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Public Health Is Not the Hudson River 

By GREGORY HOPSON

There is no doubt Robert F. Kennedy, Jr. is sincere about wanting to make the world a better place. The Hudson River cleanup, which he helped lead, is one of the most successful environmental achievements in the United States. It had bipartisan support, set global standards, and earned the highest compliment: imitation.

It was quite reasonable to believe Mr. Kennedy could use those same skills and passion to lead Health and Human Services (HHS). He has a proven track record with complex systems, scientific evidence, and protecting public welfare. Even skeptics of his appointment want him to succeed.

But skill sets in one domain do not always translate to another domain—no matter how strong that skillset is. And it can be very difficult to realize this until the effects of the Law of

Unintended Consequences start to complicate things—as is now happening with Mr. Kennedy’s approach to public health. I know the feeling — because I had made the very same mistake.

Lessons from Databases

I had over fifteen years of experience with databases in auto parts, newspapers, manufacturing, and insurance before I started working with healthcare databases. Each domain had its own complex logic but I could adapt from one domain to another relatively easily. 

When I started at the University of Iowa’s Department of Anesthesia, I was confident I could make a smooth transition to a new domain as I always had.

My first assignment was simple: create a report of the active prescription medications listed for a patient at a given appointment. It didn’t take very long to figure out how to find patient data, appointment data, and prescription data. My expertise in databases was transferring to a new domain quite smoothly!

All I had to do was use a chart I had and see how to make the connections.

I can read…how hard could that be?

Not only was it harder than I expected it to be, but I also didn’t immediately recognize why.

Parallel Paths

Mr. Kennedy took a similar path with vaccines and autism. He could see patient data. He could see vaccine data. He could see autism data. The connections seemed clear.

In my case, a researcher at Iowa had a theory that the length of a clinical appointment could be predicted by the number of prescriptions a patient was taking. My job was to combine all of the relevant data. He would then use that for his calculations.

I built a dataset. Everything looked right. But I was so new I didn’t realize there were hidden flags that identified appointment types. And flags for prescriptions that were active on the date of the visit. I didn’t even know there was a database flag that identified them. Flag is an oversimplification; it was far more complex than that. 

Kennedy thought he had confirmation of his theory in 1998, when Andrew Wakefield and colleagues published a study in The Lancet suggesting a link between the MMR vaccine and autism. It looked right. It seemed obvious. A lot of people believed it. But like my report, it was flawed — a small sample size, uncontrolled design, and speculative conclusions. My initial dataset had “false” data because I missed some flags. My mistake was caught long before the data ever got close to any kind of study.  Not only did the Wakefield study include falsified data, it made it to the publication stage. 

My researcher kindly showed me my errors and I was fortunate it was early on in the process. Meanwhile,  epidemiologists and clinicians have repeatedly shown Mr. Kennedy where his conclusions don’t stand up. Yet, like a friend of mine who once argued astronomy with Dr. James Van Allen — yes, the Van Allen Belts Van Allen — some convictions are hard to let go of, no matter how authoritative the counterevidence.

Three Questions for Transferring Expertise

I have learned to ask myself three questions whenever I enter a new domain — and I think they apply to all of us…including Mr. Kennedy. 

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We Should Write a Really Stern Letter

By KIM BELLARD

On the heels of the disastrous floods in Texas, days away from the Hurricane Katrina twenty year anniversary, and with Hurricane Erin almost becoming another Hurricane Sandy, the dedicated employees at FEMA are worried. Very worried. They’ve got a President who repeatedly has called to dismantle the agency, a DHS Secretary who is more interested in photo ops and slow walking expenditure requests, and an acting administrator who has no experience in emergency management. Oh, and they’ve suffered losses of about a third of their workforce.  

So some of the more outspoken employees have written a letter.  That should do the trick.

The letter, which they call the FEMA Katrina Declaration, was signed by almost two hundred current and past employees (although only three dozen allowed their names to be public). They charge:

Since January 2025, FEMA has been under the leadership of individuals lacking legal qualifications, Senate approval, and the demonstrated background required of a FEMA Administrator. Decisions made by FEMA’s Senior Official Performing the Duties of the Administrator (SOPDA) David Richardson, Former SOPDA Cameron Hamilton, and Secretary of Homeland Security Kristi Noem erode the capacity of FEMA and our State, Local, Tribal, and Territorial (SLTT) partners, hinder the swift execution of our mission, and dismiss experienced staff whose institutional knowledge and relationships are vital to ensure effective emergency management.

The letter goes on to list “Six Statements of Opposition,” calling to reverse various actions the Administration has taken that they believe impairs FEMA’s ability to fulfill its mission. Each seems perfectly reasonable, and none seems likely to result in action, at least unless/until disasters strike enough red states to force action.

FEMA spokesperson Daniel Llargues was not impressed, responding: “It is not surprising that some of the same bureaucrats who presided over decades of inefficiency are now objecting to reform. Change is always hard. It is especially for those invested in the status quo. But our obligation is to survivors, not to protecting broken systems.”

I probably wouldn’t have paid much attention to the letter, except it comes two months after some 90 NIH scientists issued their “Bethesda Declaration” to protest what has been happening to the NIH so far in the Trump Administration. Addressed to Director Jay Bhattacharya, it declared:

For staff across the National Institutes of Health (NIH), we dissent to Administration policies that undermine the NIH mission, waste public resources, and harm the health of Americans and people across the globe. Keeping NIH at the forefront of biomedical research requires our stalwart commitment to continuous improvement. But the life-and-death nature of our work demands that changes be thoughtful and vetted. We are compelled to speak up when our leadership prioritizes political momentum over human safety and faithful stewardship of public resources.  

The Declaration lists five categories of cuts the Administration has taken, about which they warn: “Combined, these actions have resulted in an unprecedented reduction in NIH spending that does not reflect efficiency but rather a dramatic reduction in life-saving research.”

Amen to that.

Director Bhattacharya was somewhat more respectful than Mr. Llargues in his response, claiming: “The Bethesda Declaration has some fundamental misconceptions about the policy directions the NIH has taken in recent months, including the continuing support of the NIH for international collaboration. Nevertheless, respectful dissent in science is productive. We all want the NIH to succeed.”

I don’t believe him. This Administration does not recognize any dissent as “respectful.”

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We Cannot Let RFK Jr Lead Us Backwards in Health

By ARIEL FRISTOE

As the artistic director of Out of Hand Theater, an arts organization that promotes anti-racism, social activism and health equity, I believe the recent appointment of Robert F. Kennedy, Jr. (RFK) as Secretary to the Department of Health and Human Services is beyond concerning. RFK is not a doctor, nor is he a scientist, yet he has been very vocal about his vaccine skepticism and has promoted misinformation about vaccine safety. Now, along with the removal of scientific information and warnings from the Centers for Disease Control (CDC) website, RFK’s appointment could lead to major increases in preventable and serious illnesses, outbreaks and deaths.

COVID-19 and its various mutations are still very much part of our daily landscape. According to the World Health Organization (WHO), more than 7 million COVID-related deaths have been reported since 2020 worldwide, nearly 2 million deaths were recorded in 2020 alone. The first vaccines were developed and became available by November 2020 and reported deaths from the last 28 days is 3,872, which is a 98.7% decrease from the onset of the pandemic. Vaccines work and save lives!

Diseases like smallpox and the bubonic plague were wiped out because scientists developed vaccines. Currently, with the “anti-vax” rhetoric being embraced and misinformation being so commonplace, reports of measles went from 4 cases in 2023 to 285 in 2024. Nine of these cases required hospitalization. The affected individuals include six children under four years old, 16 individuals aged 5-17, and two adults over 18 – the numbers rise as the days go by with 124 cases in in Texas in 2025 alone. We cannot and should not be going backwards where medicine is concerned.

Health experts are concerned that increasing nonmedical vaccine exemptions among schoolchildren could lead to more frequent outbreaks. Declining vaccination rates are worrisome as measles can cause serious illness, including hospitalization and brain swelling. I am not a doctor nor a scientist, but I place my trust in the actual doctors and scientists who have the greater good in mind when developing medicines to combat and prevent diseases. Why does this matter to me? Through our Equitable Vaccines program, we use art, information and conversation to encourage vaccine confidence and educate the community about resources so that we can create a healthier community, and we’re proud to have helped deliver 650 vaccines across Georgia. A healthy community is a strong community – and to me, that is the most valuable commodity over what is imported and exported.

As a woman, as a mother, as a human, I worry about our health and our children’s future with RFK Jr leading the Department of Health and Human Services.  I implore that all of us contact our local and state representatives to express our concerns over RFK’s Department of Health and Human Services appointment. We cannot go backwards when we have the resources available to us to create a safe and healthy place for every citizen to thrive. We must prioritize our communities’ health and allow proven data to guide our most important decisions that impact those that are most precious to us.

Ariel Fristoe is the Artistic Director at Out of Hand Theater

Goodbye, American Science

By KIM BELLARD

Many people don’t realize it, but a hundred years ago America was something of a scientific backwater. Oh, sure, we had the occasional Nobel laureate, but the center of science was in Europe, particularly Germany. Then in the early 1930’s the Nazis decided that “purity” – of political ideas, of blood – was more important than truth, making life uncomfortable at best and deadly at worst for their scientists. So hundreds of them fled, many of them ending up in the U.S. And – voila! – American science came of age and hasn’t looked back.

Until now. Now, I fear we’re going to suffer what Germany did, a brain drain that will bode well for some other country’s scientific fortunes.

Once of the first chilling announcements from the Trump Administration was that it was freezing NIH grants in order to ensure they were in compliance with Trump’s executive order banning DEI-related efforts. That froze some $1.5b in grant funding.

Piling on, the Administration announced that NIH grants would limit indirect costs to 15%. Sounds reasonable, you might say, but the vast machinery of U.S. biomedical research uses these “indirect” costs to fund the infrastructure that makes the research possible. Numerous state Attorney Generals immediately filed a lawsuit to block the cuts, claiming:

This research funding covers expenses that facilitate critical components of biomedical research, such as lab, faculty, infrastructure and utility costs. Without it, lifesaving and life-extending research, including clinical trials, would be significantly compromised. These cuts would have a devastating impact on universities around the country, many of which are at the forefront of groundbreaking research efforts – while also training future generations of researchers and innovators.

Oh, and on top of all this, as many as 1,500 NIH employees are in line to be laid-off.  

Katie Witkiewitz, a professor at the University of New Mexico, lamented to The New York Times: “The N.I.H. just seems to be frozen. The people on the ground doing the work of the science are going to be the first to go, and that devastation may happen with just a delay of funding.”

Universities are similarly frozen, not sure when or how much money they can expect. The University of Pittsburgh has paused all Ph.D. admission, until it can better understand its funding future. One has to suspect it won’t be the only such program to do so, and we may never know how many would-be Ph.D. students will simply decide a future in U.S. science is too bleak to risk.

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Doctors Must Fight the RFK Nomination

By DANIEL STONE

As a doctor, I consider Secretary Xavier Becerra and his Department of Health and Human Services (HHS) to be allies of practitioners like me. The behemoth federal agency administers Medicare and Medicaid, the Food and Drug Administration, and an army of public health workers. The Surgeon General, symbolic leader of the nation’s healthcare providers, reports to HHS. For decades, the Department has supported medical science in safeguarding the public’s health. Now that sacred trust faces the threat of Donald Trump’s nomination of Robert F. Kennedy Jr. to run HHS.

RFK’s first problem is a stunning lack of qualifications. After a laudable triumph over drug addiction, he used his legal background to work on environmental protection. Kennedy never held a federal government position nor administered any public agency. He now appears poised for on-the-job training at an agency with 80,000 employees and a $1.7 Trillion budget. In contrast, Becerra served for years in Congress and on its Health Sub-Committee. He also served as State Attorney General, managing 4,800 employees. The qualification issue is not political. During Trump’s first term, his last HHS secretary, Alex Azar, had served as HHS general counsel and president of pharmaceutical giant Eli Lilly. RFK has nothing remotely resembling his would-be predecessors’ qualifications.

Unfortunately, RFK’s shortcomings go well beyond mere lack of qualification. His distortions and public denials of established medical science infuriate practitioners like me. He casts baseless doubt on the well-established benefits of vaccines and on the polio vaccine in particular. Despite the seven decades since polio vaccine’s introduction, doctors still see patients who were infected before it was available. My patient Donna, born in 1955, counts herself among this group. She wears leg braces and often struggles with daily activities. For me, she symbolizes those who by accident of birth or happenstance missed the profound benefits of vaccines that RFK now disparages.

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Public Health Policy: At the Intersection of Law and Medicine.

By MIKE MAGEE

As 2025 kicks off, it’s wise to pause, and gather our thoughts as a nation. Few would argue that we’ve been through a lot over the past decade. And quite naturally, we humans are prone to blame individuals rather than circumstances (most of which have been beyond our control) for creating an environment that feels as if it is unraveling before our eyes.

How should we describe our condition – dynamic, tense, complex? Is peace, contentment, and security achievable in this still young nation? Have accelerationist technocrats, armed with bitcoins and Martian fantasy, short-circuited our moment in time that had been preserved for recovery from a deadly pandemic that eliminated a million of our fellow citizens seemingly overnight?

Who do we turn to for answers, now that we’ve largely lost faith and trust in our politicians, our religious leaders, and our journalists? And how exactly do you create a healthy nation? Certainly not by taking doctors and nurses offline for miscarriages, and placing local bureaucrats in exam rooms. Are they prepared to deal with life and death decisions? Are they trained to process human fear and worry? Do they know how to instill hopefulness in parents who are literally “scared to death” because their child has just been diagnosed with cancer? It certainly must require more than a baseball cap with MAHA on it to heal this nation.

Historians suggest this will take time. As Stanford Professor of Law, Lawrence M. Friedman, wrote in A History of American Law, “One hundred and sixty-nine years went by between Jamestown and the Declaration of Independence. The same length of time separates 1776 and the end of World War II.”

During those very early years that preceded the formal declaration and formation of the United States as a nation, our various, then British colonies, fluidly and independent of each other, did their best first to survive, and then to organize into shared communities with codified laws and regulations. It was “a study of social development unfolding over time” impacted by emotions, politics and real-time economics. At the core of the struggle (as we saw with the pandemic, and now the vaccine controversy) was a clash between the rights of the individual and those of the collective community.

This clash of values has been playing out in full view over the past five years of the Covid pandemic. In 2023, Washington Post columnist, Dr. Leana Wen, asked, “Whose rights are paramount? The individual who must give up freedoms, or those around them who want to lower infection risk?”

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Stick to the Science

By KIM BELLARD

A year ago I wrote about disturbing news from the Pew Research Center that trust in science, and in scientists, had fallen since the pandemic. I am slightly relieved to report that a new follow-up study by Pew indicates that trust is up slightly – but still way below where they were pre-pandemic.

Overall, 76% of Americans express fair or a great deal of confidence in scientists to act in the public’s best interests (versus 87% in April 2020). The public is about evenly split about how active a role scientists should take in policy debates – 51% think they should, 48% think they should stick to science. A year ago those numbers were flipped.

I think about all this in the context of the proposed members of President-elect Trump’s health team, whose takes on “science” are often considered out of the mainstream.

Trump surprised many a few months ago when he brought Robert F. Kennedy Jr. into his fold. Over the years, RFK Jr., an environmental lawyer by background, has expressed numerous startling views about health and our healthcare system. According to Jennifer Nuzzo, the director of the Pandemic Center at Brown University, RFK Jr. “is just in a category by himself. R.F.K. Jr. just willfully disregards existing evidence, relies on talking points that have been consistently debunked.”

Nonetheless, Trump vowed: “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.” He has now named him as his candidate for Secretary of Health and Human Services.

The team behind RFK Jr. have their own unconventional views. A quick rundown:

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Take a deep breath: Trump may not mean that much change–for health care, that is

By MATTHEW HOLT

At some point I had to crawl out of my hole and put pen to paper on the election debacle that just took place, and what the ensuing lunacy might be like for the health care system. So this is my attempt to do just that.

It’s really hard to understand why Trump won this election or why Harris and the Democrats lost. There was a lot of weirdness going on. Remember that before the vote Harris was generally praised for running a steady campaign, the Democrats had tracked to the right on immigration (trying to pass what IMHO was a horrendous bill ), and Harris kept talking about having a Glock, being a prosecutor and campaigned with a Cheney. The swing states (which vote at a much higher proportion than everyone else) all (with the narrow exception of Pennsylvania) voted for Democratic senators. For President they only went 3% against where they were in 2020. Even weirder was that hundreds of thousands of Trump voters didn’t appear to vote down the ballot at all. Yet nationwide the swing was big enough for Trump to win the popular vote. (If you really want to dig in, Charles Gaba has put together a great spreadsheet)

The simplest explanation is that the teeny middle in American politics voted against the incumbent. And the “middle” is getting teenier. In 1964 Johnson got 61% of the vote. Nixon (1972)  and Reagan (1984) won with nearly 60% of the vote. Obama’s big 2008 victory was with just 53% of the vote and he won by 7%.

Biden won in 2020 with just over 51% and Trump will end up winning while likely getting just less than 50% of the vote. This isn’t an overwhelming mandate. It’s a small minority of voters switching because they are pissed off with the status quo. This year the bug bear was inflation, which really wasn’t Biden’s fault even though he got the blame. It also appears that a decent slug of Arab-Americans and far left Democrats stayed home or voted for Jill Stein because of Gaza.

And let’s not forget the impact of the Electoral College which reduces turnout outside of swing states (not exclusively). Surely if we had a popular vote in which every vote counts, turnout would be higher, including in the big 2 states that are Dem strongholds (NY & CA).

However, even if you think it’s inconceivable that a majority would vote for Trump because of what happened in 2016 to 2021 (especially on January 6, 2021!), apparently that’s not enough of a disqualifier. He’s going to be President.

So what happens next? Particularly in health care.

My expectation (and hope) is that this is a snake eating its own tail. There are so many repugnant egos circling around Trump that it’s more than likely they’ll turn on each other, and little to nothing gets done. That doesn’t mean nothing will happen.

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Will Trump and RFK Jr. Revive His Covid Pandemic Performance?

By MIKE MAGEE

It has been a collision of past, present and future this week in the wake of Trump’s victory on November 6, 2024. The country, both for and against, has been unusually quiet. It is unclear whether this is in recognition of political exhaustion, or the desire of victors to be “good winners” and no longer “poor losers.”

Who exactly are “the enemy within” remains to be seen. But Trump is fast at work in defining his cabinet and top agency officials. In his first term as President, Trump famously placed himself at the front of the line of scientific experts sowing confusion and chaos in the early Covid response.

His 2024 campaign alliance with Robert F. Kennedy Jr. suggests health policy remains a strong interest. As his spokesperson suggested, his up-front leadership led to a resounding victory “because they trust his judgement and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr.”

For those with a memory of Trump’s checkered, and disruptive management of the Covid crisis, it is useful to remind ourselves of those days not long ago, and consider if throwing Bobby Kennedy Jr. in the mix back then would have been helpful.

I have been revisiting the Covid pandemics I have prepared for a 3-session course on “AI and Medicine” at the University of Hartford’s Presidents College. The course includes a number of case studies, notably the multi-prong role of AI in addressing the Covid pandemic as it spun out of control in 2020.

The early Covid timeline reads like this:

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