Give Briefings a Chance, Secretary Kennedy
First published in MedPage Today in its Second Opinions columns
Open minds and expert input are crucial for policymaking….
Based on my personal experience, dating back more than 40 years and spanning the administrations of 12 prior HHS secretaries, I can say that Robert F. Kennedy, Jr. stands alone in the breadth of his ambition to remake public health, vaccine policy, and the American diet. By itself, that might be laudable.
However, Kennedy's approach is uniquely his own. He declared his singular vision; then imposed it as an article of faith to which all must adhere. He has backed this by firing, marginalizing, or exiling seemingly everyone with the expertise or impudence to disagree.
One of those he fired, former CDC director Susan Monarez, PhD, just appeared before the Senate Health, Education, Labor & Pensions (HELP) Committee to recount her experiences as a senior official who tried to help her boss, but found his singular vision could not be reconciled with public health data and expertise. She spoke truth to power. She paid for it with her job.
The most salient point she made at the hearing was that Kennedy didn't listen and had no interest in considering data and analysis by CDC experts. He wanted her to pre-approve vaccine recommendations that had not yet been formulated and would be decided at a future Advisory Committee on Immunization Practices (ACIP) meeting that she knew would be composed of all Kennedy appointees. He wanted a rubber stamp.
As was on display during the Sept. 4 Senate Finance Committee hearing, Kennedy's vision starts with conclusions rather than questions; his style seemingly favors disruption over smooth transitions; and he appears to work from the premise that expertise is worthless. Several senators asked whether he had been briefed by HHS expert staff before specific decisions were made. None of those senators appeared to receive satisfactory answers.
Ignoring the Experts
Unlike his predecessors, Kennedy appears to have no commitment to policymaking.
I have spent decades as a policy analyst -- serving, among others, two of Kennedy's Republican predecessors and two Republican senators on the Senate HELP Committee, the committee of jurisdiction for HHS' public health programs. Based on that experience, I have insights into what Kennedy's predecessors would have done—without hesitation—with a similar goal and comparable ambition.
While trying to reshape public health, vaccine policy, or the American diet, each of Kennedy's predecessors would have sought sources of expertise -- both within and outside the government. One common starting point has always been the Office of the Assistant Secretary for Planning and Evaluation-- historically a powerhouse of intellect, knowledge, and policy insight. Then, these predecessors would have drawn more expertise from leaders and staff of various HHS agencies, such as FDA Commissioner Marty Makary, MD, MPH, and FDA staff. They would probably seek further insights from subject matter experts in academia, or those working for non-profits and companies. Depending on the nature of the initiative, they might also consult Congress.
The initiatives of HHS secretaries -- Republican and Democrat alike -- have tended to be methodical in identifying a specific problem, evaluating possible solutions, and then developing a plan of action.
In the past, that process has always included a briefing book or books, developed on the secretary's behalf, to help the secretary understand the issues and any draft proposals. Among other things, the briefing book might include an analysis of the field, a discussion of policy needs, and a delineation of "the known and real," "the unknown and speculative," and "the unproven but plausible." One or more in-person briefings usually followed.
Part of the current disconnect between the secretary and CDC on vaccine policy is Kennedy's unwillingness to be briefed by expert CDC staff. I find it troubling and quite sad that briefings and briefing books are no longer valued at HHS.
Kennedy is at war with experts and the value they bring to problem-solving. We will all pay the price in policies that are destructive to our nation's well-being.
If Kennedy Listened to Experts
What if, instead of banishing experts and precluding debate, Kennedy sought input from specialists in their respective fields?
Here are some of the things that the experts would likely tell him about developing successful health and food policies:
Anecdotes are not proof, and they cannot be generalized. At best, a collection of anecdotes serves as the basis for a hypothesis to be tested scientifically.
Correlation is not causation. Our brains are wired to connect events that are correlated over time, even if they are unrelated or random. Most of the time, the first event did not cause the second event.
Problems are visible, while benefits are often invisible. When there are problems, there are lots of noisy complaints. When things go well, people rarely notice or speak up.
Assume all problems are multi-factorial unless data to the contrary are overwhelming. As journalist H.L. Mencken observed, "For every complex problem there is an answer that is clear, simple, and wrong."
In science, believing doesn't make something true. Numerous conclusions are circulating on the Internet that are not supported by data and analysis. Nonetheless, many people believe them to be true.
You can't prove a negative. While science can be overwhelming in one direction, there is rarely a way to prove that there are no possible exceptions.
Briefings and Briefing Books Are Integral to Policymaking
If Kennedy were receptive to these tenets, then he might be more willing to review and learn from briefings prepared by expert HHS policy experts and scientific staff.
Reading briefing documents stimulates discussion and usually leads to policy proposals that identify plausible solutions to real-world problems.
That is not to say that briefings (and briefing books) always change minds. Often, they strengthen the position of the secretary by making him or her better informed and more prepared to respond to opposing views.
Open minds, combined with expert input, are crucial for developing effective and beneficial policies.
Please stop the war on expertise and give briefings a chance, Secretary Kennedy. And please listen.
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