RFK Jr. is not a serious person. Don't take him seriously.

Well, president-elect Trump has announced that he will nominate Robert F. Kennedy Jr. to be the Secretary of Health and Human Services (HHS), putting him in charge of most of the nation's public health and medical research.

I can't say strongly enough how unqualified RFK Jr. is for this job. He isn't qualified to come anywhere within a thousand miles of any medical or science-related issue, much less to be in charge of health policy for the whole country. Virtually everything RFK says about science is wrong–actually, it's worse than that, because he speaks with such absolutely certainty, despite being wrong, that he convinces people to take actions that end up hurting themselves. To a normal person, someone not accustomed to lying so boldly, these claims can be convincing.

Since Trump's announcement of the nomination, I've been seeing columns in major media outlets (I'm looking at you, New York Times and Washington Post) saying things like "hey, some of RFK's ideas aren't entirely wrong." 

Just. Stop. Even a broken clock is right twice a day. Don't take RFK Jr., or his nomination, seriously.

I don't want to try to list all of RFK's mistaken views, which would require a book-length column, but here are a few. Just last year he said, on the Lix Fridman podcast, that "there’s no vaccine that is safe and effective," and that the polio vaccine did more harm than good. (Both of those statements are wildly wrong.) In 2005, he wrote a long essay for Rolling Stone and Salon which claimed that thimerosal-containing vaccines cause autism (they don't), and that the government knew about it and had been covering it up:

“The story of how government health agencies colluded with Big Pharma to hide the risks of thimerosal from the public is a chilling case study of institutional arrogance, power and greed.” [quote from RFK Jr.]

The article was full of dramatic claims like this one. The only problem was, all of them were false. Rolling Stone and Salon eventually retracted the article and deleted it from their websites. 

In 2019, Kennedy visited the island nation of Samoa to spread his anti-vaccine message, sponsored in part by his anti-vaccine organization, Children's Health Defense. (The name is highly misleading.) Vaccination rates plummeted, and just a few months later a tragic measles outbreak began, causing 83 deaths and 1,867 hospitalizations. Kennedy published an article afterwards calling it a "mild measles outbreak," and in the same article claims (falsely) that vaccines themselves, rather than measles, caused the deaths.

RFK Jr. is someone who never admits he was wrong, even (or especially) when his mistakes cause the deaths of innocent children. Instead, his conspiracy-addled brain blames someone else.

And that's only a tiny sample of RFK's misinformation. He also loves raw milk, which I wrote about in 2014 and again in 2023. Raw milk sometimes contains nasty bacteria and viruses, but fortunately Louis Pasteur solved this problem in the 1860s, when he invented what we now call pasteurization. As I pointed out in my 2023 piece, bacteria just love raw milk. And you know what else is in raw milk but not pasteurized milk? Cow poop. Just don't tell this to RFK Jr. 

By writing columns saying "RFK Jr. has some good ideas" (which I won't link to, since that's just feeding the beast), media organizations are falling into a trap: they're taking RFK seriously. I'd like to ask these journalists: if Trump nominated a first-grader instead, would you write similar stories? Maybe something like "hey, this nominee has some good ideas about nutrition!" 

Don't do it. This nomination deserves ridicule and scorn, nothing more.

I've written multiple columns (both on this site and at Forbes, my former site) warning about RFK Jr. and his dangerous anti-vaccine craziness, starting with this 2014 piece where I called him out for his efforts to lobby Congress against vaccines. His primary obsession then–and he still has this obsession–was the mistaken notion that thimerosal, a harmless preservative that isn't even used in vaccines today, causes autism. This claim has been thoroughly debunked in multiple studies. 

In 2017, I wrote about "Trump's lovefest with anti-vaxxer RFK Jr." – a lovefest that apparently still continues, seven years later. That column was about Trump's promise to put RFK in charge of a commission on vaccines. Fortunately, that vaccine commission never happened, but today we face a much more dangerous threat, if RFK Jr. is confirmed as Secretary of HHS.

I've also pointed out that Kennedy is one of the "Disinformation Dozen," a group of twelve people who, as reported by the Center for Countering Digital Hate, was responsible for 65% of all the anti-vaccine disinformation online. And earlier this year I asked how he could possibly be so arrogant as to think he's qualified to be President, given that his only claims to fame are his name, which he inherited, and his anti-vaccine notoriety.

My problem with RFK Jr. is not just that he is wrong about vaccines, although that is the most immediate threat to public health. But he's also an idealogue, someone who holds onto his mistaken ideas despite mountains of contradictory evidence, and someone who simply makes up things to "prove" his points. 

And in that quote from him above, where he uses the phrase "institutional arrogance," highlights another danger: RFK Jr. is the one who is arrogant. He believes that he can substitute his own unsubstantiated beliefs for the knowledge of genuine experts, and why? Because he's a Kennedy, a man who has lived a life of great privilege, getting into Harvard as a "legacy" despite being expelled from prep school over his drug use, all the while pretending to be fighting against the system. He is too arrogant to listen to others, or to admit his mistakes.  

So no, I cannot take this nomination seriously. Children will die if RFK Jr. is put in charge of HHS. There are tens of thousands of people who are far, far more qualified than Kennedy, and I hope the Senate will refuse to confirm him. I'm not optimistic, but I hope a few Senators will look at the man's record and treat him with the scorn he deserves.

Yes, we should all get boosters! Eventually.

The hubbub for the past few weeks in the U.S. has been all about whether or not the government should recommend that people get booster shots for Covid-19. Conflicting messages have emerged, with some officials saying boosters will be recommended, and others saying boosters are unnecessary or premature.

Just this past Friday, an expert panel at the FDA recommended boosters for people over 65 and for immunocompromised people, but not for anyone else.

But here’s the thing: boosters obviously help to fight Covid-19. In all the objections I’ve read, I can’t find any credible scientific or medical reason not to get a booster. All else being equal, you should get a booster vaccine, probably around 6-8 months after your second shot (if you had a 2-shot vaccine).

The confusion–and the arguments–derive from that little phrase I threw in there, “all else being equal.” You see, it’s really not controversial that a booster vaccine provides better immunity against an infection. We already have boosters for other vaccines, and there’s a wealth of very strong evidence showing that they work. For the Pfizer/BioNTech and Moderna Covid-19 vaccines, we have some early data showing that they, too, provide an excellent boost in antibody levels, which means (almost certainly) that the recipients of the boosters have better protection against Covid-19.

Indeed, a just-published Israeli study shows that in people over 60, the risk of severe disease drops nearly 20-fold and the rate of infection drops by a factor of 11 after a booster shot. (The study only looked at people over 60 because they were the only ones who got boosters.)

So yes, boosters work. The best arguments against them, scientifically, are that we don’t yet know exactly how well they work. That’s merely because these vaccines have only existed for a short time, so of course we haven’t had time to collect much data. But all the data that we do have is positive. So I’d be willing to bet a large sum of money that the evidence in favor of boosters is only going to get stronger.

But all else is not equal. What’s not equal is access to the vaccines. In the U.S., we have an excess supply, so much that pretty much anyone can get a vaccine by simply walking into one of several national-chain pharmacies, without even making an appointment. And that includes those who want a third shot (an unauthorized booster).

Meanwhile, though, many countries still face a severe shortage of vaccines. In most of Africa, for example, only 1-2% of people have received even one dose of any vaccine. Just this week, President Biden authorized a purchase of 500 million Pfizer vaccines that the U.S. will ship to other countries, and we’re going to need more. The pandemic is a worldwide crisis, and as long as the virus is circulating widely in any country, it is a threat to everyone.

Thus the argument against boosters is not a scientific one. The argument is really about where to ship the vaccines that we have. For example, as several vaccine experts wrote in this Lancet article last week, “even if some gain can ultimately be obtained from boosting, it will not outweigh the benefits of providing initial protection to the unvaccinated.”

The only problem with that statement is the use of “even if”: we already know that boosting almost definitely provides a benefit, so they should have acknowledged that fact.

So the question about boosting really should be a different one: what should the U.S. do with its abundant vaccine supply? Should it allow people to get a booster shot, which is clearly beneficial? Or should we make sure those shots go to people who haven’t yet been vaccinated at all?

It’s perfectly reasonable to argue, as some have, that we should get first shots into people’s arms before we start administering 3rd shots. If the choice is 1st shot versus booster, then yes, we need people to get their first shot. But that doesn’t justify any statements playing down the benefits of booster shots.

And is that really the choice? Well, no. At the moment, the U.S. is wasting millions of shots per month, most of them in retail pharmacies that aren’t using their full supply. The vaccines expire quickly, and it’s simply impossible to manage the supply so that all doses are used. At a minimum, we could offer the extra doses (at the end of each day, say) as 3rd shots to anyone who wants them. The alternative is to throw them away.

So to the public health authorities who are saying “no” or “not yet” to boosters: cut it out! You know very well that boosters almost certainly work, and you also know that in a year or two, we’ll likely be recommending boosters for everyone. When that time rolls around–and it will–people will be asking, quite reasonably, why you are contradicting yourself? And you can be sure that the anti-vax crowd will queue up every quote they can find in which government officials expressed any doubt about boosters.

We saw a near-identical version of this scenario play out very early in the pandemic, only then it was over masks. In early 2020, few prominent public health officials in the U.S. made ill-advised statements that people shouldn’t wear masks. They were worried that we didn’t have an adequate supply of masks, but they knew perfectly well that masks helped prevent transmission of the virus. Even so, they made statements casting doubt on masks, thinking that this would help preserve the very limited (at that time) supply. Those statements were truly damaging, and they contributed to the toxic anti-mask movement in the U.S. today.

The same thing seems to be happening again. The public health experts speaking out against boosters are worried about the supply of vaccines. So they are making statements casting doubt on the efficacy of boosters, statements that are potentially very damaging. For example, the recent Lancet piece states that “currently available evidence does not show the need for widespread use of booster vaccination.” But in the same article they admit that widespread boosting “might ultimately be needed because of waning immunity.”

Vaccine booster shots work, and the experts know it. To fight this pandemic, we need more vaccines, including boosters. We don’t need more misinformation.

Gluten-free diet has no effect on autism, according to a new study

Parents of autistic children are constantly seeking new treatments. Autism spectrum disorder, or ASD, is a developmental disorder that causes problems in social interaction and communication, ranging from mild to severe. It's an extremely challenging condition for parents, and as of today there is no cure.

However, there are plenty of websites that offer treatments for autism, many of them unproven. One of the more common claims is that autistic children will benefit from a gluten-free, casein-free diet. There has been some weakly supportive evidence for this idea, such as this 2012 report from Penn State, but that study was based entirely on interviews with parents. Interviews are notoriously unreliable for scientific data collection.

Perhaps because so few effective treatments are available, many parents of autistic children have tried gluten-free diets, in the hope that perhaps they might work. (One can find entire books dedicated to this diet.)

The science behind the idea that gluten or casein causes (or worsens) autism has always been sketchy. The push for diet-based treatments has its origins in the anti-vaccine movement, beginning with the fraudulent 1998 study (eventually retracted) in The Lancet led by Andrew Wakefield, a former gastroenterologist who lost his medical license after his fraud was discovered. Wakefield claimed that autism was caused by a "leaky gut," which somehow allowed vaccine particles to make their way to the brain, which in turn caused autism. That chain of events was never supported by scientific evidence. Nonetheless, it morphed into the hypothesis that gluten (or casein) somehow leaks out of the intestines and causes some symptoms of autism. There's no evidence to support that either.

(Despite losing his medical license, Wakefield has become a leading voice in the anti-vaccine movement, making speeches and even movies to try to convince parents not to vaccinate their kids. Many journalists and scientists have written about him and the harm that he's done, but that's not my topic today.)

Another hypothesis, according to WebMD, is that autistic children have some kind of allergic reaction to gluten. There is no good evidence for this either.

Surprisingly, virtually no good studies have asked the question, do gluten-containing foods actually cause the symptoms of autism? Now we have a carefully-done study that provides an answer.

The new study, just published in the Journal of Autism and Developmental Disorders, is the first randomized, well-controlled study of gluten-free diets in children with autism. The scientists, all from the University of Warsaw, Poland, recruited 66 children, and assigned half of them at random to a gluten-free diet. The other half were given a normal diet, with at least one meal a day containing gluten, for 6 months. The children ranged from 3 to 5 years old. After 6 months, the scientists evaluated all children using multiple standardized measurements of autistic behavior.

The results were very clear: the study found no difference between the diets. None of the core symptoms of ASD were different between children in the two groups, and there were no differences in gastrointestinal symptoms either. As the study itself stated:

"There is no evidence either against or in favor of gluten avoidance for managing symptoms of ASD in children." 

This study should put to rest all of the claims that a gluten-free diet can somehow improve the symptoms of autism. It doesn't provide an easy answer for parents, and the medical community still needs to do much more work to find better treatments. But let's hope that parents get the message: don't feed your autistic child a restricted diet.

Another anti-vax paper bites the dust

Anti-vaxxers learned a lesson from discredited, de-licensed former doctor Andrew Wakefield, who in 1998 published a badly flawed article in The Lancet pushing a link between vaccines and autism. Wakefield's study was eventually shown to be not only flawed but fraudulent, leading all of the co-authors except Wakefield himself to disavow it, and in 2010 the journal finally retracted it after Wakefield lost his medical license.

But it took The Lancet 12 years to retract the paper, and in that time the anti-vaccine movement flourished. Wakefield became a hero within that movement, and continues to push his anti-vaccine propaganda today, even making films presenting himself as a lone hero fighting for truth.

Other anti-vaxxers are very familiar with this saga, and they have followed Wakefield's recipe by writing scientific papers and attempting to get them published in reputable journals. Usually they fail, but now and then one slips through, which they then point to as "proof" that vaccines are harmful.

The latest example is a paper that appeared in Scientific Reports in November 2016 and that the journal just retracted last week. It has a title that sounds highly technical: "Murine hypothalamic destruction with vascular cell apoptosis subsequent to combined administration of human papilloma virus vaccine and pertussis toxin." (Wakefield's 1998 paper had a similarly obscure title.)

What that lengthy title hides is the paper's anti-vaccine message: that the HPV vaccine might cause neurological damage. The paper was quickly called out as pseudoscience by the scientific community, who reacted within days in the blogosphere and elsewhere, as described by a news article in Science that appeared just after the paper's publication.

(Aside: the HPV vaccine protects people from human papillomavirus, which causes many cases of cervical cancer as well as throat cancer. It's the first vaccine that prevents these cancers, which is an amazing breakthrough. Millions of doses have been administered with essentially zero cases of harm.)

What did the paper do? Basically, it was a setup. The authors–most of them from Tokyo Medical University–gave mice a huge dose of HPV vaccine plus (here's the kicker) a large dose of pertussis toxin. There's no valid reason to administer that toxin except to try to induce brain damage, which the authors could then blame on the HPV vaccine. The study design was clearly awful, and the paper should never have been published.

Just after the paper appeared, two groups of scientists wrote to the Nature publishing group (which publishes Scientific Reports) to protest, as reported in the Science story. One letter, from a group of HPV experts at the University of Antwerp, explained that:

"This experimental setup in no way mimics the immunization with HPV vaccines but is gross over-dosage and manipulation of membrane permeability."

This is putting it mildly. For a blunter assessment, see Orac's aptly titled "Torturing more mice in the name of antivaccine pseudoscience," which appeared in November 2016.

What was not publicly known before now was that I too wrote to the journal editors, asking them to "take action quickly, rather than waiting for over 10 years as The Lancet did." First I wrote to the immunology sub-editor, who forwarded my letter to the Editor-in-Chief, Richard White. Dr. White replied on 29 Nov 2016 that "We are looking into the specific issues raised regarding this paper."

That was the last I heard of it, until the journal announced last week that they have retracted the paper.

So in the end, the scientific record was corrected. But why did it take Scientific Reports 18 months to do it? Haven't they learned from the Wakefield debacle how much damage can be done while antivaccine articles like this one remain in the literature? The journal's editors had a responsibility to act more quickly, and they failed. The scientists who wrote those letters back in 2016 had the same complaint, as reported by Dennis Normile in Science last week. Not surprisingly, Scientific Reports refused to comment (when asked by Science) on any details of their review process.

That's not good enough. Scientific Reports is a "mega-journal," a new type of journal that publishes thousands of papers per year, with a relatively low bar for acceptance. The idea (not a bad one, in theory) is that any valid scientific study, even one that makes only a very small contribution, still merits publication somewhere.

What publishers have learned is that these mega-journals are very profitable, because they charge a publishing fee that more than covers their costs. In return for these profits, Nature Publishing has an obligation to remove harmful papers far faster than they did in this case. Otherwise, it's only a matter of time before anti-vaxxers do this again.

Finally, let me repeat something that can't be said often enough: vaccines are perhaps the single greatest medical advance in human history. They have saved millions of lives, and they continue to save lives today. Scourges such as smallpox and polio, which once swept through populations causing terrible pain, suffering, and death, have been conquered thanks to vaccines. Medical researchers continue to work on new vaccines against the infections that still plague us, and they are the real heroes.

Anti-vaxxers use religious exemptions as false cover for their beliefs

History of measles in the 20th century.

For several years now, anti-vaxxers have been claiming that they have religious objections to vaccines. This is nonsense.

Just last month, the New England Journal of Medicine featured an article describing how the federal Equal Employment Opportunity Commission (EEOC) has been suing hospitals that deny employee requests for religious exemptions to the hospitals' vaccination requirements. The NEJM documented 14 cases where employees sued claiming that they had religious objections to the flu vaccine. Six of the cases were settled, and in the other cases, sometimes the hospital won, sometimes the employees. It's a mess.

The NEJM article focused on the legal perspective, advising hospitals on how they might avoid lawsuits. That's understandable, but it misses the broader point: there's virtually no such thing as a religious objection to vaccines. All of the world's major religions support vaccination, and only a few tiny, extremist sects teach their followers that vaccines are contrary to their faith.

What's really going on is that anti-vaxxers are using religious exemptions as cover for non-religious (and erroneous) objections to vaccines. The anti-vaxxers have convinced people that vaccines are harmful, or scary, or both. They are wrong.

Vaccines are the probably the greatest success story in the history of medicine. They've saved millions of lives. Consider that in the decade before the measles vaccine was introduced in 1963,

"3 to 4 million people in the United States were infected each year [and] an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain) from measles." (Source: CDC)

And that's just measles. People no longer suffer and die from smallpox and polio, which have been eradicated worldwide (except for a few countries where polio still has a foothold). Vaccines protect us from multiple other formerly common childhood infections, and they've been so effective that people are no longer afraid of these diseases. That very success is the opening that the anti-vaxxers use to spread disinformation and fear.

It's not just the EEOC that has been enabling anti-vaxxers. Many U.S. states have passed laws that allow religious exemptions to vaccination. (Note that vaccines are required before children can enroll in public school systems, an incredibly important public health requirement. The exemptions refer to this requirement.)

Here, though, there are signs of hope. After suffering from repeated outbreaks of preventable diseases like measles, many states have recently awakened to the risks caused by unvaccinated children in public schools, and they are moving to remove or tighten these exemptions.

New Jersey is the latest state to act. While the bill introduced in the New Jersey legislature last week doesn't quite eliminate religious exemptions, it makes them harder to get, requiring considerably more documentation from parents claiming a religious exemption from vaccines for their children. NJ took action after realizing that these so-called "religious" objections had risen dramatically, from 3,865 in 2009 to 10,407 in 2016. That rise was fueled, apparently, by anti-vaxxers taking advantage of the loophole in the law, not by any genuine religious objection to vaccines.

It's worth noting that all states allow medical exemptions to childhood vaccination, which are legitimate and necessary. For example, a child undergoing leukemia treatment may have a severely weakened immune system, and a vaccine would be ineffective and possibly harmful. These children are precisely the ones who can only be protected by requiring all the other children in their school to be vaccinated.

Meanwhile, the EEOC should stop suing hospitals. Hospitals are filled with very sick and vulnerable people, and employees have an obligation not to expose patients to possibly deadly infections. If a hospital employee doesn't take that obligation seriously, then s/he should find another job.

Anti-vax movement helps create worst year of mumps in a decade

The year isn't quite over yet, but we've already had 4,258 cases of mumps in the U.S., more than any year since 2006, when we also experienced a dramatic spike in cases. As the chart here shows, before 2006 we only saw a couple of hundred cases per year, but the numbers have been trending higher since then. After two years with about 1200 cases each, this year looks to quadruple last year's total when the final numbers come in.

Source: CDC, Morbidity and Mortality Weekly Report (MMWR), Notifiable Diseases and Mortality Tables

Just as in 2005, the outbreaks were centered in a few states, mostly on college campuses in the middle of the country, especially Iowa, Illinois, and Indiana. (The 6500+ cases in 2005 were mostly in or near Iowa and Illinois.)

Why are we seeing this increase?

At least some of the blame, if not all of it, belongs to the anti-vaccine movement. Despite overwhelming evidence that vaccines save lives, and that the risks are miniscule compared to the enormous benefits, the anti-vaxxers remain in denial. They claim that the government–usually the CDC–and pharmaceutical companies have been conspiring for years to hide the so-called harms of vaccines, and they spread misinformation and fear in a continual effort to get parents to withhold vaccines from their children.

The main harm claimed by the anti-vax movement is autism. This belief, though fervently held by many anti-vaxxers, is absolutely false. It was originally proposed in a now-retracted, discredited 1998 study by Andrew Wakefield, who was later shown to have fraudently manipulated data, hidden his secret payments from lawyers who wanted to sue vaccine makers, and treated the children in his own study unethically. In 2010, Wakefield was stripped of his UK medical license. As the BMJ editors wrote in a 2011 editorial:

"Who perpetrated this fraud? There is no doubt that it was Wakefield."

Nonetheless, Wakefield he continues to promote his bogus claims (most recently with an anti-vax movie, which I won't name here to avoid promoting it), and remains a hero to the anti-vax movement, who seem blind to his flaws.

This is reprehensible–and frightening. If all parents followed the anti-vaxxers advice, we would see massive surges in vaccine-preventable illnesses, sometimes leading to permanent harm or even death in helpless children. Fortunately, most children are still getting their vaccines, but the anti-vaxxers have succeeded in reducing vaccination rates in many communities around the country, illustrated most recently by the 19-fold increase in vaccine exemptions in Texas.

Twenty years ago, we had under 200 cases of mumps per year, and it was no longer endemic in the United States. In other words, the only cases in the country were imported by people traveling here from other counties. The same was true for measles, which is much deadlier than mumps. Fortunately, rates of measles are low again this year, after the major outbreak that started in Disneyland in 2015, but if anti-vaxxers have their way, more outbreaks are in our future.

This amazing progress was all thanks to the mumps vaccine, which today is part of the MMR vaccine, which also protects you from measles and rubella. Before the vaccine program started in 1967, we saw about 186,000 cases of mumps annually in the U.S. The vaccine led to a 99% reduction in mumps (and measles). It's not perfect: the mumps vaccine is about 88% effective, but when everyone is vaccinated, "herd immunity" prevents the disease from spreading, even if a few people get sick. As the CDC explains,

"outbreaks are much larger in areas where vaccine coverage rates are lower."

Perhaps more alarming than the surge in mumps cases is that the U.S. has just elected the first anti-vaccine President in history. Others have documented Trump's "long, sordid antivaccine history," so I won't attempt to describe it here. We can only hope that reason will eventually prevail, and Trump's ignorance about vaccines won't lead to thousands of unnecessary cases of measles, mumps, whooping cough, and other diseases that vaccines can prevent.