I am an emergency medicine (EM) physician and I'd like to suggest a change of expectation and perspective, which I am sure Dr. Panthagani would agree with as she learns emergency medicine. To the untrained eye, every day in an emergency department is chaotic. During training, EM physicians learn to expect and manage daily chaos allowing us to rapidly identify the sickest people while still caring for everyone else. Like the early pandemic, the administration has many advantages, for the moment. By using the EM model of expectation management, we can calm our minds, use time efficiently and focus on mobilizing our best ideas and resources. Just like treating any severe disease, it's going to take many clear heads to reverse this disaster.
I had this exact thought too -- in many ways, the specialty of emergency medicine is training in chaos management, and how to stay calm. Also important at the end of a chaotic shift to recognize how much was accomplished and the lives that were impacted, otherwise burnout comes quite quickly.
We need you now more than ever. Never has a president done so many stupid things in such a short time with the unanimous support of his party. It is easy to get depressed but your column was a ray of sunshine.
This is a beautiful essay and couldn't be better timed. My morning news read left me feeling helpless and hopeless. I did write to my US and NC senators in an attempt to add whatever power of persuasion I still retain. My theme was that unless they recover their senses and stand up to this putsch, their names will be remembered in history... and not in a good way! I fear I have been too sanguine in my comments up to now. One of our failures as intellectuals is that we believe in the power of language to persuade others. I fear that language is helpless in the face of a determined army of sadists. But I think Dr Panthagani's essay holds out the main hope for this year: that we can use the power of speech, the power of law, the fear of losing the last best hope for democracy, and the determination of free peoples to remain free as thorns in the shoe of autocracy... to slow the takeover long enough for the people's voices to be heard in the next election; and that we will let NOTHING delay or prevent that accounting!
Just saw that PA Dem Sen Fetterman will not vote to confirm RFK. We need every Dem to vote no. Write call or tweet senators. LA. NC Maine Alaska Kansas Kentucky Florida especially.
I live in Canada and so only peripherally share your pain. The sharing of trusted, truthful information will outlast the lies and the suppression of facts. Sharing real facts saves lives. Please keep sharing what ever public health data and trends you can get when ever possible. It will save lives
Now that one of the co–authors of P2025 has been confirmed for OMB, one of the most powerful offices in this White House the speed at which this dumpster fire is plowing through the federal bureaucracy will accelerate.
My advice to you to minimize burnout would be to pick out the most vital couple of topics and concentrate on those fights. Don't try to cover all bases. You don't have the size or resources of Trump or Musk or Vought. Besides a lot of the stuff spewing out of the Oval Office is ment as a distraction for other initiatives.
I’m glad president Trump is making good on his promise to cut waste and corruption out of our behemoth government. We need to look at the big picture here. We’re $37 trillion in debt and climbing $100 billion a month! This is totally unsustainable and will destroy our country. USAID, that everyone seems to be upset about here, is low hanging fruit. Totally corrupt. Only 3% of its $50 billion budget is actually spent on its stated mission to save lives. And USAID is just the tip of the iceberg.
Posting this "too fast to actually read" stories report on Instagram, owned by META, is no help at this time. Surely there is another way to bypass the use of a Zuckerberg product. PLEASE do not use this forum. When he first came on the scene I experienced him as the anti-Christ - evidently I was right. If we have more "masculine energy in corporate America" we will have a world filled with walking penises pushing their way around - as if they don't already. As a reproductive and sexual health provider for over 30 years I am beginning you not to use Instagram or Facebook.
Evelyn Resh, your post made me giggle about this deadly uptick on Masculine energy along with trying to yank women back into whelping rooms just off the kitchen. ‘Walking penises’ is too wonderful. If only I was a cartoonist. Thank you 🙏🏼
As you suggested, power did come from the bottom up. That power is the result of decisive election win for President Trump. Rather than wait to see what develops from the new directives, either good, bad or in- between, your biases have turned your newsletter into a somewhat unhinged, propaganda piece.
Thanks for your feedback. The problem is that I’m a human and this is all incredibly personal as I’m an active member in the field of public health. In fact, I was directly impacted by DOGE yesterday. I’ve been doing my best to have a steady head rather “unhinged” as you say. Don’t know what else to do
Dear Katelyn -- Your response is far too kind. An electoral victory by Trump entitles him and his administration to work to implement his vision and policies, but that is NOT what has happened. Trump and his unelected and unvetted Muskrats, and his GOP enablers are making a mockery of oaths of office when they ignore and/or violate Constitutional and legal guardrails in trying to implement change. None of this can be justified by an electoral victory.
Two basic problems - First, there's nothing good about unelected kleptocrats taking control of our federal government piece by piece, and Donald Trump was elected - not Elon Musk. The second basic problem is that the election was for a President - which is a defined role within the framework of the laws of our country, principally including the Constitution - and that role does not give him absolute power to do or deputize others to do whatever he wants. If you're going to appeal to his election by democratic means as a defense, you can't just take the part of those means that legitimizes his authority without taking the other inherent parts that limit his authority.
It may have been "decisive" depending on your definition, but the popular votes showed that he won by about one and a half percent and didn't even get 50% of the total vote. "Close" in most peoples lexicon. But regardless of that, no election win, however "decisive" gives him the authority to run rampant over laws passed by Congress and regulations properly arising from those laws, ignore the Constitution and to authorize non-elected people (and not confirmed agency heads) to assume control of government agencies and take a sledgehammer to them while viewing and possible stealing and irresponsibly revealing the information they have on Americans.
This is the newsletter I needed to get this morning. As someone who works at a demographic data research institute, I am indeed exhausted, and this is just the bit of encouragement I needed to get through another full day of meetings about how to preserve access to our nation's data. Thank you for all that you do!
The video is a brilliant piece of advocacy, and the executive summary an absolute must-read (as I am sure the full report is, too—just haven’t cracked the Q code, old Luddite that I am). Thank you so much for all you do.
We need to focus on the dismantling of USAID as a political matter. In this case, one needs to determine what political leverage one might have over Republicans who two weeks ago supported foreign aid for global health and are now attacking USAID and kissing Trump’s and Musk’s rings.
I suggest three urgent steps to deal with this. These are oriented to making Trump believe that “the political costs to him of destroying USAID outweigh the benefits:”
· It will not be easy, but I suggest we learn from the civil rights movement. Americans recoiled when they saw Bull Connor and his dogs attacking civil rights protesters they didn’t care a bit about two days earlier. A massive effort must be made to show Americans in video format over and over again how the dismantling of USAID is contributing to illness and the deaths of people in low-income countries.
· Second, I would help bring the faith community to the table in a major way. They need to speak out in a manner that makes the MAGA folks worry about their base.
· Third, The Democrats and individual citizens need to shout from the rooftops and in every media outlet possible that the Republicans are complicit in the harms and killing of innocent people in poor countries. Republicans need to believe that the costs of ignoring this are greater than what Trump can do to them.
Thanks for the good essay today. I just finished another Substack opinion from Paul Krugman, the noted economist and former NYT opinion writer. His piece is entitled "Autogolpe" which is Spanish for "Self-coup." He points out many of the unconstitutional moves Trump and Musk are doing that threaten our democracy. Our public health system is certainly one, but there are many more that he identifies that we need to focus on and make our views known.
Thanks for the reminder that, as Aragorn said before the Battle of Helms Deep, "There is always hope." [I am a LOTR fan, but have yet to achieve the rank of "geek."]
A few more notes on communicating with elected and appointed officials:
1) Be respectful - anything less closes their ears and if you are angry, those we seek to persuade count that as proof they are right.
2) Be nice - be especially respectful - but don't be afraid to make them afraid. In my experience as a state health officer, I learned that the one thing all officials truly fear is causing harm to the people that elected / hired them. So, its fine to talk about the benefits of public health science, programs and data, but above all else, give valid examples of the harm that will befall their constituents if the worst errors are not corrected. These officials know they will be held accountable, but remind them anyway.
3) In my personal opinion, many of these executive orders and pronouncements are Kabuki Theater - scary actors wearing masks. The primary modus operandi of the new administration is disruption, shock and awe. And yet, as YLE points out, major portions of the defunding memo were quickly rescinded ONCE THE AUTHORS REALIZED THEY WERE GOING TO HARM THE VERY PEOPLE THAT PUT THEM IN POWER. Real, lasting harm is something voters will never forgive or forget and the administration knows that, if it knows little else.
I took a course on Influence once. The central mantra was, "Remember, people never do anything for YOUR reasons; they only do things for THEIR reasons. So, if you want to influence, learn what their reasons are and speak to them." Push the "you're going to hurt the very people you depend on" button wherever it makes sense.
Remember, the new administration very much wants to hurt certain people. You can plead their case if you wish, just don't expect the administration to do anything other than silently (or loudly) congratulate themselves.
Call: don't email. Calls make a greater impression on staff and those sentiments gets conveyed to the boss. Politics is really all about emotions. Politics is the art of the possible.
Given the "let's throw it against the wall and see if it sticks" zeitgeist that is de rigor among Trump 2.0!'s Young Turks, there is indeed great risk if we resign ourselves to inaction.
There is indeed a rational basis for great hope; that hearing the right message from millions of us will keep the train from flying off the rails. [They know causing harm will finish their run.]
"Fasten your seat belts until YLE turns off the 'Fasten Your Seat Belt' sign: major turbulence ahead."
I am an emergency medicine (EM) physician and I'd like to suggest a change of expectation and perspective, which I am sure Dr. Panthagani would agree with as she learns emergency medicine. To the untrained eye, every day in an emergency department is chaotic. During training, EM physicians learn to expect and manage daily chaos allowing us to rapidly identify the sickest people while still caring for everyone else. Like the early pandemic, the administration has many advantages, for the moment. By using the EM model of expectation management, we can calm our minds, use time efficiently and focus on mobilizing our best ideas and resources. Just like treating any severe disease, it's going to take many clear heads to reverse this disaster.
I had this exact thought too -- in many ways, the specialty of emergency medicine is training in chaos management, and how to stay calm. Also important at the end of a chaotic shift to recognize how much was accomplished and the lives that were impacted, otherwise burnout comes quite quickly.
Rebecca Solnit on the word “emergency:” https://meditations-in-an-emergency.ghost.io/welcome-to-meditations-in-an-emergency/
We need you now more than ever. Never has a president done so many stupid things in such a short time with the unanimous support of his party. It is easy to get depressed but your column was a ray of sunshine.
This is a beautiful essay and couldn't be better timed. My morning news read left me feeling helpless and hopeless. I did write to my US and NC senators in an attempt to add whatever power of persuasion I still retain. My theme was that unless they recover their senses and stand up to this putsch, their names will be remembered in history... and not in a good way! I fear I have been too sanguine in my comments up to now. One of our failures as intellectuals is that we believe in the power of language to persuade others. I fear that language is helpless in the face of a determined army of sadists. But I think Dr Panthagani's essay holds out the main hope for this year: that we can use the power of speech, the power of law, the fear of losing the last best hope for democracy, and the determination of free peoples to remain free as thorns in the shoe of autocracy... to slow the takeover long enough for the people's voices to be heard in the next election; and that we will let NOTHING delay or prevent that accounting!
Thank you for giving us hope.
Just saw that PA Dem Sen Fetterman will not vote to confirm RFK. We need every Dem to vote no. Write call or tweet senators. LA. NC Maine Alaska Kansas Kentucky Florida especially.
Calling is best. Professional lobbyists tell us so.
I live in Canada and so only peripherally share your pain. The sharing of trusted, truthful information will outlast the lies and the suppression of facts. Sharing real facts saves lives. Please keep sharing what ever public health data and trends you can get when ever possible. It will save lives
Now that one of the co–authors of P2025 has been confirmed for OMB, one of the most powerful offices in this White House the speed at which this dumpster fire is plowing through the federal bureaucracy will accelerate.
My advice to you to minimize burnout would be to pick out the most vital couple of topics and concentrate on those fights. Don't try to cover all bases. You don't have the size or resources of Trump or Musk or Vought. Besides a lot of the stuff spewing out of the Oval Office is ment as a distraction for other initiatives.
I’m glad president Trump is making good on his promise to cut waste and corruption out of our behemoth government. We need to look at the big picture here. We’re $37 trillion in debt and climbing $100 billion a month! This is totally unsustainable and will destroy our country. USAID, that everyone seems to be upset about here, is low hanging fruit. Totally corrupt. Only 3% of its $50 billion budget is actually spent on its stated mission to save lives. And USAID is just the tip of the iceberg.
Posting this "too fast to actually read" stories report on Instagram, owned by META, is no help at this time. Surely there is another way to bypass the use of a Zuckerberg product. PLEASE do not use this forum. When he first came on the scene I experienced him as the anti-Christ - evidently I was right. If we have more "masculine energy in corporate America" we will have a world filled with walking penises pushing their way around - as if they don't already. As a reproductive and sexual health provider for over 30 years I am beginning you not to use Instagram or Facebook.
Evelyn Resh, your post made me giggle about this deadly uptick on Masculine energy along with trying to yank women back into whelping rooms just off the kitchen. ‘Walking penises’ is too wonderful. If only I was a cartoonist. Thank you 🙏🏼
I am a cartoonist. This might be my next project. 😎
As you suggested, power did come from the bottom up. That power is the result of decisive election win for President Trump. Rather than wait to see what develops from the new directives, either good, bad or in- between, your biases have turned your newsletter into a somewhat unhinged, propaganda piece.
Thanks for your feedback. The problem is that I’m a human and this is all incredibly personal as I’m an active member in the field of public health. In fact, I was directly impacted by DOGE yesterday. I’ve been doing my best to have a steady head rather “unhinged” as you say. Don’t know what else to do
Dear Katelyn -- Your response is far too kind. An electoral victory by Trump entitles him and his administration to work to implement his vision and policies, but that is NOT what has happened. Trump and his unelected and unvetted Muskrats, and his GOP enablers are making a mockery of oaths of office when they ignore and/or violate Constitutional and legal guardrails in trying to implement change. None of this can be justified by an electoral victory.
Two basic problems - First, there's nothing good about unelected kleptocrats taking control of our federal government piece by piece, and Donald Trump was elected - not Elon Musk. The second basic problem is that the election was for a President - which is a defined role within the framework of the laws of our country, principally including the Constitution - and that role does not give him absolute power to do or deputize others to do whatever he wants. If you're going to appeal to his election by democratic means as a defense, you can't just take the part of those means that legitimizes his authority without taking the other inherent parts that limit his authority.
It may have been "decisive" depending on your definition, but the popular votes showed that he won by about one and a half percent and didn't even get 50% of the total vote. "Close" in most peoples lexicon. But regardless of that, no election win, however "decisive" gives him the authority to run rampant over laws passed by Congress and regulations properly arising from those laws, ignore the Constitution and to authorize non-elected people (and not confirmed agency heads) to assume control of government agencies and take a sledgehammer to them while viewing and possible stealing and irresponsibly revealing the information they have on Americans.
This is the newsletter I needed to get this morning. As someone who works at a demographic data research institute, I am indeed exhausted, and this is just the bit of encouragement I needed to get through another full day of meetings about how to preserve access to our nation's data. Thank you for all that you do!
Can you please post the video on Bluesky?
Shortened it slightly and posted here: https://bsky.app/profile/kmpanthagani.bsky.social/post/3lhmhqvvbuk25
Oh was just told it’s too long for BlueSky to post there
Perhaps it could be broken into two parts for posting?
The video is a brilliant piece of advocacy, and the executive summary an absolute must-read (as I am sure the full report is, too—just haven’t cracked the Q code, old Luddite that I am). Thank you so much for all you do.
We need to focus on the dismantling of USAID as a political matter. In this case, one needs to determine what political leverage one might have over Republicans who two weeks ago supported foreign aid for global health and are now attacking USAID and kissing Trump’s and Musk’s rings.
I suggest three urgent steps to deal with this. These are oriented to making Trump believe that “the political costs to him of destroying USAID outweigh the benefits:”
· It will not be easy, but I suggest we learn from the civil rights movement. Americans recoiled when they saw Bull Connor and his dogs attacking civil rights protesters they didn’t care a bit about two days earlier. A massive effort must be made to show Americans in video format over and over again how the dismantling of USAID is contributing to illness and the deaths of people in low-income countries.
· Second, I would help bring the faith community to the table in a major way. They need to speak out in a manner that makes the MAGA folks worry about their base.
· Third, The Democrats and individual citizens need to shout from the rooftops and in every media outlet possible that the Republicans are complicit in the harms and killing of innocent people in poor countries. Republicans need to believe that the costs of ignoring this are greater than what Trump can do to them.
Thanks for the good essay today. I just finished another Substack opinion from Paul Krugman, the noted economist and former NYT opinion writer. His piece is entitled "Autogolpe" which is Spanish for "Self-coup." He points out many of the unconstitutional moves Trump and Musk are doing that threaten our democracy. Our public health system is certainly one, but there are many more that he identifies that we need to focus on and make our views known.
Thanks for the reminder that, as Aragorn said before the Battle of Helms Deep, "There is always hope." [I am a LOTR fan, but have yet to achieve the rank of "geek."]
A few more notes on communicating with elected and appointed officials:
1) Be respectful - anything less closes their ears and if you are angry, those we seek to persuade count that as proof they are right.
2) Be nice - be especially respectful - but don't be afraid to make them afraid. In my experience as a state health officer, I learned that the one thing all officials truly fear is causing harm to the people that elected / hired them. So, its fine to talk about the benefits of public health science, programs and data, but above all else, give valid examples of the harm that will befall their constituents if the worst errors are not corrected. These officials know they will be held accountable, but remind them anyway.
3) In my personal opinion, many of these executive orders and pronouncements are Kabuki Theater - scary actors wearing masks. The primary modus operandi of the new administration is disruption, shock and awe. And yet, as YLE points out, major portions of the defunding memo were quickly rescinded ONCE THE AUTHORS REALIZED THEY WERE GOING TO HARM THE VERY PEOPLE THAT PUT THEM IN POWER. Real, lasting harm is something voters will never forgive or forget and the administration knows that, if it knows little else.
I took a course on Influence once. The central mantra was, "Remember, people never do anything for YOUR reasons; they only do things for THEIR reasons. So, if you want to influence, learn what their reasons are and speak to them." Push the "you're going to hurt the very people you depend on" button wherever it makes sense.
Remember, the new administration very much wants to hurt certain people. You can plead their case if you wish, just don't expect the administration to do anything other than silently (or loudly) congratulate themselves.
Call: don't email. Calls make a greater impression on staff and those sentiments gets conveyed to the boss. Politics is really all about emotions. Politics is the art of the possible.
Given the "let's throw it against the wall and see if it sticks" zeitgeist that is de rigor among Trump 2.0!'s Young Turks, there is indeed great risk if we resign ourselves to inaction.
There is indeed a rational basis for great hope; that hearing the right message from millions of us will keep the train from flying off the rails. [They know causing harm will finish their run.]
"Fasten your seat belts until YLE turns off the 'Fasten Your Seat Belt' sign: major turbulence ahead."