Unlike the first, Donald Trump’s second campaign was not focused on the Affordable Care Act or health care policy. A Associated Press poll found that most voters did not view health care as very motivating, with only 8% of voters surveyed ranking it as a priority issue.

However, the results of this election will be detrimental to the medical profession. Over the past four years, we have seen an incredible erosion in the ability of physicians to set norms and standards for their practice. Instead, judges, politicians, and activists — many of whom have no medical training — have substituted their own judgment for what constitutes appropriate medical care. The legal erosion of the medical profession will only accelerate under the second Trump administration.

Historically, law, medicine and divinity self-regulated. Medical professional organizations, specialty societies, and physician-led organizations are those that develop both standards of care and standards of practice, including who can become a doctor. And the self-regulation of the medical profession gives doctors and patients wide latitude to make the appropriate decision in each case.

But over the past four years, doctors’ ability to self-regulate has eroded significantly. First, during the pandemic, trust in doctors has plummeted. A investigationpublished in the Journal of the American Medical Academy, indicates that between April 2020 and January 2024, trust in doctors and hospitals fell from 71.5% to 40.1%. The same study suggests that people with lower trust in the medical profession were less likely to have been vaccinated against Covid-19. Public trust is a necessary element self-regulated professions. The prevailing general distrust of doctors after the pandemic leaves the medical profession vulnerable to attacks on its ability to self-regulate.

Dobbs v. Jackson Women’s Health, the Supreme Court case that struck down the federal right to receive abortion care, provided the model for substituting political judgment for medical expertise. States have moved quickly to criminalize abortion care, usually without meaningful physician involvement. This shows how impractical the exceptions regarding the health or life of the patient are in most abortion bans. In Texas, for example, before performing an abortion, a physician must determine that a patient has a “life-threatening physical condition” that puts her either in danger of death or at “serious risk of substantial impairment.” of a major bodily function. But this requirement already deviates standard of medical care, which involves intervening before a patient develops a life-threatening physical condition. And doctors now face criminal charges, fines of hundreds of thousands of dollars, and even jail time if they attempt to provide evidence-based care to patients who need help. abort.

Trump himself certainly played a leading role in the breakdown of physician self-regulation. His Supreme Court appointees created the majority that struck down Roe v. Wade. His advice for fighting Covid-19 has often been counter to that of his own experts, as when he suggested inject bleach.

And Trump is only doubling down on his attacks on the medical profession by courting Making America Healthy Again movement. Make American Healthy Again is run by vaccine skeptics Robert F. Kennedy Jr., which promises to put an end to “ war on public health.” This could result in the cessation of water fluoridation, contrary to the recommendations of the American Dental Association and the Centers for Disease Control and Prevention. This will almost certainly mean pressure to roll back approvals of vaccines and even remove certain vaccines from the marketdespite an almost universal medical consensus on the importance of vaccination against many diseases. Kennedy, notably, has no medical expertise or training but will likely be empowered to “go wild» on health, as Trump declared.

There are also fears that Trump will “clean up” federal agencies, firing officials he considers disloyal to himself and his agenda. During his final months in office in 2020, Trump issued an executive order: “Appendix F“, which would have exempted from employment protection federal positions “of a confidential, determining, decision-making or policy defending nature.” This would have allowed Trump to easily replace up to 50,000 federal employees, including those in health-focused agencies, with the appropriate degrees and years of training. By removing career civil servants, it will be easier for Kennedy, or another Trump appointee, to push through controversial and untested initiatives.

But Kennedy is not the only challenge facing the medical profession’s control of health care in the years to come. This fall, in Braidwood v. Becerrathe 5th^th The Circuit Court of Appeals concluded that the ACA improperly incorporated preventive care recommendations issued by the U.S. Preventive Services Task Force (USPSTF), an independent, volunteer group of disease prevention and medical experts based on evidence. The appointment clause of the Constitution, the 5^th According to Circuit, this prevents public policy from being directed by a group of experts who are not supervised by government officials and who are not themselves appointed “officers of the United States.”

Braided wood is alarming not only because it may overturn the free preventive care mandate, but also because at present many other public health and health policy standards are set by non-governmental expert groups similar. Indeed, the The Braidwood Plaintiffs attempt to expand this case to include consideration of the ability of the Advisory Committee on Immunization Practices and the Health Resources and Services Administration to also make recommendations regarding preventative care. This case will likely be argued before the Supreme Court created by Trump to be skeptical of expertise, and could even include additional appointments by Trump. The result could further limit the influence of medical and public health experts by preventing government agencies from being able to incorporate their recommendations, standards and other findings into regulations.

At the state level, the same model that was used to exclude doctors from regulating abortion will be applied in other areas. Many states already prohibit gender-affirming care, particularly for minors. This term, the Supreme Court will hear United States v. Skrmettiwhich focuses on Tennessee’s ban on all gender-affirming medical treatments for minors. These bans go against the recommendations of major American medical groups, such as the American Academy of Pediatrics, American Psychiatric Associationand the American Medical Association.

If the court confirms the ban on gender-affirming care, it could open the valves for states seeking to prohibit or limit access to politically disadvantaged health care. For example, the Braidwood claimants argued that the provision of free HIV pre-exposure prophylaxis promotes sexual promiscuity and intravenous drug use. A state, using a similar approach to banning abortion or gender-affirming care, could criminalize the provision of PrEP. Drug treatment, IVF and vaccines have all been politically controversial at times and could again be caught in the crosshairs.

These bans would likely come from the states – in part because, under police power, they have greater latitude to regulate health care – and would result in the medical profession losing control over best practices and guidelines. standards of care. But the Trump administration will likely empower politicians and state advocates who seek to criminalize health care, in part because Trump has already signaled ban gender-affirming care as a priority for his first day in office.

Much has been said about the details of Project 2025 and others Trump-related projects for health care. Some, such as a focus on chronic diseases, could be beneficial. But overall, Trump and his team show little respect for doctors and other public health experts. This comes at a time when the ability of the medical profession to self-regulate, including determining what treatments are appropriate to offer to patients, is under threat.

Medical leaders must find ways over the next four years to regain public trust and emphasize to the public that the patient and physician, not the legislature, should be the decision-makers in health care. Their ability to determine the scope of medicine may depend on this.

Carmel Shachar is an assistant clinical professor of law at Harvard Law School. She is also the educational director of the Health Law and Policy Clinic at the Center for Health Law and Policy Innovation at Harvard Law School.