1 of the most important arms of the government for public health is the HHS (Health and Human Services). It was created in 1953 and was known originally as HEW (Health, Education, and Welfare). Its motto is “Improving the health, safety, and well-being of America”. The department is a cabinet level entity and currently headed by Robert F. Kennedy, Jr. who is trained as an attorney (interestingly only 3 of the Secretaries of HHS have been actual physicians). The author of this article does not know how much, if any, training the current Secretary has in biology, chemistry, medicine, pharmacology, physics, and so on. Based on the Secretary’s opinion that vaccines (especially the Covid 19 vaccine) are deadly, fluoride in the water is causing cancer, Wi-Fi is also harmful, and an assortment of other opinions which diametrically oppose “settled science”, one could reasonably assume that he has little or no such training. Indeed, one would have to go back to the notion that the earth resides on the back of one or more giant turtles to get to that level of scientific insight.
Nevertheless, giving the Secretary a sliver of credit, not all of his reported goals lack merit. He advocates for a bigger emphasis on routine exercise. He is reviewing dietary habits and offerings to Americans. He seems to endorse prevention of disease as opposed to chronic management of disease. His observation that big pharmaceutical companies like to have a large pool of patients with chronic diseases correctly identifies a conflict of interest with prevention, not intervention. Specifically, preventing pathological states such as chronic obstructive pulmonary disease (COPD) would cost the pharmaceutical industry billions of dollars per year. As has been said in the articles about Markovian Mambo in this magazine (June and July 2024), it is much more cost-effective to prevent disease than to manage it chronically. On these topics, the Secretary is in alignment with mainstream, evidence-based medicine.
However, amongst a number of directions the Secretary is taking HHS, one direction is to reduce harmful exposures by stopping the ingestion of artificial colorings, processed/ultra processed foods, calorically dense foods, and similar such items. Although at least some of these are plausibly unhealthy for consumption, where is the science to secure these opinions? Specifically, which of these large number of potential troublemakers should be addressed and in what order? This question is very relevant today because the road to better health is often strewn with bodies of the falsely accused. One such prominent scapegoat was saccharin which was banned in the United States 44 years ago (1981) because of its alleged tendency to promote cancer. Interestingly enough, it was later accepted that it was not cancerous but was sacrificed at the altar of expediency because of a poorly done study. Recommendations to the nation need to be based on more solid foundations. However, we seem to be well on our way toward this same type of problem again. How do we stratify risk, absent quality studies about environmental exposures, various foods, and additives?
Now, what would happen if well done studies indicated that Americans were frequently exposed not merely to suboptimal items (as listed above) but exposed to irrefutably lethal products? Put more succinctly, how would we address items which kill users? Would Secretary Kennedy do anything to stop any such deadly products? Over the years, some products have been pulled because in massive doses, rats may have developed “excess” cancers although there is no evidence to date of the same thing happening in humans (please note the discussion about saccharin above). Action is certainly merited if the science matches the reality. However, returning to the question about the clearly deadly products on the market today, would Secretary Kennedy and the HHS stop these?
The products in question, of course, all have tobacco as their main ingredients (cigarettes, cigars, and chewing tobacco).
Simply noting the lethality of tobacco use in the United States should shock us. According to the American Lung Association (2025 article regarding the State of Tobacco Control/Tobacco Facts), smoking is the number 1 preventable cause of death in the United States, killing >490,000 people yearly. Putting this on a different scale, we lose 1,342 citizens each day to tobacco-related disease. Tobacco also causes illness as well as death. Many more people per day suffer nonlethal, tobacco-related events such as strokes, heart attacks, ruptured aneurysms, gangrene requiring amputations, chronic respiratory failure requiring a lifetime of oxygen supplementation, and many other severe illnesses.
The 2 main ways (there are more) tobacco kills us are by carcinogenesis (causing cancer) and accelerated atherosclerosis (making obstructive plaque). Let’s briefly review these mechanisms.
Tobacco triggers cancer in 2 ways. First, it places radioactive particles deep within our lungs. Second, it also places cancer-causing chemicals into our lungs. Tobacco releases intrinsic radioactive polonium-210 which is then inspired (inhaled) as solid particles while smoking. It loves to accumulate at vertices where bigger air tubes split into 2 smaller tubes (bronchial bifurcations). There, it releases alpha radiation directly onto immediately adjacent lung tissue which damages its DNA. Subsequently, the damaged lung tissue degenerates into cancer. The above-described toxic chemicals stick to the inner walls of our lungs somewhat more evenly. They also damage local DNA triggering cancer. These 2 separate pathways synergize to increase their mutual lethality.
Tobacco also damages the lining of our arteries which promotes accelerated arterial plaque formation (atherosclerosis) leading to heart attacks, strokes, ruptured aneurysms, and a slew of other significant diseases. Some of plaque related events gradually present as symptoms such as chest pain on exertion or undulating weakness of an extremity. Other times, these events lead to “sudden death” without warning.
So, to summarize the above, tobacco kills about half a million Americans per year, additionally injures hundreds of thousands more yearly, while at the same time offering no benefit to the user (only addiction). The science behind this is settled, clear, and not controversial. In 1964 (over 60 years ago), the Surgeon General released his report about how deadly tobacco is. Yet, from this author’s point of view, little has been done to end the smoking pandemic in the United States.
A Secretary of HHS need not know all of the above at the start of one’s term. However, a Secretary must be open to learning new things quickly. Initial predispositions must be tempered by the influx of new information offered by seasoned scientists and physicians. Secretary Kennedy, as represented by his public statement, seems to believe he has a unique, special understanding of complicated medical issues such as vaccinations, fluoridation, “mitochondrial” diseases, and so on. However, if he were to end tobacco use in the United States, he would go down as the most effective and consequential health secretary in our Republic’s history (in spite of his currently espoused unscientific leanings). If he ignores the tobacco question entirely, he will be remembered as, unfortunately, a feckless fop rearranging deck chairs on the Titanic.
Science can be difficult but ignorance can be fatal.