What The Hell America!

One of the most notable things about Robert F. Kennedy Jr.—the secretary of the Department of Health and Human Services, a federal agency tasked with “improving the health, safety, and well-being of America”—is how confidently he distorts the basics of health, safety, and well-being.

In his short stint as health secretary, Kennedy has touted cod-liver oil as a valid measles treatment (it’s not), said that Americans are being “poisoned” by seed oils (they’re not), and claimed that “many” vaccines are not adequately safety-tested (they are). And he has readily cherry-picked and exaggerated findings to suit his own needs: “There’s a scientist at Harvard now who is curing schizophrenia with a carnivore diet,” he said at a press conference in March (it’s not a carnivore diet, and it’s not a cure).

The secretary also seems to think he knows what causes autism, a topic that scientists have been looking into for decades without producing a simple, clear-cut result, M. Daniele Fallin, a genetic epidemiologist at Emory University, told me. Kennedy, however, is adamant that a series of new investigations by his department will reveal at least “some of the answers” by September. “And we will be able to eliminate those exposures,” he said at a recent Cabinet meeting.

Since its first days, the new Trump administration has clearly shown where it thinks scientific attention should not be focused: It has attempted to censor federal scientific data, cut billions in government spending on research, and compromised care for some of the world’s most at-risk populations. Now, as the nation’s leaders have begun to encourage inquiry into specific areas, they are signaling that they’re willing to not just slash and burn research that challenges their political ideology but to replace it with shoddy studies designed to support their goals, under the guise of scientific legitimacy.

Just last week, in a press conference discussing a new CDC report that described a continued rise in the prevalence of autism, Kennedy pledged to “follow the science no matter what it says.” And in an email, Kush Desai, a White House spokesperson, told me that the administration’s intention is “to leave no stone unturned to get to the bottom of America’s epidemic of chronic diseases and conditions.” But those statements seem at odds with Kennedy’s behavior.

Among scientists who study and treat autism, the consensus has long been that “there is no ‘one cause’” of autism, Neelkamal Soares, a developmental and behavioral pediatrician in Michigan, told me. Genetics are likely to play a role; researchers have also explored the possible contributions of factors such as parental age; labor and delivery conditions; and exposures to certain chemicals, medications, or infections during pregnancy. Experts also generally agree that much of the growing prevalence of autism can be attributed to increased awareness and diagnosis—an explanation that the CDC, an agency Kennedy oversees, cited in its report.

But at last week’s press conference, Kennedy dismissed that explanation as “a canard of epidemic denial.” He instead claimed, without citing any data, that autism rates soared after “industry” contaminated Americans with a “toxin,” and called genetics a “dead end” for future research. “Somebody made a profit by putting that environmental toxin into our air, our water, our medicines, our food,” he said. And he appears to be trying to bolster that viewpoint with what will now count as official government research—“a series of new studies,” he said, “to identify precisely what the environmental toxins are that are causing it.”

Kennedy did promise to look at all possible environmental factors “agnostically.” But several experts told me they’re worried that the secretary has at least one particular exposure in mind. For years, Kennedy has championed the debunked idea that childhood vaccinations cause autism. And in March, he reportedly tapped David Geier, a discredited health analyst who has long promoted the notion that vaccine ingredients cause autism, to lead an HHS study to once again search for a link between immunizations and the neurodevelopmental condition. Kennedy didn’t evoke vaccines when describing this new research, and since his confirmation as HHS secretary, he has been more sanguine—albeit inconsistently—about the benefits of shots. But vaccines have, for years, stood out in his rhetoric as “a very clear preconceived hypothesis,” Megan Pesch, a developmental and behavioral pediatrician at the University of Michigan, told me.

Kennedy, who has no scientific or medical training himself, also seems confused about what a scientifically rigorous investigation would entail—and how long it might take. During this month’s Cabinet meeting, he said that by September, HHS would complete “a massive research and testing effort involving hundreds of scientists from around the world.” At last week’s press conference, however, his comments suggested that HHS might rely heavily on AI and electronic-health-record data, which aren’t gathered uniformly, can depend on self-reporting, and cover only populations that interact with the health-care system. And Jay Bhattacharya, the new, Trump-appointed director of NIH, recently gave a presentation detailing the administration’s plans to source data for these investigations from hospitals, pharmacies, wearable devices, and other private sources with limited reach.

That approach, experts told me, can’t provide enough evidence to definitively pinpoint autism’s cause, much less guide policy to eliminate it. “The chances of getting garbage are so high,” Catherine Lord, a clinical psychologist at UCLA’s Semel Institute for Neuroscience and Human Behavior, told me. Desai said that Kennedy had promised “an exhaustive examination of the underlying causes of autism,” which “naturally would include use of data points such as electronic health records, among other data sets,” and noted that the secretary is focused on fulfilling President Donald Trump’s directives “with the Gold Standard of Science.”

No matter which methodologies Kennedy chooses, his September deadline “is ridiculous,” Lord said. Even the job of assembling the expert task force to initiate such a project could go past September. And Bhattacharya has already suggested getting results could take longer. (When asked about the practicality of this timeline, Desai replied, “Would the preference be vague timelines and no commitments to address a matter of utmost concern for millions of Americans?”) One way to rigorously gather more data on autism’s causes would involve following a large, representative sample of the American population over time, tracking participants’ exposures, taking into account their genetic and health history, and monitoring whether any of them develop autism. The process would take years—and still may not yield causes as clear-cut or easy to “eliminate” as Kennedy seems to expect. But an administration that already knows the answers it wants doesn’t need years to find them.  

Government-funded science has, to some extent, always been subject to the political priorities of leadership: The National Institutes of Health, for instance, is run by a political appointee. Trump and his allies, however, have already demonstrated that they are willing not just to set priorities, but to engage in science theater, with even more broad-reaching interference in the field of trans health.

From the start, the new administration’s views on transgender health have been clear. Since January, Trump has issued executive orders denying the existence of gender and describing hormone therapy and gender-affirming surgery for children as “maiming,” “sterilizing,” and “mutilation.” One order announced that the administration would not “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another” and instructed federal agencies to end such procedures at government-funded institutions, leading hospitals and clinics across the country to pause gender-affirming care for young people. Through the NIH, the administration has also slashed funding from more than a hundred research grants involving trans people.

In place of this research, HHS is pursuing a pointed agenda to confirm the president’s statements. Last month, Matthew Memoli, the acting director of the NIH at the time, sent top agency officials a memo with instructions to urgently “fund research” into “regret and detransition following social transition as well as chemical and surgical mutilation of children and adults.” (In his email, Desai described the memo’s stipulations as “realigning taxpayer-funded research to align with the priorities of the American people.”) “This is very important to the President and the Secretary,” the memo read.

The outcomes of gender-affirming care do need further study across the age spectrum, experts told me. Scientists still don’t have a full sense of the long-term outcomes of transition on mental and physical health, or how to best tailor interventions to patients. (Extended use of certain hormones, for instance, could raise people’s risk of some cancers or cardiovascular complications.) More research is needed, in particular, on how best to support gender-diverse youth, a growing sector of the population. But the kinds of research that the Trump administration is pursuing won’t help clarify or alleviate those concerns. And of all the scientific questions that could be asked about trans health, “regret and detransition aren’t the major problems,” Arjee Restar, a social epidemiologist at Yale, told me: Studies have found that adults and adolescents are generally very satisfied with the outcomes of hormone therapy and gender-affirming surgeries, and that rates of regret following surgeries are about just 1 percent.  

NIH officials found the memo’s directives appalling. “This is not how we do science, ever,” one of them, who requested anonymity out of concern for professional retribution, told me. “This is politicized research, exactly what we were always told we would never do.” In his memo, Memoli specified that studies into the outcomes of gender-affirming care should deploy “methods that don’t themselves subsidize or incentivize such practices as previous NIH studies have done.” (Desai pointed to a case in which an NIH-funded researcher cited politics to help explain her hesitation to publish a study with unfavorable results about puberty blockers.) But previous NIH studies have never “subsidized or incentivized” gender-affirming care, the NIH official told me. Rather, they followed the recipients of that care over time, and observed the results.

In contrast, Memoli’s memo unabashedly advertised the conclusion that the administration is pushing for: that gender-affirming care is harmful and regrettable. The directive also implicitly solicits researchers who “are following the administration’s example,” Logan S. Casey, the director of policy research for the Movement Advancement Project, an equality-focused think tank, told me—and potentially, for participants who might share those viewpoints as well. That makes it all the more likely that those projects will produce the skewed results the administration wants to see.

This is consistent with everything Trump and his allies have revealed about their views on science since January: that it is not a means to better understand objective reality, but a political weapon that they must guard against, or deploy themselves. In recent months, Kennedy has accused the expert committee that counsels the CDC on its nationwide vaccine recommendations of being in the pocket of vaccine manufacturers; the administration has also fired from HHS several scientists who were prominent leaders in the COVID-19 response, including a few closely affiliated with Anthony Fauci, whom Trump has ridiculed as a “disaster” and an idiot and Desai derided as one of many “demonstrably fallible ‘experts.’” Last week, administration officials also redirected two federal websites, once used to share information on COVID-19 tests, treatments, and vaccines, to a page promoting the idea that the coronavirus pandemic began as a lab leak, rather than Fauci’s “preferred narrative that COVID-19 originated in nature.”

The causes of autism, the outcomes of gender-affirming care, and the origins of SARS-CoV-2 are all topics worthy of scientific investigation. But how questions are asked can influence the answers they yield—and directly affect the populations they’re asked about. The language in the NIH memo is “alarming and inflammatory,” Camie Nitzel, a psychologist who specializes in transgender and gender-diverse people, told me: It shows that the administration is pursuing these studies not from a place of genuine inquiry, but from prejudice. Disdain is coded into the administration’s methodology on autism, too: In his briefings on HHS’s new pursuits, Kennedy has repeatedly described autism as a scourge worse than COVID-19 that “destroys” families and children, and insinuated that it should be purged from the population. But the implication of both the administration’s statements and its proposed studies is that neither trans people nor autistic people should visibly exist in America. Science is now yet another tool that the government is using to disappear anyone it deems undesirable.

#Science

Thanks to the Team @ The Atlantic Source link & Great Job Katherine J. Wu