Comments Regarding the Proposed Major Revision of the Accreditation Council for Graduate Medical Education’s Common Program Requirements (Residency)

By Nina Zeldes, Ph.D.

Download PDF

Public Citizen, a national nonprofit consumer advocacy organization with over one million members and supporters nationwide, submits the following comments on the proposed major revision of the Accreditation Council for Graduate Medical Education’s (ACGME’s) common program requirements (residency). The proposed changes are anticipated to go into effect in July 2028.

In the United States the ACGME is solely responsible for accrediting residency programs and for monitoring compliance with the council’s work-hour standards. The ACGME has a great responsibility for the well-being and safety of resident physicians and the safety of the patients in their care.

However, when the ACGME limited work hours for all resident physicians in 2003 and again in 2011, the council limited hours to a lesser extent than recommended by expert panels.[1] In 2017, when the ACGME last implemented work-hour standards, some of the prior work-hour protections were rolled back (see Table).

Public Citizen’s Health Research Group is concerned that the proposed revisions would further erode workplace safety for resident physicians. Several of the planned changes roll back essential protections (such as the required rest time between shifts) without which resident physicians as well as the patients in their care may be harmed. Moreover, by failing to provide guidance on several key work-hour requirements, the proposed revisions may facilitate the scheduling of excessive work hours for resident physicians. The ability to enforce work-hour standards will be diminished. Moreover, reporting violations will be impossible in instances where there are no longer criteria for what a violation is.

Table. Key ACGME Work-Hour Requirements in 2011, 2017, and 2028, and Public Citizen’s Recommendations

	2011 ACGME Work-Hour Requirements	2017 ACGME Work-Hour Requirements	2028 Proposed ACGME Work -Hour Requirements	Public Citizen’s Recommendation
Maximum hours of work per week	80 hours, up to 88 hours for some specialties (averaged over four weeks)	80 hours, up to 88 hours for some specialties (averaged over four weeks)	80 hours (averaged over four weeks)	80 hours per week, no averaging
Maximum in-hospital on-call frequency	No more than every third night (averaged over four weeks) for second-year resident physicians and above	No more than every third night (averaged over four weeks)	No guidance	No more than once every three nights, no averaging
Minimum time off between scheduled shifts	8-10 hours between duty periods 14 hours free of duty after 24 hours of in-house duty	Eight hours between scheduled clinical work and education periods 14 hours off clinical work and education after 24 hours of in-house call	No guidance 12 hours off clinical work and education after 24 hours of in-house call	At least 10 hours off work after a day shift and a minimum of 12 hours off work after a night shift No extended work shifts

Background

As detailed in Public Citizen’s 2025 petition to the Occupational Health and Safety Administration (OSHA) to implement work-hour regulations for all resident physicians, substantial evidence demonstrates that long work hours and extended shifts are associated with sleep deprivation and fatigue among resident physicians, with profound effects on their health, safety, and well-being.[6] Sleep-deprived resident physicians have an increased risk of needlestick injuries, motor vehicle crashes, depression, burnout, and other mental health conditions. Pregnant resident physicians are at a higher risk of obstetric complications. Impaired sleep from long work hours has also been linked to increased medical errors, attentional failures, and preventable adverse events for patients.

Research has also demonstrated that reduced work hours help to mitigate these risks and have an overall positive effect on patient safety outcomes without significantly reducing

educational and clinical experiences of resident physicians. Evidence-based work-hour standards for resident physicians are essential for patient safety and to ensure humane and safe work environments.

Because the ACGME common program requirements lack work-hour standards that follow evidence-based recommendations, Public Citizen and co-petitioners petitioned OSHA in 2001[7] and 2010[8] and OSHA and the Centers for Medicare and Medicaid Services in 2025[9]  to implement these key requirements for resident physicians in all residency and subspecialty fellowship programs:

(1) A limit of 80 hours of work in each and every workweek, without averaging;

(2) A limit of 16 consecutive hours worked in one shift for all resident physicians and

subspecialty resident physicians, with no exceptions;

(3) At least one 24-hour period of time off work per week (no averaging) and one 48-

hour period of time off work per month, no averaging;

(4) In-hospital on-call frequency of no more than once every three nights, no averaging;

(5) A minimum of at least 10 hours off work after a day shift and a minimum of 12 hours

off work after a night shift; and

(6) A maximum of four consecutive night shifts with a minimum of 48 hours off after a sequence of three or four night shifts.

By reorganizing and condensing program requirements, the proposed major revision represents a 43% reduction of these requirements, according to the ACGME.[10] Instead of strengthening work-hour protections, however, the reduction of requirements prioritizes alleviating scheduling challenges, not the well-being and safety of resident physicians and the patients they care for. It is noteworthy that resident physicians and fellows and quality/patient safety officers were less involved in the surveys that were part of the ACGME’s process (8% and 13% of the respondents to two surveys, and 0.4% and 0.2%, respectively) than were program directors (34% and 37% of the respondents) and program coordinators (24% and 18% of the respondents).[11]

As the organization is solely responsible for setting and monitoring work-hour standards for resident physicians, the ACGME must establish evidence-based work-hour protections that 1) protect the safety of resident physicians, 2) help to reduce medical errors, and 3) contribute to a safer, better standard of patient care. We urge the ACGME to require work-hour enforcement and provide adequate guidance to ACGME-accredited programs on how standards can be best enforced and how to track violations. Inadequate enforcement has undermined previous efforts to limit resident physician work hours.

Public Citizen urges the ACGME to reconsider several of the proposed changes to the common program requirements:

1. Maximum hours of work per week (#6.29)

Although Public Citizen agrees with the ACGME proposal to no longer grant “rotation specific exceptions for … a maximum of 88 clinical and educational work hours” per week, the maximum of 80 hours work per week are still proposed to be averaged over four weeks.[12]

As detailed in Public Citizen’s 2025 OSHA petition, there is a substantial body of evidence demonstrating that excessive workweeks and extended shifts are harmful to both resident physicians and the patients they care for. We are concerned that averaging maximum work hours over a four-week period will allow programs to require resident physicians at times to work significantly longer hours in one week. We urge the ACGME to require a maximum of 80 work hours per week, without averaging.

We are also concerned that the ACGME proposes that “[a]ctivities such as reading about the next day’s case, studying, or research activities do not count toward the 80-hour weekly limit.” [13]

2. Minimum time off between scheduled shifts (#6.30 and #6.31)

The ACGME proposes to delete the requirement that “[R]esidents should have eight hours off between scheduled clinical work and education periods” and to shorten the hours free of clinical work and education after 24 hours of in-house call from 14 to 12 hours.[14] These changes are significant rollbacks of workplace protections. Public Citizen disagrees with ACGME’s assessment that this change will have no impact or not have “a significant impact” on resident/fellow education or patient safety. As discussed in our petition, long work hours and extended shifts are associated with sleep deprivation and fatigue. Moreover, acute and chronic sleep deprivation has detrimental effects on the health and safety of resident physicians and the patients under their care.

Based on the evidence presented in Public Citizen’s 2025 OSHA petition, we urge the ACGME to require that resident physicians never work shifts longer than 16 consecutive hours and have at least 10 hours off work after a day shift and a minimum of 12 hours off work after a night shift.

We are also concerned by the ACGME’s rationale for removing the requirement for eight hours off between shifts: the 80-hour-per-week limit would make it difficult “to design a schedule that provides fewer than eight hours off.” [15] Scheduling convenience for programs is an unacceptable reason to significantly roll back workplace protections for resident physicians. Programs must always prioritize the health and safety of resident physicians and the patients under their care.

The proposed revisions do not provide guidance on what the minimum time off between scheduled shifts should be. As a result, reporting certain violations may be impossible and the ability to enforce work-hour standards will be diminished. The justification for this change seems to be that the previous requirement of eight hours off between scheduled shifts was “not subject to citation for failure to meet this standard.” [16] Instead of making the minimum time off between shifts even less enforceable as a requirement, we urge the ACGME to insist that all programs comply with all work-hour requirements for resident physicians and to maintain the requirement that “[R]esidents should have eight hours off between scheduled clinical work and education periods.”

The ACGME’s rationale for reducing the hours free of clinical work and education after 24 hours of in-house call is “to reduce burden related to developing resident schedules.” [17] As previously stated, scheduling convenience for programs is an unacceptable reason to significantly roll back workplace protections for resident physicians. The wellness and safety of resident physicians and the patients in their care must always be prioritized.

3. Maximum in-hospital on-call frequency (#6.38)

The proposed revisions remove any guidance on the maximum in-hospital on-call frequency and delete the requirement that in-house on-call shifts occur “no more frequently than every third night (when averaged over a four-week period).”[18] By not providing guidance on the maximum on-call frequency, the ACGME would make the enforcement of safe limits as well as the reporting of work-hour violations effectively impossible. Public Citizen urges the ACGME to require that in-hospital on-call frequency should occur no more than once every three nights, with no averaging over a four-week period.

The stated rationale for this change is that the 80-hour workweek requirement would “make it nearly impossible for a program to assign a resident in-house call more frequently than once every third night on average.” [19] This might be the case if there was a limit of 80 hours of work in every workweek, without averaging. However, the proposed changes permit averaging of work hours over four weeks. Since the ACGME states that “monitoring compliance with the requirement [for maximum in-hospital on-call frequency] adds burden,” the proposed changes again prioritize convenience for residency programs over the wellness and safety of resident physicians and the patients in their care.

4. Less focus on the risks of sleep deprivation and fatigue (#6.16 and #6.24)

Resident physicians are at a particularly high risk of sleep deprivation. They frequently are required to work long hours, often with little opportunity to sleep during extended shifts.[20] There is extensive evidence that for resident physicians across specialties, sleep loss associated with shifts of more than 16 consecutive hours has detrimental effects, both for their own well-being and for the safety of the patients in their care. For this reason, recognizing and mitigating the health risks of sleep deprivation and fatigue must be an integral part of ACGME’s program requirements.

The proposed revisions of the common program requirements lack focus on the risks of sleep deprivation and fatigue. For instance, the ACGME suggests deleting the requirement that programs must educate resident physicians and faculty members concerning “their obligation to be appropriately rested and fit to provide the care required by their patients (6.16)” and in recognizing “the signs of fatigue and sleep deprivation, alertness management, and fatigue mitigation processes (6.24).”^[21]

Instead, the revised program requirements only state that “[T]he program … must ensure healthy and safe learning and working environments that promote resident well-being and provide for” (1.8) “safe, quiet, clean, and private sleep/rest facilities” (1.8.b.) and “safe options for residents who may be too fatigued to safely return home” (1.8.c).[22]

Resident physicians are often unable to objectively rate their own sleepiness or may think that they can acclimate to sleep deprivation. Despite being severely fatigued, they may feel that they can continue to function, learn, or care for patients. Public Citizen disagrees that the proposed “requirements appropriately address fatigue” and that the “education in fatigue and sleep deprivation” was only a “’checkbox’ exercise without additional benefit” to resident physicians.[23]

In addition to requiring sleep facilities and safe options for resident physicians who are too fatigued to return home safely, residency programs must continue to emphasize the recognition and education of resident physicians about the harms of fatigue and sleep deprivation for themselves and the patients in their care.

In summary, Public Citizen urges the ACGME to revise its program requirements in line with evidence-based work-hour protections highlighted in our 2025 OHSA petition. These program requirements would protect the safety and well-being of resident physicians and contribute to a safer, better standard of patient care.

Thank you for your consideration of our comments regarding this important issue.

 

Sincerely,

 

Nina Zeldes, Ph.D.

Senior Health Researcher, Health Research Group

Public Citizen

1600 20^th St. NW

Washington, D.C. 20009

[1] Institute of Medicine. Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedule to Improve Patient Safety, National Research Council. Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. Ulmer C, Miller Wolman D, Johns MME, editors. Washington (DC): The National Academies Press; 2009.

[2] Accreditation Council for Graduate Medical Education. The ACGME 2011 duty hour standards: enhancing quality of care, supervision, and resident professional development. 2011. https://www.acgme.org/globalassets/pdfs/jgme-monograph1.pdf. Accessed October 22, 2026.

[3] Accreditation Council for Graduate Medical Education. ACGME common program requirements (residency). September 17, 2022. https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2022v3.pdf. Accessed October 22, 2026.

[4] Accreditation Council for Graduate Medical Education. ACGME common program requirements (residency). Proposed major revision. September 8, 2028. https://www.acgme.org/globalassets/pfassets/reviewandcomment/2026/cprresidency_rc_09082026.pdf. Accessed October 22, 2026.

[5] Public Citizen. Petition to OSHA to implement work-hour regulations for all resident physicians. May 20, 2025. https://www.citizen.org/article/re-petition-to-osha-to-implement-work-hour-regulations-for-all-resident-physicians/. Accessed October 22, 2026.

[6] Ibid

[7] Public Citizen. Petition requesting medical residents work hour limits. April 30, 2001. https://www.citizen.org/article/petition-requesting-medical-residents-work-hour-limits/. Accessed October 22, 2026.

[8] Public Citizen. Petition to reduce medical resident work hours. September 2, 2010. https://www.citizen.org/article/petition-to-reduce-medical-resident-work-hours-2/. Accessed October 22, 2026.

[9] Public Citizen. Public Citizen petitions OSHA and CMS to implement work-hour regulations for resident physicians. May 20, 2025. https://www.citizen.org/article/public-citizen-petitions-osha-and-cms-to-implement-work-hour-regulations-for-resident-physicians/. Accessed October 22, 2026.

[10] Accreditation Council for Graduate Medical Education. ACGME common program requirements major revision rationale and impact statement. https://www.acgme.org/globalassets/pfassets/reviewandcomment/2026/cpr_impact_09082026.pdf. Accessed October 22, 2026.

[11] Koh NJ, Alston MJ, Buser BR, et al. The ACGME common program requirements major revision process: Engaging the graduate medical education community. J Grad Med Educ. 2026 Aug 1;18(4):510-514.

[12] Accreditation Council for Graduate Medical Education. ACGME common program requirements major revision rationale and impact statement. https://www.acgme.org/globalassets/pfassets/reviewandcomment/2026/cpr_impact_09082026.pdf. Accessed October 22, 2026.

[13] Accreditation Council for Graduate Medical Education. ACGME common program requirements (residency). Proposed major revision. September 8, 2028. https://www.acgme.org/globalassets/pfassets/reviewandcomment/2026/cprresidency_rc_09082026.pdf. Accessed October 22, 2026.

[14] Accreditation Council for Graduate Medical Education. ACGME common program requirements major revision rationale and impact statement. https://www.acgme.org/globalassets/pfassets/reviewandcomment/2026/cpr_impact_09082026.pdf. Accessed October 22, 2026.

[15] Ibid.

[16] Ibid.

[17] Ibid.

[18] Ibid.

[19] Ibid.

[20] Public Citizen. Petition to OSHA to implement work-hour regulations for all resident physicians. May 20, 2025. https://www.citizen.org/article/re-petition-to-osha-to-implement-work-hour-regulations-for-all-resident-physicians/. Accessed October 22, 2026.

[21] Accreditation Council for Graduate Medical Education. ACGME common program requirements (residency). Proposed major revision. September 8, 2028. https://www.acgme.org/globalassets/pfassets/reviewandcomment/2026/cprresidency_rc_09082026.pdf. Accessed October 22, 2026.

[22] Ibid.

[23] Accreditation Council for Graduate Medical Education. ACGME common program requirements major revision rationale and impact statement. https://www.acgme.org/globalassets/pfassets/reviewandcomment/2026/cpr_impact_09082026.pdf. Accessed October 22, 2026.

Expert Witness Testimony Opposing Dominion-NextEra Merger

October 19, 2026

By Tyson Slocum

Download PDF

Public Citizen serves as an expert witness in testimony before the Virginia Corporation Commission. The transaction involves NextEra acquiring Dominion, thereby subsuming Dominion within NextEra. NextEra is the dominant entity making the acquisition, and therefore Dominion’s assets and operations should be considered as subsidiaries to NextEra’s investment strategies. In my view, NextEra’s primary financial justifications for the transaction are to use Dominion’s assets and service territory to maximize monetization opportunities on behalf of its unregulated NextEra Energy Resources division, while at the same time using Dominion’s regulated, franchise utility as a hedge against data center and unregulated NEER market risk. This dynamic exposes Dominion’s regulated utility operations and residential ratepayers to unacceptable risk. Some may ask why Dominion agreed to the acquisition, and the simple explanation is that investors and top executives will earn a windfall from NextEra’s price premium, but Dominion’s ratepayers will not. For these and other reasons, Virginia regulators should reject the transaction. Read the full testimony here: slocum-direct-testimony-10-19

Written Responses to Ways and Means’ Questions on Trump’s Critical Minerals Deals

Download PDF

The following letter is a response to Members of Congress’ Questions for the Record (QFRs) following Global Trade Watch Director Melinda St. Louis’ witness testimony on September 2, 2026 in front of the House Ways and Means Committee. More on the hearing and St. Louis’ testimony can be found here.

 

October 19, 2026

Honorable Richard Neal (D-MA)
Ways and Means Committee
U.S. House of Representatives
1129 Longworth House Office Building
Washington D.C. 20515

Re: House Committee on Ways and Means full committee hearing — “Strategic Partnerships to Secure Critical Resources and Supply Chains” held on Sept. 2, 2026

Dear Chairman Neal,

My written responses to the questions for the record are as follows:

Public Financing:

• Public Citizen’s report describes billions of dollars in taxpayer-backed financing being deployed through agencies including the Export-Import Bank of the United States (EXIM), the U.S. International Development Finance Corporation (DFC), the Department of Defense, and the Department of Energy (DOE).

• What safeguards should Congress establish to ensure that public financing advances U.S. national security and economic interests rather than primarily benefiting individual companies or investors?

Congress should exercise its oversight authority before taxpayer money is committed, not only after a project fails. Guardrails must be written into appropriations, authorizing bills, and congressional review requirements. Public financing should meet a demonstrated supply-chain need and serve a clear public purpose — not simply shift risk from private investors to taxpayers. Congress should review the trade agreements, memoranda of understanding (MOUs), and frameworks behind major financing commitments. Even when those instruments are called “nonbinding,” they can lead to project pipelines, loans, and equity stakes. 

Congress should require agencies to publish their eligibility criteria, use competitive selection where feasible, and explain any sole-source or directly negotiated award. They should disclose financing terms and taxpayer exposure. 

Congress should also require strong conflict-of-interest rules for officials making these decisions, including meaningful restrictions on the revolving door between federal financing agencies and the investment firms seeking to benefit. Appropriations and authorizing legislation should require regular reporting to the committees of jurisdiction and independent Inspector General reviews.

Earlier this year, the U.S. Export-Import Bank (EXIM) launched Project Vault, the Administration’s $12 billion public-private financed critical minerals stockpile. The Congressional Research Service has already noted that Project Vault has not been authorized by Congress, and there are significant questions about its due diligence, transparency, and effectiveness. The reauthorization of the EXIM Bank this year is an important opportunity for Congress to implement stronger governance structures to prevent corruption and establish financial guardrails.  

All public financing should protect the people who bear a project’s risks. Workers, Indigenous Peoples, and other affected frontline communities need a meaningful voice before decisions are made and an opportunity for input throughout the process. Federal support should be conditioned on binding requirements and thorough Environmental and Social Impact Assessments (ESIA) at the mine or facility level for labor rights, human rights, environmental protection, and community participation, including explicit protections for human rights defenders. Standards should draw on those included in the Initiative for Responsible Mining Assurance (IRMA), the International Labour Organization (ILO), and the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). Finally, there must be swift and certain consequences for mining companies if those standards are violated. Those could include binding project-, facility-, or community-level requirements and financial consequences for noncompliance. General promises and statements of intent in an agreement are not enough, and national security arguments do not justify weakened safeguards or transparency measures.

Congress must fulfill its oversight duty. Public Citizen’s recent reports, The Trump Administration’s Many Tools for Seizing Critical Minerals Abroad, Mining Billions in the Dark, and The Secretive Commodity Traders Profiting from Trump’s Critical Minerals Agenda, document multiple potential investor conflicts of interest in the administration’s minerals deals and project financing. Congress should examine those concerns before more public money is committed, not wait until taxpayers or communities are left with the cost burdens.

• What minimum transparency, conflict-of-interest, and taxpayer-protection requirements should apply when federal agencies provide direct loans, loan guarantees, equity investments, or other financial support for critical minerals projects?

The mere designation of a given mineral as “critical” is insufficient justification for taxpayer expense. Funding agencies should have to make a clear, publicly documented case for why the project benefits the public interest. This should include an explicit explanation of the vulnerability it addresses, why federal support is necessary, and what measurable benefits taxpayers receive. Before an agency commits public money to a critical minerals project, Congress and the public should be able to see the full terms of the deal. That means the full agreement and knowing who owns, controls, and invests in the project, including its beneficial owners. The disclosure should cover the amount and type of federal support, the collateral, how much private capital is invested alongside federal funds, and who absorbs the losses if the project fails. It also means public access to any annexes or side agreements. All of this should be gathered in one public database covering every agency’s critical minerals commitments. Agencies should report regularly to the congressional committees of jurisdiction on disbursements, due diligence, timelines, expected returns, and any defaults or losses.

Agencies should also engage in their own due diligence and screen for conflicts of interest before approving support. Agencies should explain how projects are selected, consider competing options where feasible, and justify any award made. Each agency should verify a recipient’s eligibility and ownership, financial condition, credit or investment risks, technical ability to deliver, and track record, including strong adherence to ethics, environmental, and social-performance standards. Conflict-of-interest reviews should cover senior officials, their family members, major donors, and others closely tied to decision-makers. Ethics agreements and recusals should be public, and special government employees should be held to the same disclosure and recusal rules as other officials. Officials moving between these agencies and the investment firms seeking their support should face meaningful restrictions. 

Unfortunately, the Trump administration has moved increasingly away from transparency and disclosure: a March 2025 executive order waived certain SEC disclosure requirements for federally backed projects, including a requirement that publicly traded companies show a mine can actually make money. Congress should introduce legislation to block or limit that order.

Equity investments call for extra scrutiny because taxpayers share directly in any losses, not just the risk that a loan goes unpaid. Equity should therefore be an exceptional tool, and justification should be provided for why existing tools such as loans, loan guarantees, and other assistance cannot meet the need as a prerequisite. Congress should be provided an independent valuation for each stake, a clear explanation of what the public gets for its ownership, and a plan for keeping the government’s role as an investor separate from its role as owner/shareholder, regulator, and permitting authority (including of private competitors), lender/guarantor, customer/buyer, and so on.

Taxpayer support should be conditioned on enforceable commitments on labor and human rights, environmental protection, community engagement, and a funded plan for closure and cleanup. 

Taxpayers also need protection from carrying the downside while private investors keep the upside. Private investors should have to retain meaningful financial risk, without risk being moved onto taxpayers. Loans should be backed by sufficient collateral, and agencies should be able to recover funds (clawback) when companies do not meet their commitments. 

EXIM’s Project Vault is a key example of why stronger oversight is needed. EXIM approved a direct loan of up to $10 billion to set up a U.S. Strategic Critical Minerals Reserve, operating as VaultCo, in partnership with another $2 billion in private capital whose sources have not been fully disclosed. EXIM describes VaultCo as an independently governed public-private partnership in which participating manufacturers make long-term commitments and pay fees. However, despite the massive taxpayer contribution, basic governance information is still undisclosed. The public does not know who sits on VaultCo’s board, what affiliations or financial interests those members have, or what rules govern conflicts of interest. This omission is hugely concerning because EXIM President and Chairman John Jovanovic previously served as Investment Director at one of the companies selected to source material for Project Vault. The public also still does not know which manufacturers, traders, and suppliers are participating, how purchase prices and fees are set, who controls buying and selling decisions, or who absorbs the losses if mineral prices fall. Reporting about commodity traders from Public Citizen shows that politically connected investors and firms stand to benefit. Without full public disclosure of the reserve’s participants, governance, pricing, fees, and risk-sharing terms, neither the public nor Congress can judge whether EXIM and Project Vault are protecting U.S. supply chains or subsidizing and enriching private investors.

Value Addition:

• What does a win-win critical minerals partnership look like for the United States and a resource-rich partner country, particularly when the goal is to build resilient supply chains rather than simply secure access to raw materials?

In a win-win partnership, both sides build capacity. It is not one side securing access to the other’s raw materials. Supply chains are more resilient over the long term when partner countries have a stake in them. That means respecting partners’ development strategies and industrial policies and allowing local processing and beneficiation to create jobs in higher value chain segments like refining, processing, and manufacturing, not just raw-material extraction. The goal should be value addition in both the partner country and the United States. These partnerships should recognize the right of countries to benefit from their natural resources while strengthening standards on labor, human rights, and the environment. The United States can help promote value-chain addition by directly supporting technology transfer and financing higher-value processes.

Deals negotiated under this administration lock resource-rich countries into exporting raw commodities. For instance, some of the Agreements on Reciprocal Trade (ARTs) bar export bans, quotas, and requirements to process domestically. That undercuts the same kind of industrial strategy the United States once used to build its own industries. There must also be real two-way commitments. We cannot have a host of binding obligations on their side and only nonbinding statements of “intent” on ours. Congress should reject deals asserting U.S. dominance rather than mutual development. Deals signed under pressure or negotiated under duress are fragile, breed resentment, and are likely to lead to backlash or withdrawal. Trust, once broken, may not be easily repaired, and countries will find other, more reliable partners to do business with. 

• How important is it for these partnerships to build in-country capacity for processing, refining, manufacturing, infrastructure, and good jobs, rather than focusing primarily on extraction and export of raw minerals?

It’s essential. Our partnerships should focus on helping to build in-country capacity by allowing industrial policies that support capacity development and greater value addition, rather than locking them into a raw-material supplier role. For example, a report by the Resource Justice Network estimated that African countries could boost their combined GDP by $24 billion annually and create 2.3 million jobs with the right industrial policies in the critical minerals sector. However, a central problem is that African countries are largely locked into the role of extracting raw minerals for export and excluded from more lucrative downstream segments of mineral value chains. Unfortunately, deals like the U.S.–DRC Strategic Partnership Agreement effectively prevent the country from developing higher-value industries by giving U.S. companies priority access to certain minerals and directing them to the U.S. market. A better partnership would support efforts that promote technology transfer and build the partner’s practical know-how needed to process minerals or manufacture products, and prioritize U.S. investment and financing in facilities and infrastructure to use that technology and build those higher value chain segments. 

Indonesia, for instance, has relied on industrial policies restricting raw ore exports and requiring domestic processing, which has led to large gains by shifting from low-value ore to higher-value refined and semi-finished exports. Unfortunately, the Trump administration’s ART with Indonesia undermines these accomplishments by narrowing the ability to impose restrictions on exports of industrial commodities such as critical minerals to the United States. The Malaysia ART requires a similar commitment. These provisions directly undercut partners’ policy tools to encourage domestic processing and other value-addition opportunities. At a minimum, trade agreements like the ARTs should not undermine our partners’ ability to build capacity and wealth around their own mineral industries by forcing countries to give up policies that support local processing, refining, and manufacturing.  

The United States should approach these partnerships as joint industrial policy to create good jobs in all countries in the supply chain for clean energy technologies. The U.S. must also uphold high standards for communities, labor, and the environment. Mining and processing minerals is hazardous work, often conducted by marginalized sections of society, including children. Any deals with these countries should include strong, enforceable facility-level and community provisions that protect workers’ rights, health and safety, and the environment. 

• What policies can the United States use to encourage greater local value creation, and how could that approach strengthen economic resilience, regional stability, and the security of U.S. supply chains?

Raising local value creation increases partners’ processing capacity, improves job quality and quantity, and deepens economic benefits and wealth creation in partner countries. Over the long term, building local industry rather than limiting countries to ore exports helps diversify and deepen their economies, building resilience. Improving the quality of jobs and giving workers and affected communities a real voice in projects strengthens local and regional stability. Our partners having stronger and more diversified economies improves our security by reducing our exposure to instability, volatility, and supply chain disruptions. In short, the United States is stronger when our partners are better off.

For these reasons, the United States should stop undermining local value creation. It should drop provisions in ARTs and in deals like the SPA that undermine export restrictions, quotas, and domestic processing requirements, and stop requiring changes to mining codes, tax laws, or constitutions to favor U.S. investors. The United States should model future mineral demand and use that modeling to guide supply chain investments. Those investments should be coupled with strong environmental, social, job creation, and human rights standards to deliver supply chain security, clean energy, and real local benefits.

U.S. policies in the minerals sector should encourage U.S. taxpayer-backed financing through agencies such as DFC and EXIM, and the Departments of Defense and Energy, to prioritize projects that support higher value addition in partner countries, such as processing, refining, and recycling, rather than just raw materials extraction and transport. Funding should also be conditional on measures that support greater local value creation and community development, such as local hiring, training, technology transfer, and other local investment. These policies to encourage local value creation must also include environmental safeguards to ensure that impacted communities are not harmed by mining processes. At a minimum, project financing agreements should require environmental impact assessments, Indigenous and/or community consent, job creation provisions, and community benefit agreements before projects move forward. They should also require guarantees that taxpayers and local communities do not shoulder environmental costs and cleanup burdens.  

While some of the trade agreements mention the need to implement environmental standards, the language is largely hortatory and lacks meaningful enforcement. We know from past trade deals that environmental chapters do nothing to protect the environment nor stem environmental arbitrage without swift and certain enforcement mechanisms. None of the critical minerals agreements we reviewed have project-specific, enforceable environmental safeguards — a particularly concerning omission in an industry responsible for widespread environmental harms.

Partnerships:

• You have expressed concern about the use of tariffs and geopolitical pressure in negotiating critical minerals agreements. How should the United States use its trade leverage to diversify critical mineral supply chains while avoiding the forms of economic coercion that we criticize when other countries use them?

The United States should start with a coherent minerals strategy. That means clear, demand-based analyses of which minerals we need and for what purpose, instead of an open-ended grab for resources with no defined goal. That strategy should also reduce demand through recycling, recovery, and more efficient use. Once we know what we need, we can decide what can be achieved through domestic mining and processing and which international partnerships abroad make the most sense. 

Those partnerships should benefit both sides. They should use local-content rules, rules of origin, and other measures to make sure mineral wealth supports sustainable development and good jobs in resource-rich countries. Proposed projects should also undergo social, human rights, and environmental impact assessments before moving forward.

The United States has real leverage and should use it as an incentive, not a threat. Access to the U.S. market is a strong reason for partners to adopt high labor, environmental, and transparency standards. Foreign aid and market access should never be used as bargaining chips for minerals. Unfortunately, we’ve seen that coercive approach multiple times in this administration. It reportedly tied HIV assistance in Zambia to mineral access. It pressed the DRC to open a secret reserve of mineral assets to U.S. investors and to change its laws and constitution. And it used agreements such as the Indonesia and Malaysia deals to limit partners’ value-added domestic processing policies. Deals made under coercion are simply not durable or sustainable. For example, Malaysia signed its ART under the threat of steep U.S. tariffs. But after the Supreme Court struck down those IEEPA tariffs, Malaysia announced that its agreement was null and void. The United States cannot credibly criticize China’s economic coercion or extractive practices while adopting a similar playbook. Coercion leaves an opening for adversaries to offer a better deal. Leading by example means raising global standards, not dragging them down.

This should not be zero-sum. No single country can build a resilient minerals supply chain alone. The United States should work with a broad range of partners and be open to joint industrial strategies that support good jobs across the entire supply chain, in the United States and abroad. A transparent and inclusive process is essential. Agreements negotiated transparently, with input from workers, civil society, and affected communities in both countries and with meaningful congressional review, are far more likely to produce fairer and more durable deals than those signed under coercion.

• Given China’s dominant position across several critical-mineral supply chains, what should a sustainable United States-led alternative look like? Should the United States prioritize bilateral mineral agreements, a broader coalition of trusted trading partners, or a multilateral framework that establishes common rules on market access, export restrictions, labor and environmental standards, transparency, and investment?

Diverse, reliable, and adaptable supply chains are essential for many of the goods that underpin U.S. national and economic security. China’s dominance in several critical mineral supply chains is real, but the answer is not to copy the same objectionable tactics. When the United States relies on coercion, it undermines U.S. standing and credibility and leaves an opening for China to offer resource-rich countries a better deal.

The structure of an agreement matters less than the approach behind it. A bilateral, plurilateral, or multilateral agreement can be extractive and opaque, or it can be fair, transparent, and built on high standards. So far, the Administration’s approach has relied mostly on asymmetric bilateral deals, and the countries in the weakest bargaining positions have generally given up the most. A durable alternative should respect partners’ development goals, including their ability to promote local processing and value addition. It should include enforceable labor, environmental, and human rights standards, invest in recycling and recovery, and support good jobs across the supply chain in the United States and in partner countries.

The United States should support regional economic integration efforts, such as the African Continental Free Trade Area and the East African Community, instead of pulling individual, less powerful countries into separate deals on U.S. terms. Working with regional blocs and a broad coalition of partners can build more resilient supply chains and give individual countries a stronger collective voice. 

Whatever form these arrangements take, they should be negotiated transparently, with meaningful participation from workers, civil society, and affected communities, and subject to congressional review and approval.

• As the United States develops these partnerships, how should it ensure that transparency and responsible sourcing are built into the framework from the outset? The OECD has emphasized that traceability alone is not sufficient and must be paired with risk-based due diligence and credible verification. In practice, where should accountability rest among governments, mining companies, refiners, and downstream purchasers, and what consequences should follow when agreed labor or transparency standards are not met?

Transparency and responsible sourcing have to be built in from the start of negotiations, not tacked on once deals are signed. Governments should establish and enforce transparency, anti-corruption, environmental, labor, and civic space requirements.  Negotiators should publish proposed texts, open them to public comment, and release updated drafts as talks progress, as agencies do when they write new rules. Workers, civil society, and affected communities in both the United States and partner countries should have a real role in shaping the agreements. There should be no secret negotiations and no secret deals. Every concluded agreement should be published in full, including annexes, side letters, and asset lists, in a single public database, and should be subject to congressional review and approval. Right now, the Administration offers no central list of its minerals deals, and most critical minerals deals are only announced, and access to the full text is occasional and limited.

The same transparency and disclosure should apply to the terms of each project financing deal. The public should be able to see which companies benefit, who owns them, what financing and public guarantees support them, and what contracts, royalties, and revenues are involved. Accountability should run along the whole supply chain, and no participant should be able to pass the buck to someone else. 

Credible verification requires traceability from mine to market, paired with risk-based due diligence by miners, refiners, and buyers, and with independent third-party audits whose findings are made public. Mining companies should identify and address risks at the mine site, including harms to workers, land, water, and nearby communities, and should set aside money for closure and cleanup. The mining companies must accept responsibility for themselves and subcontractors complying with requirements of the United States as well as the host government. Refiners are a key control point because so much processing is concentrated in a few places and ownership is often opaque. Downstream buyers should assess how their supply chains operate, purchase from companies that engage in voluntary standards and certification schemes such as IRMA, and use their leverage to demand improvements. Broad commitments and statements of intent are not enough.

And knowing where a mineral came from is not enough. Industry-run certification programs should not substitute for independent oversight. Standards need enforcement mechanisms. Governments should write binding, enforceable standards into their agreements and enforce them, including through labor-rights enforcement, environmental protection, Indigenous rights, and human rights requirements, and strict bans on importing goods made with child and forced labor. Workers, affected communities, and civil society should have a central role in monitoring, and their voices and experiences prioritized. This should be coupled with complaint mechanisms they can use without fear of retaliation, and a U.S.-Mexico-Canada Agreement-style rapid-response mechanism to address labor and environmental violations at the individual mine or facility level, or in impacted communities, so that they can be investigated and addressed quickly. Depending on the seriousness of a violation, consequences could include losing preferential trade treatment, being blocked from the U.S. market, being suspended from federal financing, or requiring clawbacks/repayment of public funds. 

Mineral Circularity:

• As the United States seeks to build resilient critical minerals supply chains, how should the United States incorporate mineral circularity, including recycling, recovery, reuse, and more efficient use of existing materials? What policies or investments should Congress pursue to strengthen recycling and recovery of critical minerals and integrate circularity into U.S. supply chain strategies?

Circularity should be at the center of U.S. supply chain strategy, not an afterthought. Every ton of critical minerals recovered at home is a ton the United States does not have to mine or import. Recovered minerals also come from within our own borders, so other countries cannot cut off supply. Recycling, recovery, reuse, and more efficient use of existing materials reduce dependence on new mining and imported raw ore, ease pressure on communities and ecosystems near mines, and create jobs in refurbishment and recycling. A sound strategy should also aim to reduce overall demand, so less mining is needed in the first place.

The United States is significantly behind in this area. China is already the world’s mineral recycling capital and recently adopted ambitious plans to significantly expand recycling of end-of-life batteries, metal scrap, and renewable energy components by 2030 to support industrial decarbonization. For example, their plan to recycle more than 1 million metric tons of spent traction batteries, commonly used in EVs and heavy industry, is expected to meet 10%-15% of the raw material demand for new traction battery production. 

The Trump administration has largely ignored circularity. A Biden-era U.S.-Japan Critical Minerals Agreement explicitly referred to the circular economy, but the Trump U.S.-Japan Action Plan for Critical Minerals Supply Chain Resilience signed in March 2026 drops that language. Almost none of the critical minerals instruments that Public Citizen reviewed meaningfully address reuse, recycling, or end-of-life measures, and none address demand reduction. 

This disregard for minerals circularity is unfortunately consistent with the Trump Administration’s climate-hostile approach across the board; the trade deals also omit any reference to climate impacts.

Congress should make recycling, reuse, and more efficient use central to U.S. minerals strategy.  Public investment, including DOE programs and DFC and EXIM financing, should prioritize recovery and processing capacity rather than only new extraction, and assess and document whether recycling or substitution could achieve the same objective.  Minerals agreements should prioritize circularity, with binding commitments to trace, reuse, refurbish, and recycle minerals instead of burning or landfilling them at the end of a product’s life. That approach would cut the need for new extraction, strengthen supply security, and create good jobs in the United States and in partner countries.

Comments Regarding the Food and Drug Administration’s Public Workshop on Testosterone Use in Menopausal Women

By Deborah Fadoju

Download PDF

Public Citizen, a national nonprofit consumer advocacy organization with over one million members and supporters nationwide, submits the following comments to the docket for the Food and Drug Administration’s (FDA’s) September 17, 2026, public workshop on testosterone use in menopausal women. The workshop examined scientific evidence about testosterone use and gaps in knowledge about sexual function, cognition, mood, musculoskeletal health, testosterone measurement, and long-term cardiovascular and breast cancer safety.^[1],[2] These comments were prepared by Deborah Fadoju, M.D., a fellow with Public Citizen’s Health Research Group.

No testosterone product is currently FDA-approved for menopausal women in the United States.^[3],[4] The FDA stated that the workshop was intended to examine the current scientific evidence and critical knowledge gaps in order to inform future research and potential drug development.^[5] In clinical practice, clinicians have nonetheless prescribed testosterone off-label to women for a variety of symptoms, including low sexual desire. Moreover, off-label use in women nearing or after menopause has increased over the past decade.^[6],[7] Because there are no approved testosterone products for women, clinicians generally use products approved for men, with dose modification, or compounded formulations; neither are FDA-approved for this use.^[8],[9]

Public Citizen agrees with the FDA that menopausal women deserve effective, evidence-based options for symptoms that affect their quality of life. Currently, however, randomized trials support at most a modest benefit of testosterone for sexual function in postmenopausal women with HSDD.^[10] There are no adequate data supporting testosterone use for cognition, mood, or musculoskeletal health in menopausal women. Long-term cardiovascular and breast cancer safety have not been established for any use.^[11]

Before approving any testosterone product for women, we urge the FDA to require the following: (1) evidence of clinically meaningful benefit for a specific, defined indication; (2) adequate long-term safety data, particularly for cardiovascular and breast cancer outcomes; (3) separate evidence for each proposed indication; and (4) product-specific dosing, exposure, and monitoring data. We discuss our recommendations in more detail below.

1. Evidence of Benefit for Testosterone Is Limited to Sexual Function in Postmenopausal Women with HSDD, and That Benefit Is Modest

The only outcome for which randomized trials show a benefit of testosterone is sexual function, and only in postmenopausal women with HSDD, a condition characterized by low sexual desire accompanied by personal distress.^[12],[13] This is a narrower population than menopausal women in general.

In 2019, Islam and colleagues published a systematic review and meta-analysis of 36 randomized controlled trials involving 8,480 women.^[14] The trials evaluated different testosterone formulations, doses, and patient populations, comparing testosterone against placebo or, in some trials, a comparator such as estrogen with or without progestogen. Only 13 of the 36 trials specifically recruited women with low sexual function. Among postmenopausal women, testosterone use was associated with an average of 0.85 additional satisfying sexual events per month compared with control, as well as improvements in sexual desire and reductions in sexual distress.^[15] Although statistically significant, the difference between testosterone and control represents fewer than one additional satisfying sexual event per month. Because the trials included different populations, formulations, and doses, these findings should not be generalized to all menopausal women or assumed to apply equally to every testosterone formulation.

One of the largest trials included in the Islam et al. review, APHRODITE, illustrates the magnitude of benefit. The trial enrolled 814 postmenopausal women with HSDD who were not receiving estrogen therapy and randomized them to transdermal testosterone patches delivering 150 or 300 micrograms per day or placebo.^[16] At 24 weeks, women receiving 300 micrograms of testosterone per day reported a statistically significant increase of 2.1 satisfying sexual episodes over four weeks, compared with 0.7 increase in such episodes in the placebo group. In the 150-microgram group, a statistically significant increase in satisfying sexual episodes was not found.

The Islam et al. review also included three small trials in premenopausal women, which showed no benefit over placebo or a comparator for satisfying sexual events or any other sexual function domain.^[17] Neither the pooled findings nor the results of the APHRODITE trial should be generalized to women without HSDD or to menopausal women more broadly.^[18]

If the FDA were to receive a new drug application for a testosterone product for HSDD, the clinical trials supporting the application should assess not only the frequency of satisfying sexual episodes but also changes in desire, associated distress, and the proportion of women reporting meaningful improvement.

2. The Long-Term Safety of Testosterone Products for Women Must Be Established Before Approval

Testosterone treatment is associated with adverse effects that may vary by formulation. Long-term cardiovascular and breast cancer safety has yet to be established.

The Islam et al. study identified increased acne and hair growth with testosterone. Oral testosterone, but not other formulations, adversely affected lipid measures. These findings support formulation-specific evaluation rather than considering different testosterone products as interchangeable.^[19]

In the APHRODITE study, there were four breast cancer diagnoses in testosterone-treated participants and none in the placebo group.^[20] Safety was assessed for 52 weeks, with a subgroup of participants followed for a second year. The authors acknowledged that the study was neither large enough nor long enough to establish long-term safety.^[21]

The 2019 Global Consensus Position Statement on the Use of Testosterone Therapy for Women reviewed evidence on testosterone therapy in premenopausal and postmenopausal women.^[22] On safety, the review found that (1) available trials were too limited to assess long-term breast cancer risk; (2) women at elevated cardiometabolic risk were generally excluded from trials; and (3) there were no safety data for testosterone use beyond 24 months.^[23]

These concerns are not new. In 2004, an FDA advisory committee reviewed a testosterone patch proposed for use by women with HSDD following surgical menopause who were receiving estrogen.^[24] The committee voted 14 to 3 that the efficacy benefit was clinically meaningful but unanimously recommended against approval of the patch because its long-term safety had not been adequately established. Although additional studies have been conducted since 2004, the available evidence remains insufficient to resolve the safety concerns.

Before approving any testosterone product for women, the FDA should require safety evidence that adequately represents the intended treatment population, including women with typical cardiovascular risk factors, and provides sufficient follow-up to assess risks associated with the expected duration of treatment. Postmarketing studies should supplement, not replace, essential preapproval safety evidence.

3. There Are No Adequate Data Supporting Testosterone Use in Women for Cognition, Mood, or Musculoskeletal Health

The FDA workshop identified cognition, mood, and musculoskeletal health, alongside sexual function, among the topics for evidence review.^[25] Adequate evidence of clinically meaningful benefit has not been established for cognition, mood, or musculoskeletal health.

The Islam et al. study did not establish a benefit for cognitive function, musculoskeletal outcomes, or depressive mood; the evidence for these outcomes was limited.^[26] Similarly, the Global Consensus Position Statement concluded that evidence was insufficient to support testosterone for cognition, mood, general well-being, or bone and muscle health.^[27]

Data from studies of women with HSDD should not be used to support testosterone treatment for unrelated menopausal symptoms. The FDA should require adequate and well-controlled clinical trials of testosterone for each specific indication that fully assess safety and whether any benefit is clinically meaningful.

4. Product-Specific Dosing and Monitoring

Testosterone formulations differ in dosing, absorption, and systemic exposure. Evidence from one formulation should not be assumed to establish the safety or efficacy of another formulation. The FDA should require product-specific data demonstrating consistent dosing, bioavailability, and physiologic testosterone levels, together with monitoring to avoid androgen-related adverse effects.^[28]

Conclusion

Menopausal women deserve effective, evidence-based treatments for symptoms that affect their quality of life. Current evidence supports, at most, a modest benefit of testosterone for sexual function in postmenopausal women with HSDD. Long-term cardiovascular and breast cancer safety remain inadequately established. There are no adequate data supporting testosterone use for cognition, mood, musculoskeletal health, or other menopausal symptoms. Public Citizen urges the FDA not to approve any testosterone product for women without evidence of clinically meaningful benefit for a specific indication and adequate long-term safety data.

Thank you for your consideration of our comments on this important topic for women’s health.

^[1] Food and Drug Administration. Testosterone Use in Menopausal Women; Public Workshop; Request for Comments. 91 Fed. Reg. 53417 (Aug. 18, 2026). https://www.federalregister.gov/documents/2026/08/18/2026-16829/testosterone-use-in-menopausal-women-public-workshop-request-for-comments. Accessed October 19, 2026.

^[2] Ibid.

^[3] Ibid.

^[4] Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med. 2021;18:849–867.

^[5] Food and Drug Administration. Testosterone Use in Menopausal Women; Public Workshop; Request for Comments. 91 Fed. Reg. 53417 (Aug. 18, 2026). https://www.federalregister.gov/documents/2026/08/18/2026-16829/testosterone-use-in-menopausal-women-public-workshop-request-for-comments. Accessed October 19, 2026.

^[6] Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104:4660–4666.

^[7] Food and Drug Administration. Testosterone Use in Menopausal Women; Public Workshop; Request for Comments. 91 Fed. Reg. 53417 (Aug. 18, 2026). https://www.federalregister.gov/documents/2026/08/18/2026-16829/testosterone-use-in-menopausal-women-public-workshop-request-for-comments. Accessed October 19, 2026.

^[8] Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104:4660–4666.

^[9] Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med. 2021;18:849–867.

^[10] Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7:754–766.

^[11] Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104:4660–4666.

^[12] Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med. 2021;18:849–867.

^[13] Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104:4660–4666.

^[14] Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7:754–766.

^[15] Ibid.

^[16] Davis SR, Moreau M, Kroll R, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med. 2008;359:2005–2017.

^[17] Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7:754–766.

^[18] Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104:4660–4666.

^[19] Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7:754–766.

^[20] Davis SR, Moreau M, Kroll R, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med. 2008;359:2005–2017.

^[21] Ibid.

^[22] Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104:4660–4666.

^[23] Ibid.

^[24] Moynihan R. FDA panel rejects testosterone patch for women on safety grounds. BMJ. 2004;329:1363.

^[25] Food and Drug Administration. FDA Public Meeting: Testosterone Use in Menopausal Women, September 17, 2026. https://www.fda.gov/consumers/womens-health-events/fda-public-meeting-testosterone-use-menopausal-women-09172026. Accessed October 19, 2026.

^[26] Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7:754–766.

^[27] Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104:4660–4666.

^[28] Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med. 2021;18:849–867.

Letter to Attorneys General: Investigate Property Insurers’ Claims Handling Practices and Other Areas of Potential Misconduct

Download PDF

Dear Attorneys General,

In a single year, John and Jodi Phillip of Van Horne, Iowa dealt with an exceptional level of suffering. A derecho damaged their home and destroyed their business while the couple faced serious health challenges, including Jodi’s brain tumor and John’s stage four cancer. But for Jodi, the greatest stress was the “utter helplessness” she felt fighting with her property insurer for the payment of storm-related claims. Their insurer’s failure to pay for the full cost of recovery—Jodi estimates they are owed over $650,000—has left their business shuttered and home exposed to the elements. 

John and Jodi are far from alone in feeling betrayed by their property insurance company and public frustration extends beyond the claims process. Richard Zimmel of Silver City, New Mexico told the New York Times that shortly following a large financial investment to fireproof his home, he received a non-renewal letter from his insurance company. The San Francisco Chronicle has reported on the homeowners, including Mike and Kendra Kubo of Santa Cruz, California, who are unable to rebuild following wildfires and other disasters due to low coverage limits set by their insurer. For the Kubos, State Farm set their coverage limit nearly $500,000 below the estimate they received to rebuild their property following a devastating wildfire. Although the Kubos reupped their insurance coverage shortly before the fire, State Farm wouldn’t cover the full cost of rebuilding their home.  

Each of these stories represents an alarming pattern of insurance company behavior that is growing across the country. As extreme weather events become more frequent and severe, households are experiencing claims delays or nonpayments, policy nonrenewals, and revelations of inadequate coverage following disasters. Though insurance is intended to help households manage risk and avoid financial devastation in the event of a disaster, many insurers are failing to fulfil this role. 

In July 2026, Oklahoma Attorney General Gentner Drummond filed a sweeping lawsuit against Allstate Corporation, alleging the company orchestrated a racketeering scheme to systematically underpay policyholders for extreme weather damage.[1] The complaint alleges that for at least five years, Allstate secretly imposed restrictive claims standards to match predetermined outcomes, stripped licensed adjusters of their authority, and relied on unlicensed reviewers to slash payouts despite marketing “full coverage” to homeowners. During this time, Allstate made record profits.

Allegations of claims mishandling are not limited to Allstate. The Oklahoma Attorney General filed a similar suit against State Farm earlier this year. The issues raised in the Oklahoma lawsuit also have implications for households across the country. In Illinois, the Attorney General has sued State Farm for concealing its business practices.[2] In California, regulators are actively investigating patterns of claim denials, underpayment, and bad-faith conduct, and seeking a fine against the insurance behemoth. Los Angeles County subsequently filed suit seeking full restitution for policyholders, and civil fines. In Florida, the House speaker launched an investigation into property insurance companies hiding billions of dollars in profits in affiliate companies, while claiming financial losses so they could argue for rate increases.  

The scale of claims handling abuses by insurers is potentially extensive. A recent investigation by the Wall Street Journal found that the five largest home insurers failed to pay out on more than 44 percent of claims resolved last year. Separate analysis from Weiss Ratings shows that fifteen of the largest insurers closed more than half of all homeowner claims in 2025 with no payout whatsoever. This often proves highly profitable to the industry. The industry collectively takes in an extra $8.8 million in interest and investment income for each day homeowners insurance companies delay paying claims. However, it is devastating for policyholders. Families who paid premiums for years, sometimes decades, now find themselves without the coverage for which they paid. 

Home insurance is an essential financial safety net for consumers, and rising costs are a key affordability concern. Systematic mishandling of claims threatens household finances, disaster recovery and, in turn, broader US financial stability. Without a well-functioning home insurance market, mortgage markets, local economies, and state and municipal government budgets are also imperiled. 

As the impacts of climate change worsen—including severe, costly, and widespread disasters—the need for increased oversight of and accountability for claims handling and other insurance company practices grows as well. Despite the escalating impacts of climate change, the property and casualty insurance industry just recorded its most profitable underwriting year in more than two decades. In 2025, underwriting profits surged to $68.7 billion, and reported net income came in at over $150.5 billion. At the same time, policyholders and the public bear a growing share of climate change-related costs through double-digit premium hikes, coverage withdrawals, and underpayment of claims. 

Additionally, insurance companies are spending millions lobbying for legislation that restricts consumers’ private right of action, making it harder for consumers to get what they are owed. These tort “reform” measures are marketed as cost-saving reforms, but their real purpose is to make it harder for consumers to hold companies accountable. There is no evidence that shows restricting consumers’ access to courts drives down premiums or benefits consumers. Studies do show, however, that these changes in states like Florida have led to insurers denying more claims while pocketing premiums. 

This industry will not reform itself; it must be compelled to do so. Consumers need champions who will stand up for them against unethical and fraudulent insurer practices and ensure that companies face consequences for their lawbreaking. 

Attorneys general are uniquely positioned to fulfill this role through civil litigation, criminal investigation, consumer protection enforcement, and the bully pulpit. State attorneys general should also not assume that action by state insurance departments alone will be sufficient to address potentially widespread insurance company malpractice. While insurance departments have primary regulatory authority, attorneys general have distinct and broad consumer protection authority that can be an effective complement to insurance department action [3] or serve as an antidote to slow or tepid action from commissioners.

We are calling on attorneys general to investigate the following potential patterns of misconduct:

• Claim underpayments, delays, and denials after disasters. Home insurance claims payouts should not be a coin flip.
• Misleading sales tactics and policy terms, particularly related to algorithms used to determine coverage limits. Homeowners should not find out after a total loss that their coverage estimate was inadequate.
• Patterns of cancellations and non-renewals across entire neighborhoods, particularly for homeowners who have recently invested in risk reduction. Zip codes shouldn’t become a proxy for actual risk.
• Collusion, price-fixing, and anti-competitive behavior. When carriers simultaneously raise rates, shrink coverage, and tighten standards, the possibility of coordinated conduct deserves scrutiny.
• Racial premium gaps paid by Black and Hispanic homeowners. A recent study finds that these homeowners pay substantially higher premiums even after accounting for various risk factors.

And we call on attorneys general to advise legislators to do the following:

• Reject legislation that strips consumers of their right to hold insurers accountable in court. The evidence is clear: restricting access to justice does not lower premiums; it immunizes bad actors.
• Protect policyholders from widespread misconduct when insurance department oversight proves insufficient.

The public is clamoring for action. A recent SurveyUSA poll released by Climate Power and the Insurance Fairness Project found that more than 80 percent of voters want their state elected officials to do more to reduce rising insurance premiums. This is a matter of basic fairness and contract enforcement. We stand ready to support these efforts and to work alongside attorneys general to hold this industry accountable.

Sincerely,

Public Citizen
American for Financial Reform
Center for Climate Integrity
Center for International Environmental Law (CIEL)
Connecticut Citizen Action Group
Consumer Action
Consumer Federation of America
Consumer Watchdog
Extreme Weather Survivors
Every Fire Survivor’s Network
For a Better Bayou
Green America
Greenlining Institute
Metropolitan Interfaith Council on Affordable Housing
Minnesota Interfaith Power & Light
National Community Reinvestment Coalition (NCRC)
Oregon Consumer Justice
Revolving Door Project
The American Policyholder Association
Unlocking America’s Future

Individual Signers
Dave Jones, Former Insurance Commissioner

 

[1] State ex rel. Drummond v. State Farm Fire & Cas. Co., No. CJ-2026-1066 (Okla. Dist. Ct. Cleveland Cty. filed June 24, 2026)
[2] Gillespie v. State Farm Fire & Cas. Co., No. 2025CH10454 (Ill. Cir. Ct. Cook Cty. filed Oct. 14, 2025)
[3] id. 

 

How the WTO Fails to Protect Public Interest Laws

Dispute Settlement General Exceptions Have a 96% Failure Rate

Download PDF

Executive Summary

Policymakers, scholars, along with consumer, environmental, health, labor and other civil society organizations around the world have raised alarms about the way in which the “trade” rulebook has been expanded to establish new corporate privileges and limits on government regulatory measures that undermine public interest policies, including those protecting the environment and public health.

Over and over again, negotiators and government trade officials responded that “general exceptions” found in Article XX of the GATT and added to other pacts would ensure that signatory-country governments would be able to balance their “trade” obligations with the need to pursue public policy goals.

However, in practice, in the WTO’s 31 years of existence, there have been only two successful defenses of the general exceptions of the GATT (Article XX) and the General Agreement on Trade in Services (GATS Article XIV), in 2001 and 2018, out of 56 general-exception claims addressed by WTO adjudicators to defend domestic policies challenged as illegal under WTO rules.

Even successful Article XX and XIV defenses are not enough if there are other, separate WTO violations that the exceptions do not cover. This analysis is not a comprehensive account of every claim or defense raised in the disputes examined, only an examination of the general exceptions that served as a set of affirmative defenses under WTO law.

The dismal record of the WTO general exceptions that are supposed to preserve countries’ policy space so that “trade” obligations do not impede other societal objectives is, by itself, strong evidence that the system requires reform. This report breaks down the most significant obstacles for respondents that invoke general exceptions and identifies which thresholds have proven the most difficult for respondents to pass. It also describes how the complexities countries face in trying to defend a domestic measure vary depending on the specific defense raised.

The two successful exception defenses both relate to the conservation of exhaustible natural resources: Attempts to use the other policy objective defenses, such as human health and life and public morals, have been totally shut down. This is largely due to the development of stringent tests and interpretations by the WTO Appellate Body and panels that have created an inflexible framework that is often alien to the realities of domestic policymaking.
WTO adjudicators must first accept the use of the exceptions as relevant or inadmissible before governments are even able to invoke the public-interest exceptions.

The use of GATT Article XX or GATS Article XIV exceptions then successfully requires passing three successive steps of legal analysis. All three thresholds must be met for the defense to succeed. The first two thresholds relate to the subparagraphs under Article XX or Article XIV that the respondent cites as the basis for the defense, while the third threshold relates to the introductory clause or chapeau language found in both GATT Article XX and GATS Article XIV.

Of the 56 occasions in which WTO adjudicating bodies substantively analyzed GATT Article XX and GATS Article XIV defenses, only two resulted in a measure being deemed justified under a general exception. Among its most relevant findings are:

• Of the 56 analyzed exception defenses, 48 were deemed admissible.
• Thirty-seven defenses passed the subject matter/scope threshold.
• Eighteen defenses passed the “necessary” or “related to” threshold.
• Only two defenses ultimately passed the chapeau and succeeded overall.

---

The Pathway for the Two Instances of Respondents Successfully Invoking the General Exceptions Defense

Source: Public Citizen’s Global Trade Watch WTO General Exceptions Database, an analysis of the rulings posted by the WTO.

---

The defenses that are most often invoked and assessed in the WTO dispute settlement system are subparagraphs (b) and (d), especially, and (g) of GATT Article XX. These subparagraphs relate to the following policy objectives: (b) protection of human, animal or plant life or health, (d) the use of measures to ensure compliance with laws or regulations that are not in themselves inconsistent with GATT rules, and (g) conservation of exhaustible natural resources. Respondents have also tried to justify their public interest measures by claiming that they are necessary to protect public morals (GATT Art. XX (a) and GATS Art. XIV (a)) or, in addition, with respect to services, maintain the public order (GATS Art. XIV (a)) or that they are essential to acquire or distribute products in short supply (GATT Art. XX (j)).

The respondent has lost both the defense and the case in 96% of the instances in which WTO adjudicators considered the general exceptions defense. This failure rate exceeds even the overall 91% “loss” record of respondents in WTO dispute resolution.

Before a government can even attempt to satisfy the three steps in a general exception, WTO adjudicators may outright dismiss the use of the exceptions as irrelevant or inadmissible, meaning governments were denied any meaningful opportunity to invoke the exceptions to defend public-interest measures. Of the 56 exception defenses analyzed in this report, eight were deemed irrelevant or inadmissible.

After that initial determination, the first legal test a respondent must pass when it invokes an exception is the subject matter/scope threshold, which assesses whether the policy measure in question is connected to the issue named in the subparagraph. While GATT Article XX(d) now accounts for roughly one-third of the exceptions raised and analyzed in WTO dispute settlement, it represents nearly 60% of cases lost on the subject matter/scope threshold. Conversely, despite representing almost half of the exceptions raised and analyzed, defenses under GATT Articles XX(b) and (g) have failed this threshold in only two instances.

The second legal test, the qualifier threshold, requires that the policy measure be “necessary” for the subparagraph’s named policy objective (e.g., a measure for which GATS Article XIV (a) is invoked must be “necessary to protect public morals or to maintain public order”), or that the policy measure be “relating to” the objective (e.g., measures for which GATT Article XX(g) is invoked must be “relating to the conservation of exhaustible natural resources”). The “necessary” standard has proven much more difficult to fulfill than the “related to” test. Respondents failed to establish necessity in 17 of 23 claims, or 74%. By comparison, respondents failed the Article XX(g) “relating to” requirements in four of eight claims, or 50%.

Lastly, the introductory clause of GATT Article XX and GATS Article XIV, called the chapeau, requires a policy not to be applied in an arbitrary or unjustifiably discriminatory manner between countries where the same conditions prevail or in a way that ends up being a disguised restriction on trade. (This is in addition to demonstrating a certain degree of connectedness to the policy objective specified in each subparagraph.) Respondents that have reached the arbitrary/unjustifiably discriminatory or disguised restriction thresholds have had an extremely low success rate. The reasoning exhibited by the Appellate Body in these exception claims on the chapeau frequently disregards the domestic constraints and dynamics that typically underpin public interest policies.

This analysis underscores the urgent need to reform the general exceptions regime of the WTO and related general exceptions language in free trade agreements and should inform the policy discussion about how to do so. There are four critical changes that would be necessary to construct effective general exceptions, whether in the context of a broad reform of the WTO Agreements or in new agreements.

1. Widening the scope of coverage:

The subject matter of domestic policies that could be implicated by existing and new trade agreements is vast. Additionally, as shown by the wide array of policy measures that have been discussed under GATT Article XX(d), the subparagraph covering policy objectives related to compliance with laws and regulations not themselves inconsistent with the GATT, the current scope of GATT Article XX and GATS Article XIV is too narrow. As a priority, subparagraphs (b) and (g) of the GATT, related to the protection of public health and the conservation of exhaustible natural resources respectively, should be amended to include explicit reference to multilateral environmental agreements, and subparagraph (e), which covers measures related to the fight against forced labor, should be expanded to cover more core international labor standards. Additionally, new subparagraphs should be added to give room to policies related to the rights of indigenous people, and human rights in general, culture, including by clarifying that countries’ obligations under treaties on such matters, as well as on public health, including tobacco and toxics controls, and labor rights take precedence to the extent of conflict.

2. Limiting panel or Appellate Body discretion with respect to what domestic policies are necessary:

WTO jurisprudence on the “necessary” threshold has not been consistent, with rulings ranging from judgments about whether a policy itself is necessary to whether the degree to which it restricts trade is necessary. The best way to limit adjudicating bodies’ discretion would be to make the “necessary” element of the general exceptions self-judging, as has been done in some free trade agreements. Another approach recently used in investment agreements that include general exceptions inspired by GATT Article XX is to replace the “necessity” standard with a “designed and applied to” threshold for all exceptions. A less fulsome alternative would keep part of the necessity test but remove its most problematic element, i.e., the trade restrictiveness analysis.

3. Adjusting the chapeau terms to the realities of domestic policymaking:

Limiting the discretion of adjudicating bodies to define what is required to meet the chapeau tests would also be critical. In this vein, some scholars have proposed a “predominant motive test,” under which public interest measures would be deemed justified under the exceptions as long as their primary objective is one of those permitted by GATT Article XX or GATS Article XIV.

4. Placing the burden of proof on the complaining party with regard to the thresholds established in the chapeau:

Any general exception with a “specific exception-general requirements” structure should include clear rules of burden of proof where the responsibility to demonstrate that a public interest policy is applied in an arbitrary or unjustifiably discriminatory fashion falls on the country challenging the measure. As articulated in this brief, this approach would be consistent with the core tenets of public international law.

This report carefully documents the 31-year record that shows the WTO general exceptions are largely useless in their current form. Consequently, it highlights the urgent need for changes to “trade” rules and exceptions to ensure governments have the policy space needed to address the major challenges of our times.

How Trump Conned MAHA

MAHA Named 21 Dangerous Chemicals. The Trump Administration Went Easy on 20.

By Peter Whoriskey, Research Director

Download PDF

Key Findings

In May 2025 the Trump administration published the MAHA Report, a “call to action” on the declining health of American children. A key section of the report focused on the harm caused by chemicals in the environment, including pesticides, industrial pollutants, and emissions. U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., said President Donald Trump is willing to “stand up to industry when it’s the right thing to do.”

This Public Citizen report shows how far the Trump administration has strayed from the MAHA Report’s warnings about hazardous chemicals in the environment and ignored its own advice about corporate influence and corrupted science.

• Despite raising alarms about corporate influence and bias at the U.S. Environmental Protection Agency (EPA), the Trump administration staffed key regulatory posts with former industry lobbyists and employees (See Figure, page 9). Eight of the top 10 leadership posts in the EPA offices most closely overseeing chemical regulation were filled with people with industry ties. The deputy administrator overseeing them is an attorney who built his career defending companies the EPA regulates.
• Despite the MAHA Report’s claim that the Trump administration is committed to “gold-standard science to better understand… environmental exposures,” the administration disbanded the EPA’s Office of Research and Development, a division with more than 1,500 employees that for decades ferreted out environmental dangers. The Office of Research and Development had raised warnings about the dangers of formaldehyde, dioxins, and PFAS (perfluoroalkyl and polyfluoroalkyl substances), a large group of man-made chemicals are sometimes known as “forever chemicals.” The administration also abolished the EPA’s Clean Air Act Advisory Committee and appointed industry consultants and employees to the Clear Air Scientific Advisory Committee.
• For 20 of 21 environmental chemicals called out in the MAHA Report, the Trump administration has either moved toward loosening regulations protecting public health (nine chemicals); enacted no significant regulation (10 chemicals); or, in one case, endorsed the use of the herbicide glyphosate despite its links to cancer (see Table, page 5). For only one of the 21 chemicals named in the report — microplastics — has the Trump administration taken any step toward regulation, and at best it was a baby step. In preliminary reviews of two other chemical families, the EPA identified risks to workers but not the public. Those two are phthalates, the industrial chemicals used to make plastics softer and more flexible, and tetrabromobisphenol A [TBBPA], a widely used brominated flame retardant.
• Among the most egregious betrayals: The Trump administration (1) lifted limits on forever chemicals, which persist in the environment and human bodies and have been found in the drinking water of most Americans; (2) on air pollution, loosened regulation of “particulate matter,” the tiny airborne particles linked to respiratory and cardiovascular disease; and (3) on agricultural chemicals, defended and endorsed the use of glyphosate, even as the manufacturer faces tens of thousands of lawsuits from farmers and gardeners with cancer. These examples show how the Trump administration’s retreat on chemicals in the environment is failing to keep Americans healthy.

Earlier this year, leaders of the Make America Healthy Again (MAHA) movement warned the Trump administration that MAHA must be more than just a “catchy slogan.” As this report shows, however, MAHA is worse than an empty slogan. It’s a sham.

The MAHA Report called out 21 chemicals of concern in the environment. For 20 of those 21, the Trump administration has either moved toward loosening regulations protecting the public, left the regulation largely unchanged, or endorsed a chemical’s use.

Background

The MAHA movement arose out of the 2024 presidential campaign of HHS Secretary Kennedy, who had crusaded for years against vaccines and for freedom from “medical tyranny.” The movement grew to encompass wellness influencers and others critical of pesticides and food additives.

In February 2025, shortly after his second inauguration, Trump announced that he was acting to fulfill his MAHA campaign promises. He issued an executive order creating the MAHA Commission, a 14-member panel led by Kennedy.

Within months, the panel published the MAHA Report, formally known as the Make Our Children Healthy Again: Assessment, a damning checkup on American health and chronic disease, with sections on ultraprocessed foods, environmental chemicals, childhood behavior in the digital age, and the “overmedicalization of our kids.”

The report portrayed the United States as an environmental catastrophe, a dystopia in which some corporations pour poisons into the air and water and others corrupt our diets, leaving the enfeebled American public with cancer, learning disabilities, asthma, attention deficit hyperactivity disorder, and allergies.

“We are now the sickest country in the world,” Kennedy said at a MAHA press event, alongside Trump and other administration officials.

President Trump and HHS Secretary Robert F. Kennedy, Jr., unveiled the MAHA Report in May 2025.

This Public Citizen report focuses on the section of the MAHA Report about environmental chemicals. The section, titled “The Cumulative Load of Chemicals in Our Environment,“ cited more than 50 research studies providing evidence linking environmental toxins to a public health crisis.

The dangerous environmental contaminants are inescapable, the report said. “Virtually every breastmilk sample” tested in America contains persistent organic pollutants, including pesticides, microplastics, and dioxins, it warned. These same chemicals are also “commonly found” in the blood and urine of American children and pregnant women, some at “alarming levels.” Almost 90% of homes show measurable levels of at least one insecticide on their floors.  “Hundreds of industrial chemicals and pollutants” can pass through the umbilical cord and placenta to reach the developing fetus.

“[T]here is a growing concern about the link between environmental health risks, particularly cumulative risks, and chronic disease,” the report warned. “Furthermore, in the past nearly 30 years, the chemicals children are exposed to have grown – and no country fully understands how the cumulative impact of this growth impacts health.”

Among those who celebrated the MAHA Report was Vani Hari, best known as the “Food Babe,” a MAHA influencer with more than three million followers.

“It was absolutely extraordinary today to see President Trump and the highest levels of leadership and coming out of the executive branch with this report,” she said. “We’ve been mass-poisoned as Americans. We’re in a chemical soup right now. There’s an amazing chart [in the report] that shows you all the chemical exposures that are happening to the human body and our small children.”

How the Trump administration betrayed the MAHA movement

The Trump administration ignored its own MAHA warnings about environmental chemicals by (1) embracing corporate influence at the EPA, (2) crippling the EPA’s scientific research, and (3) stalling and weakening the EPA’s regulation of environmental chemicals.

Embracing Corporate Influence at the EPA

For years, Kennedy, like other leaders in the MAHA movement, accused federal regulators of being controlled by corporate lobbyists and failing to protect Americans from dangerous industrial and agricultural chemicals. Accordingly, they campaigned to curtail corporate influence at the EPA and other federal agencies.

“I have been fighting big polluters and the corrupt ‘agency capture’ that has prevented effective government action on environmental threats for my entire career,” Kennedy wrote in a 2023 essay in Newsweek, where he cited the dangers of glyphosate, among other chemicals. “In effect, that agency capture has made the U.S. Environmental Protection Agency (EPA) a partner in crime with the corporations that poison our environment and endanger our health.”

In unveiling the MAHA Strategy Report, a follow-up report released in September 2025, Kennedy said no president had been more willing than Trump to stand up to industry.

“He says again and again, ‘I don’t care, this is children,’” Kennedy said at the press conference. “’We need to save the children.’”

In practice, however, the Trump administration has not only accommodated industry demands but appointed industry lobbyists and other officials to senior positions in the EPA.

The most prominent example is the appointment of David Fotouhi as deputy administrator of the EPA, the agency’s second-highest official. An attorney, Fotouhi built a career defending the companies the EPA regulates. For example, Fotouhi defended International Paper against lawsuits accusing the firm of contaminating the environment with forever chemicals. He represented a coalition of Washington-state businesses that sued the EPA over its water-quality standards for the pollutants known as polychlorinated biphenyls (PCBs). Fotouhi challenged the EPA’s ban on asbestos on behalf of a group of automobile manufacturers, claiming the EPA “failed to demonstrate” the risks of chrysotile asbestos, a proven human carcinogen.

David Fotouhi, who built a career representing companies the EPA regulates, is a top EPA official in the Trump administration. (Photo from EPA)

The corporate influence at the EPA goes deeper into the agency’s ranks, however.

Within the agency, two key groups are charged with regulating toxic chemicals. The Office of Chemical Safety and Pollution Prevention (OCSPP) evaluates and regulates the risks of pesticides and industrial chemicals. The Office of Air and Radiation (OAR) evaluates and regulates air pollution from power plants, cars, and trucks.

The Trump administration filled eight of the 10 top leadership positions in these offices with industry-friendly appointees — officials, lawyers, and lobbyists who previously worked for chemical oil, chemical, and agriculture companies (see Figure, page 9).

For example, the chief of the OCSPP, EPA Assistant Administrator Douglas Troutman, is a former senior lobbyist for the American Cleaning Institute, a trade group representing manufacturers of household and industrial cleaning products and chemical distributors to the cleaning product industry. The group has lobbied the EPA on microplastics, tiny plastic particles less than 5 millimeters in size that have been detected inside the human body and in the environment, and, more broadly, on the implementation of toxic chemicals regulations.

Likewise, to lead OAR, EPA Trump appointed Aaron Szabo, a former lobbyist who previously represented the American Fuel and Petrochemical Manufacturers and American Petroleum Institute trade associations, as well as fossil fuel companies. His former clients lobbied the EPA on smog, particulate matter, and other air quality issues. (Szabo left the agency as this report was going to press.)

The lobbyists are not only inside the building, they are setting policy.

Crippling the EPA’s scientific research

Kennedy and others in the MAHA movement have criticized the environmental research establishment, which they view as corrupted by corporate bias.

Corporate interests have dominated and distorted scientific literature, academic institutions and medical journals, according to the MAHA Report.

It lamented that “government funding has been a small portion of the totality of research dollars being spent on chronic childhood disease,” and promised that the “U.S. government is committed to fostering radical transparency and gold-standard science to better understand the potential cumulative impacts of environmental exposures.”

Trump administration officials repeatedly refer to “gold-standard science,” but it has never defined the term.

The Trump administration, moreover, has severely cut funds for government scientific research.

The Trump administration disbanded the EPA’s scientific research arm, the Office of Research and Development (ORD). Since the 1970s, the ORD has conducted pivotal research on the effects of environmental chemicals on people and made important scientific contributions on PFAS, endocrine disruptors such as bisphenols, PCBs, and dioxins.

Of the ORD’s staff of more than 1,500 employees under the Biden administration, about a third are no longer with the government and another a third are still at the EPA but no longer working in research, two former officials told me in interviews. Many have been reassigned to EPA field offices. In place of ORD, EPA officials created a smaller unit, the Office of Applied Science and Environmental Solutions.

Among the key losses was the government’s air pollution research facility in Chapel Hill, North Carolina, the largest U.S. laboratory studying the effects of vehicle exhaust, soot, and other air pollutants on people.

The unraveling of ORD followed the ouster of all the members of the Clean Air Scientific Advisory Committee (CASAC), a key EPA advisory committee. CASAC advises EPA staff during required reviews of air quality standards for six pollutants, including lead, ozone, and particulate matter.

The Trump administration then appointed new members to CASAC, most of whom had worked for corporations whose products pollute the environment. Louis Anthony Cox, appointed the chair of CASAC in March 2026, has worked for the American Petroleum Institute, Exxon Mobil Corporation, and the American Chemistry Council and has suggested that tightening particulate matter controls might be harmful to public health.

“By removing these independent experts, this administration is—yet again—selling out our nation’s public health and environmental protections to the same polluting industries that bankrolled much of Trump’s campaign,” U.S. Senator Sheldon Whitehouse said in a statement in January 2025.

In 2025 the Trump administration also dissolved the Clean Air Act Advisory Committee, which provided independent advice on the implementation of the Clean Air Act.

Stalling and weakening the EPA’s regulation of environmental chemicals

The MAHA Report includes a graphic, shown below, that summarizes the chemical classes and common exposure pathways for environmental chemicals.

“We must understand and ameliorate any potential links between cumulative chemical exposure and childhood chronic disease,” according to the report.

Source: MAHA Report      

Although the message was urgent and specific, the Trump administration has been backtracking ever since.

In the MAHA Report, Public Citizen identified 21 environmental chemicals that were targeted for scrutiny (see Table, page 5). When the MAHA “Strategy Report” was released four months later, however, only three of the 21 environmental chemicals were mentioned at all.

The retreat was just beginning. In the 16 months since the MAHA Report highlighted those 21 chemicals, the Trump administration has moved toward loosening regulations on nine, enacted no significant regulation on ten, and, in one case — for the herbicide glyphosate — advocated its use despite links to cancer. The Trump administration also helped defend glyphosate’s manufacturer from lawsuits, as discussed in more detail below.

For only one of the 21 chemicals — microplastics — has the Trump administration moved toward regulation, and then only by a baby step. In April 2026 the administration announced that it was placing microplastics on a list of substances that could be considered for regulation in future years.  The administration simultaneously announced that it would spend $144 million to study measuring and removing microplastics and nanoplastics from the human body.

In preliminary reviews of two chemical families, the EPA did identify “unreasonable” risks for workers but said they posed no such risks to the general public. In December 2025 the agency announced that five phthalates (industrial chemicals used to make plastics softer and more flexible) pose an “unreasonable risk” in workplaces, but the agency said it “found no products…that are causing unreasonable risk to the general population.” In June 2026, in a draft assessment of TBBPA, a widely used brominated flame retardant, the EPA found risks to workers who inhale it but “did not find unreasonable risk to consumers or the general population.” Neither finding is likely to produce a ban; regulations are more likely to require workplace controls.

Three examples

Three examples — PFAS (“forever chemicals”), particulate matter air pollution, and the herbicide glyphosate — show how the Trump administration’s retreat on environmental chemicals is failing to keep Americans safe.

PFAS, or “forever chemicals”

The MAHA movement has long focused on the dangers of PFAS, better known as “forever chemicals.”

Used in consumer products since the 1940s, maybe most famously in Teflon, a fluoropolymer coating used on cookware, and other nonstick products, PFAS have been linked to multiple cancers and reduced cognitive and motor development in children. These chemicals also have been used in food packaging, stain-resistant fabrics, and firefighting foam. In 2026, forever chemicals are commonly found in drinking water across the country, reaching about 176 million Americans.

The MAHA Report refers to PFAS seven times, citing five scientific sources that describe the dangers they pose and the ways that industry has concealed their harm. Almost 100% of the U.S. population is exposed to at least one PFAS, according to a 2022 report from the National Academies of Sciences, Engineering, and Medicine (NASEM). The “pervasiveness of the contamination is alarming,” the report said.

The NASEM report found sufficient or suggestive evidence of an association between PFAS and kidney, breast, and testicular cancer; thyroid disease; decreased fetal growth; and other afflictions. The Trump administration, however, loosened regulation of forever chemicals.

In May 2026 the EPA announced that it was rescinding previous federal limits on four PFAS substances that would have compelled public water systems to test for them and, if found, reduce their prevalence. For two other PFAS, the EPA retained the previously established limits but said it would allow public water systems to remain out of compliance until 2031.

In addition, the Trump administration stalled a PFAS study that would help the EPA understand which industries dump those chemicals into their wastewater, according to two former officials, the Associated Press reported. The study, a survey of wastewater treatment plants, was submitted to the White House for approval in 2024, during the Biden administration.

In the same May 2026 press release announcing that PFAS limits were being rescinded or delayed, Kennedy asserted nonetheless that the administration was taking steps to protect Americans.

Kennedy said that the Trump administration was working “to address environmental contributors to chronic disease and advance the Make America Healthy Again agenda.”

As proof of the administration’s commitment, the EPA announced nearly $1 billion in grant funding to address PFAS and other emerging contaminants in drinking water. This funding, however, was not a Trump administration initiative. The grant funding originated with the Infrastructure Investment and Jobs Act of 2021 and the Biden administration, which appropriated $5 billion for the purpose.

MAHA advocates were not pleased. After the announcement, Kelly Ryerson, a MAHA activist, wrote on X, the social media platform: “It is not MAHA to rescind limits on harmful forever chemicals in tap water, no matter how the EPA twists the legal logic to the benefit of chemical corp interests. Not buying it.”

Among the many people worried about the administration’s retreat on PFAS regulation is Brenda Hampton of Courtland, Alabama. Hampton started a community group after the local utility reported dangerously high levels of PFAS and advised against drinking tap water. Going door to door in her neighborhood, Hampton found that on two streets alone, there had been 54 cases of cancer and 14 cases of renal failure, she said in an interview.

“Going backward on PFAS is going to put a lot of people at risk,” she said. “It’s horrible what’s going on. When would you ever think that because of a glass of water you might  get cancer 20 years later?”

After the discovery of PFAS in the drinking water in Courtland, Alabama, which draws water from the Tennessee River, Brenda Hampton saw a pattern of neighbors experiencing cancer and kidney troubles. (Photo courtesy of Brenda Hampton)

Particulate matter air pollution

The MAHA Report highlighted the dangers of “particulate matter,” the tiny particles in the air that come from human activities such as vehicle emissions and industrial processes. Also referred to as soot, particulate matter has been linked to heart attacks, asthma, and, for people with heart or lung disease, premature death.

The Trump administration moved quickly to loosen limits on the amount of particulate matter in the air.

In February 2024, under the Biden administration, the EPA had imposed stricter limits on particulate matter. In setting the stricter limits, EPA officials said they were acting in accordance with recent scientific findings. They said the new rule would avoid 4,500 premature deaths by 2032.

Industry groups immediately attacked the stricter limits. The American Chemistry Council, the American Petroleum Institute, and other business groups sued to block the limits, arguing that they were too stringent and costly.

In March 2025, not long after Trump’s second inauguration, EPA administrator Lee Zeldin began to reverse course. In what he described as the “greatest day of deregulation our nation has seen,” Zeldin said that the agency would reconsider the 2024 limits. The rules had “shut down opportunities for American manufacturing and small businesses,” the EPA announcement said.

Rather than defending the rules from the legal assault by the industry associations, the EPA agreed with the corporations and said that the new rules should be abandoned.

“EPA now confesses error,” attorneys for the agency said in a court filing.

The reversal on particulate matter air pollution was part of the Trump administration’s broader rollback of air quality regulations. The administration also has loosened rules affecting other air pollutants, including mercury, lead, nitrogen oxides (NOx), and ozone. “I don’t think these MAHA people care about breathing,” one former EPA official said in an interview.

Indeed, in July 2026 Trump pardoned nine people of Clean Air Act violations related to tampering with the emission controls on diesel vehicles. One of those pardoned had been connected to the sale or installation of more than 250,000 devices to turn off pollution controls on diesel engines. The EPA equated the impact of those devices with adding 11 million vehicles to U.S. roads.

As the legal battle continued over the stricter limits on particulate matter, the Trump administration declined to enforce them. An estimated 120 counties nationwide have particulate matter levels exceeding the 2024 standard. Several of the counties are in California’s San Joaquin Valley; others are in the Sacramento, Houston, Cleveland, and Detroit areas. Enforcing the rules would require states to impose emission controls to curb the sources of pollution, including controls on industrial facilities and diesel engines.

Allegheny County, Pennsylvania, the area around Pittsburgh, is a prominent example. The American Lung Association gives the county an “F” for particulate matter. The poor air quality has been linked to a range of chronic medical ills, most notably asthma. The prevalence of asthma among elementary schoolchildren in Pittsburgh is 23%, more than three times the national average, research has shown. A longstanding website, “Smell Pittsburgh,” allows users to rate and describe the smells in their neighborhoods.

Edith Abeyta lives less than a mile from a steel mill in Allegheny County. “What industry is doing to the air is killing people by slowly deteriorating their health,” she said in an interview. “It’s devastating.”

On the worst days, which are detected by her home air monitor, Abeyta’s eyes water and she sneezes a lot. She was appalled by the Trump administration’s decision to retreat from the stricter rules, given how much it touts the MAHA agenda and the importance of health.

“It’s an outrageous contradiction,” Abeyta said. “With MAHA, Kennedy says not to drink sodas. But the effect of this plant is a hundred times worse than drinking a Coke.”

Edith Abeyta says the pollution in her Pennsylvania neighborhood is regularly bad enough to make her eyes water. She says the Trump administration’s decision to back off air pollution limits is “an outrageous contradiction” of the MAHA agenda. (Photo courtesy of Breathe Project.)

The herbicide glyphosate

Long before becoming HHS Secretary, Kennedy warned of the potential dangers of glyphosate, one of the most used herbicides in American agriculture. On an annual basis, about 280 million pounds of glyphosate are applied throughout the country, even though scientists have repeatedly linked the chemical to many illnesses, most notably non-Hodgkins’s lymphoma, a cancer of the lymphatic system.

As a presidential candidate, Kennedy called glyphosate “one of the likely culprits in America’s chronic disease epidemic.” If elected, he said, he would ban some of its uses.

Kennedy seemed to mean it. After becoming HHS Secretary in the Trump administration, the MAHA Report reiterated Kennedy’s concerns.

Research studies on glyphosate “have noted a range of possible health effects, ranging from reproductive and developmental disorders as well as cancers, liver inflammation and metabolic disturbances,” according to the report. The report cited four research studies about such harms.

Kennedy soon reversed course, however. Four months after the MAHA Report was published, the September 2025 MAHA Strategy Report was silent on glyphosate.

The reversal was just beginning. By the end of 2025, the Trump administration had become one of the loudest advocates for glyphosate and its manufacturer, Monsanto, which had been acquired by Bayer, the German pharmaceutical and agricultural biotechnology corporation. Monsanto’s best-known product is Roundup, a glyphosate-based weedkiller. Monsanto has faced tens of thousands of lawsuits from farmers and gardeners who linked their cancers to Roundup.

Alva and Alberta Pilliod, a California couple, both had non-Hodgkin’s lymphoma. Like thousands of others, they sued Bayer’s Monsanto over the company’s failure to warn that their products could cause cancer. Photo Courtesy of Wisner Baum.

The lawsuits, filed in state courts, allege that Monsanto failed to warn consumers that its glyphosate-based herbicides could cause cancer. The company countered that glyphosate is safe and that the federal government, through the EPA, had approved the products’ label and use. Monsanto said the lawsuits should be dismissed because federal approval of the herbicides preempted state laws.

In February 2026, Trump issued an executive order declaring that glyphosate is “crucial to the national security.” The executive order praised the role of glyphosate in American agriculture and, as many MAHA devotees noted with dismay, it said glyphosate helped provide “healthy” food options.

“As the most widely used crop protection tools in United States agriculture, glyphosate-based herbicides are a cornerstone of this Nation’s agricultural productivity,” Trump’s order said. They ensure “that healthy, affordable food options remain within reach for all American families.”

As the more recent glyphosate cases reached the Supreme Court, the Trump administration sided with the company. The Trump administration not only requested that the Court take up the company’s appeal but filed a friend of the court brief. At the Supreme Court oral arguments, a Department of Justice lawyer stood with Monsanto to argue that allowing the states to regulate the product labels would create chaos.

“If you had 50 different states that are just, like, jumping the gun,” Principal Deputy Solicitor General Sarah Harris said, “Iowa says maybe this causes cancer, California says absolutely it causes cancer, some other state says this doesn’t cause cancer at all, so put that on your label too, it completely undermines the uniformity of the labeling scheme and causes confusion.”

In June 2026 the Supreme Court ruled in favor of Monsanto, 7-2, with the majority opinion citing the administration’s friend of the court brief.

Although the reasons for the Trump administration’s glyphosate reversal are not fully known, the agricultural chemical industry played a role. Soon after the MAHA Report was published, the CropLife America, the industry’s chief lobbying group, urged the administration to back off.

Alexandra Dunn, the group’s president and CEO, said that while the initial MAHA report “was well intended, it includes misleading and alarmist statements about pesticides—and calls into question the safety of the very foods critical for the healthy development of children.”

In September 2026 the administration announced an effort to coordinate EPA and HHS research into the effects of glyphosate on humans. The EPA is scheduled to complete its risk assessment of glyphosate in early 2027.

Regardless, some MAHA influencers who earlier had praised the MAHA Report saw the Trump administration’s reversal for what it was ¾ a betrayal.

Vani Hari, the “Food Babe,” called the executive order “a direct assault on MAHA” and “a gift to pesticide and chemical industry lobbies at the expense of human health.”

“MAHA voters were promised health reform, not chemical entrenchment,” she said.

Conclusion

On August 30, 2024, the MAHA movement cheered as its ideas were embraced by then presidential candidate Trump.

“We’re going to make America healthy again,” Trump said in Johnstown, Pennsylvania, a week after Kennedy, then the movement’s leader, endorsed him for a second term. “We’re going to get toxic chemicals out of our environment, and we’re going to get them out of our food supply. We’re going to get them out of our body.”

The MAHA movement cheered again when Trump appointed Kennedy to lead the nation’s health agencies as the HHS Secretary.

But like many who’ve trusted Trump over the years, many in MAHA world feel cheated ¾ for good reason.

In March 2026, less than a year after publication of the MAHA Report, more than 30 MAHA leaders wrote to EPA administrator Lee Zeldin describing their dismay at the appointment of chemical industry lobbyists as EPA officials and the regulatory roll back.

The administration, however, still hasn’t changed course. A scorecard released earlier this month by another group of MAHA activists, indicated that the Trump administration broke more than 85% of its MAHA promises on food, agriculture and the environment.

“Catchy slogans do not make people healthy,” the MAHA leaders wrote in March. “Policy does.”

For the environment, the Trump administration’s “Make America Healthy Again” approach is worse than an empty slogan. It’s a sham.

Letter to CFTC Requesting Meeting of the Commission’s Energy & Environmental Advisory Committee

Download PDF

October 14, 2026

Chairman Michael S. Selig
U.S. Commodity Futures Trading Commission
Three Lafayette Centre, 1155 21^st Street NW
Washington, DC 20581

Dear Chairman Selig,

I have served as a member of the Commission’s Energy & Environmental Advisory Committee for more than 15 years.[1]

Section 2 of the Commodity Exchange Act states that the Energy & Environmental Advisory Committee “shall hold public meetings . . . not less frequently than 2 times per year.”[2] Since the Committee has not met since May 28, 2025, the Commission is not in compliance with the law.

I am therefore requesting that a meeting be scheduled as soon as practically possible, as there are numerous pressing matters requiring the Committee’s attention:

• It is widely reported that the Commission retracted a study of billions of dollars of suspicious oil trades made minutes before a market-disrupting social media post by President Donald J. Trump.[3]
• War-related upheaval continues to significantly impact U.S. commodity markets, and exacerbate the energy affordability crisis experienced by America’s working families.[4] The Committee is poised to provide the Commission with valuable insight and perspective on these issues to assist it in ensuring end-users have access to well-functioning markets.
• The Commission’s consideration of expanding oil trading to 24 hours a day, 7 days a week presents significant challenges to market integrity.
• Whether allowing prediction markets to offer core energy commodity contracts[5] is aligned with the Commodity Exchange Act and the public interest, and similar concerns about prediction market offerings of extreme weather related products.[6]
• The need to examine whether the Commission’s approach to implementing position limits to address excessive speculation requires modifications.
• Assessment of the credibility of voluntary carbon markets, and the Commission’s ongoing investigation of their integrity.[7]

Thank you for your prompt attention to this request.

Respectfully submitted,

Tyson Slocum, Energy Program Director
Public Citizen, Inc.
(202) 256-3152
[email protected]

cc:       Dena E. Wiggins, EEMAC Chair
Natural Gas Supply Association

 

 

[1] www.cftc.gov/About/AdvisoryCommittees/EEMAC

[2] 7 USC § 2(a)(15).

[3] www.bloomberg.com/news/features/2026-10-13/cftc-staff-told-to-retract-analysis-of-suspicious-oil-trades-on-iran

[4] See, for example, www.citizen.org/wp-content/uploads/CFTCBehnam.docx

[5] www.bloomberg.com/news/articles/2026-10-07/kalshi-submits-bid-for-perpetual-style-oil-contract-to-cftc

[6] www.bloomberg.com/news/articles/2026-08-03/prediction-market-bets-on-wildfires-draw-scrutiny-from-senators

[7] www.bloomberg.com/news/articles/2026-09-15/cftc-probes-voluntary-carbon-credits-as-market-scrutiny-grows

Protest of Dominion-NextEra Merger

September 29, 2026

By Tyson Slocum

Download PDF

Public Citizen joined with Appalachian Voices, North Carolina Justice Center, South Carolina
Coastal Conservation League, and Southern Alliance for Clean Energy, Conservation Law Foundation and the Environmental Defense Fund to protest the proposed merger between Dominion Energy and NextEra in Federal Energy Regulatory Commission docket EC26-131:

DominionNextEraEC26-131Protest

Groups Raising Unlimited Amounts Give the Rich Unlimited Power

Download PDF

Since the disastrous Citizens United U.S. Supreme Court decision in 2010, the rich and corporations have played an increasingly outsized role in our elections. The reasoning behind the Court’s decision, which allowed direct corporate spending in elections, ultimately led to the widespread creation of super PACs and other campaign spending vehicles that could raise unlimited amounts.^[1]

Today, our campaign finance system is a playground for millionaires, billionaires and corporations to bombard the airwaves with ads, boost their preferred candidates, and more generally ultimately bend public policy to protect and increase their wealth. Corporate spending during the 2026 election cycle thus far, for example, has already hit nearly $650 million, a nearly 5,000 percent increase from the cycle in which Citizens United was decided.^[2]

It used to be that those looking to shape policy and raise money had to convince many to join their cause. A single donor could only have so much sway. Now, any angry billionaire can decide to spend $100 million on their own, through their own super PAC, pushing for policy changes that may only benefit them. A billionaire may soon decide to spend $1 billion on an election. All they have to do is decide whether the return on investment is worth it.

This analysis looked at super PACs^[3]  capable of raising unlimited amounts that raised at least $1 million during the 2026 cycle thus far, for which the majority of the money (50 percent or greater) came from a single donor.^[4] In total, we found 110 super PACs that fell into this category. They raised more than $1 billion in total so far in the 2026 cycle.

While Federal Election Commission (FEC) data will be updated in the coming weeks with more contribution data, The New York Times reported over the weekend that Elon Musk’s representatives disclosed another $76 million in contributions to Musk’s America PAC super PAC.[5] We have added that additional total to our data. We do not have updated data yet from the rest of the super PACs covered in this analysis.

Of the $1 billion raised by these super PACs, $913 million came from the donors contributing a majority amount to the super PACs.

While we limited our search to highlight donors responsible for at least 50 percent of the total money raised in 2026, it’s not as though most of these rich donors are just squeaking over the 50 percent majority donor threshold. If we included only super PACs for which 90 percent or more of the 2026 money came from a single donor, that would include 48 super PACs and $534 million in contributions.

The data for super PAC donations include individuals, corporations, non-profits, trade associations and unions. But the bulk of the money comes from corporations and individuals. Unions, for example, account for just 5 percent of the total contributions.

Musk’s America PAC is likely to be the largest super PAC with a single majority donor during the 2026 cycle once all the data is reported. But prior to Musk’s recent disclosure, the largest had been the Democracy PAC super PAC, which reported nearly all of the $102 million it has received during the 2026 cycle came from the Geosor Corporation and the Fund for Policy Reform (Soros family entities).^[6] Democracy PAC is followed by AI-focused super PACs Leading the Future (a16z Capital), and the Restoration of America PAC (Richard Uihlein).

The super PACs from Table 1 are well known. They raise and spend enormous amounts of money and are frequently the topic of news stories. But there are many more less-well known, but still powerful, super PACs. There are many more raising unlimited amounts that reported less than a $1 million in total receipts in 2026 with the majority of the money coming from single donors. While these super PACs are not in the same universe as the Table 1 entities, they may still be impacting smaller U.S. House of Representatives races, for example.

For some rich individuals, corporations and non-profits, one super PAC raising unlimited amounts appears to not be enough. We found many examples in which billionaires and corporations were the majority donors to multiple different super PACs in 2026. Almost all are billionaires, including:

• The richest person on earth, Elon Musk, was the majority donor to America PAC^[11] and Fight for Kentucky.^[12] Musk has given the super PACs a combined $136 million.
• Crypto billionaire Chris Larsen and his company, Ripple, were the majority donors to the Invest in Tomorrow Coalition,^[13] You Can Push Back,^[14] and the Commonwealth Prosperity Fund,^[15] giving the groups a combined $11.5 million, 92 percent of all the money raised in 2026.
• Hedge fund billionaire Ken Griffin was the majority donor for Fighting for Wyoming,^[16] American Patriots PAC^[17] and Fight on Iowa,^[18] contributing $6.5 million in total to the groups, 95 percent of the funds raised.
• Shipping billionaire Richard Uihlein and his wife were the majority supporters of three different super PACs, giving the PACs more than $63 million in total, most of which went to the Restoration of America PAC.^[19]
• Billionaire crypto investors Cameron and Tyler Winklevoss (and Winklevoss Capital Fund) were the majority donors to two PACs, the bulk of that money went to the Digital Freedom Fund. Winklevoss Capital donated more than $21 million to the super PAC, 95 percent of the money the PAC received in 2026.^[20]
• Billionaire trader Jeff Yass was the majority donor to four different super PACs,^[21] including the School Freedom Fund, a super PAC he donated $17.5 million to in 2026, 98 percent of the total receipts reported by the PAC.^[22]
• Other billionaires with multiple super PACs were Melinda French Gates (through Pivotal Ventures),^[23] oil executive Tim Dunn,^[24] and hedge fund investor Paul Singer (Elliott Management).^[25]

This is far from the only money spent by these donors. The $1 million + super PAC donor data include about 90 individuals, companies, non-profits and trade associations. Along with the $913 million in contributions covered in this analysis, these same individuals and entities have given at least $50 million to the main Trump-affiliated super PAC, MAGA Inc. and tens of millions more to the four main super PACs supporting the two major parties.

The fact that these donors were the majority donor to these super PACs in the 2026 cycle does not mean they have been the majority donor in every cycle the super PACs have existed. However, many of the super PACs we looked at appear to be PACs created to advocate for the interests of the specific billionaires supporting it, as is the case with Leading the Future.^[26] And that is what our campaign finance system looks like in 2026: Billions of dollars in billionaire money sloshing around in pet project super PACs, rendering traditional campaign accounts, which can raise a maximum of $7,000 from individuals,^[27] as barely a rounding error.

Take Bernie Sanders’ insurgent campaign for the Democratic nomination in 2016 for example, often cited as an example how traditional campaigns can still compete with big money. Sanders raised $228 million in the 2016 primary, a total driven by his famous $27 average donation.^[28]

Just looking at the slice of contributions covered in this analysis, just five individuals, George Soros, Marc Andreessen and Ben Horowitz (a16z partners), Richard Uihlein and Elon Musk, have already contributed a combined $336 million to their closely aligned super PACs.

Sanders said his nearly $230 million came from 2.5 million individual contributors.^[29] In 2026, just five wealthy individuals contributed more than $100 million more than Sanders’ total just to their pet super PACs.

^[1] See SpeechNow.org v. FEC, https://citizen.short.gy/mT1Y3n.

^[2] Rick Claypool, Corporate Money in the 2026 Midterms Surges to $650 Million, Public Citizen (Aug. 27, 2026), https://citizen.short.gy/oi8Lhf.

^[3] We also included Hybrid PACs. Hybrid PACs can give directly to candidates from a separate account that includes contribution limited donations.

^[4] In a few instances, we include spousal income, business partner and related company contributions together.

[5] Theodore Scheleifer, Inside Elon Musk’s $276 Million Midterm Rescue Mission for Republicans, The New York Times (Oct. 12, 2026), https://citizen.short.gy/l0UXEt.

^[6] Theodore Schleifer and Matt Zdun, Meet the Megadonors Who Have Poured $1.2 Billion Into the Midterms, The New York Times (Aug. 28, 2026), https://citizen.short.gy/GbsXqS  and Democracy PAC, Raising, (Federal Election Commission), https://citizen.short.gy/m8hj3o.

^[7] America PAC, Raising, (Federal Election Commission), https://citizen.short.gy/sAI1L6. Recent reporting by the New York Times shows musk contributed another $76 million to America PAC since the summer, Theodore Scheleifer, Inside Elon Musk’s $276 Million Midterm Rescue Mission for Republicans, The New York Times (Oct. 12, 2026), https://citizen.short.gy/l0UXEt.

^[8] Democracy PAC, Raising, (Federal Election Commission), https://citizen.short.gy/C1yIBU.

^[9] Leading the Future, Raising, (Federal Election Commission), https://citizen.short.gy/QxNGCU.

^[10] Restoration of America PAC, Raising, (Federal Election Commission), https://citizen.short.gy/fSRkbV.

^[11] America PAC, Raising, (Federal Election Commission), https://citizen.short.gy/Vb3mwf.

^[12] Fight for Kentucky, Raising, (Federal Election Commission), https://citizen.short.gy/vmNu1k.

^[13] Invest in Tomorrow Coalition PAC, Raising, (Federal Election Commission), https://citizen.short.gy/IvJObT.

^[14] You Can Push Back, Raising, (Federal Election Commission), https://citizen.short.gy/mJrqjt.

^[15]  Commonwealth Prosperity Fund, Raising, (Federal Election Commission), https://citizen.short.gy/NXRSik,

^[16] Fighting for Wyoming, Raising, (Federal Election Commission), https://citizen.short.gy/PW6ZV0.

^[17] American Patriots PAC, Raising, (Federal Election Commission), https://citizen.short.gy/5iI8O1.

^[18] Fight on Iowa, Raising, (Federal Election Commission), https://citizen.short.gy/6UzegO.

^[19] Restoration of America PAC, Raising, (Federal Election Commission), https://citizen.short.gy/hYT2Zu, Fair Courts America, Raising, (Federal Election Commission), https://citizen.short.gy/pQXD2O , Elizabeth Uihlein supported the Northwoods PAC, Raising, (Federal Election Commission), https://citizen.short.gy/bKStI3.

^[20] Digital Freedom Fund, Raising, (Federal Election Commission), https://citizen.short.gy/5hNDiU , First Principles Digital, Raising, (Federal Election Commission), https://citizen.short.gy/QkIa8k.

^[21] School Freedom Fund, Raising, (Federal Election Commission), https://citizen.short.gy/dDq2Tc, Protect Freedom Political Action Committee, Raising, (Federal Election Commission), https://citizen.short.gy/HM3o5M , AFC Victory Fund, Raising, (Federal Election Commission), https://citizen.short.gy/Mk0Exx, Aurora Action Network, Raising, (Federal Election Commission), https://citizen.short.gy/bK8Xls.

^[22] School Freedom Fund, Raising, (Federal Election Commission), https://citizen.short.gy/42tjAq.

^[23] CFFE PAC, Raising, (Federal Election Commission), https://citizen.short.gy/XeIYgh, WomenCount PAC, Raising, (Federal Election Commission), https://citizen.short.gy/9zlNBi, MomsRising, Raising, (Federal Election Commission), https://citizen.short.gy/OUh5c9.

^[24] GLCF Inc, Raising, (Federal Election Commission), https://citizen.short.gy/ACgiF7, Jefferson Rising, Raising, (Federal Election Commission), https://citizen.short.gy/WDdK2a.

^[25] STW PAC Inc, Raising, (Federal Election Commission), https://citizen.short.gy/TR6qhW, XXXX, Raising, (Federal Election Commission), https://citizen.short.gy/2sWP9W. Includes a $1 million contribution from Jonathan Pollock, Elliott Managements’ co-CEO, https://citizen.short.gy/N0ynns.

^[26] Sam Blum, Why Andreessen Horowitz and This OpenAI Co-Founder Are Launching AI-Focused Super PACs, Inc (Aug. 25, 2025), https://citizen.short.gy/2ly055.

^[27] Contribution Limits, Federal Election Commission, https://citizen.short.gy/rHL91N.

^[28] Behind the Candidates: Campaign Committees and Outside Groups, OpenSecrets, https://citizen.short.gy/ZK2fWa.

^[29] Will the Millions of People who Gave Money to Bernie Sanders Give to Democrats, https://citizen.short.gy/4fJpYq.