Federal government policy- and decision-making requires deep scientific, technological, and medical expertise from innumerable departments, agencies, and personnel. They include the Surgeon General, White House Office of Science and Technology Policy (OSTP), departments and agencies such as Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Nuclear Regulatory Commission (NRC), Environmental Protection Agency (EPA), Fish & Wildlife Service, Occupational Health and Safety Administration (OSHA), National Institute for Occupational Safety and Health (NIOSH), Department of Defense (DoD), Department of Energy (DoE), and on and on.
Maybe it is futile to propose sense at a time of nonsense and intense political partisanship; as Donald Trump, Jr. recently said on Fox & Friends:
“I want to make sure now that we know who the real players are, the people who will actually deliver on the president’s message, the people who don’t think that they know better than the duly elected president of the United States” (emphasis added).
What does that say about respect for scientific, technological, and medical expertise?
The President-elect’s record on listening to experts is hardly exemplary – consider his disdain for his own public health advisors, former National Institute of Allergy and Infectious Diseases director and Chief Presidential Medical Advisor Dr. Anthony Fauci, and former White House Coronavirus Response Coordinator Dr. Deborah Birx. I fear that his approach to scientific and medical advice will reflect the statement of Donald, Jr. above or rely on appointees like unhinged anti-science, anti-vaccine ideologue Robert F. Kennedy, Jr. (Department of HHS), Dr. Mehmet Oz (CMS), Dr. Marty Makary (FDA), or Dr. David Weldon (CDC), rather than seeking out qualified experts. That could have calamitous consequences for the nation’s public health.
Nautilus and the Aspen Institute asked eminent scientists from across the country to offer recommendations for the new administration’s science and technology agenda. Many members of the group called for additional investment in science, arguing that research is more essential than ever for navigating the complex challenges facing the nation, particularly in a society marked by deep political divisions.
In his introduction to the report, Dr. Aaron F. Mertz, Executive Director for Science and Society at the Aspen Institute, singled out a particular issue that science faces today – rampant anti-science propaganda and disinformation:
Our respondents see the rise of anti-science rhetoric as a dire threat to the future of the U.S. They raise alarm over growing irrationality and political manipulation of scientific facts in American society and around the world. This dangerous trend not only jeopardizes the country’s ability to advance knowledge but also undermines the capacity to confront global crises such as public health emergencies.
Note that those concerns about anti-science rhetoric were voiced before then-candidate Trump promised this at an October campaign rally about unhinged Robert F. Kennedy, Jr., who for decades has aggressively promoted unscientific ideas about nutrition, agriculture, and, especially, vaccines and medicines:
I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines.
And in his victory speech the morning after the election Mr. Trump added:
He’s going to help make America healthy again. … He wants to do some things, and we’re going to let him get to it. Go have a good time, Bobby!
Kennedy has now been nominated by the President-elect to be Secretary of Health and Human Services, a critical Cabinet position. As such, he would oversee the NIH, CDC, Centers for Medicare and Medicaid Services (CMS), and other health-related agencies. That is like appointing the president of the Flat Earth Society to head NASA.
Dr. Oz faces Senate confirmation to head CMS loaded down with significant baggage. As reported in the New York Times on November 20:
[He has]sown misinformation — about Covid treatments, weight loss hacks and unproven supplements. He has invested in drug companies, even as he has publicly taken aim at Big Pharma, and has profited from a medical device that he helped invent but that has been subject to several recalls.
Over roughly two decades in the public eye, Dr. Oz has drawn the ire of medical experts, members of Congress and even his own peers, including a group of 10 doctors [of whom I was one] who called for him to be fired from a faculty position at Columbia University, arguing he had shown a “disdain for science.” (The university appeared to quietly cut its public ties with the physician in 2022.)
Dr. Makary, a surgeon nominated to become the FDA Commissioner, repeatedly expressed controversial opinions during the COVID-19 pandemic. He has questioned the need for masking and contended that public health officials pursued overly harsh vaccination mandates and ignored alternative strategies, such as the protections conferred by infections, which confer “natural immunity.” He was part of a misguided group of physicians who called for greater emphasis on herd immunity to end the pandemic and promoted the dangerous idea that mass infections would quickly lead to population-level protection. He has also criticized the supposed overprescribing of drugs, the use of pesticides on foods, and the alleged undue influence of pharmaceutical and insurance companies over doctors and government regulators.
Dr. Nesheiwat, a family medicine physician, is generally favorable toward vaccines but has criticized government mandates and recommendations that young, healthy people receive COVID vaccines, and she has questioned the safety of masks:
Internist and former Congressman Dr. David Weldon, who has been nominated to head the CDC, will fit in well with the ill-informed vaccine skeptics heading the other principal U.S. health agencies, including HHS (Kennedy), FDA (Makary), and Centers for Medicare and Medicaid Services (TV celebrity and notorious spreader of medical misinformation Dr. Mehmet Oz). As a member of Congress, Dr. Weldon raised questions about the excellent measles, mumps, and rubella (MMR) and Human Papilloma Virus (HPV) vaccines and promulgated the myth that thimerosal, a preservative used in some vaccines, had caused a surge in cases of autism — a hypothesis without any basis. He also introduced a “vaccine safety bill” that would have transferred most vaccine safety research from the CDC to another agency, because of a supposed “inherent conflict of interest.”
Another possible member of the administration's nescience fraternity is Stanford Medical School Professor Dr. Jay Bhattacharya, who is rumored to be in line to become NIH director. One of the three authors of the notoriously flawed and dangerous Great Barrington Declaration that called for intentionally letting COVID spread widely to induce "herd immunity," he was consistently and spectacularly wrong about the COVID pandemic, claiming that COVID had been “defanged” on April 14, 2021; May 3, 2021; July 21, 2021; July 28, 2021; and January 6, 2022. Moreover, he lacks the kind of managerial and research experience required to manage what is arguably the world's foremost research organization.
There was unintended irony in President-elect Trump's statement announcing Dr. Weldon's selection: "Given the current Chronic Health Crisis in our Country, the CDC must step up and correct past errors to focus on the Prevention of Disease." How Dr. Weldon and the other healthcare-related appointees will square vaccine skepticism with the "prevention of disease" remains to be seen.
Yale epidemiologist Dr. Katelyn Jetelina, who writes the “Your Local Epidemiologist Column,” captured beautifully the dismay of the scientific and medical communities at the choice of RFK, Jr. to head HHS:
For many of us who have devoted our lives to public health, science, and medicine—driven by an unwavering commitment to improving the health and well-being of Americans—this strikes deep. A mix of profound sadness, anger, exhaustion, and disbelief because the playing field has now completely shifted: Instead of pushing forward toward a healthier society, it’s now about keeping us from moving backward.
How do you express, in a few lines, the unsettling reality that someone with a catalog of lies so long is now tapped to be in charge of the public’s health? From his false claims that vaccines cause autism (they don’t), or that HIV does not cause AIDS (it does), or antidepressants are linked to mass shootings (they aren’t), or chemicals in water making kids trans (they don’t), or to Wi-Fi causing cancer (it doesn’t). The list of falsehoods feels endless.
Given its roles in controlling government spending, confirming (or rejecting) many Presidential appointments, and oversight of Executive Branch agencies, Congress will play a pivotal role, even with the slew of executive orders that are likely to be forthcoming on Day One (as in the previous Trump term).
Congressional moderates may band together to block more extreme picks. We hope to see bipartisan agreement on health, science, and technology issues. There have been rumblings about a Senate “McConnell Caucus” comprised of a handful of moderate Republican senators such as Mitch McConnell, Lisa Murkowski, and Susan Collins, who might block approval of any unqualified appointees who require confirmation – of whom Kennedy and Oz are the most obvious ones. (However, there are possible work-arounds, including “recess appointments,” that would enable the President to evade the Senate’s advise and consent role.)
An important development is the U.S. Supreme Court’s reversal earlier this year of the Chevron Doctrine – a cornerstone of administrative law that had required courts to defer to federal agencies’ interpretation of ambiguities in statutes. It will result in a tsunami of legal challenges to established governmental consumer protections, many of which are the responsibility of the agencies enumerated above and will require that they have strong leadership and sufficient personnel and expertise to defend their decisions.
Evidence-based government policymaking should not be politicized but should strive to promote progress and benefit all Americans. It will be essential to tap into genuine expertise to formulate sound policy and make wise decisions, but the first round of science- and health-related Trump appointments are not encouraging.
Henry I. Miller, MS, MD
Henry I. Miller, MS, MD, is the Glenn Swogger Distinguished Fellow at the American Council on Science and Health. His research focuses on public policy toward science, technology, and medicine, encompassing a number of areas, including pharmaceutical development, genetic engineering, models for regulatory reform, precision medicine, and the emergence of new viral diseases. Dr. Miller served for fifteen years at the US Food and Drug Administration (FDA) in a number of posts, including as the founding director of the Office of Biotechnology.
