President-elect Donald Trump has caused more concern in health circles with his selection this week of celebrity doctor, cardiothoracic surgeon Mehmet Oz, to oversee a key government agency.
Oz will oversee the Centres for Medicare and Medicaid, which is responsible for more than $1trn in annual spending, with objectors describing him as unqualified for the mammoth task.
This comes as Trump's selection of Robert F Kennedy Jr for secretary of the Department of Health and Human Services (HHS) continues to attract mixed reactions in the US, and been called “an extraordinarily bad choice”, by Dr Ashish Jha, dean of the Brown University School of Public Health – just one of numerous experts expressing concern.
Although Trump had suggested before the election that he planned to let vaccine sceptic Kennedy “go wild” on health, food and medicine, his official selection for the nation’s top health post has sent shockwaves through the public health world, which is concerned about his potential effects on vaccination rates, research on infectious diseases and misrepresentation of established science.
“Kennedy is a clear and present danger to the nation’s health. He shouldn’t be allowed in the building … let alone be placed in charge of the country’s public health agency,” said Robert Weissman, co-president of the consumer advocacy non-profit Public Citizen.
Dr Michael Osterholm, director of the Centre for Infectious Disease Research and Policy at the University of Minnesota, told CNN before the election that he was concerned about potential Trump policies and Kennedy’s “pseudoscience”.
But even some sceptics acknowledged that they agree with parts of Kennedy’s ideas, including around fixing the food system.
Some of the areas where Kennedy is planning changes include:
‘Cleaning up’ HHS
Kennedy is eager to work with HHS employees to rid public health agencies of “corporate capture” and “clean up corruption”.
“I look forward to working with… HHS to free the agencies from the smothering cloud of corporate capture so they can pursue their mission to make Americans once again the healthiest people on earth,” he said.
“We will … return our health agencies to their rich tradition of gold-standard, evidence-based science… so they can make informed choices for themselves and their families.”
Several key agencies, like the US Centres for Disease Control and Prevention and the US Food and Drug Administration, fall under the HHS umbrella, and Kennedy fired a broadside at the FDA late last month.
“FDA’s war on public health is about to end,” he posted on social media. “This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, Ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma. If you work for the FDA and are part of this corrupt system, I have two messages: 1. Preserve your records, and 2. Pack your bags.”
That warning followed comments Kennedy has made about ending National Institutes of Health research into infectious diseases, putting doctors in the field on edge.
“Infectious diseases are very much a part of our present and will be very much a part of our future, and he wants to stop studying them?” said Dr Paul Offit, director of the Vaccine Education Centre and an infectious diseases physician at Children’s Hospital of Philadelphia.
Vaccines
Routine childhood vaccinations are estimated to have prevented hundreds of millions of illnesses, tens of millions of hospitalisations and more than 1m deaths between 1994 and 2023, according to the CDC.
However, Kennedy has promoted false claims about vaccination for years and founded the non-profit Children’s Health Defence, which promotes anti-vaccine material, like the recent documentary “Vaxed III: Authorised to Kill.”
In July 2023, in a televised interview, Kennedy said vaccines cause autism, a claim that has been repeatedly disproved.
He has also repeatedly misstated the contents of vaccines, falsely claimed there is convincing evidence that the 1918 flu pandemic and HIV both originated with vaccine research, and repeatedly touted misinformation about Covid-19 vaccines.
Hawaii Governor Josh Green, a physician, told CNN last week that Kennedy “rallied” people in Samoa against vaccinations in 2019, contributing to a measles outbreak that killed 83 people, mostly children.
Fluoridated water
Kennedy has said the government will recommend fluoride be removed from the nation’s water supply.
“On 20 January, the White House will advise all water systems to remove fluoride from public water. Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease,” he posted on social media.
Fluoride has been added to many public water systems countrywide since 1945 in efforts to prevent tooth decay by strengthening the protective outer layer of enamel. More than 60% of the US population is served by fluoridated water systems.
And although high levels of fluoride have been linked with lowered IQ in children, according to a federal review, the American Dental Association calls fluoridated water “the single most effective public health measure to prevent tooth decay”.
In September, a federal judge ordered the US Environmental Protection Agency to take additional measures to regulate fluoride in drinking water because of the possible risk to children’s intellectual development.
US District Judge Edward Chen ruled that while it’s not clear whether the amount of fluoride typically added to water is causing a drop in IQ in children, there’s enough risk to warrant investigation, and that the EPA needs to take further action in regulating it. The agency is reviewing the decision.
Food
Kennedy has advocated for regulating chemicals in food and limiting access to soda and processed foods through school lunches and the Supplemental Nutrition Assistance Programme – and proposed an idea to swop tallow fat for seed oils to make the fried chips in popular takeaway food chains healthier.
His messaging on food policy has resonated with some health experts in that field.
“They are calling for… something to co-ordinate and address diet-related chronic diseases, stopping corporate power, eliminating conflicts of interest between industry and government, getting toxic chemicals out of the food supply, and doing everything possible to refocus the food environment and dietary advice on health,” food policy researcher Marion Nestle wrote on her Food Politics blog.
“These are things I’ve been writing about here for years. It’s hard to argue with any of this and I won’t.”
Obesity drugs
And while he has also pledged to tackle high rates of chronic diseases like diabetes and obesity, it is unlikely Kennedy will tackle those goals with medications like Ozempic in mind.
“They’re counting on selling it to Americans because we’re so stupid and so addicted to drugs,” Kennedy said last month, concluding that Ozempic is not going to “Make America Healthy Again”.
He claimed that Ozempic-maker Novo Nordisk doesn’t market the medicine in its home country of Denmark because “they do not recommend it for diabetes or obesity; they recommend dietary and behavioural changes”.
In fact, Denmark does use Ozempic, so much so that the Danish Medicines Agency said in May that it would restrict its use until after people had tried less expensive medications to treat diabetes.
Instead of a shift to swop medication for lifestyle changes, as Kennedy suggested, it was a cost-cutting move, since more than 100 000 people had received the drug or others in the GLP-1 receptor agonist class.
Denmark also uses Ozempic’s sister drug approved for weight loss, Wegovy, and has similarly grappled with the cost, questioning whether its benefits justify them. It’s a debate also taking place in the US, where the drugs are priced far higher.
Kennedy also said the EU “is investigating Ozempic for suicidal ideation”, although the European regulator concluded in April that available evidence doesn’t suggest Ozempic and other GLP-1 medicines cause suicidal thoughts or actions.
He also claimed that if the US spent a fraction of what it would cost to treat every overweight person in the US with Ozempic on rather “giving good food, three meals a day to every man, woman and child, we could solve the obesity and diabetes epidemic overnight”.
Dr Angela Fitch, co-founder and chief medical officer of Knownwell, which specialises in healthcare for obesity, said Kennedy’s suggestion that diet and exercise alone can solve obesity “overnight” would set back hard-won efforts to better address the condition.
“We’ve been trying to bust that stigma for years,” Fitch told CNN. “We’ve heard his rhetoric of ‘I want people to just eat less and exercise more’, and we know that doesn’t work.”
Kennedy’s views on Ozempic don’t appear to be shared universally throughout Trump’s orbit. In a post on Friday, Elon Musk, who’s been tapped to cut government spending in the Trump administration, suggested that making GLP-1 drugs “available at low cost to Americans who wish to use them would greatly improve health and reduce healthcare costs”.
Musk said in October 2022 that he had been using Wegovy.
Oz choice questioned
On Trump’s choice of celebrity TV physician Oz to oversee the CMS, a powerful agency in charge of programmes covering more than 150m Americans, detractors say he is unqualified for the role, reports The Washington Post.
“Dr Oz will be a leader in incentivising disease prevention, so we get the best results in the world for every dollar we spend on healthcare in our great country,” Trump said.
But experts say little in Oz’s background has prepared him for the task of running the vast bureaucracy of CMS.
Frank Pallone Jr, from the House Energy and Commerce Committee which oversees CMS, called it a “workhorse agency” that helps provide healthcare to low-income Americans, older Americans, children and other vulnerable populations.
“I am alarmed that Trump has chosen a TV celebrity without the experience or background to lead it,” Pallone said.
However, Republicans have praised Oz, pointing to the cardiothoracic surgeon’s credentials: Oz obtained medical and business degrees from the University of Pennsylvania and served as a Columbia University professor.
He gained national attention for his appearances as a health expert on Oprah Winfrey’s TV show before hosting his own Winfrey-backed TV programme that debuted in 2009 and ran for more than a dozen years.
His claims on that show, including segments on possible weight-loss regimens and dietary supplements, were frequently panned by public health experts.
Trump, who has long said he was a fan of Oz’s television appearances, previously appointed him to the President’s Council on Sports, Fitness and Nutrition.
President Joe Biden removed him in 2022.
Oz also pressed officials in 2020 to authorise the anti-malarial drug hydroxychloroquine as a coronavirus treatment. Trump publicly touted the drug, despite repeated warnings from health officials that it was unproven as a possible treatment for the virus.
Some healthcare groups congratulated Oz on his nomination, like the Federation of American Hospitals, an association of for-profit hospitals, but others described it as a shocking departure.
“At this rate, they should rename the department the Department of Hydroxychloroquine, Homeopathy, and Supplements,” said Peter Lurie, president of the Centre for Science in the Public Interest, a non-profit that focuses on food and health safety.
See more from MedicalBrief archives:
Childhood jabs at risk as medical and religious freedom wins ground
Legal tussle over fluoride in US tap water and link to IQ
Anti-vaxxers target doctors on social media and rating websites
Questions remain on weight loss drugs' suicide risk – US study
Ivermectin papers show limitations of ‘inherently unreliable’ summary data