Alexandra Ciferlin: This is The Opinions, a show that brings you a mix of voices from New York Times opinion. You've heard the news. Here's what to make of it. I'm Alexandra Ciferlin, a science editor at The New York Times. I recently hosted a live event at the Brooklyn Public Library to talk about the state and future of MAHA, the Make America Healthy Again movement. I was joined by opinion science writer David Wallace Wells and columnist Trese McMillan. We discussed how Robert F. Kennedy Jr. is reshaping our healthcare system, our preparedness for future pandemics, and what vision, if any, Democrats have for what public health should look like for the nation. Thank you. All right, so to start, I thought we would talk about what MAHA is because it can sometimes be a little hard to define. Is it a grassroots movement with real political power? Is it branding for RFK Jr.? I'm curious how you guys think about what MAHA is and what influence it has or doesn't have.

Trese McMillan: Maybe Trusty. Okay. Sure. Let's start. Sure. Okay. I think the the easy answer is yes to everything that you just listed. I think much like the MAGA movement overall, what you've got is a sort of uneasy alliance of a lot of populist groups with a sprinkling of performative political factions and I think that is exceptionally true uh with Maha because there's a much longer history there of sort of what I would call like you populist health communities, right? it's drawing heavily on like eco-fascism, whatever might be left over of a sort of libertarian environmental movement. And then you've got I don't think you can overstate the role of the emergence of like the sort of mommy blogger to health influencer pipeline. Uh so you've got all of that, but then there also I think it's worth saying I think it's kind of easy particularly because it's branded as being a femaleheavy section of manga. think it's easy to sort of pick out the low fruit of like performative politics and populism, dangerous populism in fact, but there's also a really real thread there of people who have a longstanding and I think defensible position that our health systems and our health ecology does not create the conditions for them to make good healthful choices. Now, we may disagree on what ends they then come to when they and the conclusions that they draw based on that. But I do think it's worth pointing out that there is also, I think, a real contingent of people for whom health, especially the idea of health deeply tied to concerns about the environment and climate and climate change and climate crisis is a for some people a single voting issue and some of those people I think also get lumped into MA.

Alexandra Ciferlin: David, what do you think?

David Wallace Wells: Well, I mean, you use the word branding. Um, and you know, in my less charitable moments, I think of it as a fiction because the coalition that I see, which draws on a lot of, you know, pre-existing groups, many of whom are full of great conviction and passion, don't feel to me like a natural or workable political alignment. And so I think what we've had is a sort of an opportunistic branding which has made what was maybe eternal maybe growing features of the sort of libertarian fringe in America drawing on some of the frustrations you were talking about about the food system and the failure of the healthare system to deliver what Americans want from it. presented as a political force, growing in strength, maybe even sufficient to catapult RFK Jr. to the presidency after Trump is gone. A kind of successor movement even as it's also a parallel movement to MAGA.

Alexandra Ciferlin: You sound concerned.

David Wallace Wells: Well, but I think I think I think actually if you look around today in 2026, you see how much that really was or has become a fiction has been revealed to be a fiction or at least a coalition of convenience full of contradictions which could not be sustained over the long haul. I mean you know many of the people who RFK brought in have already left um the you know HHS. um those that remain. There are those who believe that medicine has been overregulated in this country and those who believe that medicine has been underregulated in this country. There are people who believe that nothing is sufficient to license a drug unless you've got a you know rockolid randomized control trial and people who think that anecdotal evidence should allow you to you know license any new drug. Um, there are people who think that we should be able to volunteer to take part in a clinical trial. There are people who believe that the world is poisoning us. And then there are people in the administration who are literally poisoning themselves with off label supplements and meds. And all of this to me suggests, you know, some basic fragmentation fracturing in what seemed a year or so ago to be an ascendant coalition. But on the core point, this is a movement that has been mobilized on behalf of or I should say against um what was basically settled vaccine science.

Alexandra Ciferlin: Mhm.

David Wallace Wells: That's how most of the country sees its threat as a the threat against vaccines. So I'm left thinking like we passed through this fever dream. We thought that you know the country had turned against science and against public health and against vaccines in the aftermath of the pandemic. For some people that was true but to the extent that we believe that it was this mass movement that was laying a claim on the future you know on the American political future I just it doesn't seem to bearing out.

Alexandra Ciferlin: Interesting. So just to stick with that vaccine point a little bit because it is a little hard to make sense of what's happening. there's a lot of conflicting threads. So, we have rising vaccine skepticism. At the same time, we have and we have pockets of measles outbreaks happening in places where they weren't before. But, as David points out, most Americans are still, the vast majority of Americans are still vaccinating their children. A lot of Kennedy's specific vaccine policies are really unpopular. So, it does raise this question. Is what we're seeing just a sort of social contagion that's actually just going to be a bit of a blip or is it the beginning of something potentially really dangerous?

Trese McMillan: I'm afraid this is going to be a thing, but I think it it's possible that it's a bit of both. I agree with David that part of what we saw was a um a mobilization of a message and not necessarily a political mobilization. And I think especially early on in sort of Trump's rise to power, I think those of us who are just not used to politicians being particularly popular, uh, we were a little slow to realize that there was a difference between a person garnering a lot of attention and someone actually being able to mobilize people. And I'm not exactly sure and I don't think that we have any strong evidence uh that everybody who selfidentifies as Maha even if they say they voted that they voted necessarily because of Trump or because of RFK, right? I think the more likely outcome is that you probably have a lot of disaffected voters, right? Uh but that doesn't necessarily mean that they could be mobilized. I'm not even entirely sure that Trump has ever tried to actually mobilize them in any significant way. Now they do however have an infrastructure to drive a lot of attention a lot of media narrative right which I think gave us yes the impression especially coming out of co which was just it's hard to at this point to overstate the shock that was I think to our public consciousness and if you've got any narrative coming out of that that helps you make sense of something that for a lot of people it was just very difficult to make sense of um especially during a moment of when we you start to see the sort of fracturing of institutions that had really just kind of atrophied, you know, after decades of either disinvestment or, you know, institutions that people just never really had to think about before. The CDC, I think, being a very good example of that. I think it was easy to mistake the clarity of the message that, you know, that conspiratorial here's what they don't want you to know. And I think if there was anything that's kind of holding that group together, it is that underlying I'm unsure about what is happening. There is a lot of change. There's a lot of un there are a lot of unknowns. There is declining trust in our institutions. And what we know from just about every conspiracy that has ever sort of captured the public imagination is that that will solve that problem for people uh for a lot of people if you tell them this is what they don't want you to know. uh there are a lot of people then were able to use that to leverage again attention and I think political proximity uh in some cases but that is not a very good framing for turning things into actual policy which is one of the reasons why I think we see pretty ineffective or chaotic policym based on Maha's agenda to the extent that they have a single agenda to David's point a lot of it is very contradictory but that's the thing about conspiratorial thinking it is inherently contradictory it is not a very good framework from which to come to consensus which is what you need to move policy along. So the people exist. I'm not sure that it is a coherent political group and even if it were because one of the things the main thing that adheres that group is thinking that someone is out to get them. Perversely solving their problem politically just lowers their trust in the political system is not a very good mechanism for someone who wants to organize people and turn it into a political organization. I think the biggest lesson however from this is that the problem remains that there are a lot of people for whom the health care system or healthful choices or living in a healthy environment is either inaccessible or unaffordable and more so than whether or not the Republicans can kind of hold the Maha Coalition together to me is the question of who is competing for that voter for whom that matters right do we have a competing vision on the other side and as of yet we don't really have a clear one and I think that's more of a a longstanding political problem than whether or not, you know, people have faith in RFK Jr. to help them live forever.

Alexandra Ciferlin: Yeah.

David Wallace Wells: I mean, taking seriously this as a social question, um, I would throw a few other ingredients into the mix with a sort of longer view. One is that I think it's really important when we talk about vaccine hesitancy and the decline of vaccination rates just to think about the fact that we no longer deal with infectious disease and we haven't for depending on how you want to count 60 70 80 years which means there are very few people around who have meaningful memories about what it was like to have to deal with those diseases and that therefore have a real appreciation for the benefits of vaccination. I think a lot of people talk about, you know, once the World War II generation died, people stopped worrying enough about World War II and it may bring us there. There's something similar happening with vaccines that people who grew up in a world with vaccination and much more limited disease spread can take for granted the basic safety of the world around them, can think to themselves, it's relatively safe for me not to vaccinate my child because around me I don't see any of this disease. And that forgetting I think is a really big part of this story. I think it also helps put us in mind that this is um while there are partisan veillances to this social movement and over the last few years they've been channeled in one particular partisan direction,

David Wallace Wells: a lot of these sentiments are kind of pre-political. Yeah.

David Wallace Wells: And exist in populations across the spectrum. Yeah. Um, it's, you know, a kind of a cliche to talk about the, you know, the left-wing vaccine skeptic, but those people have been there for a long time. In fact, RFK was one of those people not very long ago. Um, but it's also the case that even those who are relatively more conservative are not necessarily engaging with this set of questions through their politics directly. So when you think about the measles outbreak in Texas last year or the one in South Carolina this year, both of those outbreaks were in religious communities.

David Wallace Wells: Let's say religion plays a significant huge part. But of course, even those two communities responded really differently. In Texas, there was not a large, you know, the community as a whole did not decide to get vaccinated on mass in response to the measles outbreak, even though it resulted in a tragic death. in South Carolina actually they did take a turn and do much more to get vaccinated and that has to do with the very particular backgrounds of those communities the people who are there who why they were saying no which is all just to say that this is an incredibly complex terrain in which most people probably have some amount of some felt affinity for the stated causes of maja if you say like do you want our kids to be healthy do you want to end chronic illness do you want people to eat healthier who's going to say no to all that um the question is how those sentiments which are kind of pre-political get appropriated and channeled into politics and yeah I mean I don't I don't think that the last few years are going to be that satisfying to many people and I don't think when they're tallying up like this the wins and the defeats a few years from now they're going to feel like their side you know changed the world.

Alexandra Ciferlin: Yeah. Yeah.

David Wallace Wells: Agreed. I guess you know this raises this question about like has MA emerged from a genuine institutional failure or has it emerged from kind of a perception of institutional failure that's been sort of propagated by Trese you mentioned some of these like wellness influencers or people who kind of have an axe to grind you mentioned like the fiction I mean how much of this is is real and has tapped into something that a lot of Americans have felt and how much of it is like this is kind of our our backlash mechanism for

Trese McMillan: Yeah. Yeah. So, I think, you know, I've been reading a lot lately about the the trying to get my arms around understanding uh whether or not this era of populism has anything distinct to it, right? You can't overstate the role of how mass communication has changed, for example. Uh the availability of information and of misinformation that seems to be distinct. And I suspect both of those things are playing into this issue which is there is the you know there is this pre-existing populism to David's point which you you come in any moment in time when there is yawning economic insecurity and uncertainty about the future you tend to see a populist response however that is in response against real changes in people's material conditions yes my healthcare costs too much yes they keep dropping the medication I need right. Yes, it is harder and harder to get a primary care physician. Yes, somehow it seems easier to get a medical aesthetics than to get life-saving care in a lot of communities. Yes, there are rural and urban health divides. Like those things are real material conditions um that show up in people's lives. But that doesn't necessarily mean that that is what is driving the populist response in this moment in time. I think that it can be a real vein of concern, but to David's point is that doesn't necessarily explain how people get mobilized through this, you know, larger concept of whether or not I am proTrump or I'm a Republican or I'm a Democrat. How it gets funneled into our sort of pre-existing partisan divides. I think to understand that, you've got to understand how this populism is a bit different. And I think it is because it is mixing two things. people who are having real material insecurities and then people who just perceive that they are having real material um consequences, right? And when those things get conflated, you've got both a consequence I think sort of like this disease of privilege of never having had to deal with uh a health threat or really any threat that is larger than you, which is part of what people were responding to during co was a great equalizer. Everybody was vulnerable. For some people, being vulnerable was a new experience.

Trese McMillan: And the perception of that certainly made some people feel like their material conditions had changed. But that does not mean that they had the same risk and the same vulnerabilities of people who, for example, are living with decades of environmental toxins in their communities, right? Or communities that don't have clean water. But for a moment in time, if there is enough anxiety, if there's a big enough external shock, which arguably I think co was, I think it can give a sense of a greater populist movement than what is actually true on the ground. So yes, I think there's like a real thing, but Maha doesn't respond to that, right? Uh what you don't see are a lot of uh systemic responses or even arguments for those. In fact, that tends to be antithetical to the belief. What you see is a lot of doubling down on individual choice.

Trese McMillan: which suggests to me that it is more about people wanting to sort of you know manage their individual risk and again that's just going to be a really difficult thing to do uh with policy and that's even assuming that that is what you know RFK Jr. and a Donald Trump are interested in doing and so far they have not shown that they're interested in actually solving a material problem or really a perceived problem either. I mean I think that that focus on individual risk is really important and it is the main one of the main ways that MA has organized its um itself especially in the aftermath of co and I think it's really destructive. I think that there's a huge amount that we miss and fail to you know ways that we fail to protect one another if we reduce all of public health and human flourishing to matters of individual choice. And I think the pandemic itself actually illustrates that very

David Wallace Wells: neatly. And you know I think here we are six years after the pandemic. Um there is still some lingering resentment especially it seems among the people whom Trump has appointed to run the country's public health systems. Um, but I think what's really interesting is that when you look a little bit more deeply in the data, it doesn't really seem to me that there's so much widespread anger and resentment and frustration about the ways that we burdened one another and protected one another during the pandemic itself. In in survey after survey, when you ask people, do they agree even in retrospect, do they agree with the mitigation measures that were implemented? Do they agree with mask mandates? Do they agree with school closures? There are some people who say no, but you're talking about 70 to 80% of the country saying that they supported the policies that were implemented at the time. And that is just so divergent from the messaging not just that we get from HHS and RFK and Donald Trump, but honestly from, you know, establishment liberals too, who say that we we really bungled this pandemic, we mismanaged it, we alienated the trust of the public.

David Wallace Wells: And I'm not entirely sure that that's really true.

Alexandra Ciferlin: Yeah. And

David Wallace Wells: I think it's a great point.

David Wallace Wells: What worries me most about it is it's it makes me wonder what does it mean if we have a change of the page, we have a change of political leadership. What are the leaders on the other side going to be thinking about public health? Are they going to be thinking we need to rebuild the value of solidarity? Or are they going to be thinking we need to learn the lessons of the pandemic by which they mean that we overreached and went too far and need to be lighter touch in our messaging. And I I sort of worry that we're heading we're going to head down that second path.

Alexandra Ciferlin: Yeah. I mean it's interesting this sort of the way that this idea about public health as this important collective endeavor has kind of feels like it's gone away though I don't know maybe not but this very individual health focus it seems to have evolved beyond a response to COVID to now this sort of obsession with you Trese you've written about personal health the kind of aesthetics of health where do you think that's coming from now is it still related to co or is it kind of evolving into something else?

Trese McMillan: I think the easiest way to answer I think there are a couple things happening but I think the most macro trend in all of the data that you see about people's you know shifting political position visav health decisions really the biggest answer there is that gender matters a lot there's this wonderful sociological data that followed women uh particularly mothers across COVID and like a couple of years after and one of the things I found fascinating in this was that a lot of what we would think of as vaccine hesitancy among moms that, you know, if you just ask them on a survey whether or not they had questions about vaccines, you would say, "Oh, they're vaccine hesitant, but then they're, you know, they're liberal or they're well educated and, you know, then you'd have these questions and it would make it seem like, right, that there was this sort of like growing anxiety about vaccines." But when you did the qualitative analysis and you followed up with them, what you found was that they felt increasingly responsible for their children's health in every way imaginable and wholly unprepared to manage it. If my child has autism, nobody's blaming the father, right? Why didn't I do X? Right? And that a lot of what you were seeing was an undue amount of expectation specifically on motherhood to manage the fracturing of our health care system and women who were educated enough to know what they didn't know trying to ask questions in a system that is not set up to treat women seriously.

Trese McMillan: And so in that conundrum, it looked like you were vaccine hesitant when in fact it was just that you were never supposed to be managing the vaccine schedule or the biological future of your children, right? That this was never supposed to be an individual endeavor. I think that that has probably impacted women's understanding of helping something that they are personally morally responsible for. And then you add on to that all of the status benefits of uh looking healthful, of looking like you are making the right moral health choices for yourself and for your family. And then we do what it is we always do, which then an economy appears to help you solve that problem, right? It's not enough to be healthy. You have to look healthy. And then it's not enough to look healthy. You have to look like you're trying to be healthier. And then you need to have really healthy children who also care about health. and that they also look healthy, right? And again, these are not things that by and large we are asking of men, right? We are asking this mostly of mothers. And I think that then becomes a thread through how all of our medical decisions then become to be understood not just as individual consumer choices, but individual responsibility, right?

David Wallace Wells: I mean, not all only all that, you also have to sell something to your audience.

Trese McMillan: That's right.

David Wallace Wells: So that they can live as beautifully.

Trese McMillan: That's exactly it. Yes. Don't forget that part.

David Wallace Wells: But there is, as you mentioned earlier also, there is the the male side of it, right? So you were just talking, I think quite beautifully and profoundly about um the the way that pressures on women through this period have produced some of this pathology, this social pathology.

David Wallace Wells: On the male side, I think it's really quite clear. It's like these people are playing a game of social Darwinism.

David Wallace Wells: They do not care for the weak.

David Wallace Wells: Y they're happy to see the weak die. M

David Wallace Wells: and then when you look at the the genuine avatars of Maha on the you know the male avatars it is not about looking healthy.

David Wallace Wells: It's looking like

Alexandra Ciferlin: what is that look?

David Wallace Wells: It's I mean it's professional wrestling right? Um and I mean truly it is like I sort of made a crack about it earlier but the fact that like RFK Jr. puts himself forward as an icon of health. Have you seen a photo of him at 40? He does not look like that. He did not look like that 30 years ago. He has completely remade his body in ways that strike me as like quite off-putting. But the I mean if you just see him in like jeans in a hot tub even more so.

Alexandra Ciferlin: I actually have forgotten that image and I don't appreciate being reminded. Yeah.

David Wallace Wells: But he's also I mean you know I don't want to like rag too much. It's like he can't even lift that much weight. It just looks like really huge. Um,

Trese McMillan: I actually think we should say that more. I am in favor.

David Wallace Wells: But but you know the the story that's being told by his body and by the body of many men like him is not about fitness even.

David Wallace Wells: It's about um monstrousness.

David Wallace Wells: Like these people are meant to be threatening. They are meant to be intimidating. And that is a aesthetic value that has grown much more powerful over the last decade as I think in the Trump era the rightwing has gotten much more explicitly acquisitive competitive unapologetic about its claims on the rest of the world any resources etc. It's a very very dog eat dog worldview. And the way that that descends on the individual is to coach them to be warriors in a time of, you know, they would say like whatever, soy boys.

Alexandra Ciferlin: Yeah.

David Wallace Wells: Yeah.

Trese McMillan: Yeah. I just read about, you know, RFK Jr. wanting to create a men's health division as if you know the majority of medical science had not been developed for the health and well-being of men but by which he meant it was to make testosterone more freely available right to to David's point that this very limited narrow view of male health is just performative aesthetics of I love this of monstrosity um whereas I think it is very different what might be h what is happening on the other side with women and we conflate the two I think in a way that hides what I think might be the most strident fissure of the maja movement which is that one may be going about you know managing their health risk in a way that is not pro-social but the other is quite actively trying to destroy the idea of social in its performance of health and along the way are making it virtually impossible for the women of their own of their own camp to do what it is they're charged to do uh to perform motherhood effectively and to my mind it's a coalition that cannot hold but it's also a coalition that they are not very devoted to either. I don't think that the men of Maha are very devoted to the female faction.

David Wallace Wells: Well, one way of combining them would just be to say that's patriarchy.

Trese McMillan: Yes.

David Wallace Wells: I mean the men are supposed to be warriors and the women are supposed to be beautiful, eternal, youthful wives. Mhm.

Alexandra Ciferlin: You know, you you talked about the things like testosterone and, you know, the things that Kennedy is personally into. I was hoping you could help me make sense of this sort of push back against more established medications and treatments like vaccines and this embrace of unregulated substances like peptides that people are buying online from places like China. They don't really know what's in them, but they're willing to inject themselves with um

Trese McMillan: Yeah.

David Wallace Wells: We can't buy EVs from China, but we'll buy market peptides.

Alexandra Ciferlin: Yeah. What is going on?

Trese McMillan: I mean, I think of it as the merger of like what I call everyday eugenics, which is this idea that you can kind of retroactively self- select your genetic uh superiority. Um, and then just the nihilism of where I think individual choice will lead a person, right? That there is something inherently superior about me choosing to do it that overrides all of the unknowns, that overrides all of the risk. That the real problem a lot of people have, I think in particular men have with a vaccine schedule is that it was decided by someone else. it is a locus of external control and that no but if I choose the peptide right then it is obviously superior despite the fact so again it is flattering uh to one's sense of self as being able to make complex scientific decisions you know there were these wonderful studies about people you know they talk about you know I do my own research of which my listen people I love are among those groups of people I won't name them but hello mother you know who are very proud of having done their own research right and But then you get down to them of what was their research process, right? And of course they don't mean what we mean by the scientific method and debate and falsifiability and etc. They mean they read lots of things but it is very flattering to one's sense of self I think especially if you feel like you don't have a lot of control to think that if you just read enough right if you read a summary of those complicated studies that you can draw meaningful inferences that are not much different from a scientist or a medical doctor. And then so you add that to I think the egotism of looking smarter, having the superior genes and the superior physical uh strength or power or looks maxing or whatever it is at any given point in time. And then you go, well, yeah, I I did my research and I chose the peptide.

David Wallace Wells: I agree with all that. A couple small things I would add. One is that um I think one thing that people find offensive about vaccines, but also anything that you'd compare them to, is that everybody gets the same one.

Trese McMillan: That's right. It's the DMV principle.

David Wallace Wells: You are equal before the vaccine.

Trese McMillan: That's right.

David Wallace Wells: And if this the principle of equality offends you,

Trese McMillan: Yep.

David Wallace Wells: you will rebel. Mhm.

David Wallace Wells: And I think that is one big part of what has happened here is everybody wants a personal advantage because they can't tolerate being told that they are just like everybody else,

David Wallace Wells: vulnerable like everybody else and only entitled to the same protection as everybody else, not more.

David Wallace Wells: It's also the case that we're not just seeing individuals striking out on their own. We're seeing them withdraw trust from one set of people and then extend them to another set of people.

David Wallace Wells: If you think about what like the wellness influencer universe is, that's not a map of distrust.

David Wallace Wells: It's just a map of distrust to people who work at the New York Times. It's not, you know, it's like people trust Andrew Huberman like quite a lot. Y

David Wallace Wells: um and so much that they're willing to take drugs that are not approved by any regulatory body, but they're willing to forego all of that, overlook all of that because they trust the person who sent them there. And so I think we sometimes get into a little bit of a tangle when we talk about this question in terms of the decline of trust when in fact what we're really seeing is something more like trust transference and um that may be in certain ways scarier because it's not just about drawing individuals back into the fold. They are already allied with a whole new knowledge system which operates according to a completely different set of principles which is to say often like entrepreneurial principles. Yeah, I was. Yeah. And when you start talking about them, we've talked about this uh before, but when you start talking about withdrawing trust and transferring it to another entity, what you're talking about is a market. And what is fundamentally beneath wellness influencers, I think in particular, is that you don't solve people's problems. You create a new market for them. Right? Well, that market is not just competing with the other wellness influencers. It is also competing with the CDC. Right? I think it's important to keep in mind that what is being done here is for most people it's being done for profit. That means there is no profit in solving the problem and saying well the CDC has figured it out right we got this great vaccine schedule or this is how we address high blood pressure or hey everybody doesn't need a testosterone shot right that forecloses on a market right so yes not just the moving the trust from one to the other it is doing it to maximize whether it's attention or it is profit seeking and these days they are roughly the same yes I wanted to talk just a little bit about Robert F Kennedy Jr. You're the man.

Alexandra Ciferlin: Oh,

David Wallace Wells: the myth.

Alexandra Ciferlin: The lynch.

Alexandra Ciferlin: Just I'm curious if you guys think of him as sort of a true believer in his causes or as more of a sort of politically or otherwise motivated figure. What do you think?

David Wallace Wells: You know, I guess I I I think that um if he really believed that vaccines in particular were as damaging as he was saying three and six and 8 years ago before he was really in public life. If you really believe that they were as damaging as he was saying then and he was put in a position of this centrality and power and only did as much as he has done to diminish our faith in vaccines and attack the vaccine schedule that would be a huge failure for him.

David Wallace Wells: And so I think the fact that he has accommodated himself to this political moment, navigated the landscape and solved the contradiction, the contradiction being he believes vaccines are bad, the country believes vaccines are good. The fact that he has solved that contradiction by vaguely raising doubts, suppressing vaccine uptake by a couple of percentage points, that to me suggests someone who is more a grifter than a true believer. Yeah,

Trese McMillan: I do think he believes in his core that institutions are corrupt, elites are paid off, and big pharma and big a don't have the interests of Americans in their heart. I I think he believes that, but I believe that.

David Wallace Wells: I mean, it's not a it's not a weird set of things to believe. The thing that I don't believe is that, you know, vaccines cause autism and um, you know, we shouldn't be giving he B vaccines to children. Those are the like those are the things that he purports to believe. But if he really believed them and had only achieved as much as he had achieved, he'd have to be, you know, shrinking from DC as a miserable failure rather than someone who's trying to hold together a shape-shifting coalition with every ounce of political, you know, capacity that he has.

Trese McMillan: Yeah, I I think I think all of it and all of them are scam artists and I mean I was looking for an exception and I don't have many and I also like I I tend to you know I've got this like ontological position on whether or not I you know I don't know does it I don't know if I care so much about what he believes in because should he have stayed just you know RFK Jr. if he had done whatever it is the Kennedy thing is you're responsible for doing meaning a quasi private person with a public family institution behind him and believed whatever he wanted and I might think it's somewhat interesting to try to figure out whether or not he really believes it at the moment he becomes however a political actor and his decisions impact other people's ability to make good decisions for themselves right then I think the only thing that matters is what has he been willing to do? And what he has been willing to do is to further ideas, questions, doubts that fundamentally make us weaker and more vulnerable and some of us sicker and more likely to die. I don't even really care too much about what he actually believes because the stakes of that try more seriously are so high that even if he were a true believer, it would make him more monstrous, not less. And so, yeah, I but I tend to just think it's mostly a scam artist.

David Wallace Wells: One more thing I add just quickly about him and his character and his, you know, public character is I think a lot about how different the world we'd be living in right now and how different this conversation would be on stage tonight if Trump had made RFK Jr. the head of the EPA. Uhhuh. Yeah. Or even the head of the FDA. Mhm. Um or the head of the Department of Agriculture.

Trese McMillan: Uhhuh. Yeah.

David Wallace Wells: Yeah. Those would have been causes in which he had conspiratorial views. He has, you know, I think non-scientific perspectives, but his instincts are more in line with science and much more in line with public opinion. And so it wouldn't have been nearly as politically difficult for him to, at least on the public side of things, achieve real concrete gains that he might have been celebrated for. Instead, Trump made the opposite choice and put him in a kind of impossible situation, trusting that that Bobby could navigate his way out of it. And I think the ultimate, as always, like Trump like miscalculated, made a short-term decision that he thought would benefit him and it's coming at a long-term cost to his own political popularity.

Alexandra Ciferlin: So, there's been a lot of attention paid to the the HANA virus outbreak. And while there's a lot of uncertainty, and I'm not saying it's going to be a huge a huge thing, it is raising this question, I think, of what might happen should Kennedy be in a position where he does actually have to lead the country through something like a serious pandemic or some kind of novel novel virus. And I'm curious uh if this is keeping you up at night.

David Wallace Wells: I mean, I think um I should say as like a a first note that I don't think that the HANA virus is likely to take off in the ways that have animated our nightmares since co. There are too many reasons to think that it will be spreading too slowly for anything like a global takeover to happen. So, what we're dealing with is a public health threat of a distinctly smaller scale. um which is nevertheless quite scary because the strain that we're dealing with kills somewhere between 30 and 40% of those people who are infected and because at no point along the timeline of the last month has any public official public health official whether in America or internationally I think really done a very good job of communicating about the risk or building a sort of set of protocols or infrastructure that would allow us to really contain it. I think we're in a really bad spot there. I don't think that we have control over this disease, I think it's likely to continue spreading and ultimately killing more people and that those infections and those deaths were avoidable. the degree to which that's an international problem or an American problem. I think there's a lot of blame to go around. I don't think the WHO has handled itself very well here. But I will say that we are as a country

David Wallace Wells: staring this down so ill equipped. I mean literally the cabinet literally like the health cabinet is bare. Marty Mockery just quit today. There's no head of the CDC. There's there's no head of the FDA.

David Wallace Wells: Been done to the CDC. I mean alone. thousands of people fired. I mean, it's completely, you know, and the person who's nominally in charge of the American public health response is actually not RFK really. He's not really been paying much attention. It's Jay Bodacharia, um, who's the head of the NIH and technically the acting director of the CDC. And this is a man who last fall wrote an essay in the city journal in which he said that the United States should scrap its pandemic playbook because the best pandemic preparedness was to make America healthy again.

David Wallace Wells: Now, I would like to see Americans cut their BMI. I would like to see us have less chronic disease, but that is not the job of the NIH or the CDC or HHS in the face of the new virus. And I don't think any of these people take their role seriously because again they think of the world in social Darwinist eugenesis

David Wallace Wells: terms will survive. That's right. Yeah. Yeah.

David Wallace Wells: Now I don't think that means that any of these people want to see 10 million Americans die.

David Wallace Wells: But I also don't think that they care that much if a few more people die that didn't need to die. If the logic of that was that they were allowing more able-bodied people to move around more freely and unencumbered,

David Wallace Wells: these are people who take that deal after generations of public health officials would have insisted on the opposite deal. And that's not comforting in the least.

Trese McMillan: Yeah. When you think about what has happened at the CDC, which I do think about uh quite a lot, it's not just, you know, the pushing out of the head of the CDC. It is what has happened to like the two tiers of scientists and institutional knowledge below the sort of executive level and how that has been gutted in the same way you see other you know government uh institutions gutted in the same way. But in science because science is so path dependent right and it is so cumulative that when you lose that you're not just losing um you know sort of like basic you know human power labor power you really are losing sort of the consensus upon which science has a system to refine. And what those scientists will tell you many of whom have become for the first time in their professional lives advocates or think of themselves now as having to be far more radical than they'd ever thought they would have to be. What they would tell you is that it is not a matter of if we will have another pandemic event. It is a matter of when. Right? And so the question becomes what is our risk tolerance politically for having people who do not only who not only don't believe in the science but don't believe in the institutional production of any sort of public knowledge, right? But also have an overinflated sense of themselves, belief in themselves, right? What does it mean then to face down that risk? And I my risk tolerance for that is quite low. I think there are some other people who again who think that they can sort of navigate through you know individual choices. I'm healthy. I won't have these problems. Um, and I think though that if you ask most Americans more soberly, like when you're when we are facing uh which may or may not be the next uh pandemic event, but something that could be, and when they're actually thinking about what's really possible and probable, I think their sense of risk changes. And I think that becomes potentially a political problem uh for this administration. the the difference between imagined risk and real risk has a way of clarifying some people's own susceptibility to risk. Um but that is not the way you want to do a political means test. And to David's point, it's not just that people will be sick and people will die. It is the sheer possibility of the scale of which that might happen. But I worry that that is the sort of political means test it might take.

Alexandra Ciferlin: Totally. So, we have some great reader questions, but I just had one more future-looking question that I know was of interest to both of you, too. Is so what should be the response from the other side, from Democrats to all of this? What does a Democratic public health vision look like, let's say, in 2028 potentially?

Trese McMillan: That's a great question. You want to go first? Uh I think it is part and parcel of sort of the larger project that the dem and listen I really resist this thing where you know tell the Democratic party what it needs to do. Um it's not my job. Uh and also I'm not particularly sure they're interested in what I think they should do. However said that I think that you know our concerns about our health system are part of our larger set of concerns which is I think David said as well you either believe in a social compact or you do not. And as a party, you need to lay out a clear vision of listen, the other side thinks that, which it took the Democrats quite a while to even, I think, come to consensus about how to talk about what was happening in the Republican party and they've roughly settled on sort of a consensus, right? Um, you know, they've decided to throw the fbomb once in a while or something. I don't know. But, uh, but what what you don't see is a more affirmative, coherent argument about what they do believe in. And I think the issue of health is just an example of that more broadly. Like is this still the party that believes in public administration or not? And how much do they think we should have? Is this an administration that believes that, you know, economic security is kind of part of government's responsibility as citizens? And if so, how are they going to enact that? Right? I think that they're still kind of trapped in the cycle of trying to accurately describe what Trumpism is. And as it comes down to health, you know, they've got a narrative about the Democratic, you know, the sort of big uh most recent big legislative win of course is, you know, Obamacare and which they're not all equally comfortable running on, but it is a set of benefits that most Americans have become comfortable with having and it means something to them and it's a particular um you know has the possibility be a political wedge issue. But like I'm I'm stunned that they have not drawn a sort of bigger story of that about health, right? Like it's not just that you have access to the Affordable Care Act, but like we want to make it possible for you to make a range of good healthy choices. Uh you know, there's some, you know, on the fringes, you know, Sanders talks about it. Cory Booker recently was talking about organic food and vegetable, that kind of thing. Uh but that no, the Democratic party right now does not have a clear vision on that. does not seem to be competing for voters for whom that is a concern. And I think there are a couple reasons for that. You know, some of them are still smarting about what happened to Michelle Obama when she tried to, you know, lead on school lunches and that kind of thing. But I also think there's this sense that the other side is bungling it so bad and why get in the way of your enemies shooting themselves in the foot. And that maybe that is good politics, but it is not a good narrative for how why we should trust you to lead us out of this era of political dysfunction.

David Wallace Wells: Yeah. Like Trusty, I see this as part of a bigger dilemma for Democratic politicians. I also see this as, you know, the war on public health is a war on the social safety net. Um, many of these measures that have been drawn back are things that were extended to protect the most vulnerable in society and they've been withdrawn. But looking beyond health, I see a party that seems comfortable to wait for the Trump administration to self- emilate, right?

David Wallace Wells: And I see the challenges ahead looming quite large. So yeah, I'm worried that a democratic public health administration will be divided as I was saying earlier between those who basically want to restore faith in public health and the principle extend the principle of health solidarity and those who want to retreat from those principles in order to demonstrate that they learned some lessons and they heard some um criticism during co I see that on foreign policy. You know, the Democrats are very happy right now criticizing Trump's foreign policy, but like what is the postTrump Democratic vision for America's role in the world? I think it's extremely open-ended and you see people who are very hawkish even in the Biden administration now singing an extremely dovish tune. Um, I don't know if there's a possibility out there that a future Democratic president could even try to regain the world stage the way that Biden tried to regain the Obama position when he came in in 2021.

David Wallace Wells: And I see that, you know, in domestic policy and fiscal policy. Do I really think that the Democratic Party is capable of raising money via taxes sufficient to actually deliver services to their voters and and the country as a whole? It seems quite hard. um they seem like they really want to just raise taxes on the very rich and there's a kind of justice argument to that. But I'm not sure that the party's actually serious about doing what it needs to do to deliver meaningful victories there. And on that point, I think I'm, you know, sort of inspired by the model of our mayor here, Zoran Amdani, who um has really taken Yeah. Please plug.

Alexandra Ciferlin: Yeah.

David Wallace Wells: um you know um I'm not here to make a you know a personal endorsement but I think really inspiring in the sense that he is an ideological actor who nevertheless takes extremely seriously the need to do the job well and demonstrate that the system itself works for people and seems actually much more than was apparent even during the campaign to believe that that's the first job of of governance is to demonstrate attentiveness to the needs of the people and that once you've established that trust, you can go further and make ideological gains. Um, at the moment, it seems to me like there are few leaders at the national level and the Democratic party who are thinking in those terms and to the extent that they are, their impulses run against one another. And so, I don't know where we're going to end up, although I I do think we're going to end up with a Democratic president in 2029.

Alexandra Ciferlin: Okay. Um, all right. I think we have time for some reader questions.

Alexandra Ciferlin: How do we productively respond to mistrust of corporations like in agriculture food producers within MAHA? How can we question what we're being sold while rebuilding social trust? Mhm.

Trese McMillan: If I understand the question correctly, and I may not, but I think what we're what you're asking for there is meaningful regulation and meaning, you know, how do we regulate the corporations that are charged with the manufacturing and distribution of most of our sort of meaningful resources or things like food. One of the problems we have is that we're in an era where people are questioning whether or not regulation is sufficiently muscular enough to do that job. And we're also doing that after like, you know, 40 years of just sort of like actively chipping away at some regulations. Some people would say, and then and then actively making it more complex, others would say, depending on what industry you're talking about. But I think what people are really responding to there isn't necessarily the degree of regulation, but the transparency of the regulation. And I think one of the issues that we have is that when so much is provided by the private sector, there is not a meaningful feedback loop for people to respond to what's you know being done and to feel like they understand what is being done. And so I think one of the things that people are really asking for when they talk when we talk about regulation whether they think it's too much or too little I think we confuse that with public accountability, right? Um I was just recently uh speaking with someone about like how we bring the the sense of accountability and the public feedback loop to things like uh labor policy for example and she you know had come up that's how she cut a professional teeth and she was talking about ways that she tried to do that at the federal and the state level and how hard it was. She said, "Yeah, it was hard." She was like, "But when we got it right, people's trust in the system was off the charts." And to your point about Mamani and when you develop trust in one area, you were able to translate it into another area. It is hard work. I think it's going to be even harder with the way that so many of our institutions have atrophied. But I think it is fundamentally what people are asking for, which is public accountability. It can be done. People are going to have to demand it and a lot of political forces are going to have to align. Um, but yeah, I think that's the way forward.

Alexandra Ciferlin: Last question. I think this could go to either of you. Is there anything RFK could do to alienate the Maha base or is any escalation, no matter how ridiculous, excused as anti-establishment heroism?

Trese McMillan: Yeah, there is a lot of anti-establishment impulse there that will drive people to follow the personality as opposed to any sort of political uh axis. However, we are already seeing some fracturing of those coalitions. You know, one of the problems that RFK has is the same problem that like Donald Trump has and I think sort of like Trumpism at large is that it is pretty effective at mobilizing people whose beliefs are transactional. It really struggles with people who truly believe. And so some of what you see for example are uh you know what moms across America who had really led this fight against like Roundup uh weed killer and feeling deeply betrayed by this administration's you know supposed interest in um health when Trump signs you know the executive order sort of defending the corporate interests uh against many in his base who are actively saying you know he has lost my support because of this um not yet seeing many of them willing to organize on the other issue. But you know being disaffected is a political choice much like voting is a political choice and I think the real possibility of that particular fissure anyway is that those were a lot of people who were mobilizing for Donald Trump at least certainly online some of them even offline and I think you can lose some of that energy when they decide that they are no longer supporting RFK Jr. And so you're already seeing some of uh that emerge. Everybody however is not a true believer, right? It becomes a problem and then the question becomes how many of them are. But for those who actually really believe RFK genius almost, you know, wholesale inability to deliver them anything other than like symbolic victories is smarting with a lot of people.

Alexandra Ciferlin: Yeah.

David Wallace Wells: Just to pick up pick up briefly on the anti-establishment point. I mean, I do think it's worth remembering that, you know, come 2028, 2029, we will have been living in Donald Trump's America effectively for at least 12 years. And there was an interim period where we had basically an invisible president, but in the kind of collective American imagination, Donald Trump has been running this country for a very long time. And there are things about Democrats picking up the mantle of anti-establishmentarianism that make me worried and make me uncomfortable. Um, I'm, you know, I'm the kind of person who works at the New York Times. I obviously have establishmentarian values, but I also think that there are some political opportunities there. And if you think on the food front, you compare the objection to Michelle Obama is making us eat healthy food. Compare that to Donald Trump's in was in bed with all the big egg companies and he's feeding us poison. One of these actually is a like a much more is a much more potent message. I don't know exactly to what degree the Democratic party as a whole will feel comfortable playing that card, but it is available at least to some members of the coalition. And I suspect that one of the things that's going to happen over the next few years is that at least some figures, if it's Graham Platner or whoever are striking that note to national effect, even if the party itself is not singing the same tune.

Alexandra Ciferlin: That's great. David and Trusty, thank you so much.

David Wallace Wells: Thank you. Thank you guys.

Trese McMillan: Thanks for the library, too.

Alexandra Ciferlin: If you like this show, follow it on YouTube, Spotify, or Apple. The Opinions is produced by Derek Arthur, Vashaka Darba, Victoria Chamberlain, and Jillian Weinberger. It's edited by Jillian Weinberger, Jasmine Romero, and Ki Pitkin. Mixing by Pat McCusker. Original music by Isaac Jones, Sonia Herrerero, Pat McCusker, Carol Sabro, Epheim Shapiro, and Aman Sota. The fact check team is Kate Sinclair, Mary Marge Locker, and Michelle Harris. The head of operations is Shannon Busta. Audience support by Christina Samuluski. The director of opinion shows is Annie Rose Stasser.