With Robert F. Kennedy Jr. now lined up to lead the Department of Health and Human Services, it looks like his Make America Healthy Again movement is poised for real power.

Its central mandate: reverse the chronic disease epidemic that is the leading cause of death in the US and generates massive health care costs.

MAHA has set its sights on big food and big pharma, arguing that these industries use lobbying power to maximize profits at the expense of the country’s health.

This message served as an animating force in the latter part of the election, as Kennedy expressed concern about ultra-processed foods and poor nutrition, food additives, pesticides and toxic chemicals, and the harms of industrial agriculture, among other issues.

He has woven together an unlikely coalition – some from the left and some MAGA supporters – eager to take over.

“Bobby Kennedy and Trump have linked by tying the core of MAGA — which is a distrust of institutions and removing corruption from institutions — to our health care industries,” says Calley Means, an adviser to Kennedy and his transition team. Trump, who spoke. with NPR before Kennedy’s nomination.

The rise of the MAHA is a heady moment for scientists who have long pushed for more attention to lifestyle diseases — and they agree that reforms are sorely needed. At the same time, they are deeply concerned about Kennedy’s history of questioning the scientific consensus on vaccines and his antagonism toward mainstream medicine in general.

Barry Popkinprofessor of nutrition at the UNC Gillings School of Global Public Health, says he would welcome substantial policy changes that address diet-related diseases such as obesity and diabetes.

“If it comes, they’ll have a lot of support,” he says. “But I don’t see that—I fear the worst.”

He fears that if Kennedy is confirmed as head of HHS, “thousands of children could die from measles and many other infectious diseases that children have been vaccinated against for decades.” (Kennedy he recently told NPR that he will not “take the vaccines from anyone”.

And yet, it cannot be denied that there are areas of substantial overlap between MAHA’s goals and scientists who have long advocated for addressing the root causes of chronic disease.

“There are some things that RFK Jr. understands well,” says the former CDC director Dr. Tom Frieden. “We have a chronic disease crisis in this country, but we need to avoid simplistic solutions and stick with the science.”

Public health researchers note that what Kennedy is proposing to do — even wielding the power of a major federal agency — is an extremely difficult thing to do. And many wonder how realistic or actionable the mission will be in a regulation-unfriendly, Republican-controlled federal government.

An ambitious to-do list

If appointed, Kennedy would have broad influence on health policy — from the Centers for Disease Control and Prevention to the Food and Drug Administration. And he promised seismic changes from day one, including firing hundreds of staff and scientists.

Kennedy’s influence could reach deep into health care, infectious disease prevention, drug pricing and approvals, and more. But his vision for chronic disease prevention is one he spoke highly of before this appointment.

And the MAHA to-do list is ambitious to say the least.

Revising the Dietary Guidelines, reforming federal programs that pay for ultra-processed foods, taking over crop subsidies, and potentially banning pesticides and chemicals are just a few of the priorities Kennedy highlighted during the campaign.

“Despite the media’s effort to pigeonhole this movement into fringe areas like vaccines or fluoride or things like that, voters saw very clearly that they were talking about big ideas,” Means says. “I think a spiritual connection was struck.”

Means—himself a former lobbyist for the food and drug industry—has emerged as one of the leading voices in the MAHA orbit. He and his sister, Dr. Casey Means, catapulted into the political sphere after publishing a bestseller on metabolic health. Both have businesses in the health and wellness industry.

The means helped form the political alliance between Trump and Kennedy.

“The public health expert class has caused us a public health collapse,” he says. “We are on the brink of, at best, a health crisis and, at worst, a societal collapse, with 20% of GDP being spent on health.(We are) getting sicker, fatter, more depressed, more infertile for every dollar we spend.”

Means says a key to their plan is eliminating conflicts of interest.

He cites the revolving door between industry and government, fees paid by drug companies to the FDA and experts who sit on advisory panels or conduct government-funded research while receiving industry dollars.

Dr. Mark Hyman, a best-selling author and longtime friend of Kennedy’s, says he faced “massive” resistance over the years when he advocated for many of these food supply and nutrition reforms.

“I think this is a unique opportunity,” says Hyman, who is the founder of the Cleveland Clinic Center for Functional Medicine and co-founder of Health function. “Because Trump is a show-your-own kind of guy. Bobby is not looking for a gradual change.”

Political contradictions

The outpouring of attention on lifestyle diseases — and the promise to crack down on industry influence — is a surprising twist that longtime researchers in the field are still trying to reconcile with Trump’s broader agenda.

“I’m certainly excited about this idea of ​​addressing the root causes of chronic disease,” says Dr. Randall Stafford, a professor at the Stanford School of Medicine. “But I’m not sure those goals are consistent with other goals of deregulating the economy.”

He worries that “anything that contradicts other Trump policies will be thrown out.”

The first Trump administration installed industry insiders and made decisions that ran counter to MAHA priorities, such as approving dangerous pesticide products and loosening nutrition rules for school lunches.

Now Kennedy wants to do More to control food and pharmaceutical products. He calls for restrictions on a range of food additives and colourants. He wants to reduce the dominance of ultra-processed foods; he called for reform of the SNAP food assistance program — formerly known as food stamps.

And it called for an end to direct-to-consumer advertising for prescription drugs.

“A real litmus test of whether or not they’re serious is whether they take on some of the economic interests that are causing our chronic disease epidemic,” says former CDC director Frieden, who is now president and CEO of Resolve to Save Lives.

Popkin says the Republican Party doesn’t like regulation — and pushing for reforms that run counter to industry interests will face headwinds in Congress.

“Given the desire to cut government, they’re going to want to cut regulation as a huge component. They did it during Trump’s first term, they’re going to be more systematic about it even now,” Popkin says.

Calley Means pushes back, arguing that MAHA’s approach is not “over-regulation” but rather about getting rid of corporate influence in the system.

“I would say to anyone who is skeptical about it, look at the positives here,” he says. “This MAHA agenda is one of the golden zones for true bipartisan reform.”

He says Kennedy’s approach will be to insist on what he calls “exact science” and adds that “it’s the job of Congress to appropriate money. It is up to Congress to figure out how to fix the broken subsidy systems that have led to this poisoning of the American consumer. .”

Edited by Jane Greenhalgh and Carmel Wroth.

Copyright 2024 NPR