Itemoids

Americans

The Return of Snake Oil

The Atlantic

www.theatlantic.com › health › archive › 2025 › 01 › patent-medicine-supplements-rfk-trump › 681515

In a Massachusetts cellar in 1873, Lydia Pinkham first brewed the elixir that would make her famous. The dirt-brown liquid, made from herbs including black cohosh and pleurisy root, contained somewhere between 18 and 22 percent alcohol—meant as a preservative, of course. Within a couple of years, Pinkham was selling her tonic at $1 a bottle to treat “women’s weaknesses.” Got the blues? How about inflammation, falling of the womb, or painful menstruation? Lydia E. Pinkham’s Vegetable Compound was the solution. Pinkham’s matronly smile, printed on labels and advertisements, became as well known as Mona Lisa’s.

Lydia E. Pinkham’s Vegetable Compound was one of thousands of popular and lucrative patent medicines—health concoctions dreamed up by chemists, housewives, and entrepreneurs—that took the United States by storm in the 19th and early 20th centuries. These products promised to treat virtually any ailment and didn’t have to reveal their recipes. Many contained alcohol, cocaine, morphine, or other active ingredients that ranged from dubious to dangerous. Dr. Guild’s Green Mountain Asthmatic Compound was available in cigarette form and included the poisonous plant belladonna. Early versions of Wampole’s Vaginal Cones, sold as a vaginal antiseptic and deodorizer, contained picric acid, a toxic compound used as an explosive during World War I. Patent-medicine advertisements were unavoidable; by the 1870s, 25 percent of all advertising was for patent medicines.

After the Pure Food and Drug Act was passed in 1906, the newly created Food and Drug Administration cracked down on miracle elixirs. But one American industry is still keeping the spirit of patent medicine alive: dietary supplements. In the U.S., vitamins, botanicals, and other supplements are minimally regulated. Some can improve people’s health or address specific conditions, but many, like the medicines of old, contain untested or dangerous ingredients. Nevertheless, three-quarters of Americans take at least one. Some take far more. Robert F. Kennedy Jr., the longtime conspiracy theorist and anti-vaccine activist who’s awaiting Senate confirmation to run the Department of Health and Human Services, has said he takes a “fistful” of vitamins each day. Kennedy has in recent years championed dietary supplements and decried their “suppression” by the FDA—an agency he would oversee as health secretary. Now he’s poised to bring America’s ever-growing supplement enthusiasm to the White House and supercharge the patent-medicine revival.  

The newly created FDA eventually required all pharmaceutical drugs—substances intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease—to be demonstrably safe and effective before they could be sold. But dietary supplements, as we call them now, were never subject to that degree of scrutiny. Vitamins were sold with little interference until the “megadosing” trend of the late 1970s and ’80s, which began after the chemist Linus Pauling started claiming that large amounts of vitamin C could stave off cancer and other diseases. The FDA announced its intention to regulate vitamins, but the public (and the supplement industry) revolted. Mel Gibson starred in a television ad in which he was arrested at home for having a bottle of Vitamin C, and more than 2.5 million people participated in a “Save Our Supplements” letter-writing campaign. Congress stepped in, passing the 1994 Dietary Supplement Health and Education Act, which officially exempted dietary supplements from the regulations that medications are subject to.

Since then, the FDA has generally not been responsible for any premarket review of dietary supplements, and manufacturers have not usually had to reveal their ingredients. “It’s basically an honor system where manufacturers need to declare that their products are safe,” says S. Bryn Austin, a social epidemiologist and behavioral scientist at the Harvard T. H. Chan School of Public Health. The agency will get involved only if something goes wrong after the supplement starts being sold. As long as they disclose that the FDA hasn’t evaluated their claims, and that those claims don’t involve disease, supplement makers can say that their product will do anything to the structure or function of the body. You can say that a supplement improves cognition, for example, but not that it treats ADHD. These claims don’t have to be supported with any evidence in humans, animals, or petri dishes.

In 1994, the dietary-supplement industry was valued at $4 billion. By 2020, it had ballooned to $40 billion. Patent-medicine creators once toured their products in traveling medicine shows and made trading cards that people collected, exchanged, and pasted into scrapbooks; today, supplement companies sponsor popular podcasts, Instagram stories are overrun with supplement ads, and influencers make millions selling their own branded supplements. The combination of modern wellness culture with lax regulations has left Americans with 19th-century-like problems: Pieter Cohen, an associate professor of medicine at Cambridge Health Alliance, has found a methamphetamine analogue in a workout supplement, and omberacetam, a Russian drug for traumatic brain injuries and mood disorders, in a product marketed to help with memory.

Last year, Kennedy accused the FDA of suppressing vitamins and other alternative health products that fall into the dietary-supplement category. But “there is no truth about the FDA being at war on supplements over the last several decades,” Cohen told me. “In fact, they have taken an extremely passive, inactive approach.” Experts have repeatedly argued that the FDA needs more authority to investigate and act on supplements, not less. And yet, Kennedy continues to champion the industry. He told the podcaster Lex Fridman that he takes so many vitamins, “I couldn’t even remember them all.” Kennedy has vocally opposed additives in food and conflicts of interest in the pharmaceutical industry, but has failed to mention the dangerous additives in dietary supplements and the profits to be made in the supplement market. (Neither Kennedy nor a representative from the MAHA PAC responded to a request for comment.)

In an already permissive environment, Kennedy’s confirmation could signal to supplement manufacturers that anything goes, Cohen said. If the little regulation that the FDA is responsible for now—surveilling supplements after they’re on the market—lapses, more adulterated and mislabeled supplements could line store shelves. And Americans might well pour even more of our money into the industry, egged on by the wellness influencer charged with protecting our health and loudly warning that most of our food and drug supply is harmful. Kennedy might even try to get in on the supplement rush himself. Yesterday, The Washington Post reported that, according to documents filed to the U.S. Patent and Trademark Office, Kennedy applied to trademark MAHA last year, which would allow him to sell, among other things, MAHA-branded supplements and vitamins. (He transferred ownership of the application to an LLC in December. Kennedy’s team did not respond to the Post.)

A truly unleashed supplement industry would have plenty of tools at its disposal with which to seduce customers. Austin studies dietary supplements that make claims related to weight loss, muscle building, “cleansing,” and detoxing, many of which are marketed to not just adults, but teenagers too. “Those types of products, in particular, play on people’s insecurities,” she told me. They also purport to ease common forms of bodily or mental distress that can’t be quickly addressed by traditional medical care. Reducing stress is hard, but ordering the latest cortisol-reducing gummy on TikTok Shop is easy. Your doctor can’t force vegetables into your diet, but a monthly subscription of powdered greens can.

Judy Z. Segal, a professor emerita at the University of British Columbia who has analyzed patent-medicine trading cards from the 19th and 20th centuries, told me that supplement-marketing strategies “have not changed that much since the patent-medicine era.” Patent medicines appealed to ambient, relatable complaints; one ad for Burdock’s Blood Bitters asserted that there were “thousands of females in America who suffer untold miseries from chronic diseases common to their sex.” And the makers of patent medicine, like many modern supplement companies, used friendly spokespeople and customer testimonials while positioning their products as preventive care; according to one ad for Hartshorn’s Sarsaparilla, “The first deviation from perfect health should receive attention.”

In 1905, the muckraker Samuel Hopkins Adams lamented that “gullible America” was so eager to “swallow huge quantities of alcohol, an appalling amount of opiates and narcotics, a wide assortment of varied drugs ranging from powerful and dangerous heart depressants to insidious liver stimulants; and, far in excess of all other ingredients, undiluted fraud.” Compounds and elixirs go by different names now—nootropics, detoxes, adaptogens—but if Adams walked down any supplement aisle or browsed Amazon, he’d still find plenty of cure-alls. He could even pick up a bottle of Lydia E. Pinkham’s Herbal Supplement, which is sold as an aid for menstruation and menopause. Pinkham’s face smiles at buyers from the label, though its advertised benefits are now accompanied by a tiny disclaimer: “This statement has not been evaluated by the FDA.”

If Iranian Assassins Kill Them, It Will Be Trump’s Fault

The Atlantic

www.theatlantic.com › politics › archive › 2025 › 01 › iran-death-threats-trump-staff › 681510

Donald Trump likes to tell his supporters that he’s a fighter, a fearless champion who always has their back. Such guarantees, however, apparently do not apply to people who worked for him when they’re threatened by foreign assassins. Former Chairman of the Joint Chiefs of Staff Mark Milley, former National Security Adviser John Bolton, former Secretary of State Mike Pompeo, and the former Pompeo aide Brian Hook have all been targeted by Trump for political retribution. They are also being targeted by the Iranians, but the regime in Tehran has marked them all for death.

The president may be spoiling for a fight with career bureaucrats and “woke” professors, but when it comes to Iranian assassins, he is willing to walk away from men who carried out his orders. Milley, Bolton, Pompeo, and Hook all served in Trump’s first administration—he appointed them to their posts—and they were part of the Trump national-security team when the United States killed Iranian General Qassem Soleimani in a strike in January 2020. In 2022, an Iranian national was arrested and charged with trying to arrange Bolton’s murder, and American intelligence believes that other officials—including Trump himself—have been targeted by Iran because of their involvement in killing Soleimani.

The Biden administration briefed the incoming Trump administration on these threats and on the security details it had authorized to protect Bolton and others. Last week, Trump removed the details protecting Bolton, Pompeo, and Hook; yesterday, Secretary of Defense Pete Hegseth removed the guards around Milley and announced that he would be investigating Milley for undermining the chain of command during Trump’s first term. Trump also revoked the security clearances held by all four men.

[From the November 2023 issue: The patriot]

The revocation of security clearances is petty, but it harms the administration more than it does any of these men. Retaining a clearance helps former federal employees find work in the consulting world, and it is typical to hold on to them after leaving government service. (I was offered the opportunity to keep mine when I left the Naval War College.) But at more senior levels, clearances allow people in government to get advice from former leaders. Some of these people could have been of significant help to Trump’s staff during a crisis, although Trump himself is unlikely to care about that possibility.

Removing the security details, however, could have deadly consequences. The Iranians seem determined to seek revenge for the killing of Soleimani, and sooner or later, they might succeed. (“The Iranians are not good but they’re very enthusiastic,” a former Pentagon official said in October. “And of course, they’ve only got to get lucky once.”) And the Iranians aren’t the only threat out there; the Russians have no compunctions about attacking people in their home country, often using gruesome methods.

Trump takes such threats very seriously where he is concerned. When Biden officials alerted Trump to the danger from Iran, Trump asked for more security from the U.S. government, and during his campaign, according to The New York Times, he even asked that military assets be assigned to protect him, something usually provided only to sitting presidents.

Lesser mortals, however, must fend for themselves: Trump and Hegseth not only took away the security details of these former policy makers but did so with significant publicity, almost as if to broadcast to America’s enemies that anyone who wanted to settle scores with these officials would get no trouble from the current White House. (Trump also canceled protection for 84-year-old Anthony Fauci, the former director of the National Institute of Allergy and Infectious Diseases, who has been the target of multiple threats from other Americans.) Trump despises critics such as Bolton and Milley, and it is unsurprising that he has no obvious issue subjecting them to physical danger. But even some Republicans —who should be used to this kind of vengefulness from the leader of their party—have been shocked, and are trying to get Trump to reverse course. They are particularly concerned about Pompeo and Hook, loyalists whose lives have been placed in jeopardy for sins that are known only to the president.

[Read: Trump can’t escape the laws of political gravity]

In another time, Americans would rally to protect their own from the agents of one of their most dedicated enemies. Today, most citizens seem either unaware or unperturbed that the president of the United States is exposing his own former staff to immense risks. Nevertheless, it should be said clearly and without equivocation: President Trump will bear direct responsibility for any harm that could come to these people from foreign actors.

This is far more than Trump’s usual pettiness. He has always considered the oath of federal service to be little more than an oath of loyalty to him, and he has always been willing to threaten his opponents. (In 2018, he apparently considered handing Michael McFaul, the former U.S. ambassador to Russia, over to Moscow, a move that provoked a level of outrage that seems quaint today.) Trump’s message in this second term is that friends and subordinates are literally disposable if they cross him: He will not only humiliate and fire them, but he will also subject them to actual physical danger.

This escalation of Trump’s vindictiveness should serve as a very personal warning to anyone willing to work for him in his second term. Senior officials at the Pentagon, the State Department, the CIA, the National Security Council, and other organizations are routinely asked to go head-to-head with representatives of some of the most dangerous nations on the planet, and to contribute to operations against those regimes. In the past, such officials could do so knowing that their own government would do everything it could to keep them—and their family—safe from foreign agents. As one of Bolton’s former deputies, Charles Kupperman, told the Times: “Trump’s national security team must provide guidance based on their assessment of what needs to be done to protect America without regard to their personal security.”

Good luck with that. No one who works in defense or national-security affairs can assume that, when Trump orders them to cross America’s many enemies in the world, he will protect them from foreign vengeance. Trump has now made clear that he will abandon people who have taken risks in the service of the United States—even those who were following his own orders—if they happen to displease him. (Or, in the case of Pompeo and Hook, for no apparent reason at all.) Hegseth, for his part, may have no real idea what he’s done, and may merely be courting favor from a boss who has elevated him far beyond his abilities. But Trump knows better; he is himself the survivor of an assassination attempt, and no level of security was enough when he thought the Iranians were gunning for him.

People still considering whether to serve Trump can have no illusions about what awaits them. True leaders take responsibility for their team. Trump is no such leader; he will, on a whim, place other Americans in danger and then, as he famously put it in his previous term, take no responsibility at all.

The Near Misses at Airports Have Been Telling Us Something

The Atlantic

www.theatlantic.com › ideas › archive › 2025 › 01 › airport-faa-crowded-regulation › 681509

Until just moments before an American Airlines regional plane and an Army helicopter collided over the Potomac River last night, nothing in particular seemed amiss. Conditions were clear, Sean Duffy, the new secretary of transportation, noted in a press conference this morning. The passenger jet, coming from Wichita, Kansas, was about to arrive at Ronald Reagan Washington National Airport—one in a succession of airliners landing about two minutes apart. The Black Hawk helicopter was on a training mission from Virginia’s Fort Belvoir. Both aircraft were in a “standard flight pattern,” Duffy said. Referring to the crowded and shared air space around D.C., he added, “This was not unusual.”

And that may turn out to be the problem. The precise immediate cause of the crash—which killed all 64 passengers and crew members aboard the airliner and all three people in the helicopter—will not become clear until investigators fully analyze recordings of air-traffic-control communications and the plane’s black box. But the accident follows a long string of alarming near collisions at airports across the country—a pattern suggesting that the aviation-safety systems upon which human life depends are under enormous strain.  

[Conor Friedersdorf: Don’t politicize aviation safety]

In 2023, the Federal Aviation Administration identified 19 “serious runway incursions,” the most in almost a decade. The causes of these events are varied: air-traffic-control staffing shortages, pilot inexperience, demand for air travel, outdated technology. The increase in near misses led the FAA to create a safety review team and issue a rare industrywide “safety call to action” demanding greater vigilance throughout the community. These incidents do not appear to have prompted any major changes in safety practices either nationally or in the Washington area. Last year, the number of serious incursions declined, making the issue seem less urgent.

Reagan National’s tight footprint and three intersecting runways, along with the presence of military and other government operations nearby, make the air space surrounding the facility relatively tricky for pilots to navigate. As the popular open-source intelligence account @OSINTtechnical noted on X once footage of the accident and its aftermath began spreading on social media, “For many in the DC-area flying community, the crash tonight wasn’t a matter of if, but when.” (This morning, Defense Secretary Pete Hegseth announced an investigation of the Army helicopter’s role in the incident.)

In 2013, an airliner and a military helicopter flying at the same altitude near Reagan National came within 950 feet of each other. Last May, a Boston-bound jet traveling 100 miles an hour on the runway had to abort its takeoff because another plane had been cleared to land on an intersecting runway. Even so, the FAA added additional flight slots to Reagan National last year, over the objections of local politicians who worried about congestion and overburdening capacity.

[Read: Inside the busy, stressful world of air traffic control]

The crash near Reagan National was the first major aviation disaster involving a U.S. airline since 2009—long enough that nearly a generation of Americans are experiencing this crash as their first. Such incidents have become so rare that Americans come to assume that safety precautions automatically work.

Safety systems are vulnerable to a phenomenon known in the disaster-management world as the “near-miss fallacy”—an inability to interpret and act upon the warnings embedded in situations where catastrophe is only narrowly avoided. Paradoxically, people may come to see such events as signs that the system is working. In her groundbreaking research on NASA after the space shuttle Challenger exploded in 1986, the American sociologist Diane Vaughan faulted the agency for its “normalization of deviance.” The direct culprits in the spacecraft’s fate were faulty booster-rocket parts known as “O-rings.” Vaughn noted that shuttle missions had been experiencing problems with the parts for years, but NASA had downplayed their importance. Engineers were able to normalize O-ring incidents and other safety issues because none had caused significant harm—until one did.

The immediate cause of the crash over the Potomac may turn out to be a single tragic mistake. But this deadly tragedy occurred within a broader context. For some time, our aviation system has been ignoring warning signs and normalizing deviance. Good luck can last only so long, and it ran out last night.

Don’t Politicize Aviation Safety

The Atlantic

www.theatlantic.com › ideas › archive › 2025 › 01 › aviation-security-dca › 681507

Yesterday, the United States suffered the first fatal crash of a U.S. airliner in 16 years. American Airlines Flight 5342, a regional jetliner, originated in Wichita, Kansas. Just before landing at Ronald Reagan Washington National Airport in northern Virginia, it collided with a military helicopter over the Potomac River. Scores of people were feared dead late Tuesday. Authorities haven’t yet determined the cause of the collision. The National Transportation Safety Board will lead an investigation, hoping to determine what happened and prevent any similar accidents in the future.

There is no reason to believe that the dramatic changes to the federal government made by the Trump administration, or the chaos they introduced, played any role in this tragedy. But the success of regulators in improving the safety of commercial aviation is among the great triumphs of the last half-century. And in its first week in office, the Trump administration did take one unrelated step that suggests a cavalier disregard for the consequences of politicizing those efforts: it dismissed all of the members of the federal Aviation Security Advisory Committee, a body which advised the Transportation Security Administration.

“The aviation security committee, which was mandated by Congress after the 1988 PanAm 103 bombing over Lockerbie, Scotland, will technically continue to exist but it won’t have any members to carry out the work of examining safety issues at airlines and airports,” the Associated Press reported last week. “Before Tuesday, the group included representatives of all the key groups in the industry — including the airlines and major unions — as well as members of a group associated with the victims of the PanAm 103 bombing. The vast majority of the group’s recommendations were adopted over the years.”

My colleague James Fallows, a longtime pilot who has reported on aviation for decades, noted yesterday that dismantling the committee one week ago “wasn’t part of tonight’s tragedy,” but argued that it is a thoughtless destruction of a taken-for-granted institution that will erode safety over time, when the United States should instead be conserving the gains of recent decades. Pointing his readers to a list of the board’s former members, Fallows wrote that it “was collaborative; it combined public, private, military, civilian, academic, and other institutions to pool knowledge; it avoided blame; but it focused relentlessly on lessons learned.”

I favor a smaller federal government, and will likely cheer some cuts that the Trump Administration makes. My hope is for a bureaucracy that does fewer things and does them well.

But aviation safety in America is the envy of the world––it’s among the few things that was working well, having improved significantly in recent decades under a status quo that Trump is disrupting. To what end? Perhaps the Trump administration has some compelling rationale that it hasn’t shared for disbanding the Aviation Security Advisory Committee. If so, it should speak up.

Instead, a Department of Homeland Security official offered a vague and unpersuasive statement to Aviation International News: “The Department of Homeland Security will no longer tolerate any advisory committee which pushes agendas that attempt to undermine its national security mission, the President’s agenda, or Constitutional rights of Americans,” he said.

Congress should demand better answers, for the sake of the due diligence that airline safety warrants, and because stripping a mandated board of all its members would seem to thwart its legitimate power with a technicality. If Congress judges that the board is still useful, it should use the power of the purse to force its restoration, rather than giving in to the president.

Will Republicans, who hold a majority in the House and the Senate, jealously guard the legislature’s powers and diligently discharge its oversight responsibilities? Perhaps not. Deferring to presidents from one’s own party is a bipartisan sin, however derelict it makes legislators in their duties. While Trump undoubtedly has a popular mandate for aspects of his agenda, however, no voter sent him to Washington to end an aviation safety committee. He is owed no deference on that move.

Trump is making a lot of changes very quickly. If GOP legislators won’t probe this one to see if it is arbitrary or ill-considered, it’s hard to imagine what will spur them to exercise their oversight responsibilities––after all, most members of Congress are frequent flyers.

RFK Jr. Has a Lot to Learn About Medicaid

The Atlantic

www.theatlantic.com › health › archive › 2025 › 01 › rfk-jr-hearing-medicaid › 681504

Put on the spot, a lot of Americans might hesitate over the difference between Medicaid and Medicare. People who aren’t affected by one of these programs, which together enroll about 150 million people in the U.S., don’t generally have a need to be well versed in their intricacies, and the two programs sound quite similar. The names don’t really hint that Medicare is a federal program that covers older Americans and Americans with disabilities, and that Medicaid covers low-income people in the United States.

Most Americans, though, are not nominated to become secretary of the Department of Health and Human Services. Robert F. Kennedy Jr. is. And yet today, at his confirmation hearing before the Senate Finance Committee, he made clear that he also does not know very much about Medicare and Medicaid.

As HHS secretary, Kennedy would oversee a suite of government agencies, including the FDA, CDC, and National Institutes of Health, that are focused on improving American health. He also would oversee the Centers for Medicare and Medicaid Services, which, as the name implies, manages those two programs. HHS services, in other words, touch the lives of every American—and Medicaid and Medicare are, in particular, two of the most common ways for people to directly benefit from the government’s services.

During the three-and-a-half-hour hearing, in which the Senate committee pressed Kennedy on a range of issues—his anti-vaccine views, endorsements of conspiracy theories, stance on abortion, potential financial conflicts—senators grilled Kennedy on various aspects of the two government programs. In his new role, Kennedy could be charged with overseeing substantial changes to one of them. Donald Trump has pledged to preserve Medicare. He has made no such promise about Medicaid, which health-policy experts anticipate may be targeted for spending cuts. (On Tuesday, Medicaid reimbursement portals abruptly stopped working after the Trump administration ordered a freeze on federal grants and loans; states have since regained access to the portals.) Some Republicans have argued that an increased focus on public-health insurance in the U.S. won’t make Americans healthier, and Kennedy appeared to echo that viewpoint today when he criticized Medicaid, saying “our people are getting sicker every single year,” and lamented the program’s expansion to people with higher incomes. “The poorest Americans are now being robbed,” he said.

But Kennedy also seemed to mix up the two programs when he described them. Part of the issue with Medicaid, he said, is that “the premiums are too high, the deductibles are too high.” The majority of people enrolled in Medicaid don’t pay premiums or deductibles; federal law actually prohibits premiums for the program’s lowest-income enrollees. (He did seem better versed in Medicare Advantage, a program that provides private insurance coverage for older Americans and that he himself is enrolled in.)

To be fair, Kennedy was in a high-pressure situation. But being HHS secretary is a high-pressure job. Kennedy had time to prepare in advance of today’s hearing. If confirmed, he won’t need to master every minute detail of Medicare and Medicaid, but he will need to be able to navigate both programs—their differences, their weaknesses, and how they might evolve. People who are eligible for both programs, for instance, have created sticking points in the health-care system, in part because coordinating coverage between the two is difficult and can complicate care. When pressed by Senator Bill Cassidy of Louisiana on how to deal with that issue, Kennedy suggested that the programs should be “consolidated” and “integrated”—but when asked how that might happen, said, “I’m not exactly sure.”

Kennedy struggled with other policy specifics, too. One of his goals, Kennedy said, is to fulfill Trump’s directive to improve the quality of care and lower the price of care for all Americans. But he was vague on any plans to reform Medicaid, explaining that he’d “increase transparency” and “increase accountability.” When pushed by Cassidy to clarify, Kennedy said, “Well, I don’t have a broad proposal for dismantling the program.”

Nor did Kennedy have a clear sense of how he would approach one of the more contentious and legally sensitive health questions of the past few years: whether women whose lives are threatened by pregnancy should be able to receive emergency abortions under EMTALA, the law that requires emergency rooms that receive Medicare funding to provide care to anyone in a life-threatening situation. The Biden administration argued that this federal law supersedes state abortion bans, and in 2024, after the Supreme Court demurred on the issue, the administration made clear to doctors, in a letter co-authored by Health and Human Services Secretary Xavier Becerra, that abortions could qualify as emergency treatment. Kennedy admitted this morning that he didn’t know the scope of the authority he’d have to enforce the law in his new job.

Jacinda Abdul-Mutakabbir, a clinical pharmacist at UC San Diego, told me that Kennedy's apparent failure to understand the intricacies of the two programs wasn’t just a harmless fumble. If the health secretary is not well versed in the programs he’s tasked to run, he might not appreciate the impacts of his decisions. Should health coverage for some of the most vulnerable Americans be altered—perhaps even taken away—then health disparities in this country would likely widen. And if any part of his agenda does include increasing transparency, as Kennedy described in today’s hearing, expertise will have to be a prerequisite. “You can’t increase transparency on something you don’t have clarity on,” Abdul-Mutakabbir told me. (Kennedy’s press team did not immediately return a request for comment on his performance at today’s hearing.)

During the hearing, Kennedy’s more radical views on vaccines and infectious disease did come up. He copped to describing Lyme disease as “highly likely a militarily engineered bioweapon.” (The bacterium, which has been around for at least tens of thousands of years, is not.) He stood by his assertion that the measles vaccine killed two children in Samoa in 2018. (The vaccine did not; those children died following the administration of an improperly mixed vaccine by two nurses who were ultimately sentenced to five years in prison for the act.) He said that young children are at “basically … zero risk” from COVID-19. (Young children are at risk, especially babies under six months of age, who have similar hospitalization rates from the disease as adults 65 to 74 years old.) Kennedy’s falsehoods about infection and immunity were already well known, though. What the country learned today was that he may lack basic competency in some of the most wide-reaching aspects of his future job—and didn’t take the time to prepare answers for Congress, which he’ll ultimately have to answer to.