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⚡️ Join Axios' Caitlin Owens and Peter Sullivan Wednesday at 8am ET in Washington, D.C., for an event looking at the future of cognitive care, featuring conversations with Sen. Susan Collins (R-Maine), Rep. Nanette Barragán (D-Calif.), and more. RSVP here.

Between Robert F. Kennedy Jr. and Vivek Ramaswamy, the incoming Trump administration has highly divergent views on regulating the pharmaceutical industry.

Why it matters: Both say there are deep problems with America's drug development system. But RFK Jr., the HHS secretary designee, is calling for more oversight of drugs and vaccines and diminished federal funding for R&D.

• Ramaswamy, a biotech entrepreneur who will lead a new "Department of Government Efficiency" with Elon Musk, is a small government aficionado who's called for fewer barriers to bringing drugs to market.

Their differences add another layer of uncertainty for pharmaceutical companies trying to navigate what could be dizzying changes in the new administration.

Where it stands: Kennedy's priorities include a crackdown on direct-to-consumer drug ads and diverting half of the National Institutes of Health's research budget from infectious diseases to alternative cures and preventive health.

• The vaccine critic wants to see more safety data on shots already on the market. And before Trump selected him for the top health care post, Kennedy also pledged to end the FDA's "war" on "anything that can't be patented by Pharma."

Ramaswamy wrote on social media last week that his biggest problem with the FDA is the agency's layers of bureaucracy, which he said stifle innovation.

• "This stops patients from accessing promising therapies & raises prescription drug costs by impeding competition. The agency's staff have callous disregard for the impact of their daily decisions on the cost of developing new therapies, which inevitably gets passed on to the healthcare system," Ramaswamy posted on X.

Yes, but: Ramaswamy and Kennedy are aligned on some issues. Both have said they want to root out corruption in the FDA. They've also both advocated for restructuring federal departments and firing career civil service employees.

More here

Kennedy's call to end the public health practice of putting fluoride in water is resurfacing decades-old concerns about fluoridation, and some conspiracy-tinged ideas that are unsupported by science.

State of play: RFK Jr. said earlier this month that "the Trump White House will advise all U.S​. water systems to remove fluoride from public water" on Inauguration Day.

• He called fluoride "an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease."
• But health experts have called fluoridation one of public health's greatest achievements over the past century for the way it's reduced dental disease, especially in children and in populations that don't have access to regular dental care.

Water fluoridation in U.S. started in 1945 and 72% of the U.S. population served by community water systems receives fluoridated drinking water.

• Fluoridated water helps strengthen a tooth's surface, making it more resistant to decay.
• Fluoridation systems saved an estimated almost $6.8 billion in dental expenses in one year, per a Colorado School of Public Health study.

But there are concerns over water fluoridation, include fluorosis, when growing teeth are exposed to too much fluoride and develop white flecks or spots, and reduced IQ in children.

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Allowing enhanced Affordable Care Act marketplace subsidies to expire next year would add 4 million more people to the ranks of the uninsured, with coverage losses concentrated in conservative-led states, a new analysis finds.

Why it matters: The findings underscore the degree to which the enhanced premium tax credits that Democrats passed in 2021 have benefited red states that haven't expanded Medicaid.

• That could be a dilemma for Republican lawmakers in Congress, who've indicated they're set to let the subsidy enhancements sunset next year.
• Congressional scorekeepers have estimated that permanently renewing the subsidies would increase the deficit by more than $325 billion over a decade, plus billions more in interest outlays.

What they found: Urban Institute researchers estimated subsidized ACA marketplace enrollment would fall by 7.2 million people, and 4 million people would become uninsured, if the tax credits expire.

• Mississippi would experience a 41% increase in uninsurance (112,000 people), while Tennessee and South Carolina would see increases of more than 33 percent.
• In contrast, Hawaii, New Mexico, New York and Washington, D.C. would all see increases of less than 2%.

Most of the people exiting the marketplaces would be under age 55, which could skew the risk pool in the long run toward older adults with more health care needs, the researchers wrote.

Hospitals provide essential care in rural America where access to physicians is limited. In 2021 alone, rural patients turned to hospital EDs 18 million times for care.

Get the facts on how hospitals care for patients in rural America 24 hours a day, 7 days a week, 365 days a year.

Public awareness of the 988 national suicide prevention hotline is growing but still low, new survey data from University of Pennsylvania found.

Why it matters: Calls and texts to 988 are increasing. Still, the hotline can't help someone if they don't know about it, said Kathleen Hall Jamieson, director of University of Pennsylvania's Annenberg Public Policy Center.

What they found: 15% of people surveyed in September said they knew of the hotline and correctly identified its number as 988 in an open-ended format.

Yes, but: The survey doesn't show a significant increase in knowledge of 988 between October 2023 and September 2024.

• The federal government in June launched an eight-month ad campaign for 988 awareness.

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