More Reasons for Hope in 2025

"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness..."

That's Charles Dickens, in the opening lines of a Tale of Two Cities, describing America in 2025.

In what sense might we be living in the best and worst of times? Consider the CDC's widely-cited list of ten great public health achievements during the 20th century:

This list captures some of the reasons we might call this the best of times. I never worried about my kid catching smallpox, polio, or roughly a dozen other infectious diseases, for instance. A study published last August estimated that between 1994 and 2023, routine childhood vaccinations in the U.S. prevented more than a million deaths and half a billion illnesses.

But what's with the red font?

Items in red are the public health achievements whose scientific foundations have been ignored, questioned, or attacked by at least one of Donald Trump's six nominees for top health positions. (I excluded family planning, because there the attacks are focused more on policy than science.) RFK Jr., poised to be HHS secretary and thus our leading health official, has misrepresented the data behind every one of those red-font achievements.

I provide details in the Appendix. Take a look if you have any doubts that in some respects, this may also be the worst of times for American public health.

Scientific progress, political skulduggery. The best of times, the worst of times...

This newsletter focuses on two sources of hope. Specifically, hope that in 2025 and beyond, Americans will be able to live healthier lives, in spite of the current political climate.

1. The silver linings of Republican leadership.

Like many others, I find RFK Jr., Dr. Oz, and Trump's other health nominees to be dangerous and mostly unqualified for their respective roles. But there are silver linings to this dark cloud.

Hope in common ground

These presumptive leaders aren't cartoon villains. RFK Jr. promotes safer foods, healthier diets, and more exercise. Both RFK Jr. and Marty Makary, tapped to lead the FDA, rail against the overprescription of drugs and the influence of Big Pharma on the FDA and other regulatory agencies. These are ideas that even the crunchiest liberals tend to embrace.

As always, the devil is in the details. Although we all want safer foods, RFK Jr. demonizes additives and pesticides that appear to be safe, while promoting raw milk, which is neither safe nor beneficial (see here for details). But there is common ground, at least on the broadest aims. We all want a healthier country.

Common ground isn't useful unless you can build on it. What are the options here?

Rachel Bedard argues that liberals should engage with RFK Jr. rather than fighting his agenda for the next four years, though she offers more good will than strategies for engagement. Apart from recommending that RFK Jr. become a more sensible person, her only concrete proposal is that he establish a "nonpartisan and independent vaccine commission" to review new data.

Unfortunately, when it comes to something like vaccines, nobody can be nonpartisan anymore. Present yourself that way and others will still find a way to label you politically. (You're impartial and stick close to the data? Which data? If it comes from peer-reviewed scientific publications, you must be a liberal, if not a brainwashed victim of the Deep State.) If RFK Jr. establishes such a commission, even a bipartisan version could be dangerous if it, say, reanimates the scientifically dead question of whether vaccines cause autism.

In my view, what's hopeful about common ground that it enables dialogue. It's the best starting point for difficult conversations.

For instance, all parents worry about their children's health. From the wokest liberals to far-right MAGA extremists, all parents have stories about how their son broke his leg or stuffed a peanut up his nose. We're all more or less anxious about school shootings and fentanyl and the latest TikTok challenge. From this common ground of experiences and concerns, parents can, at least in theory, ease into topics like raw milk, and from there maybe even proceed to vaccines.

Am I suggesting that by talking, people create little epiphanies and, conversation by conversation, the world gradually becomes a better place? Sure, it happens. But simply telling someone they're wrong won't. You need to listen too, and make the other person feel heard, and keep on establishing common ground while you share your own perspective. (Gina Masullo at UT Austin and others offer great advice on how to talk with a political opponent.)

Hope in dissent

The new Republican health leaders disagree on a lot of health-related issues. As usual, Trump has assembled a team of adversaries, because he appreciates a diversity of perspectives (or, more likely, because he thrives on chaos).

All the same, I see some benefits to their disagreements (and not just in the sense that dissent might undermine their most harmful agendas).

For instance, consider the obesity epidemic. At least two independent studies published last year show that around 40% of American adults are obese. How should we be addressing this problem?

According to Mehmet Oz, Trump's nominee to run the Centers for Medicare and Medicaid Services, the solution will primarily come from weight-loss drugs like Ozempic. As Dr. Oz noted last August,

“...the amount of good done by these medications by helping people lose weight and improve their cardiovascular system — and it might have long-term benefits in a lot of other areas as well... — is massive.”

In contrast, RFK Jr. emphasizes healthier diets as the primary strategy. Last month, he told Greg Gutfield that the new weight-loss drugs are dangerous and expensive, and that

"giving good food, three meals a day, to every man, woman and child in our country would solve the obesity and diabetes epidemic overnight, for a tiny fraction of the cost."

Although RFK Jr. would have greater authority if confirmed, Oz is joined by Elon Musk and, of course, the pharmaceutical industry, in extolling the virtues of weight-loss drugs.

In the meantime, while we're waiting to see how this clash of perspectives plays out, public discourse around health may benefit.

Narrowly speaking, anything that spurs public debate about the pros and cons of weight-loss drugs is a good thing. Here's my view: For some people, the drugs are a quick, unsustainable fix for poor lifestyle choices, and we can blame corporate interests for exploiting their plight. For others, the drugs are a genuinely-needed treatment for genetically-driven problems such obesity. Whether you agree with me or not, these issues merit discussion.

More broadly, RFK Jr. and Oz represent different philosophies of disease management. Crudely speaking, the difference is in whether to focus more on prevention (RFK Jr) or on treatment (Oz).

Nobody would simply choose one over the other, of course. The question we should be discussing is which to prioritize when resources are limited.

For instance, RFK Jr. has promised more than once that he'll pause research on infectious diseases so that chronic illness can be more extensively studied. This would be a dangerous intensification of the prevention philosophy – and short-sighted, given that preventive strategies are needed to manage both kinds of disease (not to mention their inherent interconnectedness).

One of countless reasons not to interrupt infectious disease research is that as of this Monday, 67 cases of H5N1 bird flu have been identified in the U.S., and companies like Moderna are racing to develop vaccines under the assumption that it could spread. Hopefully, pushback from others in the new administration will prevent RFK Jr. from derailing infectious disease research and creating other mayhem.

2. Science marches on

If you don't share my concerns about the new administration, you may still worry about the health impacts of climate change, pollution, ultra-processed foods, and other downstream consequences of scientific progress.

Fortunately, science can help identify and fix the very problems it creates. Commercial plastic use, for instance, is barely over a century old, but microplastics have already harmed thousands of species and turned in parts of the human body ranging from the penis to the brain (which, in the case of men, can be a pretty small range). But scientists are also developing solutions to the problem. I'm especially encouraged by a November study in which Japanese researchers described the creation of plastic that dissolves in seawater.

The rest of this newsletter describes some treatment-related scientific progress in 2024 that bodes well for public health in the coming year. My examples aren't new treatments but rather repurposed or modified versions of existing ones.

Lenacapavir ("lena-CAP-a-veer")

In 2024, lenacapavir, an FDA-approved treatment for drug-resistant HIV, was found to be 96 to 100% effective at preventing HIV. Science deemed lenacapavir their Breakthrough of the Year owing to its effectiveness, and to what the scientists who developed it learned about the capsid proteins that protect the genetic material of a virus.

Administered twice per year, lenacapavir is more convenient than current PreP drugs, and it appears to be much more effective. Regulatory approval could occur as early as this year, although the initial price tag is likely to be high.

GLP-1 approvals

In 2024, the FDA approved the use of Zepbound for treating obstructive sleep apnea – the the first prescription medicine used to treat this common problem – as well as the use of two other existing GLP-1s for treatment of type 2 diabetes.

IVF

In December, the biotech company Gameto announced the first live human birth using Fertilio, a technology that promises to be faster, safer, and less invasive than current IVF methods.

Has this newsletter started to feel listicle-ish? That was the intent. The more we look, the more hope we can find in scientific progress related to health. I want to share just one more example out of the many that could be discussed.

Gene therapy

Last week I mentioned Opal Sandy, the British toddler who was born deaf but then, via a cochlear implant to her left ear and a single, 16-minute infusion to her right ear, acquired nearly normal hearing in both ears at 18 months. Apparently her favorite activity now is making noise.

Opal's infusion contained copies of the OTOF gene, which produces a protein that allows hair cells in the inner ear to transmit information to the auditory nerve. Simply put, the infusion replaced a defective gene with one that works properly.

Gene therapies have been successful recently in treating inherited blood disorders such as thalassemia and sickle cell anemia. I'm excited about these therapies, in spite of their relative newness and cost, owing to the depth of treatment they provide.

Imagine a factory that's producing defective cars. Gene therapy isn't like repairing those cars. Nor is it like replacing those cars with properly-working ones. It's like fixing the factory.

Conclusion

I'm hopeful about the coming year – as hopeful as I can be while acknowledging that, in some respects, this is still the worst of times.

Health experts continue to worry about the impacts of climate change, pollution, antibiotic resistance, unhealthy lifestyles, bird flu, as-yet unanticipated pandemics, and much more. But I find hope in the conversations being driven by President Trump's health-related nominations. And in the way science manages to forge ahead, regardless of who's temporarily running the show. And in the way Opal Sandy is said to smile when her parents whisper in her ear. Either ear.

Thanks for reading!

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Appendix: Trump nominees vs. the great 20th century public health achievements

This is a brief sketch of how Donald Trump's six nominees for top health positions have ignored or falsely impugned the scientific foundations of five of the ten great 20th century public health achievements identified by the CDC.

I'll keep it simple. First, the cast of characters and the agencies they're nominated to lead:

—RFK Jr., Health and Human Services (HHS)

—Dave Weldon, Centers for Disease Control and Prevention (CDC)

—Marty Makary, Food and Drug Administration (FDA)

—Mehmet Oz, Centers for Medicare and Medicaid Services (CMS)

—Janette Nesheiwat, Surgeon General (SG)

—Jay Bhattacharya, National Institutes of Health (NIH)

Below you'll see the five public health achievements I mentioned, followed by a few of the many statements of relevance these nominees have made.

RFK Jr. gets the most attention because, apart from Dr. Oz, he's been the worst offender, and because if all six nominees are confirmed, the other five would report to him.

Each quote you'll see below is contradicted by current scientific or factual evidence.

Vaccination

"Some children can get an autism spectrum disorder from a vaccine." (Weldon, 2019)

"I do believe that autism does come from vaccines." (RFK Jr., 2023)

Myocarditis is "four to twenty-eight times more common after the vaccine" than after a COVID-19 infection." (Makary, 2023)

The COVID-19 vaccine "is the deadliest vaccine ever made". (RFK Jr., 2021).

Control of infectious diseases

"There are much better candidates than HIV for what causes AIDS." (RFK Jr., 2023)

"We have [COVID-19] under control, it's contained, we have the resources to keep it contained....So, we shouldn't panic, we shouldn't be concerned." (Nesheiwat, February 26 2020)

Discussion of new COVID-19 variants is "fearmongering [designed to] manipulate people to get vaccinated." (Makary, 2021)

"[T]he magnitude of the protective effect of the [COVID-19] lockdowns, if it's not zero, it's very, very close to zero." (Bhattacharya, 2023)

"Covid-19 is targeted to attack Caucasians and Black people. The people who are most immune are Ashkenazi Jews and Chinese." (RFK Jr., 2023)

Safer and healthier foods

"[S]cientists [are] saying they have found a magic weight-loss cure for every body type. It’s green coffee beans, and, when turned into a supplement—this miracle pill can burn fat fast." (Oz, 2013)

Raspberry ketones are "the No. 1 miracle in a bottle to burn your fat." (Oz, 2012)

"I was always telling my patients who were unwell drink some tea, take some vitamin b12 and vitamin C. I found myself repeating my all natural regimen to my patients over and over “take some B12 and C to help Boost your immune system.” Thats how I came up with BC Boost." (Nesheiwat, 2025)

"The USDA was created to help the family farmer and to ensure a wholesome food supply, but its actual job is to do exactly the opposite. It is to give us poisoned, processed, addictive foods that are mass-poisoning us and killing us, and making us the sickest population in the world." (Kennedy, 2024)

Healthier mothers and babies

"I am not aware of a single healthy child in the U.S. who has died of COVID-19 to date." (Makary, June 10, 2021)

"Children just didn't die at very high rates from COVID, especially healthy children, one in a million, on that order." (Bhattacharya, 2023)

"Somewhere between 15 and 20 weeks" fetuses experience pain "and will actively resist the instruments of abortion." (Makary, 2022)

"Induced abortion [is] not only a risk factor for breast cancer, but also the most avoidable risk factor for breast cancer." (Weldon, with Tom Coburn, 1998)

“[W]e are drugging kids at scale, as the American Academy of Pediatrics is pushing Ozempic on 6 year olds.” (Makary, 2024)

American children are “swimming through a soup of toxic chemicals....that can....chemically castrate and forcibly feminize....frogs. If it’s doing that to frogs, there’s a lot of other evidence that it’s doing it to human beings as well.” (RFK Jr., 2023)

Fluoridation of drinking water

"Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease." (RFK Jr., 2024)