The Dangers of RFK Jr. in the Department of Health and Human Services

I published my first op-ed in response to Tom Price being selected to head the Department of Health and Human Services in the first Trump Administration. I weighed in on his extremist attitudes toward reproductive health care as well as his hostility to protecting health insurance access. I published it in The Guardian and discussed it with one of my doctors, who I saw a couple of weeks later to get long-acting reversible contraception (LARC) in anticipation of the bad things to come. (I may have joked that I had never before thought about a Republican while being in that position.)

A couple days after I made my appointment to preemptively replace my LARC in anticipation of more bad things to come (some Republicans have incorrectly targeted IUDs as “abortifacients” on the grounds that they can prevent both fertilization and implantation), and while on a plane heading across the country for a wedding, I got the notification of the next appointee to head the Department of Health and Human Services: Robert F. Kennedy Jr.

I shouted an expletive. I whispered more expletives to the like-minded person sitting next to me. And I realized why, when I’d dozed off for a couple of minutes, most of my public health and political science group texts had increased in expletives by about 500%.

Of course, I knew that RFK Jr. is in Trump’s inner orbit. I knew that he was told he would have a significant role in public health. But my operating assumption has been that he is not confirmable, and would thus be relegated to the status of “health czar,” ceding the title of HHS Secretary to the also very dangerous Joseph Ladapo. (If he gets picked for Surgeon General, rest assured I’ll certainly have thoughts on that.)

Some of the moderate people I’ve known over the years (not so much academics, but older friends and some family) tend to steer of major alarmism over Trump and his Cabinet picks. I understand this to an extent: it can be exhausting being angry. It can be exhausting being scared. And with unified Republican control of Congress, a lot of resistance feels futile.

The reality, however, is this: Every bit of alarmism around RFK Jr. is justified (and then some).

He is anti-vaccines and toward that end has spread dangerous misinformation about the (nonexistent) connection between vaccines and autism. These are positions that had thankfully, been relegated to fringe movements for quite some time. We saw with the COVID-19 pandemic an unfortunate and dangerous resurgence of anti-vax sentiment that was legitimized by Donald Trump and a number of people on Fox News who pivoted their careers toward a strategy of placating Trump and elevating even his worst conspiracy theories. (Remember hydroxychloroquine? Good times.)

Tom Price favored the repeal of the Affordable Care Act, on which millions rely in order to get both preventive and life-saving treatment. This is an Act that has brought the uninsured rate to a historic low which public health professionals (myself included… shocking, I know!) would say is, you know, a good thing, whether looking at health economics, patients health outcomes, or issues of uncompensated care to health care providers. Tom Price is anti-choice, and thus is misaligned with organizations such as the American College of Obstetricians and Gynecologists, which recognize the importance of access to comprehensive reproductive health care.

But he believed in the basic science of vaccines. It’s a low bar, but it’s where we are.

RFK Jr.’s hostility to vaccines is, importantly, not a new phenomenon reflecting Trump Administration politics getting ensnared with the politics surrounding the COVID pandemic and the effects of media echo chambers. Political scientists have found, for example, that those watching Fox were less likely to believe in the importance of public health guidelines ranging from masking to social distancing to obtaining the COVID vaccine. This is both a selection issue in terms of viewership, but also a reflection of a news network that downplayed the effects of the virus. And while vaccines should theoretically be an evidence-based public health issue that transcends partisanship, political scientist Matt Motta finds that Republicans are more likely to believe vaccine misinformation such as (nonexistent) connections to autism.

Rather, his hostility to vaccines extends to issues such as measles, which we’ve seen a resurgence of given the elevation of vaccines skeptics to high levels of authority in some states. (Florida and Joe Ladapo, yes, I’m looking in your direction). Indeed, as of November 7, 2024, the Centers for Disease Control and Prevention report that there have been 277 measles cases reported by 32, jurisdictions, with 16 outbreaks and 71% of cases are outbreak-associated. What’s more, 40% of these cases were serious enough to necessitate hospitalization.

This is avoidable. But given this nomination pick, it won’t be avoided.

We have had great public health accomplishments across the decades, from combatting polio to dramatically reducing the incidence of measles and diphtheria to introducing vital drugs to the market to manage HIV/AIDS to reducing tobacco to protecting the blood supply to imposing safety standards that reduce motor vehicle deaths. We have done so much. But we have so much left to do. And allowing someone who not only dabbles in pseudoscience but actively disseminates it will do a grave threat in moving our country backward in ways that are anything but pro-life.

Now let’s talk about drinking water. RFK Jr. has a misguided, anti-science belief that fluoridation of our drinking water is unsafe and must be stopped. As anyone in public health can tell you, that’s simply not true. Not only is it harmless in the dosages that it is found in U.S. drinking water, but it helps to prevent dental problems that require intervention. (And as a health insurance expert, this feels like a good time to remind you, dear readers, that dental insurance is not exactly where American insurance excels.) The problems about which he raises alarms are simply not associated with doses to which one is exposed in drinking water and brushing one’s teeth.

So far, we’re making measles great again and we’re making cavities great again. But sure, “make America healthy again.”

Now let’s move on to what RFK Jr. has said about school shootings. I know this will shock you, but his allegations are likewise baseless, arguing not for the importance of gun control, but rather about the dangers of antidepressants.

Let me be very clear: Mental health problems and their evidence-based treatments.

If mental health problems were the cause of school shootings, we would see mass shootings much more prevalently across the globe. The reality is, we don’t. People across the globe (myself included) struggle with depression, and antidepressants can offer an important way to better manage these symptoms and to create the space to process the underlying causes and develop strategies to better manage symptoms and not only survive, but thrive. Some antidepressants aren’t for everyone. It can take a while to find the right one, or the right combination of them. I’m not saying this because of any attachment to the pharmaceutical industry, on which I taught just yesterday in my undergraduate health policy class. Of course, this industry is imperfect and has profit motives of its own. But that doesn’t mean that people can’t reap benefits.

Attributing devastating school shootings to antidepressants is deeply damaging for (at least) two reasons:

1. It stigmatizes the use of antidepressants, which can be literal lifesavers for those who are struggling with mood disorders. Untreated depression can lead to a host of problems, from worsened symptoms to diminished productivity at work, even necessitating medical leave and reliance on government programs.

2. It legitimizes ignoring the true cause of these mass shootings, which is the limited degree of gun control in the United States. Let me say this louder for the people in the back: IT’S THE GUNS. The longer we elevate people who ignore this basic fact, the longer we will continue to see needless suffering and death – not to mention the trauma that children experience having to go through active shooter drills and wonder every day if their school will be next, and the trauma of parents when they drop their children off at school and wonder if they’ll get a dreaded text, or worse.

Again, none of this is pro-life.

Now let’s talk about RFK Jr.’s positions on HIV/AIDS. Despite sound, very established science laying out HIV as the retrovirus that causes AIDS, or Acquired Immune Deficiency Syndrome, RFK Jr. has claimed that “nobody knows” whether HIV is actually the cause of AIDS and characterized AIDS research as being comprised of “phony, crooked studies.” Indeed, he has offered unfounded speculation that the true cause of AIDS might be poppers drugs and lifestyle factors, as opposed to HIV. Not too surprisingly, this allegation is not simply a reflection of mere misinformation to which he might be open to correction. Rather, it is borne out of a conspiracy surrounding the desire to profit off of the manufacture of AZT, the first drug approved by the FDA to treat AIDS in 1987. Indeed, in an interview with Rebecca Traister, RFK Jr. insisted that “there are much better candidates than HIV for what causes AIDS.” And it fits neatly – though disturbingly – within a broader pattern of anti-science beliefs surrounding the pharmaceutical industry, which touches on everything from prescription drugs to vaccine development.

The LGBTQ community would be well within reason to have concerns about having our nation’s Department of Health and Human Services headed by someone skeptical over the causes and treatment of AIDS, less than 40 years after seeing the public health community headed by people who refused to acknowledge AIDS in public. And the LGBTQ community should take no comfort in his views on gender-affirming care for youth, as well as the drivers of “sexual confusion” in minors. His anti-LGBTQ views are likewise exhibited in his speaking with the extremist group Moms for Liberty, which has promoted harmful “groomer” rhetoric surrounding efforts to support LGBTQ youth.

Donald Trump prominently said that he would encourage RFK Jr. to “go wild” in the space of public health, including issues of women’s health. So, let’s start with abortion, which has been at the center of much debate over reproductive health policy, especially with the overturning of Roe v. Wade. When running his campaign as a Democrat, RFK Jr. expressed support for banning abortion after the first trimester, though he shifted as an Independent candidate to only banning abortion at the point of fetal viability. It is difficult to know where he would stand as a prominent figure in the Trump Administration, with an incoming president who has boasted about contributing heavily toward the fall of Roe and an incoming vice president who has been amenable to a national ban on abortion access. So much for “states’ rights.”

An area in which RFK Jr. has been silent (there aren’t many…) is that of contraception, which has become all the more significant in the absence of abortion access nationwide. In fact, some Republicans have sought to restrict access to particular forms of contraception – namely, IUDs and Plan B emergency contraception – on the grounds that they constitute “abortifacients,” language that the Supreme Court incorporated into its landmark Hobby Lobby ruling. What we do know is that we are likely to see continued trends toward long-acting reversible contraception (IUDs, implants) as well as tubal ligations, which increased in the aftermath of Dobbs v. Jackson. And obtaining this contraceptive care will become all the more difficult as we almost assuredly see returns to cuts to Title X family planning services that include but extend well beyond Planned Parenthood.

Such cuts are misguided. In my own research which I summarized in The Washington Post, I found that greater access to Planned Parenthood clinics is associated with lower rates of teen births as well as lower rates of STIs. This is to say, regardless of one’s political stance on abortion, these are good public health outcomes both health-wise and economically.

And we haven’t even gotten to RFK Jr.’s comments about the FDA, whose “war on public health is about to end,” according to him as he singled out “aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals, and anything else that advances human health and can’t be patented by Pharma.”

If you’re reading my Substack, I probably am not going to be the first or the last person to tell you about the problems associated with raw milk (let’s just say that as a public health researcher, I’d rather not make e coli great again).

I do not know whether RFK Jr. is confirmable. There are only so many nominees who Republicans will likely be willing to break from party lines to oppose, and Matt Gaetz seems like the leading contender. But for those of us who study public health – from vaccines to reproductive health to the public health crisis of gun violence – there is understandably a great deal of concern not only about the general distrust of science and acknowledgement of facts, not to mention his plan to replace 600 employees at the National Institute of Health.

Many public health experts have said that the next pandemic is not a matter of “if” but “when,” and there is so much good that can be accomplished in public health in non-emergent states as well as to ensure that we are in the best possible position for public health challenges that may come (whether infectious diseases or issues driven by the existential threat of climate change).

I taught Constitutional Law under the first Trump Administration, and it was exhausting. Before the RFK Jr. announcement, I posed on social media the question of which would be more overwhelming: Constitutional Law under Trump 45 or Public Health amid Trump 47.

Today, I got my answer.