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Mobile clinic brings mammograms to women on Skid Row

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Mobile clinic brings mammograms to women on Skid Row

Sharon Horton stepped through the door of a sky-blue mobile clinic and onto a Skid Row sidewalk. She wore a yellow knit beanie, gold hoop earrings and the relieved grin of a woman who has finally checked a mammogram off her to-do list.

It had been years since her last breast cancer screening procedure. This one, which took place in City of Hope’s Cancer Prevention and Screening mobile clinic, was faster and easier. The staff was kind. The machine that X-rayed her breast was more comfortable than the cold hard contraption she remembered.

Relatively speaking, of course — it was still a mammogram.

“It’s like, OK, let me go already!” Horton, 68, said with a laugh.

The clinic was parked on South San Pedro Street in front of Union Rescue Mission, the nonprofit shelter where Horton resides. Within a week, City of Hope, a cancer research hospital, would share the results with Horton and Dr. Mary Marfisee, the mission’s family medical services director. If the mammogram detected anything of concern, they’d map out a treatment plan from there.

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Naureen Sayani, 47, a resident of Union Rescue Mission, left, discusses her medical history with Adriana Galindo, a medical assistant, before getting a mammogram on last week.

(Kayla Bartkowski / Los Angeles Times)

“It’s very important to take care of your health, and you need to get involved in everything that you can to make your life a better life,” said Horton, who is looking forward to a forthcoming move into Section 8 housing.

Horton was one of the first patients of a new women’s health initiative from UCLA’s Homeless Healthcare Collaborative at Union Rescue Mission. Staffed by third-year UCLA Medical School students and led by Marfisee, a UCLA assistant clinical professor of family medicine, the clinic treats mission residents as well as unhoused people living in the surrounding neighborhood.

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The new cancer screening project arrives at a time of dire financial pressures on county public health services.

Citing rising costs and a $50-million reduction in federal, state and local grant and contract income, the Los Angeles County Department of Public Health on Feb. 27 ended services at seven of 13 public clinics that provide vaccines, tests and treatment for sexually transmitted diseases and other services to housed and unhoused county residents.

Although Union Rescue Mission’s own funding comes mainly from private sources and is less imperiled by public cuts, the 135-year-old shelter expects the need for its services to rise, Chief Executive Mark Hood said.

Even as unsheltered homelessness declined for the last two years across Los Angeles County, the unsheltered population on Skid Row — long seen as the epicenter of the region’s homelessness crisis — grew 9% in 2024, the most recent year for which census data are available.

For many local women navigating daily concerns over housing, food and personal safety, “their own health is not a priority,” Marfisee said.

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Those whose problems have become too serious to ignore face daunting obstacles to care. Marfisee recalled one patient who came to her with a lump in her breast and no identification.

In order to get a mammogram, Marfisee explained, the woman first needed to obtain a birth certificate, and then a state-issued identification card. Then she needed to enroll in Medi-Cal. After that, clinic staff helped her find a primary care physician who could order the imaging test.

Given the barriers to preventative care, homeless women die from breast cancer at nearly twice the rate of securely housed women, a 2019 study found. Marfisee’s own survey of the mission’s female residents found that nearly 90% were not up to date on recommended cancer screenings like mammograms and pap smears, which detect early cervical cancer.

To address this gap, Marfisee — a dogged patient advocate — reached out to City of Hope. The Duarte-based research and treatment center unveiled in March 2024 its first mobile cancer screening clinic, a moving van-sized clinic on wheels that it deploys to food banks and health centers, as well as to companies offering free mammograms as an employee benefit.

“In true Dr. Mary fashion, she saw the vision,” said Jessica Thies, the mobile screening program’s regional nursing director. After working through some logistical hurdles, the mission and City of Hope secured a date for the van’s first visit.

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The next challenge was getting the word out to patients. Marfisee and her students walked through the surrounding neighborhood, went cot to cot in the women’s dorm and held two informational sessions in December and January to answer patients’ questions.

At the sessions, the team walked through the basics of who should get a mammogram (women age 40 or older, those with a family history of breast cancer) and the procedure itself. (“Like a tortilla maker?” one woman asked skeptically after hearing a description of the mammography unit.)

The medical students were able to dispel rumors some women had heard: The test doesn’t damage breast tissue, nor do the X-rays increase cancer risk. Others questioned a mammogram’s value: What good was it knowing they had cancer if they couldn’t get follow-up care?

On this latter point, Marfisee is determined not to let patients fall through the cracks.

Thirteen patients received mammograms at the van’s first visit on Wednesday. Within a week, City of Hope will contact patients with their results and send them to Marfisee and her team. She is already mentally mapping the next steps should any patient have a situation that requires a biopsy or further imaging: working with their case manager at the mission, calling in favors, wrangling with any insurance the patient might have.

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“It’ll be a good fight,” Marfisee said, as residents in the adjacent cafeteria carried trays of sloppy joes and burgers to their lunch tables. “But we’ll just keep asking for help and get it done.”

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NASA’s Artemis II Is the First Crewed Moon Mission Since 1972. Why Are We Going Back?

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NASA’s Artemis II Is the First Crewed Moon Mission Since 1972. Why Are We Going Back?

An animated 3-D model of the moon, shown on a black background.

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A 3-D model of the moon with the near side in view. It reads: This is the side of the moon we see from Earth

In the first era of moon exploration, NASA and the Soviet Union focused on the near side of the moon, where there was direct radio communication with Earth.

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A 3-D model of the moon with the near side in view and circles for landing and crash sites, including Luna 9, 1966 (U.S.S.R.) and Apollo 11 and Apollo 12 (both in 1969, U.S.A).

Today, NASA and other space agencies, like those of China and India, are intrigued by the far side of the moon, which is out of view from Earth…

A 3-D model of the moon with the far side in view and circles for landing and crash sites, including Chang’e 4, 2019 (China) and Chang’e 6, 2024 (China).

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…as well as the polar regions.

A 3-D model of the moon with the south pole in view and circles for landing and crash sites, including the same Chang’e missions and also Chandrayaan-3, 2023 (India).

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A new lunar race is now underway: The United States wants to land humans back on the moon by 2028, two years ahead of China. But the motivations are somewhat different from what put men on its surface 50 years ago.

There is water at the moon’s poles, frozen in the eternal shadows within craters.

Water molecules can be broken apart into hydrogen and oxygen. If countries set up moon bases there, the oxygen could provide breathable air, and hydrogen and oxygen could be used as rocket propellants. Astronauts could also get their drinking water from the moon’s ice. NASA has identified potential landing sites in this area, and China wants to build outposts around the moon’s south pole.

For scientists, the water and other chemicals trapped in the shadowed regions could provide a record of comet and asteroid impacts. Cores drilled from the crater floors could provide a history of the solar system stretching back 4.5 billion years, similar to how ice cores extracted from Greenland and Antarctica tell of Earth’s climate over the past few thousand years.

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Helium-3 could be mined from the lunar soil.

Helium-3, a lighter version of helium, with only one neutron in its nucleus instead of two, is exceedingly rare on Earth. It costs about $9 million a pound, and the biggest source is decayed tritium, a heavy form of hydrogen found in nuclear weapons stockpiles.

The moon could provide much more. The fusion reactions that light up the sun produce helium-3, some of which is propelled throughout the solar system as part of the solar wind that blows outward from the sun. Some of those atoms slam into the moon and become embedded in the lunar soil.

Titanium-rich minerals are more likely to trap helium-3. The rocks on the near side of the moon contain more of these minerals and those locations are believed to be most promising for the mining of helium-3.

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Although concentrations are low, they are still higher than on Earth, whose magnetic field deflects the solar wind around the planet.

Decades in the future, helium-3 could be an ideal fuel for fusion power plants. A more immediate use could be for ultracold refrigerator systems needed for quantum computing.

Animated 3-D model of the moon that shows higher concentrations of helium-3 on the near side of the moon.

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A lunar telescope could be installed in a crater on the far side of the moon.

Over the past century, the Earth has become a noisy place for astronomers wishing to listen to the radio waves that fill the universe. Those waves emanate from glowing gas clouds of hydrogen, auroras of distant planets and fast-spinning neutron stars. But those signals are often drowned out by ubiquitous transmissions of modern society like radio and television shows, cellphone calls and industrial electrical equipment.

The Earth’s ionosphere also blocks long-wavelength radio waves, which would give clues about the very early universe, from reaching ground-based radio telescopes. But on the far side of the moon, all that radio noise from Earth is silenced, unable to pass through 2,000 miles of rock. And the long-wavelength radio waves could also be observed.

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Building a radio telescope in a crater on the moon would take advantage of that natural concave shape. A location near the equator in the middle of the far side could be an ideal listening spot.

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After years of talking about lunar outposts in vague terms for sometime in the indefinite future, NASA recently shifted, putting a continuing U.S. presence on the moon solidly on its road map for the coming decade.

Plans for a moon base would proceed in phases. It would go from regular moon visits to building permanent infrastructure; power and communication systems; vehicles to carry astronauts and cargo across the surface; and possibly nuclear power plants.

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Methodology

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The 3-D model’s base imagery is from NASA’s Moon CGI kit. Data on lunar landing and crash sites was gathered and verified using multiple sources: NASA Space Science Data Coordinated Archive; China National Space Administration; Japanese Space Agency; European Space Agency; Indian Space Research Organization; and the Smithsonian Institution.

To create the time-lapse animation showing the moon’s permanently shadowed areas at the south pole in January 2026, New York Times journalists used a digital elevation model from the Lunar Orbiter Laser Altimeter (LOLA), data from LOLA’s Gridded Data Records (GDRs) and ephemeris sourced from the U.S. Geological Service (USGS) Astropedia.

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Frozen water detections were provided by Shuai Li from the University of Hawaii.

Lunar landing sites for future Artemis missions at the South Pole are from NASA’s update from October 2024.

Helium-3 concentration data was provided by Wenzhe Fa from Peking University, China.

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Diagrams of the lunar radio telescope deployment and radio interference are based on NASA Jet Propulsion Laboratory’s concepts.

This project also used geographic references from the USGS Geologic Atlas of the Moon and the Lunar South Pole Atlas by the Lunar and Planetary Institute.

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Autistic people are more likely to experience suicidal crisis. 988 is changing to serve them better

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Autistic people are more likely to experience suicidal crisis. 988 is changing to serve them better

Free, largely confidential and available 24 hours a day via call, text or online chat, the 988 Lifeline — formerly the National Suicide Prevention Lifeline — is among the most accessible and effective suicide prevention tools in the U.S.

People have contacted the service roughly 25 million times since July 2022, when the previous 10-digit telephone number officially converted to the shorter and more memorable 988. An overwhelming majority of system users in a study commissioned by the agency that oversees the lifeline said they found it helpful and potentially lifesaving.

Yet for one particularly vulnerable population, the decision to reach out can be especially complicated.

Many autistic people require additional time to process verbal information, particularly in stressful or overwhelming situations. If a question is long or laden with metaphoric speech — “feeling blue,” “get it off your chest” — the time required only expands. Some have reported being hung up on when a 988 counselor misinterpreted their silence to mean they’d walked away.

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Others have struggled to make their needs understood, or found that the encounter unfolded in a way that unintentionally caused further harm.

Some years ago, before the launch of the national lifeline’s text service, Rae Waters Haight contacted a text crisis line during a challenging period. The counselor asked a routine question to assess his safety: Was there anything in his house right now that he could use to hurt himself?

Like many autistic people, Haight’s mind interprets language in its most literal sense. Mentally he scanned the rooms of his Carlsbad home, envisioning various objects and the ways they might cause harm. He had no intention of using any of these items, but that wasn’t the question he had been asked.

Yes, he replied.

Haight ended the conversation and headed to bed, telling himself he’d feel better after a night’s sleep. To his alarm, police lights soon flashed through his bedroom window. They were officers dispatched by a concerned counselor who misinterpreted his factually accurate answer as a statement of intent.

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Haight is now part of a growing network of researchers and advocates working to ensure that crisis counselors have the tools they need to help autistic callers, and that autistic people and those who care for them understand what to expect from 988 and similar crisis intervention services before they need to dial.

“Misunderstandings happen frequently between autistic and non-autistic individuals, and this can be difficult at the best of times,” he said. “But during a crisis, the stakes are high.”

Autism spectrum disorder is a neurodevelopmental condition that manifests differently in nearly every person who has it. While the spectrum encompasses a wildly diverse range of behaviors, skills and communication styles, its core traits center on differences in social communication and sensory processing.

For a variety of reasons, autistic people of all ages are significantly more likely than neurotypical peers to experience suicidal thoughts and attempt suicide. In the compressed world of a 988 call, in which both counselor and caller are strangers with little information to go on besides the words they exchange, the potential for miscommunication is high.

“The crisis counselors try to help, but end up kind of just landing wrong.”

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“Autistic people are misunderstood and have difficulty conveying what they’re going through in a way that’s productive,” said Lisa Morgan, founder and co-chair of the Autism and Suicide Prevention Workgroup, a research collective dedicated to the issue. “The crisis counselors try to help, but end up kind of just landing wrong.”

An autistic person’s tone of voice or emotional affect may sound to a non-autistic person as if it doesn’t match the situation’s gravity. Some are mentally soothed by repeating specific words or phrases, a phenomenon known as echolalia, which can be misinterpreted by someone unfamiliar with the trait as mocking or uncooperative.

Many autistic people also have alexithymia, a trait that makes it exceptionally difficult to identify and describe emotions, and have been stymied by questions intended to assess their internal state.

Such misunderstandings can leave the caller feeling frustrated and alone. They can also inadvertently escalate a situation.

According to 988’s confidentiality policy, counselors may share a caller’s information with people outside of the lifeline system if they believe the caller or someone else is at immediate risk of harm, and discussing an alternative safety plan directly with the caller isn’t possible.

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Emergency services are contacted in fewer than 2% of calls, according to Vibrant Emotional Health, the nonprofit organization that administers 988, and most of these dispatches are made with the caller’s consent.

For many autistic people, even a slim prospect of an unwanted encounter with law enforcement or an emergency room is frightening.

“I’ve called 988, I’ve texted 988 before, and my experience was I don’t want to do it anymore.”

“I’ve called 988, I’ve texted 988 before, and my experience was I don’t want to do it anymore. You know why? Because the police will come. And they’ll take me to the hospital,” said Kayla Rodriguez, 29, an autistic woman who lives in the Greater Atlanta area.

Although an emergency room can keep someone safe, many autistic people find its bright lights, incessant noise and unfamiliarity to be more distressing than helpful. A hospitalization during one suicidal period triggered for Rodriguez a yearlong episode of autistic burnout, a form of exhaustion in which the ability to function or tolerate stimuli plummets.

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An encounter with police carries its own risks. Rodriguez was particularly unsettled by the March 1 death of Alex LaMorie, a 25-year-old autistic man who called 911 (not 988) during a suicidal crisis and was shot by responding officers after allegedly failing to drop a knife at their command.

“I wish there were more options to deal with suicidality than just the police and the hospital,” Rodriguez said. “But also, I just wish people would calm down … try to talk to us, try to engage with us and help de-escalate the situation, instead of making it worse.”

Autistic people who have called the crisis line say they don’t expect counselors to be mind readers. But they would like them to be open to adjusting their approach.

“Adapt to the person [calling]. Don’t make the person adapt,” said Andrea Bleifuss, 43, of Portland, Ore., who has worked in mental health care facilities and called the crisis line herself.

The counselors who made her feel truly understood “don’t even have to understand what I’m going through, but they do understand how to relate to someone, how to adapt whatever training they’ve had.”

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Morgan, who is herself autistic, and her research partner Brenna Maddox, a clinical psychologist and co-chair of the workgroup, set out to help the 988 system do just that.

In 2023, they published a guide to help crisis workers assess whether the person they are talking to could be on the autism spectrum. It also offered specific conversation strategies that could improve the call: asking if the person has any special interests; asking clear, short, direct questions; allowing ample time for the person to respond; and being open to the caller’s own suggestions for what works for them. The final page of the guide is a single sheet of tips that crisis workers can print out and hang by their desk.

“An autistic individual may say that spinning quarters is a good distraction technique for them,” reads one tip. “Even if that sounds unusual to the crisis center worker, it is still a valid and acceptable answer.”

The following year, they published a detailed guide for autistic adults on what to expect when contacting 988. This includes the likelihood of a wait time (the 988 number connects to a network of more than 200 individual call centers around the U.S. and it can take a few minutes to find an available counselor) and how to sign off on a call or text chat. Earlier this year, the workgroup released a version for autistic youth and their caregivers.

Then last year, they achieved a goal long in the works: direct training for 988 counselors. Morgan and Maddox conducted three one-hour webinars for Vibrant that covered the fundamentals of autism, autism-specific suicide warning signs and support strategies for autistic people in crisis.

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The sessions were voluntary, and their recordings were placed in the online library of continuing education materials available to all 988 counselors. More than 1,200 people have already viewed the training live or watched the webinars, according to Vibrant.

No single approach works for every 988 caller, autistic or not. The goal is to expand the skills and ideas a counselor can draw from when trying to form a connection.

“Across multiple trainings, we have had attendees say or put in the chat, ‘These recommendations would be helpful for anyone,’” Maddox said. “If anyone is in crisis, do they want you spewing a lot of words at them [and] having this really long, wordy conversation? Or do they want you to be concise, to the point?”

Haight is now pursuing a doctorate in autism studies at Towson University in Maryland, and hosts meetings for autistic peer support groups. His long-term goal is to create a crisis hotline specifically for people on the spectrum, staffed by counselors who are either autistic themselves or have been trained by autistic people.

Right now, 988 offers callers direct access to counselors with specialized training in supporting veterans, another population with higher suicide rates than the national average. (A dedicated option for LGBTQ+ youth disappeared last year after the Trump administration terminated its funding.) Haight believes autistic people should have something similar.

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“I was convinced that a unique crisis support for autistic people must exist, given our high rate of suicidality and unique needs, so I searched for one, but I found none. What I did find was a wealth of evidence that a dedicated support should exist,” he said. “Autistic people have unique communication needs, yet crisis supports were not created with autistic needs in mind.”

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Amid E. coli outbreak, California-based Raw Farm voluntarily recalls cheddar cheese

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Amid E. coli outbreak, California-based Raw Farm voluntarily recalls cheddar cheese

Yes, Mark McAfee is pulling his cheese.

No, he is not happy about it.

The U.S. Food and Drug Administration asked McAfee’s Fresno-based Raw Farm weeks ago to voluntarily withdraw its unpasteurized cheese products from the market as the agency investigates an E. coli outbreak that has sickened nine people in three states — seven of them in California.

The U.S. Centers for Disease Control and Prevention has warned the public not to buy, sell or serve the company’s raw cheddar cheese, which five of those who had an E. coli infection say they ate before their illness.

For three weeks, McAfee refused to abide by the government’s wishes. But on Friday he finally relented, saying he has “involuntarily” recalled seven batches of cheese, even though the FDA has yet to confirm that E. coli has been found in any Raw Farm products. The agency has not issued a formal recall, though it has sent out a warning letter telling customers to avoid Raw Farm products purchased on or after Jan. 4, particularly raw milk cheddar cheese.

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“This Voluntary Recall is being performed under protest,” the company wrote in an announcement posted Friday by the FDA. “This Voluntary Recall is performed as a path forward.”

McAfee said he tests every batch of milk that comes out of his milking parlors, and none has been positive for E. coli, salmonella, campylobacter, listeria or any other contaminant that causes human illness. He has shared those results with both the FDA and state regulators, he said.

He said the agency came to his farm and “spent nearly a week” reviewing his tests.

“They were very impressed,” he said.

“There’s no pathogenic bacteria correlating us to anybody,” said McAfee. “What they did was a backdoor move. They said, ‘We’ll just let everybody know we’re concerned,’ and that is enough to have stores kick you out.”

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The FDA has not yet responded to requests for comment.

Last month, the FDA and CDC announced an investigation into an E. coli outbreak that since September has sickened nine people in California, Florida and Texas, three of whom have been hospitalized. More than half the cases are children aged 5 or younger. One patient required treatment for hemolytic uremic syndrome, a serious kidney complication.

Genome sequencing of E. coli isolated from each patient found that the strains were closely genetically related, suggesting that all of the ill people were exposed to the same source of infection.

State and local public health officials were able to interview eight patients or their caregivers. All said they’d consumed raw dairy products before falling ill. Two whose illness started in late 2025 said they drank Raw Farm’s raw milk, and five who fell sick in 2026 had eaten the company’s raw cheddar. (The eighth couldn’t recall the brand of the raw milk they drank.)

While testing of retail samples of Raw Farm cheese on sale in March found no E. coli, California has not ruled out the farm as the outbreak’s source given the number of patients who consumed its products before infection, a California Department of Public Health spokesperson said.

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“Retail cheese samples collected do not represent all raw cheese products sold by Raw Farm and may have been from different lots of production than those consumed by ill persons,” the agency said in a statement. “CDPH considers Raw Farm raw dairy the source of the outbreak based on this strong epidemiologic data, despite the negative laboratory testing results from a limited sample of retail products.”

Raw, or unpasteurized, dairy has not undergone the heating process that kills harmful bacteria while leaving nutrients largely intact. Raw Farm’s products alone have been associated with at least 239 reported cases of food poisoning since 2006, including a salmonella outbreak in October 2024 that sickened 171 people, according to Bill Marler, a food safety lawyer with Seattle-based MarlerClark.

He said the FDA’s decision to send out a warning letter instead of issuing a recall is “completely normal,” and the agency is very conservative when it comes to food safety.

“It makes sense, under the circumstances, to pull the product from the shelves,” he said of grocery stores. “Hell, if I was a retailer, I would pull it, because the last thing you’d want to do is have the product on the shelf, have it test positive for some E. coli, and have it poison some little kid and who then gets kidney failure.”

Proponents of raw dairy have long insisted that it prevents allergies and promotes beneficial bacteria, claims that are not supported by research. They include U.S. Health and Human Services Secretary Robert F. Kennedy Jr., a longtime fan who celebrated the release of the 2025 “MAHA Report” with a shot of raw milk.

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McAfee was among those hopeful that Kennedy’s tenure would usher in a more favorable regulatory environment for raw dairy producers. But despite having been contacted by Kennedy surrogates before Trump’s second inauguration, he’s not heard from them since.

He said the administration has done little to promote raw dairy as part of a revamped food policy that emphasizes meat and whole-fat milk as essential for a healthy diet.

The FDA’s webpage about raw dairy was last updated during the Biden administration, and cautions people to avoid raw milk products and dispels research claiming it is healthy.

“They fired their best people at FDA and hired some good people and weird people and whatever,” McAfee said. “It’s so emblematic of a three-ring circus. The entire freaking administration is showing that through their lack of consistency, the lack of policy adherence, they just do what the hell they want to do.”

What has changed under the new administration is the FDA’s ability to carry out investigations like the one it says it has initiated at Raw Farm. Inspections, lab work and outbreak investigations are among the agency functions most hindered by significant staff reductions that have taken place since Trump took office, industry experts have warned.

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The Department of Health and Human Services has lost 18,200 employees since Trump took office, according to the Department of Personnel Management’s Federal Workforce Data tool. More than 3,000 of those losses were at the CDC, and about 4,500 were at the FDA.

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