Annotating the "MAHA report" with AI

This is an experiment in AI-based fact-checking and contextualization. I have used specialized AI-based tool I built -- SIFT Toolbox -- to annotate over 50 claims in the MAHA introduction (and only the introduction so far; pages 7-19), using a human-in-the-loop process that on average takes about 20 minutes a claim. This allowed me to check the report fairly deeply, even though this work is (at this point) merely a weekend hobby of mine (it has been a very long weekend, tbh).

While sometimes the annotations function as fact-checks, they more generally aim to bring broader context to the report: not everything checked is "wrong" -- part of the experiment was to see what happens when tools allow you to check nearly everything. To see the annotations, you can access "context reports" by clicking the links in the document below. Output has been checked only in the briefest way (generally less than 15 minutes a claim) so please see these context files as a first pass at the issues described, and check all facts if the stakes of error are high. Go to report/annotation start

About me

If you’re coming here from somewhere other than my substack and don’t know who I am, I’ve spent more than a decade working on how to use search to contextualize artifacts, events, and claims. With Sam Wineburg I wrote the definitive book on that subject (University of Chicago Press, endorsed by Maria Ressa, the Nobel Prize winner). There are features delivered on every Google search result that are inspired by my work. My SIFT method is used in hundreds of universities, and over the past decade has become the primary way that information literacy in taught in U.S. universities and around much of the world, and the Google Super Searchers curriculum I co-developed with Google has been translated into a dozen languages and is one of the most successful information literacy initiatives in history.

I’ve recently begun exploring how AI can assist with providing quick context to claims, quotes, media, and events. This is my latest experiment in that area. I am currently doing this as personal exploration and have no institutional support or funding.

-- Mike Caulfield, June 8, 2025

Go to report/annotation start

Prompting layer used for this project is here. It is designed to run on a paid version of Claude Sonnet 3.7 or 4. (Paid account is necessary so it will execute the necessary searches). It can also run fairly well on ChatGPT o3. I would not run it on other platforms or models due to link hallucination issues.

7 Introduction The health of American children is in crisis. Despite outspending peer nations by more than double per capita on healthcare, the United States ranks last in life expectancy among high-income countries – and suffers higher rates of obesity, heart disease, and diabetes. 12 Today’s children are the sickest generation in American history in terms of chronic disease and these preventable trends continue to worsen each year, 3 posing a threat to our nation’s health, economy, and military readiness. In 2023 alone, national health expenditures were projected to grow by 4.4%, 4 outpacing real U.S. GDP growth of just 2.5%. 5 Yet despite the ever-growing financial investment in the U.S. healthcare system, American life expectancy lags other high-income countries. 1 Wager, E., Telesford, I., Rakshit, S., Kurani, N., & Cox, C. (2024, October 9). How does the quality of the U.S. health system compare to other countries? Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system- compare-countries/. 2 Tikkanen, R., & Abrams, M. K. (2020, January 30). U.S. health care from a global perspective, 2019: Higher spending, worse outcomes? The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019 3 Wisk, L. E., & Sharma, N. (2025). Prevalence and Trends in Pediatric-Onset Chronic Conditions in the United States, 1999-2018. Academic Pediatrics, 102810. 4 Centers for Medicare & Medicaid Services. (2024). National health expenditure (NHE) fact sheet. U.S. Department of Health and Human Services. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet. 5 Bureau of Economic Analysis. (2024, February 28). Gross domestic product, fourth quarter and year 2023 (second estimate). U.S. Bureau of Economic Analysis. https://www.bea.gov/news/2024/gross-domestic-product-fourth-quarter-and-year-2023-second-estimate. Life Expectancy and Health Expenditure Per Capita By Country (1970-2023)
8 Over the past century, U.S. GDP has grown over 30,000%. 6 Today, American farmers feed the world, American companies lead the world, and American energy powers the world. This economic growth has been a force for technology, health and agriculture innovations that have increased U.S. life expectancy by more than 30 years compared to 1900. But the same forces of modernization and industrialization have also introduced threats to our health and revealed growing inefficiencies in our ability to respond to them. Over the past two generations, we have failed to address the alarming rise in childhood chronic disease. Federal and state policy have sometimes been guided more by corporate profit than the public interest. Many of our leading scientific and medical institutions have grown complacent, defaulting to symptom management rather than harnessing gold-standard science to prevent and reverse root causes. The U.S. food and agricultural systems have embraced ultra-processed ingredients and synthetic chemicals. Meanwhile, our healthcare system has over-medicalized children, frequently masking and compounding underlying issues. Coupled with rising screen addiction and sedentary lifestyles, these factors are converging to produce a chronically stressed, sick, and isolated generation. This crisis is undermining national resilience and competitiveness. The purpose of this report is radical transparency about our current state to spur a conversation about how we can build a world – together – where: American farmers are put at the center of how we think about health. The American healthcare system thrives when disease is prevented and reversed, not just “managed” in a sick-care system. The Great American Comeback of energy dominance powers AI technology that will develop new tools and push the frontiers of science to help us better understand how to measure and reverse chronic disease. The next ten years see a revolution in living standards and prosperity, while we understand how to better manage the increased threats to our children’s health that come from industrialization. America will begin reversing the childhood chronic disease crisis during this administration by getting to the truth of why we are getting sick and spurring pro-growth policies and innovations to reverse these trends. These concerning trends persist despite decades of federal investment in nutrition standards, physical activity campaigns, chemical risk assessments, and clinical quality initiatives. Still, childhood chronic disease continues to rise. To Make Our Children Healthy Again, we must go further. This assessment begins with a shared understanding of the crisis. 6 Federal Reserve Bank of St. Louis. (n.d.). Gross Domestic Product [GDP]. FRED, Federal Reserve Economic Data. Retrieved May 16, 2025, from https://fred.stlouisfed.org/series/GDP.
9 The Chronic Disease Crisis: A Generation at Risk America’s children are facing an unprecedented health crisis. Over 40% of the roughly 73 million children (aged 0-17) in the United States have at least one chronic health condition, according to the CDC, such as asthma, allergies, obesity, autoimmune diseases, or behavioral disorders. 7 Although estimates vary depending on the conditions included, all studies show an alarming increase over time. 8 9 This chronic disease crisis has far-reaching consequences: Over 75% of American youth (aged 17- 24) are ineligible for military service—primarily due to obesity, poor physical fitness, and/or mental health challenges. 10 Here, we provide a brief overview of the problem – the main epidemiological trends related to childhood chronic disease in America, including obesity, diabetes, neurodevelopmental disorders, cancer, mental health, autoimmune disorders, and allergies. 7 National Survey of Children’s Health. (n.d.). NSCH 2018-19: Number of current or lifelong health conditions, nationwide, age in 3 groups. ChildHealthData.org. Retrieved February 24, 2021, from https://www.childhealthdata.org. 8 Wisk, L. E., & Sharma, N. (2025). Prevalence and Trends in Pediatric-Onset Chronic Conditions in the United States, 1999–2018. Academic Pediatrics, 25(4), 102810. 9 Bethell, C. D., Kogan, M. D., Strickland, B. B., Schor, E. L., Robertson, J., & Newacheck, P. W. (2011). A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations. Academic pediatrics, 11(3), S22-S33. 10 Novelly, T. (2022, September 28). New Pentagon study shows 77% of young Americans are ineligible for military service. Military.com. https://www.military.com/daily-news/2022/09/28/new-pentagon-study-shows-77-of-young-americans-are-ineligible-military-service.html.
10 Childhood Obesity is a Worsening Health Crisis ● Today in the U.S. more than 1 in 5 children over 6 years old are obese. 11 This is a more than 270% increase compared to the 1970s, when less than one in twenty children over 6 were obese. 12 ○ Rates of severe obesity increased by over 500% in the same period. ● The U.S. obesity rate is, on average, more than double that of its G7 peers. ● Approximately 80% of obese teens will be obese into adulthood. 13 ● Around 70% of youth with obesity already have at least one risk factor for heart disease 14 11 National Center for Health Statistics. (2021, January 29). Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. Centers for Disease Control and Prevention (CDC). 12 Fryar, C. D., Carroll, M. D., & Afful, J. (2020). Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. NCHS Health E-Stats. https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/obesity- child.htm. 13 Simmonds, M., Llewellyn, A., Owen, C. G., & Woolacott, N. (2016). Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obesity reviews: an official journal of the International Association for the Study of Obesity, 17(2), 95–107. https://doi.org/10.1111/obr.12334. 14 Freedman, D. S., Mei, Z., Srinivasan, S. R., Berenson, G. S., & Dietz, W. H. (2007). Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. The Journal of pediatrics, 150(1), 12–17.e2. https://doi.org/10.1016/j.jpeds.2006.08.042. Prevalence of Obesity Amongst G7 Countries, Ages 5-19 (1990-2022)
11 Diabetes is Increasing among American Youth ● In the 1980s, there were very few cases of type 2 diabetes in children, and incidence rates for both type 1 and type 2 diabetes have consistently increased the past 2 decades. 15 16 ● Today, over 350,000 children have been diagnosed with diabetes (3.5 per 1,000). 17 18 One study estimated a 65% increase in type 1 diabetes and a more than 600% increase in type 2 diabetes by 2060 if current trends continue. 19 ● Prevalence of pre-diabetes (elevated blood sugar levels but not high enough to be classified as diabetes) is more than one in four teens, having more than doubled over the last 2 decades. 20 21 15 Cizza, G., Brown, R. J., & Rother, K. I. (2012). Rising incidence and challenges of childhood diabetes. A mini review. Journal of endocrinological investigation, 35, 541-546. 16 Divers, J., Mayer-Davis, E. J., Lawrence, J. M., et al. (2020). Trends in incidence of type 1 and type 2 diabetes among youths — Selected counties and Indian reservations, United States, 2002–2015. MMWR Morbidity and Mortality Weekly Report, 69(6), 161–165. https://doi.org/10.15585/mmwr.mm6906a3. 17 Centers for Disease Control and Prevention. (2023, November 29). National diabetes statistics report: Estimates of diabetes and its burden in the United States. https://stacks.cdc.gov/view/cdc/148231. 18 Fang, M., Wang, D., & Selvin, E. (2024). Prevalence of type 1 diabetes among US children and adults by age, sex, race, and ethnicity. JAMA, 331(16), 1411-1413. 19 Tönnies, T., Brinks, R., Isom, S., Dabelea, D., Divers, J., Mayer-Davis, E. J., ... & Imperatore, G. (2023). Projections of type 1 and type 2 diabetes burden in the US population aged< 20 years through 2060: the SEARCH for diabetes in youth study. Diabetes Care, 46(2), 313-320. 20 Liu, J., Li, Y., Zhang, D., Yi, S. S., & Liu, J. (2022). Trends in prediabetes among youths in the US from 1999 through 2018. JAMA pediatrics, 176(6), 608-611. 21 Andes, L. J., Cheng, Y. J., Rolka, D. B., Gregg, E. W., & Imperatore, G. (2020). Prevalence of prediabetes among adolescents and young adults in the United States, 2005-2016. JAMA pediatrics, 174(2), e194498-e194498. Prevalence of Pre-Diabetes Ages 12-19 (1999-2018)
12 Rates of Neurodevelopmental Disorders are Increasing ● Autism spectrum disorder impacts 1 in 31 children by age 8 and is estimated to be 3.4 times more common in boys than girls, according to the CDC. 22 Rates also vary significantly by state – from 9.7 per 1,000 in Texas (Laredo) to 53 per 1,000 in California. 23 In 1960, autism occurred in less than 1 in 10,000 children. 24 25 In the 1980s, autism occurred at rates of 1 to 4 out of 10,000 children. 26 ● Over 10% of children have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), with approximately 1 million more children diagnosed in 2022 compared to 2016. 27 ● Rates of other neurodevelopmental disorders and learning impairments are also increasing. 28 29 Over 7.5 million K-12 students received special education services in 2023-24. 30 22 Centers for Disease Control and Prevention. (2024). Autism data & research. National Center on Birth Defects and Developmental Disabilities. https://www.cdc.gov/autism/data-research/index.html. 23 Shaw, K. A., Williams, S., Patrick, M. E., et al. (2025). Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years — Autism and developmental disabilities monitoring network, 16 sites, United States, 2022. MMWR Surveillance Summaries, 74(SS-2), 1– 22. https://doi.org/10.15585/mmwr.ss7402a1. 24 Talantseva, O. I., Romanova, R. S., Shurdova, E. M., Dolgorukova, T. A., Sologub, P. S., Titova, O. S., ... & Grigorenko, E. L. (2023). The global prevalence of autism spectrum disorder: A three-level meta-analysis. Frontiers in psychiatry, 14, 1071181. 25 Treffert D. A. (1970). Epidemiology of infantile autism. Archives of general psychiatry, 22(5), 431–438. https://doi.org/10.1001/archpsyc.1970.01740290047006. 26 https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5601a1.htm. 27 Danielson, M. L., Claussen, A. H., Bitsko, R. H., Katz, S. M., Newsome, K., Blumberg, S. J., ... & Ghandour, R. (2024). ADHD prevalence among US children and adolescents in 2022: diagnosis, severity, co-occurring disorders, and treatment. Journal of Clinical Child & Adolescent Psychology, 53(3), 343-360. 28 Zablotsky, B., Ng, A. E., Black, L. I., & Blumberg, S. J. (2023, July 13). Diagnosed developmental disabilities in children aged 3–17 years: United States, 2019–2021 (NCHS Data Brief No. 473). Centers for Disease Control and Prevention. https://stacks.cdc.gov/view/cdc/129520. 29 Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., Danielson, M. L., Bitsko, R. H., ... & Boyle, C. A. (2019). Prevalence and trends of developmental disabilities among children in the United States: 2009–2017. Pediatrics, 144(4). 30 National Center for Education Statistics. (2024). Students with disabilities. Condition of Education. U.S. Department of Education, Institute of Education Sciences. https://nces.ed.gov/programs/coe/indicator/cgg. Autism Rates Amongst Children by Age 8 (1992-2022)
13 Childhood Cancer Incidence Has Risen Dramatically ● Childhood cancer incidence has risen over 40% since 1975. 31 31 National Cancer Institute, SEER-8 Registries, 1975-2022. Cancer Rates Per 100,000 Ages 0-19 (1975-2022)
14 American Youth face a Mental Health Crisis ● Teenage depression rates nearly doubled from 2009 to 2019, with more than 1 in 4 teenage girls in 2022 reporting a major depressive episode in the past year. 32 33 ● Three million high school students seriously considered suicide in 2023. 34 ● Suicide deaths among 10- to 24-year-olds increased by 62% from 2007 to 2021, and suicide is now the second leading cause of death in teens aged 15-19. 35 ● The prevalence of diagnosed anxiety increased by 61% among adolescents between 2016 and 2023. 36 ● Over 57% of girls report feelings of sadness and hopelessness, while suicidal ideation in teen girls has surged by 60% since 2010. 37 32 Substance Abuse and Mental Health Services Administration. (2024). National Survey on Drug Use and Health (NSDUH). U.S. Department of Health and Human Services. Retrieved May 16, 2025, from https://www.samhsa.gov/data/sites/default/files/reports/rpt53159/2023-nsduh-pop- slides-female.pdf. 33 Daly, M. (2022). Prevalence of depression among adolescents in the U.S. from 2009 to 2019: Analysis of trends by sex, race/ethnicity, and income. Journal of Adolescent Health, 70(3), 445–452. https://doi.org/10.1016/j.jadohealth.2021.08.026. 34 Centers for Disease Control and Prevention. (2024). Youth risk behavior survey data summary & trends report: 2013–2023. U.S. Department of Health and Human Services. Retrieved May 16, 2025. 35 Curtin, S. C., & Garnett, M. F. (2023). Suicide and homicide death rates among youth and young adults aged 10–24: United States, 2001–2021. NCHS Data Brief, 471. Hyattsville, MD: National Center for Health Statistics. https://dx.doi.org/10.15620/cdc:128423. 36 Maternal and Child Health Bureau. (2023). Adolescent mental and behavioral health data brief [PDF]. U.S. Department of Health and Human Services. Retrieved May 16, 2025, from https://mchb.hrsa.gov/sites/default/files/mchb/data-research/nsch-data-brief-adolescent-mental- behavioral-health-2023.pdf. 37 Centers for Disease Control and Prevention. (2023, February 13). U.S. teen girls experiencing increased sadness and violence. U.S. Department of Health and Human Services. https://www.cdc.gov/media/releases/2023/p0213-yrbs.html. Had at Least One Major Depressive Episode (MDE) in Past Year, Ages 12 to 17, by Sex (2004-2022)
15 Allergies are Widespread, and Autoimmune Disorders are Rising ● Today, over 1 in 4 American children suffers from allergies, including seasonal allergies, eczema, and food allergies. 38 ○ Eczema (atopic dermatitis) and skin allergies increased from 7.4% of children under 18 from 1997-1999 to 12.7% from 2016-2018. 39 ● Between 1997 and 2018, childhood food‑allergy prevalence rose 88%. 40 ● Celiac disease rates have increased 5-fold in American children since the 1980s. 41 42 ● Rates of Inflammatory Bowel Disease (IBD), including Crohn’s, have increased by 25% over the last decade. 43 38 Zablotsky, B., Black, L. I., & Akinbami, L. J. (2023). Diagnosed allergic conditions in children aged 0–17 years: United States, 2021. NCHS Data Brief, No. 459. National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db459.htm. 39 National Center for Health Statistics. (2019). National Health Interview Survey (NHIS): Family core and sample child questionnaires. https://www.cdc.gov/nchs/data/hus/2019/012-508.pdf. 40 Centers for Disease Control and Prevention. (2019). Health conditions among children under age 18, by selected characteristics: United States, average annual, selected years 1997–1999 through 2016–2018 (Health, United States, 2019, Table 12). National Center for Health Statistics. https://www.cdc.gov/nchs/hus/data-finder.htm?year=2019&table=Table%20012. 41 Catassi, C., Gatti, S., & Fasano, A. (2014). The new epidemiology of celiac disease. Journal of pediatric gastroenterology and nutrition, 59, S7-S9. 42 McGowan, K. E., Castiglione, D. A., & Butzner, J. D. (2009). The changing face of childhood celiac disease in North America: impact of serological testing. Pediatrics, 124(6), 1572-1578. 43 Kappelman, M. D., Brensinger, C., Parlett, L. E., Hurtado-Lorenzo, A., & Lewis, J. D. (2025). Prevalence of pediatric inflammatory bowel disease in the United States: Pooled estimates from three administrative claims data sources. Gastroenterology, 168(5), 980–982. https://doi.org/10.1053/j.gastro.2024.11.015. Prevalence of Food Allergies, Ages 0-17 (1997-2018)
16 What is Driving the Increase in Childhood Chronic Disease? Rising rates of childhood chronic disease are likely being driven by a combination of factors, including the food children are eating, the chemicals they are exposed to, the medications they are taking, and various changes to their lifestyle and behavior, particularly those related to physical activity, sleep and the use of technology. This report focuses on these four major drivers. The food American children are eating The American food system is safe but could be healthier. Most American children’s diets are dominated by ultra-processed foods (UPFs) high in added sugars, chemical additives, and saturated fats, while lacking sufficient intakes of fruits and vegetables. This modern diet has been linked to a range of chronic diseases, including obesity, type 2 diabetes, cardiovascular disease, and certain cancers. 44 The excessive consumption of UPFs has led to a depletion of essential micronutrients and dietary fiber, while increasing the consumption of sugars and carbohydrates, which negatively affects overall health. 45 Nearly 70% of an American child’s calories today comes from ultra-processed foods 46 (increased from zero 100 years ago), many of which are designed to override satiety mechanisms and increase caloric intake. UPFs makeup over 50% of the diets of pregnant and postpartum mothers. 47 American children’s exposure to environmental chemicals The cumulative load of thousands of synthetic chemicals that our children are exposed to through the food they eat, the water they drink, and the air they breathe may pose risks to their long-term health, including neurodevelopmental and endocrine effects. Over 40,000 chemicals are registered for use in the U.S. 48 Pesticides, microplastics, and dioxins are commonly found in the blood and urine of American children and pregnant women—some at alarming levels. 49 50 51 Children are particularly vulnerable to chemicals during critical stages of development—in utero, infancy, early childhood, and puberty. Research suggests that for some chemicals, this cumulative load of exposures may be driving higher rates of chronic childhood diseases. 52 53 54 44 Clemente-Suárez, V. J., Beltrán-Velasco, A. I., Redondo-Flórez, L., Martín-Rodríguez, A., & Tornero-Aguilera, J. F. (2023). Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review. Nutrients, 15(12), 2749. https://doi.org/10.3390/nu15122749. 45 Martini, D., Godos, J., Bonaccio, M., Vitaglione, P., & Grosso, G. (2021). Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples. Nutrients, 13(10), 3390. https://doi.org/10.3390/nu13103390. 46 Wang, L., Martínez Steele, E., Du, M., Pomeranz, J. L., O’Connor, L. E., Herrick, K. A., Luo, H., Zhang, X., & Mozaffarian, D. (2021). Trends in consumption of ultraprocessed foods among US youths aged 2–19 years, 1999–2018. JAMA, 326(6), 519– 530. https://doi.org/10.1001/jama.2021.10238. 47 Jouanne, K. M., Tinker, S. C., Vannucci, A., Chiu, C.-Y., & Bailey, R. L. (2022). Greater ultra-processed food intake during pregnancy and postpartum is associated with multiple aspects of lower diet quality. Nutrients, 14(20), 4290. 48 U.S. Environmental Protection Agency. (2025, January 17). Now available: Latest update to the TSCA Inventory. https://www.epa.gov/chemicals-under-tsca/now-available-latest-update-tsca-inventory-7. 49 LaKind, J. S., Verner, M. A., Rogers, R. D., Goeden, H., Naiman, D. Q., Marchitti, S. A., ... & Fenton, S. E. (2022). Current breast milk PFAS levels in the United States and Canada: after all this time, why don’t we know more?. Environmental health perspectives, 130(2), 025002. 50 U.S. Environmental Protection Agency. (2015). America’s children and the environment. https://www.epa.gov/americaschildrenenvironment. 51 Ospina, M., Wong, L. Y., Baker, S. E., Serafim, A. B., Morales-Agudelo, P., & Calafat, A. M. (2019). Exposure to neonicotinoid insecticides in the US general population: Data from the 2015–2016 national health and nutrition examination survey. Environmental research, 176, 108555. 52 Elcombe, C. S., Evans, Neil P. & and Bellingham, M. (2022) Critical review and analysis of literature on low dose exposure to chemical mixtures in mammalian in vivo systems. Critical Reviews in Toxicology 52, 221–238. 53 Taiba, J., Beseler, C., Zahid, M., Bartelt-Hunt, S., Kolok, A., & Rogan, E. (2025). Exploring the joint association between agrichemical mixtures and pediatric cancer. GeoHealth, 9, e2024GH001236. https://doi.org/10.1029/2024GH001236. 54 Kassotis, C. D., & Phillips, A. L. (2023). Complex mixtures and multiple stressors: evaluating combined chemical exposures and cumulative toxicity. Toxics, 11(6), 487.
17 Yet, current risk assessment methods may not allow us to fully understand how these exposures affect human health. American children’s pervasive technology use Over the past four decades, American children have transitioned from an active, play-based childhood to a sedentary, technology-driven lifestyle, contributing to declines in physical and mental health. Specifically, these declines have been driven by increased screen time, reduced physical activity, and psychosocial stressors like loneliness, chronic stress, and sleep deprivation. Teens average nearly 9 hours of non-school screen time each day. 55 56 Over 70% of children, and 85% of teens, fail to meet the 2024 federal guideline of 60 minutes of daily moderate-to-vigorous physical activity. 57 58 Nearly 80% of U.S. high school students do not sleep at least 8 hours per night, up from 69% in 2009. 59 Persistent sadness and hopelessness among U.S. high school students surged between 2011 to 2021 from 28% to 42%, with female students’ suicidal ideation rising 58% from 19% to 30%. 60 In 2024, 73% of 16–24-year-olds reported loneliness, with 15% of young men having no close friendships—a fivefold increase since 1990. 61 Teens using social media over 3 hours daily face double the risk of anxiety and depression, with a 2022 meta-analysis showing each additional hour increases depression risk by 13%, and girls face nearly four times the risk of boys. 62 American children are highly medicated – and it’s not working The health system has aggressively responded to these increases in childhood chronic disease with increasing rates of pharmaceutical drug prescriptions which may cause further harm to the health of American children when used inappropriately. Stimulant prescriptions for ADHD in the U.S. increased 250% from 2006 to 2016, 63 despite evidence they did not improve outcomes long-term. 64 55 Common Sense Media. (2021). The common sense census: Media use by tweens and teens, 2021. https://www.commonsensemedia.org/research/the-common-sense-census-media-use-by-tweens-and-teens-2021. 56 Anderson, M., Faverio, M., & Park, E. (2024, December 12). Teens, social media and technology 2024. Pew Research Center. https://www.pewresearch.org/internet/2024/12/12/teens-social-media-and-technology-2024/. 57 Physical Activity Alliance. (2024). 2024 United States report card on physical activity for children and youth. https://www.physicalactivityalliance.com/reportcard. 58 Tomkinson, G. R., & Olds, T. S. (2007). Secular changes in pediatric aerobic fitness test performance: The global picture. Medicine & Science in Sports & Exercise, 39(5), 742–749. https://doi.org/10.1249/mss.0b013e318031b51c. 59 Centers for Disease Control and Prevention. (2021). Youth Risk Behavior Survey data summary & trends report: 2009–2021. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2021_508.pdf. 60 Centers for Disease Control and Prevention. (2021). Youth Risk Behavior Survey data summary & trends report: 2009–2021. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2021_508.pdf. 61 Cigna Corporation. (2024). The loneliness epidemic: Insights from the 2024 loneliness in America survey.https://www.cigna.com/about- us/newsroom/studies-reports/loneliness-epidemic. 62 Ivie, E. J., Pettitt, A., Moses, L. J., & Allen, N. B. (2022). A meta-analysis of the association between adolescent social media use and depressive symptoms. Journal of Affective Disorders, 275, 165–174. https://doi.org/10.1016/j.jad.2020.06.014. 63 Piper, B. J., Ogden, C. L., Simoyan, O. M., Chung, W., & Kim, M. (2018). Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PLOS ONE, 13(11), e0206100. https://doi.org/10.1371/journal.pone.0206100. 64 Jensen, P. S., Arnold, L. E., Swanson, J. M., Vitiello, B., Abikoff, H. B., Greenhill, L. L., ... & Hur, K. (2007). 3-year follow-up of the NIMH MTA study. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8), 989–1002. https://doi.org/10.1097/CHI.0b013e3180686d48.
18 ● Antidepressant prescription rates in teens increased by 14-fold between 1987 and 2014, 65 even though a systematic overview shows that psychotherapy is just as effective as drugs in the short term, and potentially more effective in the long term. 66 ● Antipsychotic prescriptions for children increased eight-fold between 1995 and 2005, with most of these medications prescribed for conditions not approved by the FDA for use in children. 67 ● Studies find that more than 35% (equivalent to more than 15 million prescriptions) of childhood antibiotics are unnecessary 68 and that infants exposed to antibiotics in the first 2 years of life are more likely to develop asthma, allergic rhinitis, atopic dermatitis, celiac disease, obesity, and ADHD. 69 Corporate Capture and the Revolving Door Although the U.S. health system has produced remarkable breakthroughs, we must face the troubling reality that the threats to American childhood have been exacerbated by perverse incentives that impact the regulatory bodies and federal agencies tasked with overseeing them. While Congress is ultimately in charge of authorizing federal regulatory agency research budgets, government funding has been a small portion of the totality of research dollars being spent on chronic childhood disease. The majority is funded by the food, pharmaceutical, and chemical, as well as special interest Non- Governmental Organizations (NGOs) and professional associations. The following examples illustrate how deep and widespread this influence has become across multiple sectors: ● The food industry funds the bulk of research in the field. A BMJ analysis found that industry spent over $60 billion on drug, biotechnology, and device research in nutrition science; 70 by comparison, the government spends an estimated $1.5 billion on nutrition research. 71 Concerningly, industry-funded nutrition research may bias conclusions in favor of sponsors’ products. 72 Government funding for nutrition research through the NIH is only 4-5% of its total budget 73 and in some cases is subject to influence by food industry-aligned researchers. 74 65 Zito, J. M., Zhou, E., Pennap, D., Burcu, M., Safer, D. J., & Ibe, A. (2020). Antidepressant use in Medicaid-insured youth: Trends, covariates, and future research needs. Frontiers in Psychiatry, 11, 113. 66 Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Papola, D., Ebert, D., & Karyotaki, E. (2023). Psychological treatment of depression: A systematic overview of a ‘Meta-Analytic Research Domain’. Journal of affective disorders, 335, 141–151. https://doi.org/10.1016/j.jad.2023.05.011. 67 Alexander, G. C., Gallagher, S. A., Mascola, A., Moloney, R. M., & Stafford, R. S. (2011). Increasing off-label use of antipsychotic medications in the United States, 1995–2008. Pharmacoepidemiology and Drug Safety, 20(2), 177–184. 68 Fleming-Dutra, K. E., Hersh, A. L., Shapiro, D. J., Bartoces, M., Enns, E. A., File, T. M., Finkelstein, J. A., Gerber, J. S., Hyun, D. Y., Linder, J. A., Lynfield, R., Margolis, D. J., May, L. S., Merenstein, D., Metlay, J. P., Newland, J. G., Piccirillo, J. F., Roberts, R. M., Sanchez, G. V., ... Hicks, L. A. (2016). Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA, 315(17), 1864- 1873. https://doi.org/10.1001/jama.2016.4151. 69 Aversa, Z., Atkinson, E. J., Schafer, M. J., Theiler, R. N., Rocca, W. A., Blaser, M. J., & LeBrasseur, N. K. (2021, January). Association of infant antibiotic exposure with childhood health outcomes. In Mayo Clinic Proceedings (Vol. 96, No. 1, pp. 66-77). Elsevier. 70 Mozaffarian, D., and N. G. Forouhi. 2018. Dietary guidelines and health—is nutrition science up to the task? BMJ 360:k822. https://doi.org/10.1136/bmj.k822. 71 Toole, A.A. & Kuchler, F. (2015). Improving Health Through Nutrition Research: An Overview of the U.S. Nutrition Research System. U.S. Department of Agriculture, Economic Research Service. ERR-182. 72 Lesser LI, Ebbeling CB, Goozner M, Wypij D, Ludwig DS (2007) Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Med 4(1): e5. 73 Fleischhacker, S. E., Woteki, C. E., Coates, P. M., Hubbard, V. S., Flaherty, G. E., Glickman, D. R., ... & Mozaffarian, D. (2020). Strengthening national nutrition research: rationale and options for a new coordinated federal research effort and authority. The American journal of clinical nutrition, 112(3), 721-769. 74 Kearns, C. E., Schmidt, L. A., & Glantz, S. A. (2016). Sugar industry and coronary heart disease research: A historical analysis of internal industry documents. JAMA Internal Medicine, 176(11), 1680–1685. https://doi.org/10.1001/jamainternmed.2016.5394.
19 Moreover, one analysis reported that 95% of the 2020 Dietary Guidelines Advisory Committee members had financial ties to food and pharmaceutical companies. 75 ● The chemical-manufacturing industry spent roughly $77 million on federal lobbying activities in 2024, while 60% of their lobbyists previously held federal posts. 76 In addition, more than ten thousand chemicals listed on the EPA’s inventory are designated as confidential, and generic chemical names are used to identify them. 77 The pharmaceutical industry, from 1999 to 2018, spent $4.7 billion on lobbying expenditures at the federal level, more than any other industry. 78 In addition, 9 out of the last 10 FDA commissioners 79 —and approximately 70% of the agency’s medical reviewers 80 —have gone on to work for the pharmaceutical industry. Over 80% of clinical departments and teaching hospitals at U.S. medical schools receive some degree of pharmaceutical funding, while half of the total costs for continuing medical education (CME) is funded by industry. 81 82 Between 2010 and 2022, industry provided $6 billion to over 20,000 patient advocacy organizations. 83 75 Mialon, M., Serodio, P., Crosbie, E., Teicholz, N., Naik, A., & Carriedo, A. (2022). Conflicts of interest for members of the U.S. 2020 Dietary Guidelines Advisory Committee. Public Health Nutrition, 27(1), e69. https://doi.org/10.1017/S136898002200035X. 76 OpenSecrets. (n.d.). Federal lobbying: Industries summary (N13, 2021 cycle). https://www.opensecrets.org/federal- lobbying/industries/summary?cycle=2021&id=N13. 77 U.S. Environmental Protection Agency. (2025, January 17). TSCA Chemical Substance Inventory. https://www.epa.gov/tsca-inventory. 78 Wouters, O. J. (2020). Lobbying expenditures and campaign contributions by the pharmaceutical and health product industry in the United States, 1999-2018. JAMA Internal Medicine, 180(5), 688-697. 79 Foley, K. E. (2022, July 21). Trust issues deepen as yet another FDA commissioner joins the pharmaceutical industry. Quartz. https://qz.com/1656529/yet-another-fda-commissioner-joins-the-pharmaceutical-industry. 80 Piller, C. (2018). FDA's revolving door: Companies often hire agency staffers who managed their successful drug reviews. Science. https://www.science.org/content/article/fda-s-revolving-door-companies-often-hire-agency-staffers-who-managed-their- successful. 81 Wouters, O. J. (2020). Lobbying expenditures and campaign contributions by the pharmaceutical and health product industry in the United States, 1999-2018. JAMA Internal Medicine, 180(5), 688-697. 82 Campbell, E. G., Weissman, J. S., Ehringhaus, S., Rao, S. R., Moy, B., & Goold, S. D. (2007). Institutional academic-industry relationships. JAMA, 298(15), 1779–1786. https://doi.org/10.1001/jama.298.15.1779. 83 Pradhan, R. (2023, December 15). Millions of dollars flow from pharma to patient advocacy groups. KFF Health News. https://kffhealthnews.org/news/article/health-202-pharma-money-patient-advocacy-groups-public-citizen/.