​The guest on this week’s Al Franken podcast is author, public health advocate, and American surgeon Atul Gawande.  As Al writes, “Elon Musk and DOGE have been taking a chainsaw to the federal government since Trump was re-elected. It could take us generations to fully recover from the damage inflicted by the careless and cruel nature of these cuts. We’re joined by Atul Gawande to discuss just how devastating these actions are. During the Biden administration, Gawande was a senior official at USAID. He walks us through many of the great works the program did around the world… and the damaging and deadly road that lies ahead now that it’s been gutted.
 
“We also discuss the state of our healthcare system and the popularity of Medicaid expansion. The Affordable Care Act has improved the lives of millions of Americans, but Donald Trump and the Republicans threatened to take it away from Americans in his first term. Does he dare try again?”

When I was back in Chicago -- Evanston actually, staying just a few blocks from the beloved Northwestern -- I saw the news story on how the Trump administration (in its ongoing fascist effort to destroy education in the United States) had added Northwestern to its list and was demanding "changes" or else they would freeze $790 million in federal funding from the school. This stems from, as the New York Times stated it, Trump team "accusations of racial discrimination stemming from their efforts to promote diversity."

As the article later notes, Northwestern (a Big Ten university) is the first non-Ivy League school to have funding from the Trump administration targeted.

A spokesman for the school, Jon Yates, said -- "Federal funds that Northwestern receives drive innovative and lifesaving research, like the recent development by Northwestern researchers of the world’s smallest pacemaker, and research fueling the fight against Alzheimer’s disease. This type of research is now at jeopardy.”

Before we get to that, I think it's important to know what this actually means, and that's it's not just "spokesman fluff".  When he says "recent, that "world's smallest pacemaker" was announced literally less than two weeks ago, on April 2, and it's utterly remarkable.  Jaw-dropping breathtaking.  Whatever you may have in mind about "world's smallest pacemaker," you almost certainly might want to think smaller -- and even that's not the only thing that's stunning about it.  The device is so small, it can be inserted with a syringe, and then dissolves after it’s no longer needed!

Yes, that's a pacemaker.  And yes, that is small.  And it dissolves when not needed.  Here's a 90-second video about it --

And that's the thing about this fascist Trump effort -- accepted and enabled by MAGOPs in Congress -- to destroy education.  No doubt the base (and the word was never more accurate) loves when its party tries to undermine and shred education by freezing funding for all those "elites."  Except what so much of the federal funding goes for is critical research that impacts the lives of everyone -- Red, Blue and every color in between -- and also helps the U.S. lead the world in scientific and medical advances.

The $2 billion in funding that Trump/MAGOPs now want to freeze may be a joy to the base, but they might want to find out first that the bulk of the money goes for medical research into cancer and Alzheimer's Disease (neither of which discriminate on the basis of political belief...), and also Harvard-based hospitals, like the renowned Mass General and Boston Children's Hospital.  Neither of which discriminate on the basis of...oh, you know.  

If you (whoever you are) ever need and can benefit from the medical care or scientific advances from any of this research that Trump/MAGOPs are trying to freeze, because they want to destroy education and have it heel to their fascist beliefs, just know what could be lost could affect you or your loved ones.  And leadership in the fields might now go overseas.

That's what this is about. Not falsely presumed "elites" or the MAGOP-hated "education."

Which is why I was thrilled to see Harvard turn down the Trump/MAGOP demands, even if it meant losing $2 billion.  It will hurt Harvard -- but it will also hurt all Americans, because they're who benefit from medical advances and needs.  They and everyone in the world.

As Harvard President Alan Garber said, spot-on properly: “No government — regardless of which party is in power — should dictate what private universities can teach, whom they can admit and hire, and which areas of study and inquiry they can pursue.”

I must assume there will be lawsuits from Harvard and all the universities under threat of their government funding being frozen, including of course Northwestern.  So, hopefully, they will either get to keep their funding for research or won't be blocked.

In the meantime, though, great for Harvard.  What a courageous, important stand to take.

Which leads me to end with this from Tom Lehrer.  To be clear, it's a comic song that has nothing to do with medical research (though does with scholarship), and is really just a chiding number about what a football fight song should be for the school.  But its title fits perfectly, and so that's why we're going with it. 

"Fight Fiercely Harvard," indeed.
​

 
In fact, I recorded a brief video of one of the numbers at the rehearsal, to give you a bit of sense of it all.  You'll see a young, core combo backed by the members performing "Bye Bye Blackbird".  (Alas, there’s no dancing in this clip, but on the good side, you get to see John singing along.  He’s on the left in the second row, in a dark sweater and glasses.  He comes from good music pedigree.  As I’ve mentioned previously, his uncle is also John Kander, who wrote the music to such shows as Cabaret and Chicago.  My friend is JK II.)

​The Holiday Concert with the 5th Dementia Band and Special Guests will be held in Brentwood at the Presbyterian Church at 12000 San Vicente Blvd.  There’s free parking at the church lot south of San Vicente on Bundy Drive – or for for those who are better able to walk (to free up spaces in the closer lot), across the street at the Comerica Bank: 12001 San Vicente at Saltair (on the Upper Level)
 
For those in the area who can’t make it, or who live elsewhere, I believe they will be livestreaming the concert, which you should be able to watch at this link here.  It’ll be worth it.  They livestreamed yesterday’s rehearsal, and it was a treat.

For that matter, you can click on this link right now or anytime to watch the rehearsal I attended on November 21, to give you a very ragged sense of what it's like.  No, you can't see me -- though at the 6:15 mark you do see John get up to greet me!  So, that's the best I can do...  But if you do check out this particular rehearsal, jump to the 24:45 mark -- there's a beautiful, original song, "Christmas Must Be Somewhere," written and performed by one of the members, Bryan Scott Johnson.  He is a New York-based actor and singer, who as it happens was on Broadway in Mama Mia for around 10 years. He got Parkinson's eight years ago, yet his performance is terrific.

As is the full event and organization.

When I saw that Trump had nominated Robert Kennedy, Jr. to be Health and Human Services Secretary, my first reaction was to literally laugh.  Honest.  It was just one of those immediate, reflexive bursts, along with an eye roll and shake of the head.  An “Of course, he did!: sardonic laugh.
 
I mean, seriously, what did anyone expect?  Especially after nominating Matt Gaetz to be Attorney General, Tulsi Gabbard to be Director of National Intelligence and Fox Host Pete Hegseth to be Secretary of Defense.  And naming Elon Musk and Vivek Ramaswamy as co-Directors of Government Waste.

More on Kennedy in a moment, but first, because it's still too otherworldly nonsensical --  
How ludicrous a choice is Matt Gaetz to head the DOJ?  Former FBI Director Andrew McCabe told CNN that Matt Gaetz is someone who “quite frankly, couldn’t get hired by the FBI” (which is under the control of the Attorney General.  “Probably couldn’t qualify for a clearance.”
 
Head-numbing funny as that was to read, I then realized the same was true for Trump.  Except that, with 34 felony convictions and being found liable for rape and guilty of fraud, there would be no “probably” about it.
 
And the nomination is even more problematic for Trump because any nomination can only afford to lose through MAGOP votes and the Wall Street Journal reported that a person close to Senate discussions said that “as 30 Republican senators may cast a ‘no’ vote on Gaetz.”  To which he added, “It won’t even be close.”
 
(While I agree this is very possible, given how detested Gaetz is in Congress, there is still no evidence of a spine being found in the party’s caucus.  So, we’ll have to wait and see.  Most of the other nominees are likely safe, no matter how woefully unqualified and dangerous, but again, we’ll have to wait and see.  After all, Gabbard for the risks she poses, and Kennedy for his risk and out-of-control craziness may be a couple of bridges too far for some MAGOP senators, as well.  And could either be voted down or have their nominations withdrawn.  But…well, you know the mantra:  we’ll have to wait and see.)
 
But, of course, there’s a lot of ludicrous to pass around.  High on that list is Elon Musk saying that he wants to cut $2 trillion from the federal budget, which is about 30% of the $6.8 trillion budget.  Former Treasury Secretary Larry Summers explained how impossible, indeed close to lunatic this is. As he pointed out, the entire federal workforce makes up just 15% of the national budget.  That means if you got rid of absolutely every person who works for the government – everyone -- and had zero people left to do any work, you still would only be halfway to the amount that ace economist Musk wants to cut.
 
These are the clueless people Trump is putting in charge.  That was the richest man in the world.  Matt Gaetz is under an ethics investigation by his own party, and he quit the House so that he wouldn’t face condemnation.  And we haven’t gotten to Tulsi Gabbard as DNI – or Robert Kennedy Jr. as head of the Department of Health and Hu…
 
Sorry, I can’t even type the name again.  Once is enough.  And I won’t even get into all the vast reasons so many consider him a total nutjob whose own, honored family has separated themselves from his politics and issues.  Some of which are related to medical matters (like condemning vaccines, saying COVID only attacked certain groups of people, wanting to remove health-protecting fluoride from water systems, recommending quack COVID “cures” like Ivermectin, a version of which is known as horse drench, and hydroxychloroquine, which treats malaria, and saying that Dr. Anthony Fauci should be prosecuted), and some of which exist on their own planet (like running dumping a dead bear in Central Park).
 
More problematic is that the Department of Health and Human Services (I feel comfortable typing it here in its own standalone paragraph) doesn’t just deal with vaccines – but whoever heads the division oversees Medicare and Medicaid, as well as 11 other programs, decides what drugs are approved, and much more.  Including the areas of mental health, public health, alcohol and drug treatment, social services, assistance to people with disabilities and controls a $1 trillion budget, the largest in the country.
 
And, of course, Trump has nominated anti-vaxxer and conspiratorialist Robert Kennedy Jr. to be in charge.  Who is surprised?  What could go wrong?
 
(NOTE:  The people of Samoa could tell you.  After a tragic mistake in 2019 when two nurses accidentally mixed a measles vaccine with a muscle relaxer, two babies died.  The Children’s Health Defense non-profit came to Samoa, met with prominent anti-vaxxers and railed against vaccines.  The CDF’s founder and chairman came the country, encouraged the anti-vaxxers and met with the Samoan president to make the case against vaccines. As a result, the vaccination rate dropped from 75% to 31%, and a measles epidemic ensued.  In a population of 200,000, 83 people died – most children, the equivalent of 120,000 deaths in the U.S.  Oh, that founder and then-chairman of Children’s Health Defense was Robert Kennedy, Jr.  After the Samoan government instituted emergency vaccination regulations, a leading anti-vaxxer in the country was arrested for incitement against a government order.  Kennedy wrote an article calling the man “a medical freedom hero” and blamed the deaths on the vaccines, adding that the increase of cases – which led to all those deaths, mostly children – was nothing more than “a mild measles outbreak.”)
 
What could go wrong?  Now, add in being in charge of mental health, public health, alcohol and drug treatment, social services and assistance to people with disabilities.
 
And we haven’t even gotten to Kash Patel rumored to head the FBI and Sebastian Gorka to be National Security Advisor.
 
But…no one should be surprised.  Nobody.  This is who the 65 million people who voted against Trump tried to explain who he was.  Because…this is who Trump is.  When MAGOP officials would try to cover for Trump’s lapses into dementia and pathological behavior by dusting aside with “It’s just Trump being Trump,” I noted that that is precisely the problem.
 
And cabinet nominations of Matt Gaetz, Robert Kennedy Jr., Tulsi Gabbard, Kristi Noem, Marco Rubio, Elise Stefanik, and maybe Kash Patel and Sebastian Gorka, with Elon Musk and Vivek Ramaswamy as advisors is the damning result.  And God help us, who else to come.
 
The bad is that this is horrible for the country.  The good is that this is horrible for Trump.
 
The midterm elections are November 3, 2026.

​The guests on this week’s Al Franken podcast are Laura Bassett from The Cut and Sarah Zhang of The Atlantic. As Al writes, “This election could all come down to abortion. Both Laura and Sarah have been writing about the issue of abortion and how it’s playing into this election. Sarah’s recent piece in The Atlantic examined how Idaho’s draconian abortion laws have set the state’s healthcare back for women. Laura has been writing about the issue for years and says that it poses a serious threat to Ted Cruz’s reelection campaign in Texas.”  Together, they discuss the impact of abortion on the 2024 election.

​
There are a great many blunt, pointed, dark, critical words that have been used to describe Trump -- all accurate.  Except one:  narcissist.  While yes, on one level, it's absolutely correct (recently reported past comments from Mitch McConnell called him that), it really isn't fully accurate.  That's because the proper description that has been dropped over time is "malignant narcissist."  And though it may seem nitpicking, just a harsh adjective added on, it's not nitpicking at all, because the two are very different things.  The first is descriptive.  The second, malignant narcissist, is an actual medical term and describes a serious condition that can be a danger to society.

And though I've always kept the term in mind -- and reacted when I'd hear him called only a narcissist -- what got me thinking about it is that we're really seeing in full the critically important meaning of a "malignant narcissist" in the person of Trump.  Someone willing to literally destroy everything around them if they don't get their way.

A few years back, I came across an article on the Psychology Today website, written by Dr. Rhonda Freeman on the subject of malignant narcissism.  "A person with malignant narcissism has the potential to destroy families, communities, nations, and work environments," she wrote.  Later adding.  "However, they process information in ways that can hurt society in general, but also the people who love or depend on them."

Lest it got buried in the string of nouns, let me highlight it here:  "A person with malignant narcissism has the potential to destroy...nations."  (Not to mention "communities."  Just ask Springfield, Ohio.)

I wrote an article about this four years ago, and it occurred to me that as we are seeing that description of "malignant narcissist" coming to light in full force, it's proper to repeat it and see how impactfully it all relates to Trump.  Not his mere narcissism, but his malignant narcissism.  

Making clear that when MAGOPs dismiss his repugnant words and inexplicable actions as just "That's Trump being Trump," what they are unknowingly describing is the actual, serious dangerous problem.  Combined with his dementia, it's a disastrous combination.

Here is that article.  It leaps out profoundly, almost shockingly accurate, how what Dr. Freeman and others described about malignant narcissism in 2017 is manifesting itself with Trump in public before our eyes today.

 
You can read the full article here.
 
I am not going to start listing all the examples we've witnessed in Trump that appear to fit this description perfectly.  This list would be overwhelmingly too long.  I'm not even going to list examples from this year even.  In fact, I think it's telling enough to just say I'm not going to even list examples from the past week because it would be too many.  Even the weekend would be too much, since Trump went on a rampage of attacks against President Barack Obama, Vice President Joe Biden and now Dr. Rick Bright, the whistleblower who testified before Congress last week and appeared on 60 Minutes last night.  It's not that he attacked them all, and so often, but so maniacally.  And no, that's hot hyperbole.  And most sane people know it's not.  Trump literally tweeting "Obama was always wrong" is maniacal.  And that's without even the standard that U.S. presidents not criticize their predecessors.  Just on general principle is a maniacal comment.
 
(Okay, sorry, I gave an example.)
 
And we've all seen this malignant narcissism play itself out exactly as Dr. Freeman says about how it can be considered dangerous.  Again, no hyperbole here.  After all, Trump has said that the coronavirus will go away like a "miracle" and that he thinks testing is overrated and not only are there (as of this writing) 90,972 Americans who have already been confirmed to have died of the coronavirus, but only last week Trump -- despite knowing that -- still said that that even without a vaccine it will go away
 
That's malignant narcissism, and when you have 90,972 people dead and continuing, it's clearly profoundly dangerous.
 
(Okay, sorry, I gave another example.  Some things just can't be helped.)
 
The thing is, this is just my unschooled opinion, and of course means nothing.  My opinion is not based on being a professional psychiatrist examining a patient.  It's just based on one person looking from afar at another person over a lengthy period of time, and reacting as a human being to what I see.  Others are free to make their own subjective observation.  Some may agree -- I suspect most would agree -- and some wouldn't.  Fine, fair enough.  They are free to write their own articles attempting to explain why Trump's endlessly repeated actions are normal and just grand.
 
I only suggest one really basic, straightforward situation for anyone to judge their opinion by -- if you were a parent with a four-year-old, would you feel comfortable leaving your child alone with Trump as a babysitter?
 
No additional, challenging conditions like that there's more than one child, or a medical condition involved, or that it's for a whole weekend, or a bottle of disinfectant is left out.  Just one child, a few hours, Trump alone in charge of your four-year-old.
 
If your answer is, "No, but that's unfair because there are a lot of adults I wouldn't want leave a four-year-old child with," keep in mind that Trump is the most powerful man in the world, entrusted with the security of the United States and the free world, and commander-in-chief of the America armed forces.
 
If  your answer is "Yes," please expect a visit from social services.
 
To be clear, the answer to this question does not remotely prove that Trump is a malignant narcissist.  He is, but the question isn't what proves that.  The question just suggests is that something is seriously, deeply, profoundly wrong with him.  And, if your answer was "Yes," with you.
 
This isn't about name-calling.  The point is about something much larger.  Rick Wilson, who used to be a Republican strategist, wrote a book, Everything Trump Touches Dies.  It was a funny, telling line when the book was published.  The point is that "Everything Trump Touches Dies" isn't a funny line -- it's the ultimate result taken to the final extreme of a malignant narcissist.
 
Trump is a malignant narcissist.  I don't say that as a doctor.  I say that because my eyes are not shut tight.
 
And the elected members of the Republican Party are know this because they are not insane.  And yet knowing this, they still enable him.  And are complicit -- with blood on their hands.