Robert F. Kennedy Jr., President-elect Donald Trump’s decide to steer the Division of Well being and Human Providers, is coming into the nomination course of in an uncommon place: an extended checklist of his personal coverage priorites separate from the president-elect’s, and a public promise by Trump to let him “go wild” on his concepts.
CBS Information medical contributor Dr. Céline Gounder, the editor-at-large for public well being at KFF Well being Information, solutions questions beneath in regards to the position Kennedy has been tapped to tackle and a number of the concepts within the sweeping “Make America Wholesome Once more” platform he could attempt to push by means of.
Q: What’s the position of the Division of Well being and Human Providers, and the way a lot energy does the HHS secretary have over its work?
The U.S. Division of Well being and Human Providers contains a number of companies and workplaces together with the Nationwide Institutes of Well being, the Facilities for Illness Management and Prevention, the Meals and Drug Administration, the Facilities for Medicare and Medicaid Providers, the Workplace of the Surgeon Basic and rather more.
There’s a large distinction between political appointees and profession civil servants. Political appointees set strategic priorities and align their division or company’s insurance policies with the present administration’s goals. Civil servants have the institutional information to know tips on how to get issues carried out and have specialised scientific or technical experience. Scientific questions require specialised experience. For this reason there are profession scientists who advise the HHS secretary, NIH director, CDC director and FDA commissioner.
The HHS secretary has the authority to determine laws that govern well being, together with meals and drug security, public well being and well being care high quality. The HHS secretary can declare public well being emergencies and coordinate federal responses to well being crises, corresponding to illness outbreaks or pure disasters. The secretary wields important affect over the division’s insurance policies and its constituent companies, which embrace the CDC, FDA, NIH and others.
The HHS secretary can also be ready to form public opinion if given a platform to take action by the media. Absent media consideration, their affect on public opinion is extra restricted. We within the media have a accountability to fact-check their statements and maintain these in energy accountable — no matter who’s in energy.
Q: One in every of Kennedy’s most controversial stances is his his criticism of vaccines, selling the concept that they trigger autism, amongst different situations, and claiming “there is no vaccine that’s protected and efficient.” What’s the actuality?
In depth analysis has conclusively proven that vaccines don’t trigger autism. The “analysis” behind these claims was retracted resulting from moral violations and sloppy work. The physician who initially made these claims misplaced his medical license because of his skilled misconduct.
For fogeys whose youngsters have autism or individuals who have autism, this issues. For too lengthy, claims in regards to the security of vaccines haven’t solely put individuals at pointless threat of getting diseases that vaccines can stop, however have additionally been a crimson herring, distracting individuals from the true causes of autism and tips on how to diagnose them and deal with them. That distraction is unproductive and dangerous.
Secondly, nothing on this world is 100% protected and efficient. It is all about weighing dangers, the professionals and cons. Is one alternative extra useful or extra dangerous? Do the professionals of carrying a seatbelt within the automobile outweigh the dangers? Do the professionals of exercising frequently outweigh the dangers of not exercising? Do the professionals of vaccinating as a substitute of permitting infectious illnesses to unfold in the neighborhood outweigh the cons? Sure, sure and sure.
Q: Kennedy has stated he needs to go away it as much as people to determine whether or not to vaccinate themselves or their kids. What impression might which have?
More and more, persons are formulating opinions about vaccines primarily based not on science, however on Google searches, social media, what household and associates assume and private remark. That’s not analysis. Analysis is formulating a speculation and making an attempt to disprove that speculation. It means you perceive tips on how to differentiate correlation from causation. And it means doing repeated experiments to point out consistency, not simply an opportunity or random consequence.
This is not a query of whether or not persons are good or not. However most individuals do not have the coaching, expertise and context to objectively assess the professionals and cons of vaccination. You would not need me repairing your automobile’s transmission or brake system. I am not silly, however I’ve no coaching or expertise on this.
The chance of leaving these selections to untrained people is that these selections will not be made on science. They are going to be made primarily based on emotion and affirmation bias, which is to say, Google searches searching for opinions that line up together with your preexisting beliefs or inclinations. This can put youngsters in danger, and since vaccines shield towards transmissible infectious illnesses it will put others in the neighborhood in danger, particularly different youngsters and people who find themselves immunocompromised.
Q: Kennedy has additionally stated chemical substances in meals are tied to autism in addition to psychotic episodes and melancholy. What do we all know in regards to the connection between meals and psychological well being?
He isn’t flawed that there’s a relationship between weight-reduction plan and autism in addition to weight-reduction plan and psychological well being. These are areas of ongoing analysis. No weight-reduction plan has been confirmed to remedy or universally enhance autism or psychological well being signs, however sure dietary interventions enhance signs in some individuals. These dietary adjustments could embrace elimination of ultra-processed meals, eliminating gluten and avoiding sure meals components or preservatives.
Q: Kennedy has stated one of many Trump administration’s first acts might be to work to take away fluoride from consuming water, arguing it is related to most cancers, IQ loss, thyroid illness and different well being issues. Why is fluoride in consuming water, and is it protected?
Fluoride is put within the water to cut back the chance of cavities, particularly in youngsters.
As with many issues, fluoride security is all about dose. Consuming just a few glasses of water a day is wholesome. Consuming a barrel of water would land you within the hospital. The extent of fluoride in U.S. water is protected and protects towards tooth decay.
When municipalities stopped placing fluoride within the water, cavity charges went up. This was noticed, for instance, in Calgary and in Juneau, Alaska.
There are components of the world, together with India, China and East Africa, the place fluoride ranges 30 to 40 instances greater than ranges within the U.S. have been discovered to be dangerous. However we do not have anyplace close to these ranges of fluoride in our water.
However Kennedy’s assertion demonstrates a standard misunderstanding about public well being authorities within the U.S. We’re the United States of America — public well being powers reside on the state stage. The federal authorities has the authority to tax and spend and to control commerce throughout state strains, however the federal authorities’s authority doesn’t lengthen past that.
The CDC supplies scientific steerage to assist state and native authorities to make knowledgeable selections. The CDC doesn’t mandate fluoridation. The EPA units the utmost allowable fluoride focus in public water programs. However states have the authority to mandate fluoridation or can go away it as much as native jurisdictions.
Q: Kennedy has criticized a number of public well being companies he might now lead. He is stated the FDA’s “struggle on public well being is about to finish,” claiming the company suppresses something that “advances human well being and cannot be patented” by pharmaceutical firms. What do you make of those criticisms?
This once more demonstrates a misunderstanding of federal company authority. Congress has handed legal guidelines that give the FDA particular authority to control medicine, dietary supplements and meals, and people legal guidelines grant the FDA totally different powers over medicine, dietary supplements and meals.
Medication require FDA approval earlier than they are often marketed. Beneath the regulation, medicine are outlined as substances used to diagnose, deal with or stop illness.
Dietary supplements do not want FDA approval earlier than they’re offered. The FDA screens dietary dietary supplements as soon as they’re in the marketplace and may take motion if they’re unsafe or in the event that they make claims about analysis, remedy or prevention of illness.
Dietary complement producers usually select to not search FDA approval to market their merchandise as medicine as a result of:
- There are much less stringent necessities on dietary dietary supplements than on medicine
- The FDA approval course of is dear and prolonged. Medical trials take years to conduct and value hundreds of thousands of {dollars}. Producers foot the invoice for scientific trials.
- Dietary dietary supplements might be offered on to shoppers with out a prescription.
It is the producer that decides whether or not it needs to hunt FDA approval for a drug or if it needs to market a product as a dietary complement — and that call sometimes comes all the way down to money and time. Pharmaceutical firms are much less inclined to speculate hundreds of thousands of {dollars} in scientific trials of unpatented remedies because of the lack of unique advertising rights, which might have an effect on profitability.
The FDA usually goes after complement manufacturers that take a look at this line when it sees firms advertising merchandise with claims that quantity to what must be regulated as a drug. For this reason dietary supplements usually carry a disclaimer that they are not being offered to “diagnose, deal with, remedy, or stop any illness.” Kennedy has praised the complement business for “combating again,” following a courtroom win over an anti-aging complement that the FDA argued must be regulated as a drug.
Lastly, the FDA would not grant patents. That is the job of the U.S. Patent and Trademark Workplace.
Q: Trump has stated Kennedy will “finish the persistent well being epidemic.” What are a number of the constructive actions he might take if he turns into HHS secretary to cut back persistent illness within the U.S.?
Kennedy has known as for higher regulation of meals components and ultraprocessed meals. Ultraprocessed meals in American diets have led to an explosion in weight problems, diabetes, hypertension and different persistent illness.
Nonetheless, it is unclear which factions inside Trump’s orbit will prevail. Congress must give the FDA the authority to be extra aggressive in regulating and the funding to implement laws. Traditionally, the Republican Social gathering has been against regulation. Trump’s chief of employees decide, Susie Wiles, is a longtime lobbyist who has labored on behalf of the meals, insurance coverage and tobacco industries.
The Heritage Basis’s Venture 2025 — which concerned numerous former Trump advisers, however which Trump has tried to distance himself from — would roll again dietary tips would make it more durable to combat ultraprocessed meals.
Alexander Tin
contributed to this report.
