Alexandra Sifferlin, a health and science editor for Times Opinion, hosted a written conversation with the Opinion columnist Ross Douthat and the Opinion writers Jessica Grose and David Wallace-Wells about Robert F. Kennedy Jr.’s first two months as secretary of health and human services.
Alexandra Sifferlin: Robert F. Kennedy Jr. vowed to tackle chronic disease and take on the food and pharmaceutical industries. But his response to a measles outbreak in the Southwest — and inflammatory remarks about autism at a press briefing — have drawn criticism from all sides.
Ross, you’ve written about your own experiences with chronic illness and the limitations of the U.S. medical system. What’s been your view of Kennedy’s Make America Healthy Again movement, and what do you make of his tenure as health leader so far?
Ross Douthat: I think debates about the limitations of the U.S. medical system tend to be polarized in a very, shall we say, unhealthy way. On one side, you have people who haven’t hit the limits of medical consensus and knowledge in their own lives, and therefore struggle to understand why so many of their fellow citizens would want to wander outside those limits in search of answers or wisdom. On the other side, you have people with very good reasons for skepticism of conventional wisdom, but who have allowed that skepticism to become total, making them reject everything the establishment says while fastening onto a specific outsider narrative as an absolute alternative even if the evidence is lacking.
On a lot of fronts, Kennedy and the MAHA movement exhibit the latter problem. There’s absolutely room for new research and new debate about the causes of chronic illness, or autism or obesity — all areas where the official understanding of things doesn’t have definite answers for a lot of people. And there’s always good reason for skepticism about the medical-industrial complex writ large. But Kennedy seems committed to his own set of low-evidence theories — the vaccine-autism link being the most prominent example — and he seems to be working backward from the outsider perspective, rather than trying to genuinely create dialogue between the establishment and its critics.
David Wallace-Wells: I’m not sure it’s even just low-evidence theories. I worry about the quality of the evidence demonstrating the problem. One thing I’d really like to see an autism commission tackle is the seemingly simple question of to what degree we actually are really living through an epidemic. I think there are reasons to worry about an increase in cases, and about environmental factors contributing. But I also think the alarming charts you see showing exponential growth in prevalence are really not very credible, and yet they are what is powering our panic.
I see this as a problem much bigger than autism, by the way. Bipolar diagnoses recently grew 40-fold in America. Among college students, A.D.H.D. diagnoses have gone up 72 percent since 2010, and Paul Tough just wrote a long piece in the Times magazine exploring the possibility that the country has grown quite hysterical about the disorder. Across the board, I worry that we are living through a crisis of diagnostic inflation.
What’s interesting is that Kennedy and the MAHA folks are open to thinking about these things at some level. They’re worrying about overmedicating children, for instance. But they are also motivated by the scary charts, and persuaded by them that there is something deeply wrong.
Jessica Grose: I don’t know that I see the framing of the polarization in the same way as Ross. Most scientists are themselves very skeptical people. When you interview them, their explanations are full of caveats. MAHA and Kennedy have a much easier communications task, because as you say, Ross, he’s often working backward from a conclusion, like vaccines cause autism. It’s definitive and it’s clear, even though from all available evidence it’s not correct.
I also push back against your framing that MAHA and Kennedy are the only people who are thinking about this problem and other issues with the American medical system. I have personally written about the side effects of birth control, for example, and how I think pharmaceutical advertising should be banned, which Kennedy agrees with. The genius of this movement is that they frame themselves as uniquely skeptical or truth-telling, when they’re not. I would say the biggest problem in terms of health polarization is social media, and how Kennedy and the Children’s Health Defense, the organization that he helped found and run, science-wash their statements to make them seem like they have a veneer of official medical knowledge.
Wallace-Wells: On some level I am inclined to see Kennedy as a good-faith actor on this — deluded and conspiratorial, yes, but operating consistently over a long period of time. What worries and depresses me more is the support he’s won from people like Jay Bhattacharya, the new director of the National Institutes of Health, and Marty Makary, the new head of the Food and Drug Administration — good, serious scientists who in my view went through the Covid rabbit hole and came out the other side with a new set of standards for themselves and for science. How can Bhattacharya say with a straight face that scientists are scared to look into the link between vaccine and autism? It’s absurd.
Douthat: I definitely don’t think Kennedy is the only person thinking about these problems, and I think it’s unfortunate that the specific claim about a link between vaccines and autism — which as far as I can tell has no real evidence behind it — has become a kind of condensed symbol of the entire establishment-outsider debate. I do think, though, Jess, that while working scientists are often very skeptical and good at self-criticism and offering caveats, doctors and public health officials, in somewhat different ways, feel pressure to project often unwarranted certainty about their own expertise, in a way that their outsider rivals then imitate and mirror.
To your points about diagnostic inflation, David, I think two things can be true at once: There is a set of difficult conditions, some congenital and some probably related to infection, where existing medical investigations have hit something of a wall in understanding the origins and proposing effective therapies, and there’s also a tendency to overdiagnose. Social media contagion makes it hard to tell how fast any of these conditions are actually increasing — and that creates a feedback loop where skeptics become more dismissive of the real problems because they assume that if you say you have certain chronic conditions you must just be a hysteric.
Wallace-Wells: I agree that both things are true. I also think we’ve developed an unfortunate tendency — not just in the world of MAHA but even in institutions like ours — to lay quite a lot of blame on the failure of establishment actors to comprehensively address questions like these, and much less blame on those simply setting fire to the institutions. This marks me as quite a normie liberal, I know, but I just can’t look back on the pandemic and think, the problem here is that Anthony Fauci and Rochelle Walensky, the former director of the Centers for Disease Control, slightly oversold the ability of vaccines to entirely stop spread, rather than the numbers of pretty high-profile people circulating video compilations of sudden vaccine death.
Grose: I’d love evidence that Kennedy is a good faith actor. I think he’s someone who has become wealthy and powerful based on his advocacy and he holds anyone who disagrees with him in contempt.
Wallace-Wells: Fair enough. Maybe it’s better to say his is a long-form variety of opportunism.
Douthat: I would say — again, from my own lived experience — that someone can have an entirely good faith attraction to helping a specific suffering community that medical orthodoxy seems to be failing, which can then curdle into its own kind of orthodoxy that doesn’t leave room for contrary evidence. If Kennedy were a self-interested political opportunist, he wouldn’t have ended up quite so far out on the fringe; to me it looks more like a path of sincere idealism leading into a bubble of the like-minded and self-righteous.
Sifferlin: As you all have noted, Kennedy built his brand on criticizing the public health establishment. But now that he’s in charge of it, he has to deliver real results. Including responding to the growing measles outbreak. Do you think being in power could counterintuitively fracture the MAHA movement, which was until now arguably characterized by its opposition and outsider status?
Wallace-Wells: One thing that worries me here is the possibility that we’ve passed through a disturbing bottleneck, to quote Ross, in which many of the old social rules don’t apply. People used to talk about the “Disneyland effect”: when there was a large measles outbreak at the amusement park in 2014, it produced an international wave of concern, a measurable increase in popular support for vaccines and vaccination, and, in policy, a change to the California rules about vaccine exemption.
But now? The Texas outbreak is still relatively new, and I haven’t seen large-scale surveys measuring the effect on vaccination. But the families of the dead are not expressing regret, and Kennedy’s old organization is highlighting their unwavering commitment. According to one recent poll, nearly half of surveyed Trump voters believe it is at least “probably” true that the Covid-19 vaccine — which saved several million American lives, and more than 20 million worldwide — was “the deadliest vaccine ever created.” Will there be meaningful blowback against destructive public health policies? I’m a lot less sure than I would’ve been a few years ago.
Grose: David, I share your concern and I think it’s hard to know what will happen. I talked to a doctor in West Virginia — who practices in a very conservative area — who told me that he’s seen more vaccine skepticism in the past year than ever before in his career. It was his opinion that we’re going to have to experience many outbreaks like the ones we’re having now to get the hard-core skeptics back on board. It might have to be something even deadlier than measles, which is horrible to contemplate.
Douthat: I spent a lot of time in my own youth in the 1980s and 1990s around people on the crunchy left who were anti-vaccine, and my sense then was that it often followed from some kind of personal experience — a kid having a bad reaction to a vaccination course, knowing someone who had a vaccine injury, etc. — rather than just from imbibing a broader antivaxx worldview. I don’t know if the internet or polarization has changed that pattern, but one thing to keep in mind about the vaccine debate is that it has always been a difficult collective-action issue. You are exposing your child to some (yes, statistically modest, but nonetheless real) risk of vaccine side effects or injury for the sake of achieving herd immunity. So in a more fractured society it wouldn’t be surprising that the prosocial pitch would weaken.
Grose: I have found the same thing in my reporting, Ross. Moms who become vaccine-skeptical often had a bad experience around the medical system during their pregnancy or postpartum and they felt unheard, and it led to a total distrust of the system. The internet just super powers it because there’s a well-trod path from general medical skepticism to specifically antivaccine takes. But it’s not just collective action or desire to be a good person; it’s law. Over time, more states allow for exemptions. Historically, the states with the highest vaccination rates have few loopholes for exemptions.
Wallace-Wells: I see the math here a little bit differently, because I don’t think the real purpose of vaccination is to achieve herd immunity, however much “pro-science” liberals like to talk about that. I see the main purpose as lowering your child’s risk of serious illness. We may talk about vaccination trade-offs in these terms — personal risk versus social benefit — because given widespread vaccination, the additional risk to your child may be relatively small. But the much more significant impact of a shot is on the person getting the shot, not on the rest of his or her nursery school, right?
I remember being pretty frustrated about this during the first year of Covid vaccination, when liberals were outraged about the relatively low rates of vaccination among conservatives. I kept thinking to myself, yes, there is some cost to society of lower vaccination rates leading to increasing disease prevalence, pressure on hospitals and need to reimpose social restrictions. But at a disease level, the person refusing the shot is also the person shouldering a much larger share of risk — so much larger than the additional risk he or she is imposing on the community.
Sifferlin: To return to autism — Kennedy caused a stir during his recent press briefing where he said autism “destroys families.” While there seem to be plenty of families that would welcome more support, as Jess has covered, Kennedy has also offended many people. What do you all think about Kennedy’s making autism the centerpiece of his early agenda? Why take on autism first over, say, obesity or cancer?
Douthat: I think it just reflects his particular interests and obsessions, and again, his obvious belief that there might be an explanation here — the vaccine theory, which again I think clearly lacks evidence — that the establishment is ignoring or covering up.
The one thing I’d say about the controversy over his remarks is that, yes, many people with autism diagnoses lead flourishing lives and see their families successfully adapt, but Kennedy isn’t wrong that the condition and others like it can be truly devastating, a tremendous cross to bear, in ways that do make causal explanations urgent. It’s just that, again, the causal explanation he wants reinvestigated seems to be clearly wrong.
Grose: But there are all sorts of disabilities that children have that are very difficult for families, and those families feel unseen and unsupported. I agree that our care systems don’t spend enough time, money or advocacy on those families, but it’s hard to take Kennedy’s concern seriously when he is absolutely gutting his own department.
Wallace-Wells: The thing that most struck me about his comments was what Jess emphasized at the top of her recent piece about it: the undertone of eugenics, and the suggestion that we should be much more hardhearted in applying measures of fitness to the population as a whole. This is something I’ve been writing about as a deeper shift in our social politics since the pandemic, with more people seeming to believe not just that the world is a dog-eat-dog place, but that it should be, and that building a genuine meritocracy means growing much less sensitive about, and attentive to, those we judge weak or even just ill-suited.
Sifferlin: It’s not hard to envision where this might be headed — it seems likely that Kennedy’s autism study will draw a connection to vaccines. Is there anything that can or should be done to prevent or respond to that inevitability?
Grose: I hold out minor hope that Republicans in the administration who have actual medical degrees will put the health of our country over party and say something. They are the only ones who can influence this, because anything mainstream doctors, science communicators or the journalists say will just be framed as a deep state/fake news conspiracy trying to suppress the truth.
Sifferlin: The Trump administration has cut the work force of H.H.S. by around a quarter. Are Kennedy’s MAHA goals even feasible with such cuts?
Douthat: If the MAHA goal is to try to somehow substitute wellness programs for treatment programs, then you could argue yes. But that idea of substitution, again, reflects the weakness of outsider theories: Instead of trying to supplement the medical establishment where it’s missing things or doing too little, they tend to want to replace or reject too many things the establishment gets right.
Grose: The No. 1 thing we could do to help more people is expand health care coverage — I think there’s a zero percent chance that happens under this administration. Maternal and child health programs have already been cut.
Sifferlin: No one’s job ever seems truly safe in a Trump administration, but how much does Trump still need Kennedy and his MAHA movement? Do you think he’s around for the long haul?
Douthat: If he just keeps saying controversial things, he can stick around for a long while, because there’s plenty of that to go around. If you get a real public health emergency, then he would become vulnerable in a hurry.
Grose: I don’t think anyone is ever permanently safe. I think if Kennedy angers the wrong business interest groups, that would also be bad for him — Trump seems to care only about the market response to policy. But as long as Kennedy is willing to smile and eat fast food next to the president, he can hold on.
Alexandra Sifferlin is a health and science editor for Times Opinion. Ross Douthat is an Opinion columnist, and Jessica Grose and David Wallace-Wells are Opinion writers.
Source photographs by Ash Ponders for The New York Times, and Mary Conlon/Associated Press
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Ross Douthat has been an Opinion columnist for The Times since 2009. He is also the host of the Opinion podcast “Interesting Times with Ross Douthat.” He is the author, most recently, of “The Deep Places: A Memoir of Illness and Discovery.” @DouthatNYT • Facebook
Jessica Grose is an Opinion writer for The Times, covering family, religion, education, culture and the way we live now.
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