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.

Do we all need PSA tests?

Say your doctor offers to run a PSA test, which might detect early signs of prostate cancer.  The test is free to you, because insurance covers it.  And you're already getting a blood test to measure cholesterol, so the cancer test doesn't involve any extra pain.  Why not?  And by the way, the American Urological Association recommends regular PSA screening for all men over 40.  Based on this information (or less), millions of men get a PSA test every year.

But hold on.  Suppose your doctor tells you a different story.  First he explains that a recent, large-scale US study looked at the effect of annual PSA screening on more than 75,000 men, and found no benefit at all.  A separate large study in Europe showed a very small benefit, but only in 2 of the 7 countries participating in the study.  Suppose your doctor also explained that if you have a positive PSA test, there's an 80% chance that it will be false - that you won't have cancer.

Suppose your doctor also explained that "PSA-based screening leads to a substantial overdiagnosis of prostate tumors" and that treatment usually requires surgery.  The effects of treatment are serious: 20-30% of men treated with surgery and radiation suffer from long-term incontinence and erectile dysfunction.

Prostate cancer tends to grow so slowly that many men with prostate cancer should not be treated at all.  Unfortunately, once someone knows he has cancer, there's a very good chance he will elect treatment, even though we can't really tell if treatment will help.

Do you still want a PSA test?  Do you want one every year?

Well, after a thorough review of the evidence from multiple trials, the US Preventive Services Task Force recommended a few weeks ago that men not get PSA screening for prostate cancer.  They concluded:

"there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms." (USPSTF, Annals of Internal Medicine, 22 May 2012)

This recommendation, although based on a thorough assessment of risks and benefits, was met with howls of protest from urologists, who conduct most of the prostate cancer screening and treatment in the U.S. and elsewhere.  The American Urological Association stated bluntly:

"The AUA is outraged and believes that the Task Force is doing men a great disservice by disparaging what is now the only widely available test for prostate cancer, a potentially devastating disease."

The AUA also issued press releases and launched a lobbying effort, asking their members to contact the media and Congress.  They even provided a sample letter for urologists to send to their representatives in Congress.

Unfortunately for the AUA, their responses contain a very slanted presentation of the facts.  The AUA president's response emphasizes the studies that found a benefit for PSA testing, but ignores those that found no benefit.  In addition to this cherry-picking, they make the misleading claim that the recent U.S. PLCO study found "a significant reduction of prostate cancer death rates," which it did not.  In fact, the PLCO study found a higher death rate from prostate cancer in men who received PSA testing.
And the AUA statements ignore the very serious risks of prostate surgery; essentially they are pretending the risk is zero.

Why did the urologists react so strongly?  The answer appears to be simple: money.  Urologists make a lot of money on prostate cancer treatments. The USPSTF estimated that in the first 20 years of PSA testing, 1 million additional men were treated as a result of screening.   And if the surgery is unnecessary, you don't get a refund.  

So who are you going to believe?  The Preventive Task Force report presents a thorough review, laying all the details on the table.  Their members don't make a profit from prostate surgeries.  Their report simply more credible than the knee-jerk reaction from the urologists' association.  I'll let the Task Force have the last word:

"The harms of PSA-based screening for prostate cancer include a high rate of false-positive results and accompanying negative psychological effects, high rate of complications associated with diagnostic biopsy, and—most important—a risk for overdiagnosis coupled with overtreatment. Depending on the method used, treatments for prostate cancer carry the risk for death, cardiovascular events, urinary incontinence, erectile dysfunction, and bowel dysfunction. Many of these harms are common and persistent." 

At my last checkup, my doctor asked if I wanted a PSA test.  I told him no thanks.

Eat more chocolate! Lose weight!

It's a holiday weekend, and many of us will be eating chocolate, especially chocolate bunnies and chocolate eggs.  (Where does that come from, anyway?  Bunnies don't lay eggs.) We don't really need an excuse to eat chocolate.  But isn't it wonderful when a scientific study tells us that we should?  Even the skeptics among us really want to believe that eating chocolate is good for you.

Last week, a new study in the Archives of Internal Medicine claimed that eating chocolate more frequently is associated with a lower body-mass index, or BMI.  The study's authors carefully stated their results as a "link," but then they went on to say that other evidence would "suggest the association could be causal."

Of course the media ate this up (pun intended), with headlines like "The Chocolate Diet?" at The New York Times.  The Times story was filled with caveats, pointing out that it was frequency of chocolate consumption (how many times per week you eat it) that was associated with lower body weight,  and that people who simply eat more chocolate tend to be, well, fatter.  Surprise!

Beatrice Golomb, the lead author of the study, explained to the Times that:

“It’s not the case that eating the largest amount of chocolate is beneficial; it’s that eating it more often was favorable.”  

Because the thinner people in the study ate less chocolate overall, they must have eaten much less at each sitting.

Alas, this is just a bad study.  The biggest problem is that it was based entirely on questionnaires, in which 1018 men and women answered questions about how often they excercise and how often they eat chocolate.  Here are some key features of these subjects:

• Their average BMI was 28.  So they are kind of fat. (A BMI of 25-30 is overweight.)
• They claim to exercise 3.6 times per week, on average.
• They report eating chocolate 2 times per week.

We all know how this works. Even though the questionnaire is anonymous, we still want to look like we're doing the right thing.  So we over-state how often we exercise (3.6 times per week? ha!) and we under-state how often you eat unhealthy foods.  The entire result can be explained by a tendency of thinner people to admit eating chocolate more often.  Observational studies like this one are notoriously unreliable.

On this note, I have to give kudos to Gary Taubes at Discover magazine, who isn't buying any of this.  Taubes explains that:

"Both of these studies were classic examples of what is known technically as observational epidemiology, a field of research I discussed at great length back in 2007 in the New York Times Magazine.  I made the argument that this particular pursuit is closer to a pseudoscience than a real science."

Taube looked at multiple observational studies done at Harvard's School of Public Health, by one of the top epidemiology groups in the country.  But when observational studies "discovered" a causal relationship, it never seemed to pan out, says Taube:

"I pointed out that every time that these Harvard researchers had claimed that an association observed in their observational trials was a causal relationship—that food or drug X caused disease or health benefit Y—and that this supposed causal relationship had then been tested in experiment, the experiment had failed to confirm the causal interpretation—i.e., the folks from Harvard got it wrong. Not most times, but every time."

A zero percent validation rate - it doesn't get any worse than that.  Taube makes a very good case that the whole "nutritional epidemiology business" is pseudoscience.  You just can't go around asking people what they eat and expect to get reliable answers.

So nope, it just isn't so, no matter how much we'd like to believe it.  Eating chocolate isn't going to lower anyone's BMI.  But the really important question is, which part of the chocolate Easter bunny do you eat first?  I go for the ears.

A surprising triumph in the fight against polio

Source: polioeradication.org

The last case of polio in India occurred exactly one year ago, on January 13, 2011.  In the decades-long battle against this devastating disease, this is one of the best pieces of news in a long time.  Just two years ago, health officials counted 741 polio infections in India, and it seemed that the battle was far from over.  It may yet be, but in 2010 the cases dropped dramatically, to just 42, and last year there was only one, on January 13.


As recently as the 1950s, polio was a dreaded, incurable disease that killed or paralyzed millions of children each year.  The U.S. alone had 58,000 cases in 1952. Then came the invention of a vaccine by Jonas Salk, one of the great medical breakthroughs of the 20th century.  By the 1960s, widespread vaccination campaigns had virtually eliminated polio from Europe and the U.S.  Polio lingered in the U.S., mainly in the Amish population who refused to accept vaccinations, but it finally disappeared in 1979.

The worldwide campaign to eliminate polio started in 1988, when 350,000 infections were recorded.  Polio is extremely difficult to control, because a large majority of infected people show no symptoms, but they can still spread the virus.  Vaccination campaigns need to treat everyone who comes in contact with an infected individual in order to break the cycle of transmission.  This is especially hard to do in remote areas of poor countries, especially when the populace is suspicious and uncooperative.

The greatest challenge in India came in the desperately poor, crowded regions of the north, where health care, hygiene, and education are all very poor.  The vaccination efforts were made even more difficult by conspiracy theories among the Muslim population.  As Simon Denyer wrote in the Washington Post this week:

"Rumors spread among the region's numerous Muslims that the polio vaccination campaign was an American conspiracy to wipe them out, by making their sons impotent and their daughters infertile.... Vaccinators were stoned as they approached Muslim neighborhoods. 'The general mind-set was that the immunization campaign was aimed at ending our lineage,' said Anwar Ahmad, the head of a madrassa in a Muslim neighborhood in the city of Meerut."

The campaign turned around after UNICEF and Rotary international launched a major education effort that first convinced Muslim leaders, and then everyone else, that the vaccine would benefit their communities.  With this success in India, polio is now endemic in only three countries in the world: Afghanistan, Pakistan, and Nigeria.  The same rumors and conspiracy theories that plagued India have spread within Muslim populations in these countries as well, but India shows that the misinformation - and polio - can be defeated.

Unfortunately, even here in the U.S. we have our own conspiracy theorists: the anti-vaccination zealots over at Age of Autism, where Dan Olmsted and Mark Blaxill recently posted a series of articles claiming that polio is "a harmless intestinal bug" that only causes disease when triggered by pesticides or by arsenic.  Never mind that there is no evidence to back this truly wacky assertion; these two anti-vaxxers seem happy to invent facts to support their single-minded campaign against all vaccines, even when the vaccines are demonstrably saving tens of thousands of lives.

Polio is still with us, and it could return.  Besides the 3 countries with endemic polio, 9 other countries continue to suffer polio cases that were imported from endemic countries.  Without widespread vaccination in those countries, polio could re-establish itself in any of them.

If polio stays out of India, we can thank the thousands of health care workers who traveled to remote villages, in extremely difficult conditions, to dispense lifesaving vaccines.  Their heroic efforts have paid off for everyone.  We should also thank the combined efforts of the WHO, UNICEF, Rotary International, the Gates Foundation, and the CDC, all of whom are backing the worldwide effort to eradicate polio.  Let's root for humanity to win this one.