Ideological Crusade Against DEI Will Yield Dire Consequences for Medical Research

“The tenets of DEI demand that you discriminate against white people by giving preferential treatment to other races,” said right-wing activist Robby Starbuck on Jordan Peterson’s podcast on February 2nd, 2025 (Jordan B. Peterson, 2025)

This conspiracy theory is the underlying sentiment being used by the current Trump Administration to justify its targeted actions against people of color, women and gender-nonconforming people, and lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people in the United States. Unfortunately, it will yield dire consequences for medical research…and undercut efforts to achieve health equity!

How these actions have played out across the federal government’s various agencies and throughout the medical and scientific research spaces has been both stark and shocking:

An analysis conducted by the chairs of dozens of boards at the National Institutes of Health (NIH) in March found that, of the 43 experts whose review board positions were eliminated without notice or reasons—scientists with expertise in the fields of mental health, cancer, and infectious disease—38 were female, Black, or Hispanic:

According to the analysis, six percent of White males who serve on boards were fired, compared with half of Black and Hispanic females and a quarter of all females. Of 36 Black and Hispanic board members, close to 40 percent were fired, compared with 16 percent of White board members. The analysis calculated the likelihood that this would have happened by chance as 1 in 300 (Johnson, 2025).

National Institutes of Health

Board members generally serve terms lasting five years; several members’ terms had just begun in the past year.

Beyond the firing of non-White males serving in the NIH, funding has also been stripped from dozens of NIH-funded research efforts, including those studying Black maternal and fetal health, as well as cancer and HIV. These efforts, according to the termination letters received by the researchers, are “antithetical to the scientific inquiry, do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness” (Hellmann, 2025).

“At HHS, we are dedicated to restoring our agencies to their tradition of upholding gold-standard, evidence-based science. As we begin to Make America Healthy Again, it’s important to prioritize research that directly affects the health of Americans,” said U.S. Department of Health and Human Services (HHS) spokesman, Andrew Nixon. “We will leave no stone unturned in identifying the root causes of the chronic disease epidemic as part of our mission to Make America Healthy Again” (Hellmann, 2025).

Similar to the justification for terminating non-White male employees, the underlying sentiment of this statement implies that any research efforts that seek to identify the root causes of why chronic diseases disproportionately impact minority populations are scientifically invalid, and that we should instead be generalizing research rather than investigating how to help those who bear the greatest impacts.

This is the “new normal” in the United States, and the impacts that the conspiracy-laden politics of revenge and white grievance will have on scientific research could potentially take a generation to correct and repair. Many of the scientists, themselves, have chosen to abandon the United States, quickly sliding into dysfunction, for safer pastures:

• Since the current administration began occupying The White House, universities in European nations have been opening their doors to scientists fleeing ‘censorship” and “political interference” (Kassahm, 2025a). So far, opportunities for relocation have been posted in Belgium, Canada, France, and the Netherlands (Duster, 2025), with other countries in active discussions on how to capitalize on the desires of U.S. scientists to leave the country.

…and these countries will have thousands of takers. According to a survey conducted the scientific journal, Nature, of the 1,608 scientists who responded to their poll question asking, “Are you a U.S. researcher who is considering leaving the country following the disruptions to science prompted by the Trump administration,” 75.3% (n=1,211) responded that they were considering doing so (Witze, 2025).

• Aix-Marseille University set up a program called “Safe Place for Science” (Mokhtarthu, 2025), which created 20 positions for fleeing scientists:

At a time when academic freedom is sometimes called into question, Aix-Marseille University is launching the Safe Place For Science program, providing a safe and stimulating environment for scientists wishing to pursue their research freely (Mokhtarthu, 2025).

This program received 298 applications in a month, of which 242 were deemed eligible, and included applicants from Johns Hopkins University, NASA, Columbia, Yale, and Stanford (Kassam, 2025b).

An article also published in Nature clearly defines what is occurring in the United States.:

Many countries have tried to emulate this model of science-led growth, and to stop the ‘brain drain’ of talent to better-resourced laboratories in the United States. Now, the actions of the administration run the risk of slowing, if not halting, that trend, as the country seeks to devalue scientific evidence in policymaking and attack the structures supporting the domestic knowledge ecosystem, including universities, libraries, and museums (Nature, 2025).

This type of exodus from scientific minds and expertise is called a “brain drain,” a term coined after World War II to describe the emigration of scientists and technologists to North America from post-World War II Europe. We are now seeing this again…but in reverse. The United States has long served as a safe haven for scientists and experts escaping political influence and authoritarian regimes across the planet; we are now the country to which they are fleeing.

Missing from many of these discussions is the very real concern of what this means for any data publications released during the current administration:

The current administration has made no efforts to hide that they will be actively directing and controlling the release of information from federal agencies and departments:

One of the first official actions under this administration was to immediately pause all external communications from health agencies, including social media posts, scientific reports, website updates, and Federal Register notices (Association for the Advancement of Blood & Biotherapies, 2025). This pause ordered all documents and communications to be reviewed by a presidential appointee before issuing, directed federal employees not to speak at any public speaking engagements, and required coordination with political appointees before corresponding with Congress or state governors.

Further evidence comes from Robert F. Kennedy, Jr., who has ordered the Centers for Disease Control and Prevention (CDC) and the NIH to disregard decades of scientific studies and findings in order to find the “environmental factors” that are “causing” the “autism epidemic” (Wadman, 2025).

Both incidents, along with a litany of other incidents of overt attempts by this administration to not only control the flow of information but to force research to be rewritten to comply with a conspiracy-driven ideology, raise troubling questions that have yet to be fully confronted:

Can anything put forth by the Trump Administration be considered trustworthy?

How can any data released during these troubling times be considered valid when this administration has made clear that only data that agrees with their worldview is acceptable?

For example, the CDC releases its annual HIV Surveillance Report, and its current year’s findings vastly differ from those of previous years.

What if demographic data are missing? What if states whose governments align with the regime receive glowing reports, while those that don’t receive black marks? After scientists have drafted their findings, how can we guarantee that the data has not been tampered with and altered to support the regime’s positions?

More importantly, how vast will the devastation be to our institutions and to public trust in them, particularly at a time when the regime has spent nearly a decade sowing conspiracy theories and disinformation against them?

We need to grapple with these questions and consider their implications for the future of equity research and our nation.

RSV Surveillance After the Pandemic and the Growing Risks to Life in Appalachia

Respiratory Syncytial (sin-SISH-uhl) Virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States.

In 2022, PlusInc published summaries highlighting the disparities in the incidence and mortality rates of RSV between various regions, states, and populations. In 2024, PlusInc, in collaboration with the Appalachian Learning Initiative (APPLI, pronounced like “apply”), will be focusing on highlighting the risks that RSV poses in the 13 states, 423 counties, and 8 independent Virginia cities that make up the Appalachian Region.

In our 2022 report, we highlighted the following trends:

• The incidence of RSV in the 2020-2021 RSV season—which generally runs from early August through late July—saw record low rates of antigen test detections and polymerase chain reaction (PCR) test detections for RSV in every U.S. Census Region except for South, which includes the following states: Alabama, Arkansas, Delaware, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, and West Virginia. This historically low level of infections was likely the result of COVID-19-related pandemic shutdowns and the proliferation of public masking and social distancing policies.

  • The Midwest Region, which typically has the highest rates of detection out of any region, saw just 610.0 antigen test detections and 5,142.0 PCR detections.

  • By comparison, the South saw 3,220.0 antigen detections and 14,148.2 PCR detections during the same period.

    • This is likely due to the fact that many states in the Southern region began attempting to “return to normal” in 2021, after the first year of COVID-19-related shutdowns. These decisions to “normalize” were made in large part because of public and political outcries against what some believed to be “government overreach,” and were accompanied by legislative changes in many Southern states that highly limited the legal ability of state and local departments of health to enact public health protocols in response to disease outbreaks.

• The 2021-2022 season saw a resurgence of RSV across every region, with a total of 10169.1 antigen detections and 42,880.7 PCR detections, with the Midwest leading the nation with 42,880.7 PCR detections and the Northeast with the fewest, at 13,353.7.

  • The likely reason behind this increase was, again, a return to normal daily interactions and a move away from pandemic protocols.

After that initial disparities report, PlusInc continued to gather data about the disease and the following trends have occurred:

• The 2022-2023 season saw an explosion of new RSV detections across the United States, with a total of 14,129.1 antigen detections and 203,193.9 PCR detections, with the Midwest again leading the nation with 73,559.9 PCR detections, followed by the West with 67,286.2. The number of detections in the South continued to climb in that season with 36,023.3 PCR detections.

• In the 2023-2024, to date, the nation has seen 10,603.5 antigen detections and 148,382.1 PCR detections, with the Midwest again leading the nation at 48,710.6. This year, however, the South has already surpassed the 2022-2023 season, with 38,095.4 PCR detections, while both the Midwest and West regions are unlikely to reach the same levels as the year before (Centers for Disease Control and Prevention, 2024a)

So—why are these data from the South so concerning?

10 of Appalachia’s 13 states—Alabama, Georgia, Kentucky, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia—are located in this region (Figure 1).

Figure 1 – United States Census Regions

Notes: Retrieved from the Centers for Disease Control and Prevention (CDC), 2023. (https://www.cdc.gov/surveillance/nrevss/downloads/us-census-regional.pdf)

When breaking down surveillance into the 13 states, we gathered data for the 2021-2022, 2022-2023, and 2023-2024 RSV seasons. The findings are troubling for a number of reasons:

• As is the case with all diseases, the states with the higher populations are going to have higher incidence numbers both because there are more people and because there are larger population centers with tighter population density.

• Georgia, North Carolina, and Tennessee are seeing incredibly concerning trends:

  • Georgia saw a 14% increase in PCR detections from the 2021-2022 season to the 2022–2023 season, and has seen a 45.4% increase in PCR detections this season, to date, above the previous season.

  • North Carolina saw a 279.4% increase in PCR detections from the 2021-2022 season to the 2022-2023 season, and has seen another 23.8% increase in PCR detections this season, to date, above the previous season.

  • While the overall incidence of RSV detections is traditionally low in Tennessee, the state still saw a 47.6% increase from the 2021-2022 season to the 2022-2023 season, and has seen another 54.5% increase in the current season.

However…the more concerning issue with the state of Tennessee lies a bit deeper and actually extends to the state of Alabama, as well:

An unusual trend has occurred in the current RSV season, where antigen tests in both Alabama and Tennessee are showing significantly higher detection levels than PCR detections for the same period of time. Normally, the antigen detections are lower than the PCR detections because PCR testing is more definitive. Essentially, the antigen tests can only determine if you have an active virus in the body and cannot detect small amounts of the virus or asymptomatic cases as accurately as PCR testing.

When we see a trend of antigen testing results being much higher than PCR testing results, it can mean a couple of things:

1. Finalized testing data may not be finalized for those periods. This may occur early in the report stages when the individual clinics and state agencies have either not received all of the data, there are duplicate data, or other issues with the data exist, or;

2. A more concerning issue exists where patients are testing positive for RSV using rapid test but are not following up those rapid tests with definitive PCR testing. This may be the result of lacking access to facilities that provide that testing, being unable to afford additional testing, being afraid or hesitant to follow up with confirmatory testing, or simply choosing not to proceed with additional testing for whatever reason.

Another dangerous trend is emerging in West Virginia:

When looking at the 2021-2022 RSV season, infections coincided with the start of the first full year of in-person school attendance during the second year of the COVID-19 pandemic, and essentially ending shortly after the New Year going into 2022. In the 2022-2023 season, infections didn’t really start to get going until late September, again trailing off after the New Year going into 2023.

In the 2023-2024 season, however, RSV got a very late start, with infection rates not really spiking until early-November, and continuing to stay high throughout January. Across the state of West Virginia, anecdotal reports of respiratory illnesses are showing up all over social media and in school district Facebook pages. And, while the state may not have already surpassed the numbers from 2022-2023, many residents are concerned about that possibility, particularly in a state where vaccine uptake rates across all disease states are starting to see sharp declines (CDC, 2024b).

Aside from these trends, another risk is posed, particularly in Central Appalachian counties located in Kentucky, North Carolina, Tennessee, Virginia, and West Virginia: the terrible ravages that have resulted from drug addiction.

Since the mid-2000s, the rates of drug addiction and overdose deaths as a result of drug use have increased nationwide, and few regions have been more impacted than Central Appalachia. While finalized drug overdose data for 2022 have not yet been released by the CDC, West Virginia, Tennessee, and Kentucky occupied the first, third, and fifth spots for the highest rates of overdose deaths per 100,000 residents in 2021, at 90.9, 56.6, and 55.6, respectively. Unfortunately, due to changes in the CDC drug overdose reporting systems, access to previous surveillance reports and dashboards appears to have disappeared in the process of transitioning to the new systems. However, state-level reporting outside of the CDC appears to remain unchanged, which allows us to access older records.

Because these states and counties have experienced high rates of overdose deaths, as well as non-fatal overdoses and drug charge-related incarceration, the impacts of drug addiction tend to stretch far beyond the individual living with substance use issues. According to a 2020 interview with Katrina Harmon, Executive Director of the West Virginia Child Care Association, over 90% of children currently in West Virginia’s foster care system are there due to drug-related issues. However, the foster system isn’t the first choice for the Department of Child Protective Services; CPS always tries placing a child whose life has been upended by drug-related issues with a family member. This has led to a broad increase in intergenerational households, with children being raised by grandparents and great-grandparents, all of whom are particularly susceptible to RSV. These circumstances mean that children who attend school and pick up colds, flus, RSV, and other respiratory ailments then bring those illnesses home to their loved ones, which can result in entire families being all but incapacitated by disease with normally high survival rates.

These concerns are further complicated by growing reports, both scientific and anecdotal, about growing vaccine hesitancy and distrust of healthcare providers, particularly in Southern, Appalachian, and largely rural states (Vestal, 2023). While child-age vaccination rates decreased during the pandemic shutdowns and reduction of healthcare services provision, these rates have not returned to their pre-pandemic rates.

After vaccine requirements were legally instituted by federal and state governments for COVID-19, many states have begun to reexamine their own general vaccination requirements for children prior to attending schools. Prior to the pandemic, relatively few state-level bills related to vaccines were introduced. With the release of the vaccine in 2021, several states began enacting legislation preventing COVID-19 vaccine requirements, specifically, but also began looking at the possibilities of either eliminating or expanding exemptions to existing routine immunization requirements for students (Roth, 2023).

As the RSV continues, we will continue to monitor national, regional, and state-level surveillance as we work to raise attention about.

Patients Have a Stake in Health Equity, too

In recent years, “health equity” terminology has become increasingly used in the national conversation about healthcare in the United States. Health equity is often used interchangeably with another term, health disparities, although each one has its own unique meaning. According to the U.S. Centers for Disease Control & Prevention (CDC), “Health equity is when everyone has the opportunity to be as healthy as possible. Health disparities are differences in health outcomes and their causes among groups of people. Many health disparities are related to social determinants of health, the conditions in which people are born, grow, live, work and age.” (CDC, 2020) To achieve greater health equity, our healthcare infrastructure needs to identify the health disparities that exist in the United States, and how they can vary from one health condition or another.

In 2016, a multimodal survey of mayors and health commissioners was conducted by Jonathan Purtle, et al. and it yielded some interesting findings. First of all, less than half of the mayors and health commissioners contacted took the time to complete the survey — which in and of itself, is a sad indictment on how those officials prioritize public health in their respective jurisdictions. That aside, Purtle reported, “Forty-two percent of mayors and 61.1% of health commissioners strongly agreed that health disparities existed in their cities. Thirty percent of mayors and 8.0% of health commissioners believed that city policies could have little or no impact on disparities.” Not surprisingly in today’s political climate, ideology is strongly associated with opinions about disparities. (Purtle, 2018)

Maybe part of the problem is the terminology, health equity and health disparities, is not defined explicitly. Nearly a decade ago, Paula Braveman, MD, MPH warned, “Ambiguity in the definitions of these terms could lead to misdirection of resources.” Dr. Braveman outlined the why explicit definitions are needed, because “not all health differences are health disparities” (Brakeman, 2014).

Health disparities exist, as defined by Dr. Bravemen through a social justice lense, and they are getting worse. Whereas numerous organizations committed to health equity exist, none approach health disparities specific to health conditions from the patient perspective. This is why PlusInc exists.