RFK Jr. as HHS Secretary will be a catastrophe for public health and medical research

It figures.

Remember about a month and a half ago, when I described why this blog, which had been known for rather prolific and prodigious content over nearly 20 years—no, seriously, my 20th blogging anniversary is in less than a month—had become nearly fallow? The reason, you might recall, is the declining health of my parents, both of whom are in their mid-80s and both of whose health is simultaneously declining? You might also remember that I thought the situation had stabilized and that I could get back to something resembling a normal blogging schedule? That lasted less than a week, and since this post on DMSO over two weeks ago, this blog has been silent, which is probably an unprecedented amount of time to go without a new post over the last two decades. Without going into detail, let’s just say that my father had another health crisis and hospitalization. He’s in rehab now; so things are again stabilizing. (I hope.)

And then, late yesterday afternoon, I learned that, as I had feared, speculated, and predicted, Donald Trump had nominated Robert F. Kennedy, Jr. for Secretary of Health and Human Services. Yes, I had started speculating that that’s the job that RFK Jr. was angling for when he suspended his campaign and bent the knee to Donald Trump nearly three months ago, but even as I was predicting it I wasn’t quite sure that I believed that Trump would go through with it, if only because of discussions I had had with a reporter and others who said that many thought RFK Jr. would be “unconfirmable.” My retort, although not my 100% certain retort, was: Are you sure about that? Are you really sure, given the current state of the Republican Party? I’m not, nor was I at the time.

In any case, if there’s anything that could motivate me to get back in the blogging game, it has to be something like this. After all, I’ve been writing about RFK Jr.’s antivax stylings and conspiracy mongering since June 17, 2005. If ever there was a time to get back to my old ways, it’s now. So, regardless of my personal family challenges, I’m going to try to do just that. I’m also going to start out by calling out reporters for sanewashing RFK Jr., just as Jonathan has. I experienced one example of this just this morning on the way to work. While flipping channels, I came across NPR’s Morning Edition, which in a story about the nomination kept referring to RFK Jr. as a “vaccine skeptic,” although the story as published on the website has the less offensive title Trump picks RFK Jr. to oversee the Department of Health and Human Services. However, if you listen to the report, which is nearly four minutes long, you will hear the term “vaccine skeptic” applied to RFK Jr. several times:

Let’s just say that, every time I heard the term “vaccine skeptic” used, I cringed. No, I literally cringed. It wasn’t just NPR, either, which pulled a masterpiece of “bothsides” reporting in which the reporter counters RFK Jr.’s stated claim that vaccine science is inadequate and vaccines are unsafe with, basically, a pathetic, “Experts disagree.” The venerable BBC is guilty too (Trump picks vaccine sceptic RFK Jr for health secretary). So are STAT News (Trump taps RFK Jr. to run HHS, nominating vaccine skeptic for nation’s top health role), The Washington Post (Trump taps Robert F. Kennedy Jr., vaccine skeptic, to lead HHS), and the New York Times (Trump Picks R.F.K. Jr. to Be Head of Health and Human Services Dept., which has the tag line, “Whether the Senate would confirm Robert F. Kennedy Jr., a vaccine skeptic who has unorthodox views about medicine, is an open question.”) I might have to write yet another post about this soon (maybe as soon as my Monday post at my not-so-super-secret other blog), but my message to reporters is this: Stop it! Just stop it! RFK Jr. is not a “vaccine skeptic.” He is antivaccine. That I still have to keep saying this now, two decades after RFK Jr. Be more like NBC News and the AP (Trump picks RFK Jr., anti-vaccine activist, for health and human services secretary and Trump chooses anti-vaccine activist Robert F. Kennedy Jr. as health secretary, respectively), at least on this. Stop sanewashing RFK Jr.

And don’t get me started on reporters referring to Kennedy’s views on health as “unorthodox” or “outside the mainstream.”

Let’s take a look at what worries me about RFK Jr. being in charge of HHS.

Prelude: A shift in the political center of gravity of antivax and quackery

I’ve said many times that I strive to be nonpartisan but make no promises to be apolitical. After all, promoting science-based medicine is not just a scientific and medical endeavor; it is also a political endeavor, given that the federal government regulates and funds healthcare, drug approval, and national public health programs, while state governments regulate the practice of medicine, as well determining vaccine requirements for school and a number of other medicine- and public health-related requirements and local governments have their own laws and regulations. Indeed, that is why I liked Jann Bellamy’s posts at a certain other blog about “legislative alchemy” designed to provide the imprimatur of the state on pseudoscientific and quack medical practices and specialties and, before the pandemic, I used to write regularly about efforts to weaken or eliminate school vaccine mandates and the “right-to-try” movement, which was custom-designed to weaken the power of the Food and Drug Administration.

I will admit, however, that it’s become increasingly difficult to remain totally nonpartisan, given the events of the last decade, but, even more, events since the pandemic hit nearly five years ago. While there are still crunchy lefties promoting various woo, including alternative medicine, antivaccinationism, unwarranted fear mongering about pesticides and “chemicals” in food, and false beliefs that, for instance, cell phone radiation causes cancer, by and large it’s difficult not to accept in the face of overwhelming evidence that the ideological center of gravity in terms of hostility to science-based medicine and science-based health policy has shifted far to the right. I’ve described how it’s a process that I first started noticing 10-15 years ago, as more and more antivaxxers started promoting conservative and right-leaning candidates; accelerated beginning in 2015, when opposition to California law SB 277, which eliminated nonmedical exemptions to school vaccine mandates galvanized the antivaccine movement to successfully use the rhetoric of “freedom” and opposition to government overreach to attract conservatives; infested the Republican Party during the 2016 Presidential primaries and the 2018 midterms; and became (if you’ll excuse the term) turbocharged after the pandemic, when opposition to non pharmaceutical public health interventions like masking or school and business closures, vaccine mandates, and basically any non-voluntary public health interventions resulted in the fusion of the antivaccine movement with right wing resistance to what it saw as “tyranny.”

As I’ve written about and the Conspirituality Podcast has documented over the last five years or so, basically a lot of the New Age “spirituality” and quackery, including the antivaccine movement, has shifted far to the right, to the point that we see lots of pseudoscience and conspiracy theorists who used to be perceived as being on the left now fully MAGA and aligned with Donald Trump. Whether this is because the grift is better there or because of a genuine ideological shift or both, it’s happened, and I still haven’t decided what the biggest factor was fueling this shift.

One such example is Robert F. Kennedy Jr. When I first started writing about RFK Jr. nearly two decades ago, he had just “come out” as an antivaxxer, publishing his deceptive conspiracy-fest of an article Deadly Immunity in Salon.com and Rolling Stone promoting a conspiracy theory falsely claiming that the mercury-containing preservative thimerosal, which had been used in many childhood vaccines until around 2001-2, was responsible for an “epidemic” of autism that the CDC was covering up. (My deconstruction of the article was my first blog post ever to go viral.) It might be hard for our younger readers to recall that, when RFK Jr. first launched his antivax crusade in 2015, he explicitly linked it to his previous environmentalist activism fighting pollution and mercury contaminating water supplies. It was just the start of many years of demonizing vaccines and promoting antivaccine pseudoscience and conspiracy theories. Although I could see signs of this in him before the pandemic, the pandemic led RFK Jr. to embracing far right movements. As you probably know, in 2023 RFK Jr. announced that he was running for President. However, by August, he suspended his campaign and embraced Donald Trump, who promised him a major role in his administration overseeing health policy. By September, RFK Jr. had coined the term “Make America Healthy Again” (MAHA), an obvious homage to Donald Trump’s longstanding slogan “Make America Great Again” (MAGA), although in his MAHA manifesto he hid his antivax proclivities, which his antivax followers did notice and were dismayed.

They shouldn’t have been. It should always have been clear to anyone that, if RFK Jr. were ever to be put in charge of the federal health apparatus, either as Secretary of Health and Human Services (HHS) or in some “czar” role, it would be an extinction-level threat to science-based federal health policy, which would be replaced with pseudoscience, quackery, and conspiracy theories. When I first wrote about RFK Jr.’s antivax conspiracy-fest of an article two decades ago, never in my worst nightmares did I envision that he might be on the cusp of being put in charge of the nation’s healthcare policy, regulatory, and research apparatus. Now he’s been nominated. While there is still some slight hope that the Senate might have just enough of a modicum of sanity left not to confirm RFK Jr., I have little confidence that they won’t. (I don’t even have confidence that they won’t confirm Matt Gaetz, even though conservatives are making crude jokes about his penchant for young girls; e.g., Barbara Comstock, who responded to a joke by George Conway that Gaetz “couldn’t make it here tonight because he had a hot date” by chiming in, “It’s called a recess appointment.)

Donald Trump: Letting RFK Jr. “go wild” on health?

Not long ago, I wrote about what the “health freedom” movement and its takeover of the Republican Party in terms of anything having to do with medicine and public health might mean after I had come across a post by RFK Jr. on X, the hellsite formerly known as Twitter, saying that he would “declare war on The FDA”:

The full version of what this might entail can be found here; the CliffsNotes version follows. Basically, it would mean the dismantling of a regulatory and public health apparatus built up over decades that, while flawed, has mostly successfully improved the health of Americans and protected them from unsafe medications and foods. No one, least of all I, is saying that the system couldn’t use significant improvement, possibly even major reform, but that’s not what RFK Jr. is about. What he is about is tearing the system down.

The night before that post went live, Donald Trump held what was basically a fascist rally at Madison Square Garden that made the news because of the racist comments of some of his surrogates. Less reported was something that Donald Trump promised his followers:

And we also have somebody that is great. And look, we’re not going to let him go too crazy, Elon, with the oil and gas stuff. Because Robert F. Kennedy cares more about human beings and health and the environment than anybody. And he’s going to be absolute. Having him is such a great honor. I’ve been friends of his for a long time. And I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on medicine. The only thing I don’t think I’m going to let him even get near is the liquid gold that we have under our feet. I don’t know, Elon. He might not like liquid gold. It’s oil and gas. Sometimes referred to as oil and gas. J. D. , I think we’re going to have to keep him away from the oil and gas. What do you think, Howard? Yes?

But where is Robert? He’s around. He gave a beautiful speech. And it’s an honor.

I must admit that one consolation in all this, as minor as it is, is that I do find it rather amusing that RFK Jr. willingly signed on to be part of a campaign in which Trump explicitly states that he can’t address the environment—you know, where his roots were—if it interferes with the profits of the fossil fuel industry. Given that so much of public health is related to the environment, that is a rather large no-fly zone for RFK Jr. I suppose, in his lust for power, he considers it an acceptable price to pay, but who knows? Be that as it may, what do “go wild on health” and “go wild on medicine” mean in this context?

When I originally started writing about RFK Jr.’s having joined Team Trump, I feared that he would want to be HHS Secretary, because the Department of Health and Human Services oversees the vast majority of the federal health and medical apparatus, including Centers for Medicare & Medicaid Services (which oversees the massive Medicare and Medicaid programs), the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, and more. I started to wonder if that were true, based on a recent news report in The Washington Post suggesting that he would be more of a “health czar”:

Robert F. Kennedy Jr. is poised to have significant control over health and food safety in a potential Trump administration, with discussions about some Cabinet and agency officials reporting to him, according to four people familiar with the planning process who spoke on the condition of anonymity to detail private conversations.

Kennedy has been privately meeting with Trump transition officials to help draw up an agenda for a new administration, which could involve the longtime anti-vaccine activist taking a role as a White House czar rather than attempting to win Senate confirmation to lead an agency, the people said. Kennedy and his advisers have also been drafting 30-, 60- and 90-day plans for what they would like to accomplish after Trump is inaugurated, according to one person familiar with the planning process.

“The president has asked me to clean up corruption and conflicts at the agencies and to end the chronic disease epidemic,” Kennedy said in an interview Wednesday. “He wants measurable results in two years and to return those agencies to their long traditions of gold-standard evidence-based science and medicine.”

And:

Kennedy told his own supporters in a Zoom call Monday that Trump has promised him “control of the public health agencies,” singling out the Department of Health and Human Services and its subagencies, and also naming the Department of Agriculture. The agencies are collectively responsible for implementing food and public health regulations; approving vaccines, medications and health-care devices; enforcing safety measures in food-processing facilities; steering billions of dollars in federal research initiatives; and overseeing Medicare, Medicaid and the Affordable Care Act, among many other responsibilities.

“Long traditions of gold standard evidence-based science and medicine”? Anyone who’s paid attention to RFK Jr. over the years knows that RFK Jr. is pretty much the opposite of evidence-based science and medicine. He has been spreading antivaccine misinformation, disinformation, and conspiracy theories for close to 20 years now, and, more recently, has increasingly entered the “wellness” grift side of things. To envision him in charge of so much of the health policy, science, and research apparatus of the federal government should truly terrify you. Certainly it terrifies me. Now we know that Trump has rewarded him with the nomination for HHS.

Since the election, RFK Jr. has been suggesting picks for key posts who are in line with his “thinking,” such as it is. The list will include some names that should be familiar to our readers:

Kennedy has been working to identify possible personnel for a future Trump administration, a list that Trump advisers say includes Casey and Calley Means, siblings and health-care entrepreneurs who have become close advisers to Kennedy; Marty Makary, a Johns Hopkins University physician who advised the Trump White House on health-care price transparency; and former Trump health officials such as former Centers for Disease Control and Prevention director Robert Redfield and former Department of Health and Human Services spokesman Michael Caputo.

The Means siblings, Makary, Redfield and Caputo have been working with Kennedy to roll out his “Make America Healthy Again” (MAHA) platform, an initiative to tackle chronic disease and childhood illnesses — and a deliberate riff on Trump’s “Make America Great Again” (MAGA) slogan. None of them responded to questions about their potential roles in a future Trump administration, with several declining to comment.

Dr. Martin “Marty” Makary was, before he became a COVID-19 contrarian who has appeared frequently on right wing media outlets minimizing the pandemic and advocating a “Great Barrington Declaration”-style “let ‘er rip” approach to the pandemic claiming that “we’ll have herd immunity any day now” while fear mongering about the vaccines, first made a name for himself publishing some of the most risibly bad science I’ve ever seen. Sadly, that awful science, which claimed that medical errors are the third leading cause of death in the US (they aren’t—far from it), “stuck,” to the point that it’s become a commonly cited (and totally erroneous) factoid that even people who should know better sometimes casually cite when discussing the shortcomings of our medical system. Basically, like RFK Jr.’s resistance to vaccines, the viewpoint promoted by Makary and his allies has devastated public health—and didn’t work. Truly, given that Dr. Makary is, like me, a surgical oncologist, whenever I discuss him I feel like Sylvester Jr. in the old Looney Tunes cartoons, putting a paper bag over my head in extreme embarrassment and shame due to his father.

Casey and Calley Means, of course, I have discussed before. They’re a brother-sister team. Calley is an “entrepreneur” who runs a business based on attracting federal health savings funds to purchase alternative medicine treatments. His sister Dr. Casey Means is a physician who trained to become an otolaryngologist, but dropped out of her residency in her final year. (Who does that, so close to the finish line?) In any case, her company promotes “metabolic health” as the answer to all diseases. From my perspective, they are simply health grifters who have seized upon the shift of the political center of gravity of the wellness movement in order to latch themselves onto Donald Trump and make money selling their wares to (mostly) the right. As for Dr. Redfield, he started out semi-reasonable (and provaccine) when he served as CDC Director during the Trump Administration, but has of late gone further and further down the MAGA conspirituality rabbit hole, promoting doubt about COVID-19 vaccines and, of course, lab leak conspiracy theories. Finally, back in 2020, Michael Caputo, who at the time was Assistant Secretary of Public Affairs at HHS, publicly stated some bizarre conspiracy theories, such as accusing the “Centers for Disease Control and Prevention of harboring a ‘resistance unit’ determined to undermine President Trump, even if that opposition bolsters the Covid-19 death toll,” led “efforts to warp C.D.C. weekly bulletins to fit Mr. Trump’s pandemic narrative,” promoted disinformation about COVID-19 vaccines, and is perhaps best known for having written an email in which he stated that “we want them infected” in order to pursue “natural herd immunity.”

It’s quite a motley crew, a rogues’ gallery of COVID-19 antivax disinformation. But what would they do?

A dagger aimed at federal health policy and public health

So now we know a bit about the proposed role for RFK Jr and about some of the characters he might bring in to run HHS, the FDA, the CDC, the NIH, and CMS, but what would it mean? One indication came in the form of a post like this:

On January 20, the Trump White House will advise all U.S​. water systems to remove fluoride from public water. Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease. President…

— Robert F. Kennedy Jr (@RobertKennedyJr) November 2, 2024

…which were discussed in stories like this one:

As president, Mr. Trump would not have the power to order states and municipalities to remove fluoride from their water supplies; fluoridation is a matter of local control.

But a presidential pronouncement would inject the White House into a debate that stretches back to the 1950s, when conspiracy theories swirled around fluoridation, with critics claiming it was a Communist plot to poison Americans’ brains — a view that was memorably parodied in Stanley Kubrick’s film “Dr. Strangelove.”

I like that the reporter mentioned one of my favorite movies of all time, and, really, we know 60 years ago, when this movie was released, that this anti-fluoride fear mongering of the kind that RFK Jr. is now resurrecting was a conspiracy theory not based in evidence. Fluoride is safe and has been one of the most effective public health interventions ever. Again, states determine whether to fluoridate their water and what concentration to use, but a federal official recommending against it would likely lead to states whose current governments are aligned with the MAGA movement deciding to stop fluoridating their water, likely with predictably bad outcomes in terms of dental health of their populations, especially children.

Unfortunately, unlike regular readers of this blog, there are a lot of people who don’t know a lot about RFK Jr., haven’t paid attention to his antivax activism, and were maybe even reassured by his intentionally not mentioning vaccines in his MAHA manifesto, even if his own followers weren’t and were dismayed. Remember, in 2019, a mere three months before a pandemic was declared by the World Health Organization, RFK Jr. directly contributed to vaccine fear mongering in Samoa even as a measles epidemic that would claim the lives of over 80 children was raging. Before that he used to routinely compare vaccines and the vaccination program to the Holocaust. That is, of course, why his followers were so disappointed when he first published his MAHA manifesto that left out any mention of vaccines. If you were in any way reassured by that, you shouldn’t be.

One thing I’ve been wondering, though. If RFK Jr. is not confirmed, who might be the second choice? RFK Jr. could just be a head-fake. Trump might have nominated him just to say that he kept his end of the deal, neither knowing nor caring much if RFK Jr. were actually ever confirmed. If RFK Jr. were to fail to be confirmed, given what a shitshow the nomination hearing will be given the 20 years of ammunition RFK Jr. has provided for Democrats, who might step in?

I have…ideas:

Florida’s top health official, whose tenure has been marked by his warnings against vaccines, threats to TV stations for running abortion ads and frequent clashes with public health experts, has emerged as a candidate to run the Department of Health and Human Services in a potential Trump administration, according to two people familiar with the process.

Joseph A. Ladapo is on a list of HHS secretary candidates being assembled by Robert F. Kennedy Jr., who has been charged with helping select staff for the nation’s health and food agencies if Donald Trumpwins office, according to the people, who spoke on the condition of anonymity to describe the planning process. HHS is responsible for overseeing Medicare, Medicaid and the Affordable Care Act; approving vaccines, medications and health-care devices; coordinating responses to disease outbreaks; and numerous other priorities across its nearly $2 trillion budget.

Ladapo, who has served as Florida’s surgeon general since 2021, has repeatedly defied public health practices — such as failing to urge parents to vaccinate their children or keep unvaccinated students home from school during a recent measles outbreak — drawing scorn from public health experts who say his decisions have imperiled Florida residents.

I’ve been writing about how bad Dr. Joseph Ladapo has been regarding vaccines going back a few years. You might remember that Ladapo first came to prominence during the early days of the COVID-19 pandemic as a founding member of America’s Frontline Doctors, which made a name for itself in that horrible first summer of the pandemic by touting hydroxychloroquine as a miracle cure for COVID-19 and later turned to telehealth grift selling prescriptions for ivermectin to cure COVID-19, and a signatory of the Great Barrington Declaration, the document published by contrarian scientists brought together by a right-wing think tank to advocate a social Darwinist “let ‘er rip” approach to the pandemic with poorly defined “focused protection” for those most at risk for severe disease and death from the pandemic. In 2021, Florida Governor Ron DeSantis appointed Ladapo Surgeon General, a position that put him in charge of the Florida Department of Health, where he proceeded to do everything in his power to impede public health responses to the COVID-19 pandemic and to spread fear and uncertainty about COVID-19 vaccines, even if he had to cook the numbers and lie with statistics to do it. In the meantime, he continued to promote COVID misinformation, even going so far as to refuse to recommend COVID-19 vaccines to almost anyone this year, the first time, as far as I’m aware, that a state government health department failed to recommend an FDA-approved and CDC-recommended vaccine against anything. I feared and speculated that Ladapo might score a high ranking federal position related to health policy if Donald Trump were elected. Ladapo is, after all, one of the golden docs in the MAGA antivax movement. Now, if Trump wins, that fear is likely to become reality:

The prospect of a vaccine skeptic such as Ladapo in a national health role has alarmed public health experts, pointing to his decision to warn Florida residents against the mRNA coronavirus vaccines while citing debunked claims. No other state public health officer has followed his lead.

Even if RFK Jr. is confirmed as HHS Secretary, look for Ladapo to be considered for positions like CDC Director or FDA Commissioner. Or maybe he will be Deputy Secretary of HHS, given that that role serves as the COO of HHS and oversees all operations within the Department, including overseeing Medicare, Medicaid, public health, medical research, food and drug safety, welfare, child and family services, disease prevention, Indian health, and mental health services under the leadership of the HHS Secretary.

Then there are the others. One of the names that I keep seeing popping up to be FDA Commissioner is Dr. Martin Makary, although sometimes I see his name popping up to lead the CDC. Makary is a well-published surgical oncologist at Johns Hopkins, which is why I frequently joke (as a fellow surgical oncologist) about needing to put a paper bag over my head when I see some of his pronouncements. You probably recall that we at SBM don’t think much of Makary, who first came to my attention as one of the foremost promoters of the myth that medical errors constitute the third leading cause of death in the US, all based on a risibly incompetent study that used unjustifiable extrapolation from small numbers to conclude that 250,000 deaths occur each year in hospitals due to medical error. As I pointed out at the time, whenever you see an estimate of how many deaths are “deaths by medicine,” it’s very helpful to compare that estimate with what we know to assess its plausibility. According to the CDC in 2016, of the 2.6 million deaths that were occurring every year in the U.S., 715,000 occurred in hospitals, which meant that, if Makary’s estimates were correct, 35% of all hospital deaths were due to medical errors. But the plausibility of Makary’s estimate was worse than that. Remember that the upper estimate used by Makary and Daniels was 400,000 inpatient deaths due to medical error. That was 56%—yes, 56%—of all inpatient deaths. It was never anywhere near plausible that one-third to over one-half of all inpatient deaths in the US were (or are) due to medical error.

Then there’s Dr. Jay Bhattacharya, co-author in 2020 of the Great Barrington Declaration, which advocated a “let ‘er rip” approach to the pandemic, with “focused protection” of those at highest risk for severe disease and death, in order to achieve “natural herd immunity,” while not spelling out what, exactly, was meant by “focused protection.” It’s an approach that never would have worked and whose advocates devastated (and continue to devastate) public health. What position is his name popping up for? CDC Director, of course.

I could go on, but I’m getting depressed, because the situation could end up being worse than you think, as was reported right before the election:

A co-chair of Donald Trump’s transition team said Trump supporter Robert F. Kennedy Jr. wants access to federal health data so he can show vaccines are unsafe and lead to them being pulled from the market in a second Trump administration.

Howard Lutnick echoed a number of Kennedy’s debunked anti-vaccine talking points in a CNN interview Wednesday, including falsehoods about the vaccine schedule and the disproven theory that vaccines cause autism. Trump has talked often about how Kennedy, who suspended his own presidential bid and endorsed him in August, will have a big role to play if the former president returns to the White House.

While Lutnick said Kennedy would not be chosen as secretary of health and human services, he was not specific about what Kennedy’s role might be. Lutnick made the comments the same day that Kennedy told NewsNation that Trump asked him to “reorganize” agencies including the U.S. Centers for Disease Control and Prevention, the National Institutes of Health, the Food and Drug Administration and some agencies under the Department of Agriculture.

If you’ve read this blog and/or my not-so-secret other blog, you know that antivaxxers use data from vaccine safety databases the same way that a drunk uses a light pole: For support, not illumination. Just look at Steve Kirsch and his increasingly ridiculous torturing of any data that he can get his hands on, all designed not to determine if vaccines are safe, but rather to prove, by any means necessary, including torturing the data, that vaccines are dangerous and ineffective. You can be sure that, should RFK Jr. gain access to federal vaccine and medication safety databases, what will follow will be a tsunami of poor quality and misleading studies designed to demonstrate that vaccines cause autism, childhood chronic health problems, and all manner of health issues, and that they don’t work. Count on it. That’s what his antivax org Children’s Health Defense has done for years. Why would it be any different if RFK Jr. gains power over the massive federal health apparatus. Trump’s own co-chair for his transition team has told you what RFK Jr. wants to do. He wants to “prove” that vaccines are unsafe, as a prelude to taking all of them off the market:

Lutnick, the CEO of the financial services company Cantor Fitzgerald, told CNN that Kennedy wants access to data “so he can say these things are unsafe” and that will stop the sales.

“He says, if you give me the data, all I want is the data and I’ll take on the data and show that it’s not safe. And then if you pull the product liability, the companies will yank these vaccines right off of the market. So that’s his point,” Lutnick said.

It was unclear what data Lutnick was referring to since extensive data and research on vaccine safety is publicly available.

Seriously, the title of an article published the a couple of weeks ago by NBC News is not an exaggeration: Trump team fully embraces RFK Jr.’s vaccine skepticism. (One more time, I hate it when editors and journalists describe his antivax conspiracy theories that way.) More appropriate is this headline for an article published over the weekend in The Intelligencer, a section of New York Magazine, Trump Transition Chair Blurts Out Plan to End All Vaccines: Kook Robert F. Kennedy Jr. to steer Trump public health:

In the interview, Lutnick calmly repeated a series of vaccine-skeptic talking points. He did not even limit his vaccine skepticism to the COVID-19 vaccine, which is safe and effective, but to all vaccines, which he painted as unregulated, dangerous, and part of a for-profit conspiracy between the pharmaceutical industry and the federal government. The steps he proposed would be to give Kennedy data about vaccines, and if Kennedy decides they are not safe, which he already has, the FDA could pull approval.

Exactly. RFK Jr. finally has the opportunity to realize his longtime dream of eliminating vaccines from the market. Sure, he denies that that’s what he wants and claims that he’s “not antivaccine” or, even more risibly, that he’s “fiercely provaccine,” even though his history demonstrates that he is neither.

And:

The federal government plays an essential role in authorizing vaccines and pharmaceuticals. It is true that the government’s scientific authority is not omniscient, and there are enough cases in which scientific authorities have imposed political judgment in place of evidence to raise ample grounds for treating any of their pronouncements with some skepticism.

But justified skepticism is one thing. Subjecting public-health decisions to RFK Jr.’s cracked worldview is something else altogether. And the process Lutnick proposed to Collins — that the FDA could withdraw approval for a suite of life-saving vaccines because Kennedy decides the data is insufficient — is a glimpse into a public-health nightmare.

It’s more than just vaccines and fluoride, though. With RFK Jr. as HHS Secretary, the entire federal public health establishment could be reorganized and recast, to the detriment of public health everywhere:

Project 2025 describes the C.D.C. as “perhaps the most incompetent and arrogant agency in the federal government,” and calls for it to be divided into two entities.

One would be responsible only for publishing data gathered from states and other sources. The other would retain a “severely confined ability to make policy recommendations” under the auspices of political leaders.

“He’ll go down the path that he started, which is to fully politicize the C.D.C.,” said Lawrence Gostin, the director of the W.H.O. Collaborating Center on Global Health Law, referring to a second Trump administration.

Exactly. The article mentions that a lot of this would require Congressional approval and that “moderate Republicans” might balk at going so far, but there is a widespread belief in the GOP that the CDC has “gone too far,” which has led to a desire to “pare it back” to stop it from investigating or intervening in legitimate public health issues whose findings are not in line with MAGA politics, such as gun violence and the like.

Worst of all, however, RFK Jr. would have huge influence over the CDC. A number of pundits and apologists have been trying to reassure the public that it isn’t that bad, that what RFK Jr. can actually do is fairly limited given that much of the current construction of HHS and the agencies that make it up is defined by statute and would require an act of Congress to change too dramatically. True enough, but that doesn’t mean that RFK Jr., through the appointment of his buddies, couldn’t do enormous damage anyway. Let’s look at one example, the Advisory Committee on Immunization Practices (ACIP). This is the committee that advises the CDC on vaccination policy and which vaccines to include on the childhood and adult schedules, which is why it has long been a target of ire for antivaxxers. In August, Dr. Paul Offit wrote about what sort of mischief that could be done to ACIP by antivaxxers in a Trump administration, although he focused on The Heritage Foundation’s Project 2025 and the desire to basically eliminate the CDC as a recommending body for vaccines. I don’t think that even RFK Jr. would do that.

First, Dr. Offit describes ACIP and its history:

During the 1940s and 1950s, the United States Public Health Service (USPHS) relied on committees that met intermittently to address various vaccine issues. For example, in 1955, the USPHS convened experts to determine who should get Jonas Salk’s polio vaccine. By the early 1960s, with the licensure of new vaccines, it became evident that these committees needed to meet regularly. In March 1964, the Surgeon General created the Advisory Committee on Immunization Practices (ACIP), which was composed of experts in virology, immunology, microbiology, pediatrics, epidemiology, public health, and preventive medicine. The charge to the ACIP was clear: “The Committee shall concern itself with immunization schedules, dosages and routes of administration and indica­tions and contraindications for the use of these agents. The Committee shall also provide advice [to the CDC] regarding the relative merits and methods for conducting mass immunization programs.”

Since 1964, ACIP experts have recommended many safe and effective vaccines. Prior to these recommendations, every year in the United States polio caused 20,000 cases of paralysis and 1,500 deaths; measles caused 48,000 hospitalizations and 500 deaths; mumps was the most common cause of acquired deafness; rubella (German measles) caused 20,000 cases of congenital birth defects; rotavirus caused 70,000 hospitalizations from severe dehydration; and bacteria such as pneumococcus and Haemophilus influenzae type b (Hib) caused tens of thousands of cases of pneumonia, sepsis, and meningitis and hundreds of deaths. Thanks to vaccines, and the clear, strong recommendations by the ACIP and CDC, these diseases have been dramatically reduced or eliminated. Indeed, in a recent report published on August 8, 2024, researchers found that among 117 million children born between 1994 and 2023, CDC-recommended vaccines prevented about 500 million illnesses, 32 million hospitalizations, and 1.13 million deaths.

All of this is true, which is why I don’t think RFK Jr. would eliminate ACIP, even though he could. (The ACIP charter expires if it isn’t renewed every two years.) Rather, more likely he would subvert ACIP. The Secretary of HHS picks the members of ACIP, after a nomination and selection process. These members serve staggered terms, and the current roster has four members, including the chair Dr. Helen Keipp Talbot, whose term expires June 30, 2025, four whose terms expire in 2027, with the rest expiring in 2028. (The reason for this is that, for whatever reason, the Biden administration left a number of ACIP committee positions vacant after the members’ terms had expired and then appointed several new members in February.) By the end of a Trump administration, all members of ACIP could be replaced. Now imagine putting, say, RFK Jr. or his designee in charge of vetting potential new ACIP Members, a process that could be used to place four antivax and/or contrarian “scientists” and physicians on the committee next June, qualifications that prospective members be “acknowledged experts with an outstanding record of achievement in their own field and an understanding of the immunization issues covered by ACIP” be damned. Then in 2027, he could add four more, followed in 2028 by replacing the eight remaining voting members appointed this year.

Regular readers can only imagine the disaster that would be. Likely no new vaccines would be added to the CDC-recommended schedule, while some might even be removed, as committee members harass CDC and FDA scientists to torture the safety and efficacy data to make it “confess” that vaccines are unsafe and ineffective. I shudder at the thought. Of course, one thing that I do know about ACIP is that its conflict of interest reporting requirements are quite rigorous. That might keep the worst grifters off the committee, but I can’t guarantee that.

Can RFK Jr. succeed in destroying federal public health policy and programs?

There are many contradictions inherent in the MAHA movement that RFK Jr. has forged with Donald Trump. For example, RFK Jr. rails against the FDA as being too beholden to drug companies and quick to approve products without adequate evidence of efficacy and safety, while also wanting to lower the bar for the approval of the various quack treatments that he espouses, such as ivermectin for COVID-19 and cancer. He wants to make the FDA more strict and accountable, which, even if one could trust him to do this right, would run headlong into the interests of big business supporters of Trump in big pharma. One might easily see Trump being swayed to rein in or get rid of RFK Jr. because billionaires running pharmaceutical and medical device companies don’t like him interfering with their business. Given Trump’s history, who do you think Trump will listen to, his billionaire supporters or RFK Jr., whom he only took on as his health advisor (whatever position he ends up occupying) as an expedience, to get rid of a potential threat to his election?

Even so, and even considering that it will take years to accomplish what RFK claims to want to accomplish, be afraid. Be very afraid. Even if RFK Jr. accomplishes only a fraction what he promises, the damage to public health, the vaccination program, the FDA drug and device approval process, and federal science-based health policy in general, especially public health, will be incalculable. Previously controlled or even conquered vaccine-preventable infectious diseases are likely to return, although it might take a few years, by which time Trump will be out of office and his successor will be blamed. As for the rest, RFK Jr. will not “make America healthy again.” Far from it. He will jeopardize the health of Americans by making them vulnerable to infectious disease, keeping the FDA from approving safe and effective medications while encouraging it approve quackery of which he approves, and subjecting them to foodborne illness in the pursuit of the “natural,” like raw milk. And I haven’t even gotten into how he could change the rules at CMS to force it to pay for quackery under Medicare and Medicaid.

The next four years will be a disaster for science-based health policy and programs. The only question is: How bad? Again, my thought is: Plenty bad, man, and I haven’t even talked about RFK Jr.’s plans for the NIH yet. Let’s just say that he’s looking to pervert what is arguably the greatest engine of biomedical science and discovery ever created into Lysenko 2.0. More on that, sadly, soon enough.