Robert F. Kennedy Jr., President-elect Donald Trump’s pick to lead the Department of Health and Human Services, is coming into the nomination process in an unusual position, with a long list of his own policy priorities separate from the president-elect’s, and a public promise by Trump to let him “go wild” on his ideas.

Céline Gounder, the editor-at-large for public health at KFF Health News and a CBS News medical contributor, answers questions below about the role Kennedy has been tapped to take on and some of the ideas in the sweeping “Make America Healthy Again” platform he may try to push through.

What is the role of the Department of Health and Human Services, and how much power does the HHS secretary have over its work?

The U.S. Department of Health and Human Services comprises several agencies and offices including the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Centers for Medicare & Medicaid Services, the Office of the Surgeon General, and much more.

There is a big difference between political appointees and career civil servants. Political appointees set strategic priorities and align their department or agency’s policies with the current administration’s objectives. Civil servants have the institutional knowledge to know how to get things done and have specialized scientific or technical expertise. Scientific questions require specialized expertise. This is why there are career scientists who advise the HHS secretary, NIH director, CDC director, and FDA commissioner.

The HHS secretary has the authority to establish regulations that govern health, including food and drug safety, public health, and health care quality. The HHS secretary can declare public health emergencies and coordinate federal responses to health crises, such as disease outbreaks or natural disasters. The secretary wields significant influence over the department’s policies and its constituent agencies, which include the CDC, FDA, NIH, and others.

The HHS secretary is also in a position to shape public opinion if given a platform to do so by the media. Absent media attention, their influence on public opinion is more limited. We in the media have a responsibility to fact-check their statements and hold those in power accountable — regardless of who is in power.

One of Kennedy’s most controversial stances is his criticism of vaccines, promoting the idea that they cause autism, among other conditions, and claiming “there’s no vaccine that is safe and effective.” What is the reality?

Extensive research has conclusively shown that vaccines do not cause autism. The “research” behind these claims was retracted due to ethical violations and sloppy work. The doctor who originally made those claims lost his medical license as a result of his professional misconduct.

For parents whose kids have autism or people who have autism, this matters. For too long, claims about the safety of vaccines have not only put people at unnecessary risk of getting illnesses that vaccines can prevent, but have also been a red herring, distracting people from the real causes of autism and how to diagnose them and treat them. That distraction is unproductive and harmful.

Secondly, nothing in this world is 100% safe and effective. It’s all about weighing risks, the pros and cons. Is one choice more beneficial or more risky? Do the pros of wearing a seat belt in the car outweigh the risks? Do the pros of exercising regularly outweigh the risks of not exercising? You could get injured while exercising. Do the pros of vaccinating instead of allowing infectious diseases to spread in the community outweigh the cons? Yes, yes, and yes.

Kennedy has said he wants to leave it up to individuals to decide whether to vaccinate themselves or their children. What impact could that have?

Increasingly, people are formulating opinions about vaccines based not on science but on Google searches, social media, what family and friends think, and personal observation. That is not research. Research is formulating a hypothesis and trying to disprove that hypothesis. It means you understand how to differentiate correlation from causation. And it means doing repeated experiments to show consistency, not just a chance or random result.

This isn’t a question of whether people are smart or not. But most people don’t have the training, experience, and context to objectively assess the pros and cons of vaccination. You wouldn’t want me repairing your car’s transmission or brake system. I’m not stupid, but I have no training or experience in this.

The risk of leaving these decisions to untrained individuals is that these decisions won’t be made on science. They will be made based on emotion and confirmation bias, which is to say, Google searches looking for opinions that line up with your preexisting beliefs or inclinations. This will put kids at risk, and because vaccines protect against transmissible infectious diseases this will put others in the community at risk, especially other kids and people who are immunocompromised.

Kennedy has also said chemicals in food are tied to autism as well as psychotic episodes and depression. What do we know about the connection between food and mental health?

He’s not wrong that there is a relationship between diet and autism as well as diet and mental health. These are areas of ongoing research. No diet has been proven to cure or universally improve autism or mental health symptoms, but certain dietary interventions improve symptoms in some people. These dietary changes may include elimination of ultraprocessed foods, eliminating gluten, and avoiding certain food additives or preservatives. 

Kennedy has said one of the Trump administration’s first acts will be to work to remove fluoride from drinking water, arguing it’s connected to cancer, IQ loss, thyroid disease, and other health problems. Why is fluoride in drinking water, and is it safe?

Fluoride is put in the water to reduce the risk of cavities, especially in kids.

As with many things, fluoride safety is all about dose. Drinking a few glasses of water a day is healthy. Drinking from a fire hydrant all day would land you in the hospital. The level of fluoride in U.S. water is safe and protects against tooth decay.

When municipalities stopped putting fluoride in the water, cavity rates went up. This was observed, for example, in Calgary, Canada, and in Juneau, Alaska.

There are parts of the world, including India, China, and East Africa, where fluoride levels 30 to 40 times higher than levels in the U.S. have been found to be harmful. But we don’t have anywhere near those levels of fluoride in our water.

But Kennedy’s statement demonstrates a common misunderstanding about public health authorities in the U.S. We are the United States of America — public health powers reside at the state level. The federal government has the authority to tax and spend and to regulate commerce across state lines, and federal government authorities derive from that.

The CDC provides scientific guidance to help state and local authorities to make informed decisions. The CDC does not mandate fluoridation. The EPA sets the maximum allowable fluoride concentration in public water systems. But states have the authority to mandate fluoridation or can leave it up to local jurisdictions. 

Kennedy has criticized multiple public health agencies he could now lead. He has said the FDA’s “war on public health is about to end,” claiming the agency suppresses anything that “advances human health and can’t be patented” by pharmaceutical companies. What do you make of these criticisms?

This again demonstrates a misunderstanding of federal agency authority. Congress has passed laws that give the FDA specific authority to regulate drugs, supplements, and food, and those laws grant the FDA different powers over drugs, supplements, and food.

If anything, given the Supreme Court’s “major questions doctrine,” the courts can determine that agencies may not make regulations on issues of significant economic or political importance unless Congress has clearly authorized such actions. For example, in the case FDA v. Brown & Williamson Tobacco Corp. (2000), the Supreme Court concluded that the FDA lacked the power to regulate tobacco. In 2009, Congress passed the Family Smoking Prevention and Tobacco Control Act, granting the FDA the authority to regulate tobacco.

Drugs require FDA approval before they can be marketed. Under the law, drugs are defined as substances used to diagnose, treat, or prevent disease.

Supplements don’t need FDA approval before they are sold. The FDA monitors dietary supplements once they are on the market and can take action if they are unsafe or if they make claims about diagnosis, treatment, or prevention of disease.

Dietary supplement manufacturers often choose not to seek FDA approval to market their products as drugs because:

  • There are less stringent requirements on dietary supplements than on drugs.
  • The FDA approval process is expensive and lengthy. Clinical trials take years to conduct and cost millions of dollars. Manufacturers foot the bill for clinical trials.
  • Dietary supplements can be sold directly to consumers without a prescription.

The manufacturer decides whether it wants to seek FDA approval for a drug or if it wants to market a product as a dietary supplement — and that decision typically comes down to time and money. Pharmaceutical companies are less inclined to invest millions of dollars in clinical trials of unpatented treatments due to the lack of exclusive marketing rights (in other words, a time-limited monopoly), which can affect profitability.

The FDA often goes after supplement brands that test this line when it sees companies marketing products with claims that amount to what should be regulated as a drug. This is why supplements often carry a disclaimer that they aren’t being sold to “diagnose, treat, cure, or prevent any disease.” Kennedy has praised the supplement industry for “fighting back,” following a court action over an anti-aging supplement that the FDA argued should be regulated as a drug. 

Finally, the FDA doesn’t grant patents. That’s the job of the U.S. Patent and Trademark Office. 

Q: Trump has said Kennedy will “end the Chronic Disease epidemic.” What are some of the positive actions he could take if he becomes HHS secretary to reduce chronic disease in the U.S.?

A: Kennedy has called for greater regulation of food additives and ultraprocessed foods. Ultraprocessed foods in American diets have led to an explosion in obesity, diabetes, high blood pressure, and other chronic disease.

However, it’s unclear which factions within Trump’s orbit will prevail. Congress may have to give the FDA the authority to regulate more aggressively and the funding to enforce those regulations. Historically, the Republican Party has been opposed to regulation. Trump’s chief of staff pick, Susie Wiles, is a longtime lobbyist who has worked on behalf of the food, insurance, and tobacco industries.

The Heritage Foundation’s Project 2025 — which involved a number of former Trump advisers, but which Trump has tried to distance himself from — would roll back dietary guidelines, making it harder to fight ultraprocessed foods.

Alexander Tin contributed to this report.

This story was published by KFF Health News on November 15, 2024. It is republished with permission.