President-elect Donald Trump has named Robert Kennedy Jr. as his pick for secretary of health and human services. This was not my desired outcome. like many liberals and health care providers, I’ve been alarmed at Mr. Kennedy’s dubious claims about public health and science.
In the spirit of wanting the best for the country, however, I believe there’s a health care agenda that finds common ground between people like myself — medical researchers and clinicians — and Mr. Kennedy. There are seeds of truth to some of what Mr. Kennedy says. We can’t spend four years simply fighting his agenda; noncooperation won’t protect the integrity of American public health or advance its interests. Rather, there’s opportunity to leverage Mr. Kennedy’s skepticism and relative political independence for good — to turn his most valid criticisms of the American health care system into constructive reforms.
One place to start: Americans’ concerns about management of the Covid-19 pandemic. Mr. Kennedy’s rise to power was fueled by the anxieties of antivaxxers, and though the pandemic was rarely discussed during the election, its aftermath loomed large and may have contributed to Democrats’ defeat.
There’s been no meaningful, public reckoning from the federal government on the successes and failures of the nation’s pandemic response. Americans dealt with a patchwork of measures — school closures, mask requirements, limits on gatherings, travel bans — with variable successes and trade-offs. Many felt pressured into accepting recently developed, rapidly tested vaccines that were often mandated to attend school, keep one’s job or spend time in public spaces.
The lack of effort to build consensus about what the country did well and what to avoid next time is a missed opportunity to bring closure to a difficult era while preparing for the next pandemic.
Restoring people’s willingness to take vaccines is urgent, and Mr. Kennedy’s skepticism on this topic may counterintuitively be an advantage. His statements on vaccinations are more complex than they’re often caricatured to be. He’s said he is not categorically opposed to them or, as an official in the new Trump administration, planning to pull them from the market: “I’m not going to take away anybody’s vaccines, I’ve never been anti-vaccine,” he said recently in an interview with NBC News. But he consistently raises largely unsupported safety concerns and positions vaccine refusal as a matter of personal freedom.
Still, Mr. Kennedy is right that vaccine mandates are a place where community safety and individual liberties collide, and that official communication about vaccine safety can be more alienating to skeptics than reassuring. His approach, he said in the same interview, will be respectful, rather than scolding: “I’m going to make sure the scientific safety studies and efficacies are out there, and people can make individual assessments.”
The trick with vaccination, of course, is that it works reliably only if most people get the jab. To encourage vaccine uptake, experts need to communicate with the public about vaccination differently, which is why Mr. Kennedy should create a nonpartisan and independent vaccine commission. A commission made up of good-faith scientists, clinicians, patients, regulators and civil rights advocates with divergent viewpoints could examine available data and reach conclusions on which circumstances justify vaccine mandates, how to prioritize who is vaccinated first in a crisis, how vaccine refusals should be handled and how to address people’s concerns.
Treating Mr. Kennedy’s supporters as fools has not brought them into the pro-vaccine tent, and the country risks outbreaks of dangerous diseases such as measles if vaccination refusals continue to rise. If Mr. Kennedy approaches his role with the same us-versus-them spirit that powered his failed independent campaign for the presidency, he will sow division and put lives at risk. But if he de-escalates conspiracist rhetoric and leads a sincere national conversation about vaccination, he just might save them.
Mr. Kennedy has promised to expose how the relationship between the medical establishment and corporate interests distorts American health care. He argues that the country underinvests in interventions that prevent chronic disease in favor of over-treating patients with drugs once they’ve fallen ill. This critique has significant merit and is not especially controversial among health care providers.
The nefarious influence of the pharmaceutical industry on health care is well established. There are many examples of drug makers funding advocacy groups and influencing regulators into approving ineffective or potentially harmful drugs, and then wining and dining doctors into prescribing those therapies to patients.
This raises serious questions: Have we become too reliant on treating every matter of discomfort with a pill instead of tackling questions about environment, culture and behavior? Are we over-diagnosing and over-treating mental illness with prescription drugs while failing to prevent rising self-harm?
Mr. Kennedy has vowed to take on these questions by firing health agency leaders and personnel, withholding funds and dismantling current regulatory practices. There are better ways to achieve his goals. He can, as he’s promised, divert research and policy efforts toward disease prevention, diet and exercise. He can apply more rigor and skepticism to the drug approval process. He can use the federal government’s robust scientific apparatus to investigate how environment and lifestyle contribute to poor health, and change what treatments are incentivized for reimbursement.
Mr. Kennedy often speaks about chronic disease as a problem caused by the government in cahoots with industry for corporate gain. For me, this oversimplifies and overpoliticizes the roots of disease. But he’s right that the public is owed more transparency about how scientific knowledge is produced.
Lastly, Mr. Kennedy should prove his independence and seriousness by prioritizing a concern traditionally promoted by Democrats and opposed by Republicans: protecting and expanding health care access. Mr. Kennedy has weakly endorsed a public option for health care. And so far his emphasis on lifestyle and disease prevention hasn’t been in conflict with seeking traditional medical care.
Expanded subsidies for health insurance premiums are set to expire at the end of 2025. Mr. Kennedy could play an important role in preventing this rollback of federal support and be an important advocate for universal health care. If Mr. Kennedy has concerns about how Obamacare is structured and what it covers, he could make changes there, too. It could be rearranged to subsidize more lifestyle and dietary interventions, and disincentivize redundant, expensive tertiary care.
Adopting a spirit of resistance against all practices and policies of the incoming administration, or dismissing a man with a growing movement behind him, won’t help those working in medicine and public health advance the causes they care about. This doesn’t mean accepting or normalizing conspiracy theories. It is a matter of engaging in the places where the critics have a point, and trying to find ways to practice science without partisan interference.
One of Mr. Kennedy’s repeated talking points is that he is not anti-science, but he’s against the perversion of scientific credibility for greed and power. He should, accordingly, use his newfound power and responsibility to strengthen science and public health for the good of us all. Rather than fight him every step of the way, I want to find a middle ground we might stand on together.
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