Meet the Mass. doctor chronicling Trump's impact on health and medicine

When news broke last month that the Trump administration was planning to propose deep cuts to the Department of Health and Human Services, it didn't first arrive via The New York Times, The Washington Post or any traditional media outlet.

Rather, it was a doctor at Brigham and Women's Hospital who had the scoop. And it wasn't the first time.

Through his Substack newsletter, Inside Medicine, Dr. Jeremy Faust has been providing his 75,000 subscribers with an insider's view over the last few months of how the Trump administration is changing public health and health care — in real time.

Faust has been tracking the administration's moves, and talking to colleagues across the country about their impacts. He frequently shares his own opinions, too. (Spoiler alert: He's not a fan.) But this emergency medicine physician, who is also an assistant professor at Harvard Medical School, sometimes beats — or at least matches — major news organizations at their own game.

In addition to last month's scoop on the White House's draft budget proposal, he has broken news about the Trump administration's closure of a long COVID research office and a "power vacuum" at the Centers for Disease Control and Prevention. Faust also provided insider accounts of the chaos accompanying a new in-person work policy at the FDA. And he was among the first to write about health researchers whose grants were terminated because they included terms that are not favored by the Trump administration.

Sometimes the newsletter is a digest of significant developments in Washington, D.C., punctuated by his own views and observations; sometimes, he’s conducting live video interviews with prominent experts like Dr. Atul Gawande or Dr. Michael Mina, of COVID-19 testing fame.

I had to ask how he’s managing to do all this and keep up a physician’s schedule. He graciously agreed to answer a few questions via email, after attempts to set up an interview didn’t pan out. (Like I said, he's busy!)

Here’s our exchange, lightly edited for clarity:

First of all, Dr. Faust, thank you so much for doing this. I have to start out by asking how you got into all this. What was the moment when you decided to start writing about what was happening to public health and medical research under the Trump administration?

"Until inauguration day, my intention was to do the opposite of what I’ve been doing!

"I wanted to put my head down and do some meaningful work on areas that matter greatly to me but may not be headline-grabbing stuff now. For example, I was returning to a long-planned project to write a book about sepsis. And I’m still very interested in understanding the COVID-19 pandemic, because I feel like there continue to be massive misunderstandings and revisionism there.

"But then the administration started to attack our cherished and essential national public health and biomedical resources. As an emergency physician, my instinct is always to go to where the most acute and time-sensitive crisis is. So, I used my existing newsletter, Inside Medicine, as a platform to document this and, hopefully, to contribute something productive to the narrative."

Where do the ideas for your newsletter come from? Are you thinking about how to break news?

"Mostly my ideas come from sources within the government. Sometimes a scoop is explicit and direct. An HHS staffer will say, 'Hey, I’ve got something for you.' That’s how I got the draft for the HHS budget proposal, for example. Two sources sent it to me on the same day and a third one offered to send it as well, when I was trying to verify its authenticity. Other times, during a check-in conversation a source might say something unexpected, and it's like, 'Wait a second, let’s talk about this a little more.'

"Most of the time, I’m not thinking about breaking news. I’m interested in offering analysis that adds value beyond what’s already out there, either from my own perspective or by conveying the opinions of government employees or other experts whose voices need to be heard."

How do you see yourself fitting into the media ecosphere — if you do see yourself as part of it. Are you an opinion writer? A journalist trying to fill holes where you see gaps in coverage? Do you think individualized efforts like yours are the news media of the future?

"I think about this a lot. Whatever 'this' is, it certainly feels like a part of the future of media. It’s not pure journalism and I’m not a pure journalist, though I certainly engage in pure journalism and at times function as a pure journalist.

"But I’m also under no obligation to hide my feelings on a topic, which is a huge benefit because it probably reads as more authentic and urgent. When I present the 'other side' of an argument, it’s not because I have to — out of some journalistic principle — but because I think it’s important and the right thing to do. But there are times when I can skip the pro forma lip service because something that’s happening is frankly just terrible, and there’s no point in dressing that up."

What are the biggest challenges you’ve faced when working to “bear witness,” as some of your columns say, to what is happening right now?

"It’s impossible for me to cover everything. I have to embrace that and remember that other outlets have great reporters who are doing a great job. So, I do occasionally feel FOMO when I have a story that I want to do, but it gets scooped by one of the majors. And sometimes the news cycle is so quick that some interesting insights I’ve gathered from HHS sources go from relevant to irrelevant in a matter of hours.

"Another challenge is that I occasionally see where the majors get something wrong. And it’s not fake news, so much as it’s a matter of interpretation. Sometimes rank-and-file HHS employees think one thing, but they don’t have the whole perspective. At the same time, if I were to report that, I would be compromising sources who are higher up in government who have not given me permission to use that information. So, there are times where I don’t report something which is my indirect way saying that what is being reported elsewhere is not entirely accurate. But nobody could possibly intuit that. So, on the inside, I’m screaming, 'That’s wrong!' but I can’t do anything about it."

You’re a practicing clinical emergency medicine physician in addition to writing this Substack newsletter. How do you find time for all the research, reporting, interviews and writing that goes into this project —  plus being a dad and everything else? When do you sleep?! And more seriously, what are you doing to take care of yourself? What keeps you going?

"In 2020, I stopped sleeping and did not get tired for a couple of years. This has had shades of that, except this time I’ve already needed to sleep at times. For example, I worked a bunch of ER shifts a couple of weeks ago and was operating on a sleep deficit. Then, after an overnight shift a few days later, I slept 18 of the next 24 hours and spent most of those six waking hours with my family. I missed a news cycle, and I’m fortunate that my readers forgive that. Also, my clinical workload is around 55% of full-time, so I don’t want people to think I’m carrying as much as many of my colleagues.

"Finally, every Tuesday evening, I direct The Longwood Chorus (Boston’s ensemble of wonderful singers from the medical and science community), and that is extraordinarily healing and energizing for me. It takes preparation, but I already know a lot of the music like the back of my hand, so that helps. I leave re-energized and ready for the next thing."

Bonus question: Do you, or have you, watched the TV show "The Pitt”? A bunch of us at WBUR are obsessed with it. Curious to hear your thoughts about the show, its portrayal of the ER and the health care industry, and why it seems to be striking a chord with audiences.

"I have not watched it. I generally cannot handle prestige television because bad things constantly happen to good people, and I deal with that enough in my professional life.

"I can’t even handle 'Finding Nemo,' because a cartoon fish loses a parent in a mass casualty event and is then estranged from his father, whose overbearing nature is clearly an expression of a completely understandable earned PTSD. This is torture to me.

"My spouse and I occasionally watch stuff, but I actually had to turn off the last episode of 'The White Lotus' about halfway through. I’m not sure whether I’m going to just read the spoilers or let her watch it and tell me what happens before I decide whether to finish it.

"I’ll probably watch 'The Pitt' at some point, but mainly so I can answer people’s questions about it. I probably missed the opportunity to educate and interact with readers on this, and I feel a little guilty about that. So, I’ll probably watch it for them so that I can be a useful resource. But, if it were entirely up to me, I’d probably skip it."

Editor's note: This post has been updated to reflect a promotion for Dr. Faust from instructor to assistant professor at Harvard Medical School.