First they came for our AHRQ article, …then they came for AHRQ*�

Gordon Schiff MD

Associate Director Brigham & Women's Center for Patient Research and Practice

Director Quality and Safety Havard Med School �Center for Primary Care

*Agency for Healthcare Research & Quality

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I regret to inform you that your wonderful Case and Commentary from 2022 on “Multiple Missed Opportunities for Suicide Risk Assessment,” has been removed from the PSNet website due to a perception that it violates the White House policy on websites “that inculcate or promote gender ideology.”

Knock on the door Friday evening January 31 �from AHRQ PSNet editor

https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/

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https://web.archive.org/web/20241113202106/https:/psnet.ahrq.gov/web-mm/multiple-missed-opportunities-suicide-risk-assessment-emergency-and-primary-care-settings

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Suicide Article that� was removed

Why was our article removed?

• 18-year adolescent male who had thoughts of killing himself and was found in a hotel room with a gun.
• Discussion of screening, diagnosis, management, prevention of suicide and suicide risks

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• Reason we learned was that mention of banned word in a paragraph listing suicide risk factors:� “High risk groups include male sex, being young, veterans, Indigenous tribes, lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ)” along with “serious mental illness, prior suicide attempts and self-harming behavior, alcohol or substance use, serious recent illness or diagnosis, physical pain, a history of trauma or recent loss, and severe anxiety or insomnia.”

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Why was our suicide article removed?

• 18-year adolescent male who had thoughts of killing himself and was found in a hotel room with a gun.
• Discussion of screening, diagnosis, management, prevention of suicide and suicide risks

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• Reason we learned was that mention of banned word in a paragraph listing suicide risk factors:� “High risk groups include male sex, being young, veterans, Indigenous tribes, lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ)” along with “serious mental illness, prior suicide attempts and self-harming behavior, alcohol or substance use, serious recent illness or diagnosis, physical pain, a history of trauma or recent loss, and severe anxiety or insomnia.”

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Endometriosis Article �that was removed

https://web.archive.org/web/20241113093130/https:/psnet.ahrq.gov/web-mm/endometriosis-common-and-commonly-missed-and-delayed-diagnosis

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Why was our Endometriosis article removed?

• Discussion of patient with endometriosis, condition affecting 1 in 10 women with average ddelays of 7-10 years.

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• Reason article was removed:

“Although not germane to this particular case, it is important to note that endometriosis can occur in trans and non-gender-conforming people and lack of understanding this fact could make diagnosis in these populations even more challenging.”

Why was our Endometriosis article removed?

• Discussion of endometriosis, condition affecting 1 in 10 women with average delays of 7-10 years.

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• Reason article was removed:

“Although not germane to this particular case, it is important to note that endometriosis can occur in trans and non-gender-conforming people and lack of understanding this fact could make diagnosis in these populations even more challenging.”

https://www.boston.com/news/local-news/2025/03/13/harvard-doctors-sue-trump-administration-for-removing-their-research-from-government-run-website/

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https://media.wbur.org/wp/2025/03/Schiff-v.-OPM-Complaint.pdf

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5. Defendants’ censorship violates the First Amendment by imposing a viewpoint based and unreasonable restriction on Plaintiffs’ speech and violates the Administrative Procedure Act (“APA”) because it is arbitrary and capricious. �

The OPM guidance further violates the APA because it exceeds OPM’s statutory authority. Plaintiffs request that the Court declare this censorship unlawful, restore Plaintiffs’ censored research, and enjoin Defendants from further censoring research.

To the [Improving Diagnosis]community:

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The University of California Davis is proud and honored to have been part of the Pantheon team supporting AHRQ's Patient Safety Network (PSNet) for the past 6 years.

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Due to shifting priorities for the Agency, the team will no longer be supporting PSNet.

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We sincerely thank our 41,000 subscribers and millions of readers across the country, and we encourage users to access PSNet resources while they remain available.

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Best wishes to all and let’s continue the journey together!

Knock on the door Part 2 �from AHRQ PSNet editor Friday night March 28

Taking Down AHRQ PSNet

• Widely used
• >10 times in past week for my teaching & research
• 41,000 subscribers, millions of readers/hits
• Reliable, readable
• Carefully reviewed content
• Nicely summarized in simple language for docs, nurses, public
• Repository 3 decades of research, ideas, advances
• Effectiveness and efficiency
• Research and Dissemination for cost effective evaluations of what works, efficient ways to implement, unnecessary care
• Who is taking down and why?
• Ill-informed actions
• Translate “research” into practice.
• Helps healthcare organizations know what to do

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Knock on the door Part 3 - HHS Executive Order 3/27

Research and Evaluation for Health Policy: HHS will merge the Assistant Secretary for Planning and Evaluation (ASPE) with the Agency for Healthcare Research and Quality (AHRQ) to create the Office of Strategy to enhance research that informs the Secretary’s policies and improves the effectiveness of federal health programs

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Kristallnacht of public health

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Carlos del Rio, MD,

Distinguished Professor Infectious Disease and Associate Dean, Emory Atlanta

As you have heard, the brutal, unlawful, and short-sighted RIF that is devastating throughout HHS has also just hit AHRQ. We are in the process of getting more information. What we do know is that at least 100 AHRQ staffers were sent this RIF, which in addition to the buyouts is over half of the Agency. We also know that many of these staffers were informed of this RFI when they were denied entrance to their office this morning, adding further insult and disrespect to the incredible public servants who have worked tirelessly to improve the health outcomes of our country.

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We currently understand that these RIFs were focused on: Office of Extramural Research, Education and Priority Populations (OEREP); Center for Evidence and Practice Improvement (CEPI); and Office of Communications (OC); and the Office of Management Services (OMS). But we are still gathering more information.

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We have heard from health leaders on the Hill from both parties that they were blindsided by today’s announcement and were themselves trying to get information on it.

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A 50 percent cut to AHRQ is like a 50 percent cut to a car – it doesn’t go half as fast, instead it just does not go anywhere. Let’s be clear – these cuts are going to mean Americans are going to get sicker, die from preventable deaths, go further into debt, and destabilize our health care systems. We are not going to let that happen without a fight.

https://academyhealth.org/page/stand-ahrq-toolkit

4/1/2025 Email from Academy Health Director Governmental Affairs

Employees being “Badged” �(finding out they were fired when reported to work) at FDA Monday)

Does the Public Know and Care

Does the Public Know and Care

Does the Public Know and Care

Does the Public Know and Care

Does the Public Know and Care

Does the Public Know and Care

Does the Public Know and Care

Does the Public Know and Care

Science of Healthcare Safety Culture�November 6, 2024

• Replacing blame with support and learning
• Driving out fear
• Honesty, integrity
• Humility
• Admitting error
• Kindness, compassion caring
• Inclusion of all staff teamwork
• No to bullying
• Informed by science

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• Respect for women
• Respect for people and their working conditions
• Fairness, equity, overcoming gaps and past injustices
• Transparency
• Health insurance and access
• Driven by professionalism not greed
• Cooperation rather than competition
• Long term thinking;�Planning for future

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How We will Win

• Resist -At every small and big step
• Caving in to threats, intimidation, does not protect us
• Expose -to win war of public opinion
• Pin on them consequences of their deadly, ill-informed, meanspirited, �unacceptable actions: make hurt them much more than hurt us.
• Mindful of “collateral damage”
• Remember problems with not go away, only get worse w/ their actions
• Legal actions
• Challenge legality on multiple levels. Losing every court case
• Connect issues – to forge coalitions, major alliances Academy
• Draw connections between multiple attacks
• To further expose, discredit, and radicalize the public
• Long term strategy
• Keep eye on prize, pick battles strategically w/ long-term goals in mind
• Everything matters – even when doesn't seem apparent
• Zinn- impossible to predict when spark will catalyze big change
• People on inside –whistler blowers

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Supplemental Slides (not used)

RENEWING AMERICAN LEADERSHIP IN CRITICAL AND EMERGING TECHNOLOGIES: Today, President Donald J. Trump announced the establishment of the President’s Council of Advisors on Science and Technology (PCAST) to spearhead American innovation and competitiveness in critical and emerging technologies.

FOCUSING SCIENCE AND TECHNOLOGY ON EXCELLENCE: President Trump is refocusing science and technology policy to emphasize results-driven excellence and merit-based achievement.

• The United States must leverage its pioneering spirit to lead in transformative science and technology, reshaping industries and securing the nation’s leadership.
• The pursuit of scientific truth is under threat from ideological agendas that prioritize group identity over individual merit, enforce conformity at the expense of innovative ideas, and inject politics into the heart of the scientific method.
• These threats have not only distorted truth, but have eroded public trust, undermined the integrity of research, stifled innovation, and weakened America’s competitive edge.
• PCAST will restore excellence by bringing together the brightest minds from academia, industry, and government to prioritize measurable results, foster innovation, and dismantle barriers to scientific progress.

Howard Lutnick said at the Oval Office that potential applicants for the “gold card” visa would have to go through a vetting process to ensure they are “wonderful world-class global citizens,” but did not give further details.

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When asked by the press whether Russian oligarchs could apply to the program, Trump said: “Possibly. I know some Russian oligarchs who are very nice people.”

Gold Card Visa to bring brightest minds