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Ronald Reagan took regular meetings with congressional leaders to discuss his legislative agenda; George H.W. Bush spearheaded negotiations with the nation’s allies and led the United States to war in Iraq; and George W. Bush was, for better or worse, “the decider” who performed leadership for the cameras as much as he tried to exercise it from the Oval Office. Trump is a ubiquitous cultural presence, but there is no outward sign that he is an active participant in running the national government. He was mostly absent during discussions of his signature legislation — the One Big, Beautiful Bill Act — and practically AWOL during the monthlong government shutdown.

It is difficult for any president to get a clear read on the state of the nation; it takes work and discipline to clear the distance between the office and the people. But Trump, in his second term, does not seem to care about the disconnect. Abraham Lincoln once remarked that it would “never do for a president to have guards with drawn sabers at his door, as if he fancied he were, or were trying to be, or were assuming to be, an emperor.” A president has to be engaged — attentive to both the government and the public he was elected to serve.

Trump is neither. He is uninterested in anyone except his most devoted fans, and would rather collect gifts from foreign businessmen than take the reins of his administration. “The president doesn’t know and never will,” Susie Wiles, the White House chief of staff, said in an interview with Vanity Fair, commenting on the work of Elon Musk in the first months of the year. “He doesn’t know the details of these smallish agencies.”

Instead, the work of the White House has been delegated to a handful of high-level advisers. Russell Vought, the director of the Office of Management and Budget, is the de facto shadow president for domestic affairs. As one senior government official told ProPublica, “It feels like we work for Russ Vought. He has centralized decision-making power to an extent that he is the commander in chief.” It was Vought who orchestrated the administration’s assault on the federal bureaucracy, including the wholesale destruction of U.S.A.I.D. It was Vought who either froze or canceled hundreds of billions of dollars in funding for anti-poverty programs, H.I.V. reduction initiatives and research into science, medicine and technology. And it is Vought who has been pushing the boundaries of executive power as he attempts to turn the federal government into little more than an extension of the personal will of the president — as channeled through himself, of course.

If Vought is the nation’s shadow president for domestic policy, then Stephen Miller is its shadow president for internal security. Miller, Trump’s top domestic policy adviser, is using the president’s authority to try to transform the ethnic mix of the country — to make America white again, or at least whiter than it is now. He is the primary force behind the expansion of Immigration and Customs Enforcement and Customs and Border Protection into a roving deportation force. He has pushed both agencies to step up their enforcement operations, targeting schools, restaurants, farms and other work sites and detaining anyone agents can get their hands on, regardless of citizenship or legal status. It is Miller who is behind the militarization of ICE, the use of the National Guard to occupy Democrat-led cities and assist deportation efforts, and the plan to blanket the United States with a network of detention camps for unauthorized immigrants and anyone else caught in his dragnet.

Traditionally, presidents have had a mostly free hand in the conduct of American foreign policy. But here as well Trump has handed the power of the presidency over to a set of figures — inside and outside of government — who are not so much acting on his behalf as they are acting in his stead. Marco Rubio, the secretary of state, and Pete Hegseth, the secretary of defense, are orchestrating a war — and possibly regime change — in Venezuela, while Steve Witkoff, a real estate developer, and Jared Kushner, the president’s son-in-law, are busy pushing a so-called peace deal that would give large parts of Ukraine to Russia, rewarding Vladimir Putin for his decision to wage a war of conquest.

In his foreword to Theodore Sorensen’s 1963 book, “Decision-Making in the White House,” President John F. Kennedy wrote that the “heart of the presidency is therefore informed, prudent and resolute choice” and that the “secret of the presidential enterprise is to be found in an examination of the way presidential choices are made.”

What do we make of a president who chooses not to make these choices?

For Chief Justice John Roberts and the conservative majority on the Supreme Court, the answer is to deliver that president an expansive grant of executive power. In a series of decisions on the court’s so-called shadow docket, Roberts and his allies have backed Trump’s repeated claims to virtually uncontested authority over the entire executive branch. The court has allowed the president to fire officials otherwise shielded by for-cause protections created by Congress, and has signaled quite clearly that it intends to overturn a New Deal-era decision that affirmed the power of Congress to create agencies that are independent of the president’s direct control.

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Kenny Holston/The New York Times

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Hmmmm… Give yourself a gold star if you can play the uTube video as described above the link below the picture!

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Carin Leong: What if people with type 1 diabetes could start making their own insulin?

Scientists have just taken a big step in that direction. They treated a patient with 80 million lab-made insulin-producing cells that are designed to hide from the immune system. This is the first time a cell transplant like this hasn’t triggered a rejection in a human, and researchers say that this opens exciting possibilities for treating diabetes and other autoimmune diseases in the future.

About two million people in the U.S. currently live with type 1 diabetes. It’s an autoimmune disease where the body mistakenly wipes out the cells in the pancreas that make insulin. Without this hormone, people have to rely on injections and pumps every single day to keep their blood sugar in check and avoid serious complications.

Scientists have tried replacing these insulin-producing cells before, but the body kept attacking them. And patients would need to take strong immune-suppressing drugs for life, which come with their own laundry list of side effects.

This time, researchers took donor cells and used the gene-editing technique CRISPR to deactivate two genes that normally flag the immune system to attack foreign cells while also boosting expression of a gene that discourages attacks by the body’s immune cells.

So 12 weeks after injecting these cells into the patient, they were still alive and making insulin in his body. Granted, it wasn’t a ton—about 7 percent of what he’d need to ditch insulin injections entirely. But experts say it’s a major milestone for his body to be producing even a little bit of insulin on its own and, most importantly, without the need for immunosuppressants. They’ll continue monitoring him over the next year and test higher doses of these edited cells. And if all goes well, this could potentially lead us toward a cure for type 1 diabetes.

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What if people with type 1 diabetes could start making their own insulin?

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From

Paul Krugman

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Warner Bros. Discovery, which among other things controls CNN, has agreed to sell itself to Netflix. But it isn’t a done deal, because Paramount has made a rival, hostile bid.

Now, most Americans, even those like me who pay a lot of attention to the economy, don’t usually take much interest in insider baseball about corporate wheeling and dealing. But this is a bigger story than usual, for three reasons.

First, there’s an antitrust issue. In an earlier era, when the U.S. government took monopoly power seriously, both proposed acquisitions would probably have been blocked by regulators.

Second, there’s a financial issue. On its own, there is no way that Paramount, which is deeply in debt and whose credit rating is “a notch below ‘junk’” could afford to buy Warner. It’s able to make a semi-credible bid only because of assurances of support from Larry Ellison, one of the world’s richest men thanks to his stake in the software giant Oracle. But when analysts look closely at the details, they find that Ellison’s promises of support are more than a bit squirrely:

[T]he Warner Bros. Discovery board worried that Mr. Ellison did not personally guarantee the bid under his name and is planning to contribute equity for the deal through a trust with holdings that could be modified at any time.

Adding to the risk of Oracle’s deal is the fact that Oracle is itself shaky according to the estimation of gimlet-eyed financial markets due to its huge, debt-financed bets on AI.

As Bloomberg reports, its investment grade debt now “trades like junk.”

But it’s not just about the money. For the average American, there is something fundamentally important about this corporate cage-match to win Warner Bros. Discovery. And it’s not about entertainment, it’s about democracy. You should understand that Paramount’s hostile bid is, above all, a political move in the pursuit of cementing the dominance of MAGA-supporting tech billionaires and further eroding American democracy.

Back in 2018, during Trump I, the political scientists Steven Levitsky and Daniel Ziblatt published How Democracies Die, which described how nations like Hungary had descended into one-party authoritarianism although the formal, but now toothless, institutions of democracy remain. In the latest edition of Foreign Affairs Levitsky, Ziblatt and Lucan Way say that this process is already well underway here in the U.S.:

In Trump’s second term, the United States has descended into competitive authoritarianism—a system in which parties compete in elections but incumbents routinely abuse their power to punish critics and tilt the playing field against their opposition. Competitive authoritarian regimes emerged in the early twenty-first century in Hugo Chávez’s Venezuela, Recep Tayyip Erdogan’s Turkey, Viktor Orban’s Hungary, and Narendra Modi’s India. Not only did the United States follow a similar path under Trump in 2025, but its authoritarian turn was faster and farther-reaching than those that occurred in the first year of these other regimes.

Now, in some ways America is unusually well-positioned to resist this authoritarian push. As Levitsky et al note, we have a “well-organized and rich civil society” — ranging from law firms to universities to nonprofits — that can push back. And while some of these institutions are led by cowards, not all are. We also have unified political opposition in the form of the Democratic Party, which is very different from the splintered opposition that faced Viktor Orban in Hungary, for example.

Yet, ominously, Trump and Trumpism have powerful allies that had no counterpart in previous competitive authoritarian regimes. Namely, there is a network of deeply anti-democratic tech billionaires, of which Ellison is a very significant player. The Authoritarian Stack project, which tracks that network, calls it the “Authoritarian Tech Right”. I’ve put their chart of some of the keyplayers at the top of this post. Some of us refer to that network, less formally, as the “broligarchy.”

As I have written recently, the broligarchy has deep antipathy to liberal principles in general and to democracy in particular, which they don’t try to hide. Peter Thiel has declared, “I no longer think that freedom and democracy are compatible.” Musk has derided empathy and made common cause with the German neo-Nazi party AfD. Alex Karp, head of the Pentagon contractor Palantir, has said that he hopes killing helpless shipwrecked sailors will be made constitutional so that he can make more money selling equipment to the Pentagon. And Joe Lonsdale says that public executions should come back.

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Source: The Authoritarian Stack

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Indeed, the strategy paper warns, unless our European allies elect more “patriotic” nationalist parties, committed to stemming immigration, Europe will face “civilizational erasure.” Unstated but implied is that we will judge you not by the quality of your democracy but by the stringency by which you stem the migration flow from Muslim countries to Europe’s south.

That is a flying elephant no one should ignore. It is language unlike any previous U.S. national security survey, and to my mind it reveals a deep truth about this second Trump administration: how much it came to Washington to fight America’s third civil war, not to fight the West’s new cold war.

Yes, in my view, we are in a new civil war over a place called home.

First, I need to make a quick detour to “home.” These days there is a tendency to reduce every crisis to the dry metrics of economics, to the chessboard machinations of political or military campaigns, or to ideological manifestoes. All, of course, have their relevance, but the longer I have worked as a journalist, the more I have found that the better starting place for unlocking a story is with the disciplines of psychology and anthropology. They are often much better at revealing the primal energies, anxieties and aspirations that animate our national politics — and global geopolitics — because they uncover and illuminate not just what people say they want, but also what they fear and what they privately pray for, and why.

I was not here for the Civil War of the 1860s, and I was still a boy during our second great civil struggle, the 1960s civil rights movement and the assassination of Martin Luther King Jr. But I am definitely on duty for America’s third civil war. This one, like the first two, is over the questions “Whose country is this anyway?” and “Who gets to feel at home in our national house?” This civil

war has been less violent than the first two — but it is early.

Humans have an enduring, structural need for home, not only as a physical shelter, but as a psychological anchor and moral compass, too. That is why Dorothy in “The Wizard of Oz” (my favorite movie) got it exactly right: “There’s no place like home.” And when people lose that sense of home — whether by war, rapid economic change, cultural change, demographic change, climate change or technological change — they tend to lose their center of gravity. They may feel as though they are being hurtled around in a tornado, grabbing desperately for anything stable enough to hold onto — and that can include any leader who seems strong enough to reattach them to that place called home, however fraudulent that leader is or unrealistic the prospect.

With that as background, I cannot remember another time in the last 40 years when I have traveled around America, and the world, and found more people asking the same question: “Whose country is this anyway?” Or as Itamar Ben-Gvir, the far-right nationalist Israeli minister, put it, in Hebrew, in his political banner ads during Israel’s 2022 election: “Who is the landlord here?”

And that is not an accident. Today, more people are living outside their country of birth than at any point in recorded history. There are approximately 304 million global migrants — some seeking work, some seeking education, some seeking safety from internal conflicts, some fleeing droughts and floods and deforestation. In our own hemisphere, the U.S. Customs and Border Protection office reports that migrant encounters at our southern border hit historical highs in 2023, while estimates from the Pew Research Center suggest that the total unauthorized population in America grew to 14 million in the same year, breaking a decade-long period of relative stability.

But this is not just about immigrants. America’s third civil war is being fought on multiple fronts. On one front it is white, predominantly Christian Americans resisting the emergence of the minority-dominated America that is now baked into our future sometime in the 2040s, driven by lower birthrates among white Americans and growth in Hispanic, Asian and multiracial American populations.

On another front are Black Americans still struggling against those who would raise new walls to keep them from a place called home. Then there are Americans of every background trying to steady themselves amid cultural currents that seem to shift by the week: new expectations about issues like identity, bathrooms and even a typeface, as well as how we acknowledge one another in the public square.On yet another front, the gale-force winds of technological change, propelled now by artificial intelligence, are sweeping through workplaces faster than people can plant their feet. And on a fifth front, young Americans of every race, creed and color are straining to afford even a modest home — the physical and psychological harbor that has long anchored the American dream.

My sense is that we now have millions of Americans waking up each morning unsure of the social script, the economic ladder or the cultural norms that are OK to practice in their home. They are psychologically homeless.

When Donald Trump made building a wall along the Mexican border the central motif of his first campaign, he instinctively chose a word that did double duty for millions of Americans. “Wall” meant a physical barrier against uncontrolled immigration that was accelerating our transition to a minority-majority-led America. But it also meant a wall against the pace and scope of change: the cultural, digital and generational whirlwinds reshaping daily life.

That, to me, is the deep backdrop to Trump’s National Security Strategy. He is not interested in refighting the Cold War to defend and expand the frontiers of democracy. He is, in my view, interested in fighting the civilizational war over what is the American “home” and what is the European “home,” with an emphasis on race and Christian-Judeo faith — and who is an ally in that war and who is not.

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Alex Kent for The New York Times

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At a controversial meeting of the U.S. Centers for Disease Control and Prevention’s vaccine advisory panel recently, members voted to remove a long-standing recommendation that all babies get a first dose of the hepatitis B vaccine at birth. Public health experts derided the move, which goes against evidence that the shot is safe and effective. Members of the CDC’s Advisory Committee on Immunization Practices (ACIP) and agency officials cited a curious rationale for the change: a need to align the U.S.’s vaccine schedule with Denmark’s.

Shortly after the meeting, President Donald Trump ordered the CDC to fast-track a review of the U.S. vaccination schedule to align with that of other “peer, developed countries,” including Denmark. But there’s something rotten in this comparison.

The U.S. and Denmark have starkly different populations, disease rates, and health care systems. It makes sense that they have different vaccination policies.

“The United States is not Denmark,” says Katelyn Jetelina, an epidemiologist who writes a popular health newsletter and who previously advised the CDC on its COVID policy. “The health care and safety net system of the United States is drastically different than other high-income countries around the world. We should expect country-level policy decisions to vary.”

The U.S. has more than 340 million people; Denmark’s population is a little more than six million. Denmark is also much more demographically and economically homogenous than the U.S. And the countries have different burdens of disease.

Take hepatitis B—there were 99 new cases of chronic hepatitis B in Denmark in 2023, compared with more than 17,000 new cases in the U.S. Denmark also screens practically every single pregnant person for the disease, and most of those who test positive receive treatment. In the U.S., about 85 percent of pregnant people are screened, and many never get treatment. Hepatitis B is a liver infection, and if it is left untreated and becomes chronic, it can lead to cirrhosis, liver cancer and death.

The U.S. and Danish health care systems are incomparable. With the exception of Medicare and Medicaid, the U.S. system operates largely on privately funded insurance. Denmark has a universal health system that is paid for by the government, and all residents have access to free care. The CDC’s advisory panel made no mention of this difference during its recent meeting, and the Trump administration has no appetite for a universal health care system in the U.S.

“Managing and following a small population with universal health care is much different than an enormous population with multiple delivery systems and multiple payers,” says Kathryn Edwards, a professor of pediatrics at Vanderbilt University Medical Center. It’s “like comparing apples and oranges.”

Jetelina concurs. In Denmark, people are less likely to fall through the cracks of their health system, she says, whereas the U.S. has a “very different health care capacity, and we don’t have a safety net.”

A consequence of universal health care systems is that countries like Denmark are also more likely than the U.S. to take cost-effectiveness into consideration when deciding which vaccines to recommend and to whom. Even though providing vaccines is generally far cheaper than treating a disease, it still costs money. For example, in the U.K., which also has state-funded universal health care, flu vaccines aren’t routinely recommended for children because the shots are more cost-effective in older adults. Similar logic may explain why the hepatitis B vaccine isn’t universally given at birth in Denmark.

A lot of the discussion at the December 5 ACIP meeting focused on hypothetical risks from the hepatitis B vaccine in babies born to people who test negative for the disease; there was very little emphasis on the societal benefits of widespread vaccination.

When it comes to targeting vaccination only to individuals born to parents who are known to have hepatitis B, Jetelina says, “we’ve tested this before.” Prior to 1991, the U.S. attempted to vaccinate only people at high risk for hepatitis B. “Even when mothers screened negative for hep B, and the birth dose was withheld, thousands of children did end up infected via another member of the household,” she says. In contrast, after ACIP recommended a universal birth dose in 1991, cases declined dramatically: in children, teens, and young adults up to age 19, cases of acute hepatitis dropped by 99 percent from 1990 to 2019.

The push to alter the U.S. hepatitis B vaccine recommendation fits into a broader effort by the Trump administration and many Republican lawmakers to prioritize individual freedoms over collective action. Yet strong public health systems—and vaccination in particular—rely on collective action to protect those who cannot protect themselves, such as immune-suppressed people, older adults, and young babies.

“I’m concerned about that,” Jetelina says. “If we land too much on individualism, diseases are going to come back.”

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