Robert F. Kennedy Jr. is wrong about a lot of things in public health. Vaccines don’t cause autism. Raw milk is more dangerous than pasteurized milk. And cellphones haven’t been shown to cause brain cancer. But the basic idea behind his effort to “Make America Healthy Again” is correct: America is not healthy, and our current system has not fixed the problem.

Joe Biden entered office promising to “beat” the coronavirus pandemic, cure cancer, and get more people health care. Arguably no one on Earth can talk more passionately about funding cancer research than Biden, whose son Beau died of brain cancer in 2015 and who, in 2022, announced an initiative to halve U.S. cancer deaths in the next 25 years. Robert Califf, Biden’s FDA commissioner, has been particularly stalwart in arguing that the agency must play a role in reversing a “catastrophic decline” in Americans’ life expectancy, and has repeatedly warned of “an ever-growing epidemic of diet-related chronic diseases,” such as cardiovascular disease and type 2 diabetes. A 2019 study found that just 12 percent of Americans are considered metabolically healthy, based on their waist circumference, blood sugar, blood pressure, and cholesterol.

Of course Biden’s White House was never going to end cancer or obesity in four years. But many of its policies barely scratched the surface of America’s wide-ranging health problems. Despite Califf’s dramatic language about the country’s diet problems, for example, the FDA’s efforts to improve the situation have mostly revolved around giving Americans more information about healthy foods.

The public-health bureaucracy that the Trump administration will inherit is more focused on and skilled at treating America’s health problems than preventing them. That shortcoming—despite the billions of dollars spent every year at these agencies—has damaged the credibility of the public-health establishment enough that Kennedy is now Donald Trump’s nominee for secretary of Health and Human Services. Marty Makary, Trump’s pick to lead the FDA, has similarly risen in prominence by second-guessing "medical dogma" in the U.S. and beyond. And Trump’s pick to lead the CDC, former Representative Dave Weldon, has criticized the agency’s vaccine policies and once attempted to block its vaccine-safety research because of what he claimed were conflicts of interest. A set of men who have made careers of distrusting our existing health-care agencies may soon be empowered to try to blow them up.

The Biden administration, to be fair, had less time to deal with America’s deeper health issues, because it was forced to deal with at least a few calamities. Much of Biden’s term was spent navigating the country out of the pandemic. On the whole, his administration achieved most of its COVID goals. The Biden White House provided Americans with free COVID tests and mounted a vaccination campaign that resulted in more than three-quarters of the country getting a shot. Still, the pandemic left the CDC beleaguered by claims that it was simultaneously too slow and too aggressive in its efforts to fight the virus. During Biden’s presidency, the agency promised to “share science and data faster” and “translate science into practical policy,” but it has struggled to respond to the continued spread of bird flu. Public-health experts have slammed the CDC for not sharing enough information about the virus’s spread, including a human case in Missouri earlier this year, and farmers have been reluctant to implement the agency’s recommendations for preventing transmission of the virus from sick cattle to humans.

Some of those calamities were self-inflicted. The FDA is entrusted with ensuring that our food and medicines are safe, and it generally does spot issues quickly after they occur. But for months, the FDA failed to act on a whistleblower complaint alerting regulators to deplorable conditions at an infant-formula factory that eventually caused nationwide formula shortages and two infant deaths. The FDA is also supposed to decide what tobacco products can be sold, but it has failed to police the illegal market for vapes and nicotine pouches, such as Zyn. And for all the administration’s talk of being guided by “science and truth,” the White House seemingly bowed to political pressure and abandoned a plan to ban menthol cigarettes at the very end of a long rule-making process. The past four years have revealed that crucial parts of the agency’s remit—most notably its oversight of tobacco and the food system—have been neglected by agency leadership; in 2022, independent reviews of the FDA’s food and tobacco centers found that both lacked clarity on mission and goals.

At the same time, the administration has failed to deliver on its loftier ambitions. Biden quietly dropped some of his bolder ideas, such as his campaign promise to create a public-option insurance plan. The Advanced Research Projects Agency for Health, a new government agency that funds high-risk, high-reward research and is essential to Biden’s cancer goals, is in its infancy, and Republicans in Congress are already eager to cut its budget. And some promises, such as Biden’s grand goal to help change America’s diet, have been approached more like trivial pursuits.

The administration branded its 2022 hunger and nutrition conference, for instance, as the largest and most important gathering on nutrition policy since the Nixon administration. That 1960s conference led to millions of children gaining access to school lunch and to the creation of the Special Supplemental Nutrition Program for Women, Infants, and Children (or WIC), which provides food to about 6 million Americans each month. The Biden administration’s summit ended with a pledge to end hunger and improve America’s diet by 2030, but the steps taken toward tackling those goals—such as developing a plan to add warning labels to unhealthy foods—have been modest. And all the agency has done so far on that project is conduct research on the labels’ potential design. The FDA has also pledged to lower the sodium in foods, but the targets it’s set for the food industry are entirely voluntary.

These efforts are understandably careful and bureaucratic. The agency’s caution over warning-label design comes amid threats from the food industry to sue over any label deemed unjustified. Indeed, in the U.S. legal system, regulators have trouble mandating that companies do much of anything without it being branded as unconstitutional. But the Biden administration’s efforts look comically inadequate given the scope of America’s health problems.

RFK Jr. is promising a break from the status quo. This is not to say that he, should he be confirmed as health secretary, has a better plan. Most of his ideas amount to little more than pronouncements that he will take sweeping actions immediately once Trump is sworn in as president. The reality is that many of those efforts would take months, if not years, to implement—and some might not be feasible at all. He has signaled, for example, that he will clear house at the FDA’s food center, despite rules that prevent government bureaucrats from being fired willy-nilly. He also has pledged to ban certain chemicals from food, which he’s argued are contributing to American’s lower life expectancy. But for every chemical the FDA bans, it will have to go through a lengthy regulatory process, which would likely be challenged by food companies in court. Kennedy’s notion of significantly altering the system of fees that drug makers pay the FDA to review their products would likely send the agency into a budgetary crisis.

If Kennedy gets confirmed to lead HHS, he will quickly be confronted with the reality that governing is a slow and tedious process that doesn’t take kindly to big, bold ideas, even with an impatient leader like Trump calling the shots. At the outset of his first term, Trump declared war on drug companies, which he claimed were “getting away with murder” due to their high prices. Trump’s then–health secretary, Alex Azar, in turn spent the next four years trying radical fixes that included requiring drug makers to post their prices in TV ads, importing drugs from Canada, tying American drug prices to other countries’, and eliminating the rebates that middlemen negotiate for insurance companies. But each idea got bogged down in bureaucracy and lawsuits. Trump’s early attempts to contain COVID by blocking international air travel similarly did little to keep the virus out of America, despite his claims at the time that the policy “saved us” from widespread outbreaks.

Biden benefited from Operation Warp Speed's rapid push to create vaccines, but it was his team of technocrats that finally got them distributed. And they eventually lowered drug prices too, in a much simpler way than Trump was proposing. But technocracy has also failed to address our most pressing—and most visible—health problems. Trump’s picks have little experience navigating the Rube Goldberg puzzle that is American bureaucracy. They certainly aren’t afraid of trying something new, but we’re about to find out how far that will get them.

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Robert F. Kennedy Jr., the nominee to be the next secretary of Health and Human Services, is America’s most prominent vaccine skeptic. An advocacy organization that he founded and chaired has called the nation’s declining child-immunization rates “good news,” and referred to parents’ lingering doubts about routine shots as COVID-19’s “silver lining.” Now Kennedy may soon be overseeing the cluster of federal agencies that license and recommend vaccines, as well as the multibillion-dollar program that covers the immunization of almost half the nation’s children.

Which is to say that America’s most prominent vaccine skeptic could have the power to upend, derail, or otherwise louse up a cornerstone of public health. Raising U.S. vaccination rates to where they are today took decades of investment: In 1991, for example, just 82 percent of toddlers were getting measles shots; by 2019, that number had increased to 92 percent. The first Trump administration actually presided over the historic high point for the nation’s immunization services; now the second may be focused on promoting vaccines’ alleged hidden harms. Kennedy has said that he doesn’t want to take any shots away, but even if he were to emphasize “choice,” his leadership would be a daunting test of Americans’ commitment to vaccines.

In many ways, the situation is unprecedented: No one with Kennedy’s mix of inexperience and paranoid distrust has ever held the reins at HHS. He was trained as a lawyer and has no training in biostatistics or any other research bona fides—the sorts of qualifications you’d expect from someone credibly evaluating vaccine efficacy. But the post-pandemic era has already given rise to at least one smaller-scale experiment along these lines. In Florida, vaccine policies have been overseen since 2021 by another noted skeptic of the pharmaceutical industry, State Surgeon General Joseph Ladapo. (Kennedy has likened Ladapo to Galileo—yes, the astronomer who faced down the Roman Inquisition.) Under Ladapo’s direction, the state has aggressively resisted federal guidance on COVID-19 vaccination, and its department of health has twice advised Floridians not to get mRNA-based booster shots. “These vaccines are not appropriate for use in human beings,” Ladapo declared in January. His public-health contrarianism has also started spilling over into more routine immunization practices. Last winter, during an active measles outbreak at a Florida school, Ladapo abandoned standard practice and allowed unvaccinated children to attend class. He also seemed to make a point of not recommending measles shots for any kids who might have needed them.

Jeffrey Goldhagen, a pediatrics professor at the University of Florida and the former head of the Duval County health department, believes that this vaccine skepticism has had immense costs. “The deaths and suffering of thousands and thousands of Floridians” can be linked to Ladapo’s policies, he said, particularly regarding COVID shots. But in the years since Ladapo took office, Florida did not become an instant outlier in terms of COVID vaccination numbers, nor in terms of age-adjusted rates of death from COVID. And so far at least, the state’s performance on other immunization metrics is not far off from the rest of America’s. That doesn’t mean Florida’s numbers are good: Among the state’s kindergarteners, routine-vaccination rates have dropped from 93.3 percent for the kids who entered school in the fall of 2020 to 88.1 percent in 2023, and the rate at which kids are getting nonmedical exemptions from vaccine requirements went up from 2.7 to 4.5 percent over the same period. These changes elevate the risk of further outbreaks of measles, or of other infectious diseases that could end up killing children—but they’re not unique to Ladapo’s constituents. National statistics have been moving in the same direction. (To wit: The rate of nonmedical exemptions across the U.S. has gone up by about the same proportion as Florida’s.)

All of these disturbing trends may be tied to a growing suspicion of vaccines that was brought on during COVID and fanned by right-wing influencers. Or they could be a lingering effect of the widespread lapse in health care in 2020, during which time many young children were missing doses of vaccines. (Kids who entered public school in 2023 might still be catching up.)

In any case, other vaccination rates in Florida look pretty good. Under Ladapo, the state has actually been gaining on the nation as a whole in terms of flu shots for adults and holding its own on immunization for diphtheria, tetanus, and pertussis in toddlers. Even Ladapo’s outlandish choice last winter to allow unvaccinated kids back into a school with an active measles outbreak did not lead to any further cases of disease. In short, as I noted back in February, Ladapo’s anti-vaccine activism has had few, if any, clear effects. (Ladapo did not respond when I reached out to ask why his policies might have failed to sabotage the state’s vaccination rates.)

  

If Florida’s immunization rates have been resilient, then America’s may hold up even better in the years to come. That’s because the most important vaccine policies are made at the state and local levels, Rupali Limaye, a professor and scholar of health behavior at Johns Hopkins University, told me. Each state decides whether and how to mandate vaccines to school-age children, or during a pandemic. The states and localities are then responsible for giving out (or choosing not to give out) whichever vaccines are recommended, and sometimes paid for, by the federal government.  

But the existence of vaccine-skeptical leadership in Washington, and throughout the Republican Party, could still end up putting pressure on local decision makers, she continued, and could encourage policies that support parental choice at the expense of maximizing immunization rates. As a member of the Cabinet, Kennedy would also have a platform that he’s never had before, from which he can continue to spread untruths about vaccines. “If you start to give people more of a choice, and they are exposed to disinformation and misinformation, then there is that propensity of people to make decisions that are not based on evidence,” Limaye said. (According to The New York Times, many experts say they “worry most” about this aspect of Kennedy’s leadership.)

How much will this really matter, though? The mere prominence of Kennedy’s ideas may not do much to drive down vaccination rates on its own. Noel Brewer, a behavioral scientist and public-health professor at the UNC Gillings School of Global Public Health, told me that attempts to change people’s thoughts and feelings about vaccines are often futile; research shows that talking up the value of getting shots has little impact on behavior. By the same token, one might reasonably expect that talking down the value of vaccines (as Kennedy and Ladapo are wont to do) would be wasted effort too. “It may be that having a public figure talking about this has little effect,” Brewer said.

Indeed, much has been made of Kennedy’s apparent intervention during the 2019 measles crisis in Samoa. He arrived there for a visit in the middle of that year, not long after measles immunizations had been suspended, and children’s immunization rates had plummeted. (The crisis began when two babies died from a vaccine-related medical error in 2018.) Kennedy has been linked to the deadly measles outbreak in the months that followed, but if his presence really did give succor to the local anti-vaccine movement, that movement’s broader aims were frustrated: The government declared a state of emergency that fall, and soon the measles-vaccination rate had more than doubled.

As head of HHS, though, Kennedy would have direct control over the federal programs that do the sort of work that has been necessary in Samoa, and provide access to vaccines to those who need them most. For example, he’d oversee the agencies that pay for and administer Vaccines for Children, which distributes shots to children in every state. All the experts I spoke with warned that interference with this program could have serious consequences. Other potential actions, such as demanding further safety studies of vaccines and evidence reviews, could slow down decision making and delay the introduction of new vaccines.

Kennedy would also have a chance to influence the nation’s vaccine requirements for children, as well as its safety-and-monitoring system, at the highest levels. He’d be in charge of selecting members for the Advisory Committee on Immunization Practices, which makes recommendations on vaccines that are usually adopted by the states and result in standardized insurance coverage. He’d also oversee the head of the CDC, who in turn has the authority to overrule or amend individual ACIP recommendations.

Even if he’s not inclined to squelch any determinations outright, Kennedy’s goal of giving parents latitude might play out in other ways. Brewer, who is currently a voting member of ACIP (but emphasized that he was not speaking in that capacity), said that the committee can issue several different types of rulings, some of which roughly correspond to ACIP saying that Americans should rather than may get a certain vaccine. That distinction can be very consequential, Brewer said: Shots that are made “routine” by ACIP get prioritized in doctor’s offices, for instance, while those that are subject to “shared clinical decision-making” may be held for patients who ask for them specifically. Shifting the country’s vaccination program from a should to a may regime “would destroy uptake,” Brewer told me.

Those would seem to be the stakes. The case study of vaccine-skeptical governance that we have in Florida may not look so dire—at least in the specifics. But Kennedy’s ascendancy could be something more than that: He could steer the public-health establishment off the course that it’s been on for many years, and getting back to where we are today could take more years still.

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Heading into the presidential election, voters voiced concerns about many issues: abortion, housing, the war in Gaza, immigration. But the one that really resonated at the polls had long dogged the Biden administration, appearing over and over as the top concern on voters’ minds: the economy. In the end, abortion—much as Democrats tried—wasn’t the policy issue that defined the race. Instead, millions of Americans cast their vote based on fear and anger about the state of the economy—all stoked by Donald Trump, who claimed that he was the only one who could solve America’s problems.

On Tuesday, Americans unhappy with the status quo rebuked the current administration for COVID-sparked inflation, following an anti-incumbent pattern that is playing out in elections worldwide. As my colleague Annie Lowrey wrote this week, the “everyday indignity” of heightened food prices, in particular, haunted and enraged American voters even after inflation cooled meaningfully from its 2022 peaks. Though the economy improved by many measures under President Joe Biden, the message from Democrats that you’re doing fine didn’t land—and even seemed patronizing—to Americans who saw high prices all around them. And as Annie noted, although wages have outpaced inflation in recent months, “people interpret wage gains as a product of their own effort and high costs as a policy problem that the president is supposed to solve.”

Trump’s proposals on the economy were frequently incoherent; he scapegoated immigrants for Americans’ financial woes and made promises about tariffs that economists said would lead to higher prices. Still, voters said consistently that they felt that Trump was the right person to handle the economy (even as Kamala Harris started to close in on Trump’s lead on the issue), perhaps because of nostalgia for a pre-pandemic economy that’s unlikely to return. For all the criticism Harris faced early in her campaign for not issuing clearer policy proposals (she ultimately did), Trump was the one whose appeal was rooted largely in “vibes”: He brought heavy doses of hateful culture-war rhetoric to the race, spreading false and dangerous messages about transgender people, blaming immigrants for societal ills, and smearing women, including Harris.

Even though Trump was president just four years ago, he framed himself as the candidate of change, whereas Harris was pegged as the status-quo candidate and struggled to differentiate herself from Biden. Harris, of course, is not the incumbent president. But she was an imperfect messenger on the economy. Even as she started releasing more detailed economic-policy proposals, which included tackling price gouging and making housing more affordable, she was still the governing partner of a president whom voters blamed for inflation—a president whose policies she did not seem willing to openly break with. Trump seized on that dynamic, framing her as a continuation of the current administration and surfacing clips of Harris defending Bidenomics.

Democrats, meanwhile, tried to center abortion rights. When Harris took over for Biden, some pundits saw the issue as a strength for her. It was reasonable for Democrats to think appeals on abortion could work, Jacob Neiheisel, a political-science professor at SUNY Buffalo told me: In 2022, emphasizing abortion proved a decisive issue for Democrats in the midterm elections (though, he noted, it actually helped Democrats only in specific parts of the country—just enough to fend off a midterms “red wave”). But this time around, the economy mattered more: CNN national exit polling found that only 14 percent of voters said abortion was their top issue, compared with more than 30 percent who said that about the economy. And Trump, it seemed, managed to muddle the message on abortion enough that many voters didn’t view him as patently anti-abortion (even as Democrats emphasized that he was responsible for the fall of Roe v. Wade). More than a quarter of women who supported legal abortion still chose Trump, according to exit polling.

Fears about the future of democracy were also at the top of voters’ minds more commonly than abortion, according to CNN exit polling: 34 percent of voters said it was their top issue, suggesting that the Harris campaign’s rhetoric about the existential threats posed by Trump did have some effect on voters’ perceptions. My colleague Ronald Brownstein noted today that in national exit polling, 54 percent of voters agreed that Trump was “too extreme,” “but about one in nine voters who viewed Trump as too extreme voted for him anyway.”

For nearly a decade now, Trump has felt like the dominant figure in American politics. But as David Wallace-Wells noted in The New York Times yesterday, a Democrat has been president for 12 of the past 16 years. Democrats, he argues, for a generation now have been “the party of power and the establishment,” with the right becoming “the natural home for anti-establishment resentment of all kinds—of which, it’s now clear to see, there is an awful lot.” Ultimately, much of the dynamic in this race came down to whether voters were hopeful or fearful about their and their country’s future. When people have the choice to “vote hopes or vote fears,” Neiheisel said, “fears tend to override.”

Related:

What swayed Trump voters was Bidenomics. Why Biden’s team thinks Harris lost

Today’s News

In a speech about Trump’s electoral victory, President Biden urged Americans to “bring down the temperature” and promised a peaceful transfer of power. Special Counsel Jack Smith has been speaking with Justice Department officials about how he can end the federal cases against President-elect Donald Trump, in accordance with the department’s policy against prosecuting sitting presidents. German Chancellor Olaf Scholz fired his finance minister yesterday, ending his coalition government. Scholz pledged to hold a confidence vote, which will likely lead to early elections in March.

Dispatches

Time-Travel Thursdays: In 2015, David A. Graham wrote about America’s dire lack of talented and experienced politicians. Almost a decade later, Stephanie Bai spoke with him to ask how much of his argument has held up, and how much has changed. The Weekly Planet: A tiny petrostate is running the world’s climate talks—again, Zoë Schlanger writes.

More From The Atlantic

Triumph of the cynics Democrats actually had quite a good night in North Carolina. What the left keeps getting wrong

Evening Read

Sources: Israel Sebastian / Getty; Scharvik / Getty.

America Has an Onion Problem

By Nicholas Florko

Onions have an almost-divine air. They are blessed with natural properties that are thought to prevent foodborne illnesses, and on top of that, they undergo a curing process that acts as a fail-safe. According to one analysis by the CDC, onions sickened 161 people from 1998 to 2013, whereas leafy greens sickened more than 7,000. Onions haven’t been thought of as a “significant hazard,” Susan Mayne, the former head of food safety at the FDA, told me.

Not anymore.

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Certain foods are more likely than others to wreak havoc on your stomach. Cucumbers have carried Salmonella, peaches have been contaminated with Listeria, and eating a salad feels a bit like Russian roulette. Romaine lettuce, tomatoes, and sprouts are all considered high risk for foodborne illnesses. (Scott Faber, a food-safety expert at the Environmental Working Group, put it to me bluntly: “Don’t eat sprouts.”)

By comparison, onions have an almost-divine air. They are blessed with natural properties that are thought to prevent foodborne illnesses, and on top of that, they undergo a curing process that acts as a fail-safe. According to one analysis by the CDC, onions sickened 161 people from 1998 to 2013, whereas leafy greens sickened more than 7,000. Onions haven’t been thought of as a “significant hazard,” Susan Mayne, the former head of food safety at the FDA, told me.

Not anymore. Late last month, McDonald’s briefly stopped selling its Quarter Pounders in certain states after at least 90 people who ate them fell sick with E. coli. Last Wednesday, the CDC announced the likely culprit: slivered onions. This is the fourth time onions have caused a multistate foodborne outbreak since 2020, in total sickening at least 2,337 people, according to available data. In that same time span, leafy greens have caused eight multistate outbreaks that have affected 844 people. All of a sudden, the United States seems to have an onion problem—and no one knows for sure what is causing it.

The investigation into the cause of the McDonald’s outbreak is still ongoing, but the problem likely started where many foodborne illnesses begin: in the field. The culprit, in many instances, is contaminated water used to irrigate crops. An outbreak can also start with something as simple as a nearby critter relieving itself near your veggies. Any additional processing, such as when onions are cut into prepackaged slivers, can give bacteria lots of opportunities to spread. That’s why the FDA considers most precut raw vegetables to be high risk. (As with other foods, cooking onions to 165 degrees Fahrenheit kills pathogens.)

But the fact that onions appear to get contaminated with E. coli and Salmonella at all is striking. Onions have long been thought to have antimicrobial properties that can help them fight off bacteria. Hippocrates once recommended that onions be used as suppositories to clean the body, and onions were placed on wounds during the French and Indian War. Medical knowledge has thankfully advanced since then, but the onion’s antimicrobial properties have been documented by modern science as well. In various lab experiments, researchers have found that onion juice and dehydrated onions inhibit the growth of E. coli and Salmonella. And in 2004, researchers found that E. coli in soil died off faster when surrounded by onion plants than when surrounded by carrot plants, a result the authors said might be due to “the presence of high concentrations of antimicrobial phenolic compounds in onions.”

Onions have another powerful weapon in their food-safety arsenal: their papery skin, which research suggests may act as a barrier protecting the insides of an onion from surface bacteria. The way that onions are processed should add an additional layer of protection: To extend their shelf life, onions are left to dry, sometimes for weeks, after they are harvested. This curing process should, in theory, kill most bacteria. Stuart Reitz, an onion expert at Oregon State University who has intentionally sprayed onions with E. coli–laced water, has found that the curing process kills off a significant amount of the bacteria—likely because of ultraviolet radiation from the sun and because drier surfaces are less conducive to bacteria growing, Reitz told me.

But clearly, onions are not contamination proof. Onion experts I spoke with floated some plausible theories. Linda Harris, a professor of food safety at UC Davis, posited that bacteria could hypothetically bypass an onion’s protective skin by entering through the green tops of the onion and then traveling down into the layers of the onion itself. And although onions might have antimicrobial properties, that might not always be enough to prevent an E. coli infection from taking hold, Michael Doyle, a food microbiologist at the University of Georgia, told me; when it comes to antimicrobial activity, he said, “not all onions are created equal.” And the McDonald’s onions could have become infected simply by way of probability. One of Reitz’s recent studies on the effect of curing found that 2 percent onions sprayed with E. coli still had detectable levels of the bacteria after being cured.

Still, none of this explains why onions seem to be causing more foodborne illnesses now. Harris told me that she and a colleague have “spent a lot of time trying to figure out how these outbreaks happen, and I will tell you: We don’t have an answer.” Unfortunately, we may never understand the cause of the onion’s heel turn. In many cases, regulators are unable to figure out exactly what causes a foodborne outbreak. They failed to find a definitive cause in the three other recent onion outbreaks, and perhaps the same will be true of the McDonald’s debacle.

The entire situation demonstrates the maddening inscrutability of foodborne illness. The reality is that although these outbreaks are rare, they can be dangerous. One person died after eating a contaminated Quarter Pounder, and a 15-year-old had to undergo dialysis to stave off kidney failure. Yet for all of the technology and science that goes into food safety—the genome sequencing of foodborne pathogens, blockchain technology that traces crops from farms to store shelves—we continue to be stuck with more questions than answers. America has less of an onion problem than an everything problem.

If Donald Trump and Robert F. Kennedy Jr. really do team up to “make America healthy again” from the White House, the implications would be surprisingly trippy. On Sunday, at his rally in Madison Square Garden, Trump said he would let Kennedy “go wild” on health, food, and medicine if he wins the presidential election. The next day, Kennedy shared that Trump had promised him control of several agencies, including the CDC, the FDA, the Health and Human Services Department, the National Institutes of Health, the U.S. Department of Agriculture, “and a few others.”

Kennedy, an anti-vaccine advocate, has not explained how such a position—which does not currently exist within the U.S. government—might be created. But a recent post on X offers some clues about what his leadership might entail. He outlined a number of products and interventions he wants released from federal “suppression,” including raw milk, ivermectin, and sunshine. The very first item on his list was psychedelics.

Since the 1960s and ’70s, when mushrooms and LSD were considered inseparable from the anti-war movement and hippie culture, psychedelic drugs have been culturally associated with the American left. But in this election cycle, many prominent people who’ve expressed support for or have personally used psychedelics, such as Kennedy and Elon Musk, have rallied behind Trump, the hard-right candidate. Over the past few years, libertarians, wellness influencers, research scientists, MAGA die-hards, and titans of corporate tech alike have endorsed hallucinogenic drugs. It’s clear that modern psychedelic users and advocates, as a group, have no consistent political slant. Instead, they may reveal the polarization that already plagues us.

Although the use of psychedelics long predates American politics, about half a century ago, the substances began to take on a distinctly political valence in the United States. Psychedelic advocates championed the idea that these drugs would end wars and promote left-wing ideals. In 1966, the poet Allen Ginsberg told a roomful of ministers that if everyone tried LSD, “we will all have seen some ray of glory or vastness beyond our conditioned social selves, beyond our government, beyond America even, that will unite us into a peaceful community.” The Harvard psychologist Timothy Leary wrote in 1968 that “turning on people to LSD is the precise and only way to keep war from blowing up the whole system.”

Echoes of that philosophy still resound today, in speculations that wider psychedelic use would encourage personal and political action on climate change, or that MDMA will help eradicate all trauma by 2070. But now you’re just as likely to encounter psychedelic use in clinical trials as a mental-health treatment, as a tool for spiritual exploration, or in more individualistic applications such as optimizing and enhancing productivity. In contemporary U.S. society, there is no longer one psychedelic culture. “If the only thing you knew about someone is that they’re pro-psychedelics, that wouldn’t necessarily be an obvious indication of their political affiliation,” Aidan Seale-Feldman, a medical anthropologist at the University of Notre Dame who studies the current psychedelic renaissance, told me. “It is surreal that in this era of so much division and difference in the U.S. that psychedelics are something that people would actually have in common.”

[Read: When does a high become a trip?]

An affinity for psychedelics may be bipartisan these days, but when it comes to current advocacy, “it seems like those on the right promote psychedelics more than the left,” Jules Evans, a philosopher who directs the Challenging Psychedelic Experiences Project, told me. Before the FDA rejected MDMA-assisted therapy as a treatment for PTSD this summer, members of Psymposia, a nonprofit that describes itself as offering “leftist perspectives on drugs,” raised concerns about the approval. Rick Perry, the conservative governor of Texas, said of psychedelic legalization last year that “at the federal level, this is more supported by the Republicans.”

Last week, the German psychedelic investor Christian Angermayer wrote on X that many attendees at a recent psychedelics event in San Francisco were pro-Trump, “some of them very openly.” In recent years, Silicon Valley has moved both to the right and toward psychedelics. Musk, Trump’s largest donor, has said that he has a ketamine prescription for depression, and has been reported to take other psychedelics. Rebekah Mercer, a benefactor of Breitbart News and of Trump’s 2016 presidential campaign, gave $1 million to MDMA research. Peter Thiel, a co-founder of PayPal, has invested millions in companies researching psilocybin and other psychedelics; Thiel is also the vice-presidential candidate J. D. Vance’s mentor, and was Vance’s largest donor during his 2022 senate race.

Kennedy hasn’t said whether he’s used hallucinogenic drugs, but he has talked about how ayahuasca helped his son process his grief over his mother’s death. Before he dropped out of the presidential race and endorsed Trump, Kennedy had “more psychonauts around him than any presidential candidate in American history,” Evans said. Kennedy’s vice-presidential pick, Nicole Shanahan, was once married to the psychedelic enthusiast and Google co-founder Sergey Brin, from whom she separated after taking ketamine and having sex with Musk. (Shanahan denies the affair.) Kennedy’s former senior adviser Charles Eisenstein has said that psychedelics are necessary to “get us out of the Matrix.”

Groups with varying political or cultural motives have long dabbled with psychedelics. The CIA wanted to use LSD as a truth serum during enemy interrogations, or as a brainwashing tool, or as a weapon on the battlefield to incapacitate soldiers. President Richard Nixon, who signed the Controlled Substances Act in 1970, which prohibited many psychedelics, was close friends with Claire Booth Luce, a Republican Congress member and staunch advocate for psychedelic therapy. (Once, while she was tripping on LSD, Nixon called her for advice about his upcoming debate with John F. Kennedy. She had to call him back later.) But on the right, such views were mostly fringe. “If Richard Nixon could be alive today and see the Republican governor of Texas advocating for psychedelics, it would completely blow his mind,” Benjamin Breen, a historian at UC Santa Cruz and the author of Tripping on Utopia, told me.

Even five years ago, psychedelics might have been accurately described as a horseshoe issue, picking up people on both extremes of the political spectrum. But today, the drugs are more like a magnet, attracting Americans indiscriminately. Thanks to years of positive coverage in both traditional media and extreme outlets such as Breitbart, “psychedelics did go mainstream in the U.S.,” says Nicolas Langlitz, an anthropologist at the New School and the author of Neuropsychedelia. The number of young adults using mushrooms has nearly doubled over the past three years, and use of other psychedelics is increasing too. “The mainstreaming of psychedelics perhaps ironically signals the end of the psychedelic community,” Ido Hartogsohn, an assistant professor of science and technology studies at Bar-Ilan University and the author of American Trip, told me.

One of the paradoxes of psychedelics is how they can sometimes amplify ideas people already hold or the values of the communities they’re immersed in, but at other times (such as during therapy) they can provide an opportunity for radical change. Leary thought this was the influence of “set and setting”—that a person’s mindset and environment can affect whether a psychedelic experience ends up hardening or cracking open a person’s worldview. Hartogsohn has argued that the social and cultural context in which the psychedelic experience happens matters too. And right now, the American cultural context is hyperpolarized. That might help explain why, as Evans wrote in March, “psychedelics don’t seem to dissolve the arguments of the culture wars of the last few years. They amplify them.”

This year, social-media users have circulated AI-generated videos of Trump and Musk renouncing their wealth and power after an ayahuasca ceremony, and choosing to instead devote their lives to those less fortunate. But as much as Americans yearn to reduce the country’s political polarization, the idea that psychedelics will automatically do so is a fantasy. “People may be taking the same drugs, but they are imagining very different futures,” Evans said. Psychedelic enthusiasts have long hoped that widespread acceptance of the drugs would usher in utopia. Instead, it may actually reveal how starkly American visions of utopia diverge.