Robert F. Kennedy, Jr.'s nomination to lead HHS.

I’m Isaac Saul, and this is Tangle: an independent, nonpartisan, subscriber-supported politics newsletter that summarizes the best arguments from across the political spectrum on the news of the day — then “my take.”

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Today's read: 15 minutes.

Two important reminders.

• First, on Friday, we published our final recap of the 2024 election — exploring why Harris and Democrats lost, and what narratives should finally be put to bed. You can read it here (members only).
• Second, we are still accepting applications for an assistant to the editor, who would work with Isaac in Philadelphia. The job listing is here. 

Quick hits.

1. President Joe Biden authorized Ukraine's military to use U.S.-provided long-range missiles on targets inside Russian territory, reportedly prompted by the presence of North Korean troops in Russia. (The decision) Separately, Russia launched its largest drone and missile attack on Ukraine in months, targeting the country’s energy infrastructure. (The attacks)
2. President-elect Donald Trump announced he plans to nominate North Dakota Gov. Doug Burgum (R) as secretary of the Department of the Interior, natural gas executive Chris Wright as secretary of the Department of Energy, and former Rep. Doug Collins (R-GA) as secretary of the Department of Veterans Affairs. (The nominations)
3. Israel killed Hezbollah's media relations chief Mohammad Afif in a strike on a building in Beirut, according to Lebanese officials. (The strike)
4. President Biden and Chinese President Xi Jinping met during the Asia-Pacific Economic Cooperation summit, agreeing to refrain from using artificial intelligence to control nuclear weapons systems and discussing the release of two imprisoned U.S. citizens from China whom the State Department considers wrongfully detained. (The meeting)
5. The Indian government said it conducted its first successful test of a long-range hypersonic missile, joining the U.S., China, and Russia as countries with hypersonic missile capabilities. (The test)

Today's topic.

Robert F. Kennedy Jr. as HHS secretary. On Thursday, President-elect Donald Trump announced he would nominate Robert F. Kennedy Jr. to lead the Department of Health and Human Services (HHS). Kennedy, who ended his independent bid for president in August and endorsed Trump, is a longtime environmental and public health activist whose views on vaccines and other healthcare issues have run counter to the medical establishment. If confirmed by the Senate, he would lead the largest health agency in the U.S., made up of organizations like the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH). 

"The Safety and Health of all Americans is the most important role of any Administration, and HHS will play a big role in helping ensure that everybody will be protected from harmful chemicals, pollutants, pesticides, pharmaceutical products, and food additives that have contributed to the overwhelming Health Crisis in this Country,” Trump wrote in a post announcing the decision. “Mr. Kennedy will restore these Agencies to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again!”

On the campaign trail, Kennedy promised significant changes to the departments that comprise HHS. Shortly before Election Day, Kennedy said that a prospective Trump administration would reverse the CDC’s recommendations on fluoride in drinking water. Additionally, Kennedy said he would replace hundreds of NIH employees and suggested half of the department’s research budget should go toward “preventive, alternative and holistic approaches to health.” He has also argued against efforts supported by members of Congress in both parties to cover Ozempic, a diabetes and weight-loss medication, under Medicare and Medicaid.

Kennedy’s views on vaccines could also factor heavily into his oversight of the FDA, which regulates vaccine use. Though he denies that he is opposed to vaccines and said that he would not “take away anybody's vaccines” after Trump’s victory, Kennedy has suggested that autism has become more common due to modern vaccinations and criticized the NIH for not doing enough to study a connection between the two. Kennedy has also cast doubt on the efficacy of measles vaccines. 

Trump’s announcement prompted a divided response among Republican lawmakers, while Democrats largely criticized the pick. Many prominent members of the medical community objected to the pick, suggesting that Kennedy’s anti-establishment views on key public health issues could pose a danger to Americans who rely on HHS to guide public health policy. 

Today, we’ll explore what writers on the right and left are saying about Kennedy’s nomination, followed by my take. 

What the right is saying.

• The right is mixed on the pick, with many suggesting that Kennedy lacks the qualifications to lead HHS.
• Some say Kennedy is poised to overhaul public health in America for the better.
• Others say Kennedy should have a role in the Trump administration, but HHS is the wrong one. 

The New York Post editorial board wrote “putting RFK Jr. in charge of health breaks the first rule of medicine.”

“We sat down with RFK Jr. back in May 2023, when he was still challenging President Biden for the Democratic nomination. As we noted then, he’s an independent thinker who sees through a lot of bull, an incisive critic of some of Biden’s worst policies, who saw that ‘the Democratic Party lost its way most acutely in reaction to’ Donald Trump’s first election. But the insights we were impressed with had nothing to do with health,” the board said. “He told us with full conviction that all America’s chronic health problems began in one year in the 1980s when a dozen bad things happened. Convincing to the gullible conspiracy-hungry crowd on Twitter, but not to the rest of us. In fact, we came out thinking he’s nuts on a lot of fronts.

“And even where he makes fair points as a critic, it’s hard to see how he’s the guy to lead HHS and its staff of 83,000 to practical solutions. The relationship between Big Pharma and the feds is deeply dysfunctional, for example — but drug companies do a lot of good, and employ a lot of people. Sending the industry — or even just its stocks — into a tailspin would be a disaster in its own right,” the board wrote. “A radical, prolonged and confused transition ordered by a guy like RFK Jr., who will use his high office to spout his controversial beliefs, leaves a lot of room for things to go wrong — and for people to wind up harmed or even dead.”

In The Hill, Douglas MacKinnon said “RFK Jr. is poised to save the health and lives of millions of Americans.”

“Kennedy will transform our ‘sick-care’ industry and literally save millions of lives in the process. Anyone paying attention to the utter catastrophe that has become America’s ‘health care’ industry knows that this is not political hyperbole or an exaggeration. It is an outright obscenity that we are losing so many Americans to entirely preventable causes,” MacKinnon wrote. “If Kennedy is even halfway successful in his quest to save the American people — and especially our children — from the life-robbing threats of ultra-processed foods and toxic chemicals, he can potentially save or improve tens of millions of lives over the next four years.

“That ‘cure’ will transcend every demographic and income level. Under the direction of Trump, Kennedy may turn ignorance to acceptance, acceptance to hope, hope to belief and belief to results. Again, what is the value of someone who literally has the potential to save millions of lives and improve the health of tens of millions of children and adults? I suspect we are about to find out.”

In National Review, Jack Butler argued “RFK Jr. could be useful — but not atop Health and Human Services.”

“It is not out of some sacrosanct respect for HHS that Trump’s nomination of Robert F. Kennedy Jr. to lead it gives me pause. It is, rather, out of concern that his priorities do not align with what must be done to HHS specifically, and that he would better achieve them elsewhere in the government’s massive health apparatus,” Butler said. “The next head of HHS should have two priorities for the department as a whole: to figuratively drive out its demons, and to restrain government meddling in health care. That would require someone who understands its intricacies, and who would have the requisite principles to apply to them.”

“Kennedy’s views on a variety of subjects have entailed controversy, particularly on vaccines… [but] his opposition to processed foods (in contrast to the man who would appoint him) and dubious chemical additives in them is far sounder. The same goes for his objection to government nutrition advice, and other unsavory aspects of the linkages between corporations and government in this area,” Butler wrote. “But these sentiments do not add up to a case for putting him in charge of HHS… A different role, one that would make him an intentional interdepartmental irritant, constantly and rightfully harassing institutions under the remit of HHS and forcing transparency, would be a better fit.”

What the left is saying.

• The left is critical of Kennedy’s nomination, expressing concern that his openness to conspiratorial thinking will endanger public health. 
• Some say the reforms Kennedy is pushing for will not fix the problems they purport to address. 
• Others say Democrats should seek a partnership with Kennedy based on common ground. 

In Bloomberg, Lisa Jarvis argued “RFK Jr.’s junk science will put every American at risk.”

“The list of his disqualifying attributes for HHS secretary is long. There’s his lack of public health expertise or experience navigating, let alone managing, a hulking government agency — one he promises to significantly overhaul, scrapping entire departments and firing hundreds. And then there’s the larger issue of his embrace of anti-vaccine activism, AIDS denialism and offensive theories about transgender children. He’s also suggested that WiFi causes cancer and blamed school shootings on antidepressants.”

“He is correct that the US has a serious problem with childhood obesity, and rates of chronic diseases, such as diabetes and Alzheimer’s, are on the rise. And few would argue against putting more resources into disease prevention or making fundamental changes to improve everyone’s access to healthier, safer food,” Jarvis wrote. “But noticing a problem (one many people within HHS, of course, have not only noticed but are actively working on) is one thing. Assessing the evidence to understand the complex sources for our current ‘sick’ state and crafting the appropriate set of evidence-backed solutions to make us all healthier is something entirely different.”

In MSNBC, Kavita Patel said “Robert F. Kennedy Jr. will not make anybody healthier.”

“One of the most alarming aspects of Kennedy’s potential appointment is his long-standing skepticism of vaccines. Despite overwhelming scientific evidence that supports the safety and efficacy of vaccines, Kennedy has repeatedly promoted debunked theories inaccurately linking vaccines to autism and other health issues,” Patel wrote. “If he were to implement policies based on these unfounded beliefs, it could lead to, among other things, decreased vaccination rates, potentially causing outbreaks of preventable diseases; weakened immunization programs, putting vulnerable populations at risk; and erosion of public trust in vital health institutions.”

“Kennedy’s national reputation was built on his environmental advocacy, but even there his approach has been antiscientific. Should he bring his approach to chemical regulation to the role of HHS secretary, it could have unintended consequences. Without the proper scientific backing and research, overzealous regulation could impede the development of actually beneficial products and treatments,” Patel said. “Perhaps most concerning is the potential for Kennedy’s views to shape broader public health policy. His stance on issues like water fluoridation, despite its proven benefits for dental health, could lead to policy changes that harm millions of Americans.”

In The New York Times, Rachael Bedard wrote about “how to handle Kennedy as America’s top health official.”

“Like many liberals and health care providers, I’ve been alarmed at Mr. Kennedy’s dubious claims about public health and science… however, I believe there’s a health care agenda that finds common ground between people like myself — medical researchers and clinicians — and Mr. Kennedy,” Bedard said. “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.

“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,” Bedard wrote. “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.”

My take.

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• I’m very concerned about Trump picking Kennedy to lead HHS.
• Kennedy does make a lot of great points about our poor health systems, and he is a great communicator of the distrust many Americans feel in our institutions.
• But Kennedy’s belief that vaccines cause autism, and fringe beliefs like WiFi causing cancer, make him a disqualifying candidate to lead one of our largest federal departments.

I'll be frank: I'm pretty disturbed by this pick. I put Kennedy’s nomination in a similar bucket as naming Pete Hegseth, Tulsi Gabbard and Matt Gaetz, all of whom I believe have disqualifying resumes for the jobs they’ve been tapped for. Still, in the spirit of Tangle, let me start by saying a few things about Robert F. Kennedy Jr. that I earnestly support.

As I wrote when he decided to run for president, understanding his appeal isn’t difficult. Our country is incredibly unhealthy, and it seems like very few politicians even care. We're suffering from addiction, we're morbidly obese, we're overly medicated, and we're facing genuine epidemics of anxiety, depression, and loneliness. This combination has led to skyrocketing rates of disease and deaths of despair, which seem to be all around us.

Kennedy, in earnest and human ways, speaks to these ills — more bluntly and persuasively than most people in healthcare or politics. He rails against Big Pharma, preaches healthy eating and exercise, and implores us to look more critically at ourselves — our lifestyles, the corporations we trust, and even our healthcare system. I appreciate all of this, and I appreciate that he has dedicated his life to being deeply skeptical of power, which has made him a legend among many liberals, the new right, and the politically homeless. 

And, of course, let's not forget the single biggest reason Kennedy is sitting where he is: Our government’s response to the Covid-19 pandemic. At a time when many healthcare professionals failed to communicate well to the public, or when many Americans felt their personal freedoms were curtailed in the name of dubious public health push, Kennedy captured the skepticism and frustration a lot of Americans (including me) were feeling. 

Even some of his most crank-ish ideas are actually far more legitimate and worth debating than some experts allow. For instance, there’s a good argument that widespread fluoridation of toothpaste makes removing fluoride from public drinking water a good option (I'm not at all sold, but it's at least a reasonable debate to have). Even on one of his most-divisive issues, autism, Kennedy is right that autism rates have skyrocketed and that we don't have a very good scientific consensus as to why (and no, it isn't due to how we diagnose it). He even has the right ideas about fast food and healthy eating. 

But Kennedy's beliefs and ideology go beyond just a focus on what we put in our bodies, skepticism of Big Pharma, or wariness about an over-medicated and over-vaccinated population. He has, in many respects, earned his mainstream label as a crank or huckster. He does assert a lot of totally bonkers, ridiculous, easily debunkable things, and he deserves criticism for that. 

Kennedy started a nonprofit to campaign against child immunization, an innovation that has been one of the most astonishing healthcare achievements of the 21st century. He infamously wondered aloud if Covid-19 was ethnically engineered to spare Jewish and Chinese people, and has suggested cellphones and ultrasounds are driving up rates of Tourettes and peanut allergies. If I could sum his worldview up in a sentence, it’s that correlation does equal causation, always and forever, and government and big corporations are in on it (whatever it is). 

In his book on Dr. Anthony Fauci, Kennedy shared conspiracy theories about AIDS, even going so far as to cite AIDS activist Christine Maggiori — without mentioning that she was HIV positive, believed HIV to be harmless, refused treatment, died of AIDS at 52, and breastfed and passed the virus onto her daughter (who then died at the age of three). 

Again: Kennedy propped this person up in an edited, fact-checked book criticizing healthcare experts, without ever informing his readers of her background.

This stuff makes him dangerous. I don't mean that in a mysterious, scornful sense. I mean that, because Kennedy is such a good communicator, is right about some very important issues and has such a strong brand among the power skeptical, he can say things that sound smart but are really quite obviously wrong, potentially dumbing down our collective understanding of public health. 

Let me give you an example. One of Kennedy’s go-to lines when he broaches the subject of vaccines and autism is: “I have never in my life seen a man my age with full-blown autism, not once. Where are these men?” The implication is that autism is not prevalent in Kennedy’s peer group because autism rates only started ramping up when we started giving kids in the generations after his vaccines. Kennedy is partially right: Studies have not found many individuals with profound autism from Kennedy’s generation. However, that doesn’t mean there weren’t any, and there are plenty of reasons why Kennedy doesn’t see them.

I have a very good friend who recently completed a PhD studying the molecular biology of autism and also has an older brother who is autistic and nonverbal. I asked him about Kennedy's comments, and he responded with a storm of questions and frustration: Where is he expecting to see adults with profound autism? These people are not out in the community; most are confined to institutions, and many live in group homes and spend their days there. The life expectancy of people with profound autism is also much lower — often in the 40s or 50s — because most people with severe disabilities have other comorbidities and health problems, preventing them from reaching Kennedy's age (70 years old).

Of course, no matter how much he tries to downplay it, Kennedy continues to insist that vaccination schedules are causing autism. And while he claims he isn’t going to take away vaccinations, Trump certainly seems to believe he might. Many Americans hope that he will, and as head of HHS, he would be able to impact vaccinations in some significant ways. So the vaccines-cause-autism belief is worth exploring.

It’s easy to understand why this belief is so compelling. Children with autism often look to be developing normally, but then lag behind developmental milestones between the ages of 18 and 36 months — a time when children typically start to develop more complex social behavior. That is also when kids get a lot of vaccines, making the large-scale, government-approved round of childhood vaccination a convenient culprit.

But that belief is ill-founded. Jill Escher, one of my favorite writers covering autism (who has two children impacted by profound autism), helpfully reminded us how we know that autism is not caused by vaccines, as Kennedy often insinuates or says outright. In her piece in The Free Press, Escher writes:

• We know that a hallmark of autism is dysregulation of brain development starting in the prenatal period. Childhood immunizations simply cannot explain what goes wrong during gestation. 
• There is not a single ingredient in vaccines that can cause childhood brain development to go awry, and no animal study shows links between vaccines and the abnormal brain development seen in autism. 
• There is no plausible reason vaccines could explain autism’s strong heritability (e.g., sharply increased incidence among siblings), or its strong male-to-female ratio of about 4 to 1. 
• The vaccine schedule cannot possibly explain the steadily accelerating rates over time. 
• And most importantly, every epidemiological study on the topic has confirmed zero association between vaccination status and the development of autism. 

This is the whole ballgame to me: Someone who cannot understand these realities should not be running HHS. Kennedy is not a doctor, not an expert in any field, and has zero experience running any organization even close to as far-reaching, critical, and complicated as HHS. This is an agency with 83,000 people on staff. It has the largest bankroll of any department in the federal government. One out of every four dollars in our budget flows through it, including the money going to Medicare and Medicaid. It is, arguably, our most important federal department — and Kennedy is deeply and profoundly unqualified to lead it.

Of course, this is to say nothing of the bizarre spectacle of Republicans rallying behind a pro-choice former Democrat who has repeatedly fantasized about throwing his political opponents in jail and is now pushing a Michelle Obama-esque program to strictly regulate what American kids eat at school. Alas, partisanship is one helluva drug.

While I respect much of what Kennedy stands for (skepticism, healthy living, and an anti-establishment attitude), his personal being is dominated by far too many characteristics that should not be anywhere near the levers of power at HHS (gullibility, conspiratorial thinking, and distrust of science).

My list of concerns here is just the tip of the iceberg — there is a lot more dirt out there on Kennedy, and a lot of it will come up during a Senate confirmation hearing. With any luck, that process will scare off some Senate Republicans and he won’t be confirmed; instead, I hope he finds a smaller but still important role in the administration where he can continue to challenge the mainstream consensus and push Americans to live healthier lives. But HHS secretary? No thanks. 

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Your questions, answered.

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Under the radar.

On Friday, a federal judge in Texas blocked a Department of Labor rule that significantly expanded overtime pay for salaried workers, determining that the rule exceeded the department’s authority. The Labor Department sought to increase the limit under which salaried workers in executive, administrative, and professional roles would qualify for overtime from $43,888 to $58,656, making an estimated four million workers eligible for overtime protections. However, U.S. District Judge Sean Jordan ruled that the department could not designate overtime eligibility based on wages. The Associated Press has the story.

Numbers.

• $1.7 trillion. HHS’s proposed mandatory spending budget for fiscal year 2025. 
• 23.4%. HHS’s budget in fiscal year 2024 as a percentage of the total U.S. federal budget.
• 13. The number of operating divisions encompassed by HHS.
• 71%. The percentage of U.S. adults who favor substantially increasing federal spending on improving public health programs in a May 2021 survey by the Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health. 
• 72%. The percentage of U.S. adults who believe the activities of public health agencies are important to the health of the nation.
• +12.1%. Robert F. Kennedy Jr.’s net favorability rating on May 19, 2023, one month after announcing his challenge to President Joe Biden in the Democratic primaries, according to FiveThirtyEight.
• +9.7%. Kennedy’s net favorability rating on October 9, 2023, the day he announced his independent bid for president. 
• -6.2%. Kennedy’s net favorability rating on August 23, 2024, the day he announced the suspension of his presidential campaign. 

The extras.

• One year ago today we had just written about U.S.–Iran relations.
• The most clicked link in Thursday’s newsletter was Jack Smith stepping down as special counsel.
• Nothing to do with politics: A historian separates fact from fiction in Gladiator II.
• Thursday’s survey: 2,121 readers responded to our survey asking about Trump proposing recess appointments with 86% finding it inappropriate or mostly inappropriate. “Should not be needed with a majority in the House and Senate,” one respondent said.

Have a nice day.

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