We need a 'disruptor' HHS Secretary, but not RFK Jr.
Despite a few good thoughts about the problems facing health in America, RFK Jr.'s confirmation would undoubtedly harm Americans
Today was the first of several confirmation hearings held for RFK Jr., who was nominated for HHS Secretary by President Trump. I watched the entire thing. Given that my prior knowledge about his stances came from various podcasts and media articles, I wanted to wait until this formal session to finalize my thoughts on his candidacy.
In short, this hearing only confirmed what I and many others had already thought - that RFK Jr. is a poor candidate for HHS secretary.
I’ll separate my opinions into the good, the bad, and the ugly. Unfortunately, there is a lot of the latter two and not much of the first. However, there are inklings of his stances that I think would be valuable in an HHS Secretary.
The Good
If there is one aspect where RFK is spot on, it is that there is a rotten relationship between the government and the companies involved in our healthcare system. RFK has been very outspoken on this topic and his rhetoric conveys that he wants to do something about it. Insurance companies lobby extensively for cozy regulation and attempt to cover as little care as possible. The pharmaceutical and medical device industries lobby Congress for FDA drug approval with imperfect study largely funded on the public dollar and sells it to the public at exorbitant rates. Healthcare regulation also suffers from a revolving door where industry employees are the ones selected to run their respective regulatory agencies, and vice versa. He is also one of the only people to point out the consolidation of the food industry, which also receives massive subsidies to produce toxin-contaminated and unhealthy processed foods. Many practices, additives, and preservatives used in food production in the United States have not been allowed in our peer nations for decades. This has undoubtedly contributed to our poor health as a nation - what RFK aptly calls a “chronic disease epidemic.”
RFK is right that with regards to these topics, both Democrat and Republican HHS Secretaries have failed the public and maintained the status quo. And he is right that we have reached a tipping point where this simply cannot continue. These are sentiments that I wish were shared as strongly by HHS Secretaries in the past. While Xavier Becerra did make some progress in introducing Medicare drug price negotiation for commonly-used medications, this was a drop of water in a bucket with a large hole cut out of the bottom.
The Bad and Ugly
The fact is, I simply cannot get behind an HHS secretary who has expressed such severe skepticism about routine vaccinations that are undoubtedly some of the greatest achievements of modern medicine. It is one thing to compare our vaccination schedules to those of other advanced countries and question if there is a better way we can do it (many EU countries have large variety in their schedules compared to the US). It is even okay to question if new vaccines such as COVID-19 should be so readily adopted into routine schedules without long-term or safety signaling studies being conducted first.
However, RFK has taken it several steps further. Beyond ludicrous statements such as vaccines causing autism, several Democratic senators made very transparent today RFK’s former chairmanship of the Children’s Health Defense, an anti-vaccine advocacy group that has spread vaccine misinformation to the public for over a decade.
This is not even the most egregious example of his anti-vaccine advocacy - that spot belongs to his involvement in the 2019 measles outbreak in American Samoa. Very briefly, several sentinel events caused by the administration of faulty MMR vaccines in 2018 caused significant vaccine hestiancy on the small island territory. The sharp decline in MMR vaccination over the course of the next year led to a significant outbreak, leading to over 5,700 confirmed measles cases and even killing 83 (the population of Samoa was about 200,000). RFK saw this as an opportunity and visited the island during this time in 2019, exploiting the crisis to further campaign against vaccines to an already underserved population reeling from extreme hesitancy.
To some extent, I am usually not the first person to bring up past statements/stances made by someone and actively use it against them in the future. In politics, this often leads down a slippery slope and nearly everyone, no matter how good or bad, has said something wrong in the past. But it is clear from RFK’s history that his vaccine skepticism goes beyond a passing comment made on a podcast and is instead a core belief that he has committed much time towards. This makes him less sincere in my eyes about his newfound commitment to not ban vaccines.
Some have mentioned that the HHS itself does not make vaccine recommendations - they are done by CDC’s expert panel ACIP. However, vaccination rates have plummeted in the post-pandemic era and more Americans are skeptical of vaccines than ever in the recent past. Throughout the pandemic, the US government’s imperfect messaging surrounding the COVID vaccine’s benefits and risks (i.e myocarditis in young men), flawed translation of evidence to policy decisions, and politicization were the likely catalysts. We need a leader now more than ever who is and has always been firm on the stance of vaccines.
To the lay on-the-fence skeptic with a new child approaching 1 year of age and will be due to get MMR dose #1, what message are we saying by installing RFK to this position? This will only serve to introduce more needless controversy and will be a step backwards for public health.
RFK has also shared similar fringe theories regarding Wi-Fi causing cancer, HIV not really causing AIDS, COVID being engineered to target certain ethnic groups, and denying the germ theory of disease. Some of these questions were answered decades, and in the last instance, more than a century ago. His denial of almost the basics of science make me question if the good views I mentioned above were a product of thoughtful evaluation of our healthcare system or simply conspiracist spitballing as these extreme views seem to be. A broken clock is right twice a day right?
In politics, optics do matter. Cabinet-level positions are as symbolic as they are legally influential. Although HHS secretaries historically have not been scientists or physicians, given the nature of the position, the bare minimum should be to at least believe in good science that has been validated extensively for years. I liken this to if we were to nominate a flat-earther to run NASA.
My Final Thoughts
By the end of the hearing, I got the sense that RFK is trying to brand himself as this anti-corporate “disruptor” that we need in order to “tear down the walls” and enact sweeping reform to fix our absolutely failed healthcare system. I saw some parallels between this and the brand created by Trump in 2016 - an unabashed outsider who would “drain the swamp” and fight for the common man who had been failed by government institutions for decades.
But while I feel that he is certainly passionate about several key issues that plague our healthcare system, I fear that his personal record and extreme views may tear down too many walls and turn the nation away from the science that does work. This would ultimately make our crumbling trust in public health even worse and defeat the purpose of RFK’s own stated mandate. As a result, I cannot support his candidacy for HHS.
Does that mean there is zero place for him in the Trump Administration? Probably not - he certainly seeks to be rewarded for his big endorsement in the 2024 campaign. Perhaps a position in the Department of Agriculture fighting Big Food would be better suited for him. It is lower stakes than HHS and would limit his influence to areas where his views are more sensible. But maybe that is a topic for another post.