I’m not paranoid. And I don’t believe in conspiracy theories. But as a physician who has spent decades watching the pendulum of medical ethics swing back and forth, I can’t ignore the pattern emerging across public health and politics today. Some of what I’m seeing looks uncomfortably familiar. It looks like eugenics, not the caricature of white coats and calipers, but the quieter, policy-driven, values-encoded version that shaped America a century ago.

Eugenics never disappeared. It simply evolved. And in ways both subtle and overt, it is slipping back into our public conversations, our health policies, and our assumptions about whose lives are worth protecting.

Consider immigration policies. As pointed out in the Washington Post, there is a parallel between Trump’s recent anti-immigration rhetoric and the nativist policies of the 1920s, which were heavily influenced by eugenics. The 1924 Johnson-Reed Act, rooted in eugenic pseudoscience, established quotas to favor Northern and Western Europeans and exclude others, aiming to “preserve” America’s racial makeup. Today’s explicit rhetoric echoes the same exclusionary logic, though without the scientific veneer, reviving fears of using immigration policy as a tool for racial and cultural engineering.

Closer to home for those of us in medicine, many have detected a troubling shift in vaccine policy. A newly reconstituted CDC vaccine advisory committee, appointed by HHS Secretary Robert F. Kennedy Jr., voted to end the universal recommendation for hepatitis B vaccination at birth, now limiting it to infants of mothers who test positive or are untested (acting CDC Director Jim O’Neill is expected to decide later whether to accept the committee’s recommendation). Critics argue this shift echoes eugenic logic by prioritizing individual risk over population health, effectively accepting higher risks for vulnerable infants and undermining equity. By restricting universal protection, the policy risks exposing only certain groups (often the most vulnerable) to preventable disease. It reflects a social Darwinist approach where the “fit” are protected and the “weak” are quietly left behind.

Meanwhile, The Guardian’s investigation into the Free Birth Society (FBS) reveals how its promotion of unassisted childbirth and rejection of medical care has led to preventable stillbirths, neonatal deaths, and severe maternal and infant harm. FBS reframes obstetric emergencies as “variations of normal,” discourages intervention and resuscitation, and normalizes infant death as an acceptable outcome. Parallels to eugenics emerge in the movement’s rhetoric of “radical responsibility,” which shifts blame onto mothers and selectively values which lives are worth saving. By discouraging care and intervention for compromised newborns, FBS ideology echoes eugenic practices of differential treatment and the moralization of reproductive outcomes, effectively determining survival based on ideology rather than clinical need.

Even academia has not been immune. For decades, the UC Berkeley School of Public Health managed a research fund explicitly established to support eugenics (the “Genealogical Eugenic Institute Fund”) transferred to the university in 1975. The fund’s stated purpose was to promote research and education in eugenics and related areas, including family planning, infertility, prenatal screening, abortion, and gene editing, all framed as ways to “improve the human race.” Although later disbursements supported student aid, staff salaries, and a genetic counseling program (with no evidence of direct eugenic research), the fund’s existence and original intent went largely unexamined until 2018. Only recently was it repurposed to do the opposite: support projects that confront the legacy of eugenics and benefit the communities most harmed by its application.

All of this forms the backdrop to a rapidly accelerating frontier: gene editing and reproductive technologies. These tools risk reviving eugenics by enabling selection for “desirable” traits and heritable modifications that could entrench inequality and reduce genetic diversity. Concerns include polygenic embryo screening for non-disease traits, germline editing with uncertain long-term effects, and unequal access that favors the affluent. Without robust oversight, these technologies could normalize a “newgenics” that echoes historical eugenics while avoiding the name.

Most people believe it is ethical to use technology to prevent agonizing suffering and certain early death (for example, choosing against embryos with genetic markers for Tay-Sachs disease). But is it an equally acceptable exercise of individual freedom to choose desired traits in a child?

What about individuals with Down syndrome, many of whom lead happy, meaningful, and productive lives? Or the growing practice of sex selection, with boys overwhelmingly favored in countries like China and India? We can alter DNA to help treat devastating diseases, but should we also intervene to favor future generations with certain skin colors, hair textures, or height? Who decides what characteristics are desirable? And who draws the line between preventing heritable disease and enhancing future children to position them for social advantage, potentially worsening inequities?

These and other questions we face are ones our predecessors could scarcely imagine:

• Who benefits from genetic knowledge, and who is harmed by it?
• What happens when market forces or state interests shape reproductive choice?
• What is the moral cost of equating health with value, or vulnerability with burden?

Our reckoning with eugenics is long overdue, and it is not merely about issuing apologies, renaming buildings, or becoming more aware of reproductive technologies and vaccine policies. The lessons of the past must inform our vigilance against ableism, racism, and the seductive logic of “improvement” and “survival of the fittest” at the expense of equity and human dignity.

True understanding and reconciliation require not only confronting uncomfortable histories but also committing to justice, transparency, and ensuring that communities once targeted in the name of science have a meaningful role in shaping the future of medicine. Only then can society fulfill its highest mission: to advance knowledge in service of all humanity, not just the privileged few.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine and the fictional series Real Medicine, Unreal Stories. His latest book, a novel, is Standard of Care: Medical Judgment on Trial.