RFK Jr. to be Trump's nominee for HHS Secretary.

That and other stories in "Five on Friday" for November 15, 2024...

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Getty Images: fhm

Item 1: RFK Jr. floated for HHS leadership position.

President-elect Donald Trump announced that he would nominate Robert F. Kennedy Jr. to be the Secretary of the US Department of Health and Human Services. This will put a man with no relevant experience and a well-documented history of highly dangerous ideas atop the nation’s public health infrastructure. The Secretary of HHS oversees the CDC, the FDA, and Medicare and Medicaid.

There’s really no realistic justification for this move. Most public health experts are rightly worried about this. But others rushed to point out areas where RFK Jr. has been right on an issue here or there. Oh, so some guy gets some things right once in a while? To quote Shania Twain, “That don’t impress me much.”

Pope Francis believes that the Big Bang and evolution do not contradict his religious beliefs. That doesn’t mean we need him running the Centers for Disease Control and Prevention of the FDA. But that’s literally the analysis some are floating in order to justify this choice (or curry favor with the new administration, in some cases).

In what single way does RFK Jr. possess the domain expertise or track record to suggest that he can make difficult decisions soundly? To place him in the HHS Secretary position is to say that every single Republican with public health experience is less equipped to do this important job than RFK Jr. is. If I were in that group, I’d be insulted.

Yale’s Dr. Ben Mazer had a nice piece on this in The Atlantic. I refer you to it. He reaches to the same conclusion that I do. Who cares if RFK Jr. has occasionally been right? That’s just not the standard for this role. As Mazer puts it, “Why should he have input on anything? This nation has no shortage of public-health and medical experts with thoughts on raw milk or fluoridated water. Some experts will surely agree with aspects of Kennedy’s platform, but they will also bring the credibility, experience, rigor, and honesty he lacks. Let’s not pretend that Kennedy’s views have any value whatsoever.”

Well said.

My friend Dr. Katelyn Jetelina also summarized the situation aptly: “We all want a healthier world; RFK Jr. isn’t the answer. The playing field is now completely changed. Instead of pushing the needle forward toward a healthier society, it’s now more about keeping it from moving backward.”

Folks, the fight for public health is on. For my part, I will work with anyone in the next administration who is willing to have reasonable discussions. That means I will stand up for vaccines and other achievements of public health to anyone who will listen.

Item 2: Trial: GLP-1 recipients had lower rates of new-onset diabetes.

A clinical trial of tirzepatide (a GLP-1 drug like Ozempic and Wegovy) has found that people with obesity and “pre-diabetes” (i.e., tests that put them near the diagnostic threshold for diabetes, but not above it) lost a lot of weight over a 3-year period. The study was published in the New England Journal of Medicine this week. Trial participants on the highest dose had lost an average of 20%-25% of their body weight just 1.5 years into the trial. This is not a surprise anymore, though it’s another impressive trial showing how GLP-1s can effectively and impressively treat obesity.

But two secondary findings should be noted. First, after 176 weeks of treatment, the participants were taken off of the drug for 17 weeks. During that time, the average participant gained back around 7% of their initial weight. Is this proof that people need to stay on the medications forever? No. But it is an indicator that staying on the drugs may be best for some. For others, it remains possible that cycling might work as well—i.e., patients might take the drugs for 3 years solid, and then take a 3-month break. If they need to resume the drug, they can do so. If such “drug holidays” work, it could save a lot of money and patients wouldn’t have to inject themselves in perpetuity. Alternatively, a transition to slightly less effective pills may someday work against the weight regain. Second, researchers found that those randomized to receive tirzepatide were less likely to cross the threshold from “pre-diabetes” to diabetes. Among placebo recipients, 13.3% crossed the threshold and were given a new diabetes diagnosis during the study, compared to just 1.3% in the tirzepatide group. This is a highly encouraging finding. If confirmed, it may be another benefit that saves money, yet again changing the cost effectiveness analysis around these drugs.

Item 3: H5N1 update: The CDC beefs up PPE recommendations a bit.

Following last week’s news that a number of farm workers had antibodies to H5N1 bird flu (7% of those tested), the CDC has amended some of its protocols around preventing infection in high-risk environments. The CDC now says it will offer tests to asymptomatic workers who have had exposure to potentially infected animals if they were not wearing the right PPE or there was a problem with said PPE. That’s good. We really need to do asymptomatic testing in high-risk people—as I’ve argued. Symptoms (or lack thereof) cannot be relied on. The CDC is also offering post-exposure prophylaxis medications to individuals with high-risk exposures. That’s fine, but in all transparency, it’s unlikely that these drugs will prevent many infections. They work, but not that well.

Meanwhile, in Canada, a teen who contracted H5N1 is in critical condition. To the best of my knowledge, this is the most severe case of the 2024 outbreaks, and it appears to be because the particular version of this influenza is different from the one that has been circulating in US cattle. If the Canadian case leads to others, we could be in trouble. So far, though, no other cases have been reported.

Item 4: Texas doctors are not happy with required immigration questions.

As if doctors don’t have enough to do. As if doctors don’t have enough to worry about while practicing medicine in Texas. A new rule there requires hospitals to inquire whether their patients about their citizenship or immigration statuses during their visits. This is terrible policy.

A story in MedPage Today by Michael DePeau-Wilson covers the issue. In it, doctors voiced concern about the rule, including those around EMTALA, the law that requires hospitals to treat and stabilize everyone, regardless of their demographics or ability to pay. As my friend and ER colleague in Houston Dr. Cedric Dark said in the piece, “Am I personally as a physician going to be liable for an EMTALA violation if the policy is enforced?” It’s a chilling notion—that hospitals would be forced to send patients away if they gave the “wrong” answers to immigration questions. As an ER doctor, I take pride in the fact that our practice environment is a safe place for everyone who needs help. It horrifies me to think of governments trying to extend their tentacles further into patient-doctor relationships. But, here we are.

Item 5: Poll of the Week.

Here are the results from the last poll. Thanks for your votes! Maybe we’ll have some guest posts from time to time.

Item 5a: Poll of the Week for this week!

How well do you think GLP-1s such as tirzepatide work? Let’s find out! In the new clinical trial discussed above, the average starting weight was 237 lbs….

That’s it. Your “Friday Five!” Questions? Comments? Please chime in!

Feedback! Have any ideas for next week’s Poll of the Week? Any great articles you’ve read elsewhere that you want to share with the Inside Medicine community?