“[N]early eight in 10 Americans still say they believe that scientists act in the public interest—a far higher level of trust than people give to politicians or the news media.”
Pew Research Center
“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. ...The gap between what we know and what we aim for persists. And this gap complicates everything we do.”
Atul Gawande, MD, American surgeon and author
A recent PEW survey showed “76% of Americans now have a great deal or fair amount of confidence of scientists to act in the public’s interest.” In his editorial in the November 22, 2024 issue of Science, “Trust edges up—slightly,” editor-in-chief H. Holden Thorp acknowledged that since last year, the trust of Americans in science had increased a smidgeon but he also recognized the need to improve communication with the general public about the nature and value of science. I am doubtful that this will happen under the next administration.
Unless you’ve been living under a rock over the past several weeks, you’re likely aware that the President-elect has been shaking up most federal healthcare organizations by his nominations for the heads of key health-related agencies and cabinet positions. In this week’s post, I briefly review the track records of these nominees and, for what it’s worth, offer my opinion on whether these nominees are likely to build confidence in Americans to trust our healthcare institutions.
Restoring trust. A fundamental principle of physicians and health researchers is respect for science. Highlighting the uncertainty that is inherent in medical practice, Sir William Osler, the founder of internal medicine, frequently stated that “Medicine is a science of uncertainty and an art of probability.” Because of this uncertainty, skepticism and humility are essential qualities of practitioners of medicine and of medical science.
The dust of the COVID-19 pandemic hasn’t totally settled. Nonetheless, I believe it was often the lack of appreciation of the inherent uncertainty of medical science—as well as the arrogance of some medical experts—that fed the outrage of critics of the public health response to the pandemic. Sadly, in the process some members of the general public lost confidence in public health officials and in physicians. And, we are now seeing the dire consequences of this loss of trust.
Restoring the general public’s trust in science and in our scientific and medical communities should figure importantly in the new administration’s selection of leaders for our preeminent health organizations. This is a responsibility of the President-elect and the U.S. senate. Here is where the nominations for these positions currently stand.
Robert F. Kennedy, Jr. (RFK Jr.): Secretary Health and Human Services. Of all the President-elect’s nominations for leadership positions in the U.S. health enterprise, none is more flabbergasting and frightening to me than that of RFK Jr. for the Secretary of Health and Human Service (HHS), the top health official in the U.S.. For those who share my view that development of vaccines is the single most important accomplishment of modern medicine, the Senate’s approval of Kennedy, an anti-vaxxer and anti-science proponent, couldn’t be more disastrous.
Kennedy’s anti-vaxx track record prompts worries that infections like measles and whooping cough will take off if he is approved. And his endorsement of conspiracies, such as HIV doesn’t cause AIDS and Wi-Fi causes cancer, demonstrate his astonishing lack of knowledge about many scientific facts.
Countless articles have been published enumerating the reasons RFK Jr.’s nomination shouldn’t move forward. In his “Medical Alert” article in the December 2, 2024 New Yorker, Dr. Dhruv Khullar sums them up well stating: “For years, [Kennedy] has propagated half-truths and outright falsehoods in an environment of mistrust that he helped to create, and he now will be abetted by a cadre of MAGA influencers who share his passions and proclivities.”
Before he won, the President-elect made it clear that his appointments and decisions would be guided by personal interest in exacting vengeance rather than in promoting the principals of trust in science and in our scientific and medical institutions. RFK Jr.’s nomination for HHS Secretary is therefore not surprising. It epitomizes the serious problem facing the American people: politics is no longer separate from science. (See “One major challenge facing Trump’s chosen health leaders: Keeping politics separate from science,” CNN, November 26, 2024). Unfortunately, it may be the health of the American people that will suffer.
Jay Bhattacharya, physician and health economist: National Institutes of Health Director. The National Institutes of Health (NIH) is the world’s largest biomedical research funder and has a budget of $47.4 billion. The President-elect nominated Jay Bhattacharya, a physician and health economist, to head the NIH.
Dr. Bhattacharya is a Stanford University professor best known as one of three authors of the 2020 “Great Barrington Declaration,” an open letter arguing that school and work closures during the COVID-19 pandemic were not worth the societal and economic costs. The Declaration authors argued that instead of closures, efforts should focus on protecting just the most vulnerable and that the rest of the population would develop “herd immunity” as the virus spread.
The Declaration never caught on in the academic community. Francis Collins, the former director of the NIH, called the authors “fringe epidemiologists,” a term Bhattacharya has apparently embraced.
According to an article in the December 1, 2024, New York Times, many scientists view the nomination of Dr. Bhattacharya to head the prestigious NIH as a “tipping point”—in a perilous direction. Some contend that Bhattacharya will destroy the NIH.
Many defenders of the agency acknowledge that the NIH needs modernization. But as Dr. Harold Varmus, a former NIH director, said: “None of us who are in the scientific community think that the N.I.H. is perfect. But everyone I know in the N.I.H. domain views it as one of the great creations of the modern government and respected throughout the world. The last thing we want is someone coming in and saying we’re not going to fix it, but we’re going to blow it up.” (See, Rosenbluth, Teddy, and Anthes, Emily, “Long a ‘Crown Jewel’ of Government, N.I.H. Is Now a Target,” New York Times, December 3, 2024).
David Weldon, physician and former Republican congressman: Centers for Disease Control and Prevention Director. David Weldon is the President-elect’s nominee to head the Centers for Disease Control and Prevention (CDC). Weldon, a former congressman, has been off the political stage for 15 years and now runs a private medical practice in Malabar, Florida.
According to a December 2, 2024 New York Times article, “Dr. Dave Weldon, Trump’s C.D.C. Pick, Was Not on Anyone’s Radar,” not much is known about Weldon’s qualifications for this position. What is known is that when Weldon was a U.S. congressman, he was opposed to stem cell research. It is also known that Dr. Weldon’s views are closely aligned with those of Robert F. Kennedy Jr., including that vaccines cause autism. It is thought that Weldon would push for big changes in vaccine policy.
The most optimistic view I could find on Weldon’s qualifications to run the CDC was expressed in the aforementioned New York Times article which stated, “He’s not the worst possible person who could be appointed to direct C.D.C.”
But given the long list of CDC priorities which include responding to emerging infectious diseases, including pandemics, it’s not at all clear Dr. Weldon has the “chops” for this hugely important job. As Dr. Jerome Adams stated: “The CDC plays a critical role in global health and it would be disastrous if its leader were to promote unfounded theories and exacerbate vaccine hesitancy.” (Dr. Adams served as Surgeon General in the first Trump administration. He is quoted from an email to CNN.)
Marty Makary, professor and chief of islet cell transplantation, Johns Hopkins Hospital: U.S. Food and Drug Administration Commissioner. The Food and Drug Administration (FDA) is a $6.5 billion agency with more than 18,000 employees. Marty Makary, the nominee to head the FDA, is a professor at Johns Hopkins School of Medicine.
Makary is primarily known as a health researcher and author of books about price transparency and the cost of health care. When the COVID-19 pandemic hit, he became an outspoken critic of the federal response to the pandemic. Among other things, he espoused the view that natural immunity is “at least as effective as vaccinated immunity, and probably better”—a very controversial opinion. In addition, in 2021, Makary called for an overhaul of the FDA claiming that it was “defined by counterproductive rigidity and a refusal to adapt.”
U.S. Healthcare: Is It Broke? Like all bureaucracies, the NIH, CDC, and FDA have inefficiencies that in some cases may require major restructuring. Hence, “cleaning their houses” could be a good thing if it is done correctly and by people who are qualified to do the job.
I’m most concerned about what will happen to the NIH—“the jewel in the crown of the U.S. government.” Of all the U.S. health-related agencies, the NIH is driven by science and innovation. The NIH’s achievements during the COVID-19 pandemic were absolutely remarkable. The U.S., and for that matter, the world would be in much worse shape had the NIH not stepped up by facilitating development of a safe and effective vaccine as well as treatments for the disease.
The United States needs qualified people to head the HHS, NIH, CDC, and FDA. In my view, none of the President-elect’s current nominees for leadership positions of any of these U.S. healthcare agencies is likely to improve the health of U.S. citizens or restore the general public’s trust in these institutions or, for that matter, in science. And sadly, it is the health and welfare of the American people that is at stake.
