This appeared recently:
Order out of Chaos
Author: Eric J. Rubin, M.D., Ph.D. Author Info & Affiliations
Published March 3, 2025
DOI: 10.1056/NEJMe2502874
The young woman and her husband were terrified. Her first pregnancy had been difficult, although she had eventually given birth to a healthy boy. But she’d had two subsequent miscarriages. Now, despite another rocky course, she’d carried a baby almost to full term. But something was very wrong. The obstetrician and nurse spoke quietly to each other while the woman’s contractions continued. When the baby was finally delivered, he was pale and swollen. The obstetrician offered him to the mother to hold while the baby took his last few breaths.
This is the story my parents told me about my brother Alan. My mother was Rh-negative, while my father was Rh-positive. As a medical student, I put it together — my birth had induced antibodies to Rhesus factor, and Alan had developed immune hemolytic disease of the newborn. It is a disease of largely historical significance that is now almost completely preventable with the administration of RhoD immune globulin. Unfortunately, this agent came almost a decade too late for Alan.
But it did come, an early product of a new and substantial investment in medical research. Its development has been followed by multiple miracles — the transformation of childhood leukemias into curable diseases, immunotherapy for some tumors even when they are widely metastatic, and the restoration of normal function in many people with cystic fibrosis, to name just a few of many breakthroughs. And this research has been an enormous economic engine for the United States, generating tens of billions of dollars annually and more than 400,000 jobs. It’s difficult to imagine an investment that has paid more dividends, both in bettering the health of Americans and in making the United States the global leader in life science — which is why the current administration’s seemingly random assault on scientific research is so puzzling.
The raft of executive orders issued by this administration and the judicial responses to them have been dizzying, and chaos seems to reign. Collectively, these actions have crippled many of the institutions we rely on to promote and improve health. The National Institutes of Health (NIH) is a jewel, and the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) set the international standard for monitoring health and maintaining safety. The President’s Emergency Plan for AIDS Relief (PEPFAR) has by itself saved millions of lives. And even more innovation comes from externally funded university and hospital labs. Already, as funding is disrupted and funding decisions suspended, many people have lost their jobs, new hiring is frozen, patients are losing access to life-saving treatments, and research is being interrupted, sometimes with tragic and expensive consequences. Research studies, once stopped, cannot necessarily be restarted. And the longer this chaos persists, the greater the damage will be.
The editors of the Journal are clinicians, researchers, and patients. We strive to care for anyone who needs help, we write and review grants, and we serve on federal advisory committees. We join our colleagues in celebrating every new and exciting medical insight that can lead to longer and healthier lives (even when the findings are published elsewhere). In other words, we are members of the same communities as our readers and authors, and today we share their pain and their concerns about the threats to health.
What can we do to counter the current chaos? At the least, we can try to maintain order. In our roles as editors, this means continuing to do what we think makes a difference: publishing the highest-quality research, analysis, opinion, and educational content that can improve patient health. We are proud of our communities, and we seek to provide a platform where authors can speak out, even when topics are controversial.
I never met Alan. But I hope that the research continues that will allow others to meet their future family members.
Notes
This editorial was published on March 3, 2025, at NEJM.org.
Disclosure forms provided by the author are available with the full text of this editorial at NEJM.org.
Supplementary Material
Disclosure Forms (nejme2502874_disclosures.pdf)
Here is the link:
https://www.nejm.org/doi/full/10.1056/NEJMe2502874?query=RP
Heaven help us all. They have collectively "slipped their moorings"
David.
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