As hard as it is to believe, I’ve been writing about Robert F. Kennedy, Jr. for nearly two decades. It all began in 2005 when RFK Jr. first “outed” himself as an antivaxxer by writing a conspiracy-laden “exposé” of the CDC falsely claiming that it was covering up evidence that the mercury-containing preservative thimerosal had been responsible for an “epidemic” of autism (it wasn’t). More recently, in August RFK Jr. bent the knee to Donald Trump, suspending his campaign to go all MAGA, in the hopes of landing a high-ranking health policy-related position in the Trump administration, should he win, to “make America healthy again,” which produced one of the more risibly silly acronyms I’ve ever seen, MAHA. Of course, in his MAHA agenda, RFK Jr. has thus far tried very hard to ignore or disguise his utterly bonkers antivax conspiracy mongering in favor of proposals ranging from the seemingly reasonable (decreasing regulatory capture at the FDA, although obviously I’m suspicious and the devil is in the details), to the dubious (getting rid of “chemicals” in food, in reality fear mongering about preservatives and GMOs), to the utterly pseudoscientific (promoting more research into alternative medicine quackery at the NIH). Although antivaxxers easily saw right through this misdirection, this sanewashing of RFK Jr.’s history by the Trump campaign is a strategy that unfortunately might work, as there are a lot of people susceptible to these sorts of fear mongering campaigns but just haven’t yet gone down the antivax rabbit hole yet.
I hadn’t really intended to write about RFK Jr.’s MAHA nonsense again unless Trump wins the election, but then over the weekend I saw this post by him on X, the hellsite formerly known as Twitter:
A few thoughts ran through my mind seeing this. First, it’s clear that RFK Jr. has now pivoted from being mainly antivaccine to a more general “health freedom” orientation frequently associated with the antivaccine movement that paints the Food and Drug Administration as the pharma-serving villain suppressing “natural” treatments, low cost medications, and “miracle cures.” Second, I can’t recall ever having seen the FDA being opposed to sunshine or exercise. I can see one twisting warnings about too much sun exposure being a risk factor for skin cancer that way, but when has the FDA ever opposed exercise as something that “advances human health”? (Answer: It hasn’t, except in the fevered delusions of people like RFK Jr.) Third, I realized that I should be surprised by this open attack on the FDA at all, given that it’s long been a goal of the “health freedom” movement to dismantle the FDA and return it at least to a pre-thalidomide state if not to eliminate it entirely. Recall that, before the thalidomide scandal, drug manufacturers were only required to submit evidence of safety, not efficacy, to win approval to market their products. Also recall that, contrary to the myths of quacks and “health freedom” advocates, the FDA actually worked; thalidomide was never approved for use in the US, thanks largely to the steadfastness of one of its scientists, Dr. Frances Oldham Kelsey , upon whom RFK Jr.’s uncle John F. Kennedy, bestowed the Distinguished Civilian Service Medal on her in 1962 for her refusal to buckle under pressure and support the approval of the drug.
Indeed, after Washington Post reporter Morton Mintz broke the story of Dr. Kelsey’s battle to keep thalidomide from being approved, public pressure mounted on Congress to do something. As a result, in 1962 Congress passed the Kefauver-Harris Drug Amendments to the Federal Food, Drug, and Cosmetic Act. These amendments required that drug companies not just show safety, as had been the case prior to the amendments, before their drugs could be FDA-approved, but also to provide substantial evidence of effectiveness for the product’s intended use. That evidence had to be in the form of adequate and well-controlled clinical trials, which at the time was considered a revolutionary requirement. (Believe it or not, no FDA requirement for high quality clinical trials showing evidence of efficacy and safety existed before 1962, and often the safety data used to obtain drug approval consisted largely of animal studies.) With tweaks over time in FDA regulations, amendments led to the current system of phase I, II, III, and IV clinical trials in force today. The amendments also included a requirement for informed consent of study subjects and codified good manufacturing processes, as well as the requirement that adverse events be reported, all very good things from the perspective of science-based medicine. Whatever shortcomings in the FDA approval process might exist now (and we’ve discussed many of them right here, indeed one time arguing that, if anything, the FDA drug approval process now might no longer be sufficiently rigorous), there is no doubt that since 1962 the FDA has been a far more effective guardian of drug safety than it was before the Kefauver-Harris Amendments were passed.
Of course, that’s what the “health freedom” warriors hate the most about the FDA and exactly why they wish to dismantle it.
“Health freedom” as epitomized by the antivaccine movement: A brief history
At this point, I’m half-tempted to quip that the main goal of the “health freedom” movement is freedom for quacks from pesky government laws and regulations that keep them from defrauding people by selling their ineffective and sometimes dangerous nostrums to them. While I certainly continue to argue that freedom from interference by government that prevents the sale of everything and anything to treat everything and everything (regardless of whether any of it is effective and/or at least safe) is certainly a major motivation behind “health freedom,” even I recognize that it’s far from the only motivation. It is, however, the one motivation that health freedom advocates tend to do their damnedest to downplay or disguise, although almost inevitably quacks rail against the FDA, even as they append “Quack Miranda” warnings about how their nostrums haven’t been approved by the FDA to their sales pitches, in order to try to ward off investigations.
Whenever I discuss the “health freedom” movement, I like to look back at some of the rhetoric of one of its major components, namely the antivaccine movement. Antivaccine rhetoric has long been steeped in the language of “freedom,” going back to the 19th century. Moreover, this sort of rhetoric, although mainly the province of the right these days, has broad appeal across the political spectrum. Back when I first started writing about the antivaccine movement in 2004, there existed an exaggerated if not outright false stereotype that antivaxxers tended to be hippy-dippy crunchy lefties, particularly suburban moms, in liberal enclaves like Marin County or Manhattan. To be sure, there was such a contingent of a “back to nature” crowd, but in reality that stereotype was very wrong in a number of ways. However, dating back to long before the pandemic, there has been a libertarian right-wing component to the antivaccine movement, for example, General Bert Stubblebine III’s Natural Solutions Foundation, far right libertarians, and others with extreme distrust of the government, including government-recommended vaccine schedules.
Antivaxxers using the rhetoric of “freedom” vs. “oppression” is nothing new, as this letter from 1907 demonstrates:
And this cartoon from the 1880s also shows it:
Here’s one more from roughly the same time period:
None of this rhetoric would be out of place in 2024 among the antivaccine movement or the movement that promotes ivermectin to cure COVID-19 (and now cancer and almost everything else). The health freedom movement has always represented any attempt by the government—or even academia or companies—to protect the public from ineffective quackery and fraudulent claims about what a product can do or to urge the public to cooperate with interventions designed to improve public health and prevent disease as “tyranny.”
Many years ago, I routinely used to point out that the level of support for vaccination was pretty similar on both the right and the left. I also used to suggest that, back in Jenny McCarthy‘s heyday as the celebrity face of the antivaccine movement 14-15 years ago, it was the heavy representation of celebrities among famous antivaxxers that contributed to the public perception that the antivaccine movement was predominantly left wing, Hollywood celebrities like Rob Schneider (admittedly, I’m probably being generous in my definition of “celebrity”), Mayim Bialik, Alec Baldwin, and Robert De Niro (who, as an aside, teamed up with RFK Jr. in 2017 to promote a bogus antivaccine scientific “challenge”), among others. It’s also true that areas with a lot of affluent people on the coasts, whose politics tend to lean heavily liberal, have suffered outbreaks of vaccine-preventable illnesses in recent years leading up to the pandemic due to low vaccine uptake. Then, of course, there was (and, alas, still is) Robert F. Kennedy, Jr.
Even then, though, with relatively few exceptions, the most motivated antivaxxers still tended to be conservative, with right wing media giving voice to antivaccine views. As early as 2011, Fox News was airing sympathetic segments on Andrew Wakefield, interviews with Dr. Bob Sears, SafeMinds’ anti-vaccine PSA campaign, and Louise Kuo Habakus (who was virulently anti-vaccine herself and politically active in New Jersey advocating for more easily obtained “philosophical exemption” laws). Politically, some of the most rabid anti-vaccine activists in government were conservative, for instance, Rep. Dan Burton (R-IN). Moreover, as was the case for anti-evolution beliefs, fundamentalist and evangelical Christianity was not uncommonly a motivation for antivaccine views, and, if anything, has become much more so.
I’ve been documenting the increasingly tight association between the right and the antivaccine movement, going back to when the political party formed by antivaxxers, The Canary Party, founded in 2011, started working with Tea Party-affiliated groups in California. Not long after, the Canary Party became known for sucking up to Rep. Darrell Issa (R-CA), with one of its major financial backers Jennifer Larson contributing a lot of money to Issa’s campaign (indirectly, of course) in order to buy influence and win a hearing by his committee examining autism and focused on vaccines as one potential cause. Around the same time, at the right-wing Libertarian FreedomFest in 2012 I was privileged to watch a debate between Julian Whitaker and Steve Novella about vaccines. At the debate, vaccine pseudoscience flowed freely from Whitaker in a most embarrassing fashion, and I couldn’t help but note that FreedomFest that year featured two screenings of Leslie Manookian’s antivaccine propaganda piece, The Greater Good and had featured antivaccine talks in previous years. I was there, too, and amazed at the merchandise and conspiracy theories being touted, although in retrospect, in the era before the rise of QAnon, conspiracy theories about the gold standard and New World Order now seem almost quaint.
This movement rightward by the antivaccine movement appears to have been turbocharged in 2015 during the debate about SB 277, the California law that banned nonmedical exemptions to school vaccine mandates. That was when antivaxxers pivoted from messaging that was primarily about “toxins” in vaccines and the false claim that vaccines caused autism, autoimmune disorders, sterility, and death to messaging that primarily emphasized “vaccine choice,” “freedom,” “parental rights,” and resistance to government mandates. It was a winning message that attracted those of a conservative/libertarian bent, and many of the groups formed in the wake of that political struggle were clearly conservative, such as Texans for Vaccine Choice, Empower Texans, Michigan for Vaccine Choice, and others. (Notice the common thread in the names of these groups?) It is there where the politicization of school vaccine mandates really took off, particularly after Donald Trump entered the mix. By 2015-2016, even Republican presidential candidates like Chris Christie, Ben Carson, and, of course, Donald Trump—Rand Paul, too, but I leave him out because he was always antivaccine—were invoking the same language to pander to the antivaccine movement under the guise of supporting personal and parental rights.
By 2018, I was personally observing this rightward shift and infiltration of conservatism, including the Republican Party, in my neck of the woods, when a candidate for the Republican nomination for my district’s Congressional seat held an antivaccine “vaccine choice roundtable” that I attended incognito and documented. In Michigan, openly antivax candidates were running for state governor and other offices. By 2019, Republicans in Oregon were openly opposing anything resembling tightening school vaccine mandates, and the Ohio Statehouse was rife with antivax legislators, to the point that antivaxxers were bragging about them. Also, to bring it around, antivaxxers in California were openly marching with the California State Militia, specifically the California State Militia, First Regiment, California Valley Patriots, and the State of Jefferson.
Then came the pandemic, and the rest you know. Antivaxxers quickly allied themselves with antimaskers, pandemic minimizers, anti-“lockdown” protesters, ivermectin and hydroxychloroquine promoters, and QAnon, with antivaccine rhetoric becoming increasingly violent. One might, in fact, say that all these groups rapidly merged under the banner of “health freedom” opposed not just to public health but to government regulation of health and medicine in general. However, I will reiterate my contention that the fact that right here, right now, in 2024, the antivaccine movement is overwhelmingly right wing appears to be more a product of our times and its politics than of anything else. Again, back when Jenny McCarthy was leading her “Green Our Vaccines” rally in 2008, for instance, a lot of the appeal was to environmentalism-based concerns appealing to people leaning more left in their politics.
Even before this, however, I used to like to point out that a key belief of the “health freedom” movement has long been that the FDA—or, in other countries, whatever government entity is responsible for regulating drugs and food safety—is not a benign force. Far from it, “health freedom warriors” tend to believe fervently in a conspiracy theory that there are all sort of fantastic “cures” out there that the FDA, through bureaucratic inertia and/or being in the thrall of big pharma, is keeping from you, thereby killing your loved ones, friends, and, ultimately, possibly even you. To illustrate this conspiracy theory, I often refer to a 2014 article by Nick Gillespie, who expressed this hostility towards The FDA quite clearly in a Daily Beast article entitled Kill The FDA (Before It Kills Again). In the article, referencing the movie Dallas Buyers Club, Gillespie proclaimed that the FDA “continues to choke down the supply of life-saving and life-enhancing drugs that will everyone agrees will play a massive role not just in reducing future health care costs but in improving the quality of all our lives.” And what was his rationale for arguing this? Get a load of this:
As my Reason colleague Ronald Bailey has written, this means the FDA’s caution “may be killing more people than it saves.” How’s that? “If it takes the FDA ten years to approve a drug that saves 20,000 lives per year that means that 200,000 people died in the meantime.”
Completely missing from Bailey’s and Gillespie’s equation was the number of drugs that the FDA doesn’t approve because they aren’t safe and don’t demonstrate sufficient efficacy in randomized clinical trials, which could result in even more than 20,000 people a year dying (or some of them even being actively killed). Even Bailey had to concede that the FDA had prevented approval of Thalidomide in the US and the rash of birth defects seen elsewhere in the world. Bailey’s argument is, at best, tenuous, at worse misleading. (I favor worst. It’s just plain misleading.)
You get the idea, though. Promoters of the “health freedom” movement often claim that the FDA is an impediment to innovation, often exaggerating legitimate complaints about the FDA to make this argument and basically arguing that the answer is to make the approval process less onerous. Moreover, there was indeed such an argument to be made during the AIDS epidemic in the 1980s and 1990s, when activists, facing a disease that would kill them in a time period much shorter than it would take for new drugs to be developed, pressured the FDA to accelerate its approval process for certain classes of drugs for deadly diseases, such as drugs designed to treat HIV. The government eventually listened, too, and the FDA developed its accelerated approval program that would tentatively approve drugs based on less evidence, with the proviso that the drug maker had to provide more rigorous evidence within a certain timeframe or risk having their drug’s approval reversed, and expanded access (sometimes called compassionate use) programs that would allow patients to gain access to an investigational drug to use in treatment outside of a clinical trial when no comparable or satisfactory alternative treatment options exist or are available. Unfortunately, as we and others have argued, it is quite possible that now the pendulum has already swung too far in the direction of too easy approval, as epitomized by the track record of the accelerated approval program for cancer drugs.
Let’s look at what RFK Jr. really means, though, when he argues that he’s going to declare war on the FDA.
War on the FDA?
Let’s start the discussion of what RFK Jr.’s plans would likely really mean, if realized, by revisiting his post:
What’s often left out of this meme is that, after Dr. Ley left the FDA in 1969, he did private consulting work for drug companies until the early 1990s. That little tidbit aside, it is true that Dr. Ley said this in a New York Times interview in 1969, shortly after he left the FDA because the incoming Nixon administration had nominated its own candidate, Dr. Charles Edwards. One thing I like to point out is that this quote is juxtaposed in a significant way. It is true that he said:
The thing that bugs me is that people think the FDA is protecting them. It isn’t. What the FDA is doing and what the public thinks it is doing are as different as night and day.
However, nowhere in the 1969 NYT interview did Dr. Ley say, “The FDA protects the big drug companies and is subsequently rewarded,” or “Using the government’s police powers, they attack those who threaten the big drug companies.” I could not find any reliable source quoting Dr. Ley saying either of these things, and this “quote” appears to have been added somewhere over the last 55 years. (If anyone out there can find a reliable source for that part of the quote, please let me know, and I will amend my post.) What’s really interesting to me, though, is that Dr. Ley’s sentiments did not align with the health freedom movement. Indeed, after saying that he thought the FDA was failing to protect the public, Dr. Ley lamented that the agency lacked the funding and resources to fulfill its mission and that more money was needed for it to fulfill its functions. Later in the interview, he described at length incidents when intense pressure was brought upon by pharmaceutical companies that his agency had to resist, including entreaties from Senators and Congressional Representatives speaking for the drug companies. Indeed, he complained that there were days when he spent up to six hours fending off complaints by pharmaceutical companies.
Some things never change, do they? Then, as now, the FDA is grossly underfunded, outmanned, and outgunned compared to the forces arrayed against it. In the past, it was mainly big pharmaceutical companies, but now it also includes powerful politicians aligned with the health freedom movement, such as Senators Rand Paul and Ron Johnson—to whose ranks have been added Donald Trump and RFK Jr. There’s also another interesting article by Dr. Ley that I came across from 1970, The Doctor, the Patient, and the FDA. In it, Dr. Ley makes no bones about his belief that the FDA needed more funding and was totally correct to crack down on quackery, as it did when it issued public warnings about Hoxsey cancer treatments in the 1950s. Let’s just say that Dr. Ley was anything but an ally of the health freedom movement, his complaints about the FDA and what he had to deal with during his three year tenure as FDA Commissioner notwithstanding.
Onward, however. That additional little deception by RFK Jr. supporters aside, let’s look at RFK Jr.’s claims. Basically, it’s a misrepresentation of what the FDA has done and, of course, the promise of all the things listed. Again, I will start by saying that the FDA has never engaged in suppression, much less “aggressive suppression” of exercise or sunlight that I am aware of. Moreover, as we’ve complained about before, the FDA, if anything, has been far too lax in regulating, for example, quackery involving unproven stem cell treatments for conditions ranging from autism (for which quack clinics have even set up unethical and scientifically dubious pay-to-play clinical trials registered with ClinicalTrials.gov to sell their quackery), to stroke, to cancer. There are even profitable companies marketing stem cell quackery without evidence that it works. Ditto chelation therapy, which has never been shown to work for anything except acute toxicity from heavy metal poisoning and has even been studied for cardiovascular disease in two very expensive and unnecessary (and negative) randomized clinical trials. Let’s also not forget that neither hydroxychloroquine nor ivermectin have been demonstrated to work against COVID-19—quite the contrary, in fact—nor ivermectin shown to be efficacious against cancer. As for raw milk, it has no health benefits greater than pasteurized milk, but it does have a much higher risk of food borne infections. (It is, however, “natural,” I guess.)
Of course, nutraceuticals (and vitamins and supplements) are already legal and weakly regulated (if you can call it regulated at all), thanks to the Dietary Supplement Health and Education Act of 1994 (DSHEA), which we’ve written about here many, many times, most recently how it helped conspiracy theorist Alex Jones fund his media empire. Basically, as long as you are vague enough about the health claims for your supplement, nutraceutical, or vitamin concoction, you can sell it to treat almost anything, and the supplement industry has, through its powerful patrons, prevented any strengthening of the law to deal with all the quacks who claim without evidence that their supplements treat disease. On the rare occasions when the FDA does try to crack down on quacks selling unproven or even potentially harmful supplements, the health freedom movement inevitably portrays it as “fascist” or “jack-booted thugs” trying to “suppress” all those “natural” cures.
A field day for quacks if Donald Trump wins and RFK Jr. is put in charge of health policy?
So what would the FDA look like if Trump were to win next week and actually follow through with his appointment of RFK Jr. to a high-ranking health position? The answer illustrates a bit of the dilemma that the “health freedom” movement has, being, as it is, an uncomfortable alliance between crunchy “all natural” health freedom lovers and more hard core libertarians like Nick Gillespie, who believe that the “power of the free market” will “unleash innovation” if only the nasty old FDA were less strict about its standards for pharmaceutical companies. There is an inherent tension there between wanting to be more strict with the “bad” pharmaceutical companies, while approving modalities (or at least much more weakly regulating them) that alternative practitioners want.
On the one hand, MAHA would seem to want to muzzle the FDA with respect to all the quackery listed in RFK Jr.’s post, basically letting quacks do whatever they want with almost anything. Remember, a lot of what is in RFK Jr.’s list is not “natural.” Certainly extracting and isolating stem cells and injecting them into the bloodstream is not “natural,” nor are chelation therapy and hyperbaric oxygen—and especially ivermectin, hydroxychloroquine, peptides, and psychedelics, all of which are manufactured drugs. Again, what “health freedom” really wants is the freedom for quacks to ply their grift without interference from the government.
What will be fascinating to watch is how tensions between the libertarians who believe that big pharma should be unleashed in order to produce “innovation” and cures and the “natural” crunchy crowd and its overwhelming suspicion of anything produced by big pharma will be resolved. Don’t get me wrong, I really don’t want to see RFK Jr. in any sort of official capacity with power over federal health care policy, but, in the unfortunate event that Trump wins and he is appointed HHS Secretary (or, at least, keeps helping Trump pick leaders of the FDA, CDC, and NIH), in particular because his MAHA agenda conflicts with so much of Trump’s other agenda:
RFK’s health mission puts him at odds with Trump’s own track record. As president, Trump heavily subsidized the agricultural industry to alleviate pains he inflicted on farmers with his own tariff policies. His administration peeled back toxic chemical regulations and environmental rules. He undermined school lunch programs and flooded cafeterias with junk food, rejecting the healthy options pioneered by the Barack Obama administration.
The reason is, likely, this:
Being responsive to public opinion doesn’t necessarily make someone smart. It makes them pliable. And perhaps that’s why Kennedy and his followers are willing to take a chance on Trump. They see him as a person who—in his lust for adulation—can be changed or manipulated.
The challenging thing about being around RFK and his crowd is that while their ideas can be hard to take seriously, the underlying concerns they carry are basically unimpeachable: frighteningly high healthcare costs, the murky relationship between pharmaceutical companies and doctors who prescribe their pills, and a very real decline in overall health among the population.
But they are seeking solutions to real problems in the wrong places. Looking into the past won’t save us any more than forgoing your vaccine shots, drinking raw milk, or voting for Trump will.
That is precisely the issue. There are very real concerns about US health policy, but, as is the case with the nostrums RFK Jr. champions for disease and to demonize vaccines, he’s applying policy quackery to address these problems in a way that is inherently self-contradicting. After all, the “free market” contingent of the “health freedom” movement that wants to “unleash innovation” by neutering the FDA is good at manipulation too. I hope we never have to see which faction of the health freedom movement will triumph if there is a second Trump administration. I fear that federal health policy will end up being the worst of both worlds, with far less regulation on big pharma and much laxer standards for drug approval, plus a lot more freedom for quacks to peddle quackery like bogus stem cell therapies, chelation, and “repurposed” ivermectin for everything, while NIH is forced to waste even more money studying useless quackery.
As for a “corrupt system,” no one out-corrupts Donald Trump.