In the coming weeks, the American Congress will have to decide on the casting proposed by Donald Trump to lead the country’s health administrations. The list is not long. But the mission will not be easy. All the selected candidates are “skeptics”, they doubt scientific data, dream of overturning the “medical dogma” defended by the institutions. The opposite in short, of what is normally considered a good choice for these positions.
Speaking out against the scientific consensus should be disqualifying. Not for Donald Trump. During his first term, the President of the United States constantly displayed his detestation of the scientific method. In the midst of a health crisis, he recommended drinking bleach against this “flu” of Covid-19. For him, everything should be able to be said and done, even in science: he therefore only chose critical profiles, capable of “liberating” the agencies. All seem aligned with the potential future Minister of Health, the anti-vaccine conspirator Robert F. Kennedy Jr., who has also made it a priority to reform these institutions.
At the forefront of these personalities capable, according to Donald Trump, of “undoing the yoke of the establishment” – we still need to know what this is – is Jay Bhattacharya, 56 years old. The American president wants to make this health economics researcher at Stanford the head of the National Institutes of Health (NIH), these biomedical research agencies among the most powerful in the world. What does it matter if during the Covid-19 crisis, he alienated the researchers at this same institution, by opposing confinements.
An enemy: chronic pathologies
Like all the selected personalities, Jay Bhattacharya’s mission will be to “restore institutional efficiency”. According to the American president, these structures, whose work is nevertheless closely followed by many nations, would have failed to combat the only “real” health enemy of the United States: chronic pathologies, diabetes, obesity, or even cardiovascular problems. Convinced that they have become disorganized, that they have drifted to the left and into the hands of industrialists, Donald Trump wants to reform them, maximize their action, while reducing their costs, on the model of what Elon Musk did with the Twitter platform.
If Jay Bhattacharya may appear as a curious choice in the eyes of the most rigorous scientists, he remains well placed to implement these changes: “He has a very enlightened opinion on the question. For example, he wants to give more money to young people researchers, and to prevent professionals at the end of their careers from appropriating resources, this is the conclusion of his work”, explains Yves Gingras, historian of science. Although it is described by former NIH Director Francis Collins as “marginal”, it should easily pass the Congressional filter. “Jay Bhattacharya appears qualified, even in the eyes of non-Trumpist researchers,” illustrates Jocelyn Kaiser, specialist journalist for the scientific journal Science.
This is also the case for Dr. Martin Makary. Announced to lead the drug watchdog, the Food and Drug Agency (FDA), it has a comparable pedigree. This surgeon from the prestigious Johns Hopkins medical school is no more rigorous than Jay Bhattacharya: for example, he proclaimed that vaccinating young people was more dangerous than useful, an assertion popular with covid-sceptics yet repeatedly invalidated. Carried away by the fears caused by the health crisis, he also affirmed that making children wear a mask to prevent them from spreading Covid-19 would amount to “mistreatment”. Without ever making a mea culpa.
Skeptical, but…
But, just like Jay Bhattacharya, Martin Makary also showed that he was capable of shaking up the established order, without ever completely disqualifying himself. He made the fight against medical errors his obsession during his career. According to him, this is the third cause of death in the United States. His calculations turned out to be wrong but his fight still bore fruit: convinced that there was an urgent need to make surgical operations more reliable, he developed a guide to good practices. Its recommendations, simple like verifying the patient’s identity or the location of the operation, ended up being adopted throughout the country. “If some see him rather as a man in need of influence, who only seeks contradiction, he can also be considered as an independent thinker, respectful of science,” writes specialist journalist Lizzy Lawrence, in a portrait for the american biomedical journal Stat.
If Martin Makary appears to be the “least worst” of the personalities capable of attracting the attention of Donald Trump for this position, this is not necessarily the case for Janette Nesheiwat. Donald Trump wants to position this doctor in Surgeon General. If she achieves this position, this young 48-year-old New York clinic director will mainly have to do health communication. As such, the professional is qualified: she regularly appears on Donald Trump’s favorite channel, Fox News. But she has no experience in public health. Congress will not fail to point this out to him.
On Fox News, Janette Nesheiwa is careful not to make anti-science remarks – yet they are legion on this channel, even coming from experts. But it is not yet appreciated by the scientific community. The fault, in addition to his lack of academic experience, is an unfortunate tendency to sell anything and everything on his website. It is thus possible to buy your book there Beyond the Stethoscope: Miracles in Medicinewhere she defends the existence of “miracles of God” in medicine. There are also a whole bunch of food supplements whose usefulness has not yet been demonstrated, apart from certain very specific pathologies. This is not exactly the kind of activity valued by the medical community.
An anti-vaccine to vaccines?
But Donald Trump’s most controversial choice undoubtedly lies in the person of David Weldon, a former hospital doctor announced as head of the Centers for Disease Control and Prevention (CDC). Convinced against facts and evidence that certain vaccines cause autism, David Weldon has never stopped accusing the institution he is led of fomenting a conspiracy. According to him, the CDC would have “kept secret” the evidence for its theories. He has made it known on several occasions that he wants to withdraw the vaccination prerogative from this structure, to entrust it to another agency.
By opting for David Weldon, Donald Trump is simply trying to place an anti-vaccine conspirator at the head of the institution responsible for establishing vaccine rules. Enough to undermine the functioning of the structure. It is therefore difficult to imagine Congressional support for this profile. The CDC’s sole role is to enforce the medical consensus, and this is by far favorable to the vaccines in circulation. Placing David Weldon at their head would be tantamount to declaring their dismantling.
If they obtain the vote of Congress, these profiles will become, willingly or unwillingly, the guarantors of the medical order, the same order that they have never ceased to decry. Jay Bhattacharya, Martin Makary, Janette Nesheiwat and David Weldon have in common that they have considered the dysfunctions of institutions – this is even why they are known to the general public and to Donald Trump. They also have the advantage of having the trust of a portion of American citizens who are skeptical of science. They can only be judged on their record, but one thing is certain: in office, they will have to choose between reason or the dictates of a political “camp”. The future of institutions is at stake.
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