Robert F. Kennedy Jr., President-elect Donald Trump’s choose to steer the Division of Well being and Human Providers, is coming into the nomination course of in an uncommon place, with an extended listing of his personal coverage priorities separate from the president-elect’s, and a public promise by Trump to let him “go wild” on his concepts.
Céline Gounder, the editor-at-large for public well being at KFF Well being Information and a CBS Information medical contributor, solutions questions under concerning the position Kennedy has been tapped to tackle and among the concepts within the sweeping “Make America Wholesome Once more” platform he might attempt to push by means of.
Q: What’s the position of the Division of Well being and Human Providers, and the way a lot energy does the HHS secretary have over its work?
A: The U.S. Division of Well being and Human Providers contains a number of companies and places of work together with the Nationwide Institutes of Well being, the Facilities for Illness Management and Prevention, the Meals and Drug Administration, the Facilities for Medicare & Medicaid Providers, the Workplace of the Surgeon Basic, and far more.
There’s a huge distinction between political appointees and profession civil servants. Political appointees set strategic priorities and align their division or company’s insurance policies with the present administration’s goals. Civil servants have the institutional information to know the best way to get issues achieved and have specialised scientific or technical experience. Scientific questions require specialised experience. Because of this there are profession scientists who advise the HHS secretary, NIH director, CDC director, and FDA commissioner.
The HHS secretary has the authority to ascertain laws that govern well being, together with meals and drug security, public well being, and well being care high quality. The HHS secretary can declare public well being emergencies and coordinate federal responses to well being crises, similar to illness outbreaks or pure disasters. The secretary wields vital affect over the division’s insurance policies and its constituent companies, which embrace the CDC, FDA, NIH, and others.
The HHS secretary can be able to form public opinion if given a platform to take action by the media. Absent media consideration, their affect on public opinion is extra restricted. We within the media have a accountability to fact-check their statements and maintain these in energy accountable — no matter who’s in energy.
Q: Certainly one of Kennedy’s most controversial stances is his criticism of vaccines, selling the concept that they trigger autism, amongst different situations, and claiming “there’s no vaccine that’s secure and efficient.” What’s the actuality?
A: In depth analysis has conclusively proven that vaccines don’t trigger autism. The “analysis” behind these claims was retracted as a result of moral violations and sloppy work. The physician who initially made these claims misplaced his medical license because of his skilled misconduct.
For folks whose youngsters have autism or individuals who have autism, this issues. For too lengthy, claims concerning the security of vaccines haven’t solely put folks at pointless threat of getting diseases that vaccines can stop, however have additionally been a pink herring, distracting folks from the actual causes of autism and the best way to diagnose them and deal with them. That distraction is unproductive and dangerous.
Secondly, nothing on this world is 100% secure and efficient. It’s all about weighing dangers, the professionals and cons. Is one selection extra helpful or extra dangerous? Do the professionals of sporting a seat belt within the automobile outweigh the dangers? Do the professionals of exercising often outweigh the dangers of not exercising? You may get injured whereas exercising. Do the professionals of vaccinating as an alternative of permitting infectious illnesses to unfold locally outweigh the cons? Sure, sure, and sure.
Q: Kennedy has stated he desires to depart it as much as people to determine whether or not to vaccinate themselves or their youngsters. What affect may which have?
A: More and more, individuals are formulating opinions about vaccines primarily based not on science however on Google searches, social media, what household and associates assume, and private commentary. That’s not analysis. Analysis is formulating a speculation and making an attempt to disprove that speculation. It means you perceive the best way to differentiate correlation from causation. And it means doing repeated experiments to point out consistency, not simply an opportunity or random consequence.
This isn’t a query of whether or not individuals are sensible or not. However most individuals don’t have the coaching, expertise, and context to objectively assess the professionals and cons of vaccination. You wouldn’t need me repairing your automobile’s transmission or brake system. I’m not silly, however I’ve no coaching or expertise on this.
The chance of leaving these choices to untrained people is that these choices received’t be made on science. They are going to be made primarily based on emotion and affirmation bias, which is to say, Google searches in search of opinions that line up together with your preexisting beliefs or inclinations. It will put youngsters in danger, and since vaccines shield towards transmissible infectious illnesses this may put others locally in danger, particularly different youngsters and people who find themselves immunocompromised.
Q: Kennedy has additionally stated chemical substances in meals are tied to autism in addition to psychotic episodes and melancholy. What do we all know concerning the connection between meals and psychological well being?
A: He’s not mistaken that there’s a relationship between weight loss program and autism in addition to weight loss program and psychological well being. These are areas of ongoing analysis. No weight loss program has been confirmed to treatment or universally enhance autism or psychological well being signs, however sure dietary interventions enhance signs in some folks. These dietary modifications might embrace elimination of ultraprocessed meals, eliminating gluten, and avoiding sure meals components or preservatives.
Q: Kennedy has stated one of many Trump administration’s first acts will probably be to work to take away fluoride from consuming water, arguing it’s related to most cancers, IQ loss, thyroid illness, and different well being issues. Why is fluoride in consuming water, and is it secure?
A: Fluoride is put within the water to cut back the chance of cavities, particularly in youngsters.
As with many issues, fluoride security is all about dose. Consuming just a few glasses of water a day is wholesome. Consuming from a hearth hydrant all day would land you within the hospital. The extent of fluoride in U.S. water is secure and protects towards tooth decay.
When municipalities stopped placing fluoride within the water, cavity charges went up. This was noticed, for instance, in Calgary, Canada, and in Juneau, Alaska.
There are elements of the world, together with India, China, and East Africa, the place fluoride ranges 30 to 40 occasions greater than ranges within the U.S. have been discovered to be dangerous. However we don’t have wherever close to these ranges of fluoride in our water.
However Kennedy’s assertion demonstrates a typical misunderstanding about public well being authorities within the U.S. We’re the United States of America — public well being powers reside on the state degree. The federal authorities has the authority to tax and spend and to manage commerce throughout state traces, and federal authorities authorities derive from that.
The CDC offers scientific steering to assist state and native authorities to make knowledgeable choices. The CDC doesn’t mandate fluoridation. The EPA units the utmost allowable fluoride focus in public water techniques. However states have the authority to mandate fluoridation or can go away it as much as native jurisdictions.
Q: Kennedy has criticized a number of public well being companies he may now lead. He has stated the FDA’s “struggle on public well being is about to finish,” claiming the company suppresses something that “advances human well being and may’t be patented” by pharmaceutical corporations. What do you make of those criticisms?
A: This once more demonstrates a misunderstanding of federal company authority. Congress has handed legal guidelines that give the FDA particular authority to manage medicine, dietary supplements, and meals, and people legal guidelines grant the FDA completely different powers over medicine, dietary supplements, and meals.
If something, given the Supreme Courtroom’s “main questions doctrine,” the courts can decide that companies might not make laws on points of great financial or political significance until Congress has clearly licensed such actions. For instance, within the case FDA v. Brown & Williamson Tobacco Corp. (2000), the Supreme Courtroom concluded that the FDA lacked the facility to manage tobacco. In 2009, Congress handed the Household Smoking Prevention and Tobacco Management Act, granting the FDA the authority to manage tobacco.
Medicine require FDA approval earlier than they are often marketed. Below the legislation, medicine are outlined as substances used to diagnose, deal with, or stop illness.
Dietary supplements don’t want FDA approval earlier than they’re offered. The FDA screens dietary dietary supplements as soon as they’re available on the market and may take motion if they’re unsafe or in the event that they make claims about analysis, therapy, or prevention of illness.
Dietary complement producers typically select to not search FDA approval to market their merchandise as medicine as a result of:
There are much less stringent necessities on dietary dietary supplements than on medicine.
The FDA approval course of is pricey and prolonged. Scientific trials take years to conduct and value tens of millions of {dollars}. Producers foot the invoice for medical trials.
Dietary dietary supplements may be offered on to shoppers and not using a prescription.
The producer decides whether or not it desires to hunt FDA approval for a drug or if it desires to market a product as a dietary complement — and that call usually comes all the way down to money and time. Pharmaceutical corporations are much less inclined to take a position tens of millions of {dollars} in medical trials of unpatented therapies because of the lack of unique advertising rights (in different phrases, a time-limited monopoly), which might have an effect on profitability.
The FDA typically goes after complement manufacturers that check this line when it sees corporations advertising merchandise with claims that quantity to what must be regulated as a drug. Because of this dietary supplements typically carry a disclaimer that they aren’t being offered to “diagnose, deal with, treatment, or stop any illness.” Kennedy has praised the complement trade for “combating again,” following a courtroom motion over an anti-aging complement that the FDA argued must be regulated as a drug.
Lastly, the FDA doesn’t grant patents. That’s the job of the U.S. Patent and Trademark Workplace.
Q: Trump has stated Kennedy will “finish the Continual Illness epidemic.” What are among the constructive actions he may take if he turns into HHS secretary to cut back power illness within the U.S.?
A: Kennedy has referred to as for higher regulation of meals components and ultraprocessed meals. Ultraprocessed meals in American diets have led to an explosion in weight problems, diabetes, hypertension, and different power illness.
Nonetheless, it’s unclear which factions inside Trump’s orbit will prevail. Congress might have to offer the FDA the authority to manage extra aggressively and the funding to implement these laws. Traditionally, the Republican Celebration has been against regulation. Trump’s chief of workers choose, Susie Wiles, is a longtime lobbyist who has labored on behalf of the meals, insurance coverage, and tobacco industries.
The Heritage Basis’s Challenge 2025 — which concerned various former Trump advisers, however which Trump has tried to distance himself from — would roll again dietary tips, making it tougher to combat ultraprocessed meals.
Alexander Tin contributed to this report.
cgounder@kff.org
