A photo of Trump, his besties, and the son he tolerates eating McDonalds went viral on Sunday. What made this photo so special? Lots! The boys are on a private jet, Mike Johnson doesn’t have a seat at the table, Elon Musk has a weird (eccentric?) way of putting ketchup on his fries, and RFK Jr. looks like he’s being held against his will. I’d guess Robert F. Kennedy Jr. didn’t sign off on Don publishing the photo because he looks pained from being forced to eat seed oil-laden McDonalds. And we know “seed oils are poison” is an RFK Jr. “Make America Healthy Again” view.
Just three days prior, Trump said he’d nominate RFK Jr. as the Health and Human Services Department Secretary. All eyes were on biopharma.
I fielded questions on this via texts, DMs, and IRL. I’ll share those thoughts with you because the topic fits within Of Note’s “On Health” newsletter ethos! It boils down to 1) what we know to be true about Kennedy’s health policy positions (not a lot!) and 2) what’s actually feasible. We know what the Market thinks about this. The SPDR S&P Biotech dropped after the announcement, and drugmakers like Pfizer, Eli Lilly, Amgen, and Novo Nordisk. Vaccine makers, the New York Times reported, lost over $8 billion in market value. I asked one of my Cambridge-based pharma colleagues how they’re talking about this in town, and she said everyone’s being very private about it. Fair! My advice to the industry? Stay calm and have some tact. Let’s get into it.
WHAT DO WE KNOW ABOUT KENNEDY’S HEALTH POLICY VIEWS?
Fluoride fearmonger
It’s well-known that he disagrees with the public health win of adding fluoride to drinking water. Though he concedes that fluoride in the water was good when it first started (1940s), he’s also stated, “fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.” The American Cancer Society has looked at the data and concluded there’s “no clear association” between fluoride and cancer.
My view on fluoride? Fluoride has helped strengthen and remineralize teeth, reducing cavities and tooth decay. If you’re going to bed after a late night out and are too lazy to brush your teeth, fluoride in the drinking water is your guy (allegedly). Some data show that HIGH fluoride exposure could be toxic, but that level is well below the federally recommended dose. Too much of anything is bad, even turmeric.
Anti-vax tendencies
Kennedy touts misinformation, like linking MMR vaccines to autism, but these claims aren’t backed by science. His anti-vax tone has evolved, championing the issue as a personal choice. His latest talking point is, “We’re not going to take vaccines away from anybody.” Despite cooling down his anti-vax rhetoric, he’s still skeptical. He has suggested that we don’t have vaccine safety profiles, stating, “I just want to make sure every American knows the safety profile, the risk profile, and the efficacy of each vaccine.” This information is already out there, btw. Vaccine makers aren’t hiding it. It’s required for FDA submissions.
My view on vaccines? They’re another public health win. I don’t know anyone impacted by polio (flex!), but people my parents’ age and older do. This is because of vaccination and herd immunity. Vaccines are also why we have the potential to eliminate cervical cancer! The thing to keep in mind is we don’t have a federal vaccine mandate, but the Federal government does make recommendations for states and local governments to follow. Vaccine requirements and exceptions (e.g., for medical/religious reasons, personal philosophy) fall under state jurisdiction. Child vaccination rates are dropping, which can lead to outbreaks of vaccine-preventable diseases. If he removes vaccine recommendations and favors a personal choice philosophy, I also wonder whether insurers will opt out of covering these drugs. Doing so could limit vaccine access for parents who want their kids vaccinated but can’t afford to pay for the service. I hope they’ll still cover from a cost-effectiveness angle. It’s cheaper to prevent a measles outbreak than treat one.
Raw milk promoter
I’m Californian, so I didn’t think much about buying or not buying raw milk until I moved to NYC in 2015. It’s always been accessible to me. You can sell raw milk in California if your dairy farm meets certain criteria: Are they clean? Are your animals healthy? In NYC, you can buy raw milk from certified raw milk suppliers at farmer’s markets/stands. You can also text a random guy and schedule a weekly hand-off outside a TriBeCa dentist’s office if you want. Some states only let you buy raw milk products if they’re for “your pets.” Others let you buy from farms or herdshares AKA where farmers + customer(s) co-own herds of livestock (obvio). Rhode Island, DC, and Nevada have the most restrictive access to raw dairy. At the Federal level, the FDA bans selling raw milk products across state lines, but nothing prevents states from selling it if they want to. Kennedy could, in theory, boost the use of raw milk products by touting his views and hiring raw milk-friendly lackeys. The issue with raw milk is you’re more likely to get sick from it. In a New York Times Opinion essay, Emily Oster cited a 2009-2014 analysis that found 760 people get sick from raw milk a year out of about 11 million Americans who consume it. That same analysis concludes that raw milk makes us 840 times more likely to get sick and 45 times more likely to be hospitalized vs. pasteurized dairy.
Where do I fall on raw milk? I seldom had it as a kid; now, I sometimes have it in cheese or kefir form in CA or Europe. Mostly in the Nordics (my brain is convinced they have cleaner dairy farming practices). I miss my Spring St. French government-subsidized cheesemonger, from whom I bought French raw milk cheese weekly. I’m willing to take the risk if something is fermented, betting that the good bacteria will fight off the bad bacteria. Raw milk promoters will say that it is better for your immune system. Sure, you’re exposed to good bacteria, but raw milk also exposes you to bad bacteria from animal poop. I wouldn’t choose it as my primary dairy source, wouldn’t recommend it for children, nor consume it if I were elderly/immunocompromised. It’s not worth it.
Drug ad hater
RFK Jr.’s argument here is that the US is one of two countries that hasn’t banned DTC drug marketing. He’s promised to sign an executive order banning pharmaceutical marketing on television on day one in office (if appointed). 24% of Americans don’t even watch live TV anymore. Will this mean radio/podcast and influencer drug marketing will boom?
What’s my position on drug ads? If you’ve read Of Note before, you would know I believe in equipping people with information. This empowers us to make informed choices with our clinicians and choose treatments that work for us, our lifestyles, values, and needs. Pharma is tightly regulated when it comes to what they can and cannot say in these ads. Of course, these ads should be clear and avoid misleading the public. The FDA is already addressing this by releasing updated guidelines for prescription drug advertising. Direct-to-consumer advertising is an education and awareness personal autonomy tool that encourages open dialogue around health, diseases, and how to treat them.
Aspirational chronic disease fighter
He has a mandate to tackle chronic diseases. So far, we know part of his plan is to address chronic diseases by promoting healthier diets, banning processed foods and seed oils, and moving away from preservatives/additives in foods.
My thoughts on tackling chronic diseases? This is great! But will he work with other health agencies to ensure timely access to quality care? What about preventive services? He may have some misinformation on certain root causes and treatments, but he shares this end goal with both the healthcare industry and the general public. I already try to avoid ultra-processed foods, and it’s common knowledge that eating whole foods, fruits + vegetables, etc. is good for you. Food is medicine! But will he also push the government to address systemic issues that force some of us to heavily index towards ultra-processed foods? Think food desserts and the cost of fresh, whole foods. The other piece to note is Americans hate being told what to do. Let’s walk down memory lane. When NYC Mayor Michael Bloomberg tried banning large sodas (>16 oz) in 2012, New Yorkers and soda corporations fought back. The Center for Consumer Freedom bought ad space in the New York Times accusing Bloomberg of giving “nanny state” vibes. The amendment was repealed in 2015.
Alternative medicine and environment champion/pesticide despiser
This week, he released his position on agriculture and how he wants to take on Big Agriculture and reduce harmful chemicals.
My view on alternative medicine and the environment? Here, he lands some but misses most. For example, touting hydroxychloroquine + ivermectin, both of which were debunked as COVID-19 treatments. His attitude towards psychedelics might be a good sign for Lykos (whose MDMA drug approval the FDA rejected) and supplement companies (future supplement-sponsored HSS content, anyone?). If he can bring change to industrialized farming and make food more accessible (read: affordable), I’m on board.
WHAT DON’T WE KNOW ABOUT KENNEDY’S HEALTH POLICY VIEWS?
Larry Levitt of the Kaiser Family Foundation sums it up nicely:
WHAT IS FEASIBLE?
It’s unlikely that he’ll try banning vaccines outright. At a minimum, he will sow distrust in vaccines by spreading misinformation. Payers, schools, and employers will still want kids/people to be vaccinated. On water fluoridation, local governments manage actual water levels. The Federal government only makes recommendations. I don’t think a federal recommendation to de-fluoridate water would stop this practice altogether. Implementing a ban would take a while. This is the common theme across all of these issues. I texted my grad school advisor for her thoughts on US health policy under Trump because I rely on her when my faith in the American Experiment falters. She replied, “Messy, divided responsibility equals difficulty of change.” Ain’t that the truth!
Despite disagreeing with most of Kennedy’s views, I bring a curious lens to his nomination because I think he genuinely wants to be good and do good. Like at his core. With that lens, I wonder whether he could be an ally in promoting public health and lowering the information asymmetry between experts + the rest of us by elevating health education.
The takeaway? If he’s confirmed as HHS secretary, he WILL be a healthcare stakeholder and decision-maker. We (industry/scientists) can’t shoot ourselves in the foot by writing him off as an incompetent quack. The first rule of getting what you want is to find common ground with others, not make them your enemy. What do I want? A strong and innovative healthcare system that works for patients and their loved ones. Let’s use this as an opportunity. In the meantime,
xxsem
Just wanted to tell you that you are my favorite public health writer. Not that I follow many to begin with, which is a problem in itself! Too many degreed professionals get stuck in private reporting or stuffy reports that don't interest the general public (I've been there). You provide just the angle and voice I'm looking for.