Atul Gawande on Elon Musk’s “Surgery with a Chainsaw”
Mar 14, 2025
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Atul Gawande, a prominent surgeon and public health expert, dives deep into the repercussions of Elon Musk's controversial remarks about U.S.A.I.D. The conversation highlights the vital role of soft power in global health initiatives, particularly how funding cuts can jeopardize lives in conflict zones. Gawande reflects on the efficiency and impact of American foreign aid, admonishing the shift towards a more power-centric worldview. He also touches on vaccine confidence, linking it to historical hesitancy, and discusses ethical considerations in surgical practices.
USAID has been instrumental in saving millions of lives through global health initiatives, yet recent cuts threaten its operational capacity and effectiveness.
The retreat of U.S. foreign aid undermines soft power, potentially destabilizing international relationships and shifting global alliances away from American influence.
Deep dives
Impact of U.S. Foreign Aid Programs
U.S. foreign aid programs, particularly through USAID, have significantly contributed to global health and well-being, saving over 1.2 million lives after COVID-19 alone. These efforts focused on addressing critical health issues such as HIV, malaria, and tuberculosis by strengthening health systems in various countries. The work of USAID included collaboration with thousands of health professionals across the globe, demonstrating the importance and effectiveness of soft power in international relations. However, recent cuts and criticisms have threatened the continuation of these life-saving programs and created fear about future impacts on global health.
Challenges Facing USAID
USAID has faced drastic reductions in funding and staffing, with over 80% of its contracts terminated and many employees placed on administrative leave or dismissed. This dismantling of the agency has led to critical disruptions in health services, including the cessation of treatments for millions of people reliant on HIV and other vital medicines. Furthermore, the leadership of the agency has experienced a loss of credibility and trust from both international partners and health workers on the ground, leading to significant operational chaos. The challenges for USAID are compounded by a political environment that dismisses the empirical successes of foreign aid, often labeling it as wasteful or corrupt.
The Importance of Soft Power in Foreign Relations
Soft power plays a crucial role in U.S. foreign policy by promoting stability, compassion, and development, as opposed to military intervention. This form of influence helps to foster relationships and trust among nations, encouraging cooperative solutions to global challenges such as disease outbreaks and humanitarian crises. The current dismantling of aid programs and the shifting focus on might over compassion threaten to create chaos and instability internationally. As global partners witness the retreat of U.S. support, they may turn to other nations, leading to a significant shift in international alliances and a loss of trust in American leadership.
Two weeks after the Inauguration of Donald Trump, Elon Musk tweeted, “We spent the weekend feeding USAID into a wood chipper.” Musk was referring to the Agency for International Development, an agency which supports global health and economic development, and which has saved millions of lives around the world. “A viper’s nest of radical-left lunatics,” Musk called it. U.S.A.I.D.’s funding is authorized by Congress, and its work is a crucial element of American soft power. DOGE has decimated the agency with cuts so sudden and precipitous that federal workers stationed in conflict zones were stranded without safe passage home, as their own government publicly maligned them for alleged fraud and corruption. Courts have blocked aspects of the federal purge of U.S.A.I.D., but it’s not clear if workers can be rehired and contracts restarted, or whether the damage is done.
In January, 2022, Atul Gawande, a surgeon and leading public health expert who has written for The New Yorker since 1998, was sworn in as assistant administrator for global health at U.S.A.I.D. He resigned as the new administration came to power, and is watching in shock as Trump and Musk make U.S.A.I.D. a guinea pig for the government-wide purge now under way. U.S.A.I.D. was, he admits, a soft target for MAGA—helping people in faraway countries. Gawande calls U.S.A.I.D. “America at its best.” But with Trump and Musk, “there’s a different world view at play here,” he says. “Power is what matters, not impact.”
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