What Does RFK’s Confirmation Tell Us About the US and Health Care?

The constitutional processes are now complete and Robert F Kennedy, Jr. has been confirmed as U.S. Secretary for Health and Human Services despite a vicious, and at times vitriolic, campaign waged by the biomedical and public health establishment. For more than 50 years, I have been reading work by U.S. medical sociologists on the power and influence of this group, and its consequences for health policy. In the light of this literature, it is difficult to convey just what an extraordinary event we have just witnessed. It goes against everything that social scientists writing about the US health system, have argued since at least the 1960s. Necessary health reforms have, it is said, been consistently blocked by the unchecked strength of the medical-industrial complex.

Now, it appears, that ascendancy is over, at least for the time being. This is not, of course, a guarantee that necessary reforms will be enacted. If RFK takes a wrecking ball to childhood vaccination programs, for example, children will suffer and die preventable deaths. I am old enough to have known the threat of polio and experienced measles, mumps and chicken pox. I am glad that my children and grandchildren have been spared these. I am pleased that my grandchildren will receive HPV vaccines in due course and see their cancer risks greatly reduced. But, I think, we should also ask how it has become possible for the biomedical and public health elites to become so discredited that such programs can be questioned.

RFK’s nomination and confirmation should be considered alongside the popular response to the murder of the CEO of United Health Care in December 2024. As of February 11, it is reported that $300,000 has been raised by a crowdfunder for the alleged killer’s defense costs. Many commentators were deeply offended by the apparently common popular response to the crime, namely that anyone working at that level for a for-profit health care organization had it coming. Americans may value some features of their system but seem to be increasingly disillusioned by its culture, costs and constraints. While individual doctors may still be loved and respected, the profession seems to be increasingly distrusted for its collusion with other profit-seeking players and lack of accountability for the consequences. It is no longer assumed that doctors are the allies of patients against a corporate world so much as participants in the exploitation of the sick for profit.

Public health elites have fared little better. We should not underestimate the impact of their patrician disdain for the struggles of ordinary people as a result of their actions during the COVID-19 pandemic. They are not the ones who suffered from the social and economic dislocation caused by endless lockdowns or whose children were alternately shut out of school or subjected to control regimes more appropriate to state prisons. As time has passed, it has become increasingly clear that many of these non-pharmaceutical interventions had little or no evidence base despite the claims that policies were science-driven. In his evidence to Congress, for example, Anthony Fauci admitted that the ‘6-foot rule’ ‘just appeared’ and that he could not recall reading any studies that would have justified masking children. Throughout the questioning, his ‘recall’ failed at least 100 times.

The licensed opposition went missing in action. Where were the scholars noting that Foucault was right to draw attention to the parallels between carceral punishment and public health discipline? Aged bioethicists and legal scholars allowed their own vulnerabilities to trump principles of consent and autonomy that they had devoted their working lives to promoting. Epidemiologists who drew attention to the social distribution of risk and the flimsy assumptions of modelers were smeared as COVID-deniers. Proportionality went out the window.

If the space for scientific debate was vacated, no-one should be surprised that it was filled by others distrustful of their recent experience of U.S. medicine. The country has always had a rich seam of alternative healing practices, based on assumed indigenous traditions, faith and counter-cultures. Trumpism is an unlikely, and probably unsustainable, coalition of people with grievances – poor men with limited education who feel undermined by female advances in legal protection and the labor market; women threatened by the proliferation of diverse identities and family forms; faith groups hostile to an increasingly secular society; billionaires who see the power of money diluted by democracy.

You might think that this was an appropriate moment for some self-reflection on the part of leaders in biomedicine and public health. How had they come to lose the confidence of the American public? What would they need to do to regain that trust? How could they reach out to engage with people who thought differently from themselves? Had they really failed to understand what was going on around them in societal change and the expectations of debate, participation and accountability?

Not a bit of it. There are simply loud assertions about the scandal of someone who is not a ‘member of the club’ being appointed as secretary of HHS, as if it were an aristocratic office like the Keeper of the Royal Stool. The secretary’s role should properly be to secure political accountability and challenge expertise. RFK may not be the best equipped to do this but the principle is important. Similar complaints are voiced about the appointment of a health economist to lead the National Institutes of Health, as if this were not a professional background wholly suited to asking hard questions about science policy and value for the investment of taxpayers’ money.

This is an issue that many national governments are currently struggling with. In the fat years of national prosperity, biomedical science became so used to a stream of public funding that this gave rise to a sense of entitlement. Many scientists assumed that they would be supported to pursue their interests, funded by levies on people who earned much less than they did, without ever being required to justify their work. If they engaged with those publics, it was out of altruism or benevolence rather than accountability and self-interest.

Biomedical and public health elites cannot simply dissolve the American people and elect another, to misquote Bertolt Brecht. This is a moment for a degree of humility rather than doubling down on calls to remedy the ignorance of those who do not afford the medics and scientists the status that they assume for themselves. It is time to ask ‘where did we go wrong?’ rather than denouncing the deficient intellects of those who think unapproved thoughts.