The skin is more than an expression of your health and youthful good looks. It is your one and only barrier between the internal and external realms, keeping in the good things and barring the bad. This complex organ is ingeniously designed, yet it faces new challenges in the modern world. It’s at risk of breaking down. “Broken skin barriers” are real. They’re the subject of great interest from "skinfluencers" on TikTok, but they’re also studied rigorously by dermatologists. “We love the skin barrier but in a very physiologic and scientific way,” says Dr. Anthony Rossi, a dermatologist at Memorial Sloan Kettering Cancer Center. In addition to physically blocking the elements, the barrier employs its own micro police: immune cells and millions of healthy microbes that crack down on rogue skin pathogens, among other important jobs. In recent years, researchers have learned more about why the barrier fails, the consequences of a compromised barrier, and how to protect it for health and—yes—beauty. The skin barrier is real The skin barrier involves four layers of protection: physical, chemical, immune, and microbial. Rather than a pancake stack, think of these layers as links in a chain. “Everything is interconnected and interdependent,” says Dr. Richard Gallo, professor and chair of the department of dermatology at the University of California, San Diego. “If any link is weak, your chain breaks.” The visible outermost part of the skin, called the epidermis, is responsible for most of the physical protection. It’s made of protein-rich cells plus fats, or lipids, that fill gaps between the cells. When this “brick and mortar” wall is robust, it holds natural moisturizing factors that keep the skin hydrated. It’s plump, crack-resistant, and shields harmful substances like UV rays and bacteria. The fats in the epidermis play another role: supporting the chemical layer of protection. They do so by promoting an acidic environment that’s ideal for preserving the epidermis. This acidity also provides a comfy home for beneficial microbes while repelling pathogens. Read More: 5 Dermatologists on the 1 Thing You Should Do Every Day The third layer, immune, involves specialized cells that fight off skin infections before they spread. These immune cells are found in the epidermis and the layer beneath it, the dermis, which also houses nerves and blood vessels. The fourth pillar of skin barrier defense is the skin microbiome. These microbes “produce all kinds of great stuff,” Gallo says, like molecules that kill pathogens and help build the fats needed for acidity and epidermal strength. Healthy microbes also outcompete pathogens for nutrients, adds Dr. Erin Chen, assistant professor of biology at MIT and a dermatologist at Massachusetts General Hospital. If these protective layers fail, the skin breaks down, literally and figuratively. Tears or cuts can expose underlying tissue to harm. Skin conditions may develop such as atopic dermatitis and psoriasis. Life-threatening infections like MRSA and streptococcal bacteria could also gain a toe-hold. “They exploit the breaks in the skin,” Gallo explains. Additionally, the risk of skin cancer goes up and wrinkles and skin blotchiness spread, along with acne. It’s not just looks; a compromised barrier may lead to systemic inflammation, which drives biological aging. So, which intrusions chip away at the barrier’s defenses, and how can we thwart them? Products that hurt the skin barrier It turns out that we do much of the damage ourselves by applying skin products that harm the very flesh envelope we seek to protect. Like stunting a plant’s growth by over-watering it, overzealous self-care can undermine the skin barrier. That’s especially true when using abrasive products. Chemical soaps and harsh cleansers have ingredients—such as foaming agents like sodium lauryl sulfate—that disrupt the fats in the epidermis, damaging and irritating the physical layer of protection. Cosmetics may have similar effects. “They dismantle the lipid membranes,” Rossi says. Soaps made from plant-based and other natural ingredients are often gentler on the skin than ones with sulfates and other synthetic additives. Another issue is too much showering. Full-body soaping is rarely if ever needed, Rossi says. “The natural lather of washing with water is going to clean you off,” unless you’ve been sweating profusely, he explains. Dr. Bruce Robinson, a dermatologist in New York City, advises the regular use of soapy body wash for hairier parts only; soap more thoroughly just 1-2 times per week and limit showers to about five minutes. Read More: 12 Weird Symptoms Endocrinologists Say You Should Never Ignore Steer clear of heavy exfoliants, says Dr. Esther Freeman, associate professor of dermatology at Harvard Medical School. These harsh products can change the acidity of your skin, impairing its microbial police powers against pathogens. Many products have alcohols, dyes, and preservatives called parabens that can trigger allergic reactions and otherwise rub the barrier the wrong way. In particular, products with fragrances should be avoided. “We see so many skin allergies with fragrances,” Freeman says. “Especially if the barrier is not fully intact, you can induce an allergy over time.” Look for “fragrance-free” products. “Unscented” ones could still have chemicals masking fragrance, according to the EPA. Since the pandemic, dermatologists have seen an overage of personal cleaning behavior, harming the skin barrier. Gallo notes one example: constant hand sanitizer, even without significant germ exposure. Just don’t underestimate the value of washing your hands, says Akiko Iwasaki, professor of immunology at Yale University. “Washing hands regularly with warm water and soap goes a long way in preventing infections,” she says. When handwashing isn’t possible, sanitizer becomes key, especially in germy environments. However, none of this requires a lot of showering, she adds. Battling the elements: UV rays and pollution Excessive self-care has ramifications beyond the confines of our bathrooms. Because it weakens the skin barrier, we’re more vulnerable to threats outdoors—most troublingly, UV rays from the sun. Overcleaning strips away natural oils needed to produce a special protein called filaggrin in the epidermis. When plentiful, filaggrin keeps the barrier more hydrated and UV-resistant. With less filaggrin, more UV passes through. By the same token, high UV exposure may cause filaggrin to degrade, as well as collagen and elastin, which boost the skin’s pliability and resilience, Rossi says, “and we know that it causes skin cancer.” By age 70, skin cancer strikes 1 in 5 Americans. Read More: 8 Symptoms Doctors Often Dismiss As Anxiety Sunscreen is critical to prevent the barrier’s breakdown. Clothing matters, too, if you’re outside when the sun is strongest, from 10 a.m. to 4 p.m. “I’m a big fan of fabric with ultraviolet protective factor, which is like SPF for clothes,” Freeman says. A UPF rating of 30 or above is recommended. Another threat to the barrier is environmental pollution such as particulate matter and hydrocarbons. “They wreak havoc on the skin by causing free radical oxidation,” Rossi says. “They definitely cause reactions in the skin that prematurely age it,” Robinson notes. Preliminary evidence suggests that applying vitamin C topically before going outside could be protective. “It could potentially reduce some of the cytotoxic effects of particulate matter,” Freeman says. Yet another issue is dry air, which “causes an inflammatory response and a whole cascade of problems,” Robinson says. “You begin itching, and the scratching causes physical trauma, which compromises the skin more, so it loses moisture.” Moisturizer to the rescue A good moisturizer can salvage the skin barrier. “We do things all of the time that make our skin function poorly,” Chen says. “So we have to put the water back in.” Moisturizer battles the barrier’s enemies. Look for one with ingredients called humectants that attract and retain water from deeper layers of epidermis and dermis, keeping the outermost layer plump and strong. Robinson notes hyaluronic acid as an example; it holds up to 1,000 times its weight in water. Gallo recommends a close cousin, heparan sulfate, as potentially more effective. Glycerin is another beneficial humectant ingredient. Rossi tells patients to dampen the skin before applying moisturizer. This “soak and smear” technique traps the water on the skin, which enhances the moisturizer’s effect, he says. Other good moisturizing ingredients, known as occlusives, deliver fats to reinforce the gaps in the epidermis. “They act like cement or glue for our skin cells to stick together,” forming a unified front against assaults, says Rossi. Read More: Is Intermittent Fasting Good or Bad for You? Petroleum jelly, such as vaseline, is another kind of occlusive. It acts as a second shield over the skin barrier like a parapet protecting a castle, or as Freeman puts it, “a brick wall you’re putting on the skin.” The greasier the better, Chen says (but people with sensitive skin should avoid olive oil, which can be irritating). Gallo sees a downside to occlusives. “They could block pores,” he says. “It’s worth considering, but shouldn’t be the only component to keep the barrier operating.” Emollients like coconut or shea butter are a third moisturizer category. Experiment with products to find a personalized approach; a person’s needs depend on their genetics, among other factors. “What works well for one person might not work for others,” Gallo says. A dermatologist can provide guidance. As with other products, moisturizers should be fragrance-free. Go with your gut Companies offer products for fixing a broken skin barrier. Few have been studied to determine their benefits. However, Robinson thinks some injectable medications handle the repair job capably. “They interrupt a cascade of inflammation in the skin,” he says, noting dupixent and JAK inhibitors as “gamechangers” for the right patients. Some supplements provide probiotics marketed as improving the skin microbiome. These supplements “have not been shown to help the skin barrier,” Robinson says. More generally, though, scientists are actively studying links between the gut microbiome and skin microbiome, called the gut-skin axis. Gallo found that when the skin barrier was damaged in mice, their gut microbiomes changed. “The organs talk to each other, and the microbiome responds,” he says. This suggests that diets supporting a healthy gut microbiome could benefit the skin biome for a more effective barrier. Preliminary evidence shows that products made by gut microbes end up as building blocks for the skin. “The small molecules circulate through your blood to influence tissues throughout your body, including your skin,” Chen says. Nutrition also promotes the development of building blocks for stem cells essential for the skin barrier to regenerate and repair itself. A healthy lifestyle overall slows down aging, which supports skin barrier longevity, Chen says. Protect the barrier preventatively, before it breaks. “It’s more important than people probably realize,” Chen says. “Everyone should be thinking about their skin health.

As the Trump Administration moves aggressively to shrink the federal government and cut its spending, the Occupational Safety and Health Administration (OSHA) may be next on the chopping block. Arizona Rep. Andy Biggs, a Republican, recently reintroduced legislation to abolish OSHA, which is part of the U.S. Department of Labor. The bill, called the Nullify Occupational Safety and Health Administration Act, has been nicknamed “NOSHA.” What would it actually mean to abolish OSHA? Here’s what to know. What does OSHA do? OSHA’s objective is to keep Americans safe and healthy at work. “The OSHA law says that employers have the legal responsibility to provide safe workplaces for their employees,” says David Michaels, who was assistant secretary of labor for OSHA from 2009 to 2017 and is now a professor at the George Washington University’s Milken Institute School of Public Health. “OSHA’s job is to ensure that employers do that.” Grottoes bear the enduring touch of Tang Branded Content Grottoes bear the enduring touch of Tang By China Daily Since President Richard Nixon signed the law that established OSHA in 1970, it has gone on to set standards on a wide range of potential workplace health hazards, from limiting exposure to harmful substances like asbestos and benzene to avoiding falls and other on-the-job injuries. Almost 700,000 lives have been saved by such safety standards since OSHA was established, according to the American Federation of Labor and Congress of Industrial Organizations, a group of 61 labor unions. Why do some Republicans want to abolish OSHA? This isn’t the first time OSHA has been caught in political crosshairs. Biggs first proposed abolishing the organization in 2021, after OSHA began enforcing COVID-19 vaccination measures under the Biden Administration. OSHA’s policy, which was quickly withdrawn after being blocked by the Supreme Court, required employers with at least 100 workers to either mandate COVID-19 vaccination, or require unvaccinated workers to mask on the job and undergo regular testing. In 2021, Biggs’ bill had nine cosponsors, but it never advanced to a congressional vote. This time, Biggs does not have any cosponsors on his bill. He is not alone among Republicans in criticizing OSHA, however. Last year, an Ohio contractor—with the support of 23 attorneys general from Republican states—asked the Supreme Court to hear a complaint arguing that OSHA’s far-reaching authority is unconstitutional, The Hill reported. Although the Supreme Court did not take up the case, conservative Justice Clarence Thomas called the question at its heart “undeniably important.” By reintroducing the bill, Biggs is trying to further the Trump Administration’s goal of reducing the government’s size and scope; stop “federal meddling” in workplaces; and turn regulatory powers over to the states, he said in a YouTube video explaining his motivations. “I have constitutional concerns about the federal regulation of private workplaces,” Biggs said in the video. “I think most Americans who read the Constitution also have those similar questions.” The Arizona Congressman specifically mentioned concerns about OSHA’s “one-size-fits-all” standards around outdoor work in hot weather, which he said unfairly penalize states with warm climates, like his. “It makes no sense to set a uniform national standard for heat,” Biggs said. What would happen if OSHA is abolished? “There would be a race to the bottom,” Michaels says. Without a legal requirement to do so, companies might decide not to expend the time, effort, and money necessary to keep staff safe—especially if their competitors aren’t doing so. “What would be the impetus to protect workers from [dangerous] exposures?” Michaels asks. State regulations could fill some of the void. Twenty-two states or territories currently operate federally approved OSHA State Plans. But, Michaels says, it would be a mistake to rely on state-level regulation alone. Current law does not require states to regulate workplace safety; it says only that if states choose to do so, they must set policies that are at least as effective as those spelled out by federal OSHA. Even still, that doesn’t always happen. Arizona, for example, has an OSHA State Plan—but Michaels notes that its policy has previously conflicted with that set by federal OSHA, including around fall protections for residential construction workers. The safest way to protect workers, Michaels says, is to maintain national workplace protections across the country.

Alcohol has long been synonymous with relaxation. If you want to unwind after a rough day at work—or kick back on the couch, at a baseball game, or in the pool—there’s historically been a good chance you’ll have a drink in hand. Now, the tides are turning. In early January, then-U.S. Surgeon General Vivek Murthy issued a report warning that even small amounts of alcohol can cause cancer. Drinking just one alcoholic beverage a day increases the risk of liver cirrhosis, esophageal cancer, oral cancer, and various injuries, a federal analysis suggests. According to a recent survey, nearly half of Americans are trying to cut back on their alcohol consumption in 2025—a 44% increase since 2023. The message is especially getting through to young Americans, who increasingly view less as more, leading the charge among age groups going dry. As the science around alcohol’s health risks crystallizes, a new question is brewing: What are you supposed to do to relax and unwind and escape your mental headspace if you ditch booze? Is there a healthier way to turn off your brain temporarily or shift into a happier place—and if so, how do you achieve it? “It’s a major dilemma,” says Dr. Anna Lembke, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic and author of Dopamine Nation: Finding Balance in the Age of Indulgence. She works with people struggling with alcohol use disorder, who have to give up drinking altogether. They often wrestle with “what to do to relax to deal with their negative emotions, and to have fun, because alcohol is what they've relied on to achieve those goals,” she says. “It’s a real challenge, because many of the alternatives are also addictive, like scrolling online. The risk of cross-addiction is huge.” We asked experts why it’s so hard to figure out what to replace alcohol with—and to share their favorite ideas on how to relax booze-free.

Now that bird flu has been detected in animals in all 50 states, and nearly 70 cases have been confirmed in people, health officials are racing to find better and more reliable ways to track the virus. One promising method is sampling wastewater. The technique continues to prove useful for monitoring COVID-19; since most people now self-test and formal data collection has diminished, wastewater is the most reliable way of tracking upticks and changes in infections since it doesn’t require people to report results. Scientists are now figuring out how to apply the same principle to test wastewater on farms for H5N1, the avian influenza virus. On Feb. 4, the Foundation for Food & Agriculture Research (FFAR) announced a grant to Barnwell Bio, Inc. to fund the development of a farm-based system for testing wastewater for pathogens. The nonprofit research group FFAR was created by Congress in 2014 via the Farm Bill to use both government and private funding to support important agricultural research, and Barnwell Bio focuses on agricultural applications of wastewater testing. "The system is pretty patchwork" when it comes to understanding what makes animals sick, says Michael Rhys, CEO of Barnwell Bio. “There isn’t a gold standard for understanding animal health of different species.” Grottoes bear the enduring touch of Tang Branded Content Grottoes bear the enduring touch of Tang By China Daily Read More: We Are Not Safe from Bird Flu Until We Protect Farmworkers Part of the problem has to do with the many species of animals that reside on farms, from pigs to chickens and cows. And not all farms have a central wastewater system, like towns and cities do, where all waste is processed. Developing a way to detect H5N1 in these conditions required specific strategies for each species, says Rhys. To evaluate pathogens that affect chickens, which relieve themselves everywhere in the barn, the farmers wear booties that end up getting covered in the animals’ waste. Vets or health officials take samples from those booties, places them in test tubes, and analyzes them for the presence of H5N1. As for cows, most dairy farms generally focus on milk-producing cows, so effluent can be sampled after workers hose down milking areas, since that's where cows urinate. The grant, which totals around $150,000, will help Rhys’ team to develop a test that farmers can use on site to detect H5N1 early. “Can we detect H5N1 early such that on a big chicken farm, it’s not spreading barn to barn?” says Rhys. “We’re also looking at different variants of H5N1 which can be helpful in understanding where it came from, whether it was a wild bird or it was an animal-to-animal infection.” The company is currently working with two poultry farms to test the feasibility of their wastewater surveillance system.

In late January, scientists at the World Organization for Animal Health (WOAH) reported the first cases of H5N9 avian influenza in the U.S., on a duck farm in California. The latest strain isn’t a surprise, say public-health experts, since influenza takes different forms in different species and is constantly mutating. But the appearance of H5N9 is still concerning, especially in light of the ongoing outbreaks in chickens and cows of H5N1. Here's what to know. Why bird flu is so rampant right now “We’ve never seen a global spread of avian influenza virus like this,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “We’ve seen an explosion in the number of outbreaks in poultry and duck operations over the course of recent weeks. This reflects the fact that there is so much H5N1 in migrating waterfowl." There are about 40 million migratory aquatic waterfowl in North America, Osterholm says—which means there are plenty of potential bird-flu hosts, whose poop spreads disease. Read More: Scientists Are Starting to Track Bird Flu in Farm Wastewater "What we are seeing more and more are outbreaks in poultry operations because this virus is common in the environment and it’s blowing around," he says. "That’s different from anything we’ve seen before.” How H5N9 is different from H5N1 H5N9 is “not commonly seen in poultry in general,” says Eman Anis, assistant professor at the University of Pennsylvania School of Veterinary Medicine. (Anis is part of a lab that conducts national testing of poultry samples for avian influenza.) The virus is the result of a combination of H5N1, H7N9, and H9N2, according to researchers in China who studied samples isolated from bird markets in 2015. At the time, the scientists said it wasn't clear how adept the virus was at infecting people—which remains the case today—but warned it was "imperative to assess the risk of emergence of this novel reassortant virus with potential transmissibility to public health." Why scientists are worried about H5N9 When H5N9 was recently detected in ducks, H5N1 was detected along with it. That's concerning, since viruses are able to combine and reassemble their genetic material. With so much H5N1 circulating, the danger of that strain coming into contact with other avian viruses—like H5N9—increases the chances that new, mutant strains can emerge. The fear is that one of those reassortments could result in a strain that easily infects and spreads among people. Read More: Trump’s Freeze on Foreign Aid Will Make Diseases Surge By allowing bird flu to spread among animals mostly unchecked, “We are increasing the risk of something really terrible happening,” says Dr. Ashish Jha, dean of the Brown University School of Public Health. “When you take risks, sometimes you get lucky. I always say you can close your eyes and cross a busy street, and you might not get hit by a car. But that doesn’t mean it’s a good idea." Concern for the future "What absolutely needs to be happening right now is we need a global coordinated strategy," Jha says. "Migratory waterfowl do not observe national boundaries, and any surveillance for [avian influenza] has to be done in a multi-national way.” President Trump’s decision to withdraw the U.S. from the World Health Organization (WHO), and his instructions for federal employees not to work with anyone from the global health agency, will make such a coordinated effort nearly impossible, Jha says—and that it will heighten the chances that viruses, including bird flu, cause larger outbreaks.

On his first day back in office, President Trump ordered a sweeping 90-day spending freeze on almost all U.S. foreign aid, initially making exceptions only for military funding to Egypt and Israel and emergency food aid. The “stop-work order” in the directive had immediate consequences for people’s health and wellbeing. HIV clinics around the world funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), a highly successful aid program launched by George W. Bush that has saved more than 25 million lives, had to cancel appointments and turn patients away. Two-thirds of the staff of the President’s Malaria Initiative—the world’s largest funder of malaria control programs, also founded by George W. Bush—have been fired. Humanitarian assistance programs in Gaza, Sudan, and Syria that provide services like clean water and cholera treatment were halted. Oxygen supplies are no longer reaching health facilities in some low-income countries. Funding was frozen for critical disease control programs that prevent and treat a range of deadly infectious diseases, including malaria, Marburg virus, mpox, and tuberculosis. In Zambia, distribution of life-saving medical supplies to treat childhood diarrhea and bleeding in pregnant women came to a stop. At one U.S.-funded hospital in the Mae La refugee camp on the Thai-Myanmar border, 60 patients were sent home. “It feels like one easy decision by the U.S. president is quietly killing so many lives,” one of these patients, who has tuberculosis, told the New York Times. He was sent home with only one week’s supply of medicine and has no other way to get treatment when the supply runs out. Read More: I’m a Veteran. Trump’s Trans Military Ban Betrays Our Troops Restoring a city’s charm Branded Content Restoring a city’s charm By China Daily Last week, the distressing reports of people being denied their HIV medicines led Secretary of State Marco Rubio, who oversees U.S. aid, to issue an emergency temporary waiver that—in theory, at least—allowed U.S. aid to be used to pay for HIV antiretroviral medications. But there was a huge amount of uncertainty about what this waiver covered. Colleagues in low- and middle-income countries who provide HIV services funded by PEPFAR say that they were instructed to stop work and that the language of Secretary Rubio’s waiver was too vague to have any meaningful impact. Facing pressure to clarify the confusion, on Feb. 1, 2025, the Department of State issued a memo saying that the waiver covers HIV treatment as well as services for preventing transmission of HIV from mother to children—but not other kinds of preventive services. While these waivers are welcome, they are narrow in scope and temporary, and they do not do enough to overcome the confusion, disruption, and paralysis in U.S.-funded health programs worldwide. It is true that many low- and middle-income countries are working towards increasing their own domestic spending on health so that they become less aid dependent, and that aid donors, including the U.S., have signaled their support for such a transition out of aid. PEPFAR, for example, in its latest 5-year strategy, commits to helping countries mobilize domestic financing and gradually increase country ownership and management of their national HIV control programs. But the key word here is “gradually.” Sudden shocks, like freezing aid overnight, do not accelerate the transition process; they blow it up and can cause disease resurgence. Read More: A Study Retracted 15 Years Ago Continues to Threaten Childhood Vaccines There is now a wealth of research evidence and real-world experience on how best low- and middle-income countries can transition out of aid and take over the funding of their disease control programs in a way that is careful, safe, well-planned, and unhurried. The process typically takes around a decade or more, during which countries spend an increasing amount of their own domestic resources on these programs, year on year, so that they don’t face a sudden spending cliff when the donor exits. Managing donor exits well is critical in order to maintain the remarkable gains that have been made by countries, with the support of aid donors, in controlling deadly infectious diseases over the last few decades. These gains are fragile; in places where there is still ongoing transmission of an infectious disease, disease control programs must be maintained and never interrupted. The reason that transition is done slowly and carefully is that countries need adequate time to get their health delivery systems and their finances strong enough to fully take over these programs. Sudden, chaotic withdrawal of aid is the worst kind of interruption—one that puts lives on the line. To see what happens when aid donors withdraw their support precipitously, we only need to look at what happened in Romania when two donors exited simultaneously. In 2010, the Global Fund for AIDS, Tuberculosis and Malaria—the world’s largest multilateral donor to HIV programs—rapidly departed from Romania, with no plan put in place for the Romanian government to fund or take over HIV prevention services. Romania was a so-called “first wave” transition country; it was in the group of countries that first lost support from the Global Fund. As we noted in our study on donor transitions from HIV services, withdrawal of the Global Fund from Romania “left a significant gap in financing for HIV prevention activities that was not covered by the government.” The Global Fund’s exit was compounded by the simultaneous withdrawal of funding from the United Nations Office on Drugs and Crime, an aid donor that had previously supported HIV-prevention efforts among people who inject drugs, such as needle and syringe exchange programs. The double whammy of two donors withdrawing their aid was catastrophic. HIV prevention and treatment services in Romania for vulnerable populations—sex workers, men who have sex with men, and people who inject drugs—collapsed, and the HIV prevalence shot up quickly. For example, among people who inject drugs, HIV prevalence rose from 1.1% in 2009 to 6.9% three years later; by 2013, 53% of this population had HIV. Read More: Why We Need to Remember the Physical Effects of Polio We can also look to see what happens when funding for malaria control programs is halted in places where there is still ongoing transmission. In a study we published in 2012, we looked back through history to identify all episodes of malaria resurgence. We found 75 resurgence events in 61 countries that occurred from the 1930s through the 2000s. The most important finding of our study was that almost all of the resurgence events—68 out of 75—were due at least in part to weakening of the malaria control program. The most common reason for this weakening was a disruption in funding. The message is clear. Trump’s sudden disruption to funding disease control programs worldwide will wreak havoc. When people stop taking HIV medicines, they don’t just become sick; their HIV viral load also rises, which can drive disease transmission. The New York Times reports that in Uganda, aid workers estimate that about “40 newborns contracted HIV per day when the U.S. stopped funding for antiretroviral drugs.” Sudden treatment interruptions can also cause the rise of drug-resistant HIV strains. If a patient develops a resistant strain, then they will not be able to go back on the same HIV drugs as before. They will need different, more costly second-line medicines. Make no mistake: freezing U.S. health aid is the opposite of a well-managed, careful transition out of aid. It puts people at risk of illness and death and risks diseases raging out of control.

If you've tried to schedule a doctor’s appointment recently, you might have had to flip your calendar to a different season. There simply aren’t enough physicians in the U.S.: By 2037, the deficit is expected to reach 187,130 doctors, including more than 8,000 cardiologists and 4,000 nephrologists. That means patients routinely wait a long time—an average of 38 days, according to some data—before they’re able to snag an appointment with a doctor they really need to see. “People are constantly trying to get in to see doctors,” says Dr. Gerda Maissel, a physician in New York’s Hudson Valley who works as a patient advocate and helps people navigate the health care system. She once worked with a man who wanted to see a specialist at a major academic center about his worsening neurological disease. After he accepted an appointment 10 months down the road, “he and his wife were just beside themselves,” she recalls. “He had a tremendous need, and the academic center was just like, ‘Yeah, sorry, everybody wants [that specialist].’” Thousands of different versions of that story unfold every single day for patients across the country, she says. Long waits for necessary care can add emotional distress during an already stressful time—plus, of course, open the door to symptoms that aren’t caught or treated in time. Fortunately, patients can sometimes take steps to get in sooner. We asked experts to share their favorite hacks to see a specialist as soon as possible. Find out if the office has multiple locations Many doctors see patients in a variety of locations—some of which are busier than others. Always ask for the wait time at alternative locations, advises Sara Mathew, associate director of research and operations administration at Weill Cornell Medicine, where she leads the surgery department. Mathew thinks about health-care wait times constantly, both as an administrator and as a patient, and has found traveling slightly farther away can be helpful. When she recently tried to schedule an OB-GYN appointment in Manhattan, for example, she was told the next available slot was a year out. So she asked if there was anything available sooner—and the doctor’s office told her that if she was willing to travel to the Upper West Side instead of the East Side, she could be seen in two months. Flexibility is your friend when you’re in a hurry to see a doctor. Make sure you’re on the cancellation list Not every medical office automatically adds patients to the cancellation list. If you want to be notified if an earlier appointment opens up, let the receptionist know—and make it a point to flag that you could drop everything and be there with little notice, if that's in fact the case, says Christina Robertson, a regional director for Reproductive Medicine Associations, where she oversees the patient scheduling team. “Ask their percentage of cancelled appointments,” she suggests, as well as whether those cancellations usually happen the same day or a few days in advance. That information can help set your expectations. Read More: 8 Symptoms Doctors Often Dismiss As Anxiety If the office where you’re trying to get an appointment doesn't have a cancellation list, call and check in frequently. “I knew somebody who called every day,” Maissel says. You run the risk of annoying the scheduler, she acknowledges, but you’ll also stay front of mind. “It’s communicating what you would like, and if you're not quite getting it, then nicely popping up again and asking for it.” Ask your referring doctor to call on your behalf Depending on the severity of your situation, your primary care physician or other referring doctor could make a call on your behalf. Sometimes, that extra step will encourage the specialist’s staff to squeeze you into the schedule, which might mean before or after typical clinic hours, Mathew says. “I wouldn’t abuse that for every kind of diagnosis,” she says. “But if you went for a routine GI checkup and they noticed something on your gallbladder or colon, and there’s a possibility it could be cancer, find every way to get in faster. You definitely want to know if you have something like that sooner, so you can be treated faster.” Make a personal plea Nicoletta Sozansky’s daughter was born needing life-saving surgery, which she received in Florida. When the family returned to their home in New Jersey, they wanted their daughter to see a pediatrician who specialized in complex care. None of the doctors they shortlisted were accepting new patients—or, they had impossibly long wait lists. So Sozansky, a patient advocate and founder of the concierge health care navigation company Healthcare Redefined, called each doctor’s office and requested to speak to a practice manager. These staffers tend to be empathetic, she’s found, and are more inclined to offer empty slots to people they’ve connected with on a personal level. Read More: Long Dismissed, Chronic Lyme Disease Is Finally Getting Its Moment After introducing herself, Sozansky asked if she could write an email to the specialist, explaining her daughter's medical history and making the case for an appointment that wouldn't require waiting many months. It worked: “This letter opened the door to every pediatrician we reached out to,” she says. “From what I've experienced, doctors who are treating complex cases like your stories. They like a challenge.” Be clear about your needs When you’re trying to schedule an appointment, clearly state whether you’re seeking a new diagnosis or already have one and are looking for treatment or a second opinion. Diagnostic appointments tend to be more time-consuming, Sozansky says, so it might be easier to grab an appointment if you simply need to start a treatment plan. It took her years to be diagnosed with mast cell activation syndrome, for example, but once she knew what she was dealing with, appointments became much shorter and more readily available. “When I was switching from one doctor to another, the helpful thing was that I already had the diagnosis, and I could say, 'Hey, I would love to get on the schedule,’” she says. “It’s much easier to convince the front desk.” Consider providers who aren’t doctors Keep an open mind about whether you’re willing to see another type of provider—like a nurse practitioner or physician's assistant—who typically has greater availability. Every office works a little differently, Maissel says: In some, these providers are “very much like an extension of the physician,” she says. They’ll collaborate closely with the doctor to figure out how to best treat you. In other offices, they operate more independently. Read More: What to Do If Your Doctor Doesn’t Take Your Symptoms Seriously “In general, if I have to choose between waiting six months or seeing the NP next week, I’m going to see the NP next week,” she says. “And then I’m in the practice, and if I make friends with that NP, I can say, 'I'm really worried about this thing that you've told me you're not sure about. How do I get in to see Dr. Jones?’” The nurse works with the doctor every day, she points out, and has insights into their schedule—which means they could help facilitate more rapid care. Plus, providers like physician’s assistants can get crucial testing started, Maissel adds, and often have more time than physicians to spend addressing your needs. Ask the receptionist for their ideas If the next available appointment requires an unbearably long wait, politely tell the scheduler instead of hanging up the phone and grumbling, Maissel advises. “It’s fine to say, ‘Oh, gosh, that’s too far out,’” she says—but be mindful of your tone: “It’s not exactly what you say; it’s how you say it.” Barking at the scheduling team won’t do you any favors. But if you make it clear that you know the lack of appointments isn't their fault, you might find they're willing to brainstorm with you. Ask them if they have any suggestions, she suggests, and perhaps they’ll recommend calling a different office or will identify another doctor with more availability. “Most people want to be helpful,” Maissel says. “Most people in health care are there because it’s a mission-driven thing to do.” Be nice Not being able to see a doctor as quickly as you want to—or need to—can feel maddening. But it’s essential to not let your emotions get the best of you when you're trying to schedule an appointment. “Be nice to the scheduler,” Maissel urges. “Despite what they say, they may have a little bit of discretion—so you want them to know, like, and think of you.” Asking how their day is going, and remaining positive while you talk, can go a long way. And remember: Physicians are typically doing their best to see as many patients as possible, as quickly as possible. Some are simply so specialized that they’re in impossibly high demand. “It is truly hard to accommodate," Mathew says. “I rarely see any of our surgeons sitting. They don't end up taking lunch, and they see as many patients as they can. Just be mindful, and explore the possibilities.”

Robert F. Kennedy Jr., one of the most famous vaccine skeptics in the U.S., tried to distance himself from his decades of anti-vaccine sentiment during his Jan. 29 hearing to be confirmed as secretary of the U.S. Department of Health and Human Services (HHS). If confirmed, Kennedy would oversee agencies including the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health. “News reports have claimed that I am anti-vaccine or anti-industry. I am neither. I am pro-safety," Kennedy said in his opening statement before the Senate Committee on Finance, prompting a protester to shout, “He lies!” Kennedy added that all of his children are vaccinated—a decision he has previously said he regrets—and said vaccines “play a critical role in health care.” Some Republican senators accepted Kennedy's pro-vaccine comments at the hearing. But many senators—including Oregon’s Ron Wyden, a Democrat—pressed Kennedy on discrepancies between his past public statements—in which he has repeatedly questioned the safety and necessity of vaccines and said they are linked to autism and chronic diseases—and his sanitized comments during the hearing. “Mr. Kennedy, all of these things cannot be true,” Wyden said. “So are you lying to Congress today when you say you are pro-vaccine, or did you lie on all those podcasts?” Here’s what to know about Kennedy’s history on vaccines. Holiday inbound tourism thrives Branded Content Holiday inbound tourism thrives By China Daily What RFK has said in the past about vaccines Despite Kennedy’s efforts to distance himself from the anti-vaccine movement during the hearing, he has “made a career” out of “planting seeds of doubt about vaccines,” says James Hodge, director of the Center for Public Health Law and Policy at Arizona State University. Kennedy has for years questioned vaccines and spread misinformation about them, ignoring broad scientific consensus about their safety and efficacy to argue that they have not been adequately studied. He has also perpetuated the thoroughly disproven idea that vaccines cause autism. “I do believe that autism does come from vaccines,” Kennedy said in a 2023 interview with Fox News. Kennedy repeated that view in private emails recently published by STAT, along with other false claims—including that one COVID-19 vaccine had a “100% injury rate” in early clinical trials. Read More: The Origins of the Anti-Vaccination Movement He “has a series of beliefs that are not supported by science,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, in a November interview with TIME. Kennedy’s views are amplified by Children’s Health Defense (CHD), a nonprofit he founded and recently resigned from as he’s considered for HHS secretary. CHD’s website implies, without qualitative evidence, that vaccines are to blame for rising rates of autism and chronic disease in the U.S. The organization has also brought legal challenges against COVID-19 vaccine mandates and laws that allow minors to be vaccinated without parental consent. What happened with the measles outbreak in Samoa Kennedy and CHD have reportedly exploited tragedy to spread anti-vaccine sentiment. In 2018, two babies in Samoa died after they received improperly prepared measles, mumps, and rubella shots, leading to a temporary pause on vaccine distribution. Even after regular vaccination resumed, some parents were afraid to have their children vaccinated, worsening a dramatic drop in the small South Pacific nation’s vaccination rates. In the aftermath of the incident, Kennedy traveled to Samoa and met with numerous health officials, apparently to perpetuate anti-vaccine ideas. (Kennedy denied that characterization during the hearing, saying that his trip had “nothing to do with vaccines.”) CHD also used the situation as fodder for social media posts questioning vaccines, as NBC News recently reported. Read More: Trump’s Choose-Your-Own-Adventure Health Agenda Is a Wake-Up Call for Cities and States Not long after Kennedy’s visit, a measles outbreak killed 83 people—most of them children—in Samoa. While Kennedy has repeatedly denied responsibility for the outbreak, many scientific experts disagree. Offit said in November that there is “no better example” of the real-world consequences of vaccine skepticism. Kennedy again denied blame during the hearing. "You cannot find a single Samoan who will say, 'I didn't get a vaccine because of Bobby Kennedy,’” he said. Kennedy’s stance on banning vaccines During the hearing, Kennedy said he will “do nothing, as HHS secretary, that makes it difficult or discourages people from taking” vaccines, saying specifically that he supports the polio and measles vaccines. But his past actions—and ongoing alliances—make experts and lawmakers doubt those assurances. In 2021, on behalf of CHD, Kennedy unsuccessfully petitioned the FDA to reverse its emergency authorization of COVID-19 vaccines and refrain from fully approving any COVID-19 shots in the future, according to the New York Times. The following year, Aaron Siri, a lawyer working closely with Kennedy, petitioned the FDA to revoke approval of the polio vaccine, the Times reported in December. (The petition is reportedly still under review.) And, as of 2024, Kennedy had ongoing financial relationships with law firms suing vaccine manufacturers. Read More: RFK Jr.’s Confirmation Hearings Could Be Banner Moment For Anti-Vax Movement Kennedy tried to walk back some of his most blatantly anti-vaccine statements during the hearing, sparking anger from several lawmakers. "There is no reason that any of us should believe that you have reversed the anti-vaccine views that you have promoted for 25 years," said New Hampshire Senator Maggie Hassan, a Democrat. How Kennedy could shape vaccine policy as HHS secretary HHS wouldn’t need to ban or rescind approvals of vaccines to affect U.S. health policy, Hodge says. His research has outlined numerous ways that a Kennedy-led HHS could erode current vaccine standards, from adding additional warning labels to vaccine packaging to refusing to stock the Strategic National Stockpile with shots needed for emergencies. Kennedy outlined some similar possibilities in his 2023 book Vax-Unvax: Let the Science Speak. Massachusetts Senator Elizabeth Warren, a Democrat, listed others during the hearing, including making it easier for people to sue vaccine makers based on "junk science" or seek compensation for allegedly vaccine-related health issues. "No one should be fooled," Warren said. If confirmed, "Kennedy will have the power to undercut vaccines and vaccine manufacturing across our country." Even seemingly small changes, Hodge says, have the potential to chip away at the confidence Americans have in vaccines, thereby reducing vaccination rates and increasing the chances of disease outbreaks. Hodge also points to three major pathways by which Kennedy could act. First, he could influence people who hold key roles at the FDA and CDC as well as on those agencies’ vaccine advisory committees, potentially slow-walking the approval of new vaccines and influencing guidance about which already-approved shots should be recommended for the general public and covered by insurance. Second, his HHS could attach strings to federal funding for vaccines. While states set their own vaccine policies, including which are required for children entering school, the CDC provides much of the funding states use to carry out their vaccination programs. The federal government could require states to comply with certain policies set by Kennedy’s HHS if they want to continue to receive that money, Hodge says. Third, and perhaps most importantly, Kennedy would have a major and official platform from which to spread vaccine skepticism. “The anti-public-health impact of that, from a pure influencer perspective, is profound—even though it doesn’t require any legal action,” Hodge says. “It would be damaging beyond all control.”

Robert F. Kennedy Jr., President Trump's pick to lead the U.S. Department of Health and Human Services (HHS), has been tough to tie down to one stance on abortion. For most of his career, he has supported it—in stark contrast to the views of many prominent figures in the current Administration. But in a Senate confirmation hearing on Jan. 29, Kennedy clarified his position on abortion. “I serve at the pleasure of the President," he said in response to a question about his abortion beliefs. "I’m going to implement his policies.” The following day, Kennedy further cemented his new position when asked if he was hiring people who are pro-life for his department. "Yes, I am," he said. Here's what to know about Kennedy's past and current stance on abortion. Branded Content XPRIZE at the 2025 TIME100 Summit: Making the Impossible, Possible By XPRIZE What Kennedy has said in the past about abortion Kennedy, a former Democrat, has long advocated for women's reproductive rights and supported a woman's right to choose whether or not she gets an abortion. As a presidential candidate in May 2024, Kennedy described every abortion as a “tragedy” but said the decision should be left up to women, going as far as to say this freedom to choose should extend to full-term pregnancies. Shortly after, in a long post on X, he clarified his statement but essentially continued to back abortion. “I support the emerging consensus that abortion should be unrestricted up until a certain point. I believe that point should be when the baby is viable outside the womb. Therefore I would allow appropriate restrictions on abortion in the final months of pregnancy, just as Roe v. Wade did." Read More: RFK Jr. Denied He Is Anti-Vaccine During His Confirmation Hearing. Here’s His Record In a video he posted to Facebook in June, he further explained that his stance on late-term abortion, in particular, had evolved. He initially believed that the only reason a woman would get an abortion in the third trimester is if the pregnancy put her life at risk or the baby had a fatal condition. “I don’t think a bureaucrat or a judge is better equipped than the baby’s own mother to decide what to do in those circumstances,” he said. "I had been assuming that virtually all late-term abortions were such cases, but I’ve learned that my assumption was wrong," he wrote on X. "Sometimes, women abort healthy, viable late-term fetuses. These cases of purely 'elective' late-term abortion are very upsetting. Once the baby is viable outside the womb, it should have rights and it deserves society’s protection." His position on abortion now At the Jan. 29 confirmation hearing, Kennedy stuck to a different refrain: "I agree with President Trump that every abortion is a tragedy," he said several times. “I agree with him that we cannot be a moral nation if there are 1.2 million abortions a year," he also said. "I agree with him that states should control abortion.” The statements reflect Kennedy's changing position as he attempts to appease Trump's conservative anti-abortion supporters. Read More: The Origins of the Anti-Vaccination Movement Numerous Democratic senators pointed out his past pro-choice position in the hearing. "I have never seen any major politician flip on that issue quite as quickly as you did when Trump asked you to become HHS Secretary," said Sen. Bernie Sanders of Vermont. Sen. Catherine Cortez Masto, a Democrat from Nevada, asked if a pregnant woman with a life-threatening bleed should be able to get an emergency abortion even if her state bans them. "You would agree, also as an attorney, that federal law protects her right to that emergency care. Correct?” Kennedy responded after a long pause, “I don’t know.” A clash with conservatives and changing stances Kennedy's views on abortion have put him at odds with more conservative Republicans, who have successfully instituted abortion bans in 13 states. The anti-abortion agenda outlined in Project 2025—from which President Trump has already drawn for many of actions early in his second term—calls for an end to abortion medications, which is how most women in the U.S. get abortions. Concerned that new policies could restrict or remove that access, some providers have reported spikes in these requests after Trump was elected President in November. But Kennedy made it clear that on abortion medication, too, he would defer to Trump to inform his new stance. "President Trump has asked me to study the safety of mifepristone," Kennedy said during the Jan. 29 hearing—despite the fact that the medication has already been reviewed and approved by the U.S. Food and Drug Administration as safe and effective. "He has not yet taken a stand on how to regulate it. Whatever he does, I will implement those policies, and I will work with this committee make those policies make sense.

Robert F. Kennedy, Jr., President Trump’s nominee to lead the U.S. Department of Health and Human Services, speaks with a raspy quiver in his voice. That’s because he has spasmodic dysphonia, a rare neurological condition that causes the muscles affecting the vocal cords to spasm. Kennedy has previously spoken about the way the condition affects his life. He “can’t stand” his voice, he told the Los Angeles Times last year. “I feel sorry for the people who have to listen to me,” he said in a phone interview with the outlet. “My voice doesn’t really get tired. It just sounds terrible. But the injury is neurological, so actually the more I use the voice the stronger it tends to get.” Here’s what to know about how common spasmodic dysphonia is, what causes it, and how it’s treated. What is spasmodic dysphonia? Spasmodic dysphonia (SD) is a rare disorder that causes involuntary movements of the voice box, says Saul Frankford, an assistant professor in the School of Behavioral and Brain Sciences at the University of Texas at Dallas who has researched the condition. About 1 in 100,000 people worldwide have it. Grottoes bear the enduring touch of Tang Branded Content Grottoes bear the enduring touch of Tang By China Daily There are two main types of SD. Adductor spasmodic dysphonia, which is the kind Kennedy has, means “the vocal folds press too tightly together during speech,” Frankford says. “That causes this raspy or creaky kind of voice, often with voice breaks, as well.” Abductor spasmodic dysphonia, which is less common, causes the vocal cords to suddenly open. “That leads to a breathier kind of voice,” he says. Read More: 11 Ways to Respond When Someone Insults a Loved One’s Disability SD is sometimes referred to as laryngeal dystonia. Other types of dystonia include writer’s cramp and neck dystonia, and both occur during active movements, Frankford says, like knee-jerk contractions in the fingers, hand, or forearm. What causes spasmodic dysphonia? People usually develop SD in their 40s or 50s—Kennedy was diagnosed in 1996, at age 42—and scientists aren’t exactly sure what causes it. “It does essentially come out of nowhere,” Frankford says. Some research suggests that people with the condition report having upper respiratory infections or acute periods of stress and anxiety, both of which could play a role in triggering it, he adds. There’s also a genetic component. The exact percentage of cases in which genetics play a role is unclear, though Frankford estimates around 10% to 20% of people with the condition have family members who have it, too. Does it affect all kinds of vocal activities? Spasmodic dysphonia is considered a task-specific type of dystonia, which means it affects regular speech. It’s less likely to impact other types of vocal activities, Frankford says, including laughing, crying, whispering, and sometimes even singing. How is spasmodic dysphonia diagnosed? SD is difficult to diagnose. Because it’s so rare, not every doctor knows about it, Frankford says. Research suggests it takes an average of four to five years for patients to get an accurate diagnosis. “There’s a real problem with getting an accurate diagnosis, especially because it both overlaps with and resembles some other more common voice disorders, like muscle tension dysphonia,” he says. Read More: What to Do If Your Doctor Doesn’t Take Your Symptoms Seriously Part of the issue is that there’s nothing physically wrong with the voice muscles. “It’s a neurological disorder, but it’s not something you can see on an MRI scan,” Frankford says. “It’s not like there’s a tumor or stroke or something.” According to Johns Hopkins Medicine, speech-language pathologists often test voice production and quality, and a doctor might check the vocal folds by passing a small tube through the nose and into the voice box. Is there a cure for spasmodic dysphonia? SD is a lifelong condition that never goes away. “But it does vary depending on how stressed or tired someone is,” Frankford says. Are there treatments? The typical treatment for SD is Botox injections into the larynx muscles. “You inject the muscles of the larynx with Botox, around the vocal folds, and it weakens the muscles,” Frankford says. There are some short-term side effects, like breathiness, but over time, “it actually leads to a more typical voice.” Since Botox wears off after a couple months, however, people typically need to get it done again every two to five months. “You’d have to do this constantly, for as long as it works,” he says. According to NPR, Kennedy said on The Diane Rehm Show in 2005 that he received Botox injections every four months. Read More: Botox: The Drug That’s Treating Everything Meanwhile, researchers are exploring potential drug options, and there are some surgeries that cut the nerve that controls the movement of the larynx. But they're not always successful, making surgery a less-than-ideal option. Some people with SD choose to go to vocal therapy, which can help, Frankford says, but “it doesn't get rid of it.” Voice therapy tends to be more effective for people with muscle tension dysphonia, like teachers who talk all day and then lose their voice. What is it like to live with spasmodic dysphonia? Living with SD can be stressful. In studies, up to 62% of people with the condition have been found to have anxiety and depression. And there’s some evidence that there’s an increased risk of suicide in this population. “Communicating is an important part of the human condition,” Frankford says. “When you’re not able to communicate effectively, or when it’s more challenging, it’s definitely going to take a psychological toll. You don't want to interact with other people if you don't think your voice sounds the way you want it to.” Unfortunately, people with SD are often mocked about the way their voice sounds. Frankford stresses that it’s a neurological condition, which means it’s not anybody’s fault that they have it. Plus, it doesn’t reflect any sort of cognitive or psychological issues. “It’s not like an indication of someone’s cognitive abilities, or their abilities to think and interact with other people,” he says.