Take RFK Jr seriously: what RFK Jr. gets right and wrong

Because the media screwed up Covid19 policy & because of how they choose to cover him, RFK Jr's influence is destined to grow

RFK Jr is making the rounds on the talk show circuits. There are many parts of his platform that I am a complete supporter of. I find he articulates them in a very important way. All those have to do with pushing against corporate interests and outright governmental corruption. And he is the only person articulating these issues. The Democratic party is supposed to hold power to account, but they largely appear to be corporate sell-outs, beholden to Pfizer and other companies. In many ways RFK Jr embodies the true populist spirit of the Democratic party, as his father and uncle once did. Yet, while he gets some things right, he gets other things wrong.

RFK Jr holds views I disagree with. Mostly because I think he has not made a strong or sufficient case. Yet, I'm am willing to compromise on some of these issues, and I can devise a study that we will both agree upon that will adjudicate the question. If I were to speak with him, I would suggest that we agree to run these proposed studies, and let's let that result settle the question. I strongly suspect he's going to be incorrect about several things he believes. But I do think the best way to disarm his concerns is to sit down and agree upon the study that will settle the question. I think insulting him is very unlikely to be fruitful, yet that is the preferred media tactic.

Acknowledging that one can agree and disagree with someone, and before I get to the specific, let's be honest about his appeal. RFK Jr is an incredibly powerful speaker. He's hyper-articulate. Although he suffers from vocal cord dysfunction, that may even enhance his perception rather than diminish it. It may even be a feature and not a bug. I think many are underestimating how persuasive he is. He is poised to be one of the most influential figures of the next decade. Dismissing him outright will only backfire. When have we made that mistake? I wonder.

Let's start by acknowledging that RFK Jr is saying some things that a Democrat should have been saying all this time. RFK Jr acknowledges the deep corruption that runs in Washington. Many regulatory agencies are entirely captured by the corporations. He's the only person saying that. He is completely right. The way FDA worked with Biogen makes me sick. The revolving door at FDA makes me sick. Peter Marks behavior towards Pfizer makes me sick. RFK Jr nails this.

On Covid-19 policy, RFK Jr is absolutely correct that lockdowns were a colossal failure and abandonment of the poor. He's absolutely correct about many of the issues with the Covid vaccine program. I think the vaccine lowered death rates in older, un-immune people, but pushing COVID vaccines on people who already had covid was insane. Pushing repeat mRNA COVID vaccines on young men at high risk of myocarditis and college mandates resulted in net harm. RFK Jr is correct about many of Tony Fauci's lies. One has to give RFK Jr a lot of credit for speaking openly about these topics. Obviously he's completely wrong about ivermectin and hydroxychloroquine. The burden is on those products to show benefit in randomized studies and they have never met that burden. You can always fault the available randomized trials (as he does for dosing), but if you believe something is helpful, you must show how it will help. Mask zealots fault mask RCTs, but the burden is on them to prove how they might help. Mask supporters and ivermectin supporters are actually more similar than they know.

When it comes to the structural issues in medicine, I think RFK Jr has some good points. The US FDA is working too closely with Pharma. In fact, it appears that they are doing their bidding. I totally agree with him that vaccine manufacturers should not have indemnification. They should be able to be sued. When it comes to covid-19 vaccines, they should have their asses sued. Every young man who had vaccine myocarditis it should be filing a class action lawsuit against them, and the school that mandated it. The laws that shield them from litigation are unjust in a democratic society. He is correct.

That doesn't mean I think juries will always get it right, but I do think it's not fair to prevent them from having the opportunity. Ultimately, I think we need a better system in science and law to adjudicate which harms our due to something versus which are incidental. Our current system is not intended to arrive at truth.

When RFK Jr. talks about his father, you can't help but be moved. His family has given a lot to this country. On many issues they were on the right side of history. That legacy and gravitas is sitting on his shoulder. It must be acknowledged. This is another reason he should not be dismissed.

I think it's important to think about the fact that an environmental lawyer and an epidemiologist have different standards of evidence to conclude an intervention is net harmful. A lawyer is happy to use observational data, with persistent residual confounding, to build the courtroom case that something is a problem. But an epidemiologist will demand very pure data to believe something is harmful, especially when we think it offers alternative benefits. This is the crux of the issue with childhood immunization, and largely the root of my disagreement.

At the same time, things get messy very quickly when you talk about toxic exposures in drinking water. What should the level of evidence be to restrict the use of pesticides if trace levels are found in drinking water? Obviously corporate interest would favor permissive standards. RFK Jr would be critical of that. Demanding very stringent evidence might be counterproductive. I think there's a philosophical difference between the evidence to prevent someone from engaging in pollution versus the evidence required to sell a product that you claim make someone better off. I have long been interested in this question, and we have published many papers on the topic. I suspect I am close to RFK Jr about regulating industrial pollutants.

In order to deal with RFK Jr’s more troublesome points of view, I think the only solution is to agree that the current surveillance system— and the current epidemiologic evidence is limited in many ways. We need to improve the current surveillance system on vaccine safety, so that we can adjudicate whether or not even some of his claims are true. I personally believe that most will not hold up, but I think one must acknowledge that the current surveillance system is flawed, and some may hold up. Why do I think this compromise is worth it.

Proof that current surveillance systems are limited is that the two most salient vaccine safety issues of vaccine induced thrombocytopenia and thrombosis and myocarditis were not detected in the United States. We learned about this from other countries. And only later, and begrudgingly, we acknowledged that they were true. Our CDC director actually said that she had not seen the signal. That statement had to have been a lie when she said it. Additionally, the rates of myocarditis that have been reported in US data sets are lower than global data sets, suggesting missed cases in the numerator. Finally, we have failed to enforce fair vaccine studies. Pfizer was tasked with looking for subclinical myocarditis but this requirement was not enforced by the US FDA. We care so little about safety. We cannot enforce post marketing commitments.

I agree with RFK Jr completely that if you don't allow vaccine makers to be sued, and have low standards of evidence for approval, well then you're giving them a lot of money. And someone might be skeptical of that.

The news media keeps labeling RFK Jr as a conspiracy theorist and a charlatan, but that is a colossal mistake. He is somebody who on many issues is saying something deeply true. On other issues, I think he is off the mark. One of those is his views on wifi. Another is his views on early childhood immunization with MMR and DTAP. He has not made a strong enough case that the harms of these programs outweigh the massive benefits. I understand why many doctors are critical of his statements on these topics.

Yet on hepatitis B vaccination, RFK Jr makes a fair point that we could target higher risk populations. At least that could be the central question of a randomized control trial. He's also fair to ask if the particular timing of doses is optimized, or if it could be given it a later date. That could also be a randomized trial. I think this century will see the pediatric childhood immunization schedule the subject to a multi-arm, factorial RCT. It is better to launch that effort now before public distrust gets too out of control.

Some in public health believe that debating RFK Jr legitimizes him, and should never be done. That is a tragic error. It need not be framed as a debate. It can be framed as a conversation. And one should be honest about what he's saying that's right. But one can also push back on what he's saying that's wrong.

Recently many have proposed that Dr. Peter Hotez debate RFK Jr. Peter Hotez, unfortunately, is woefully incapable of this task. Any single public health expert to advocated for lockdowns, school closure, vaccine mandates, lowering the regulatory standards to rubber stamp, covid-19 vaccines and young populations, using non-inferior geometric mean antibody titers, will be obliterated. Any person in public health who has gotten everything wrong the last 2 years will not survive such a dialogue. RFK Jr would mop the floor with Peter Hotez, and the no one will be defending the truth.

Check this out

https://twitter.com/anish_koka/status/1670515925261467648?s=20

These are some scattered thoughts on the topic. If you find them interesting, feel free to subscribe. Censorship is wrong, as is painting with a broad brush. The key to persuasive refutation is to agree what someone gets right and wrong, and also to agree on the study that may resolve open questions. That is the only way to respond to RFK Jr. Given how elites mishandled COVID19, I think the next 25 years will be incredibly disruptive to science and medicine. Sadly the same people in media who supported school closure are covering RFK Jr all wrong.