rnAdam resides in Washington, D.C.
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Perspectives
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Prescriptions for a Broken System
— In early 2025, I was overly optimistic he might get a thing or two right for public health
by N. Adam Brown, MD, MBA, Contributing Writer, MedPage Today
December 30, 2025 • 4 min read
rnAdam resides in Washington, D.C.
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Last January, N. Adam Brown, MD, MBA, compared HHS Secretary Robert F. Kennedy Jr. to a broken clock: even he might stumble onto the right answer a couple times a day. As part of our review of the past year’s biggest events, Brown revisits his previous assertion and reviews what Kennedy has gotten right — and wrong — on health and medicine in the past year.
As our clocks get ready to ring in the new year, let me amend my earlier statement about HHS Secretary Robert F. Kennedy Jr. being a “broken clock” and say this: I was wrong.
There is not much, if anything, Secretary Kennedy has done well in 2025. While he hides behind a smokescreen of small victories, the reality is that the intricate, complex agency he is leading has not simply stopped advancing. It is shattered, and it is the secretary and his cronies who have done the breaking.
In doing so, he has placed generations of Americans at risk.
America Once Led the World
To understand the magnitude of the damage Secretary Kennedy has done, one must first appreciate what we once had: global leadership.
While imperfect, because U.S. healthcare agencies largely represented independence, ingenuity, and innovation, the CDC, NIH, FDA, and CMS were considered leaders on the global health stage. These institutions were led by a set of principles, including commitments to evidence-based practices, scientific rigor, interdisciplinary debate, transparent public communications, detailed surveillance, and improved access to care. These organizations were not regarded as bureaucracies, but beacons — institutions toward which other nations could look for truth and leadership.
In 2025, that beacon barely flickers.
Kennedy’s Broken Promise on Vaccines
A lot has been written about Kennedy’s personal crusades — his lawsuits against vaccine manufacturers and his conspiratorial thinking. But in his Senate confirmation hearings in early 2025 he managed to convince Republican lawmakers that he would not tear down our system of developing, recommending, and administering vaccines.
“All of my kids are vaccinated, and I believe vaccines have a critical role in healthcare,” he testified under oath.
Sen. Bill Cassidy (R-La.), a physician who voted for Kennedy’s confirmation, and his colleagues were fooled.
Just look at what Kennedy has done to the Advisory Committee on Immunization Practices (ACIP). In June, the secretary fired all 17 sitting ACIP members. He then appointed around a dozen new officials, many of them vaccine critics. Decades of thoughtful, multidisciplinary, evidence-based vaccine policy has subsequently been upended.
Medical societies — organizations historically cautious in their public criticism — were outraged. The American Medical Association said Secretary Kennedy’s move “undermines that trust and upends a transparent process that has saved countless lives.” The Infectious Diseases Society of America said, “Unilaterally removing an entire panel of experts is reckless, shortsighted and severely harmful.”
I cannot think of another time when the nation’s leading scientific bodies have warned Americans to distrust their own government’s public health agencies.
Decimating ACIP is not the only way Secretary Kennedy has gone back on his promises. The rolled back — scientifically indefensible — hepatitis B newborn vaccination recommendations place millions of children at risk. Kennedy also has undermined confidence in the HPV vaccine, one of the greatest cancer-prevention tools of the last half-century, virtually eliminating cervical cancer in countries where there has been strong uptake.
These moves are reckless, as are Kennedy’s NIH cuts.
NIH Reductions, Leadership Cuts Threaten Americans’ Health
The Trump administration has severely curtailed healthcare spending, and it has done so in the most political of ways. The NIH’s “sweeping cuts of grants that fund scientific research are inflicting pain almost universally across the U.S., including in most states that backed President Donald Trump in the 2024 election,” the Kaiser Family Foundation reported in April.
These reductions have shuttered community research centers, halted promising cancer trials (an outcome Kennedy’s cousin wrote passionately about in The New Yorker in the face of her own terminal cancer diagnosis), and gutted the early-stage science that forms the backbone of future medical breakthroughs.
NIH funding is essential, forming the foundation for progress in oncology, neurology, infectious disease, and chronic disease prevention. Funding cuts slow science for people whose lives depend on breakthroughs.
Equally alarming is the quiet culling of experienced leadership at CMS, FDA, NIH, and the CDC. Generations of institutional knowledge have been purged. Scientists, epidemiologists, regulatory experts, and policy leaders are gone. These civil servants — who could have earned millions of dollars in the private sector but chose a life of contribution to the public good instead — have knowledge borne from weathering pandemics, building vaccine programs, modernizing drug approval pathways, and stabilizing insurance markets.
And Secretary Kennedy has driven them out.
A fish rots from the head. The rot is visible now, spreading through the nation’s health agencies, wearing away at scientific norms, and replacing them with political expediency and conspiratorial thinking.
What’s at Stake
The outcome of Secretary Kennedy’s destruction is that the U.S. has ceded global leadership in health and science to Europe, the United Kingdom, and maybe even China. Pharmaceutical companies, device manufacturers, and digital health innovators will now look elsewhere for regulatory predictability, scientific reliability, and pathways to commercialization.
When the gold standard becomes unreliable, the market moves on. This statement is not alarmism. It is simply what happens when a society replaces scientific rigor with pseudoscience.
The movement of reliable science abroad will mean fewer jobs here at home. But that outcome is hardly the worst one on the horizon.
If Kennedy continues on this path, the next generation will inherit a world that looks disturbingly familiar to the pre-vaccine era. Even in America, children will die from measles, mumps, rubella, chicken pox, and hepatitis. Cancer will take the lives of more mothers and fathers, and life expectancy will slowly erode.
Is that the future Sen. Cassidy and the other GOP senators who voted for Kennedy’s confirmation envisioned? I doubt it, but the question is: Will they finally speak up and get him out of HHS?
I hope so.
