Does RFK Jr. have some good ideas in this tweet?

An honest question deserves a thorough answer.

A long time patient of mine asked me several times this year whether I too liked RFK Jr. as a presidential candidate. I respect this patient. By default I respect and feel great compassion for anyone who is seeking medical help as a vulnerable person with problems. We are all patients. This person too has his share of medical issues, midlife struggles, anxieties and existential concerns. He tries to make it to his kid’s sports games, stay alive at work, and pick up the slack since his wife, also my patient, has developed some more serious problems. And so it was with sincerity and genuine concern that I briefly answered that I did not agree with RFK Jr’s ideas, and that I was troubled by his actions.

Last week he showed me this RFK Jr. post from before the election on “X.” What did I think?

Well, I only have a short 20 minutes per visit, though I tend to run late like any decent physician should in such a system. But here are some answers about “what I think.” Each could be its own 1,000 word post, but I’ll keep this shorter and relevant to primary care.

FDA’s “war on public health”

The FDA's actual legacy encompasses both landmark achievements and significant criticisms in its role as America's primary food and drug regulator. Its implementation of mandatory drug safety testing following the 1937 Elixir Sulfanilamide disaster which killed over 100 people, its successful elimination of widespread food adulteration in the early 1900s, child-resistant packaging for medications, nutrition labeling on food products, accelerated approval of HIV/AIDS treatments in the 1980s/90’s, rapid review and authorization of Covid vaccines and treatments that saved millions of lives, and response to various food safety outbreaks and recalls stand as pivotal accomplishments among many others.

However, the FDA does face persistent criticism for its allegedly slow and bureaucratic drug approval process, which some argue delays access to potentially lifesaving treatments. Critics also point to concerning industry influence through the "revolving door" between FDA leadership and pharmaceutical companies, along with questions about inadequate post-market surveillance of approved drugs. This tension between safety and efficiency reflects the ongoing challenge of balancing public health protection with the need for medical innovation.

But it’s hard to wage war when you are actually “responsible for protecting and promoting public health through the control and supervision of food safety, tobacco products, caffeine products, dietary supplements, prescription and over-the-counter pharmaceutical drugs, vaccines, biopharmaceuticals, blood transfusions, medical devices, electromagnetic radiation emitting devices, cosmetics, animal foods & feed and veterinary products.”

It’s the kind of thing you don’t miss until it’s gone.

Aggressive suppression of psychedelics

I think RFK Jr. is mostly talking about psylocibin here. Psilocybin is a naturally occurring psychedelic compound found in certain mushrooms that is being studied as a potential treatment for various mental health conditions, including treatment-resistant depression, anxiety in terminal illness, PTSD, and substance use disorders.

I’m not at expert in this, but we can briefly look at some of the issues from two studies using psylocibin for depression from an UpToDate chapter.

In two large randomized trials studying psilocybin for depression, a 25mg dose showed significant efficacy compared to controls. The first study (in JAMA,104 people) showed a 42% response rate vs 11% for control. The second study (in NEJM, 158 people) showed response rates of 37% for a 25 mg dose vs 18% for a 1mg dose at week 3.

Regarding safety, both studies reported concerning adverse events: the first study had higher overall adverse events with psilocybin (76% vs 30%), though minimal increased suicidal thoughts were seen. The second study documented several serious adverse events in the 25mg group including suicidal thoughts in two patients and self-injurious behavior in five others across the 12-week period, despite excluding high-risk patients at baseline.

Psilocibin is not something that would be prescribed to patients by family doctors. Protocols are still being honed that involve the patient being supervised and guided through the psychedelic journey before, during, and after. For example, here is a 79 page manual from Yale for performing this therapy. Johns Hopkins boasts the world’s largest psychedelic research program. They are working on some exciting stuff. Have they experienced aggressive suppression from the FDA? I don’t know, but I found this quote on their website that suggested the opposite: “Roland Griffiths, Ph.D., Professor in the Neuropsychopharmacology of Consciousness at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Center for Psychedelic and Consciousness Research… says his team was encouraged by public health officials to explore psilocybin’s effects in the broader population of those with major depressive disorder because of the much larger potential public health impact.”

I would want to see a lot of safety data, and have that reviewed by experts and the FDA, before I would recommend psychedelics to any patient. But research is absolutely ongoing.

Peptides

So “peptides” are strings of amino acids that are considered the building blocks of proteins. Our bodies are constantly making new peptides. When RFK Jr. uses this term I guess he is referring to stuff we can buy like collagen and creatine, and peptides that claim to boost testosterone levels. It’s hard to know exactly what he’s talking about here, except that we can assume it’s over-the-counter stuff sold at high prices already outside the purview of FDA approval. One of my first posts over three years ago was about the meh-efficacy of collagen supplements. Meh means uninspiring. I also wrote about Prevagen for memory loss, and what a cynical unproven money maker that is.

Most peptides carry the disclaimer: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

Stem cells

Stem cells are currently used successfully in several medical treatments, including bone marrow transplants, burn therapy, and corneal transplants, though there are still challenges with controlling cell development and preventing cancer risks. Scientists are also developing new stem cell treatments for conditions like Parkinson's disease and heart attacks, and using stem cells in labs to test how well drugs work.

However, I’m concerned that what RFK Jr. is actually referring to is the alarming rise in clinics worldwide exploiting patients by offering expensive, unproven stem cell treatments for various conditions. I’ve had patients ask me about spending thousands of dollars out of pocket for this stuff. “Stem cell clinics” often bypass FDA regulations by claiming their treatments are "minimally manipulated" using patients' own cells, and they use deceptive marketing tactics like patient testimonials, celebrity endorsements, and crowdfunding campaigns to appear legitimate. Truly legitimate stem cell treatments require extensive clinical trials and scientific validation before approval.

Raw milk

Ironically this FDA document thoroughly debunks common claims made by raw milk advocates, demonstrating through scientific evidence (~100 published references) that raw milk provides no special health benefits over pasteurized milk and may actually pose serious health risks. Raw milk does not cure lactose intolerance, asthma, or allergies. It is not more effective in preventing osteoporosis, does not contain beneficial probiotic bacteria, and does not have superior nutritional value compared to pasteurized milk. Furthermore, raw milk's supposed antimicrobial properties are insufficient to make it safe for consumption. Between 1987 and 2010, there were at least 133 outbreaks linked to raw milk consumption in the US including various disease-causing pathogens like Campylobacter, E. coli O157:H7, Salmonella, Listeria , Streptococcus, Yersinia, Staphylococcus aureus, Mycobacterium tuberculosis, and Coxiella burnetti.

And we are now playing with the fire of another pandemic should the H5N1 influenza virus infecting dairy herds jump to humans in a person-to-person way. Drinking raw milk increases the chances of this happening, as every person thus infected becomes a proving ground for chance mutations that could ignite a contagious variant.

Raw milk? Right now especially?

Hyperbaric therapies

Hyperbaric oxygen therapy is a medical treatment where a patient breathes 100% pure oxygen in a pressurized chamber. It has proven utility for rare conditions like arterial gas embolism/the bends from scuba diviոg, carbon monoxide poisoning, or hydrogen peroxide exposure. Possible additional indications for clinical use include severe anemia, actinomycotic brain abscesses, acute crush iոjuries, prior radiation therapy, aggressive soft tissue infections, nonhealing ulcers, sensorineural hearing loss, cyanide poisoning, or compromised skin grafts and flaps. It’s already being used in mainstream medicine for this stuff.

But hyperbaric oxygen therapy is also promoted without FDA approval for conditions including anti-aging, autism, cerebral palsy, COVID-19, depression, hair loss, HIV/AIDS, migraines, sports injuries, and strokes, despite lacking solid scientific evidence for these uses. I’m guessing this is what RFK Jr. is talking about rather than raising awareness about actinomycotic brain abscesses.

Medical spas and alternative medicine centers will take cash.

Chelating compounds

Chelation therapy is a medical treatment that involves using chemicals (chelating agents) to bind and remove heavy metals or minerals from the body, either for treating metal poisoning or, more controversially, for other health conditions. Specifically, chelаtion is used to remove excess iron that cannot be treated by phlebotomy (drawing off blood). Some patients with thаlaѕѕеmiа, sickle cell disease, and myelodysplasia to name a few conditions are sometimes treated with chelation. The goal is to maintain a safe level of iron by removing excess stored irоn, while preventing irоn accumulation from ongoing transfusions for the actual condition.

Some practitioners controversially promote chelation therapy, without scientific evidence, as an alternative treatment for conditions like heart disease, autism, and Alzheimer's disease, despite FDA warnings about its risks when used outside of proven medical necessity. For example, an authoritative Cochrane Review found insufficient evidence of benefit for heart disease, stating: “Overall, this review did not find any clear differences between people treated with chelation and people given the control.” In terms of autism, Cochrane found limited quality studies, and concluded in their systematic review: “no clinical trial evidence was found to suggest that pharmaceutical chelation is an effective intervention for Autism Spectrum Disorder (ASD). Given prior reports of serious adverse events, such as hypocalcaemia, renal impairment and reported death, the risks of using chelation for ASD currently outweigh proven benefits. Before further trials are conducted, evidence that supports a causal link between heavy metals and autism and methods that ensure the safety of participants are needed.” Alzheimers? Same sort of story from Cochrane: “We therefore conclude that there is no current evidence that treatment with (chelation agent) clioquinol (PBT1) has any significant effect on cognition and in particular memory (as measured by the ADAS‐Cog scale) in patients with Alzheimer's dementia. This drug has now been withdrawn from development. The trial of PBT2 showed it was safe after 12 weeks of treatment but demonstrated no overall significant effect on cognition or memory.”

If you google “chelation therapy near me,” you’ll find lots of places willing to sell this treatment to you.

Ivermectin and Hydroxychloroquine

Ivermectin and hydroxychloroquine do not work for the treatment of Covid. (Hyperlinks are to Cochrane Systematic Reviews if you’d like references.)

And yet a survey published in JAMA of 13,438 US adults who had Covid found that 6% used non-evidence-based treatments (ivermectin or hydroxychloroquine), with users more likely to endorse vaccine misinformation, have lower trust in healthcare institutions and scientists, and exhibit greater conspiratorial thinking. Trust in social media and consumption of certain news sources were associated with higher use of these treatments, independent of political affiliation. The study suggests that misinformation's harms extend beyond avoiding health-promoting behaviors to actively pursuing potentially ineffective and toxic treatments.

What happens when our leaders promote unproven/disproven medications? Patients come in and ask their family doctors for ivermectin when they have Covid, and lose trust in us when we explain it doesn’t work. I know this from experience, and another study confirms this. During March to April 2020, the president promoted unproven Covid therapies 65 times in briefings and 11 times on Twitter, reaching an audience 300% larger than his average tweet engagement. His promotion led to increased coverage on conservative networks and spikes in Google searches and purchases of these medications, including a 200% increase in hydroxychloroquine-related purchases on Amazon.​​​​​​​​​​​​​​​​

Paxlovid, remdesevir, and to some degree molnupiravir have all been shown, over and over again, to help. They are FDA-approved. Hopefully that will continue to mean something in the future.

Vitamins

Forgive me for cutting and pasting from UpToDate, but I pay for a subscription, and I think this is important. The vitamin and supplement industry continues to boom with or without promotion from the highest levels of government.

Role of supplementation of various vitаminѕ in disease prevention – There is limited evidence to support vitamin supplementation in the prevention of various conditions.

• Vitamin D – Subclinical vitamin D deficiency may contribute to the development of οѕtеοрοrοsiѕ, falls, and fractures in older adults. Vitamin D supplementation may attenuate bone loss, reduce fracture risk, and reduce falls in deficient persons.

• Antioxidants – Although diets high in vegetables and fruits that are rich in аոtiοхiԁаոtѕ are associated with a reduced risk of ϲaոϲer and cardiovascular disease (СVD), there is no evidence to support the use of antioxidant supplements to prevent ϲаոϲеr or atherosclerotic СVD.

• Vitamin A and the carotenoids – In resource-limited regions, vitamin A supplementation in children ages 6 to 59 months is advised as it is associated with decreased mortality.

  In some adult populations, supplementation with carotenoids is associated with increased mortality, risk of ϲaոϲer, risk of οѕtеοpeniа, and fractures. Vitamin A in high doses (ie, >10,000 international units) taken during the first trimester of рrеgոanϲy has been shown to increase the risk of congenital anomalies.

• Vitamin C – There is no evidence that vitamin C supplementation reduces ϲaոcer, СVD, or mortality risk. Vitamin C supplementation may also increase the risk for oxalate kidney stones.

• Vitamin E – Evidence does not support a role for vitamin E supplementation in the prevention or treatment of cancers, СVD, ԁemeոtia, or iոfеϲtiοո. Further, high-dose vitamin E (≥400 units daily) might be associated with increased all-cause mortality.

• Vitamin B2 (ribοflaviո) – There is no evidence of benefits in supplemental vitamin Β2 in healthy people eating a balanced diet. B2 supplementation may have a role in management in adults with episodic migraines.

• Vitamin B6 (pyridoxine) – There is no evidence that vitamin B6 supplementation is associated with a decreased risk of ϲаnϲer or CVD.

• Vitamin B9 (folic acid) – Folic acid supplementation during рrеgոаncy can prevent neural tube defects.

• Vitamin B12 (ϲоbаlamin) – Vitamin B12 deficiency is associated with neuropsychiatric manifestations and megaloblastic anemia. Vitamin B12 supplementation or testing is reasonable for those at increased risk for poor vitamin Β12 intake, those who avoid all meat, fish and poultry, people taking metformin, those with alcohol use disorder, and people with little dietary variation or poor-quality diets (such as some older adults and people experiencing poverty)

• Мultivitaminѕ – In healthy people with adequate dietary intake, we suggest not taking multivitamin supplementation for the prevention of chronic disease (Grade 2B). However, multivitamin supplementation is appropriate to consider for patients at risk for vitamin deficiency, such as those with alcohol use disorder, a poor-quality diet with low fruit and vegetable intake, malabsorption, a vegan diet, prior bariatric surgery, certain errors of metabolism, as well as those receiving hemodialysis or parenteral nutrition. In addition, we do not strongly discourage patients from taking mսltivitaminѕ if they wish to do so.

• Concerns over toxicity – Potentially toxic levels of individual vitamins can be achieved easily among people who take very high-potency vitaminѕ. Water-soluble vitamins (fοlate, vitamin C, B vitаminѕ) are generally tolerated at high doses; fat-soluble vitаmins (vitamins A, D, E, K) are generally more toxic than water-soluble vitamins.

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Clean foods

Agreed. Try to eat healthy. Junk food is just that. And yet I cannot stop eating Halloween candy these past two weeks. Will the conservative Heritage Foundation trash RFK Jr. and eating healthy imperatives like they did Michelle Obama?

Sunshine

I like to gamble with a little UV exposure. I wrote a post on it, and managed to quote Sheryl Crow. Australia agrees with a little sun, but it is a complicated risk/reward calculation that depends on personal choice, health goals, personal and family skin cancer history, skin type, etc. Not sure how this relates to the FDA regulating sunshine, as many have pointed out before me.

Exercise

Yes, if you can, and try to stay active and avoid prolonged sedentary time.

Not sure this is in the FDA’s purview, but they do have this excellent tip sheet about exercise supplements, intended to help physicians field questions from patients trying to get pumped.

Neutraceuticals

Nutraceuticals are food-derived products that claim to provide health benefits beyond basic nutrition. They include:

• Dietary supplements (vitamins, minerals, herbs)

• Functional foods (fortified cereals, probiotic yogurt)

• Medical foods (specialized nutritional products for specific conditions)

While they are regulated differently from pharmaceuticals, nutraceuticals aim to enhance health or prevent disease. Common examples include:

• Fish oil (omega-3 fatty acids)

• Probiotics

• Glucosamine

• Antioxidant supplements

It's important to note that while many nutraceuticals have scientific evidence supporting their benefits, the level of regulation and proof of efficacy required is generally lower than for pharmaceutical drugs. Does RFK Jr. propose to raise or lower the bar for proof and FDA approval?

Money

Get money out of politics.

But clinical trials require investment. It’s not a good time to zero out the NIH budget for infectious disease research. It’s never a good time to do that.

Vaccines

We have to go there briefly, though this was not in the tweet. RFK Jr’s long history of anti-vaccination statements and actions has been well chronicled. Samoa and the measles outbreak is the perhaps the most egregious.

Corrupt? Pack your bags?

I personally know three people who work at FDA. One is a Democrat, one is a Republican, and one is an independent… but all three are good, competent, earnest people with expertise, who have families to feed, and solid careers they take pride in.

Pack your bags? For whom? For what?

Big picture, big agency, big fail

There have been countless articles written, podcasts spoken, and social media messages sent about RFK Jr. actually heading up the Department of Health and Human Services now — not just the FDA since this tweet in October. I’ll just pick one article, published over the weekend in the NYT. It warns of this potentially devastating choice for public health. The article argues that Kennedy, despite raising some valid concerns about processed foods and exercise, has a history of spreading dangerous misinformation about vaccines, AIDS, and Covid. With control over key agencies like the CDC, FDA, and NIH, and a $3 trillion budget, Kennedy could significantly damage the public health system that has dramatically reduced infant mortality and controlled numerous diseases since 1900. The article cites specific examples of Kennedy's problematic statements and actions, including that role in Samoa during a deadly measles outbreak, his false claims about vaccines causing autism, and his promotion of ineffective Covid treatments like ivermectin.

I will conclude by giving him some credit. I’ve read he did good work fighting to clean up rivers back in the day. Head of EPA? I would not be writing this post for sure.

I hope I’ve kept this article clinical and mostly within my own lane as a primary care doc. But if you really want a call to action that pulls no punches, please read Ed Nirenberg’s substack about this whole mess next.

Take home

While RFK Jr.'s criticisms of certain FDA practices warrant discussion, his claims about treatments like psychedelics, raw milk, and hyperbaric therapy often misrepresent the scientific evidence and regulatory landscape in ways that could harm public health if implemented. Although his past environmental advocacy work deserves recognition, placing him in charge of the Department of Health and Human Services (which includes FDA, CDC, NIH, Medicare and more) would risk undermining decades of public health progress in disease prevention, drug safety, and evidence-based medicine.

Protect yourself with better sources of information. Call your representatives. Spread this word here. An honest question deserves a thorough answer. We Americans deserve better.