How many ways can the Trump administration clamp down on international researchers?

In the span of two days last week, the Trump administration issued two sweeping announcements meant to crack down on international students and scholars, who make up a sizable portion of the nation’s biomedical research workforce. On Wednesday, the Department of Homeland Security announced a proposed $70,000 fee for a work authorization program that many foreign students use to gain professional experience. The next day, the Labor Department revealed that it is investigating nine universities — including Harvard, Stanford, and Yale — for alleged fraud related to visas awarded to postdoctoral researchers.

This is all playing out while DHS is fighting in court to impose a four-year cap on stays in the U.S. by graduate students and postdocs. The department is also attempting to revive administration plans to impose $100,000 fees for H1-B visas, which are used by foreign workers in high-skill fields such as biotech.

None of these changes have taken effect, but experts warn that the administration's repeated attempts are already deterring students. A survey by the Association of American Universities found that, while domestic student applications for U.S. Ph.D. programs went up by 3% this year, international applications dipped 21%.

“This is an incredible series of self-owns,” said Elizabeth Goss, an immigration attorney based in Boston. “The government also knows that none of this will stand up in court. They just want to send a message: Don’t come here.” — Jonathan Wosen

lobbying

What $250 million in free lunches buys you

Mary Altaffer/AP

You know the saying, “there’s no such thing as a free lunch?” Turns out, that applies to doctors too. Except in this case, the cost of the free lunch is being borne by patients and the health care system, according to a new study.

A new Cochrane review of dozens of previous studies found that gifts (including meals) and payments doctors receive from drugmakers increase inappropriate prescribing, which in turn increases health care costs. One of my favorite details from STAT’s Ed Sullivan: “The research found a clear relationship between meals and inappropriate prescriptions. The more meals a doctor received from a company, the more of the company's drug they prescribed.” Another: pharmaceutical companies spent upwards of $250 million on meals alone in 2022.

Read more about the pernicious influence of lobbying on medicine. And please — if you’ve received particularly lavish or unusual gifts from drug companies, let me know. I’d love to hear more about what this experience looks like on the ground.

drugs

DEA suggests new limits for two kratom derivatives

Proponents of natural kratom leaf products have notched another win after the DEA made changes Friday to its proposed temporary order that would place some kratom derivatives — but not natural leaf products — in Schedule I, the federal category for drugs that carry the most risk without any medical benefit.

Originally, federal agencies had planned to temporarily designate 7-hydroxymitragynine (7-OH) above a certain potency threshold as Schedule I, in addition to three synthetic kratom derivatives at any level, including mitragynine pseudoindoxyl (MGPI). But a notice of intent issued Friday laid out new thresholds that apply to both 7-OH and MGPI individually or in combination. The new threshold focuses more on the concentration of these compounds within a product rather than the total amount.

The American Kratom Association, which lobbies for natural leaf products, celebrated the change as a resolution to its lawsuit against the original MGPI scheduling, which it argues could have inadvertently criminalized natural leaf products found to contain trace amounts of the compound. But some drug policy advocates and lawmakers want more limits around all kratom products, including natural ones.

It’s unclear when exactly the scheduling will be finalized. Experts agree that some sort of regulation needs to be enacted around kratom-related products, but they aren’t all sure that scheduling is the best approach long-term. Meanwhile, it’s worth remembering that a government watchdog report recently concluded that both DEA and HHS lack adequate policies and procedures on drug scheduling. — Theresa Gaffney

trust issues

How Americans feel about science, as told in charts

It can sometimes seem like Americans’ relationship to science is uniquely fraught, weighed down by the Trump administration’s deep cuts to research funds, the ever-present battle over vaccines, and our byzantine health care system.

Given all that, new data from the Wellcome Global Monitor surprised me. Those pollsters found that 52 percent of Americans report having “a lot” of trust in science. Across the globe, that number is 26 percent. Americans, in aggregate, are also more eager to get vaccines compared to peer nations; 45 percent of Americans say they would want to get vaccines recommended by a nurse or doctor “right away.” In Germany only 28 percent say the same.

To unpack what these numbers might mean, check out Nick Florko’s story.

helpless

Doctors are trained to be deferential. That follows them their whole careers

By the time doctors reach their residency programs, they have completed college and medical school, passing several rigorous exams. Many will be nearing 30, or older. And yet residents often have to ask permission to even use the restroom.

This infantilizing treatment is creating “something plaguing medicine: learned helplessness, a psychological state wherein a person stops trying to change an unfavorable or unsavory situation because they believe that they have no control over the outcome,” writes Frances Mei Hardin, a former ear, nose, and throat surgeon, in the debut of her new column Chief Complaint.

Hardin writes that today’s doctors inherit a sense of powerlessness that’s reinforced by “increasing layers of bureaucracy, hierarchy, metrics, and threats of retaliation or lawsuits that leave physicians with less and less control. And we don’t question it.” Read more about the problems that’s creating — and the possible solutions — here.

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