health

there-may-not-be-a-safe-off-ramp-for-some-taking-glp-1-drugs,-study-suggests

There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

Of the 308 who benefited from tirzepatide, 254 (82 percent) regained at least 25 percent of the weight they had lost on the drug by week 88. Further, 177 (57 percent) regained at least 50 percent, and 74 (24 percent) regained at least 75 percent. Generally, the more weight people regained, the more their cardiovascular and metabolic health improvements reversed.

Data gaps and potential off-ramps

On the other hand, there were 54 participants of the 308 (17.5 percent) that didn’t regain a significant amount of weight (less than 25 percent.) This group saw some of their health metrics worsen on withdrawal of the drug, but not all— blood pressure increased a bit, but cholesterol didn’t go up significantly overall. About a dozen participants (4 percent of the 308) continued to lose weight after stopping the drug.

The researchers couldn’t figure out why these 54 participants fared so well; there were “no apparent differences” in demographic or clinical characteristics, they reported. It’s clear the topic requires further study.

But, overall, the study offers a gloomy outlook for patients hoping to avoid needing to take anti-obesity drugs for the foreseeable future.

Oczypok and Anderson highlight that the study involved an abrupt withdrawal from the drug. In contrast, many patients may be interested in slowly weaning off the drugs, stepping down dosage levels over time. So far, data on this strategy and the protocols to pull it off have little data behind them. It also might not be an option for patients who abruptly lose access or insurance coverage of the drugs. Other strategies for weaning off the drugs could involve ramping up physical activity or calorie restriction in anticipation of dropping the drugs, the experts note.

In addition to more data on potential GLP-1 off-ramps, the pair calls for more data on the effects of weight fluctuations from people going on and off the treatment. At least one study has found that the regained weight after intentional weight loss may end up being proportionally higher in fat mass, which could be harmful.

For now, Oczypok and Anderson say doctors should be cautious about talking with patients about these drugs and what the future could hold. “These results add to the body of evidence that clinicians and patients should approach starting [anti-obesity medications] as long-term therapies, just as they would medications for other chronic diseases.”

There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests Read More »

why-you-don’t-want-to-get-tuberculosis-on-your-penis

Why you don’t want to get tuberculosis on your penis

Miliary tuberculosis (MTB) is a severe form of tuberculosis in which the instigating bacteria— Mycobacterium tuberculosis or potentially a relative that infects cows and deer, Mycobacterium bovis—spread widely through the body and create small lesions. The name “miliary” dates back to 1700, when a physician noted that the specks resembled millet seeds.

While Mycobacterium can spread through the air and are often found in the lungs, the bacteria can strike anywhere in the body. Still, penile tuberculosis is exceedingly rare. In fact, it’s uncommon to have tuberculosis erupt anywhere in the urinary and genital tracts. Among the infections that spring up in the region, penile infections account for less than 1 percent.

But, given the man’s lungs and his immunosuppressed status, the unusual presentation became their leading guess—and tests soon confirmed it. Mycobacterium were identified in the man’s respiratory tract, and penile tissue tested also showed the bacteria, though the testing couldn’t identify what species of Mycobacterium.

Treatment for tuberculosis requires a regimen of several antibiotics and takes months. In the man’s case, they customized his treatment with a 12-month, four-drug regimen that wouldn’t interfere with his transplant.

Still, the penile lesion got worse before it got better. He developed a large necrotic ulceration on the side of his penis, and his foreskin began to “break down.” Surgeons had to mechanically cut out the dead tissue. After 10 months, his infection appeared to have cleared, and his penile lesion had improved.

Unexplained exposure

It remains unclear how the man got the infection. He told doctors he wasn’t aware of coming in contact with any tuberculosis patients and wasn’t in settings where the bacteria normally spread, such as prisons. It’s possible that the bacteria had been lurking in his transplanted kidney.

Why you don’t want to get tuberculosis on your penis Read More »

from-defiant-to-contrite:-formula-maker-confirms-bacteria-amid-botulism-outbreak

From defiant to contrite: Formula maker confirms bacteria amid botulism outbreak

ByHeart announced on Thursday that its own testing identified the bacterium that causes botulism in its baby formula, which is linked to an ongoing infant botulism outbreak that has doubled since last week.

As of November 19, there have been 31 cases across 15 states—up from 15 cases in 12 states reported last week. All 31 cases so far have been hospitalized. No deaths have been reported.

The outbreak was announced on November 8, and ByHeart was, at first, unusually aggressive in deflecting blame for linked illnesses.

The link between infant botulism cases and ByHeart was first spotted by the California Department of Public Health (CDPH). The department is the world’s sole source of the infant botulism treatment BabyBIG, and, as such, is contacted when any infant botulism cases arise. CDPH started to notice a pattern of ByHeart exposure among the cases. While ByHeart products account for just 1 percent of infant formula sales, babies fed ByHeart formula accounted for 40 percent of infant botulism cases with dry formula exposure between August 1 and November 10. Soon, preliminary testing by the department identified the bacterium that causes botulism—Clostridium botulinum—in an opened can of ByHeart from one of the sick babies.

Changing tune

However, ByHeart didn’t buy it. In a video posted to social media the day the outbreak was announced, one of ByHeart’s co-founders, Mia Funt, said: “I want to make something really clear: There is no reason to believe that infant formula can cause infant botulism.” Funt claimed that “multiple regulatory bodies” have concluded that formula can’t cause infant botulism, and the US Food and Drug Administration has never found a “direct connection” between formula and infant botulism. She added that no “toxins” have been found in the formula.

From defiant to contrite: Formula maker confirms bacteria amid botulism outbreak Read More »

cdc-data-confirms-us-is-2-months-away-from-losing-measles-elimination-status

CDC data confirms US is 2 months away from losing measles elimination status

Unsurprising

This 9171 subtype “continues, unfortunately uninterrupted, across multiple jurisdictions,” David Sugerman, who leads the CDC measles response, said on the call.

According to the Times, local health officials are pessimistic that they’ll be able to stamp out the virus’ spread, saying that vaccination efforts have had “limited” impact. As Ars reported previously, vaccination rates are dangerously low in two measles hotspots: northwestern Mohave County, Arizona, and the southwest health district of Utah. Vaccination rates among kindergartners in the 2024–2025 school year were 78.4 percent and 80.7 percent, respectively. That’s well below the 95 percent target needed to keep the virus from spreading onward in the communities.

In addition, public health officials in Arizona and Utah have reported barriers to responding to the outbreak. Around a quarter of cases don’t know how they were exposed, suggesting cases and exposures are being missed. In late October, health officials in Salt Lake County, Utah, said that a person likely infected with measles refused to cooperate with their investigation, leaving them unable to confirm the probable case.

David Kimberlin, who sits on a panel of experts that analyzes measles data for the United States’ elimination status review, told the Times, “It would not surprise me in the least if there’s continued spread across these next several months.”

To date, the CDC  has tallied 1,723 measles cases across 42 states. Most (87 percent) of those cases were linked to outbreaks, of which there have been 45 this year. For context, there were 16 outbreaks and a total of 285 measles cases in the US last year. This year’s measles cases mark a 33-year high.

CDC data confirms US is 2 months away from losing measles elimination status Read More »

trump-admin-axed-383-active-clinical-trials,-dumping-over-74k-participants

Trump admin axed 383 active clinical trials, dumping over 74K participants

“A betrayal”

Jena and colleagues examined the greater context, comparing the number of cancelled trials in each treatment category to the total number of all funded trials in those categories. For instance, while cancer trials made up 30 percent of the 383 cancelled trials, the 118 cancelled cancer trials accounted for only 2.7 percent of the total 4,424 cancer trials funded in the study period. The cancelled infectious disease trials, on the other hand, accounted for over 14 percent of all infectious disease trials funded (675). The categories most disproportionately affected were infectious diseases, respiratory diseases, and cardiovascular diseases.

The researchers also looked at the purpose of the cancelled trials—for instance, for treatment of a disease, prevention, supportive care, or diagnostics. Of the 383, 140 were for treatments and 123 were for prevention.

The authors note that they weren’t able to determine the stated reasons for the cancellations (if any) or compare this year’s trial cancellations to trends from previous years, which could offer more context to the cuts. There simply isn’t the same comprehensive data on clinical trial cancellations for past years, the authors said, noting “termination of federal grant funding was rare prior to 2025.”

In the accompanying editor’s note, Teva Brender and Cary Gross blasted the revealed cancellations. To cancel trials already underway is to “squander participants’ and investigators’ valuable time, effort, and resources,” they write, since there have already been “substantive sunk costs.” It also “stifles scientific discovery and innovation.”

But “there is a more direct and sobering impact of premature and scientifically unjustifiable trial terminations: the violation of foundational ethical principles of human participant research,” they write. “First and foremost, it is betrayal of the fundamental principles of informed consent for research.” And “participants who have been exposed to an intervention in the context of a trial may be harmed by its premature withdrawal or inadequate follow-up and monitoring for adverse effects.”

Over 74,000 trial participants entrusted researchers with “their health and hope,” but even if the trial funding is restored—as it may be for some—it would “at best mitigate the harms.”

Trump admin axed 383 active clinical trials, dumping over 74K participants Read More »

judge-smacks-down-texas-ag’s-request-to-immediately-block-tylenol-ads

Judge smacks down Texas AG’s request to immediately block Tylenol ads

A Texas Judge has rejected a request from Texas Attorney General Ken Paxton to issue a temporary order barring Tylenol’s maker, Kenvue, from claiming amid litigation that the pain and fever medication is safe for pregnant women and children, according to court documents.

In records filed Friday, District Judge LeAnn Rafferty, in Panola County, also rejected Paxton’s unusual request to block Kenvue from distributing $400 million in dividends to shareholders later this month.

The denials are early losses for Paxton in a politically charged case that hinges on the unproven claim that Tylenol causes autism and other disorders—a claim first introduced by President Trump and his anti-vaccine health secretary, Robert F. Kennedy Jr.

In a bizarre press conference in September, Trump implored Americans repeatedly not to take the drug. But, scientific studies have not shown that Tylenol (acetaminophen) causes autism or other neurologic disorders. Some studies have claimed to find an association between Tylenol use and autism, but the studies have significant flaws, and others have found no link. Moreover, Tylenol is considered the safest pain and fever drug for use during pregnancy, and untreated pain and fevers in pregnancy are known to cause harms, including an increased risk of autism.

Still, Paxton filed the lawsuit October 28, claiming that Kenvue and Tylenol’s former parent company, Johnson & Johnson, deceptively marketed Tylenol as safe while knowing of an increased risk of autism and other disorders. The lawsuit sought to force Kenvue to change the way it markets Tylenol and pay fines, among other requests.

Judge smacks down Texas AG’s request to immediately block Tylenol ads Read More »

as-shutdown-ends,-dubious-cdc-panel-gets-back-to-dismantling-vaccine-schedule

As shutdown ends, dubious CDC panel gets back to dismantling vaccine schedule

Nevertheless, Kennedy’s ACIP members planned to push the first dose back a month. A vote was prepared to recommend not giving a birth dose unless there was “individual based decision-making.” While at first the panel seemed poised to vote in favor of the change, the plan collapsed with basic questioning.

Voting ACIP member Joseph Hibbeln, a psychiatrist, noted: “I’m unclear if we’ve been presented with any safety or data comparing before one month to after one month,” he said. They had not.

“And,” Hibbeln continued, “I’m wondering why one month was selected as our time point and if there are data to help to inform us if there’s greater risk of adverse effects before one month or after one month at all.”

There is no data suggesting that such a move would be more or less safe.

The discussion quickly spiraled from there with an eventual vote of 11-1 to table voting on the vaccine recommendation. According to the Federal Register notice, ACIP will try to take up the topic again. They could revive the vote or attack some other aspect of vaccine recommendations.

Pediatricians fight back

Health experts have blasted Kennedy’s lineup and their attacks on childhood vaccines, including the hepatitis B vaccination schedule. The current schedule “remains the best protection against serious health problems like liver disease and cancer,” the American Academy of Pediatrics emphasized to Ars.

With ACIP’s standing tarnished under Kennedy, AAP has put forth its own evidence-based vaccine schedule for pediatricians to trust. They’ve also been a prominent opponent among medical organizations to Kennedy’s efforts. For instance, in a revised federal lawsuit, the AAP along with other medical organizations is seeking to overturn all decisions made by Kennedy’s ACIP and replace the entire panel with actual experts.

Kennedy’s appointees “lack the credentials and experience required of their role,” and all their votes should be declared “null and void,” the organization said.

AAP President Susan Kressly said that pediatricians are already seeing the effects of having an anti-vaccine activist as the US health secretary, namely “fear, decreased vaccine confidence, and barriers for families to access vaccines.”

“The nation’s children are already paying the price in avoidable illnesses and hospitalizations,” Kressly said. “We urge federal leaders to restore the science-based deliberative process that has made the United States a global leader in public health. Urgent action is needed.”

As shutdown ends, dubious CDC panel gets back to dismantling vaccine schedule Read More »

this-flu-season-looks-grim-as-h3n2-emerges-with-mutations

This flu season looks grim as H3N2 emerges with mutations

Health officials in the United Kingdom are warning that this year’s flu season for the Northern Hemisphere is looking like it will be particularly rough—and the US is not prepared.

The bleak outlook is driven by a new strain of H3N2, which emerged over the summer (at the end of the Southern Hemisphere’s season) sporting several mutations. Those changes are not enough to spark the direst of circumstances—a deadly pandemic—but they could help the virus dodge immune responses, resulting in an outsized number of severe illnesses that could put a significant strain on hospitals and clinics.

In the UK, the virus has taken off. The region’s flu season has started around five weeks earlier than normal and is making a swift ascent.

The UK’s flu season progress. Credit: UKHSA

Jim Mackey, who became chief executive of NHS England in April, is bracing for influenza’s wrath. “There’s no doubt this winter will be one of the toughest our staff have ever faced,” Mackey told The BMJ. “Since stepping into this role, the thought of a long, drawn-out flu season has kept me awake at night. And, unfortunately, it looks like that fear is becoming reality.”

Almost all of the UK cases so far this year have been from influenza A strains, with H3N2 accounting for the lion’s share, according to the UK Health Security Agency. The two circulating influenza A strains are the new H3N2 strain and an H1N1 strain, with an influenza B strain circulating at very low rates. In the latest UK data, H3N2 was behind over 90 percent of cases that had their influenza virus type analyzed.

“Of the two seasonal influenza A viruses, the current dominant circulating virus (A/H3N2) tends to cause more severe illness than A/H1N1, particularly in older adults,” Antonia Ho, an infectious diseases expert at the University of Glasgow, said in a statement. And the early start of the flu season only makes things worse, since not as many people are vaccinated early on, Ho added. “From previous experience, influenza waves that start early tend to affect a larger number of people in the population.”

This flu season looks grim as H3N2 emerges with mutations Read More »

canada-fought-measles-and-measles-won;-virus-now-endemic-after-1998-elimination

Canada fought measles and measles won; virus now endemic after 1998 elimination

“This loss represents a setback, of course, but it is also reversible,” Jarbas Barbosa, director of PAHO, said in a press briefing Monday.

Call to action

Barbosa was optimistic that Canada could regain its elimination status. He highlighted that such setbacks have happened before. “In 2018 and 2019, Venezuela and Brazil temporarily lost their elimination status following large outbreaks,” Barbosa noted. “Thanks to coordinated action by governments, civil society, and regional cooperation, those outbreaks were contained, and the Region of the Americas regained its measles-free status in 2024.”

On Monday, the Public Health Agency of Canada released a statement confirming that it received notification from PAHO that it had lost its measles elimination status, while reporting that it is already getting to work on earning it back. “PHAC is collaborating with the PAHO and working with federal, provincial, territorial, and community partners to implement coordinated actions—focused on improving vaccination coverage, strengthening data sharing, enabling better overall surveillance efforts, and providing evidence-based guidance,” the agency said.

However, Canada isn’t the only country facing an uphill battle against measles—the most infectious virus known to humankind. Outbreaks and sustained spread are also active in the US and Mexico. To date, the US has documented at least 1,618 measles cases since the start of the year, while Mexico has tallied at least 5,185. Bolivia, Brazil, Paraguay, and Belize also have ongoing outbreaks, PAHO reported.

As of November 7, PAHO has collected reports of 12,593 confirmed measles cases from 10 countries, but approximately 95 percent of them are in Canada, Mexico, and the US. That total is a 30-fold increase compared to 2024, PAHO notes, and the rise has led to at least 28 deaths: 23 in Mexico, three in the United States, and two in Canada.

The PAHO used Canada’s loss as a call to action not just in the northern country, but the rest of the region. “Every case we prevent, every outbreak we stop saves lives, protects families, and makes communities healthier,” Barbosa said. “Today, rather than lamenting the loss of a regional status, we call on all countries to redouble their efforts to strengthen vaccination rates, surveillance, and timely response to suspected cases—reaching every corner of the Americas. As a Region, we have eliminated measles twice. We can do it a third time.”

Canada fought measles and measles won; virus now endemic after 1998 elimination Read More »

james-watson,-who-helped-unravel-dna’s-double-helix,-has-died

James Watson, who helped unravel DNA’s double-helix, has died

James Dewey Watson, who helped reveal DNA’s double-helix structure, kicked off the Human Genome Project, and became infamous for his racist, sexist, and otherwise offensive statements, has died. He was 97.

His death was confirmed to The New York Times by his son Duncan, who said Watson died on Thursday in a hospice in East Northport, New York, on Long Island. He had previously been hospitalized with an infection. Cold Spring Harbor Laboratory also confirmed his passing.

Watson was born in Chicago in 1928 and attained scientific fame in 1953 at 25 years old for solving the molecular structure of DNA—the genetic blueprints for life—with his colleague Francis Crick at England’s Cavendish laboratory. Their discovery heavily relied on the work of chemist and crystallographer Rosalind Franklin at King’s College in London, whose X-ray images of DNA provided critical clues to the molecule’s twisted-ladderlike architecture. One image in particular from Franklin’s lab, Photo 51, made Watson and Crick’s discovery possible. But, she was not fully credited for her contribution. The image was given to Watson and Crick without Franklin’s knowledge or consent by Maurice Wilkins, a biophysicist and colleague of Franklin.

Watson, Crick, and Wilkins were awarded the Nobel Prize in Physiology or Medicine in 1962 for the discovery of DNA’s structure. By that time, Franklin had died (she died in 1958 at the age of 37 from ovarian cancer), and Nobels are not given posthumously. But Watson and Crick’s treatment of Franklin and her research has generated lasting scorn within the scientific community. Throughout his career and in his memoir, Watson disparaged Franklin’s intelligence and appearance.

James Watson, who helped unravel DNA’s double-helix, has died Read More »

questions-swirl-after-trump’s-glp-1-pricing-deal-announcement

Questions swirl after Trump’s GLP-1 pricing deal announcement

While some may stand to gain access to the drugs under these categories, another factor in assessing the deal’s impact is that millions are expected to lose federal health coverage under the Trump administration’s “One Big Beautiful Bill Act.”

Unmatched prices

In addition to the deals for federal programs, the administration also announced new direct-to-consumer prices. Currently, people with a prescription can buy the most popular drugs, Wegovy and Zepbound, directly from Novo Nordisk and Eli Lilly, respectively, for $499 each. Under the new deal, Wegovy will be available for $350, as will Ozempic. And Zepbound will be available at “an average” of $346. While the prices are lower, the out-of-pocket costs are still likely to be more than most people would pay if they went through an insurance plan, and paying outside their insurance policies means that the payments won’t be counted toward out-of-pocket maximums and other tallies. Generally, experts expect that direct-to-consumer sales won’t play a significant role in lowering overall drug costs.

It remains unclear if Trump’s deal will have any effect on GLP-1 prices for those on commercial insurance plans.

Trump hailed the deals, calling them “most favored-nation pricing.” But even with the lower prices for some, Americans are still paying more than foreign counterparts. As Sen. Bernie Sanders (I-Vt.) noted last year, while Novo Nordisk set Ozempic’s list price at nearly $1,000 in the US and the new deal is as low as $245, the drug costs just $155 in Canada, $122 in Italy, $71 in France, and $59 in Germany. Wegovy, similarly, is $186 in Denmark, $137 in Germany, and $92 in the United Kingdom. Eli Lilly’s Mounjaro is $94 in Japan.

A study published last year in JAMA Network Open led by researchers at Yale University estimated that the manufacturing cost for this class of drugs is under $5 for a month’s supply.

The announcement also said that future GLP-1 drugs in pill form (rather than injections) from the two companies will be priced at $150. That price will be for federal programs and direct-to-consumer sales. While such pills are nearing the market, none are currently available or approved by the Food and Drug Administration. Given that they are not yet for sale, the cost savings from this deal are unknown.

Questions swirl after Trump’s GLP-1 pricing deal announcement Read More »

“it’s-only-a-matter-of-time-before-people-die”:-trump-cuts-hit-food-inspections

“It’s only a matter of time before people die”: Trump cuts hit food inspections


American inspections of foreign food facilities hit historic lows this year.

Credit: Biswa1992/iStock via Getty Images

American inspections of foreign food facilities—which produce everything from crawfish to cookies for the US market—have plummeted to historic lows this year, a ProPublica analysis of federal data shows, even as inspections reveal alarming conditions at some manufacturers.

About two dozen current and former Food and Drug Administration officials blame the pullback on deep staffing cuts under the Trump administration. The stark reduction marks a dramatic shift in oversight at a time when the United States has never been more dependent on foreign food, which accounts for the vast majority of the nation’s seafood and more than half its fresh fruit.

The stakes are high: Foreign products have been increasingly linked to outbreaks of foodborne illness. In recent years, FDA investigators have uncovered disturbing lapses in facilities producing food bound for American supermarkets. In Indonesia, cookie factory workers hauled dough in soiled buckets. In China, seafood processors slid crawfish along cracked, stained conveyor belts. Investigators have reported crawling insects, dripping pipes, and fake testing data purporting to show food products were pathogen free.

In 2011, Congress—concerned about the different standards of overseas food operations—gave the FDA new authority to hold foreign food producers to the same safety standards as domestic ones. Although the agency’s small team remained unable to visit every overseas facility, inspections rose sharply after the mandate—sometimes doubling or tripling previous rates.

Now, the US is on track to have the fewest inspections on record since 2011, except during the global pandemic.

Inspections began to decline early in the administration, after 65 percent of the staff in the FDA divisions responsible for coordinating travel and budgets left or were fired in the name of government efficiency.

Investigators suddenly had to book their own flights and hotels, obtain diplomatic passports and visas, and coordinate with foreign authorities, former and current FDA staffers told ProPublica. After workers tasked with processing expenses were laid off, investigators waited as a backlog of unfulfilled reimbursements climbed to more than $1 million, a former staffer said. (Investigators are responsible for paying off their own credit cards.) Senior investigators close to retirement also took the opportunity to get out.

Played out on a large scale, this combination of firings and voluntary departures has left the agency scrambling to make up for the loss of 1 out of every 5 of its workers responsible for ensuring the safety of America’s food and drugs.

Susan Mayne, the former director of the FDA’s Center for Food Safety and Applied Nutrition and an adjunct professor at Yale School of Public Health, expressed alarm at the drop in foreign inspections.

“It’s very concerning that we are seeing these kinds of reductions,” said Mayne, who emphasized the administration’s cuts have hamstrung an agency that has long struggled to retain investigators who conduct both foreign and domestic inspections. In an attempt to maintain its numbers, the agency had been working on initiatives to elevate pay and adopt specialized training for investigators. “The plans that were in place to address staffing have now been undermined.”

The gutting of the workforce coincides with other actions the administration has taken that are poking holes in the nation’s food safety net. In March, the FDA announced it was delaying compliance with a rule to speed up the identification and removal of harmful products in the food system, to give more time for companies to follow the rules. The next month, it suspended a quality control program that ensured consistency and accuracy across its 170 pathogen and contaminant labs as a result of staffing cuts.

Then in July, the administration quietly scaled back the Foodborne Diseases Active Surveillance Network, also known as FoodNet, shrinking its surveillance to just two pathogens: salmonella and a common type of E. coli. The program—a partnership between the FDA, the Centers for Disease Control and Prevention, the Department of Agriculture, and state health departments—was responsible for the critical monitoring of eight foodborne illnesses, including infections caused by the deadly bacteria Listeria. In response to the change, a CDC spokesperson previously claimed that the program’s surveillance had been duplicative.

The administration did not respond to ProPublica’s questions about these actions.

“There are going to be things that fall through the cracks, and these things aren’t negligible,” said a current FDA investigations official who spoke on the condition of anonymity, fearing reprisal. The same was true of other current and former agency staffers; those who still had jobs risked losing them, while former employees worried about their chances of being rehired or the security of their severance or retirement packages.

The Department of Health and Human Services refused to respond to any of ProPublica’s questions about the decrease in foreign food inspections, citing the government shutdown. “Responding to ProPublica is not considered a mission-critical activity,” said Emily Hilliard, the department’s press secretary. The FDA and the White House also did not respond to requests for comment.

“Basic regulatory oversight functions have been decimated,” said Brian Ronholm, the director of food policy at Consumer Reports. “There’s an enhanced risk of more outbreaks.”

An agency already struggling

The FDA has long been one of the main protectors of the American food supply. The federal agency oversees about 80 percent of what people eat, including fruits, vegetables, processed goods, dairy products and infant formula, and most seafood and eggs. It regulates more than 220,000 farms, food plants, and distributors, inspecting facilities, testing for pathogens, tracing outbreaks, and issuing recalls.

Only 40 percent of the facilities that the FDA regulates are within the nation’s borders. While the agency examines some products at ports of entry, those reviews are often cursory; workers cannot manually inspect every import or uncover whether a foreign plant properly cleans its equipment, conducts adequate salmonella testing, or has a rat infestation. In-person facility inspections are necessary for that kind of insight.

For example, in 2023, an FDA investigator inspected a Chinese manufacturer of soy protein powder, a common additive in shakes and other beverages. While the company had previously imported its products into the United States without scrutiny, the investigator’s thorough visit found numerous violations, according to an agency report obtained through a federal records request.

Live insects crawled through the facility’s production workshop, while dead ones lay on the floor. Condensation from rust-covered pipes dripped into a water tank waiting to be mixed with raw ingredients. Just outside the plant, the investigator found processing waste and stagnant water coated with a green biofilm, attracting a swarm of bugs too numerous to count.

When the investigator reviewed the firm’s bacteria testing records, which purportedly verified the products were free of salmonella and E. coli, he discovered the company was providing fake data to “satisfy the customer specifications,” according to his inspection report.

Company officials also tried to obstruct his inspection, blocking him from entering a packaging room when he tried to photograph the pest infestation. After the three-day review, the federal agent censured the company, Pingdingshan Tianjing Plant Albumen Co. Ltd., which promised to take corrective actions. The company did not respond to ProPublica’s emailed questions.

If investigators find a foreign food facility is unable to comply with American safety requirements or refuses to permit the FDA to inspect its establishment, the agency can block its products from entering the country.

These crucial foreign inspections are neither easy nor cheap. They typically last longer than domestic ones and cost nearly $40,000 a visit, and they can require months of logistical planning, special visas, and diplomatic approval from the host country.

In part because of these challenges, there was a time when the FDA conducted only a few hundred foreign inspections annually.

Then Congress passed the Food Safety Modernization Act of 2011, which set firm targets for the agency: It needed to conduct more than 19,000 foreign food inspections annually by 2016 and increase the number of food field staff to no fewer than 5,000 workers.

The FDA has never fulfilled this congressional mandate. Even before the second Trump administration, the agency was inspecting less than 10 percent of its target each year.

Dr. Stephen Ostroff, a former acting commissioner of the FDA who also served as the deputy commissioner for foods and veterinary medicine, said that the agency’s foreign food inspections have long been hindered by a lack of resources.

“It’s not because the agency isn’t interested in doing more overseas inspections—they are,” said Ostroff, who retired from the agency in 2019. “They simply don’t have the resources to be able to meaningfully do large numbers of overseas inspections.”

One major obstacle has been a lack of financial support. “Congressional appropriators have never provided the funding that FDA has determined it would need to do those foreign inspections,” said Mayne, who retired from the agency in 2023. Before the food safety act passed, the Congressional Budget Office estimated that the agency would need about $1.4 billion over five years to comply with the new requirements, which included the expansion of field staff and foreign inspections. But lawmakers approved only a fraction of that amount.

As of last year, the agency had about 430 employees conducting both foreign and domestic food inspections, with only 20 investigators dedicated solely to international assignments.

With such limitations, the agency’s inspections have often been reactive instead of proactive. In 2023, for example, FDA investigators did not descend on a Mexican strawberry farm until about 20 people had been hospitalized with hepatitis A, a highly contagious infection that causes liver inflammation and, in some cases, liver failure and death.

Hepatitis A is spread through the consumption of small or even microscopic bits of feces. Farm workers can shed the virus when picking fruit, or it can be transmitted through contaminated water.

At the Mexican berry farm, federal investigators found significant safety violations, including sanitation facilities with hand-washing water that was dirty, gray, and leaking throughout the growing area; one toilet offered no ability to wash one’s hands. The FDA censured the company, citing 11 violations of American food safety regulations. According to public data, the agency did not reinspect the farm to ensure it had made corrections even as its products kept entering the United States.

In January, less than two weeks before the second Trump administration came in, a report by the Government Accountability Office rebuked the FDA for consistently falling short of its foreign food inspection targets. The oversight office, recognizing the vital importance of the FDA’s food safety mission, urged Congress to direct the agency to assess how many foreign inspections are needed to keep the country’s food supply safe.

The FDA said in response that, in 2025, it would increase staffing levels and prioritize the training and development of investigators.

Then Donald Trump was inaugurated.

Reversing a decade of gains

During the first few weeks of the new Trump administration, foreign inspections carried on as usual. But the sudden hemorrhaging of FDA workers through firings, retirements, and buyouts quickly foiled the agency’s plans to ramp up staff and inspections.

While the administration had vowed that food safety inspectors would be spared, it began to cut critical investigative support staff in March, a move that would eventually incapacitate foreign inspections, current and former FDA staffers told ProPublica.

As the agency lost support staff, their responsibilities shifted to investigators, who were quickly overwhelmed by the new burdens. Passports, visas, and travel were all delayed.

“Support staff are not just there to bide time—they have a meaningful role,” said Sandra Eskin, who served as a top USDA food safety official in the Biden administration and is now the CEO of advocacy group Stop Foodborne Illness. “It’s like a game of Jenga: If you pull out one from the middle or the bottom, the whole tower collapses.”

In recent years, the agency has typically been able to conduct about 110 foreign food inspections each month, but in March, the number of inspections dropped almost in half compared with the monthly average in the previous two years.

As specialists who handled reimbursements were also fired, some investigators waited months for repayment, which made them reluctant to take on other foreign assignments, former and current staffers said.

The cuts and growing work burden quickly collapsed morale across the investigative division, leading many senior investigative officials with decades of experience to retire.

“We already had a significant percentage of our workforce that was eligible for retirement,” said a current FDA employee in the investigations division, “so reading the writing on the wall, they decided to exit.” These departures also interrupted the development of new investigators, as some of the senior staff members who left had been tasked with training new hires, a process that can take up to two years.

“There’s been such a brain drain,” said food safety expert Jennifer McEntire, founder of consulting firm Food Safety Strategy, “when inspectors do go out and are observing things, there’s no phone-a-friend.”

Instead of addressing the shortfall, in May, FDA Commissioner Dr. Marty Makary announced that the agency would expand the number of unannounced foreign inspections, in which investigators show up at facilities without alerting them first. Given the limited staff and resources, several current and former staffers told ProPublica that the prospect of conducting unannounced visits was impractical and even “comical.”

“A foreign unannounced trip is like an accelerated coordination process,” said a current FDA investigations official. “If you’re going to increase the number and not increase the staff, we don’t know how to make some of that stuff work.”

By the end of July, the number of foreign food inspections conducted by the agency was nearly 30 percent lower compared with similar periods in the previous two years. The administration refused to provide ProPublica with up-to-date inspection numbers, so we relied on data from the FDA’s public inspection dashboard to conduct this analysis.

Foreign inspections are not the only tool for overseeing food from abroad. The agency has developed partnerships with counterparts in other countries to ensure comparable oversight and required importers to verify that their foreign suppliers are following American standards. However, former and current agency staffers said that these initiatives also have been impacted by the administration’s cuts and recent departures.

While the administration’s cuts were ostensibly ordered to maximize efficiency and productivity, they have had an opposite effect, several former and current FDA employees said, reversing years of progress.

“The goal is to accomplish as much and more with less resources,” said a former high-level FDA investigations official. “Less inspections translate to less regulatory oversight, and that, from a public health perspective, never benefits the public.”

Scott Faber, senior vice president for government affairs at the nonprofit advocacy organization Environmental Working Group, said the fallout is simple:

“When you take a wrecking ball to the federal government, you are going to wind up undermining important government functions that keep all of us safe, especially our food,” he said. “It’s only a matter of time before people die.”

How we calculated foreign food inspections

To understand how inspections of foreign food facilities have changed, we used a publicly available dashboard where the FDA publishes the results of those inspections. This database also includes inspections for manufacturers of drugs, medical devices, cosmetics, tobacco, biologics, and veterinary products.

Beginning in May, we downloaded the entire database weekly and tracked the number of newly added foreign food facility inspections.

The dashboard is continually updated, with data added after inspections are finalized. That typically occurs 45 to 90 days after the close of an inspection, though some reports may not be posted until the agency takes a final enforcement action. Through an analysis, we determined that few reports are added more than 90 days after an inspection date.

Our story therefore only includes inspections through July. In an accompanying chart, we show the more provisional data through September. We asked HHS for recent figures, but the department refused to share them.

We considered the possibility that the downtrend in foreign food inspections was solely due to a lag in inspections being added to the dashboard. To check this, we performed the same analysis on domestic inspections. This analysis showed that while the rate of foreign inspections had significantly decreased, domestic inspections have continued almost uninterrupted.

This story originally appeared on ProPublica.

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