RFK, Jr.: The Secretary of Health and Human Services is Dangerous to Your Health!

It can sometimes seem like the public health and medical communities are “ganging up” on Robert F. Kennedy, Jr., with ongoing criticism and attacks on his beliefs and, more important, his policies. The rebuttal is that this man, whose thinking is wildly unscientific and fringe, is the incredibly powerful Secretary of Health and Human Services, in charge of the second biggest department in the US government (after Defense) in budget and staff, and responsible for the diverse, varied, and highly important components of that department. These include Medicare, the health insurance system for the aged and disabled and Medicaid, the federal/state partnership that provides insurance for many low-income Americans (mostly children and their mothers in number, mostly long-term care in dollars). It also includes the Centers for Disease Control and Prevention (CDC), which studies and intervenes in both infectious and chronic disease, the Food and Drug Administration (FDA) that oversees the safety and effectiveness of our – food and drugs, the National Institutes of Health (NIH) that funds and supports most medical research, and other major agencies, including the Indian Health Service (IHS) that provides health care on Native American reservations, the Health Resources and Services Administration (HRSA) that funds community health centers and many other major service delivery and educational program, and the Substance Abuse and Mental Health Services Administration (SAMHSA) that supports addiction and mental health services. It’s a big, responsible, job.

And, so, there are a lot of things that can be screwed up. And a lot things are being screwed up. By him. In part, this may be because of his general incompetence and lack of actual knowledge about health care (knowing little about their portfolio is a common thread among those Trump has selected to lead federal departments). Kennedy is not a health professional, although he is a health “profess-er” – he professes a lot of opinions.  A lot of the screw up is the result of the DOGE-created cuts of 10,000 people from the HHS workforce in all of these agencies. Some of it is the administration’s political antipathy to programs (like Medicaid) that help people in need instead of the wealthiest in society who don’t need help at all. And no small part of it is because the beliefs that he has about health that come from fringe proponents of every bizarre remedy from ivermectin (good for worms, not for COVID) to hydrogen peroxide to Vitamin A to prevent measles, and opponents of many of the health interventions that we know really work to save lives. Let’s look at some of these.

Measles is a bad disease. It causes a great deal of morbidity. I come from a generation of children who almost all had measles – and varicella (German measles), and mumps. Most of us survived, without even being hospitalized. But some did not. About 20% (1 in 5) people/children with measles are hospitalized, which means they are very sick. From 1-3 per 1000 die. That is a lot. Not as many as currently die from, say, being shot at school, but a lot. The thing is, though, that measles is preventable by vaccine. Per the CDC:

A vaccine became available in 1963. In the decade before, nearly all children got measles by the time they were 15 years old. It is estimated 3 to 4 million people in the United States were infected each year. Among reported measles cases each year, an estimated:

·       400 to 500 people died

·       48,000 were hospitalized

·       1,000 suffered encephalitis (swelling of the brain)

 

After the vaccine, measles went from being an endemic disease to one that was essentially eliminated. Until many people stopped vaccinating their children, based on unfounded fears of side effects, especially autism, being promoted by unscientific “experts” – like Kennedy. He has commissioned a new study on the link, to be done by discredited physician Andrew Wakefield, and thus is ignoring hundreds of studies with over 3 million children that show no link! Kennedy has also promoted using Vitamin A to prevent or mitigate measles. While in countries where there is widespread Vitamin A deficiency, this is a good strategy, there is no significant prevalence of Vitamin A in the US. And taking more to “be safe” is a bad idea since Vitamin A, a fat-soluble vitamin, accumulates and causes toxicity. So now, in addition to over 700 cases and at least 3 deaths (which suggests the number of cases is an underestimate) from measles, we have children being hospitalized for Vitamin A toxicity! And measles is only one serious condition; I have written about infections in children with Hemophilus influenza B and even worse polio (Raw milk, vaccines, and RFK, Jr: Some dates worth remembering, November 15, 2024) and was reminded of its effects on a recent episode of “Call the Midwife” which featured a man in an iron lung. Let’s not bring polio back!

Kennedy has also angered many Native American tribes, simultaneously calling for greater attention to their health status (good) and cutting the programs that benefit them, as covered by the Arizona Star (RFK Jr. says chronic disease in tribes a focus as program to do that gutted). He has also made the possibly not serious but nonetheless insulting proposal to move laid-off health workers from CDC and other HHS agencies to reservations (NY Times Kennedy’s Plan to Send Health Officials to ‘Indian Country’ Angers Native Leaders).

While on many of these issues, such as opposition to vaccines, Kennedy is simply wrong (and dangerous, see the recent NY Times article The many ways Kennedy is already undermining vaccines), on others it is less clearcut, which is why his opinions get traction. For example, he advocates strongly for the importance of diet and exercise to health. Those are generally are good. Most people should get more exercise and eat more healthful foods (and fewer unhealthful ones). But that is not a panacea. A healthful diet will not prevent measles – or COVID or smallpox or Hemophilus influenza B infections or cancer – although having good general underlying health will likely make one relatively able to weather such conditions better. Kennedy employs many logical fallacies in his pronouncements, including setting up “straw men” to knock down, using misdirection to keep you from looking at what he is saying, data-dumping to overload you, appeal to (false) authority (like Wakefield), and others. Some of these are discussed in the NY Times piece, From ‘Data Dumping’ to ‘Webbing’: How Robert F. Kennedy Jr. Sells Misleading Ideas and by Dr. Jessica Knurick. “Your Local Epidemiologist”, Katelyn Jetelina, discusses the Progress on Make America Healthy Again (MAHA), his signature plan. It has made a lot of progress, although it has been in reverse, making America less healthy. For more on his strategy, check out Paul Offit, MD, of the American Council and Science and Health, who describes the RFK Jr. Playbook. And, of course, he has traded on his family name and the reputations of his father and uncle John, who would (like most of his surviving family) be outraged by his positions.

Kennedy’s ideas and actions are both unscientific and damaging to the public’s health, leading the American Public Health Association (APHA) to call on him to resign or be fired in a statement enumerating many of his most damaging actions and dangerous pronouncements. All the “charges” it lists are accurate, and serious, and he should be gone. He is a real danger to our health. But the things he has championed, his hypocrisy and sleight of hand, and the false relativism he promotes that is dangerous, would unfortunately not be likely to be better with any HHS Secretary nominated by the current President. Most of Trump’s Cabinet and other senior-level picks have been unqualified, uninterested, and incompetent at best, and evil at worst. It has been said that their only “qualification” needs to be obsequious loyalty to Donald Trump, but a serious commitment to ruining the lives of as many American people as possible also seems to be important.

And, of course, that is the intention.

Tallow and unsaturated fats: What is "natural" and what is good -- not the same!

The NY Times “Eat” section recently had an article titled ‘How Beef Tallow Made a Comeback’, asking in the subhead ‘When McDonald’s stopped frying with beef tallow in the 1990s, most people saw it as a win for America’s health. What changed?’. The short answer, in terms of the science of the relative benefits of saturated animal fats like tallow and lard versus the unsaturated (olive oil) and poly-unsaturated (several types of vegetable oil) fats, nothing. What has changed, at least to some degree including among the restauranteurs cited, is people’s opinions and beliefs. One of them ‘said he felt a “moral and ethical obligation” to change his menu earlier this year…after reading that seed oils, like the canola oil he used to cook his fries and tortilla chips, carried potential harms. Tallow, he said, made for a healthier, more “natural” frying oil.’

There is a lot to unpack here. First is whether “seed oils” carry potential harms. Where did he read it? A reliable source? A wackjob? An earlier “Eat” piece, in January (link in the previous paragraph) was called ‘Are Seed Oils Actually Bad for You?’. It concluded that, new (not yet confirmed when the article appeared) Secretary of Health and Human Services ‘Robert F. Kennedy Jr., and others, claim they’re harming our health but the evidence suggests otherwise.’ In both articles, accomplished and respected nutrition scientists dispute this claim, and emphasize the increased risk of heart disease (and cancer) from animal fats like tallow and lard. There are physicians in the US, certainly here in Tucson, who dispute the idea that saturated fats are bad for you in terms of causing a higher risk of heart disease, but they are a distinct minority. There are at least a couple of research studies indicating they are not, but hundreds indicating that they are.

‘In 2002, a review study raised the question of whether consuming foods with high levels of omega-6 fatty acids relative to omega-3 fatty acids (a ratio typical of many seed oils) might increase inflammation in the body. “But I’ve gone through these papers and there’s not a single shred of evidence that this is actually true,” Dr. [Walter] Willett [Harvard School of Public Health] said. “This is all theoretical.”’

It should go without saying (but apparently doesn’t) that it is illegitimate to pick and choose the research you cite based not on its quality or methods but on whether it gets the results you already agree with. The American Heart Association (AHA) recommends diets with lower levels of saturated and higher levels of unsaturated fats, but critics say that this recommendation is tainted because AHA got money from Procter and Gamble, which manufactures Crisco, which contains both saturated and unsaturated fats and is not actually a particular favorite choice in the polyunsaturated sphere. While the appearance of bias/corruption always can exist when money is involved (see my piece from August 20, 2010 The AAFP, Coca-Cola, and Ethics: Serving the public interest?), it does not necessarily, or usually, mean the research supporting recommendations is flawed. P&G denies any association, but much more important is the breadth and consistency of the research supporting the use of unsaturated fats.

The other big issue is ”natural”. This one is huge. People of all political stripes love “natural”. It sounds so – well, natural! If it’s natural, it must be good – or at least better – right? Well, first of all, for this discussion, seed oils are also natural. They are, indeed, usually processed, but there is nothing in that processing that would make them less healthful, or natural. Tallow and lard when sold commercially are purified as well. A lot of stuff that is natural can be good for you, but a lot of stuff can also be bad for you. Many people advocate for the use of herbal remedies (natural, right?) and in fact many plants do have physiologic effects that can treat symptoms and diseases. Some have been the basis of commercially-produced medicines, e.g., aspirin from willow bark, digitalis from foxglove, colchicine from autumn crocus (Drug prices and corporate greed: there may be limits to our gullibility, December 27, 2015). Even in these cases the standardization of dose is much better in commercially produced drugs (and I am no fan of pharmaceutical companies or their practices, especially advertising and pricing). How many leaves of foxglove is good for your heart and how much is going to kill you (digitalis has a very narrow therapeutic:toxic ratio)? And there are many other natural things that are not good for you…I do not recommend rubbing poison ivy on your skin! Tobacco is a natural product, and Native people used it to treat wounds, as well as smoked it. Respecting those traditions and putting it on wounds, or especially smoking it, may not be the best thing for your health.

One thing that is sometimes cited as an indication of what natural things are good is the behavior of other animals. This is worth observing, but it is also worth noting that people are not the same as other animals, and the fact that they like something doesn’t mean it is god for people (or even for them!):

‘Mathaus Myga, 37, who owns a German takeout restaurant in Wisconsin, started frying his pork and chicken schnitzel in locally sourced beef tallow a year and a half ago….When Mr. Myga returns home after a day of frying with tallow, his two dogs lick his fingers. “They would never do that with rapeseed oil,” Mr. Myga said, referring to a common vegetable oil. “These are animals that have natural instincts.”’

I don’t know about Mr. Myga’s dogs, but the things my dogs’ natural instincts lead them to eat are not always things I’d recommend to people. Horse droppings are one of their favorites!

You can believe whatever you want. You can act on those beliefs in living your life (as long as they don’t hurt others). You can prepare your food based on those beliefs. But this does not necessarily make what you believe true. Finding “an article” by a reputable researcher that supports your belief is not a legitimate scientific approach, it is cherry-picking. To know what the science actually says, you have to form your belief based upon the overwhelming consensus of the research.

Of course, that is not a problem if you don’t believe in science.

Slash the VA! Make our veterans pay for increasing corporate profits!

Given the heavy-handed, mean-spirited, cruel, anti-democratic, un-Constitutional, and penny-wise (maybe) but pound-foolish actions of the current GOP/Trump/Musk administration, it is hard to know where even to begin to discuss it. Certainly many, many intelligent and well informed people, including luminaries such as politician Bernie Sanders and historian Heather Cox Richardson, as well as many news sources such as the Contrarian (established by reporters and editors fired by or resigned from Jeff Bezos’ Washington Post and the New York Times). Even in the narrower realm of health, we have outrages like the vaccine denier and proponent of ineffective and even dangerous therapies, Robert F. Kennedy, Jr. heading the Department of Health and Human Services, and Mehmet Oz, RFK, Jr’s fellow traveler, nominated to head the Centers for Medicare and Medicaid Services, presumably so those services can continue to be slashed. And even more narrowly, in health and medicine and social justice – well, all of these actions and cuts tie to social justice!

So, let’s look at the Veterans Administration (VA). The VA is tasked with providing health care for our veterans, those who have served in the military, many of whom have suffered very serious, life-threatening injuries, physical and mental (of course not counting those never got to be veterans because their lives were lost). Veterans have also had higher rates of cancers and lung diseases linked to the use of burn pits (horrific incinerators used “in country” to dispose of garbage, waste, bodies, munitions, toxic materials, using jet fuel as the source of fire, running 24/7 close to camps). The death of President Biden’s son Beau was linked to burn pit exposure, and finally during the last administration Congress passed the PACT act (Honoring Our Promise to Address Comrade Toxic Exposure) to compensate and care for those veterans whose diseases were likely caused by such exposure, often called “the Agent Orange of the Gulf wars”.

The VA was already highly stressed by underfunding and understaffing due to previous cuts made by the pro-veterans-in-words-only GOP Congress and that stress was dramatically increased by the hundreds of thousands (at least a quarter million) claims under the PACT act. Amazingly the VA clinical operation, also very short-staffed, was able to continue to provide health care to veterans. Although there were many complaints of waits and slowdowns, they were in fact much less than the routine waits and slowdowns in the non-VA health care sector (anyone tried to get a doctor’s appointment lately?) and virtually every measure of quality has shown that the VA has outperformed the civilian sector. Of course, its mission is to provide health care for veterans, not to make a profit; this distinguishes it from the civilian sector in which profit is “Job One” and accessible, quality, effective health care a distant second. The NY Times’ recent article titled ‘Chaos at the V.A.: Inside the DOGE Cuts Disrupting the Veterans Agency’ notes that the VA

…treats 9.1 million veterans, provides critical medical research and, according to some studies, offers care that is comparable to or better than many private health systems. Even Project 2025, the conservative governing blueprint assembled by Trump allies, said the V.A. had transformed into “one of the most respected U.S. agencies.

Many of the VA’s successes, as well as its challenges, are documented by journalist Suzanne Gordon in journals including these in Jacobin, Veterans Starting to Mobilize, and the American Prospect.

Then came Trump, Musk, and DOGE. Under the banner of “cutting government waste” the already far-too-lean staffing of the VA is proposed to be cut by another 80,000 jobs! This will certainly result in major delays in accessing care, in lower quality, and unconscionable disservice to our veterans. It seems like heartless cruelty, and of course it is. But the nauseating thing is that while it certainly is not about cutting waste, it is not even about the heartless cruelty. It is about one thing: transferring “government” dollars – that is, YOUR tax dollars (not Musk’s, or his companies’, they don’t pay taxes!) – to private corporations. THAT is the goal.

Think about it. Slash funding and positions from the VA, which will naturally lead to complaints about inadequate service (even the VA can only do so much when cut not only to, but deep into, the bone) and protests from veterans’ groups and maybe even GOP members of Congress. So, what will they do? We don’t even have to guess – they’ll do their favorite thing and privatize it! Contract out the care of veterans to private corporations so they can have the wonderful experiences all the rest of us have in trying to access quality care. Of course, they won’t be able to, maybe even less than the rest of us, but heck, those companies will make a lot of money!

And that is the goal. It is not saving government money, it is about transferring it to private corporations, as acknowledged by Treasury Secretary Scott Bessent. This will cost more, be less efficient, and have lower quality. This is the consistent track record of almost every government service that has been privatized – they almost never either save money or work better, they put taxpayer money in private pockets. In health care, it is even worse; it is almost impossible to think of an example where privatization has not cost far more and had worse service, accessibility, and quality outcomes. If the funding is the same, it is always worse.

But, of course, this is not an accidental outcome, it is the intention. Privatization is sold as saving money, but it always costs more, and as increasing quality but it always goes down. What it is successful at is moving public dollars to the private sector. So, it doesn’t save money by eliminating waste, it eliminates basic care and then “solves” the problem by spending even more money! The heartless cruelty is not the goal; it is simply the byproduct. It hurts our veterans, but this is not a concern to the heartlessly cruel, non-empathic (Musk thinks empathy is “destroying Western civilization”) greedheads making these decisions.

Something can be done. Veterans can rise up and protest and contact their Congressional representatives. So can the various “veterans service organizations” (VSOs) including the American Legion, VFW, and many others. Maybe even some GOP Congresspeople will take the initiative and actually do something to help veterans instead of just flapping their gums! (OK, that may be a bridge too far…)

Concentration Camps: Is the US still the "savior" or will they happen here? Fascism on the rise in health and everything else.

Recently, in Trieste, I visited the San Saba concentration camp, also known as the Rice Mill because that’s what it had been. On the scale of concentration and extermination camps of the Third Reich, it was small. “Only” 3000-5000 people, mostly Jews, were incinerated here, although others were shipped off to Auschwitz to experience a similar fate. It was my first visit to a concentration camp, and I do not know that I will ever go to Auschwitz, or Treblinka, or Sorbibor, or Belsen, but it was very disturbing. However, at one point the guide noted that it had been liberated by the Americans on May 1, 1945.* My eyes, already full of tears of sadness, teared up yet again but this time with pride. It was the same pride I have felt ever since I was a little kid, born only a few years later, every time I hear about my country, the US, standing strong against Nazism and Fascism, and liberating the camps.

But today it was a bittersweet feeling, because in just the last two weeks my country has been rapidly moving toward fascism. The separation of powers, the core structure of our Constitution has been ignored by the current President. I used to call him the Trumpenik, because it sounds very like the Yiddish word “trombenik”, defined by Wiktionary as 1. a lazy person or ne'er-do-well, or 2. a boastful loudmouth, both of which were good descriptions of him. But now he has decided to become Il Duce, another comparison that is very scary here in Italy.  And he, who was at least elected President if not dictator, hasn’t even been doing all this work himself. He has let Elon (who he sometimes calls Leon) Musk do it. Musk, not elected to anything, not appointed to anything with the advice and consent of the Senate, has taken control of the government’s two most critical functions, the funding of it and the information it possesses on all of us, including Social Security and Medicare. Medicaid has already suffered serious threats to its continued ability to help provide healthcare to poor people. As a federal/state partnership, the federal government pays from about 60-80% of the cost, higher in the poorer states – which are often also the most Republican states. The National Institutes of Health (NIH) funds health and medical research; the largest amounts are spent on cancer research, though many other conditions that affect many Americans – heart disease, stroke, Alzheimer’s disease and many others – as well as basic science research that sets the stage for discoveries on diseases we recognize. In addition to the direct funding of the research, the institutions grantees work at also get indirect funds to “keep the lights” on and to provide many of the resources that allow research to go on. The Musk lackeys see this as pork, or worse, things that “enable a leftist agenda” by, I assume, funding universities. The issue of NIH direct and indirect funding is well described by Dr. Jeff Burns, a neurologist and researcher at the University of Kansas Medical Center, in a Facebook post that unfortunately doesn’t have an out-of-FB link**.

Medicare and Social Security are the most popular programs in the country, put in place by Democratic administrations (as have virtually all programs that actually benefit a significant percent of the American people), and its recipients, mostly seniors, aren’t going to be happy to have those programs cut. It is not clear if anyone in the administration cares. Musk has his own ideas of what programs are worthwhile and what are not (often colored by his personal history and interest) and wasn’t elected to any position and is unlikely to be. Decimating the National Labor Relations Board (NLRB), which will be devastating to working people in the US, serves the interests of folks who run major corporations like himself and Jeff Bezos of Amazon. It has also been suggested that his animosity to the US Agency for International Development (USAID) may in part be a result of its support for the majority population of South Africa, from which country’s minority white former rulers Musk comes. And their investigation of his company Starlink’s contracts with Ukraine. And Trump himself is unlikely to run for election again – he got this job and will stay out of jail and make a lot of money and get his revenge on his perceived enemies. And maybe cancel future elections. But going after senior and rural people and programs that benefit red-state residents is not going to increase his popularity.

I care a lot about healthcare and the healthcare system as well as health research, but the moves toward fascism go much farther. Every agency, especially those tasked with enforcing the law and pursuing criminals (like say, felon Trump) has had its professional staff replaced with loyalists and ideologues, especially both the Department of Justice (including the FBI) and the Department of Defense. There are some glimmers of light, particularly from the federal courts, in decisions such as ‘Judge halts Access to Treasury Payment Systems by Elon Musk’s Team’, and indeed the NY Times suggests that the federal judiciary may be the last obstacle to him. But the top decision maker in the federal judiciary is the Supreme Court, to which Trump appointed three justices and has been very friendly to him. And it will be a long time before a lot of those cases get through the courts. And someone has to enforce it. And who thinks that Musk and his Gen-Z minions who have gotten access to and control of federal databases and funds will all of a sudden, even if these cases are successful, rewrite the codes to be the way they were and not leave themselves backdoors to get in? You can’t un-ring a bell.

Enough of this by me. There is plenty of detail being provided by many other sources, and almost all of it is depressing. Let us get back to my feeling of pride in the US and its fight against Nazis and Fascists, of being, on the world stage, the good guys. Of course, it was not always true that we were – plenty of countries were invaded by the US or had their governments overturned by CIA-supported coups, etc., and even in WWII there were the Allies, including the Soviet Union which lost 20,000,000 people! And there were pro-Nazis and fascists in the US, always. Even US concentration camps (if not death camps) were started by FDR, for Japanese-Americans.

But the idea that an opponent of democracy and freedom, a person who wants to be Mussolini, or Hitler, or Stalin, or Putin, or even Viktor Orban, is the President and has moved so quickly to dismantle our Constitution and has had no significant opposition? That makes me sad, and I wonder when we will re-create camps like the one I visited in Trieste, or worse?

 

*Actually, Trieste was first freed on May 1 by Yugoslav partisans. New Zealanders came May 2, and other allies (US and UK) a couple of days later.

**Jeff Burns’ FB post:

Why Cutting Indirect Rates Means Cutting Medical Research

Medical centers aren’t just buildings—they are the foundation that makes research possible. They provide specialized lab spaces, maintain infrastructure, ensure compliance with safety regulations, and handle the complex financial and regulatory requirements that keep research running. None of this is cheap, and none of it is optional.

The NIH is one of the most powerful vehicles for turning ideas into reality—funding research that directly improves lives. Securing an NIH grant is an ultra-competitive process and a gold standard for top notch research. When researchers like me win a grant, the funding covers the research itself (“direct costs”), but the university also receives “indirect costs” to support everything that makes the research possible: the facilities, oversight, administration, and ecosystem that allow scientists to do their work. Without that support, it becomes harder to do the work that advances medicine. And, NIH funding isn’t just about research—it’s an investment in people and communities, with significant downstream effects on the economy.

Cutting indirect rates doesn’t just trim a budget line—it makes research harder to conduct, slowing scientific discovery and the development of treatments that help people. For my own work in Alzheimer’s disease, this means fewer studies, fewer discoveries, and fewer opportunities to change lives. I work alongside hundreds of clinicians, scientists, students, and staff who have dedicated their careers to tackling this disease. But dramatically and suddenly cutting indirect support shakes the very foundation that allows us to take on these big scientific challenges.

This isn’t about cutting waste—it’s a massive, across-the-board budget cut to science. And the hardest hit won’t be the elite universities with massive endowments; it will be the institutions where every NIH dollar is critical. Less investment means less medical research—period. Cutting indirect rates isn’t just bad policy—it threatens innovation, economic growth, and the future of medical discovery.