RFK Jr.'s rhetoric appears to put blame on patients for health issues

On a recent weekday evening, Ashly Richards helped her 13-year-old son, Case, with homework. He did math problems and some reading, underscoring how much he's accomplished at his school for children with autism.

Richards has heard Trump administration officials suggest that food dyes and pediatric vaccines cause autism and ADHD. That stance, she said, unfairly blames parents.

"There's no evidence to support it," said Richards, 44, a marketing director in Richmond, Virginia. "As a parent, it's infuriating."

In their zeal to "Make America Healthy Again," Trump administration officials are making statements that some advocacy and medical groups say depict patients and the doctors who treat them as partly responsible for whatever ails them.

Health and Human Services Secretary Robert F. Kennedy Jr. and agency leaders have attributed a panoply of chronic diseases and other medical issues — such as autism, attention-deficit/hyperactivity disorder, depression, diabetes, and obesity — to consumers and their lifestyle choices, according to a review of 15 hours of recorded interviews, social media statements, and federal reports.

He said at a news conference on April 16 that autism is preventable and that rates are rising because of toxic substances in the environment, despite a lack of evidence there is any link.

"These are kids who will never pay taxes. They'll never hold a job. They'll never play baseball. They'll never write a poem. They'll never go out on a date," he said. "Many of them will never use a toilet unassisted."

The vast majority of people on the spectrum do not have those severe challenges.

The statements are more than rhetoric. These attitudes, ranging from judgments about individual behaviors to criticism of the chronically poor, are shaping policies that affect millions of people. The sentiments have been a factor behind decisions to cut Medicaid, keep federal insurance programs from covering anti-obesity drugs, and impose new barriers to COVID-19 vaccines for healthy people, say public health leaders and doctors. GOP lawmakers and federal health officials, they say, hold a reproachful stance toward chronic illnesses and the estimated 129 million people in the U.S. affected by them.

"This is at the heart of so much of our national problem with health," said Robert Califf, who led the Food and Drug Administration during the Obama and Biden administrations. "It's these two extreme views. It's every health decision is up to the 'rugged individual,' versus the other extreme view that it's all controlled by environment and social determinants of health. The truth is, it's on a continuum."

Self-reliance is a common theme among adherents of MAHA, an informal movement for which Kennedy has fashioned himself the figurehead that promotes medical freedom, skepticism of vaccines, and a focus on nontraditional medicine to treat disease.

Taking medication to manage diabetes? FDA Commissioner Marty Makary suggested on Fox News in late May that it would be effective to "treat more diabetes with cooking classes" instead of "just throwing insulin at people."

People with Type 1 diabetes must take insulin because their pancreases don't produce it, according to the National Institutes of Health, which also notes that many with Type 2 diabetes "need to take diabetes medicines as well."

Taking birth control pills? Casey Means, President Trump's nominee to be U.S. surgeon general, has said that's a "disrespect of life" for short-term gain and efficiency.

"We are prescribing them like candy," she said last year on "The Tucker Carlson Show," adding that birth control medications "are literally shutting down the hormones in the female body that create this cyclical, life-giving nature of women."

Have a child on ADHD meds? Calley Means, who is an adviser to Kennedy and is Casey Means' brother, said on the same show that Adderall is prescribed as the standard of care when children get a little fidgety because they're in sedentary environments with limited sunlight and eat too much ultraprocessed food.

As a society, he said, "we're really committing mass child abuse in many ways, and we're normalizing that and we're not speaking out about that. And then we're giving people stimulants developed by Nazi Germany."

Calley Means was probably referring to Pervitin, a methamphetamine-based drug administered to Adolf Hitler's forces in World War II. Adderall is a prescription drug containing amphetamine, a stimulant that's not the same as methamphetamine.

The Department of Health and Human Services didn't respond to messages seeking comment from Means.

Some conservatives and MAHA adherents argue that people need to take more responsibility for their health. But comments that shift blame to patients and physicians risk perpetuating stigmas, fostering the spread of misinformation, and eroding trust in modern medicine, say medical groups, doctors, and patient advocacy groups.

The statements assume consumers and patients have control over improving their health and preventing chronic disease when the reality is more complex, according to some public health leaders. Lower-income people, they say, often lack access to grocery stores and healthy food, may juggle too many jobs to have time to cook from scratch, and may live in dangerous areas where it's harder to get outside and exercise.

Jerome Adams, surgeon general during the previous Trump administration, told KFF Health News that he worries efforts to promote health will be undone by "the return of vaccine-preventable diseases, increasing mistrust in the health care system, and the tearing down of social supports which are critical for making healthy choices."

The attitudes held by top Trump health officials have affected policy decisions, some doctors and public health leaders say.

Kennedy and other Trump administration health leaders have been especially outspoken, targeting issues they consider especially egregious in recent federal actions, research, or policy.

For example, the Biden administration proposed a rule in November that would let Medicare cover weight loss medications such as Wegovy and Zepbound. But Kennedy and other political appointees at HHS and its agencies have criticized the drugs and the people who take them.

"I think it's very dark," Calley Means told Carlson, referring to the weight loss drugs. "I think it's a stranglehold on the U.S. population, almost like solidifying this idea that there is a magic pill."

He added: "Where is the urgency on saying 'Hey parents, maybe we shouldn't feed our kids toxic food?'"

Kennedy, too, has criticized the medications and people who use them, saying in October on Fox News that drugmakers "are counting on selling it to Americans because we're so stupid and so addicted to drugs."

In April, the Trump administration announced it would not finalize the Biden-era coverage rule.

"It's impacting the kind of care and treatments patients will have," said Andrea Love, a biomedical scientist and founder of ImmunoLogic, a science communication organization. "It sends the message that it's your fault. It's very much victim-blaming. It creates the idea that scientific progress is the devil, demonizes things that aren't individually harming health, while avoiding addressing systemic issues that play a much larger role in health."

Kennedy and HHS didn't return messages seeking comment.

Data shows that the medications are effective. People who took the highest dose of Zepbound in clinical trials lost an average of 48 pounds, and 1 in 3 on that dose lost more than 58 pounds, or 25% of their body weight.

Kennedy and other agency leaders also oppose many COVID-era health restrictions and rules. Some physicians and public health leaders note these officials downplayed COVID risks while criticizing vaccines developed during the previous Trump administration.

Kennedy has said that people who died from COVID actually fell victim to chronic diseases such as obesity, diabetes, or asthma.

"That's really what killed them," Kennedy said on "Dr. Phil Primetime" in April. "These were people who were so sick they were basically hanging from a cliff, and COVID came along and stamped on their fingers and dropped them off. But they were already living lives that were burdened by sickness."

COVID was the underlying cause of death for more than 940,000 people in the U.S. from Aug. 1, 2021, to July 31, 2022, according to a 2023 report in JAMA Network, an open-access journal on biomedical sciences published by the American Medical Association.

COVID ranked first among deaths caused by infectious or respiratory diseases for youths under age 19, based on the report. Infants under a year old may be at higher risk of experiencing severe illness from COVID compared with older children, studies show, and risks are also higher for infants under 6 months and those with underlying medical conditions.

"Vaccination during pregnancy can help protect infants after birth," according to the CDC.

But Kennedy announced in May that the federal government would no longer recommend COVID vaccines for pregnant people and children who are healthy. Medical groups such as the American Academy of Pediatrics opposed this decision and filed a lawsuit.

Kennedy also helped promote beliefs that many childless adults on Medicaid, the federal-state program for low-income people, don't work and thereby drain resources from the program.

At a May hearing of the House Energy and Commerce Committee, Kennedy said the program was in jeopardy because of "all the able-bodied people who are not working [or] looking for jobs."

It's a view embraced by Republican lawmakers who portrayed adults enrolled in Medicaid as lazy or shirking work as they advanced a budget bill estimated to cut federal spending on the program by about $1 trillion over a decade, in part by imposing work requirements on many adult beneficiaries.

"Thirty-five-year-olds sitting at home playing video games, they're going to now have to go get a job," said House Majority Leader Steve Scalise of Louisiana.

The legislation, which Mr. Trump signed into law this month, will cause about 10 million more people to be without health insurance by 2034, the Congressional Budget Office estimates.

Some health leaders who criticized the legislation say the statements inaccurately maligned Medicaid enrollees, who by law cannot hold high-paying jobs and remain in the program.

Nonetheless, nearly two-thirds of adults ages 19 to 64 covered by Medicaid in 2023 were working. For about 3 in 10, caregiving responsibilities, an illness or disability, or school attendance prevented them from working, according to KFF, the health policy organization that includes KFF Health News.

"It's using anti-welfare tropes for something that is basic health care, not a cash benefit," said Anthony Wright, executive director at Families USA, which supports the Affordable Care Act and expanded health coverage. He summarized the Republican message: "We're going to make it harder to get the help you need by imposing a bunch of paperwork, and if you don't get it, it's your fault."

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

• United States Department of Health and Human Services
• Robert F. Kennedy Jr.