My Most Correct RFK Jr. Take

“When the going gets weird, the weird turn pro.” - Hunter S. Thompson, Fear and Loathing in Las Vegas, 1971

I’ve been pretty frustrated by the internet chatter this past week around RFK Jr. Right up top: we shouldn’t try to “work with” RFK Jr. The lib politicians who are saying this (like professional bozo John Fetterman, apparently) are as full of shit about this as they are about every other thing. What’s frustrating about the discourse, though, is that it leaves a critical implied question dangling unanswered. What are we going to do instead of “working” with RFK Jr.? Nobody who gets paid to have opinions about this sort of thing is getting paid to follow through on this. I want to suggest that “whatever it is we’ve been doing” is not good enough.

It’s a very uniquely 21st-century feeling, the heart-sinking that one gets watching a Voltron of loosely connected Takes cohere, via repetition and amplification, as Facts. Online, of course, where nobody has any power, not even close. Noncollaboration is a good start, a good first principle, a noble rhetorical stance, but let’s never forget that at the level of actual lived life for just about every single one of us, it’s the default option, requiring the least effort. We (posters on Bluesky, public health commentators, slingers of takes) don’t actually have any meaningful input into the confirmation process, let alone any way to meaningfully influence HHS policy from the top down. So what actually comes next? What should we actually be doing?

The below thread by Gregg Gonsalves (the GOAT) on the topic is, in my opinion, extremely illuminating. (I’m sorry this interface insists on embedding it rather than just letting me link.)

In my reading, there are two levels to it. The first is the level of overworld national politics, the level where RFK Jr. is going to have to go through a confirmation process to become head of HHS. This is where it’s correct to dig in, and to use whatever feather-light breath of influence we might have (via swiping each other about it in the stakesless virtual arena of Online) to scuttle his nomination, to make it as hard as possible for Trump to get anybody through. Trump will get somebody through, though, and that person is probably gonna have some really wack ideas. This brings me to the to the second level of Gregg’s thread and, in my opinion, the really, really critical part of it: what the hell are we gonna do about that? The latter parts of Gregg’s thread tell a story of successful organizing for health justice around HIV in South Africa against conspiratorial national authorities bearing a family resemblance to RFK Jr. This is the level where I think we are falling short on imagination. Organizing doesn’t just happen, no matter how blithely the sages of Online handwave about it as a solution to all our problems. And the type of organizing that was successful in South Africa doesn’t sit well with the mien of aggrieved expertise that has (perhaps understandably) become the demeanor of professional public health since the pandemic. To say it as bluntly as possible, you can’t organize people you have contempt for, or that you don’t care to understand. Public health has this incurious contempt in spades. As a consequence, the field runs a huge risk of replaying the mistake we’ve been making for decades, this time via an almost-willful misunderstanding what RFK Jr. represents.

I think Gregg’s thread provides us with some outlines of a path forward here, but of course the answers suggested therein are ones that nobody really, in their heart of hearts, truly wants. It feels better to console ourselves with the idea that RFK Jr. doesn’t really have much of a constituency, or that public opinion polling shows that attitudes towards vaccines are still majority-positive. That it’s sufficient to shrug and feel good about ourselves, and hope that our Better Angels or whatever will carry the day. I contend that we shouldn’t be pacified by any of this — RFK Jr. may not be super popular, but “Big Wellness,” of which he is but an avatar, definitely is. Vaccine attitudes are still majority-positive, but there’s no reason to suspect that this is always going to be the case; they’re at an all-time low in the last fifty years, and trending downward, behind a 30-year slide towards Wellness, we as a culture slouching towards the Light. There simply is no shortcut here. If we want to have any hope of science triumphing over unreason, we are going to have to engage with people, and engaging with people necessitates trying to understand where they’re coming from, why the facts that are obvious to us are not obvious to them.

It’s an axiomatic truth that you can’t change an anti-vaxxer’s mind by presenting them with Facts. However, I need to clarify something important here — this isn’t, as the dominant thinking in public health suggests, because conspiracy or conspiracy-friendly narratives are deficient in facts. Conspiracy narratives aren’t about a deficit of correct facts — they’re about which facts are facts at all, about how facts are made, and on whose authority. In his 2000 book Empire of Conspiracy: The Culture of Paranoia in Postwar America, Timothy Melley describes conspiracy theory as a fruitful form of political representation (not misrepresentation) that derives from a sense of “diminished human agency” (Melley, 2000, 3) arising from a particularly post-war, post-modern “radical doubt about how knowledge is produced and about the authority of those who produce it” (Melley, 2000, 13).

This is how dismissing anyone who finds anything resonant in the MAHA platform as a conspiracy theorist out of hand actually lends strength to the conspiracy cyclone. The dominant attitude among my fellow credentialed public health experts is that because people who express anti-vaccine or vaccine-hesitant views (these are not the same thing at all) are recalcitrant to Facts as we present them, that they are unconvinceable, a waste of breath and resources for all but the most selfless and saintlike health care workers. The real danger here is that, if we’ve convinced ourselves that anyone who looks at RFK Jr.’s website and thinks he makes some good points is a lost cause, we’re doing the right’s work for them without even realizing it. “He actually DOESN’T make any good points” leaves people who do — whether we like it or not — find something that speaks to them in his messaging high and dry, feeling even more like the authorities don’t care about them, like the public health scicommers just don’t get it, like maybe there’s even more reason to be suspicious of the truth claims we advance. We don’t bother to offer any alternative articulation of what they’re going through — we don’t offer any articulation of it at all. I can’t emphasize enough how dangerous that is. We don’t want people who are amenable to RFK Jr.’s points on pollution or the food system left thinking “well, this stuff feels right, and the MPHs on Bluesky call me a conspiracy theorist for it, and they’re wrong; who knows what else they’re wrong about, maybe there’s something to this fluoride stuff after all.”

I have said before that RFK Jr. is speaking to emotional truths, not factual truths. You could say that public health has no business attending to emotional truths; I could say that this attitude might have something to do with how intellectually marginalized and sclerotic we are as a discipline. We talk about social determinants as one-way structural forces acting on agency-less individuals. Ironically, the only difference between this “sociological” stance and conspiracy narrative is that public health doesn’t ascribe any meaning or agency to those structural forces, whereas for the conspiratorial believer, those structural forces are alive with malicious intent (see, again, Melley). You may say that’s silly, but people do make meaning of things, even more so in an increasingly chaotic, abusive, and degrading world. All public health and the technocratic disciplines have to offer is that the terrible things that happen to you are actually random, meaningless, agentless, Just The Way Things Are.

I really urge everyone to read this recent post by one of my favorite public intellectuals, Jessica Calarco. I will quote from it at length:

Take, for example, a mom I’ll call Tara—one of the women I interviewed for my new book, Holding It Together: How Women Became America’s Safety Net. As a toddler, Tara’s daughter Reagan experienced a sudden shift in temperament not long after getting her routine vaccines. As Tara explained:

“We are pretty sure that vaccines caused my daughter to regress. She was perfectly fine. She was meeting all of her milestones at a year and a half old, and one day it was just all gone, and she started having meltdowns. She started not liking people. She doesn’t talk.”

Reagan’s pediatrician made a referral for testing for autism, but the waitlist for appointments was a year long. Private testing might have been faster, but Tara couldn’t afford to pay, because she was pregnant again and had experienced complications that forced her to leave her factory job. In the meantime, Reagan’s condition got increasingly difficult to manage, leading Tara to decide not to go back to the workforce, even after Reagan’s younger brother was born. As Tara explained, “She uses me as her security, so her own dad doesn’t know how to help her calm down from a meltdown.” In the face of that stress, vaccines gave Tara a target for the grief and the anger she felt on the days that were especially hard. Tara also opted not to immunize her son or give Reagan or her older daughter any further vaccines. As she explained: “I’m afraid that if I get vaccines for the other kids that it’s going to happen again.”

Over time, fears like Tara’s have become widespread in the US. A recent survey conducted by researchers at the University of Pennsylvania’s Annenberg Public Policy Center found that 24 percent of the 1,500 American adults they surveyed believe that it’s inaccurate to say there’s no link between autism and vaccines. And that same survey found that only 43 percent of American adults think the vaccine explanation for autism is definitely false.

Calarco’s post continues:

Against this backdrop of mother-blame and mother-burden, it’s not surprising to see mothers fear the prospect of their children being disabled or seriously ill. Erin [another pseudonymous mother Calarco interviewed], for example, had seen family members struggle with the challenges of raising a child with autism—challenges that can include long wait times and high out-of-pocket costs for diagnoses and treatments, fights with schools over appropriate accommodations, and emotional meltdowns if their children’s needs and routines aren’t met. Erin also worried that if her son did develop autism, she wouldn’t be able to afford the care he might need as result. She told me that she and her husband were still struggling to pay off the thousands of dollars in medical debt they owed after giving birth, and that they were also “going broke for insurance,” trying to pay their healthcare premiums and out-of-pocket costs every month.

It seems pretty clear to me that these women’s vaccine-hesitant stances are attempts at meaning-making within a cold and indifferent system of official health care and health messaging that, frankly, doesn’t give a fuck about them or what happens to them. “Scicomm” basically means someone with some letters after their names chiding them that “correlation isn’t causation, sweetie” then disappearing back into the ether, leaving them with zero resources for managing the real challenges in their lives and a bad taste in their mouths — again, it’s easy to read agency into the structural forces that experts represent. What do public health scicommers have to gain from undermining my attempt at a system of meaning without offering any kind of alternative, hmmm? I worry that in our righteousness about facts and science we’re leaving people like these moms on the table for the right to recruit, politically abandoning them to MLM scams.

Of course, I would say that these moms’ understanding of the structural forces at play is wrong; it links up pieces of information, both fact and fiction, in a wrong way. Melley makes the great point that while both sociological perspectives (of which I would count public health as one) and conspiracy theory attempt to describe what we might call “structural causality” by attributing the agency that people are anxious about losing at the individual level to the social system, conspiracy narratives (unlike sociological ones) obscure the actual political contours of the problem — conspiracy narratives “hide[s] the specific political features of the struggle [they] attempt to represent” (Melley, 2000, p. 10; see roughly pp. 1-25 for most of the general argument I’m summarizing here).

This kind of shell game is definitely happening with the MAHA-wellness movement. Vaccines work. That’s Facts. It’s also Facts that poor people have worse access to shittier health care, are sicker, die younger than rich people. Public health steadfastly refuses to politicize these Facts in a way that resonates with people’s experiences and speaks to people’s emotional lives in the slipstream of 21st Century American Life. MAHA, of course, hides the ball. If they asked, or encouraged their recruits to ask, why inequality is at all, why it’s so grueling to get assessment or services for your autistic child, why you have thousands of dollars of debt from giving birth, they’d have to open up these structural forces to nuanced interrogation, and wouldn’t like the results. Instead, they smooth over these issues, providing a false answer — for the low low price of $39.99 and some time Doing Your Own Research, you can take control of your life, reassert your agency amid the chaos, opt out of these systems of control, and hey, who knows — maybe you could even be one of the lucky ones to run with it and make a buck building your own downline.

I want to suggest here that the core of what RFK Jr. is “right” about, the emotional truths he is speaking to, represent contradictions within the MAHA-wellness movement (which is much bigger, and a much bigger problem to confront, than a single Cabinet appointee) that we can exploit if we want to. 25+ years of scicomm have done nothing to hold back the tide of vaccine hesitancy, which gets more and more widespread, creeping further and further into mainstream thought, every year. Why is that? Could it be that people are experiencing some things about our political economy of health as deeply wrong? That is a powerful emotional truth that we should absolutely not cede to the antivax, raw milk right. We could, for example, use it to revive the Medicare for All movement that has sort of ironically flagged under the weight of the pandemic.

Please indulge me in bringing Stuart Hall back in, reproducing this quotation from The Hard Road to Renewal (1988) that I’ve been clutching to my bosom like a healing crystal for several weeks now:

Now we are beginning ... to move into a "post-Fordist" society- what some theorists call disorganized capitalism, the era of "flexible specialisation." One way of reading present developments is that "privatization" is Thatcherism's way of harnessing and appropriating this underlying movement within a specific economic and political strategy and constructing it within the terms of a specific philosophy. It has succeeded, to some degree, in aligning its historical, political, cultural and sexual "logics" with some of the most powerful tendencies in the contemporary logics of capitalist development. And this, in part, is what gives it its supreme confidence, its air of ideological complacency: what makes it appear to "have history on its side," to be coterminous with the inevitable course of the future. The left, however, instead of rethinking its economic, political and cultural strategies in the light of this deeper, underlying "logic" of dispersal and diversification (which, after all, need not necessarily be an enemy of greater democratization), simply resists it. If Thatcherism can lay claim to it, then we must have nothing to do with it. Is there any more certain way of rendering yourself historically anachronistic?

Wellness is taking advantage of and articulating dominant currents in the culture, which is why it seems to have a degree of inner propulsion and sheer rizz that staid mainstream public health accounts — nervous and inflexible scicomm that redounds to scolding when, inevitably, it does’t work — simply don’t. I’ve written about this before: social determinants don’t just act on populations, populations are living and adapting things that “act back.” Social determinants don’t only shape objective indicators like the population-average blood pressure, they also shape people’s attitudes and behaviors. And as I have been writing about for years, health care as a qualitative social determinant (it sucks, it’s dehumanizing, it’s burdensome, it’s financially ruinous, it’s often impossible to get in ways that would make Kafka blush, doctors are assholes, etc) pushes people into the embrace of wellness. Smug rejoinders to RFK Jr. that we do in fact study the causes of chronic illness (as he suggests MAHA will do for real) really overstates the quality and impact of social determinants research which is — and I can say this as someone who has done a fair amount of it — just an extensive index of all the ways that capitalism wrecks people’s health. It doesn’t make a god damn difference.

This has been a lot of words, hopefully somewhat convincing, just to say: a very bad thing we can do here is let ourselves be backed into a defensive crouch over the status quo because some take writers don’t want to “give an inch” on RFK Jr.’s confirmation or proposed agenda. We will be left behind. How can we politicize these socio-medical ills in the right way, and construct alternative systems of meaning that confront the powerful actors and incentives in play with integrity? How can we wrench these currents in the direction of the things we want to see, and that our many years of expertise tells us will benefit everyone?