It's not hard to see through RFK Jr.'s ‘radical transparency' pledge
Peter Lurie is executive director of the Center for Science in the Public Interest. Aaron Kesselheim is a professor of medicine at Harvard Medical School. Joshua Sharfstein served as principal deputy commissioner of the Food and Drug Administration during the Obama administration.
In his inaugural speech upon taking over as secretary of the Department of Health and Human Services, Robert F. Kennedy Jr. declared that his plans include 'radical transparency.' He has subsequently repeated that phrase multiple times, but what it actually means — to Kennedy and for the rest of us — is far from clear.
Government transparency efforts generally start with the premise that an open and engaged agency functions more effectively and inspires public trust. Transparency programs have involved more public explanation of government action, quicker release of documents and databases, more opportunities for public comment, and an aversion to sudden, unexplained major changes in direction. In its conventional form, transparency operates neutrally, without regard to specific political objectives.
To date, Kennedy's 'radical transparency' looks nothing like this. After an initial pause on agency communications, HHS eliminated communications teams across the department. These teams include people who understand how to reach the public and clinicians to share information on drug and device recalls, outbreak investigations, and other health topics. Beyond the communications teams, there has been little effort to make knowledgeable people available for public engagement: HHS has not permitted experts from the Centers for Disease Control and Prevention, for example, to brief the country on one of the worst measles outbreaks in decades.
Also gone are most of the staffers who respond to requests for government documents under the Freedom of Information Act — one of the most important federal statutes related to open government — even though the department already faced formidable backlogs. (One exception appears to be the sparing of staff fulfilling requests for vaccine data filed by Kennedy's campaign lawyer, who is known for vaccine-related petitions and litigation.)
Kennedy's team also appears to be undermining the integrity of and access to important health datasets. Before Kennedy's confirmation, HHS interpreted President Donald Trump's executive orders on gender and diversity as requiring certain national health datasets to be hidden, at least temporarily, from public view. After a judge required the department to make the information available again, its websites presenting these data now state — without further explanation — that they are 'being modified to comply with President Trump's Executive Orders.'
Meanwhile, HHS has dismissed entire teams supporting major national studies. These include the National Survey of Drug Use on Health, the nation's leading effort to understand addiction, and the Pregnancy Risk Assessment Monitoring System, a critical source of information on risk factors for preterm delivery and other adverse birth outcomes.
Even completed scientific studies are being delayed, altered or quashed. After three-quarters of a century of uninterrupted publication, the department failed to publish the CDC's flagship Morbidity and Mortality Weekly Report for several weeks, delaying information on the spreading avian flu epidemic. Public Health Reports, a journal of the Surgeon General's Office, is now demanding revisions of accepted, peer-reviewed articles to conform with bans on certain terms.
Public participation in department decision-making has also been restricted. The Food and Drug Administration and the CDC have canceled or postponed open advisory committee meetings on vaccines. And HHS rescinded a federal commitment made in 1971 allowing public comment on rules related to public property, loans, grants, benefits and contracts.
Kennedy has yet to explain major changes at the department itself. HHS has dismissed approximately 10,000 employees (some erroneously) and is embarking on a major reorganization, with only a brief media statement explaining what appears to be the fundamental reshaping of multiple agencies. NIH has canceled hundreds of grants on the grounds of ill-defined 'gender ideology,' 'DEI,' or 'no longer effectuat[ing] agency priorities.' Also poorly explained: Why NIH has stopped multiple grants to South Africa that are critical to understanding how best to fight the global scourges of tuberculosis and AIDS. And Kennedy has yet to answer questions about why HHS pushed out an FDA leader in charge of reviewing vaccines, brought on a well-known anti-vaccine activist to reexamine vaccine safety data or prompted a leading food scientist at NIH to claim he was being censored.
With so much obfuscation and opacity at HHS, it has become crystal clear that 'radical transparency' is not about openness and engagement. So what does the term actually mean?
The HHS website on 'radical transparency' includes five items. One, inexplicably, is 'Ending Anti-Semitism on College Campuses.' A second is a press release stating that Kennedy has ordered the FDA to 'explore rulemaking' to stop food additives from entering the food supply without the agency being notified. A third is a list of terminated contracts that provides no explanations for the terminations.
The two remaining points are aggregations of data already in the public domain. One brings together information on chemical contaminants from several existing datasets. The other includes details on conflicts of interest among members of the CDC's Advisory Committee on Immunization Practices, a key focus of Kennedy's attention. In the past, he has claimed that 97 percent of the committee's members have conflicts of interest and has stated that 'almost all' have 'severe, severe conflicts of interest.' The new website, which aggregates information disclosed at the committee's public meetings, actually demonstrates that Kennedy is wrong. Many meetings involve no conflicts of interest, and at others, members regularly disclose conflicts and abstain from relevant votes.
Meanwhile, Kennedy's signature Make America Healthy Again Commission held its first meeting behind closed doors.
So far, the selective releases of 'radical transparency' seem to be little more than tactics in pursuit of the secretary's own agenda. With so much at stake for their health, Americans deserve to understand what HHS is up to and why. 'Radical transparency' needs a lot more transparency.
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