What science issues President Trump did—and did not—address in this year’s State of the Union

Science got a nod early on in Tuesday’s 2019 State of the Union address. “In the 20th century, America transformed science,” President Donald Trump said, emphasizing the Apollo 11 mission that landed the first humans on the moon. Here are the other science and health topics he commented on during his second SOTU, in which he was tasked with reporting to Congress “such measures as he shall judge necessary and expedient.”

“We have unleashed a revelation in American energy. The United States is now the number one producer of oil and natural gas anywhere in the world.”

The country’s production and consumption of energy stood at the core of Trump’s 2016 campaign, when he vowed to “end the war on clean coal.” In Tuesday’s address, the president instead focused on other fossil fuels, stating that for the first time in 65 years, the United States is a net exporter of energy––in the form of oil and natural gas.

President Trump recently faced criticism for his failure to attend COP24, a key United Nations climate change conference held in Katowice, Poland, after months of cutting down on environmental protections and regulations. The only event hosted by the U.S. at the conference was one promoting the use of fossil fuels.

Carbon dioxide accounts for 65 percent of all greenhouse gas emissions. Fossil fuel use is the primary source of CO2 emissions, which heat the planet and exacerbate wildfires, rising sea levels, and hurricanes.

Cities including Minneapolis, Minnesota, have recently made plans to move to 100 percent reliance on clean energy in the next decade, and not a moment too soon. According to Environmental Protection Agency data, electricity and heat contribute to one-quarter of global greenhouse gas emissions. Energy associated with fuel extraction, refining, processing, and transportation makes up another 10 percent.

“In 2018 drug prices experienced their biggest decline in 46 years. But we must do more. It’s unacceptable that Americans pay vastly more for the exact same drugs.”

The Trump Administration wants to hold pharmaceutical companies accountable for rising prescription drug prices, an initiative that draws support from both sides of the aisle.

Last week the Department of Health and Human Services proposed a plan to eliminate rebates to Pharmacy Benefit Managers (PBMs), who act as the middlemen between pharmaceutical manufacturers and patients. Manufacturers set a price for each drug and PBMs negotiate rebates for patients, which make the drug cheaper. But patients don’t actually benefit: PBMs take a cut of these rebates, which are typically 20-30 percent of the original cost set by the manufacturer. The pressure to offer larger and larger rebates, drug manufacturers say, is the main reason they raise prices. Since rebates are negotiated as a percentage, both PBMs and pharmaceutical companies benefit from these hikes.

Under the new proposal, such rebates would work differently under Medicaid and Medicare. Drug manufacturers would pass discounts usually negotiated by PBMs directly to patients. According to MarketWatch, analysts don’t all believe this action will hurt PBMs. In August, STAT reported on the general sense of confusion around the administration’s PBM policies.

The proposal is the latest addition to the president’s American Patients First plan. Blueprints of the plan also include requiring drug manufacturers to disclose cost in television ads. The president stated on Tuesday that drug companies should be forced to openly list their prices—driving a competitive pharmaceutical market and keeping drug prices in check.

“Scientific breakthroughs have brought a once distant dream within reach. My budget will ask democrats and republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”

About 1.1 million Americans live with HIV, a virus that attacks the immune system. Taking medication regularly can keep the virus at bay, enough for it to become undetectable in the blood and therefore not transmittable. The CDC reports that, already, HIV is virally suppressed in 51 of every 100 people in the U.S. living with the disease.

“Together we will defeat AIDS in America,” said the president. Improvements in medication access, better healthcare for all, and the decrease of HIV stigma could make that a reality in our lifetimes, but it’s important to note that HIV does not always lead to AIDS. Acquired immunodeficiency syndrome is the final and most serious stage of HIV, and is preventable even in individuals who have contracted the virus.

“Most childhood cancers have not seen new therapies in decades.”

Trump announced that his new budget would ask for $500 million to support childhood cancer research. The National Cancer Institute estimates that over 15,500 adolescents were diagnosed with cancer last year.

“Lawmakers in New York cheered with delight upon the passage of legislation that would allow a baby to be ripped from the mother’s womb moments before birth.”

On January 22, New York Gov. Andrew M. Cuomo signed the Reproductive Health Act, legally ensuring the right to abortion in the state of New York. This marked the 46th anniversary of the landmark Roe v. Wade Supreme Court decision, which legalized abortion on the federal level (though it left much room for interpretation in how states should weigh a person’s right to abortion with its own policies).

The Reproductive Health Act allows abortions after 24 weeks if the fetus is not viable or if the mother’s health is at risk. The bill replaced a law which only permitted abortion after 24 weeks if a woman’s life was threatened. These terminations accounted for just 1.3 percent of all abortions in the U.S. in 2015, according to CDC data.

But not all the science and health issues you’ve seen in the news lately made it into the 2019 SOTU. Here are some topics the president skipped:

The Shutdown

The State of the Union was postponed because of the recent government shutdown, but Trump’s speech didn’t mention this event.

At 35 days long, it was was the longest U.S. government shutdown in history. It cost the U.S. an estimated $11 billion. It left unstaffed National Parks vulnerable to destruction. It slowed Superfund site mitigation, which cleans up the most polluted places in the country. It furloughed 40 percent of the people who usually monitor the safety of our food system.

It also slowed down science.

The National Science Foundation (NSF) funds nearly $8 billion in research grants each year, driving progress in everything from weather data to the tracking endangered species. The foundation funds nearly one-quarter of all federally-supported basic research conducted by U.S. colleges and universities.

NPR reported Friday that 111 panels of scientists and engineers had planned to review more than 2,000 proposals, but were not able to meet during the shutdown. Some grants that were approved before the shutdown were put on hold.

“This year astronauts will go back to space on American rockets,” the president said after introducing Buzz Aldrin, one of the first two humans to walk on the moon. NSF provides virtually all of U.S. federal funding for ground-based astronomy and works closely with NASA.

Infrastructure

Some speculated the president would touch on the nation’s problematic infrastructure––54,259 of the nation’s 612,677 bridges are rated “structurally deficient” and the system of locks and dams that make waterway transportation possible are deteriorating.

Drinking water is a part of infrastructure, too.

Residents of Flint, Michigan have been dealing with a water crisis since 2014. The city identified more than 18,000 lead and galvanized steel water lines that may have contributed to their infamous water contamination. The plan is to replace them all by the end of this year, but Flint isn’t the only water system at risk.

Drinking water flows through a million miles of pipes throughout the U.S., and according to the American Society of Civil Engineers, a lot of these pipes are near the end of their lifespan.

In November, elevated lead levels were found in Newark, New Jersey, where around 15,000 lead pipes deliver water throughout the city. Chicago, Detroit, Baltimore, Milwaukee, and New York City Public Schools also struggle with lead-laden water. Any level of lead can cause permanent damage in developing children.

Bacteria such as E. coli and Legionella pneumophila (which causes Legionnaires’ disease), as well as parasites, also plague water systems in the U.S.—especially in rural areas.

Opioids

The president did mention America’s growing drug epidemic: “Tens of thousands of innocent Americans are killed by lethal drugs that cross over our borders and flood into our cities including meth, heroine, cocaine, and fentanyl.” But that’s as far as he went on opioids.

The Centers for Disease Control and Prevention estimates that misuse of prescription opioids alone costs the U.S. $78.5 billion every year. The rate of opioid-related deaths among people in the U.S. was five times higher in 2016 than in 1999, and Americans are now more likely to die due to opioid use than from a car crash. One recent study suggested that for teen users, routine procedures like wisdom tooth extraction could encourage and enable eventual drug abuse.

Massachusetts Attorney General Maura Healey filed a lawsuit last week against Purdue Pharma, the pharmaceutical company behind OxyContin, on behalf of 670 Massachusetts residents who were prescribed the drug became addicted to opioids and died of an overdose.

Purdue Pharma hired a consulting firm to target “high-prescribing doctors” after OxyContin sales took a hit in 2013.