No matter where your political beliefs may lie, there is no doubt that the next four years will see massive changes to US health and technology policy that will have global implications, most of them seriously concerning and in some areas like vaccine policy, potentially disastrous on a global scale.

Whether hallowed institutions like the National Institutes of Health or the Centres for Disease Control even survive the new Trump regime is questionable, and for healthcare technology policy, the trends are ominous.

Similar fears were aired in the first Trump administration when it came to the Affordable Care Act, also known as Obamacare, which after many years of claims of disaster has somehow survived until now. But that legislation is about health insurance and how to pay for healthcare. Post-pandemic and in the age of AI, things are infinitely more serious.

It is unlikely that Obamacare will survive the second Trump administration, and fundamental reforms to its Medicare and Medicaid entitlements are most definitely again in the sights of Republicans. But whereas in the first administration, people with healthcare experience and a dedication to public service were there to at least argue against bomb throwers such as now Oracle Health executive vice president Seema Verma, such people probably no longer exist.

Instead, Trump has surrounded himself with a cabal of distinctly dangerous people, the most obvious of whom is Robert F Kennedy Jr, who insists that he will have a big part to play in healthcare policy. It remains to be seen whether this eventuates, but having a vaccine conspiracy theorist, anti-pharma activist and outright lunatic anywhere near vaccine policy, let alone the Food and Drug Administration (FDA), is alarming.

Then there are people like Vivek Ramaswamy, who calls himself a pharmaceutical and biotechnology entrepreneur but is in reality a patent troll. The Republican party is also stacked with anti-abortion fanatics whose policies will most certainly kill people, along with those insistent on defunding the WHO. This has global implications.

But the real worry is the influence likely to be exerted by people who are far more powerful than Trump will ever be – namely the likes of Elon Musk and Peter Thiel – who have attached themselves to his coattails. The UK really needs to rethink that Palantir data platform contract for the NHS.

The Silicon Valley tech bro culture has over the years morphed from one that was libertarian in nature into one that is now scarily authoritarian and its determination to “move fast and break things” has real-world ramifications.

Nowhere is this more obvious than in AI and this is where we enter the realms of the potentially diabolical. The new AI geniuses have so far paid what we think is lip service to the regulation of AI and in this new world, they may no longer even have to do that.

The US is entitled to do what it pleases with its own healthcare policy but when it comes to technology policy that has worldwide ramifications, we all need to have a say. When it comes to AI, vaccines and pharma regulation, perhaps just the European Union stands alone as capable of diverting catastrophe with its strong regulatory framework. With no guardrails, the US seems lost.

That brings us to our poll question for the week:

Will AI regulation in healthcare be safe under the new Trump regime?

Vote here and leave your comments below.

If you voted yes, what will be the guardrails? If no, what options are there outside the US?

Last week we asked: Has the HIE architecture and roadmap made you more or less in favour of the project? This had readers split 55-45. Here’s what you said.