Nomination of RFK Jr. reflects a broader shake-up in the politics of health
During his first term in office, Donald Trump relaxed nutritional standards on school meals, undoing an Obama-era initiative to feed students with whole grains and fresh produce. He also put officials from the chemical industry . Under his watch, .
That was then.
Last week, Mr. Trump nominated Robert F. Kennedy Jr., a former Democrat who ran as an independent presidential candidate, as secretary of the Department of Health and Human Services. The president-elect said that Mr. Kennedy, an outspoken critic of the U.S. agriculture, chemical, and pharmaceutical industries, would 鈥渆nd the Chronic Disease epidemic鈥� and 鈥淢ake America Great and Healthy Again!鈥�
Why We Wrote This
In past decades, U.S. health agencies could mostly count on bipartisan support. The pandemic turned many conservatives against public health experts 鈥� creating the opening that has resulted in Robert F. Kennedy Jr.鈥檚 Cabinet nomination.
Mr. Kennedy, a former environmental litigator and scion of the Kennedy dynasty, has promised to ban food additives, remove sodas from food stamp programs, and overhaul nutritional guidelines. He rails against the federal health agencies that he would oversee and promises to radically repurpose them 鈥� by redirecting funding for medical research into holistic and alternative cures, shifting the focus from infectious to chronic disease, and slashing workforces.
He鈥檚 among several Trump nominees who could face strong resistance in Senate confirmation hearings. His , which he has lately , are certain to be scrutinized in Congress. He has repeatedly spread falsehoods about vaccine safety, particularly for children. But Mr. Trump appears to have his back in taking on what both men have framed as a 鈥渃orrupt鈥� medical and scientific bureaucracy.
Mr. Kennedy鈥檚 ascension in Mr. Trump鈥檚 policy circle follows his decision in August to end his own White House run and campaign for the former president.
But their alliance reflects a broader shake-up in politics, one that in Mr. Kennedy鈥檚 orbit has brought together health policy advocates, entertainers, and entrepreneurs on both the left and right who attack the U.S. health care system and its pharmaceutical and scientific enablers. This unlikely coalition 鈥� crunchy liberals and combative libertarians 鈥� is united by distrust of mainstream medicine, disregard for traditional scientific authority, and despair at the unhealthy nation they inhabit.
Mr. Kennedy鈥檚 grab bag of populist policies and scorched-earth approach to public health agencies, however, doesn鈥檛 square with what most voters say they want, says Robert Blendon, a Harvard professor emeritus of public health and health policy who studies public opinion on health issues. When asked, voters say they are concerned about drug costs, the fight against opioids, and health insurance rates, not about pesticides in crops or additives in breakfast cereal.
Mr. Kennedy鈥檚 priorities 鈥渁ren鈥檛 the priorities of the people who voted for Trump,鈥� says Professor Blendon, who works at the Harvard T.H. Chan School of Public Health. 鈥淭he president is repaying Kennedy [for his campaign support], but it doesn鈥檛 fit the agenda of either Republican voters or many in the House or Senate.鈥�
And the clout of rural voters in Congress could blunt Mr. Kennedy鈥檚 ability to take on food and agricultural producers. 鈥淲e are going to discover that Republicans have very strong farmer constituencies,鈥� says Professor Blendon.
A shift among conservatives
Some of Mr. Kennedy鈥檚 proposals, such as capping drug prices paid by federal insurers and keeping junk food out of public nutrition programs, are popular among Democrats. Indeed, President Joe Biden signed landmark legislation paid by Medicare enrollees, a policy that Republican legislators opposed. Former New York Mayor Michael Bloomberg was a prominent by Democratic-run cities to stop allowing food stamps to be used for sodas. On Thursday, Colorado Gov. Jared Polis, a Democrat, voiced on the social platform X for Mr. Kennedy as HHS secretary 鈥渢aking on big pharma and the corporate ag oligopoly to improve our health.鈥� He also cited his policies on prescription drug prices, nutritional programs, and farm pesticides.
But Mr. Kennedy鈥檚 biggest supporters include who want to loosen the pharmaceutical industry鈥檚 influence on drug regulation and roll back public health mandates. While anti-vaccine views were once more common on the left, and gained celebrity endorsers, the biggest pushback is now from conservatives who rebelled against mandates for COVID-19 vaccines.
And distrust of the federal health agencies that Mr. Kennedy wants to overhaul is much greater among conservatives. In a co-authored by Professor Blendon, 53% of Democrats expressed a great deal of confidence in leaders of the scientific community, compared with 22% of Republicans. A majority of Republicans said they had little or no trust in public health institutions, such as the Federal Drug Administration and the Centers for Disease Control and Prevention.
In past decades, health agencies could mostly count on bipartisan support. The pandemic and the government鈥檚 response to it, including lockdowns, and mask and vaccine mandates, turned many conservatives against public health experts and fed into conspiracy theories about global elites, creating an environment for unorthodox politicians like Mr. Kennedy to break through.
Mr. Kennedy has promoted unproven wellness cures and products, from raw milk and ivermectin to peptides and psychedelics. Just as Mr. Trump has benefited politically from relentless attacks on public institutions that increase distrust and buttress his assertions that only he can fix Washington, critics say from the causes that he pursues, rooted in an antiestablishment politics that eschews scientific authority.
He has leaned into a medical conspiracism, 鈥渨hich basically causes people to distrust regulatory agencies and scientists who actually support evidence-based medicine,鈥� says Andrea Love, a biomedical researcher and science communicator in Philadelphia.
Like many medical professionals, Dr. Love recoils at Mr. Kennedy鈥檚 nomination and the effect he could have. As HHS secretary, 鈥淗e is the face of public health,鈥� she notes. 鈥淗e could say things that contradict every scientific expert and all the consensus data,鈥� and his words would carry weight.
Seeking a broader health agenda
The medical industry is a frequent target of Mr. Kennedy鈥檚. And there鈥檚 no question it exerts influence on politics: Four of the top 10 lobbyists of the federal government are . Critics, mostly on the left, have long complained about regulatory capture of federal health agencies by these industries, including large drugmakers.
One of Mr. Kennedy鈥檚 proposals is to reform how the FDA is funded. Under the Prescription Drug User Fee Act, the majority of funding for its drug division comes from pharmaceutical firms. When the act was renewed in 2017, the only senator to oppose it was independent Vermont Sen. Bernie Sanders.
Also opposed was Public Citizen, a progressive consumer watchdog group founded in 1971 by Ralph Nader. Ending this practice, though, would require Congress to appropriate more money for the FDA, says Robert Steinbrook, who directs Public Citizen鈥檚 health group. He鈥檚 skeptical that Republicans would do this 鈥� and even more skeptical of Mr. Kennedy as an agent of reform.
鈥淓liminating user fees and having Congress fully fund the FDA budget would be a great idea. Promoting hydroxychloroquine or circulation therapy would be a horrible idea,鈥� says Dr. Steinbrook. 鈥淚f there are areas of common ground that can be moved forward on, that would be great. But we鈥檙e very concerned that a lot of [Mr. Kennedy鈥檚] ideas are rooted in false claims and conspiracy theories.鈥�
Mr. Kennedy鈥檚 crossover appeal to activists on the left and right creates some internal dissonance. While some of his supporters want to see less federal regulation of emerging medical products and technologies and for consumers to choose their own treatments, others want to see far greater regulation of food and drugs so consumers are exposed to less risk. Mr. Kennedy has advocated both types of policies, often at the same time.
This push-pull over drug regulation is baked into the process, says Kevin Cranston, a former assistant commissioner at the Massachusetts Department of Public Health, who retired last year. He recalls how communities wanted access to experimental drugs during the HIV/AIDS crisis, which led to changes in how drugs were tested and approved.
鈥淭he FDA is in a bind. Its job is to ensure safety, and its job is also to get helpful devices and medications and vaccines out the door to help people,鈥� Mr. Cranston says. 鈥淧eople on one side say, 鈥業 need my medications now. You need to approve them now.鈥� And people on the other side are saying, 鈥楾hey have to be absolutely safe, and you need to guarantee that.鈥欌��
The FDA is only one of the agencies that would fall under Mr. Kennedy鈥檚 sway if he鈥檚 confirmed. The Department of Health and Human Services, which has around 80,000 employees, also monitors and helps fight infectious diseases, decides on treatment coverage by Medicare and Medicaid, funnels billions of dollars into medical research, and contributes to recommendations on what foods Americans should eat.
That Mr. Kennedy wants to promote healthier lifestyles, require nutrition classes in medical schools, and address the root causes of disease is welcome, say public health experts. But, they add, that doesn鈥檛 mean Congress should confirm a .
鈥淭here鈥檚 nothing wrong with wanting to have a broader health agenda, and I hope he would do that. But there are many other people who have the same agenda who are well trained and have experience,鈥� says Georges Benjamin, the executive director of the American Public Health Association.
Editor's note: When this article was originally published Nov. 18, it misstated the month of Robert F. Kennedy Jr.'s departure from the presidential race. This has been corrected.聽
