Why Does He Keep Asking For What’s Already There?

“Show me the data; bring me the studies.”

Robert F. Kennedy Jr echoed this sentiment repeatedly at his confirmation hearing to be the next secretary of Health and Human Services (HHS). RFK Jr proposes a Make America Healthy Again (MAHA) mission that includes combating chronic illness, obesity, food additives, and environmental toxins. Many of these issues reflect legitimate concerns of US residents across party lines. So why is his confirmation setting a dangerous precedent in our country?

I (MBK) am a fourth-year medical student and aspiring obstetrician/gynecologist in Washington, DC. In my training, I encounter cases of metastatic cervical cancer, preterm labor after a Loop Electrosurgical Excision Procedure (LEEP) – a procedure used to remove abnormal/cancerous cells from the cervix, and patients’ anxiety about abnormal pap smear results. Many of these outcomes are preventable with the human papillomavirus (HPV) vaccine. In total, 99% of cervical cancer cases worldwide are caused by HPV.¹ When given before age 17 years, HPV vaccination results in an 88% reduction in cervical cancer.² Cervical cancer is one of few cancers that could be almost entirely prevented with vaccination and timely screenings. HPV vaccines are a revolutionary intervention for health that show strong evidence of positive results.

RFK Jr is well-known for promoting misinformation regarding the safety and efficacy of vaccines. His platforms incorrectly state that HPV vaccines, proven to prevent cervical cancer, actually increase cancer risk.³ He compares childhood vaccine schedules to a holocaust.⁴ He states his belief that “I do believe autism does come from vaccines.”⁵ However, RFK Jr has personal financial interest in promoting this claim because he receives contingency fees from a personal injury law firm suing HPV vaccine manufacturers.⁶ When asked about his previous statements regarding the dangers of vaccines, he deflects, stating that he “trusts science.”⁷

It has been 27 years since a debunked article claimed a causative link between the measles-mumps-rubella vaccine and autism.⁸ Since then, numerous robust and peer-reviewed studies have unequivocally found no such link.⁹ When Sen Bill Cassidy, MD (R-LA), mentioned one such study,¹⁰ RFK Jr responded by citing a paper¹¹ that suggested higher rates of neurological deficits among vaccinated children. This study had significant methodological flaws, ignored confounding factors (notably, health care utilization), was funded by an antivaccine group (National Vaccine Information Group), and is unavailable on trustworthy academic/scientific journal databases (PubMed and MEDLINE).¹² While the study referenced by Senator Cassidy is a meta-analysis, considered to be one of the most robust types of studies, the study referenced by RFK Jr used both cross-sectional and retrospective methodological designs, which are much less rigorous study designs. Additionally, in the study referenced by RFK Jr, the population included Medicaid patients in one state who had visits with vaccine billing codes, but did not include which vaccines were administered or accounted for the possibility of patients receiving vaccines outside of the Medicaid system. The scale of the study, the less-rigorous methodology, and the obvious confounding variables call this paper’s validity into question. The question remains: why does RFK Jr highlight flawed and biased studies to cast doubt on well-established facts while ignoring a mountain of evidence that exists?

RFK Jr represents an antiestablishment movement promoting medical freedom. His opinions reflect a public undercurrent that has gained traction in recent years. “MAHA moms”¹³ are rejoicing in a leader in Washington who voices concerns about vaccine safety and government oversight they feel have been brushed off. The common thread across many MAHA supporters is a deep and pervasive distrust of institutions. They have a belief that, despite strong evidence and monitoring guardrails, the government is mandating harmful practices and with malicious intent. This distrust is further strengthened by fear. We live in an age of anxiety and uncertainty around rising rates of autoimmune conditions,¹⁴ chronic disease,¹⁵ cancer¹⁶ among young people, and yes, autism.¹⁷ People want answers, people want explanations.

Health care professionals play a crucial role in addressing vaccine hesitancy. The latest research into the psychology behind human beliefs indicates that both rational and nonrational factors influence beliefs.¹⁸ My call to action to physicians across the country is this: (1) speak to the nonrational and (2) defend the rational.

Speak to the nonrational. Evidence alone cannot quench this thirst of doubt. Instead, we must speak to the emotion and fear behind it. By establishing patient-physician relationships rooted in trust, physicians can identify the causes of patients’ cognitive bias. Whether it’s a child with autism, the flood of false information online, or advice from a neighbor, by identifying the complex contributions to false beliefs, we can begin to challenge them. The rise of information accessibility and social media presence by health practitioners can be another effective way to promote evidence-based practices and reach targeted audiences.

Defend the rational. As political leaders seed the nonrational, now, more than ever, we must invest in the power of human reasoning. Physicians can instill vaccine confidence through clear and consistent guidance, by highlighting existing evidence and by making vaccines easily accessible. We must give an accurate risk profile of not vaccinating and appeal to the social responsibility we all share in playing an active role in public health.

The trusty “Yes, and” approach ties these together nicely. Yes, there is risk in all medical interventions, including vaccines. And that risk is exceedingly low and pales in comparison to their benefits. Yes, there is uncertainty when it comes to causes of autism. And we know that vaccines are not the cause. Yes, we must admit regulatory failures by government agencies. And the vast majority of the time, these same agencies have been successful in approving safe practices. Yes, a healthy skepticism is an important part of advancing science and recommendations. And it is dangerous to be in a position of power and cast doubt on conclusive, scientific evidence and perpetuate the cycle of misinformation.

RFK Jr has importantly brought significant attention to the burdens of chronic disease in our country. But every time he uses unproven narratives to promote false beliefs, it is a distraction. Idling on long debunked theories takes us a step away from finding the causes of autism, eliminating preventable diseases, and preventing the collateral damage of vaccine mistrust. The harms from vaccine hesitancy are hard to overstate. Preventable diseases will surge and people will die. A vaccine-preventable, deadly measles outbreak has already occurred in Texas and cervical cancer rates will rise, and still, autism rates will not change.¹⁹

People look to political leaders for medical decision-making, but they also look to their physicians. It is a great responsibility to be in that role. Be someone who defends the truth, no matter who is in Washington.