Many scientists at federal health agencies are awaiting the arrival of the second Donald Trump administration with anxiety and anxiety over how the next president will reconcile the disparate philosophies between the team’s leaders. .
President Trump promised to let Robert F. Kennedy Jr. “run amok” on medicine, food, and health. As a result, scientists say radical anti-establishment medical movements with roots in past centuries could threaten the achievements of the science-based public health order that has been painstakingly built since World War II. Some people are concerned.
If Kennedy achieves his vision of transforming public health, mandatory childhood vaccinations could be eliminated. New vaccines may never be approved, even if the FDA allows dangerous or ineffective treatments to come to market. Government websites may promote health ideas that are unproven or turn out to be false. And if President Trump’s plan to weaken civil servant rights comes to fruition, anyone who questions these decisions could be summarily fired.
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“Nobody like RFK Jr. had ever come close to actually shaping policy,” said Roberts, a law professor at American University and author of “Choose Your Medicine,” a history of public health in the United States. Lewis Grossman said. .
President Kennedy and his adviser, health care entrepreneur Carrie Means, say dramatic changes are needed because of the high levels of chronic disease in the United States. They say government agencies have corruptly tolerated or promoted unhealthy diets and dangerous drugs and vaccines.
Mr. Means and Mr. Kennedy did not respond to requests for comment. Four conservative members of President Trump’s health bureaucracy spoke on condition of anonymity. They enthusiastically welcomed the former president’s return, but expressed little opinion on specific policies. Days after last week’s election, RFK Jr. announced that the Trump administration would immediately fire and replace 600 National Institutes of Health employees. He launched a website to crowdsource candidates for federal appointments, and early candidates included anti-vaxxers and chiropractors.
According to Politico, last week’s gathering at Mar-a-Lago, which included Elon Musk, Tucker Carlson, Donald Trump Jr., Kennedy and Means, spoke out against coronavirus lockdowns. Jay Bhattacharyya, a scientist at Stanford University, was also included. Florida Surgeon General Joseph Ladapo opposed the new mRNA vaccine and rejected disease control practices established during the measles outbreak. Marty McCurry, a surgeon at Johns Hopkins University; Means’ sister, Casey Means, a Stanford-trained surgeon and health guru.
Their ideas are not unified, but they are all kind of heretics. But the idea that health care policies based on a century of science can be ignored is deeply troubling to many medical professionals. They see Kennedy’s presence at the center of the Trump transition as a victory for the “medical freedom” movement, which rose against the Progressive-era idea that experts should guide health policy and practice. There is.
Howard Markel, professor emeritus of pediatrics and history at the University of Michigan, said this could mean a departure from the expectation that mainstream doctors are respected for their expertise. He began his clinical career treating AIDS patients and ended it after experiencing difficulties treating AIDS patients. The year-long long battle against the new coronavirus.
“We’ve gone back to the idea that ‘every man is his own doctor,'” he said, referring to a phrase popular in the 19th century. It was a bad idea then, he said, and it’s an even worse idea now.
“How will that affect the morale of scientists?” Markel asked. Public health agencies are largely a post-World War II legacy and are “deserving of attention, but we have undermined these institutions not only by defunding them, but also by degrading the status of the true patriots who work in them.” You can.”
FDA Commissioner Robert Califf said at a press conference on November 12 that he is concerned about mass layoffs at the agency. “I’m biased, but I feel like the FDA is in some ways performing at its best right now,” he said. At a conference the next day, CDC Director Mandy Cohen reminded the audience of the horrors of vaccine-preventable diseases like measles and polio. “I don’t want to see us backtracking to remind people that vaccines work,” she said.
Escape from agency?
A senior NIH scientist, who spoke on the condition of anonymity for fear of losing his job, said the uncertainty about the direction of the agencies at the NIH, FDA and Centers for Disease Control and Prevention is causing many senior scientists to consider retirement. He said he is doing so.
“Everyone I talk to takes a deep breath and says, ‘This doesn’t look good,'” the official said.
“I’ve heard that a lot of people are preparing resumes,” says Arthur Caplan, a bioethics professor at New York University. That includes two former students who now work at the FDA, Caplan said.
Georges Benjamin, executive director of the American Public Health Association, and others have expressed a wait-and-see attitude. “We worked with the Trump administration last time. There were times when things went reasonably well,” he says, “and there were times when things were chaotic, especially during the coronavirus pandemic.” He said any large-scale deregulation efforts in public health would be politically risky for President Trump. Because when governments “mess things up, people get sick and die.”
At least at the FDA, “it’s very difficult to make dramatic changes,” said Dan Troy, former FDA chief counsel.
But the administration could easily score a liberal victory by, for example, instructing the new head of the FDA to reverse its denial of approval of Lycos’ psychedelic drug MDMA. The use of psychedelic drugs to treat post-traumatic stress disorder is of interest to many veterans. Vitamins and supplements, which are already loosely regulated, will likely get an even more free pass from President-elect Trump’s FDA.
‘“Medical Freedom” or “Nanny State”‘
The people influencing Trump’s health are not monolithic. Analysts believe there could be a clash between Mr. Kennedy, Mr. Musk and more traditional Republican views. “Holistic” MD Casey Means, a central figure in President Kennedy’s “Make America Healthy Again” team, urged the government to cut ties with industry and remove sugar, processed foods, and sugar from Americans’ diets. It calls for the removal of harmful substances. When Mike Bloomberg promoted the Republican Party as mayor of New York, Republicans derided these policies as an example of a “nanny state.”
While both libertarians and “medical freedom” groups oppose aspects of regulation, Silicon Valley biotech advocates such as Samuel Hammond of the American Innovation Foundation are urging President Trump to approve drug and medical device approvals. In response to pressure to speed up the process, Kennedy’s team says it is expediting FDA and medical device approval. Other government agencies have also been “captured” by industry, resulting in dangerous and unnecessary medicines, vaccines, and equipment on the market.
Kennedy and Casey Means want to eliminate industry user fees that pay to regulate drugs and medical devices and support nearly half of the FDA’s $7.2 billion budget. With Trump and Musk vowing to cut government programs, it’s unclear whether Congress will make up the shortfall. User fees are set by legislation passed by Congress every five years, most recently in 2022.
The industry supports a user fee system that would strengthen FDA staffing and speed product approval. Creating new rules requires “a tremendous amount of time, effort, energy and cooperation” from FDA staff, Troy said. Policy changes made solely through informal “guidance” are not binding, he added.
Mr. Kennedy and the Means brothers have proposed changing agricultural policy to encourage growing organic vegetables instead of industrial corn and soybeans, but “I don’t think we’ll have much influence in that area.” ” Caplan said. “Big agriculture is a strong, entrenched industry and has no interest in changing.”
Robert Johnston, a historian at the University of Illinois at Chicago, said, “There is a disconnect between the liberal impulses of the ‘medical freedom’ camp and the insistence on institutional reform in the United States, which is definitely the domain of the ‘nanny state.’ It’s a fine line,” he said.
Certain federal agencies are likely to face major changes. Republicans want to reduce Anthony Fauci’s legacy by reducing the NIH’s 27 institutes and centers to 15 and splitting the National Institute of Allergy and Infectious Diseases, which he led for 38 years, into two or three. There is.
Numerous past attempts to slim down the NIH have failed in the face of campaigns by patients, researchers, and physicians. Republican lawmakers have advocated in recent years for deep cuts to the CDC budget, including defunding gun violence, climate change and health equity research. If implemented, Project 2025, a policy blueprint from the conservative Heritage Foundation, would split government agencies into data collection and health promotion departments. Although the CDC has limited influence in Washington, former CDC directors and public health officials have defended its values.
“It would be surprising if the CDC didn’t recognize the potential for change,” said Anne Schuchat, a former CDC principal deputy director who retired in 2021.
CDC employees are “highly employable” and may start looking for other jobs if “their focus is reduced or changed,” she said.
President Kennedy’s attacks on HHS and its agencies as corrupt instruments of the pharmaceutical industry, and his demands that the FDA be granted access to scientifically controversial medicines, are linked to dangerous and ineffective apricot seeds. It is reminiscent of the 1970s campaign by conservative advocates against laetrile, which was touted as a derivative. As a cancer treatment. Just as President Kennedy defended off-patent drugs like ivermectin and hydroxychloroquine to treat COVID-19, Laetrile’s defenders argue that the FDA and a profit-driven industry have colluded to sell cheaper alternatives. He claimed that he was trying to suppress the
Grossman said the public and industry have often been skeptical of health regulators for decades. Government agencies are most successful when they are called in to solve a problem, especially when a child has died or been harmed by a bad drug, he said.
The Biological Products Control Act of 1902, the predecessor to the NIH, was enacted in response to a smallpox vaccine contamination that killed at least nine children in Camden, New Jersey. A childhood poisoning case involving sulfa antifreeze led to the creation of the modern FDA in 1938. In 1962, after the thalidomide disaster, the FDA gained authority to require evidence of safety and effectiveness before selling drugs. A woman taking anti-nausea medication was born with severe deformities in her limbs.
If vaccination rates plummet and measles and pertussis cases soar, infants could die or suffer brain damage. “The administration’s widespread attacks on public health are not harmless,” said Alfred Moravia, a professor of epidemiology at Columbia University and editor-in-chief of the American Journal of Public Health. “It’s like being stripped of home insurance.”
Sam Whitehead, Stephanie Armour, and David Hilzenrath contributed to this report.
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