Category: The Conversation

Source: The Conversation – USA (3) – By Y. Tony Yang, Endowed Professor of Health Policy and Associate Dean, George Washington University

When federal health officials announced on Jan. 5, 2026, that they were taking six out of 17 vaccines off the childhood immunization schedule, they argued that the move would give parents and caregivers more choice.

Instead of all U.S. children routinely receiving them, these six vaccines are now optional – available to families who request them after consulting a clinician, through a process called shared clinical decision-making, officials said. All six – hepatitis A, hepatitis B, influenza, rotavirus, meningococcal disease and COVID-19 – will still be covered by federal programs such as Medicaid and the Vaccines for Children program, and by private insurers, at least through 2026.

I’m a health policy researcher and the co-author of the book “Vaccine Law and Policy.” I’ve spent years studying how vaccine laws and regulations affect uptake – and who gets left behind when policies change.

Shared decision-making sounds straightforward: a patient and their doctor putting their heads together to make an informed choice. But when applied to routine childhood vaccines, the concept shifts the burden of deliberation onto already-stretched clinicians and parents.

What is shared decision-making?

Shared decision-making is an approach doctors use when there’s genuinely more than one reasonable choice – say, weighing two cancer treatments with different side effects – and the “right” answer depends on what matters most to the patient. The idea is that doctor and patient talk it through together to help make the decision that feels right for that patient.

The Centers for Disease Control and Prevention uses this term for vaccines that aren’t automatically recommended for everyone but that might make sense for some people after a conversation with their doctor.

The key difference is what happens if no conversation takes place. For routine vaccines, the default is yes. Children get the shot unless there’s a medical reason not to. For shared clinical decision-making vaccines, there’s no default. If the conversation doesn’t happen, neither does the vaccine.

That distinction matters because the federal vaccine advisory committee has historically reserved shared decision-making for narrow situations. One example is the HPV vaccine for adults 27 to 45. Most people in that age group have already been exposed to HPV, so the vaccine helps some individuals but won’t change infection rates overall. In that case, a conversation with your doctor makes sense: The benefit depends on your personal circumstances.

Childhood vaccines against rotavirus and hepatitis B are different. They’re not for a small subset of people who might benefit – they prevent tens of thousands of hospitalizations a year.

When a vaccine is routine, it pops up as an alert in a child’s medical records and becomes part of the clinic’s standard workflow. The nurse draws it up, the doctor gives a heads-up to the parent, and the shot happens before the family leaves. Parents and other caregivers typically encounter it as part of normal pediatric care rather than as a separate decision to weigh.

That’s important because even in well-resourced practices, pediatricians already have limited time to cover many priorities – growth, feeding, sleep, development, safety and any questions the family may have. For lower-income families, who often face even shorter appointments and have fewer options for follow-up visits, that limitation can get magnified.

Studies have found that many low-income families do not receive all recommended care, in part because their time with the doctor during routine visits is so short.

What this looks like for a family coming in for a checkup

Even before this policy change, lower-income children in the U.S. were falling behind on vaccines. From 2011 to 2021, kids in higher-income families got more of their shots on time, while kids in lower-income families didn’t keep pace – and that gap kept widening.

Here’s how the new policy could make things harder:

A mother brings her 2-month-old to a clinic that serves mostly low-income families – the kind of practice that sees 25 or 30 kids a day for well-child visits. Under the old schedule, the visit runs on rails: The nurse pulls up the baby’s chart, sees that six vaccines are due, draws them up, and the doctor gives them during the exam. By the time Mom is buckling the car seat, the shots are done. The whole vaccine portion takes a few minutes.

Under the new policy, two of those vaccines – rotavirus and hepatitis B – are no longer automatic. Now, the doctor has to stop and have a conversation to explain what rotavirus and hepatitis B are, walk through the risks and benefits of each vaccine and ask what the parent wants to do.

That’s fine if there’s time. But this visit is 15 minutes long, and the doctor still has to check the baby’s growth, ask about their feeding and sleep habits and make sure development is on track. If the mother has questions or feels unsure, the clinic might ask her to come back or wait for a phone call. But she took two hours off her shift to get here and she doesn’t have paid leave. There may not be a next visit.

Now multiply that by every baby on the schedule that day. And this is just the 2-month visit. The same thing will happen at other ages when other vaccines that moved out of the “routine” category come due. Something has to give. Often, it’s the vaccines that no longer happen automatically.

Why more ‘choice’ can mean less access

Talking with families about vaccines already takes time. According to the American Academy of Pediatrics, more than half of pediatricians report spending from 10 to 19 minutes counseling parents about vaccines, and nearly 1 in 10 spend more than 20 minutes – often several times per day.

Shared decision-making takes even longer. When vaccines are routine, the system does most of the work. When they require shared decision-making, that work lands on the doctor and parent in an already-packed appointment. The doctor must walk through the disease and the vaccine’s benefits and risks, ask what concerns the parent has, make sure they understand, and then document the whole conversation.

That’s one more barrier to vaccination, and one that won’t fall evenly. Getting medical care can take more time for families with fewer resources. When a policy change adds steps, those families feel it most.

The data might end up showing that some parents “chose” not to vaccinate. But for many families, it won’t really be a choice – it will be a reflection of who had time to come back, and who didn’t.

Y. Tony Yang does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. ‘Shared decision-making’ for childhood vaccines sounds empowering – but it may mean less access for families already stretched thin – https://theconversation.com/shared-decision-making-for-childhood-vaccines-sounds-empowering-but-it-may-mean-less-access-for-families-already-stretched-thin-272815

Source: The Conversation – USA (3) – By Cristina Palacios, Professor and Chair of Dietetics and Nutrition, Florida International University

Every five years, the U.S. government releases an updated set of recommendations on healthy eating. This document, called the Dietary Guidelines for Americans, has served as the cornerstone of nutrition policy for almost half a century.

On Jan. 7, 2026, the Department of Health and Human Services and the Department of Agriculture released the 2025-2030 edition of the guidelines. The updated guidelines recommend that people consume more protein and fat, and less ultraprocessed foods.

These guidelines are the foundation for governmental nutritional programs – for example, they are used to determine which foods are covered by the Supplemental Nutrition Assistance Program, or SNAP, as well as how school lunches are prepared. Eldercare centers and child care centers use them when providing meals, as do clinical nutritionists working with patients to help them achieve a healthy diet. And because the guidelines are so scientifically rigorous, many countries around the world base their own nutritional guidelines on them.

I’m a nutrition scientist specializing in developing interventions for preventing obesity. Between 2022 and 2024 I served on the scientific advisory committee tasked with assessing the best available evidence on a wide range of topics in nutrition in order to inform federal officials in updating the guidelines.

But most of the committee’s recommendations were ignored in developing the latest dietary guidelines.

On the surface, these guidelines share a lot of similarities with the previous version, published in 2020, but they also have a few important differences. In my view, the process followed was different from the norm.

How are the Dietary Guidelines for Americans developed?

For each update, HHS and USDA establish a scientific advisory committee like the one I served on. Members with expertise in different aspects of nutrition are carefully selected and vetted. They then spend two years reviewing the latest scientific studies to assess evidence about specific nutrition-related questions – such as the relationship between saturated fats in foods and cardiovascular disease and what strategies are most effective for weight management.

For each question, the committee first prepares a protocol to answer it, identifies the most rigorous studies and synthesizes its findings, discussing the evidence extensively. It then produces specific recommendations about the topic for the HHS and USDA. At each step, the public and the scientific community are invited to provide comments, which the committee considers.

All this scientific information is put together in a massive report, which the federal agencies then use to create the updated guidelines, translating the expert recommendations for the public and health professionals.

A departure from the norm

The advisory committee I served on functioned as usual – our report was published in December 2024.

But the dietary guidelines released on Jan. 7 were mainly not based on that report. Instead, they were based on a different scientific report that was also published on Jan. 7. That report drew some material from ours but went through a completely different process.

It was created by a group of people who were not vetted in the usual way, and although they repeated some of the same questions we did, they also explored other topics that were chosen with no input from the wider community of nutrition researchers or from the public. It was not based on a publicly available protocol, with no input from the scientific community, and it’s unclear how and to what degree it was peer-reviewed.

The updated dietary guidelines were developed through a different process compared with the established methodology that’s been used to assess nutrition science behind the guidelines for many years.

What’s new in the 2025-2030 guidelines

Many of the recommendations in the 2020 guidelines and the ones released on Jan. 7 are broadly the same: that Americans should consume three servings of vegetables, two servings of fruits and three servings of dairy products per day, as well as replacing refined grains with whole grains, and limiting intake of sugar and sodium.

The main differences relate to recommendations about protein and dairy products.

The 2020 guidelines recommended that Americans focus on protein such as poultry and other lean meats, seafood, eggs, legumes, nuts and seeds. The updated version instead emphasizes eating protein at every meal from different protein sources – not specifically lean ones.

The most recent guidelines also recommend a higher amount of protein – specifically 1.2 to 1.6 grams of protein per kilogram of body weight per day, up from 0.8 grams per kilogram of body weight recommended in the Dietary Reference Intakes for the U.S, the official guidelines for nutrient recommendations. Recommending a higher protein intake goes beyond the mission of the dietary guidelines.

Also, the updated dietary guidelines now recommend full-fat dairy products, rather than low-fat ones as they did previously. But in my view, this recommendation isn’t practical, because it doesn’t raise the level of recommended saturated fat, which remains at 10%. To understand how this would work in practice, I roughly translated these recommendations into a typical menu based on my weight and calorie requirements. These changes would raise my saturated fat consumption well above this limit, so the messages are inconsistent.

Naming ultraprocessed foods

Another difference is that the new recommendations specifically call out avoiding ultraprocessed foods. The previous guidelines did not explicitly name ultraprocessed foods but instead recommended consuming nutrient-dense foods, which means foods that have a lot of nutrients while also having relatively few calories. That is, in essence, less processed or whole foods.

Food scientists still lack a solid definition of ultraprocessed foods. Our committee actually spent a long time discussing this, and the Food and Drug Administration is currently working on creating a clear definition of the term that can guide research and policy.

Also, solid research on ultraprocessed foods has been limited. Most studies available for our review took a snapshot of people’s eating habits but didn’t track their effects over a long time or compare groups in randomized controlled trials, the gold-standard research method.

That’s changing, however. The committee did its assessment two years ago, but evidence linking ultraprocessed foods to chronic diseases is getting stronger.

Can Americans trust the science behind the 2025-2030 guidelines?

In my view, some of the changes in the 2025-2030 guidelines, such as limiting ultraprocessed foods, are beneficial. But the problem is that it’s not possible to determine whether the necessary scientific rigor was applied in developing them.

Much of the research on saturated fat consumption is still unsettled and controversial. That’s why it’s important to have a systematic and transparent process for evaluating the research, with input from experts with multiple perspectives who review the entire body of research published about a particular topic.

If you don’t do it properly, you can select the evidence that you prefer. That makes it easy for bias to creep in.

This article was updated to more accurately reflect the author’s views.

Cristina Palacios has received funding from NIH, USDA, RCMI and RTRN, the Robert Wood Johnson Foundation, the Children’s Trust, Caplan Foundation, and National Dairy Council for various research projects. She was part of the 2025 Dietary Guidelines Advisory Committee from 2022-2024. She has also been a consultant for the World Health Organization in several of their guidelines. Currently, she is part of the Scientific Advisory Committee for the Latin American Dairy Nutrition Congress.

– ref. New US dietary guidelines recommend more protein and whole milk, less ultraprocessed foods – https://theconversation.com/new-us-dietary-guidelines-recommend-more-protein-and-whole-milk-less-ultraprocessed-foods-272990

Source: The Conversation – USA – By Ben Jones, Assistant Professor of Public Policy and Research Associate in the Rock Ethics Institute, Penn State

Minneapolis is once again the focus of debates about violence involving law enforcement after an Immigration and Customs Enforcement officer shot and killed Renee Nicole Good, a 37-year-old mother, in her car.

The incident quickly prompted dueling narratives. Trump administration officials defended the shooting as justified, while local officials condemned it.

The shooting will also likely prompt renewed scrutiny of training and policy of officers and the question of them shooting at moving vehicles. There has been a recent trend in law enforcement toward policies that prohibit such shootings. It is a policy shift that has shown promise in saving lives.

Decades ago, the New York City Police Department prohibited its officers from shooting at moving vehicles. That led to a drop in police killings without putting officers in greater danger.

Debates over deadly force are often contentious, but as I note in my research on police ethics and policy, for the most part there is consensus on one point: Policing should reflect a commitment to valuing human life and prioritizing its protection. Many use-of-force policies adopted by police departments endorse that principle.

Yet, as in Minneapolis, controversial law enforcement killings continue to occur. Not all agencies have implemented prohibitions on shooting at vehicles. Even in agencies that have, some policies are weak or ambiguous.

In addition, explicit prohibitions on shooting at vehicles are largely absent from the law, which means that officers responsible for fatal shootings of drivers that appear to violate departmental policies still often escape criminal penalties.

In the case of ICE, which is part of the Department of Homeland Security, its policy on shooting at moving vehicles – unlike that of many police agencies – lacks a clear instruction for officers to get out of the way of moving vehicles where feasible. It’s an omission at odds with generally recognized best practices in policing.

ICE’s policy on shooting at moving vehicles

ICE’s current use-of-force policy prohibits its officers from “discharging firearms at the operator of a moving vehicle” unless it is necessary to stop a grave threat. The policy is explicit that deadly force should not be used “solely to prevent the escape of a fleeing suspect.”

That point is relevant for evaluating the fatal shooting in Minneapolis. Videos show one officer trying to open the door of the vehicle that Good was driving, while another officer appears to be in front of the vehicle as she tried to pull away.

Shooting to prevent the driver simply from getting away would have been in violation of agency policy and obviously inconsistent with prioritizing the protection of life.

ICE’s policy lacks clear instruction, however, for its officers to get out of the way of moving vehicles where feasible. In contrast, the Department of Justice’s use-of-force policy makes it explicit that officers should not shoot at a vehicle if they can protect themselves by “moving out of the path of the vehicle.”

Notably, President Joe Biden issued an executive order in 2022 requiring federal law enforcement agencies – like ICE – to adopt use-of-force policies “that are equivalent to, or exceed, the requirements” of the Department of Justice’s policy.

Despite that order, the provision to step out of the way of moving cars never made it into the use-of-force policy that applies to ICE.

The rationale for not shooting at moving vehicles

Prioritizing the protection of life doesn’t rule out deadly force. Sometimes such force is necessary to protect lives from a grave threat, such as an active shooter. But it does rule out using deadly force when less harmful tactics can stop a threat. In such cases, deadly force is unnecessary – a key consideration in law and ethics that can render force unjustified.

That’s the concern involved with police shooting at moving vehicles. It often is not necessary because officers have a less harmful option to avoid a moving vehicle’s threat: stepping out of the way.

This guidance has the safety of both suspects and police in mind. Obviously, police not shooting lowers the risk of harm to the suspect. But it also lowers the risk to the officer in the vast majority of cases because of the laws of physics. If you shoot the driver of a car barreling toward you, that rarely brings a car to an immediate stop, and the vehicle often continues on its path.

Many police departments have incorporated these insights into their policies. A recent analysis of police department policies in the 100 largest U.S. cities found that close to three-quarters of them have prohibitions against shooting at moving vehicles.

The gap between policy and best practices for protecting life

The shooting in Minneapolis serves as a stark reminder of the stubborn gap that often persists between law and policy on the one hand and best law enforcement practices for protecting life on the other. When steps are taken to close that gap, however, they can have a meaningful impact.

Some of the most compelling examples involve local, state and federal measures that reinforce one another. Consider the “fleeing felon rule,” which used to allow police to shoot a fleeing felony suspect to prevent their escape even when the suspect posed no danger to others.

That rule was at odds with the doctrine of prioritizing the protection of life, leading some departments to revise their use-of-force policies and some states to ban the rule. In 1985, the U.S. Supreme Court ruled that it was unconstitutional for police to shoot a fleeing suspect who was not a danger.

Banning that questionable tactic notably led to a reduction in killings by police.

This history suggests that clear bans in law and policy on questionable tactics have the potential to save lives, while also strengthening the means for holding officers accountable.

Ben Jones does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. ICE killing of driver in Minneapolis involved tactics many police departments warn against − but not ICE itself – https://theconversation.com/ice-killing-of-driver-in-minneapolis-involved-tactics-many-police-departments-warn-against-but-not-ice-itself-271907

Source: The Conversation – USA (3) – By Cristina Palacios, Professor and Chair of Dietetics and Nutrition, Florida International University

Every five years, the U.S. government releases an updated set of recommendations on healthy eating. This document, called the Dietary Guidelines for Americans, has served as the cornerstone of nutrition policy for almost half a century.

On Jan. 7, 2026, the Department of Health and Human Services and the Department of Agriculture released the 2025-2030 edition of the guidelines. The updated guidelines recommend that people consume more protein and fat, and less ultraprocessed foods.

These guidelines are the foundation for governmental nutritional programs – for example, they are used to determine which foods are covered by the Supplemental Nutrition Assistance Program, or SNAP, as well as how school lunches are prepared. Eldercare centers and child care centers use them when providing meals, as do clinical nutritionists working with patients to help them achieve a healthy diet. And because the guidelines are so scientifically rigorous, many countries around the world base their own nutritional guidelines on them.

I’m a nutrition scientist specializing in developing interventions for preventing obesity. Between 2022 and 2024 I served on the scientific advisory committee tasked with assessing the best available evidence on a wide range of topics in nutrition in order to inform federal officials in updating the guidelines.

But most of the committee’s recommendations were ignored in developing the latest dietary guidelines.

On the surface, these guidelines share a lot of similarities with the previous version, published in 2020, but they also have a few important differences. In my view, however, irregularities in the process the government followed raise questions about the guidfelines’ final conclusions.

How are the Dietary Guidelines for Americans developed?

For each update, HHS and USDA establish a scientific advisory committee like the one I served on. Members with expertise in different aspects of nutrition are carefully selected and vetted. They then spend two years reviewing the latest scientific studies to assess evidence about specific nutrition-related questions – such as the relationship between saturated fats in foods and cardiovascular disease and what strategies are most effective for weight management.

For each question, the committee first prepares a protocol to answer it, identifies the most rigorous studies and synthesizes its findings, discussing the evidence extensively. It then produces specific recommendations about the topic for the HHS and USDA. At each step, the public and the scientific community are invited to provide comments, which the committee considers.

All this scientific information is put together in a massive report, which the federal agencies then use to create the updated guidelines, translating the expert recommendations for the public and health professionals.

A departure from the norm

The advisory committee I served on functioned as usual – our report was published in December 2024.

But the dietary guidelines released on Jan. 7 were mainly not based on that report. Instead, they were based on a different scientific report that was also published on Jan. 7. That report drew some material from ours but went through a completely different process.

It was created by a group of people who were not vetted in the usual way, and although they repeated some of the same questions we did, they also explored other topics that were chosen with no input from the wider community of nutrition researchers or from the public. It was not based on a publicly available protocol, with no input from the scientific community, and it’s unclear how and to what degree it was peer-reviewed.

Essentially, the updated dietary guidelines were developed through a shadow process that bypassed the established methodology that’s been used to assess nutrition science behind the guidelines for many years.

What’s new in the 2025-2030 guidelines

Many of the recommendations in the 2020 guidelines and the ones released on Jan. 7 are broadly the same: that Americans should consume three servings of vegetables, two servings of fruits and three servings of dairy products per day, as well as replacing refined grains with whole grains, and limiting intake of sugar and sodium.

The main differences relate to recommendations about protein and dairy products.

The 2020 guidelines recommended that Americans focus on protein such as poultry and other lean meats, seafood, eggs, legumes, nuts and seeds. The updated version instead emphasizes eating protein at every meal from different protein sources – not specifically lean ones.

The most recent guidelines also recommend a higher amount of protein – specifically 1.2 to 1.6 grams of protein per kilogram of body weight per day, up from 0.8 grams per kilogram of body weight recommended in the Dietary Reference Intakes for the U.S, the official guidelines for nutrient recommendations. Recommending a higher protein intake goes beyond the mission of the dietary guidelines.

Also, the updated dietary guidelines now recommend full-fat dairy products, rather than low-fat ones as they did previously. But in my view, this recommendation isn’t practical, because it doesn’t raise the level of recommended saturated fat, which remains at 10%. To understand how this would work in practice, I roughly translated these recommendations into a typical menu based on my weight and calorie requirements. These changes would raise my saturated fat consumption well above this limit, so the messages are inconsistent.

Naming ultraprocessed foods

Another difference is that the new recommendations specifically call out avoiding ultraprocessed foods. The previous guidelines did not explicitly name ultraprocessed foods but instead recommended consuming nutrient-dense foods, which means foods that have a lot of nutrients while also having relatively few calories. That is, in essence, less processed or whole foods.

Food scientists still lack a solid definition of ultraprocessed foods. Our committee actually spent a long time discussing this, and the Food and Drug Administration is currently working on creating a clear definition of the term that can guide research and policy.

Also, solid research on ultraprocessed foods has been limited. Most studies available for our review took a snapshot of people’s eating habits but didn’t track their effects over a long time or compare groups in randomized controlled trials, the gold-standard research method.

That’s changing, however. The committee did its assessment two years ago, but evidence linking ultraprocessed foods to chronic diseases is getting stronger.

Can Americans trust the science behind the 2025-2030 guidelines?

In my view, some of the changes in the 2025-2030 guidelines, such as limiting ultraprocessed foods, are beneficial. But the problem is that it’s not possible to determine whether the necessary scientific rigor was applied in developing them.

Much of the research on saturated fat consumption is still unsettled and controversial. That’s why it’s important to have a systematic and transparent process for evaluating the research, with input from experts with multiple perspectives who review the entire body of research published about a particular topic.

If you don’t do it properly, you can select the evidence that you prefer. That makes it easy for bias to creep in.

Cristina Palacios has received funding from NIH, USDA, RCMI and RTRN, the Robert Wood Johnson Foundation, the Children’s Trust, Caplan Foundation, and National Dairy Council for various research projects. She was part of the 2025 Dietary Guidelines Advisory Committee from 2022-2024. She has also been a consultant for the World Health Organization in several of their guidelines. Currently, she is part of the Scientific Advisory Committee for the Latin American Dairy Nutrition Congress.

– ref. I served on the expert committee that advised the government on new dietary guidelines – most of our recommendations were ignored – https://theconversation.com/i-served-on-the-expert-committee-that-advised-the-government-on-new-dietary-guidelines-most-of-our-recommendations-were-ignored-272990