Unlike his first, Donald Trump’s second campaign did not focus on the Affordable Care Act or health care policy. A Associated Press Survey found that most voters did not consider health care to be very motivating, and only 8% of voters surveyed rated it as a top issue.

However, the results of this election will harm the medical profession. Over the past four years we have seen an incredible erosion in the ability of physicians to establish norms and standards for their practices. Instead, judges, politicians and activists (many of them without any medical training) have substituted their own judgment for what constitutes adequate medical care. The legal erosion of the medical profession will only accelerate under the second Trump administration.

Historically, law, medicine and divinity They have self-regulated. Medical professional organizations, specialty societies, and physician-led organizations develop both. standards of care and standards of practice, including who can become a doctor. And the self-regulation of the medical profession allows doctors and patients broad freedom to make the appropriate decision in each case.

But the last four years have seen a significant erosion in doctors’ ability to self-regulate. First, during the pandemic trust in doctors plummeted. One surveypublished in the Journal of the American Medical Academy, indicated that between April 2020 and January 2024, trust in doctors and hospitals fell from 71.5% to 40.1%. The same study suggested that people with less trust in the medical profession were less likely to have been vaccinated against Covid-19. Public trust is a necessary component of self-regulated professions. The general distrust that prevails in 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 abortion care, has provided the model for substituting political judgment for medical expertise. States rushed to criminalize abortion care, often without meaningful involvement from doctors. This shows how unworkable the exceptions for the patient’s health or life are in most abortion bans. In Texas, for example, a doctor must determine that a patient has a “life-threatening physical condition” that places her at “risk of death” or at “serious risk of substantial impairment of a major bodily function” before performing an abortion. But this requirement it is already deviating of the standard of medical care, which is to intervene before a patient develops a life-threatening physical condition. And doctors are now vulnerable to criminal charges, fines of hundreds of thousands of dollars, and even prison sentences if they attempt to provide evidence-based care to patients needing abortions.

Trump himself has certainly played a leading role in the unraveling of medical self-regulation. His Supreme Court appointees created the majority that overturned Roe v. Wade. His advice to combat Covid-19 was often worktop to that of his own experts, as when he suggested injecting bleach.

And Trump only redoubles his attacks on the medical profession by courting the Make America Healthy Again motion. Make American Healthy Again is the spearhead of vaccine skeptics Robert F. Kennedy Jr., that promises to end the “FDA war on public health.” This may translate into ending water fluoridation, contrary to the recommendations of the American Dental Association and the Centers for Disease Control and Prevention. It will almost certainly mean pressure to reverse the approvals of vaccines and even withdraw some vaccines from the marketdespite the almost universal medical consensus on the importance of vaccination against many diseases. Kennedy, in particular, has no medical experience or training, but will likely be empowered to “go mad”about health as Trump has stated.

There are also concerns that Trump will “clean up” federal agencies, removing officials he perceives as disloyal to himself and his agenda. During his final months in office in 2020, Trump issued an executive order: “Schedule F”, which would have exempted federal positions of a “confidential, determining, formulating or defending policy nature” from labor protections. This would have made it easier for Trump to replace up to 50,000 federal workers, including those in health-focused agencies with relevant degrees and years of training. By removing career public officials, it will be easier for Kennedy, or another Trump appointee, to push controversial and untested initiatives.

But Kennedy is not the only challenge to the medical profession’s control of health care in the coming years. This fall, in Braidwood vs. Becerrathe 5^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 voluntary group of experts in disease prevention and evidence-based medicine. . The Appointments Clause of the Constitution, the 5th^th Circuit, prevents public policy from being driven by a group of experts who are not supervised by government officials and are not themselves appointed as “officials of the United States.”

braided wood It is alarming not only because it may undo the no-cost preventive care mandate, but because right now many other public health standards and health policies are set by similar nongovernmental panels of experts. In fact, the Braidwood Claimants They are attempting to expand this case to include a review of the ability of the Advisory Committee on Immunization Practices and the Health Resources and Services Administration to also make recommendations regarding preventive care. This case will likely be argued before the Supreme Court created by Trump to be skeptical of the experience, which could potentially even include additional Trump appointments. The result may further limit the influence of medical and public health experts by preventing government agencies from incorporating their recommendations, standards and other conclusions into regulations.

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

If the court upholds the ban on gender-affirming care, it could open the floodgates for states seeking to ban or limit access to politically disadvantaged health care. For example, the Braidwood plaintiffs argued that the provision of no-cost HIV pre-exposure prophylaxis Promotes sexual promiscuity and intravenous drug use. A state that used a similar approach to ban abortion or gender-affirming healthcare could criminalize the provision of PrEP. Substance use treatments, IVF and vaccines have at times been politically controversial and may find themselves caught in the crosshairs again.

These bans would likely come from the states (in part because under police power they have greater freedom to regulate health care) and would result in the medical profession losing control of best practices and 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 flagged 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 plans for health care. Some, like focusing on chronic diseases, can be good. But overall, Trump and his team show little respect for doctors and other public health experts. This comes at a time when the medical profession’s ability to self-regulate, including determining what treatments are appropriate to offer to patients, is under attack.

Medical leadership must find ways over the next four years to regain public trust and emphasize to the public that the patient and doctor, not the legislator, should be the ones making health care decisions. Your ability to determine the scope of the medicine may depend on this.

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