Many scientists at federal health agencies await Donald Trump’s second administration with trepidation and uncertainty about how the president-elect will reconcile starkly different philosophies among his team’s leaders.
Trump has promised to let Robert F. Kennedy Jr. “go wild” on medicine, food and health care. With that, a radical anti-establishment medical movement with roots in recent centuries could threaten the achievements of a science-based public health order painstakingly built since World War II, some of these scientists fear.
If Kennedy’s vision for transforming public health is successful, childhood vaccination mandates may wither. New vaccines may never gain approval, even if the FDA approves unsafe or ineffective therapies on the market. Agency websites may trumpet unproven or debunked health ideas. And if Trump goes ahead with his plan to undermine civil service rights, anyone who questions those decisions could be summarily fired.
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“There’s never been anyone like RFK Jr. who’s come close to being in a position to really shape policy,” said Lewis Grossman, a law professor at American University and author of “Choose Your Medicine,” a history of U.S. public health. .
Kennedy and consultant Calley Means, a health activist, say dramatic changes are needed because of the high rates of chronic disease in the United States. Government agencies have approved or promoted unhealthy diets and dangerous drugs and vaccines, they say.
Means and Kennedy did not respond to requests for comment. Four conservative members of the Trump primary healthcare bureaucracy spoke on condition of anonymity. They welcomed the former president’s return with enthusiasm, but expressed few opinions on specific policies. After last week’s election, RFK Jr. announced that the Trump administration would immediately fire and replace 600 National Institutes of Health officials. He created a website seeking crowdsourced candidates for federal nominations, with many vaccine foes and chiropractors among the early favorites.
At meetings at Mar-a-Lago last week attended by Elon Musk, Tucker Carlson, Donald Trump Jr., Kennedy and Means, according to Politico, some of the candidates for top health posts included Jay Bhattacharya, a Stanford University scientist who opposed the covid lockdowns ; Florida Surgeon General Joseph Ladapo, who opposes mRNA covid vaccines and rejected disease control practices during a measles outbreak; Johns Hopkins University Surgeon Marty Makary; and Means’ sister, Stanford surgeon and health guru Casey Means.
They are all mavericks of some sort, although their ideas are not uniform. However, the idea that they could ignore a century of science-based health policy is deeply troubling to many health professionals. They see Kennedy’s presence at the heart of Trump’s transition as a victory for the “medical freedom” movement, which rose against the Progressive Era idea that experts should guide health policy and practice.
It may be a departure from the expectation that senior doctors will be respected for their specialized knowledge, said Howard Markel, professor emeritus of pediatrics and history at the University of Michigan, after a clinical career that began and ended treating AIDS patients. long year long covid.
We have returned to the idea of ”every man his own doctor”, he said, in the 19th century. It was a bad idea then and it’s even worse now, he said.
“What does this do to the morale of scientists?” Markel asked. Public health agencies, largely a post-World War II legacy, “are remarkable institutions, but you can screw up these systems, not by defunding them, but by deflating the real patriots who work in them.”
FDA Commissioner Robert Califf said at a Nov. 12 conference call that he was concerned about the mass shootings at the FDA. “I’m biased, but I feel like the FDA is at peak performance right now,” he said. In a speech the next day, CDC Director Mandy Cohen reminded the audience of the horrors of vaccine-preventable diseases like measles and polio. “I don’t need to see it go back to remind me that vaccines work,” she said.
Leaving agencies?
With uncertainty about the direction of their agencies, many scientists at NIH, FDA and the Centers for Disease Control and Prevention are considering retirement, said a senior NIH scientist who spoke on condition of anonymity for fear of losing his job.
“Everybody I talk to takes a deep breath and says, ‘It doesn’t look good,'” the official said.
“I hear a lot of people are preparing CVs,” said Arthur Caplan, a professor of bioethics at New York University. They include two of his former students who now work at the FDA, Caplan said.
Others, such as Georges Benjamin, executive director of the American Public Health Association, expressed a wait-and-see attitude. “Last time we worked with the Trump administration. There were times when things worked pretty well,” he said, “and there were times when things were chaotic, especially during covid.” Efforts at wholesale deregulation in public health would be politically dangerous for Trump, he said, when administrations “screw things up, get people sick and die. is”.
At the FDA, at least, “it’s very difficult to make seismic changes,” said Dan Troy, the FDA’s former general counsel.
But the administration could score easy libertarian-tinged victories, for example by telling its new FDA chief to reverse the agency’s refusal to approve the Lykos company’s psychedelic drug MDMA. Access to psychedelics to treat post-traumatic stress has piqued the interest of many veterans. Vitamins and supplements, already lightly regulated, will likely get more of a free pass from the next Trump FDA.
‘Medical Freedom’ or ‘Nanny State’‘
Trump’s health lobbyists are not monolithic. Analysts see clashes between Kennedy, Musk and traditional GOP voices. Casey Means, the “holistic” MD at the center of Kennedy’s “Make America Healthy Again” group, is urging the government to cut ties with industry and remove sugar, processed foods and toxic substances from the American diet. Republicans scuttled policies to denote the “nanny state” when Mike Bloomberg promoted them as mayor of New York.
Both libertarian and “medical freedom” wings oppose aspects of the regulation, but pro-Trump biotech supporters in Silicon Valley, such as Samuel Hammond of the American Innovation Foundation, have pushed the agency to speed up approval of drugs and devices, Kennedy’s group the FDA and the FDA say. other agencies have been “captured” by industry, resulting in dangerous and unnecessary drugs, vaccines and devices on the market.
Kennedy and Casey Means want to end the industry user fees that pay for drug and device regulations and support nearly half of the FDA’s $7.2 billion budget. It’s unclear whether Congress will fill the gap at a time when Trump and Musk have vowed to cut government programs. User fees are set by laws passed by Congress every five years, most recently in 2022.
Industry supports the user fee system, which empowers FDA staff and expedites product approvals. Writing new rules “requires an enormous amount of time, effort, energy and cooperation” from FDA staff, Troy said. Policy changes made through informal “guidance” are not binding, he added.
The Kennedy and Means siblings have proposed overhauling agricultural policy to promote organic vegetable farming instead of industrial corn and soybeans, but “I don’t think they’ll have much of an impact in that area,” Caplan said. “Big Ag is a powerful entrenched industry, and they’re not interested in changing it.”
“There’s a fine line between the libertarian impulse of ‘medical freedom’ types and the reformation of American bodies, which is definitely ‘nanny state’ territory,” said Robert Johnston, a historian at the University of Illinois-Chicago.
Specific federal agencies will face major changes. Republicans want to cut the NIH’s 27 research institutes and centers to 15, shrinking Anthony Fauci’s legacy by splitting the National Institute of Allergy and Infectious Diseases, which he led for 38 years, into two or three parts.
Numerous past attempts to cut the NIH have failed in the face of patient, researcher, and physician campaigns. GOP lawmakers have advocated major cuts to the CDC’s budget in recent years, including ending funding for research on gun violence, climate change and health equity. If passed, Project 2025, the policy blueprint of the conservative Heritage Foundation, would split the agency into data collection and health promotion arms. The CDC has limited influence in Washington, although former CDC directors and public health officials are championing its value.
“It would be surprising if the CDC wasn’t on the radar” for a potential change, said Anne Schuchat, the agency’s former deputy director general, who retires in 2021.
CDC workers are “very employable” and may start looking for other jobs if “the focus area is cut or changed,” he said.
Kennedy’s attacks on HHS and its agencies as a corrupt tool of the drug industry, and his demands for the FDA to allow access to scientifically controversial drugs, recall the 1970s campaign by conservative champions of Laetrile, a dangerous and effective derivative of apricot pit. as a cancer treatment. Just as Kennedy championed off-patent drugs like ivermectin and hydroxychloroquine to treat covid, Laetrile advocates said the FDA and the profit-seeking industry were conspiring to take away a cheaper alternative.
The public and industry have often been skeptical of health regulatory agencies for decades, Grossman said. Agencies do best when they’re called to fix things, especially after bad drugs kill or harm children, he said.
The Biologics Control Act of 1902, which created the forerunner of the NIH, was enacted in response to smallpox vaccine contamination that killed at least nine children in Camden, New Jersey. Child poisoning related to a sulfa drug antifreeze solvent prompted the creation of the modern FDA in 1938. The agency, in 1962, acquired the power to require evidence of safety and effectiveness before marketing drugs in pregnant women after the thalidomide disaster. women taking the anti-nausea drug were born with severely malformed limbs.
If vaccination rates drop and outbreaks of measles and whooping cough increase, babies may die or suffer brain damage. “The administration’s broad attack on public health will not hurt,” said Alfredo Morabia, a professor of epidemiology at Columbia University and editor-in-chief of the American Journal of Public Health. “It would be like taking away your home insurance.”
Sam Whitehead, Stephanie Armour, and David Hilzenrath contributed to this report.
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