Bad medicine

Watching the wrecking ball that is RFK Jr. in charge of Health and Human Services in the United States is like watching a slasher film in which the killer wanders the streets in daylight murdering everyone he can, while no one stops him.

It’s not just RFK Jr. Earlier this year, DOGE decimated NIH research in destructive sweeps, some of them seemingly searching for terms like “trans,” which led to the disappearance of funding for projects with a wide range of goals.

Lately we’ve seen RFK standing once again in opposition to pediatric experts. He’s reported to be planning to focus on a group of children who died (apparently from a variety of causes) in order to suggest that the Covid or mRNA vaccines are unsafe. He regularly says untrue things about vaccine schedules and risks for children and adults alike.

It was easy to see much of this coming. I wrote an essay for Scientific American in July of 2024 about then-candidate Trump’s abuse of scientific concepts and the pseudoscientific rhetoric adopted by his allies to push their political agenda.

But given that RFK Jr. promised people like Republican Senator Bill Cassidy of Louisiana—a doctor—that he would be restrained in his approach to vaccines, what’s been made clear is that any promise to stick to actual science in these matters was just lip service. Cassidy himself called RFK Jr. on the carpet for saying that the Covid vaccine killed more people than Covid. But it was Cassidy who cast a key vote to move the vote on his confirmation to the full Senate, for political benefit to himself rather than medical benefit to his constituents.

Wednesday morning, former CDC Director Susan Monarez is scheduled to testify before a Senate Committee that she was forced from her position this summer for “holding the line on scientific integrity.” The systems we built, it turns out, can be dismantled by just a few bad actors in key positions. And that’s what we’re facing now. Today I want to discuss the attitude toward research and medicine in the second Trump administration.

The big picture

It’s now critical to understand the larger goal sits behind the destruction of the federal government’s support of science and the scientific method across the United States.

What’s going on? Part of it is sheer grift. In U.S. research, vast amounts of money have traditionally been awarded by those who know the field and given to those best positioned to conduct investigations in areas that are current priorities and who have teams capable of doing the work. But any quasi-neutral process appears to be anathema to the Trump administration, which seems to prefer it when all money and access flow directly from the White House.

It’s true that even before Trump’s arrival on the scene, the U.S. has had a long history of anti-expert know-nothing movements. There’s always been a niche for them because many people without a good education—and frankly, many who have one—remain vulnerable to swindlers. In addition, the powerful have long tended to take advantage of the powerless. But as much as that, the government has often served moneyed interests more than it has its constituents.

One of the reasons for so much rage against conventional Democratic leaders from Bill Clinton forward is the sense that they, too, have played a part in this kind of self-dealing politics. Have the Republicans done it more openly, with more contempt for their base? Yes. But the sense of betrayal from traditional Democratic voters is palpable.

Now Trump is making that tendency among elected officials much, much worse. And he’s tapping into ongoing resentments for his own benefit as he goes along. The anti-vaccine movement, the fluoride paranoia, the Jade Helm panic that Obama was planning to put everyday people in concentration camps—all of these predate Trump’s time in office.

But he aims to capitalize on those kinds of fears and resentments by redirecting them. He tries to convince voters that they’re being hoodwinked, that everything is a hoax. And rather than have them realize the degree to which he’s robbing them blind, he’s turning their rage against anyone who is part of the existing government system.

In the end, however, Trump’s fight against science is a fight against there being any objective truth at all. The truth should only be whatever Trump says it is. And we’ve seen how this approach has played out in the past.

Scientist as symbol

History offers several instances in which scientists who were also public figures got targeted in ways that parallel the destruction of federal research in America today. As a Jewish scientist in Germany when the Nazis began to gather power, Albert Einstein became a focus of their culture-war agenda. Einstein’s breakthrough with relativity was beyond comprehension for most laypeople, which made it easier for the Nazis to rebrand it, dismissing it as Jewish physics. The Nazis held special events to burn his work and suggested that he should be hanged. He left the country a month before Hitler was appointed chancellor.

Anthony Fauci didn’t do research that fundamentally revolutionized his field, but we saw the same culture war–style attack against him during the Covid epidemic, complete with death threats. Fauci was a bureaucrat who did his job for decades, both having tremendous successes and making mistakes. By becoming a public face of medical research in America, he did a lot to promote research that had the potential to save millions of lives worldwide.

As a bureaucrat-scientist, Fauci was the ideal target for Trump. Fusing his own attack on functional government with the anti-vaccine movement already underway, Trump turned tens of millions more Americans against some of the best science ever developed by humanity, with the underlying goal being to undermine any authority but his own. The movement he encouraged tried to make Fauci a casualty of that war.

Derailing established knowledge

Scientists have played key political roles in other times and places, sometimes more willingly furthering the government line. During the career of biologist Trofim Lysenko, the opposite of a Fauci dynamic emerged, in which mid-twentieth century Soviet authorities promoted a scientist who discounted genetics. With direct praise from Stalin for Lysenko’s ideas, rivals were displaced, and another leading scientific figure who tried to embrace more scientific rigor was sentenced to death (though he eventually died from malnutrition in prison).

The state of science was so politicized that the more traditional geneticists and the Lysenko faction attacked each other and fell into a polarized dynamic that likely seemed to the public like so much squabbling among eggheads. This fight made it easier for the Party or Stalin, as leader, to step in and settle matters—which had nothing to do with the scientific method at all.

And once Stalin had picked his champion, any opposition at home or abroad to the ideas Lysenko promoted could be taken as a sign of an attack on the Leader and the state itself.

While we have already seen the spurious promotion of useless or even dangerous treatments for Covid and measles—things like ivermectin, hydroxychloroquine, vitamin A, and even bleach—here in the U.S., Trump has no pet Lysenko for now, no researcher with a high-enough profile to be the face of the administration’s takeover of science.

This is where RFK Jr. comes in. He’s already a celebrity, with some environmental activism in his past. He’s part of a legendary American political family, and a kind of guardian angel to anti-vaxxers. As the head of HHS, he speaks in quasi-scientific gibberish and denies statements he himself has previously made. In our celebrity culture, these different facets combine to afford him a kind of quack-scientist status that allows him to play the role of both Lysenko and Stalin in his ability to overturn research and medical practice in the United States today.

Trump doesn’t have the curiosity or the patience to interfere with HHS on a daily basis. Just as Stephen Miller has been given free rein over immigration, RFK Jr. is now overseeing the dismantling of key pillars of American medical science and health care.

What Trump is aiming for is dictatorship. And any dictator wants the full weight of accountability in the subjugated country run only in one direction: toward the leader.

The actual practice of science—with its goals of reproducibility, independence, and underlying principles—has had its own failures of course. And scientists are typically the ones to find and publicize course corrections. But a government-run peer-reviewed collaborative grant process holds the potential to neutralize the most political forms of abuse. It creates a long-term accountability to improvements in medical care, in the life spans of Americans, in the discovery for medical cures. That accountability is to Americans as a whole.

But the goal of the dictator is simply to garner more power and to hold it more completely. So we see not just the trashing of a traditional bureaucrat like Anthony Fauci but the destruction of the integrity of any medical-scientific enterprise itself.

As the New York Times reported this week, future-oriented cancer research is being destroyed, and current standards of care are being decimated in ways that will lead to many deaths. But the ability to recommend treatments and allocate money to allies are now under Trump’s and RFK Jr’s sway. And as those in leadership positions have been trying to obliterate databases and historical statistics left and right, we run the risk of the state of the public health now being seen as whatever they say it is.

The war on science is a war on facts, on any outside authority, and on the regulatory state—-all of which demand accountability to something outside the Leader and his circle. The process is a classic one: discredit other leaders and dismantle institutions until they’re safely under your control.

The Covid legacy

The run of the pandemic during the first Trump administration and the latter’s resistance to even the successful vaccine developed while he was president had devastating physical and psychological effects on the public. Not only did Trump normalize the rejection of science and demand his followers disregard the facts before their eyes, his failure of leadership lead to the deaths of hundreds of thousands, and sparked a national desensitization to death and suffering.

The biggest culprit is Trump, because he set up the dynamic that has dominated since. And when Biden came in on the heels of the January 6 coup, his team was facing a difficult situation in the country, with Trump supporters overwhelmingly not accepting the facts on the ground of the epidemic or the numbers of deaths that had just happened.

Rather than take up that fight at a vulnerable moment—which, to be fair, would not have been easy—the Biden administration proceeded for the most part as if everything had returned to normal. But one problem was that everything hadn’t returned to normal.

It was a mistake to pretend the regulatory state and the public health system hadn’t been damaged during the first Trump administration. It was a mistake to just try to proceed as if the January 6 coup participants could be prosecuted, and life might resume as usual. I believe that all those deaths, and the public disregard for them, set the stage for the deeper desensitization of the country and its response to everything from abuse of immigrants to those living on the streets.

Still not normal

My sense is that it’s a mistake now to do as Senator John Fetterman recently did, asking Democrats to not call Trump an autocrat. Given that Trump’s second administration rose out of the result of a popular election, Fetterman would prefer that we proceed as if we’re in a normal political process and conduct the usual debates over everyday issues.

But we can’t pretend everything is normal when it’s not. I would agree that it’s crucial not to let name-calling and Hitler references be the only thing going on. But those who aim to oppose the current regime need to offer concrete policies bundled under an overarching vision—a framework focused on the opposite of the kind of self-dealing, autocratic, anti-scientific crusade that Trump has mounted.

We see it in every direction, not just science. CNBC reported Monday that the president is advocating for companies to stop reporting earnings on a quarterly basis. There are two likely advantages to this. The toll on the economy of the kidnapping and deportation of migrant workers combined with the coming wallop from Trump’s tariffs will hit many U.S. companies hard. Skipping third-quarter reporting would be convenient for an administration trying to deny reality.

But on a larger scale, this, too is more of the assault on math and facts that’s part and parcel of the attack on science. Trump wants to be the only authority on any matter.

We see it on a weekly basis in other areas as well, with the president over the weekend claiming the right to assassinate suspected drug dealers in international waters because, according to his addled reckoning, 300 million Americans died in the last year due to drugs.

It might not surprise you to know that nearly 90% of Americans did not die last year from illicit drug use. The CDC actually has developed a process that it uses to count these deaths. It’s a process that has even been improved recently. But for Trump, the existence of real numbers and a way to count them can only be seen as a threat.

Action list

I always try to finish these Tuesday posts with concrete things you can do to address whatever problem I’ve tackled on a given day. But to be clear, you might see a specific need near you that I would never think of. My goal is to help you imagine some of the possibilities, then leave you to figure out what might actually be useful in your world. Don’t let me hem you in.

One key thing you can do in this moment is triage on the ground. Find out if you live in a state in which there are now restrictions for most people on Covid shots. See what requirements are now for getting them. In a number of cases, people might need prescriptions from a doctor. Reach out to community centers, libraries, churches, and retirement communities near you. These are the kind of places that previously hosted Covid clinics in the past but may not be able to now.

Figure out if you there’s a way to still host informational sessions on site while helping make sure people can get the paperwork they need in order. You can help communicate with their medical team or transport people off site for shots. The extra barriers to access are ones you (or you and a handful of friends) can help get people over.

Support the overall scientific enterprise in a larger way. Bring scientists, medical researchers, professors, health care workers, and others to speak at your kids’ school about the effectiveness of vaccines or the promise of all kinds of research.

As preventive testing comes under greater attack, help set up screenings or screening-information talks on the ground near you by talking to your city council or state representative. Work to guarantee independence of all kinds of research in the sciences—and the humanities as well—at your state schools and the public institutions near you.

As healthcare premiums increase for those who depend on the Affordable Care Act, help community groups bridge the gaps in coverage. Erase medical debt. Educate people about what’s happening and why. Health care is a fundamental issue, and one that can unite us as voters and as Americans.

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