

In the past five years, much has been made of the high rate of mortality and addiction that has ensued from the wide availability of prescription and illicit opioids. With meager resources, the states have responded with increasing calls to the federal government for more money for more programs. Some of these programs have been effective, but the efficacy distribution is not national in scope. Almost every state has some form of a system that allows physicians and other providers to determine whether patients are receiving opioids from multiple sources or have many concurrent prescriptions from different doctors. Some in the scientific community believe that these programs have been effective in reducing the number of prescriptions for opioids. The best available theory is that reduced exposure to opioids will decrease mortality and addiction rates.

The federal government has responded with numerous plans from multiple agencies and with no apparent central coordination. Some of the plans to reduce the burden of opioids seem to change every month. Predictably, no group, including the recent report from the President’s Commission, offers a reasonable starting point from which the federal government has indicated the billions of dollars available. With the states and local governments crying out for leadership, it would seem reasonable to formulate an understanding and a process for analyzing the problem and using the resources. Thus far, each statement from Washington seems to obscure a clear direction further.

The report on Opioids developed by the NASM in response to a request by then Commissioner Robert Califf, M.D., offers a framework for the development of a single all-inclusive national strategy to reduce death and addiction in the US. However comprehensive it appears to be, all areas that have been shown to affect the development and the resolution of this public health problem are not highlighted. For example, the part that the illicit drug pipeline plays in the problem received less than the weight that it likely deserves. However, it is the first comprehensive plan that examines the evidence and offers specific solutions that are possible.

The report does not define specific principles to guide all programs in the future, whether they are State or Federal. I would like to offer a foundation for these programs in the future, in four principles:

1. Dramatically reduce the volume of illicit drugs coming across American borders

The U.S. is facing not one problem but two: prescription and illicit opioids. These two routes of exposure are inexorably bound together, and neither can be ameliorated without considering the other. Currently, in making a sustained and intense effort to reduce prescription drugs and to provide opioid formulations that deter abuse, we are faced with a seemingly wide-open pipeline of potent opioids coming across our borders. Many of these opiates are so powerful that they kill on first use. Until the problem of the opioid pipeline is solved, it is unlikely that we will effectively reduce the rate of death and addiction no matter what we do.

2. Make medical treatment of addiction widely available and eliminate federal regulations that effectively reduce financing through the federal Medicaid program.

Medical treatment of addiction is adequate time and again.

Yet the lack of qualified practitioners and continuous funding for treatment creates a situation that effectively stalls the development of these clinical programs. The Center for Medicare and Medicaid Services has all but regulated the full development of a comprehensive national program out of existence. Congress provides incremental funding but has yet to see the wisdom of a long-term treatment strategy. Continuous funding for treatment through a federal program that guarantees its availability, in much the same way that the government supports treating patients with chronic renal failure, would encourage program development and availability.

3. Make comprehensive education concerning the risks and benefits of the use of opioids mandatory for all health care providers.

Through its Risk Evaluation and Mitigation Strategies, the FDA has provided a skeletonized version of the education that all providers need. Such a program includes training about the specific problems with opioids as analgesics and an approach that can be used to provide pain relief with agents and techniques other than opioids. In addition, the basics of addiction medicine should be included to educate physicians and nurses about recognizing a problem and how to begin managing it.

Of course, some patients have pain that can be treated effectively only with opioids. No one would knowingly prevent the appropriate use of opioids to treat pain. It is our quest to make wise use of these drugs.

4. Recognize that addiction is a chronic relapsing mental illness and requires treatment using the precepts that modern psychiatry has given us.

The modern treatment of depression, schizophrenia, and other mental illnesses involves the sophisticated use of drugs, talk, and continuous reevaluation of the patient’s condition. Models for the successful treatment of addiction suggest that this disease of the brain will require nothing less. We need more mental health clinicians capable of providing this care, which is currently in short supply. More critically, the incarceration of patients with mental illness does nothing but increase the problem. We can spend our money on prison cells, but the experience in the Netherlands suggests that our money is best spent on treatment.

Four principles to guide the distribution of a billion dollars, rather than ten separate plans from ten federal agencies and a Commission. The fundamental success of the drive to save lives and decrease addiction depends on understanding, in simple terms, where we must focus and why. These four principles are the foundation for effectively and efficiently using our scarce resources.

Rae Brown, M.D. is Professor of Anesthesiology and Pediatrics at the University of Kentucky. He serves as Chair of the FDA Advisory Committee on Analgesic and Anesthetic Drug Products.

The above reflects Dr. Brown’s thoughts alone and should not be considered to represent the thinking of the FDA or the University of Kentucky. Dr. Brown has no financial conflicts related to the subject of this article.

Look at your kids. Think about what their thoughts are about the United States in 2025. After all, if they are older than about six, they are likely aware of the anxiety displayed every day by the talking heads on the TV and the constant babble on the web. If they are younger than 16, they get a message that is undoubtedly disturbing, but they may not have the intellectual capacity to process it all. And most children of any age are sensitive to the anxieties that their parents believe they are hiding. Children are remarkably adept at ferreting out and internalizing information but without the ability to analyze and reflect. Amid the prevalent political rhetoric and exaggeration, it is challenging for adults to assess whether the behaviors observed in the nation's leadership indicate rational decision-making. How can the parents of children plan when the world seems more insane every day?

We agree that America in 2025 is moving through a period without historical precedent. Though we may be unable to reflect on history to guide our actions, certain truisms transcend modern life, which are fundamental to impart to our kids. There are messages we want children to internalize so they can grow to be happy, healthy citizens. Still, there are behaviors that kids see and messages that most American parents would not want their children to hear and internalize all too regularly in 21st-century America.

Many messages are straightforward: You will be safe in your school. But children don’t see that. They see disasters involving kids in schools with some regularity. One thing we know about the psychological makeup of the developing brain is that emotionally charged events dramatically impact future growth and behavior. Children see violence, they internalize violence, and it has an effect.

“All men and women are created equal.” – Children may hear that, but what do they see? They see and listen to adults making derogatory comments about people of color, homeless people, and those impoverished in society through no fault of their own. They observe police assaulting black teenagers with regularity, and they come to associate the color of their skin with fear and anger. In a country created by the world’s most incredible melting pot, children rarely hear that we are a great nation because of the mixing of cultures for generations, and not despite it. The seminal concept that diversity yields greatness should be celebrated daily and heard by every child. In a country that has swung away from fundamental political truths, this propaganda is as essential as the Pledge of Allegiance!

“Do unto others as you would have them do unto you.” – The basis of the Judeo-Christian Ethic is the coda espoused in every church in America and Worldwide weekly. It is repeated so often that it may have lost its true meaning for children who hear it from Sunday School and parents. Children see adults mouthing the words on Sunday and see war, hate, and racism on television the rest of the week. They hear members of Congress denigrate citizens in terrible circumstances for political gain. They see kids on the TV their age starving to death when all the kids around them seem to be thriving. Again, they are aware of differences in the behavior of adults in their lives toward those that are different, and they internalize the emotional background without necessarily having the cognitive ability to understand the fallacy of the words or the situations. It would not be surprising to have these observations regularly lead to fear and anxiety in children manifested by abrupt changes in behavior, withdrawal, and depression. And this is what pediatricians and psychologists across the United States now observe in a broad population of younger Americans.

Across the country, America is in crisis, and our children are aware. They hear words that do not reflect behaviors. They see differences in citizens and diversity that should be held up as the fundamental building block of the American culture, put down and decried. They see and internalize a level of hypocrisy that is breathtaking in its scope, and they are inundated every hour of the day with messages of violence, anger, and intolerance.

Children have remarkable eyes, ears, and brains. They are hyper-observant, and, despite a lack of the cognitive development that would allow adults to put things in perspective and make independent judgments, they internalize negative stereotypes and feelings of anxiety and fear, which, now in this America, is revealed in a whole population of children that may never reach their true potential. Every parent and grandparent wants their children to survive and thrive. The best care for the next generation of Americans requires much from parents in an increasingly complex world. Deep thought about the messages children receive and consistency in our explanations are critical to society's future fabric.

Rae Brown, M.D.

Lexington, Kentucky

rbrow120@gmail.com

Think about it. That 6 trillion dollars supported the retirement funding of the majority of Americans. That alone represents a fiasco of the first order. But beyond the destruction of economic stability for millions, the actions that led to the financial losses reflect damage to the world monetary system that, if unchecked, will affect life in the United States for decades. Shock realignment of European and Canadian markets will risk American manufactured products and services. This population alone represents half a billion people, which is not the end of it. Our allies in the Pacific are reported to be reconsidering their alignment with the US, giving China carte blanche to undercut any economic gains that have been derived by American leadership in the region during the last century. One would be hard-pressed to find a country that wishes America well now, remarkable after the Pax Americana!

And is this the work of an evil genius with heavenly knowledge of international finance and a detailed plan to improve the lives of Americans? Is this a burden placed on the American people to rectify unjust trade practices by allies and enemies alike for fifty years? Is this an open door to an improved standard of living for all?

No, No, and No! The facts are that there is no rational reason for tariffs, for the destruction of the American safety net, for the abridging of freedoms, or for the lawlessness that we see every day without fail from Trump and his minions. From a historical perspective, America in 2025 became Nazi Germany in 1933, with the exception that Hitler was responding to a terrible economic situation post-depression, and Trump is taking apart a strong, stable American economy that was the envy of the world.

Americans for the last forty-five years have been fed a fallacy that Republicans are fiscal conservatives when, in reality, their behavior is that of uneducated imbeciles. They are the profligate spenders without regard to the people's wishes or common sense. It is instructive to listen to the great majority of Congress trying to explain the theories on which the current acts are based. According to most, there is no theory; it is only stupid, and stupid is dangerous because it will act in an irrational fashion that destroys everything with no short or long-term gain. And then it will destroy itself!

Paul Krugman is right. Stupid will destroy America, and then they will destroy the world.

Rae Brown, M.D.

Lexington, Kentucky

rbrow120@gmail.com

Substack has allowed me to consider the devastating effects of the turmoil caused by dramatic governmental changes to long-established public health strategies. I have a long history of advocating for child safety and healthcare. I would like to redirect my comments to give the public my impressions and concerns about the risks associated with abrupt changes in the social safety net based on my years in the healthcare industry. For background, I need to reintroduce myself to give the reader some basis for reviewing my comments.

I served as a pediatrician for forty years and recently retired. I was very active in the American Academy of Pediatrics and, early in my career, developed an interest in the general welfare of all children ages 0 - 120. Much of my work outside the hospital involved ensuring that children were safe in vehicles, from firearms, and, more recently, from opioid poisoning. The societal problem caused by opioids has affected many children over the past two decades.

My career was spent taking care of the smallest and the sickest. Hence, I was on the front lines of trauma resuscitations, physical child abuse, poisonings, and gunshot injuries. When most other parents were sitting at home reading to their children, I was in the hospital, on the phone, in Chicago, Washington, and throughout the States, telling stories of what I had experienced, how we were failing our kids, and how I thought that we could do a better job keeping our children safe. As an officer of the American Academy of Pediatrics, I crafted legislation. I lobbied for laws protecting the safety of children riding in the back of pickup trucks - remarkably common in the South and responsible for the deaths of seven in a single accident in Texas. I testified before the Arkansas legislature about safe pain management for infants and children.

I Chaired the FDA Committee responsible for the analysis of new opioid compounds and, during those five years, delivered to Congress legislation for a moratorium on the further development of novel opioid compounds. Despite 100.000 deaths from opioids during the year that this proposed legislation was delivered, the republican majority, led by Mitch McConnell, refused to consider it. Subsequently, I lobbied the legislatures in California and five other states to increase the safety of children anesthetized for procedures in dental offices after a dramatic number of childhood deaths.

During my career, I had two overarching goals. First, to never knowingly hurt a child that was under my care, and second, to look outside the hospital setting to eliminate systemic issues that allowed injury and sometimes death in kids. Many problems were identified in forty years, with a few successes. Despite best efforts, toil, and sleepless nights, many of the issues that produced injury to children in 1980 are still a problem in 2025, underscoring the importance of constantly evaluating our state of preparedness and proactively redoubling our efforts to prevent these issues from occurring.

The circumstances that allowed children to be injured and killed during the years that I practiced happened against the background of a nation that wanted to do a better job of protecting children but had yet to institute best practices consistently. Children were put in car seats, vaccination for childhood diseases was universally accepted based on substantial scientific study, and drugs and foods were tested by the FDA, eliminating almost wholly the teratogenic horrors caused by thalidomide in the 1950s. Car safety was improved dramatically, and despite a ridiculous number of shootings of innocent children throughout the US, the development of an advanced trauma care system for children allowed us to save many. Nearly all of these public health successes occurred because of national-level programs initiated because of and sometimes despite the actions of the federal government to recognize deficits and respond to the more outstanding interests of society.

That said, I do not take solace in the requirement for an advanced trauma system that treats and continues to treat children with gunshot wounds to this day. The fact that innocent children die from gunshot wounds in a supposedly advanced society is a disgrace. This public health crisis sets the United States apart and marks it as an outlier and a pariah in the civilized world. It's high time we, as a society, reevaluate our attitudes towards child safety and take immediate action to prevent such tragedies.

Despite our collective failings, for forty years, America had a system to protect the weakest, poorest, and smallest of us: America was trying to do the right thing. Against that background, the current administration has, by fiat and proposed legislation, begun to take that system of protection apart, almost it seems, by design. Dramatically reducing the footprint of the FDA, eliminating Medicaid programs, which in some states delivers healthcare to half of all children, weakening the Environmental Protection Agency, separating children from parents of immigrants (many of which had been productive citizens for years, supporting the safety net with their tax dollars, but most not able to use the services,) destroying the infrastructure of the National Institutes of Health, and devastating the Centers for Disease Control represents a bullet aimed at our children and grandchildren. To understand the societal implications of all these changes taken together, in my next posts, I would like to explore the abrupt individual changes to our societal safety net and explain the risks to our Republic from the perspective of children’s health in the short term and the generations to come. Next week, I will discuss how Medicaid has improved healthcare in America over the last forty years.

Rae Brown, M.D.

Lexington, Kentucky

April 2, 2025

Rbrow120 @gmail.com

How do Democrats turn this around? Who do we turn to to provide instruction on crafting the new Democratic Message - a message that will paint the picture of a new American renewal, a positive message that will be acceptable to broad swaths of the public. Well, the first place to go is to the Republican Party and their communications strategy for the last four elections cycles. That strategy can be characterized as Us not Them, Be Afraid, Government can Only Hurt You, and Revenue Can be Created Out of Every Tax Cut. The remarkable sameness of every Republican candidate and their message has created a vacuum for other considerations. “ Can’t anything be good when everything is bad!”

This negative communications strategy must be met with an equal and opposite energy. It must be met every day with a powerful affirming message that reminds citizens of the greatness of this country.

Step one in turning the Titanic around is to recognize the opposing teams offense and defeat it. In this case, a group of communicators must counter the strategy in simple and direct language that reveals the fallacys in each point. Same message. Every Time. Democrats balance the budget, Republicans create deficits that are bankrupting the country. Democrats are about inclusion in large part because that is what has made America the great country that it is, Republicans want to exclude anyone that does not look like them. Democrats know that government by and for the people can raise up all of society, whereas for Republicans the services that only government on a national level can provide are always somebody else’s problem. This is of course a very simplified examination of the issue but the structure is clear. Our message is strong and good and reflects an America that we recognize and desire. It is an inclusive America and it is an America that recognizes peoples anxieties and deals with them.

Step Two is to reengage with the public about the importance of government at a time defined by recurrent economic instability. Medicare , Medicaid, and Social Security raised generations of Americans out of poverty. Without these contracts between the public and the federal government this country would be fundamentally different, and very much more impoverished than now. The continual renewal of federal programs to insure efficiency and to take advantage of new economic models and technology should be a given. But that should be part of a positive message that federal programs are integral to the health and vitality of individuals and the whole of society.

Step three is to recognize the anxiety that Americans have about the education of our children, and to offer an alternative system that is defined not by minimums, but maximums. The message is: America is a country of innovators, we want our educational system to be the best in the world. We are willing to pay the price to provide that education for every child.

Step Four is to address the cost of defense. National defense costs what it costs. If we engage in fewer wars, the price will be less. If we are good citizens and recognize the importance of our allies we may find that our needs are dramatically reduced. But the cost has to be paid and taxes pay for Defense, education, and all other government services. The larger point is that economic stability plays an important role in national security and reducing deficit spending to an agreed lower level is necessary for a strong America. This can be presented as a positive message because it is.

Step Five is to acknowledge that we live in a nation governed by the people, that the people make the laws and that more citizens must be involved in creating the laws. When there is a political elite that governs in secret, the electorate rapidly loses interest and disconnects. That is when splinter groups try to redefine the truth…making for relative truths or your facts and my facts. A fundamental role of the democratic agenda must be to protect and expand the right to vote, to press for term limits at all levels of government and to define strict ethical codes for all American leaders.

Five steps to reengage with Americans, to paint the Democratic Party as the future of the Republic, and to allay the anxieties that divide our citizens. We need to make these points repeatedly and forthrightly. The story of progress in democracy reflects inclusion, stability, compassion and the desire that every generation will be stronger, smarter , and healthier than the last. This is the positive message that Americans are ready to hear.

Traveling all over the world in the ensuing eight years, I, as an American, could take some pride in your leadership and the integrity of those in your cabinet. In Europe and Africa, people who identified us as Americans regularly thanked us for bringing you to the White House! I did not deny that you were the beginning of a new American Century, and secretly, I prayed that you would be safe for eight years and that Joe or Michelle would follow you.

Your election allowed me to believe that America, the progressive society that gave us Jefferson, Lincoln, and Roosevelt, was in a continuous upward arc - toward “a more perfect union.” For the next eight years, I witnessed an administration determined to do the right thing, even when it was politically difficult.

Thank you for your time, effort, and dedication to our country. Thank you for being a President and a First Lady that we could admire as people and leaders. Thank you for taking the world's weight on your shoulders and working to elect Harris and Waltz in place of Trump. Thank you for helping to elect a state supreme court justice in a state that was not especially good to you. Thank you for all of that, but I need to ask you to, once more, bring your charisma, intellect, and emotional stability forward to salvage the country that you left to us in 2017. Yes, I know… who am I to ask this of you? After all, you and your family have given us far more than we deserve while undoubtedly taking years off your lives and threatening relationships dear to both of you. I would not make this ask unless I, after thought and reflection, believed that our nation was at risk of losing it all - democracy, economic stability, and all of our international alliances, before the midterm elections.

You are still a young man. And energetic. You know what is at stake. I listen to you speak now, and I know that no one could bring Americans together for the common good like Barack and Michelle on the road. You still have a story to tell, and we need to hear that story repeatedly. It is the story of a man raised by a single mom and a grandmother to become the President of the United States. The story of a black man who demonstrated that the color of one’s skin is a meaningless distraction - that moral fortitude, intellectual honesty, and a drive to make a better world are the critical limiting factors to leadership development at almost any level. it is the story of America and we need to be reminded of it every day. Your election was, at once, an evolution of the American ideal and a revolution in thought for society. You gave us a chance once; please do it again.

In 1940, Winston Churchill rescued Great Britain from inevitable disaster by recognizing that no other person on that island had the wisdom, experience, and tenacity to do what needed to be done for the nation's good. It is not hyperbole to suggest that our circumstances at present, while not a war, are dire in a way that most Americans cannot even understand. We need your help. You are the leader now with the energy, intellect, and knowledge to lead us even if, in the end, you are not the one sitting in the White House.

Rae Brown, M.D.

rbrow120@gmail.com

Lexington, Kentucky

Readers can believe me or not. My thoughts are that ten experts who have spent their lives thinking about the necessary conditions for worldwide economic stability believe that this is a conflagration, for every hack that espouses an opposite view. Do yourself a favor: go to any AI research tool currently available to any of us on the WWW and interrogate it by reporting the current economic conditions, the political circumstance, and the brief history of the Trump administration. Ask the question: What are the possible outcomes and who will profit? Not a pretty picture, is it? Even for the systems created by Musk and company!

At what point do we wake up to the fact that our whole lives are being systematically undercut by Trump and a group of less than 25 other people in the US and the world. They are doing their work in plain sight and are being abetted in large part by 30% of the American public. Think of that! Lives and fortunes, years of economic stability, a reasonable social safety net, and national security, taken apart by a group of people that are stupid, not geniuses! And the problem with stupid is, Stupid is not rational! Stupid will kill themselves and everybody else while there at it.

People wake up! That is where we are going…stupid is in charge. I started my journey on Substack because I wanted to talk about healthcare for children, something that I know intimately. In the several months that I have been writing, thinking, reading and speaking to the experts I have realized that it is most important, if I care about children, the disabled, or anyone really, that I shout every day! I have not been a shouter, but if we all don’t stand up, all of us, we are going to lose something very precious, our American story, our democracy, and soon!

Rae Brown, M.D.

Rbrow120@gmail.com

Lexington, Kentucky

The recent actions of the current administration are not just troubling; they are catastrophic. The closure of USAID, the halting of essential research at the National Institutes of Health (NIH), and the proposed drastic cuts to the Medicaid program are not merely misguided decisions—they are direct assaults on the health and well-being of our children. Misinformation about vaccination programs has led to a resurgence of preventable diseases, the cuts in nutrition programs will leave countless children malnourished, and the decrease in drug research will stifle the development of life-saving treatments. America's leadership in biomedical research is now teetering on the brink of collapse, and this decline is a tragedy of the highest order.

The consequences of these actions are severe and far-reaching. Children in the United States and around the world will suffer from hunger, lack of medical care, and life-threatening situations that were once considered relics of the past. These children are not just statistics; they have names, dreams, and families who care for them. This example of poor governance will have a lasting impact on the nation for decades. Congress must understand the gravity of their inaction; they will be responsible for the ensuing suffering and loss. It is a painful reality to think that complacency could result in the deaths of many children, both in the United States and across the world. Have we reached this point? Are we so focused on taxes that we ignore the pressing need for a federal budget that supports ethical decisions? We have the resources to provide a reasonable standard of living for everyone. That is the America I once believed in and the one we had until 2025.

The current administration's decisions are setting harmful precedents for future leaders. How can lawmakers, who promise to protect the Constitution, stand by while the Executive Branch undermines the rights of American citizens? Congress needs to protect the rule of law and the people it represents. If illegal actions go unchecked, they invite more lawlessness. When unethical behavior is permitted, it tends to increase, while lawful behavior tends to decrease. This leaves us facing future decisions lacking fairness, legality, and concern for the common good.

Rae Brown, M.D.

Rbrow120@gmail.com

If you are a pediatric healthcare provider, or a parent, a grandparent, uncle, aunt, or just a rational person speak up every day. Unless we treat this as the national emergency that it is, the future looks bleak!

Rae Brown, M.D.

Lexington, Kentucky 40502

Rbrow120@gmail.com

1. Contact the Federal Circuit judge for DC. Suggest that the DC Police be deputized as Federal marshals to arrest Justice Department attorneys who were held in contempt for failing to stop an ICE plane.

2. Contact Bernie Sanders group to begin discussions for the new Democratic Platform.

3. Contact Pete B/Jamie R/Chris W to determine interest in running for president in 28

4. Contact AOC and Jasmine Crockett about interest in running for Speaker of the House.

5. Continue to identify candidates for the House and the Senate for the next cycle.

6. We will continue to work on a democratic message for the near term that identifies a positive vision for the republic's future.

7. Create a plan to teach Democratic lawmakers how to use the Democratic Message to inspire the electorate until at least 2028.

8. Begin working on democratic financial ties to provide the new Democratic Message and the PLAN FOR TAKING THE House, Senate, and the White House back.

9. Identify messengers to take the new vision to our allies in Canada, Europe, the Middle East, and the Far East. The world needs a strong voice to provide reassurance.

10. Create a cabinet to oppose every segment of the Executive Branch that can respond to the misinformation being spread daily.

That’s my to-do list for this week. Anyone interested in taking on some of these projects?

Rae Brown, M.D.

rbrow120@gmail.com

Some would argue that we have never in fact had a true democracy, that every citizen has not played a role in fashioning our system of governance; the Greeks argued about the same issue. The fact is that we have always been a work in progress, an evolving structure that could be recognized as the ultimate manifestation of political thought. We have evolved as a people and as a culture as we have had the opportunity to gain knowledge. And we have moved forward in the recognition that equal is a word to describe every human, not just white land owners. We have consistently worked for the common good and until the last quarter century compassion and the rule of law has been key to conversations about our future as a country.

The last ten years have demonstrated that Democracy, as strong a concept as it would seem to be can be brought down by those willing to avoid the history of our development and superimpose a false history, borne of lies, and disinformation, and with profound disregard for science, or the considerable basis of knowledge in economics as well as the social sciences.

We are in the throws of a civil conflagration. We have choices to make if we are to salvage our way of life. The decisions that are before us have never been faced by American citizens in the history of the republic. Yet, it appears that failure to act aggressively will produce an outcome that would have been unthinkable even six months ago.

Critical to a rational, forceful, and effective response to reverse the actions of those in control in Washington is the involvement of every thoughtful American that recognizes the value of our political freedoms and wants to preserve democracy, if not for ourselves, then for our children and grandchildren. As I examine political opinion proffered in the last days, there are other issues still being discussed, but for America in March of 2025 there is nothing more important than the recognition that we stand to lose our Democracy, unless millions of us don’t drop what we think is important to focus on what is important, American Democracy. Concerns about the environment, discussions of sexuality, sports, religion need to take a back seat while we put out the fire that is burning down our house. To do less leaves us open to becoming, in short order, a fascist state reminiscent of Italy and Germany in the thirties or the USSR at any time during its short life.

Everyone can do something, write, speak, march, call, run for office. But none has the pleasure of only observing. America is too precious to watch burn. And everyone that is an American has a responsibility to help repair what is wonderful in concept, but now is broken and must be repaired.

Rae Brown, M.D.