Yves here. The implicit RFK, Jr. position is maddening. Yes, artificial food dyes are probably not good for health and should be eliminated. But how significant is the health cost of these food additives, which consumers intake at different levels, versus, say, pesticides, air pollution (mercury!) and other chemicals? The chemical intake burden is significantly a function of economic status. Rich people don’t live near chemical plants or sewage fields. So RFK Jr.’s position is yet another flavor of “hate the poors”.
And as for the obsession with connecting autism to vaccines, the obvious explanation the rise in the population is women giving birth at much older ages than historically.
Note that going back to only 2005 does not fully show the rise in age of child-bearing. Per a CDC paper in 2002:
One theory I have heard (and this is highly speculative, but did come from a medical professor who specializes in pediatrics) is that when both parents have high mathematical aptitude, there is a greater propensity for their child to be autistic. Needless to say, this is the last thing that high-performing tech types who met their wife through work would want to hear.
And some ancedata: The story below reports that one of the conditions that RFK, Jr. and his allies are attributing to “lifestyle issues” is depression. About half the men in my father’s family suffered from severe depression. My uncle, for instance, would often spend 22 hours a day in bed and was unable to face people during his frequent down phases. He tried every medication and medication combo available in his day. He got either no relief or relief for only a few months. He sought out electroshock (which my paternal grandfather also had received) and I gather it was somewhat beneficial.
Needless to say, as the example above illustrates, to depict Americans with serious ailments as having made “poor lifestyle choices” is deeply offensive.
By Stephanie Armour, senior KFF Health News health policy correspondent, who previously worked at The Wall Street Journal, Bloomberg, USA Today, The Des Moines Register, and the Daily Tribune in Ames, Iowa. Originally published at KFF Health News
On a recent weekday evening, Ashly Richards helped her 13-year-old son, Case, with homework. He did math problems and some reading, underscoring how much he’s accomplished at his school for children with autism.
Richards has heard Trump administration officials suggest that food dyes and pediatric vaccines cause autism and ADHD. That stance, she said, unfairly blames parents.
“There’s no evidence to support it,” said Richards, 44, a marketing director in Richmond, Virginia. “As a parent, it’s infuriating.”
In their zeal to “Make America Healthy Again,” Trump administration officials are making statements that some advocacy and medical groups say depict patients and the doctors who treat them as partly responsible for whatever ails them.
Health and Human Services Secretary Robert F. Kennedy Jr. and agency leaders have attributed a panoply of chronic diseases and other medical issues — such as autism, attention-deficit/hyperactivity disorder, depression, diabetes, and obesity — to consumers and their lifestyle choices, according to a review of 15 hours of recorded interviews, social media statements, and federal reports.
He said at a news conference on April 16 that autism is preventable and that rates are rising because of toxic substances in the environment, despite a lack of evidence there is any link.
“These are kids who will never pay taxes. They’ll never hold a job. They’ll never play baseball. They’ll never write a poem. They’ll never go out on a date,” he said. “Many of them will never use a toilet unassisted.”
The vast majority of people on the spectrum do not have those severe challenges.
The statements are more than rhetoric. These attitudes, ranging from judgments about individual behaviors to criticism of the chronically poor, are shaping policies that affect millions of people. The sentiments have been a factor behind decisions to cut Medicaid, keep federal insurance programs from covering anti-obesity drugs, and impose new barriers to covid vaccines for healthy people, say public health leaders and doctors. GOP lawmakers and federal health officials, they say, hold a reproachful stance toward chronic illnesses and the estimated 129 million people in the U.S. affected by them.
“This is at the heart of so much of our national problem with health,” said Robert Califf, who led the Food and Drug Administration during the Obama and Biden administrations. “It’s these two extreme views. It’s every health decision is up to the ‘rugged individual,’ versus the other extreme view that it’s all controlled by environment and social determinants of health. The truth is, it’s on a continuum.”
The Blame Game
Self-reliance is a common theme among adherents of MAHA, an informal movement for which Kennedy has fashioned himself the figurehead that promotes medical freedom, skepticism of vaccines, and a focus on nontraditional medicine to treat disease.
Taking medication to manage diabetes? FDA Commissioner Marty Makary suggested on Fox News in late May that it would be effective to “treat more diabetes with cooking classes” instead of “just throwing insulin at people.”
People with Type 1 diabetes must take insulin because their pancreases don’t produce it, according to the National Institutes of Health, which also notes that many with Type 2 diabetes “need to take diabetes medicines as well.”
Taking birth control pills? Casey Means, President Donald Trump’s nominee to be U.S. surgeon general, has said that’s a “disrespect of life” for short-term gain and efficiency.
“We are prescribing them like candy,” she said last year on “The Tucker Carlson Show,” adding that birth control medications “are literally shutting down the hormones in the female body that create this cyclical, life-giving nature of women.”
Have a child on ADHD meds? Calley Means, who is an adviser to Kennedy and is Casey Means’ brother, said on the same show that Adderall is prescribed as the standard of care when children get a little fidgety because they’re in sedentary environments with limited sunlight and eat too much ultraprocessed food.
As a society, he said, “we’re really committing mass child abuse in many ways, and we’re normalizing that and we’re not speaking out about that. And then we’re giving people stimulants developed by Nazi Germany.”
Calley Means was probably referring to Pervitin, a methamphetamine-based drug administered to Adolf Hitler’s forces in World War II. Adderall is a prescription drug containing amphetamine, a stimulant that’s not the same as methamphetamine.
The Department of Health and Human Services didn’t respond to messages seeking comment from Means.
Some conservatives and MAHA adherents argue that people need to take more responsibility for their health. But comments that shift blame to patients and physicians risk perpetuating stigmas, fostering the spread of misinformation, and eroding trust in modern medicine, say medical groups, doctors, and patient advocacy groups.
The statements assume consumers and patients have control over improving their health and preventing chronic disease when the reality is more complex, according to some public health leaders. Lower-income people, they say, often lack access to grocery stores and healthy food, may juggle too many jobs to have time to cook from scratch, and may live in dangerous areas where it’s harder to get outside and exercise.
Jerome Adams, surgeon general during the previous Trump administration, told KFF Health News that he worries efforts to promote health will be undone by “the return of vaccine-preventable diseases, increasing mistrust in the health care system, and the tearing down of social supports which are critical for making healthy choices.”
Tough Talk
The attitudes held by top Trump health officials have affected policy decisions, some doctors and public health leaders say.
Kennedy and other Trump administration health leaders have been especially outspoken, targeting issues they consider especially egregious in recent federal actions, research, or policy.
For example, the Biden administration proposed a rule in November that would let Medicare cover weight loss medications such as Wegovy and Zepbound. But Kennedy and other political appointees at HHS and its agencies have criticized the drugs and the people who take them.
“I think it’s very dark,” Calley Means told Carlson, referring to the weight loss drugs. “I think it’s a stranglehold on the U.S. population, almost like solidifying this idea that there is a magic pill.”
He added: “Where is the urgency on saying ‘Hey parents, maybe we shouldn’t feed our kids toxic food?’”
Kennedy, too, has criticized the medications and people who use them, saying in October on Fox News that drugmakers “are counting on selling it to Americans because we’re so stupid and so addicted to drugs.”
In April, the Trump administration announced it would not finalize the Biden-era coverage rule.
“It’s impacting the kind of care and treatments patients will have,” said Andrea Love, a biomedical scientist and founder of ImmunoLogic, a science communication organization. “It sends the message that it’s your fault. It’s very much victim-blaming. It creates the idea that scientific progress is the devil, demonizes things that aren’t individually harming health, while avoiding addressing systemic issues that play a much larger role in health.”
Kennedy and HHS didn’t return messages seeking comment.
Data shows that the medications are effective. People who took the highest dose of Zepbound in clinical trials lost an average of 48 pounds, and 1 in 3 on that dose lost more than 58 pounds, or 25% of their body weight.
Kennedy and other agency leaders also oppose many covid-era health restrictions and rules. Some physicians and public health leaders note these officials downplayed covid risks while criticizing vaccines developed during the previous Trump administration.
Kennedy has said that people who died from covid actually fell victim to chronic diseases such as obesity, diabetes, or asthma.
“That’s really what killed them,” Kennedy said on “Dr. Phil Primetime” in April. “These were people who were so sick they were basically hanging from a cliff, and covid came along and stamped on their fingers and dropped them off. But they were already living lives that were burdened by sickness.”
Covid was the underlying cause of death for more than 940,000 people in the U.S. from Aug. 1, 2021, to July 31, 2022, according to a 2023 report in JAMA Network, an open-access journal on biomedical sciences published by the American Medical Association.
Covid ranked first among deaths caused by infectious or respiratory diseases for youths under age 19, based on the report. Infants under a year old may be at higher risk of experiencing severe illness from covid compared with older children, studies show, and risks are also higher for infants under 6 months and those with underlying medical conditions.
“Vaccination during pregnancy can help protect infants after birth,” according to the CDC.
But Kennedy announced in May that the federal government would no longer recommend covid vaccines for pregnant people and children who are healthy. Medical groups such as the American Academy of Pediatrics opposed this decision and filed a lawsuit.
Kennedy also helped promote beliefs that many childless adults on Medicaid, the federal-state program for low-income people, don’t work and thereby drain resources from the program.
At a May hearing of the House Energy and Commerce Committee, Kennedy said the program was in jeopardy because of “all the able-bodied people who are not working [or] looking for jobs.”
It’s a view embraced by Republican lawmakers who portrayed adults enrolled in Medicaid as lazy or shirking work as they advanced a budget bill estimated to cut federal spending on the program by about $1 trillion over a decade, in part by imposing work requirements on many adult beneficiaries.
“Thirty-five-year-olds sitting at home playing video games, they’re going to now have to go get a job,” said House Majority Leader Steve Scalise of Louisiana.
The legislation, which Trump signed into law this month, will cause about 10 million more people to be without health insurance by 2034, the Congressional Budget Office estimates.
Some health leaders who criticized the legislation say the statements inaccurately maligned Medicaid enrollees, who by law cannot hold high-paying jobs and remain in the program.
Nonetheless, nearly two-thirds of adults ages 19 to 64 covered by Medicaid in 2023 were working. For about 3 in 10, caregiving responsibilities, an illness or disability, or school attendance prevented them from working, according to KFF, a health information nonprofit that includes KFF Health News.
“It’s using anti-welfare tropes for something that is basic health care, not a cash benefit,” said Anthony Wright, executive director at Families USA, which supports the Affordable Care Act and expanded health coverage. He summarized the Republican message: “We’re going to make it harder to get the help you need by imposing a bunch of paperwork, and if you don’t get it, it’s your fault.”
As far as I understand it, the increase in autism and similar diagnoses are mainly in what at least used to be called “high-functioning” variants. Autism streatches from the severly mentally disabled who may never be able to learn to use a toilet as per RFK Jr’s example (though with proper teaching they also learn, just at a glacially slow pace) to the kid who can go to school and can be very gifted in some areas but lack social abilities. It is as I understand it the second group that has seen an in increase in diagnosed cases.
The increase in diagnosed cases could be due to external factors, for example age of mother at birth or chemicals. But it could also be an increase in diagnosed cases without any change in the population. If a diagnosis leads to treatment and/or accomodations, patients or in this case parents are more likely to jump through the hoops of the medical system to persue them. This isn’t unique to autism, or the US medical system, we can see it in all kinds of illness and medical systems. Once an untreateable illness becomes treatable it also in general increases because it suddenly becomes meaningful to get that diagnosis. When there is no or very limited treatment the patient may have figured out what ails them but also figured out that their limited energy and / or money is better spent elsewhere.
Another factor that matters is stigmatisation. If the stigma of the diagnosis weighs heavier than the treatment or accomodations, then avoiding it becomes rational. And this seems to be the direction of the Trump administration. Make America look healthy by Hiding the disable, Again! MAHA!
Agreed with your point about diagnosis and I was remiss in not making that point. I know two people who have told me they are autistic and you’d never know it. Both have made a point of working at reading emotional cues. One taught in universities to force himself to get better.
I am one of these people with Asperger’s. Late 50’s male who excelled in the tech industry until 1999 when the emotional instability became so bad I could not work anymore. In and out of psyche wards and taking meds that did not. My father was accepted top NYU when he was 16 and my mother was an accomplished artist who suffered greatly with mental illness and ME/CFS later in life. I hit the genetic jackpot.
Since the mid2000’s I have been investigating the cause of the genetic traits of this in my family, along with most of my family having heart attacks before 50. It turns out we carry a mutation (not a polymorphism) in our Cystathionine Beta Synthase (CBS) enzyme (rs773734233 (c.700G>A) )which is linked to both Asperger’s and hyperhomocysteinemia (the link to the heart attacks).
Without this enzyme being able to bind to B6 (P5P) very well we also are not enable to produce enough glutathione so there is a build up of Hydrogen Peroxide (H2O2) which leads to Grave’s disease and Erythrocytosis. The high homocysteine, being an agonists of many neurotransmitter receptors led to psychosis and mood issues. High levels of H2O2 are also linked to Autism. I am not saying this is the only cause of Autism, there are many genes in this pathway that can trigger it (ALDH7A1 is another), but this pathway (methionine/glutathione) can be easily manipulated with changes in the diet and the environment.
So after this discovery, I am able to treat myself now with supplements including B6 in the form of P5P, Vitamin C, and supplemental Catalase, along with a diet that is also high in these nutrients and low in carbohydrates.
I hate RFK, jr. and all these people becasue I know the diet answer exists becasue I am living it, but they are so pseudo-scientific it demeans what I do so when I talk to people about this I am easily dismissed. But maybe that is their goal. And the science is there, I read the papers everyday, but again, there was much more money to be made off of by by shoving my mouth full of seroquel, risperidone, and SSRI’s than to look at how all my disorders were connected.
I have more thoughts on this but will wait to see how this is received before I respond anymore.
I have a friend who is very intelligent and is pretty sure she is on the lower end of the spectrum. I think she’s probably right. She can be very frank and not always sympathetic to others. She sees no need to seek diagnosis and like Yves’ acquaintance works to read social and emotional cues. She is great with kids and has great relationships with her neighbours. I have heard the same theory about two mathematically inclined parents being more likely to produce an autistic child mentioned in the article, but yeah, who wants to do that research?
Overall I have to agree that it is indeed highly insulting to imply (and make healthcare policy that assumes) that individuals are responsible for their own illness. Could we take better care of ourselves, no doubt but there is just way too much out there that is beyond our control. Maybe if everyone had better living conditions instead of just the wealthy some blame could be laid but even then extenuating circumstances and genetics will always play a part in poor health.
>>>Some health leaders who criticized the legislation say the statements inaccurately maligned Medicaid enrollees, who by law cannot hold high-paying jobs and remain in the program.
Keep in mind that the income limits for Medicaid are not adjusted for the local costs of living. A person on Medi-Cal, California’s version of Medicaid, cannot have more than $1,650 gross, not net, in earned income (income from work instead of a something akin to a trust fund or 401k) more than nine times in a rolling 60 month period. Any income over $1,850 in earned income is an automatic disqualification for Medi-Cal.
Effectively, the highest monthly take home pay from work is roughly $1,100. Using the California’s minimum wage of $16.50 ($20 in fast food restaurants) one can work 23 (or 19) hours per week without going over the monthly $1650 earned income limit. Making $1,650.01 or more for a total of nine months during a rolling block period of sixty months gets an automatic disqualification for Medi-Cal. And two more things to consider are that an apartment in California costs about $2,000 and up, and the average monthly social security check in the state is $1,935.
If I didn’t know better, I would believe that the policy is just to have as much as possible of the surplus population go die.
Yes, I assume that’s why eldercare doesn’t qualify as “caregiving” for purposes of Medicaid work requirements. On first thought it didn’t make economic sense: they can pay a few hundred a year for my relatively routine medical needs or they can pay six figures for nursing-home care for my parents…then a home nurse pointed out that they wouldn’t be likely to survive in a facility and the only reason they’re even alive is that I’m able to take care of them at home.
Force more people into long-term-care facilities while relaxing staffing requirements for those facilities–what other explanation can there be?
It is indeed depressing to have someone like RFK Jr as Secretary of Health and Human di-Services.
It’s changes in the criteria, changes in how disability is handled at school and (partial) destigmatization. On one side, my family has lots of “autistic” traits, and we’re all quite literally on a spectrum of how they’re expressed, from people who are extremely high-functioning with a few unusual traits to someone who is very classically and obviously autistic and needs a lot of accommodation. None of us have ever been diagnosed with anything – we’re the wrong generations. I do think that the most autistic one of us would have benefited a lot from accommodation – their life has definitely been derailed.
The panic over autism is mostly rooted in misinformation. If there were a large actual increase in the number of children being born with profound disabilities, that would require a social response and it would indeed be concerning. What’s actually happening is that society is recognizing that there already exists a large number of people with autistic traits which are different from the “norm” but which are largely pretty easy to accommodate and often have an upside (like hyperfocus). Basically, there are far fewer entirely 100% “normal” people than previously believed, and in a just and reasonable society this wouldn’t matter very much.
When I was a kid, high functioning autistic children like me were just bullied a lot. We were just weirdos who needed to be kicked around until we stopped being so weird – this was the attitude of a lot of teachers. We were different because we thought we were special, so we needed to have the arrogance kicked out of us. This was extra true if we were smart or visibly different in some way – bad enough to be a weird kid if you came from a well-off family, had pretty average looks, were the usual race/ethnicity for your school, etc, and much worse if you were poorer than others, fat or scrawny or a racial/ethnic outsider.
I didn’t need academic accommodations or any really structured social accommodations (my sibling, however, could really have used them). But a less brutally conformist understanding of children would have helped me a lot. I see teachers today working with my friends’ kids, and at least in good, adequately staffed schools, there’s a lot less bullying and a lot less of the sense that it’s normal and fine for kids to be brutal to each other, and the whole “weird kids should be bullied, that’s just how kids learn” idea seems to have gone for good.
In a way, I feel like the medicalization of some parts of autism isn’t helpful. I have a good friend who is very autistic – real trouble with social cues, profound and visible difficulty with eye contact, lots of hyperfocus, needs routine – and she is very successful in a career where these things don’t matter. She’s not “sick”, she just can’t make eye contact. What she needs is a society where we don’t in fact treat people who have trouble with making eye contact like there’s something wrong with them. In our society, it seems to be much easier to say, “don’t stigmatize people, it’s a medical condition” than to say “don’t stigmatize people over unimportant social differences”.
That said, actual medical/classroom/work accommodations are important for plenty of people. It would be great if we could treat each other with more respect and helpfulness and try to meet people’s actual needs as they arise instead of making people into political footballs.
About time! I used to date an illegal on Medicaid and every week when he got his Medicaid check he took me out for steak and lobster and the fanciest place in town.
Every time I came up pregnant, I had to decide between have an anchor baby to raise on Pop Tarts and Pepsi, or a abortion paid for by your tax dollars.
But now I have a Fitbit and drink raw milk, eat uninspected meat packaged by child slaves, and it’s all better.
Where this seems to be headed: If the unhealthy are that way because of personal choice then there is no reason to devote finite health resources to them. Better that they die off, ideally before procreating. If not eugenics, it is eugenics adjacent.
The essence of MAHA is that if everyone who is unhealthy dies, then all Americans will be healthy.
I’m thinking here that the idea behind all of this is to discredit the idea of public health. If you are unhealthy then it was your decision to be so – and nobody else – and not those corporations that specialize in selling junk food or the government for failing to reign in those corporations or even failing to offer kids fitness programs and education on healthy eating. Got a rule of thumb that if a food is brown, then it is suspect health wise. In that doco “Supersize me” the guy went to a school and nearly all the foods on offer were brown. Corporations would sell this junk to schools who would pull them out of a freezer and fry them up. But then this guy went to a school that offered healthy foods and at about the same price to schools. But the kids were much better behaved and could learn more. in short these are policy failings because corporations want to keep on making huge profits so better to blame individuals for failing in their choices.
Kennedy is just another artifact of the class war that the oligarchs are winning. Despite his nepo- baby tribulations with drugs in his youth, he assumed his class status that goes with an inbuilt amount of cluelessness. He is shallowly correct on a lot of things but totally ignorant on so many others. His class status in neoliberal predatory capitalist world insulates him from any clue of what life is like for the bottom 60-70%. I have lived a lot of my life around people like him and the stupid is astonishing. Where the are right on things (environment) it arises from very narrow personal and class interests (preserving hunting and fishing opportunities) supported by a vast amount of hubris.
If I needed only one “gauge” on my personal health “dashboard”, it would be BMI.
I second Yves’ calling this out as ‘deeply offensive’. When I was 24 I had a major orthopedic surgery (spinal fusion) at Stanford University Hospital in Silicon Valley. While recuperating I developed a viral infection that never really went away. Initially I was told I was just depressed, despite fevers that lasted months at a time. There was no known precedent for these conditions, now called post-viral sequaelae, sometimes called ME/CFS. I received a formal diagnoses in 1994 as soon as the CDC issued the diagnostic criteria. However, even now many doctors disbelieve these conditions are anything but mass hysteria, a word that contains a sexist put down as its roots. The only silver lining of the Covid catastrophe was that too many people developed Long Covid for the medical establishment to continue disbelieving sufferers with impunity. I think some combination of modern life – chemicals, pathogens, stress – has been silently spreading through the population, and it’s not all in our heads.