RFK, Jr. Wants Us All To Eat Healthy, Exercise And Get Polio And Small Pox— So, Some Good, Some Bad

What Will The Trump Regime's Policy On Health Care Be?

With the Democratic congressional strategy being to, at least appear, to be cooperative with Trump, a couple of days ago, Peter Hamby wrote that “The first big showdown for Democrats will likely take place in the Senate, where a battery of Trump’s controversial cabinet nominees are set to face confirmation hearings. A new poll from Echelon Insights, in partnership with Puck, suggests that Democrats have an opportunity to drive a wedge between the American public and Trump on the subject of his more outré picks: Pete Hegseth for secretary of defense, Kash Patel for F.B.I. director, Tulsi Gabbard for director of national intelligence, and Robert F. Kennedy Jr. for secretary of health and human services. While a slim majority of likely voters in the poll (52 percent) approved of Trump’s transition so far, their views shifted when asked questions about his nominees, their experience, their views, and the role of the Senate in approving those nominations. Americans overall defend the Senate’s right to confirm or reject presidential nominees, even if it conflicts with a president’s wishes. For instance, half of Americans (50 percent) say it’s appropriate for members of the Senate to reject presidential nominees if they have concerns about them. Only 39 percent say the president should have his nominees confirmed simply ‘because he was elected by the people and has a mandate to choose the people he wants.’ I also had Echelon ask voters if they support recess appointments, which we defined in the poll as ‘when the president makes appointments temporarily without the approval or vetting normally done by the Senate.’ The concept was not popular, even with a proviso that the appointments would be constitutional. Only 30 percent of voters supported recess appointments, while 45 percent opposed the idea.”

He continued that “In the poll, a substantial majority of voters (68 percent) said the Senate should reject Trump nominees who ‘cannot pass a standard security clearance.’ Majorities also gave the Senate latitude to reject a nominee ‘who does not know a lot about the field they are being nominated for,’ a nominee ‘who has conflicting business interests,’ and a nominee ‘who has acted immorally in their personal life.’” And yet nearly half the voters just opted for Trump!!

So that standard is going to be rough for Hegseth, Patel and Gabbard. “And what about Kennedy? He’s obviously far more well-known and his favorable ratings are above water. At the same time, voters aren’t convinced he’s qualified to lead H.H.S.: 41 percent support his nomination, 45 percent oppose, and 13 percent aren’t sure. We also asked voters if they believe vaccines are linked to autism. Sixty percent of voters said no, 17 percent said yes, and the rest said they weren’t sure… Voters are queasy about eliminating or drastically reducing the size of several federal agencies that Trump and his superheated allies are champing at the bit to decimate. With DOGE, Elon Musk and Vivek Ramaswamy are proposing bone-deep cuts to the size of government. Patel has floated the idea of shrinking the F.B.I., the very agency he wants to run. Kennedy has long attacked the Centers for Disease Control. And the president-elect has vowed to abolish the Department of Education— a piece of Republican campaign rhetoric that’s been around for decades, long before Trump came along.  But Echelon found that majorities of voters want to either ‘keep most positions’ or ‘not fire anyone’ at the F.B.I., C.D.C., and the Defense Department. And when it comes to the Justice Department, H.H.S., and the Department of Education, pluralities prefer to keep them in place rather than ‘eliminate most positions’ or ‘start fresh.’”

Asked if they believe vaccines are related to autism, 60% of respondents said no and just 17% said yes. And when told that RFK Jr “has expressed skepticism of certain vaccines and has been nominated by Trump to be the next Secretary of Health and Human Services, 45% said they do not support the nomination and just 41% said they do. Too bad they didn't ask about Medicare-For-All in the poll.

After college, I left the country and lived abroad for nearly 7 years. Almost 4 of those years were in Amsterdam where I worked in a health food restaurant inside Europe’s biggest meditation center, De Kosmos. I was in my twenties. Here's a picture of me in the kitchen. We were all pretty sure that a healthy lifestyle was more effective in staying healthy than was western medicine. I stay in touch with many of my friends from that period in my life, including Ellen, who you're about to meet. Many still believe the same thing. Others have changed the way they see it— at least to some extent. Pretty much everyone, for example, believes that avoiding refined sugar, eating fresh fruits and vegetables, exercising regularly, etc will help you live a longer, healthier life… unless you get run over by a driverless Tesla or a bad case of COVID. I’d say about half of us believe in using vaccines and half don’t. No one is a Trumper. Some are cheering on RFK Jr, though.

Yesterday’s NY Times carried an article by health reporter Gina Kolata about how two perspectives of healthcare— Kennedy’s and Musk’s— are at odds inside Trump World. With 40% of Americans now officially obese, RFK Jr is pushing lifestyle. Musk is pushing cheaper GLP inhibitors (like Ozempic). “Nothing else,” he said, “is even close.”

Kolata wrote that “there, with the contrasting views of two men in Trump’s ear, lie two sides of an issue that is plaguing health and nutrition researchers. Is it even possible to change lifestyles and the food environment enough to solve America’s obesity problem? And, if not, do we really want to solve it by putting millions of people on powerful drugs? What is the right balance between the two approaches? Many people find that eating well is easier said than done. Food companies have saturated the United States and other nations with seductively cheap and tasty things to eat, available seemingly everywhere and around the clock. Obesity researchers suspect that the current food environment has allowed many Americans to be as overweight as they possibly can be. But for the first time, there is an effective countervailing force— powerful new obesity drugs like Wegovy and Zepbound that allow people to ignore the siren call of high-calorie foods and large portion sizes.”

Those with views like Kennedy’s believe it is wrong to use pharmaceuticals to manage obesity and related issues that are tied to unhealthy lifestyle and to a ruinous food environment. The makers of obesity drugs, Kennedy told Greg Gutfeld on Fox News before the election, are “counting on selling it to Americans because we’re so stupid and so addicted to drugs.”

But there are many like Musk, who says he has used Wegovy, applauding the power of the new drugs to improve health and treat the seeming intractability of obesity.

Many health and nutrition researchers say they would love for obesity to be treated through lifestyle changes alone, but they are not optimistic. They point to a history of attempts to teach people to change their diet and exercise habits. Multiple studies left them with dashed hopes and tempered their enthusiasm.

That happened with diabetes.

In 1996, the National Institutes of Health initiated a study involving thousands of people at risk of developing Type 2 diabetes. Researchers led these subjects through an intensive program of diet, counseling and exercise. It worked so well that the study was ended one year early. The intervention slashed people’s chances of developing diabetes by more than half.

The result was so consequential that Tommy Thompson, then the secretary of health and human services under President George W. Bush, joined the study’s principal investigator, Dr. David Nathan, a Harvard diabetes researcher, to announce it in 2001, telling the nation that the study showed diabetes could be conquered.

“Just walk around the block, walk down the street 30 minutes each and every day and we can lick this particular disease,” Thompson said at the time. He also said “Prevention works.”

Until it doesn’t. Diabetes incidence has actually increased since those results were announced 23 years ago.

Permanent lifestyle changes, it turns out, are not easy.

“The problem, of course, is that people being people apparently find it difficult to maintain such changes over long periods,” Dr. Nathan said in a recent interview.

Christopher Gardner, a nutrition researcher at Stanford, is a true believer in the power of a healthy diet. He has done study after study, funded by the National Institutes of Health, in which health professionals guided participants in their food choices or, in some cases, even delivered meals to them.

The studies succeeded— participants’ health improved. But when the studies ended, Dr. Gardner said, and when participants no longer had that guidance or food delivery, many, if not most, went back to their old eating habits and all those benefits of a healthy diet vanished.

“Yes, diet should be the answer,” said Dr. Gardner, who was paid five years ago by a purveyor of meat alternatives to study its products. But, he added, diet will be insufficient “unless some major changes are made to the whole food system in the United States.”

There’s also the problem of genetics, said Dr. Jeffrey Friedman, an obesity researcher at Rockefeller University in New York. Some people have a genetic tendency to become obese, and they will gain weight as long as food is cheap and plentiful. Tweaks like changing portion sizes or food advertising are not enough— if popcorn were sold in smaller bags, many would simply eat two bags of popcorn, he said.

That has led Dr. Friedman, like Dr. Gardner, and Dr. Nathan to conclude that the only practical way to improve people’s health and allow them to lose weight is to rely on the new obesity drugs.

Dr. Charles Burant, a professor of internal medicine at the University of Michigan, is sympathetic to Kennedy’s view that the problem is the food system.

He recalled an experience with one large food company that showed him how hard it could be to change what foods are marketed to Americans.

He had an idea for a palatable drink containing an amino acid that he thought might sate hunger.

So he went to the large food company and asked if it could make such a drink for him to test in a study. After a while, he received a reply: It was not in the company’s business plan to develop products that reduced appetites. It was not interested in helping.

“It wasn’t their business to sell less food,” Dr. Burant said.

“If you can rein in corporations or try to use pressure to modulate what they do, I think that’s great,” he added. “But in the meantime, until the population learns to eat good things, we need to do something to help people.”

Others, like Dr. Kevin Volpp of the University of Pennsylvania, worry about promoting the widespread use of obesity drugs. He worries about the idea of tens of millions of Americans injecting themselves weekly with drugs to curb their appetites.

“There is not enough money in the system to suddenly fund drugs for that many people,” Dr. Volpp said.

He prefers to reserve the drugs for adults with the most serious diseases related to obesity.

Instead of handing out drugs to nearly all who qualify, Dr. Volpp said the country needed to consider other solutions, like marketing restrictions and taxes on sugary beverages.

He also would like health insurers to help subsidize the purchase of healthy food for those who can’t afford it and have chronic medical problems, like diabetes, that are related to diet. Eleven states have secured permission to test the use of state Medicaid programs for pilot studies along those lines, he said.

“All this is like pieces of a jigsaw puzzle,” Dr. Volpp said. “But we have to try everything that will help make our population healthier, given the rise in obesity from 12 percent to 40 percent in the past few decades.”

It’s not clear, though, how to put the jigsaw puzzle together, or whether to even try.

For Dr. Peter Lurie, the president of the Center for Science in the Public Interest, the situation is dire enough to try everything all at once.

His organization, he said, firmly believes that the food environment is an important factor driving high obesity rates, and he wants it to change.

He also describes himself as “something of a pharma skeptic.”

But “when the pharmaceutical industry comes up with strong data that affects important outcomes,” Dr. Lurie said, “it is irresponsible to turn your back on it.”

That is also the view of Dr. Robert Califf, who has been serving as commissioner of the Food and Drug Administration under President Biden. Before he joined the F.D.A. in 2016, Dr. Califf, a cardiologist, ran a clinical trials center at Duke University that received funding from drug companies as well as from the federal government.

“While I am totally in favor of helping Americans have a better diet, these drugs are highly effective” for people with obesity, Dr. Califf said. “Not just for losing weight,” but also for preventing heart disease deaths.

In the meantime, “we have to control the advertising,” he said, and “we have to gradually change the agricultural system,” and “we have to subsidize healthier foods.”

“You can either be a cynical old vet and say this is impossible, or you could be optimistic,” Dr. Califf said.

Ellen— pictured on the right in Amsterdam with her first son, Jamil— is one of my oldest and dearest friends. We met in the mid-1960s at Stony Brook and she came to visit me in Amsterdam one summer, started working at the restaurant, got married, settled down and started a family. And wound up staying— even after I moved back to the U.S. several years later. (In fact, things were so lax then at airports, that I think I used her ticket to fly home with!) She moved back to the U.S. not long after I did and became a nurse practioner, having earned 2 masters degrees and then her PhD at a univeristy hospital, where she now works as a Nurse Researcher.

Yesterday, I asked her to weigh in on the RFK Jr vs Musk perspective from the point of view of someone who lived through the Kosmos years and then became a medical professional. "I’ve long had mixed feelings about the GLP-1 drugs.," she told me. "Over five years ago, one of my friends was in an initial clinical trial for one of those drugs. The trial ended early because of the success of the medication. Since then, there have been so many unanticipated benefits of the GLP-1 drugs, demonstrating a huge potential impact on individual and population health and the burden of chronic diseases. 

"I’ve often thought of these medications as the lazy man’s way to weight loss, wondering why people couldn’t just lose the pounds on their own. The thought of a lifelong dependence on these drugs seemed hard to comprehend. While not still macrobiotic, as we were in Amsterdam, I do try to maintain a healthy diet and active lifestyle. I also have a background in Western medicine based on my nursing education and I do take medication as needed (after some initial reluctance). So where do I stand now?

"I’ve seen my brother try unsuccessfully over the years to lose weight and begin to display the body type that my father had before he had a fatal heart attack. He’s gone on a GLP-1 drug and lost 50 pounds, and is now at an ideal weight. I’m happy not to have to worry about his health anymore. 

"I still feel strongly that the best way to lose weight and maintain health is through diet and exercise. I myself would not choose to take a GLP-1 drug. I do take some medications that I will need to take indefinitely, and have tempered my view on the issue of long term dependence on those drugs. I don’t support mass use of these medications, but sadly so many Americans fail to achieve weight loss goals on their own. Thoughtful and targeted prescribing would be my recommendation."