Robert F. Kennedy Jr. is not a Controversial Figure

Much of the media coverage of RFK Jr. sanewashes him to make him seem more reasonable than he is. Don't be fooled.

I haven’t written anything here in a while, for which readers have my sincerest apologies. Mostly, it’s because with the events over the last few weeks, I am speechless. There really is no sugarcoating it: the cabinet appointments in the upcoming US presidential administration promise to be devastating for public health. I am truly hard-pressed to see a silver lining in any of them, but there is one that stands above the rest in a higher echelon of danger, and I will direct my attention to explaining that.

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For those who may not be aware, President-elect Trump has nominated Robert F. Kennedy Jr to be Secretary of the Department of Health and Human Services (HHS). I am not exaggerating when I say that my absolute worst nightmare is RFK Jr. at the helm of any public health crisis. I am not alone- multiple expert bodies have made statements describing their serious concerns about the prospect of Kennedy at the helm of this office.

I ask that if there is someone in your life who does not know about the seriousness of the threat Kennedy poses, or his history, please share this post or points included in this post with them. We cannot let this sit in our epistemic bubbles. In the same vein, call your representatives.

I do not think it would be practical to speculate on what specific measures RFK Jr. may take in the role of HHS Secretary here. Suffice it to say, HHS secretary is one of the highest ranking positions within the US government and includes the power to oversee the 13 agencies including the FDA, CDC, CMS, and ASPR. The scope of duties in the role is vast and the potential measures he can (and cannot) take have been discussed by various sources (e.g., here, here, here). As I am not an expert in regulation and the administrative state, I do not believe I can offer more helpful commentary than that which has been described in the preceding links. Having said that, I do wish to call attention to a separate issue.

I could speculate on the reasons, but many news media outlets are covering RFK Jr’s HHS appointment in a way that is frankly dishonest. The practice has a name- sanewashing. I would describe this term as encompassing both attempts to make Kennedy’s views sound more reasonable than they are, but also attempts to emphasize the rare coincidental points of agreement that Kennedy has with the body of evidence on matters of health and science. As the adage goes- a broken clock is right twice a day. This doesn’t make it a good idea to use one to keep time. Lest people think I am being unfair, I would like to present a sampling with sources (going through everything he’s claimed would require decades) of things that Kennedy has said or done:

• He has claimed HIV is not the cause of AIDS (it is), but rather poppers are.

• He has claimed that the 1918 influenza pandemic was caused by influenza vaccines (it wasn’t).

• After causing (with the help of local anti-vaccine lobbyists) a measles outbreak in Samoa which resulted in 83 deaths, Kennedy blamed the outbreak on measles vaccines (a thing that is literally impossible).

• He has repeatedly claimed vaccines cause autism (they do not) while also dehumanizing autistic people.

• He has denied that there has ever been a vaccine that has been safe and effective.

• He claimed COVID-19 was ethnically targeted to attack Caucasian and Black people, while Chinese and Ashkenazi Jews were relatively immune.

• He has said that rather than take stimulant medications, those diagnosed with ADHD should be forced to work in labor camps.

• He has claimed that he is not anti-vaccine, despite being at the head of the world’s leading source of anti-vaccine disinformation.

• He has argued that opposing vaccines during the COVID-19 pandemic was worse than being a Jew in the Holocaust.

• He has apologized for comparing vaccination itself to the Holocaust multiple times (it’s worth asking how genuine such apologies are if you keep making the comparison).

• He has touted health benefits for unpasteurized (raw) milk that do not exist¹.

• In the wake of an era in which infectious diseases are a critical threat to public health, he has stated that he will have infectious disease research “take a break” for 8 years.

I want to detour for a moment to discuss Kennedy’s points outside of infectious diseases. Most of the sanewashing pertaining to Kennedy’s views points out that he does have some areas of overlap with experts in nutrition. Yes, indeed, Kennedy is a proponent of whole foods², which is a point that there is broad agreement within the nutrition community would be beneficial to the American diet as a whole. However, this ignores that Kennedy’s views on nutrition are little more than the naturalistic fallacy masquerading as a legitimate opinion. His major objections are related to the use of various additives in the food supply which he believes are driving an epidemic of chronic illness- something that evidence does not support as a contributor to poor health in the US. The Standard American Diet (SAD) involves a pattern of massively overconsuming calories, high intake of sodium, high intake of saturated fats, high intake of trans fats (which, incidentally, may not be explicitly identified on nutrition labels but can be confirmed when the term “partially hydrogenated” appears on the ingredients), inadequate fiber, and a deficiency of various micronutrients. Unless you are seasoning your food with botulinum toxin, your overall dietary pattern will have a much greater effect on your health than the minute quantities of additives in the food supply that have already undergone thorough testing for safety. Furthermore, the major source of these pesticides are plant foods, which Americans as a whole consume far less of than they ought to for optimal health. Setting aside the facts of what is wrong with the American diet for a moment, it is important to recognize that the food industry is an extremely potent marketing force and their profits depend on the massive overconsumption that is inherent to the American diet. Furthermore, whole, nutrient-dense foods tend to be expensive and are quite inaccessible in the numerous food deserts in this country. One of the biggest gains in public health in the nutrition space could be achieved by getting Americans to consume less calories overall, and consistently consume more nutrient-dense foods instead of hyperpalatable foods with limited nutritional value. Conversations about additives are a distraction, and yet this is the crux of what Kennedy claims to be the problem.

I ask that if you see writing that describes Kennedy’s views as being “unorthodox,” “controversial,” or “vaccine skeptic,” you should be aware that these are not honest ways to describe his views. The things he holds opinions on are thoroughly uncontroversial. There is copious evidence to address these matters. Kennedy has simply consciously chosen to take the position opposite to that evidence, in the same way that a person has 2+2 =4 proven to them and still insists that it’s 22. We don’t call that controversial, unorthodox, or whatever polite euphemism- we call it “wrong.”

With the prospect of an RFK Jr. HHS Secretary, here are specific measures I am taking right now as an individual and why I am taking them.

• Stockpiling masks

  • I am not sure what access to these will look like in the future. In general, I wear my N95 aura in poorly ventilated public spaces during the winter and it causes me no issues. At this very moment, there are concerning developments in the pandemic potential of avian influenza and mpox. While there is no guarantee that either of these viruses will rise to a human pandemic, the prospect of cutting infectious disease research as Kennedy has vowed to do is very concerning in light of recent developments.

• Confirming I am up to date on all of my vaccines and immediately getting any that I am not up to date on. I would specifically flag the following as important:

  • COVID and flu vaccines: the best time to get these would have been a month ago. The second best time is immediately.

    • Re: flu vaccines- my preference at the moment is to go with cell culture-produced flu vaccines because there is no risk of egg adaptation mutations that can reduce the immune response with this approach and there will be at least some neuraminidase content in the vaccines which may be especially important if H5N1 eventually gets to the stage of efficient spread from person to person. In the US, the only cell-culture based flu vaccine is Flucelvax. For children, Flumist is also a reasonable choice provided they don’t have one of the contraindications, but for adults it doesn’t seem to be better than any of the injection vaccines.

    • I prefer mRNA vaccines to Novavax for COVID-19 because in all the data I have seen, they seem to be better overall in terms of the immune response and I personally do not struggle with their reactogenicity. For many people, this is not the case and the mRNA vaccines are a very hard time, which would be a great reason to get Novavax. I have a very detailed post about Novavax here. While there are a few new preprints on their vaccine since I published that post, none in my view move the needle regarding my conclusions therein.

  • Getting a pertussis vaccine booster. CDC (indirectly) recommends a booster dose every 10 years (mainly motivated by concerns of waning immunity to tetanus); however, immunity to pertussis wanes much more quickly than any of us would like so I plan to get a booster since it’s been more than 3 years since my last one (any of them will do, so long as they are Tdap and not Td). There has been aggressive pursuit of next-generation pertussis vaccines that would be able to better protect people, but in the interim, these are the best tools we have. It is unclear how these pursuits will proceed with the incoming administration’s priorities.

  • Immunity to mumps is not what we need it to be. Vaccines use a strain of mumps virus whose HN protein differs significantly from that of circulating strains, which contributes to more rapid waning and results in outbreaks. Concerns have also been raised about waning immunity to measles because exposure to the virus has dropped so much that people don’t get boosted as much as they used to. It has previously been proposed to add a third dose of MMR vaccine before people go off to college because of this. It is worth mentioning that joint aches (arthralgias) can occur in those who are not immune to rubella who get MMR after puberty (usually women), but these are generally short-lived and resolve on their own.

• Stockpiling any medications that I take regularly

  • As HHS Secretary, Kennedy would have the power to overrule FDA approvals and his general attitude towards medications is adversarial. He has repeated anti-psychiatry tropes about SSRIs being the cause of school shootings, for example. If there are any medications you take regularly and can stockpile, it may be a good idea to have a store. Do be mindful of expiration dates and storage conditions, however. In general, the concern with most medications past their expiration dates is that they will not work, rather than an overtly toxic effect, but there is limited research on this question.

1. There has been a concerning rise in defense for raw milk recently; recently, I was discussing the issue with my grandmother who, to my shock, said she loved to get raw milk from the market (back in Soviet Ukraine) and it was delicious. Further inquiry revealed that while she did indeed purchase raw milk from the market, she also pasteurized it at home. When I explained to her that in the US people were engaged in heated legal battles over their right to raw milk that they had no intention of pasteurizing before drinking, it took a solid 20 minutes of explaining before she understood it because the idea of not pasteurizing your milk was absurd to her. This is important context to consider when people point to differences in the legality of raw milk sales across the world. Raw milk may be sold elsewhere in the world- that doesn’t actually mean people are consuming it unpasteurized. It also overlooks that even when it is sold in places where it is legal to do so, the regulations surrounding its sale are typically tighter than those concerning pasteurized milk- because raw milk has no established health benefits over pasteurized milk and comes with considerable risks from the perspective of infectious diseases. That said, while I cannot personally comment upon it as I do not drink milk at all, it appears that there may be some merit to the idea that raw milk tastes different- but this has nothing to do with pasteurization. Most milk sold in stores undergoes an additional process- homogenization. This basically makes it so that the milk’s contents are evenly distributed throughout each sample. Raw milk does not undergo this process, which may contribute to differences in taste that some people seem to prefer.

2. Whole is typically said in the context of nutrition to contrast with “processed” or “ultra-processed.” These terms are not the greatest because there is no standardized definition for them, but there is a general rule that whole foods are good and processed foods are bad. It is absolutely the case that eating more whole foods in the American diet, would, on average, have a beneficial effect for Americans’ health, but this dichotomy of whole food = good and processed food = bad is too simplistic. For example, protein powders could be considered ultra-processed foods, but it would be challenging to make an intellectually honest case that these are not healthful or nutrient-dense foods (assuming the comparison is matched for calories).