Charlatans, One and All

The Senate Finance Committee hearings with Robert F. Kennedy Jr. (RFK Jr.) were explosive. The Secretary of Health and Human Services was accused of “reckless disregard for science and the truth,”¹ and Senators from both parties were openly hostile as they questioned him extensively on his vaccine policies, the firing of scientific advisory board members and agency heads, and their replacement with ideologically driven anti-vaccine supporters. During the course of the more than three-hour session he was called a charlatan² and liar and he returned the insults as well. The level of distrust of Kennedy’s honesty and integrity was palpable. The question in all the Senators’ minds, and indeed all those watching on television, was “why should we trust you?”

This is not the first time that the question of trust has emerged in the history of public health. In fact, throughout the nineteenth and twentieth centuries, the American public has questioned the motives of public health leaders and scientists, sometimes with good reason. During the nineteenth century, when outbreaks of typhoid and cholera swept through New York City, public health police moved into neighborhoods, sometimes taking the residents of entire tenements away to quarantine hospitals located on secluded islands for weeks and months at a time.³ Mary Mallon, commonly known as “Typhoid Mary” spent years of her life on North Brothers Island in Long Island Sound, ultimately dying there because the public health authorities suspected her of transmitting typhoid to families for whom she cooked.⁴ In 1906, riots broke out at a public school on New York’s Lower East Side among Jewish immigrant mothers after officials performed tonsillectomies and rumors spread that officials were slitting their children’s throats.⁵ In the 1970s, the national swine flu vaccination program undermined the authority of public health expertise. And, of course, from 1932 through 1972, the infamous US Public Health Service study of the effects of untreated syphilis on Black males in Tuskegee and Macon County, Georgia engendered distrust of public health in the black community that lingers to this day.

Unlike the reaction to RFK Jr.’s policies and practices, earlier “outbreaks” of public distrust were often the product of missteps by public health authorities themselves. The arrogance of the public health community in sweeping people out of their homes and putting them on an inaccessible island in the middle of nowhere; the incarceration of someone for life because she might (and I emphasize might) be a typhoid carrier; the suspicion of an immigrant community of largely Protestant officials who had shown little sympathy for desperately poor Jews; and the overt and unquestioned racism of “experts” who would casually “study” African Americans to document their deaths from syphilis despite effective treatments represent discomforting moments in public health history.

But, of course, that is not the whole story. For, when public health has worked hard to both educate and empathize with the people who they were ostensibly serving, there have been huge successes that tell us something essential about first, how RFK Jr. is able to undermine public trust in vaccination, one of the great achievements in the history of public health. And also, what this tells us about what to do in the future to avoid a debacle like the RFK Jr. hearings and the possible (probable?) return of epidemic infectious diseases we long ago thought we had effectively suppressed.

During the Progressive Era in the 19th century, public health was an implicitly political and social issue. Officials had to fight the forces that opposed expensive sewer systems or water supplies. They were forced to confront landlords who resisted installing water pipes for bathrooms and pure water into their buildings. These were all fought for and gained through political and social reform movements with whom officials allied. Housing and sanitary and street cleaning reforms, pure milk campaigns, extension of the hospital and clinic system, workers’ compensation, and safety and health initiatives were all achieved in cooperation with communities and political movements, not in spite of them.

Even vaccination campaigns were often hailed by entire populations. The trust in the federal government itself was spurred by Franklin Roosevelt’s efforts to pull the country out of the Depression along with the nationalism engendered by our victory in World War II. The New Deal leaders muted traditional suspicions of both government and of science itself by promoting openness and trust among a population traumatized by depression and war. When public health authorities in 1948 suspected that a possible smallpox case may have entered New York City on a bus, a massive vaccination campaign was initiated by the Health Department that led to millions of New Yorkers, adults and their children, lining up around the block near clinics to receive the vaccine. In the mid-1950s, the campaign promoting the “polio shot” led to the entire nation being vaccinated. In the 1960s, a new vaccine led to the near elimination of measles, mumps, and rubella.

Peoples’ trust in government-run public health activities and the obvious effectiveness of vaccines in protecting the nation from childhood scourges was a singular victory that, unfortunately, led to a complacency among many in public health to think that the era of epidemic disease was in the past. Even in the face of a major setback with the Salk vaccine when a batch of inactivated vaccine led to the death of vaccinated children, Americans largely supported the public health authorities’ efforts at near-universal vaccination for school-age children.

But this was only part of the story. The John Birch Society, an extreme right-wing group in the 1950s and 1960s, used anti-vaccination sentiment to mobilize its base. And a growing suspicion of the integrity of elite scientists, the government, and technology itself gained a type of legitimacy during the 1960s as the Cold War, the nuclear arms race, the Vietnam War, and the political assassinations of Civil Rights leaders undercut both the left’s and the right’s faith in traditional institutions from the Army and the FBI to even public health. The 1962 movie “Dr Strangelove,” a black comedy about a nuclear holocaust and the destruction of the world by nuclear weapons, featured “Jack D. Ripper,” a paranoid general who famously justified his decision to allow for Armageddon with the statement: “”I can no longer sit back and allow … the international Communist conspiracy to sap and impurify all of our precious bodily fluids.” Ripper was speaking of fluoridation, but he captured the sentiments of those who saw government as an untrusted intrusion on all forms of bodily integrity. With the swine flu debacle in the mid-1970s, what had been a tangent in American history became more mainstream and, with cutbacks in a variety of public health funding under President Ronald Reagan, an anti-vaccination, anti-government, and anti-science movement gained a following, particularly among the right who saw in it a foundation for a larger political movement.

RFK Jr. has come to embody the anti-vaccination, anti-science movement, and is undoubtedly a charlatan, as Democratic Senator Maria Cantwell accurately said at the Senate Finance Committee hearings in early September. But this should not be surprising, given that Mr. Kennedy works for the president, who now is displaying similar behavior in pontificating without evidence about the dangers posed by acetaminophen to pregnant women or the link between vaccines and autism. Charlatanism of this kind always inflicts harm upon its unsuspecting victims, but, in this case, poses serious threats to the health of American women and children.

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