health

With the rise of Robert F. Kennedy Jr., brain worms have gotten a bad rap.

A year ago, the long-time anti-vaccine advocate and current US health secretary famously told The New York Times that a parasitic worm “got into my brain and ate a portion of it and then died.” The startling revelation is now frequently referenced whenever Kennedy says something outlandish, false, or offensive—which is often. For those who have followed his anti-vaccine advocacy, it’s frightfully clear that, worm-infested or not, Kennedy’s brain is marinated in wild conspiracy theories and dangerous misinformation.

While it’s certainly possible that worm remnants could impair brain function, it remains unknown if the worm is to blame for Kennedy’s cognitive oddities. For one thing, he was also diagnosed with mercury poisoning, which can cause brain damage, too. As prominent infectious disease expert Anthony Fauci said last June in a conversation with political analyst David Axelrod: “I don’t know what’s going on in [Kennedy’s] head, but it’s not good.”

The trouble is that now that Kennedy is the country’s top health official, his warped ideas are contributing to the rise of a dystopian reality. Federal health agencies are spiraling into chaos, and critical public health services for Americans have been brutally slashed, dismantled, or knee-capped—from infectious disease responses, the lead poisoning team, and Meals on Wheels to maternal health programs and anti-smoking initiatives, just to name a few. The health of the nation is at stake; the struggle to understand what goes on in Kennedy’s head is vital.

While we may never have definitive answers on his cognitive situation, one thing is plain: Kennedy’s thoughts and actions make a lot more sense when you realize he doesn’t believe in a foundational scientific principle: germ theory.

Dueling theories

Germ theory is, of course, the 19th-century proven idea that microscopic germs—pathogenic viruses, bacteria, parasites, and fungi—cause disease. It supplanted the leading explanation of disease at the time, the miasma theory, which suggests that diseases are caused by miasma, that is, noxious mists and vapors, or simply bad air arising from decaying matter, such as corpses, sewage, or rotting vegetables. While the miasma theory was abandoned, it is credited with spurring improvements in sanitation and hygiene—which, of course, improve health because they halt the spread of germs, the cause of diseases.

Germ theory also knocks back a lesser-known idea called the terrain theory, which we’ve covered before. This is a somewhat ill-defined theory that generally suggests diseases stem from imbalances in the internal “terrain” of the body, such as malnutrition or the presence of toxic substances. The theory is linked to ideas by French scientist Antoine Béchamp and French physiologist Claude Bernard.

Béchamp, considered a bitter crank and rival to famed French microbiologist Louis Pasteur, is perhaps best known for wrongly suggesting the basic unit of organisms is not the cell, but nonexistent microanatomical elements he called “microzyma.” While the idea was largely ignored by the scientific community, Béchamp suggested that disruptions to microzyma are a predisposition to disease, as is the state of the body’s “terrain.” French physiologist Claude Bernard, meanwhile, came up with an idea of balance or stability of the body’s internal environment (milieu intérieur), which was a precursor to the concept of homeostasis. Ideas from the two figures came together to create an ideology that has been enthusiastically adopted by modern-day germ theory denialists, including Kennedy.

It’s important to note here that our understanding of Kennedy’s disbelief in germ theory isn’t based on speculation or deduction; it’s based on Kennedy’s own words. He wrote an entire section on it in his 2021 book vilifying Fauci, titled The Real Anthony Fauci. The section is titled “Miasma vs. Germ Theory,” in the chapter “The White Man’s Burden.”

But, we did reach out to Health and Human Services to ask how Kennedy’s disbelief in germ theory influences his policy decisions. HHS did not respond.

Kennedy’s beliefs

In the chapter, Kennedy promotes the “miasma theory” but gets the definition completely wrong. Instead of actual miasma theory, he describes something more like terrain theory. He writes: “‘Miasma theory’ emphasizes preventing disease by fortifying the immune system through nutrition and by reducing exposures to environmental toxins and stresses.”

Kennedy contrasts his erroneous take on miasma theory with germ theory, which he derides as a tool of the pharmaceutical industry and pushy scientists to justify selling modern medicines. The abandonment of miasma theory, Kennedy bemoans, realigned health and medical institutions to “the pharmaceutical paradigm that emphasized targeting particular germs with specific drugs rather than fortifying the immune system through healthy living, clean water, and good nutrition.”

According to Kennedy, germ theory gained popularity, not because of the undisputed evidence supporting it, but by “mimicking the traditional explanation for disease—demon possession—giving it a leg up over miasma.”

To this day, Kennedy writes, a “$1 trillion pharmaceutical industry pushing patented pills, powders, pricks, potions, and poisons, and the powerful professions of virology and vaccinology led by ‘Little Napoleon’ himself, Anthony Fauci, fortify the century-old predominance of germ theory.”

In all, the chapter provides a clear explanation of why Kennedy relentlessly attacks evidence-based medicines; vilifies the pharmaceutical industry; suggests HIV doesn’t cause AIDS and antidepressants are behind mass shootings; believes that vaccines are harmful, not protective; claims 5G wireless networks cause cancer; suggests chemicals in water are changing children’s gender identities; and is quick to promote supplements to prevent and treat diseases, such as recently recommending vitamin A for measles and falsely claiming children who die from the viral infection are malnourished.

A religious conviction

For some experts, the chapter was like a light bulb going on. “I thought ‘it now all makes sense’… I mean, it all adds up,” Paul Offit, pediatrician and infectious disease expert at Children’s Hospital of Philadelphia, told Ars Technica. It’s still astonishing, though, he added. “It’s so unbelievable, because you can’t imagine that someone who’s the head of Health and Human Services doesn’t believe that specific viruses or bacteria cause specific diseases, and that the prevention or treatment of them is lifesaving.”

Offit has a dark history with Kennedy. Around 20 years ago, Kennedy called Offit out of the blue to talk with him about vaccine safety. Offit knows a lot about it—he’s not only an expert on vaccines, he’s the co-inventor of one. The vaccine he co-developed, RotaTeq, protects against rotaviruses, which cause deadly diarrheal disease in young children and killed an estimated 500,000 people worldwide each year before vaccines were available. RotaTeq has been proven safe and effective and is credited with saving tens of thousands of lives around the world each year.

Kennedy and Offit spent about an hour talking, mostly about thimerosal, an ethylmercury-containing preservative that was once used in childhood vaccines but was mostly abandoned by 2001 as a precautionary measure. RotaTeq doesn’t and never did contain thimerosal—because it’s a live, attenuated viral vaccine, it doesn’t contain any preservatives. But Kennedy has frequently used thimerosal as a vaccine bogeyman over the years, claiming it causes harms (there is no evidence for this).

After their conversation, Kennedy published a story in Rolling Stone and Salon.com titled “Deadly Immunity,” which erroneously argued that thimerosal-containing vaccines cause autism. The article was riddled with falsehoods and misleading statements. It described Offit as “in the pocket” of the pharmaceutical industry and claimed RotaTeq was “laced” with thimerosal. Rolling Stone and Salon amended some of the article’s problems, but eventually Salon retracted it and Rolling Stone deleted it.

Looking back, Offit said he was sandbagged. “He’s a liar. He lied about who he was; he lied about what he was doing. He was just wanting to set me up,” Offit said.

Although that was the only time they had ever spoken, Kennedy has continued to disparage and malign Offit over the years. In his book dedicated to denigrating Fauci, Kennedy spends plenty of time spitting insults at Offit, calling him a “font of wild industry ballyhoo, prevarication, and outright fraud.” He also makes the wildly false claim that RotaTeq “almost certainly kills and injures more children in the United States than the rotavirus disease.”

Inconvincible

Understanding that Kennedy is a germ theory denialist and terrain theory embracer makes these attacks easier to understand—though no less abhorrent or dangerous.

“He holds these beliefs like a religious conviction,” Offit said. “There is no shaking him from that,” regardless of how much evidence there is to prove him wrong. “If you’re trying to talk him out of something that he holds with a religious conviction—that’s never going to happen. And so any time anybody disagrees with him, he goes, ‘Well, of course, they’re just in the pocket of industry; that’s why they say that.'”

There are some aspects of terrain theory that do have a basis in reality. Certainly, underlying medical conditions—which could be considered a disturbed bodily “terrain”—can make people more vulnerable to disease. And, with recent advances in understanding the microbiome, it has become clear that imbalances in the microbial communities in our gastrointestinal tracts can also predispose people to infections.

But, on the whole, the evidence against terrain theory is obvious and all around us. Terrain theorists consider disease a symptom of an unhealthy internal state, suggesting that anyone who gets sick is unhealthy and that all disease-causing germs are purely opportunistic. This is nonsense: Plenty of people fall ill while being otherwise healthy. And many germs are dedicated pathogens, with evolved, specialized virulence strategies such as toxins, and advanced defense mechanisms such as antibacterial resistance. They are not opportunists.

(There are some terrain theory devotees who do not believe in the existence of microbes at all—but Kennedy seems to accept that bacteria and viruses are real.)

Terrain theory applied

Terrain theory’s clash with reality has become painfully apparent amid Kennedy’s handling—or more accurately, mishandling—of the current measles situation in the US.

Most health experts would consider the current measles situation in the US akin to a five-alarm fire. An outbreak that began at the end of January in West Texas is now the largest and deadliest the country has seen in a quarter-century. Three people have died, including two unvaccinated young children who were otherwise healthy. The outbreak has spread to at least three other states, which also have undervaccinated communities where the virus can thrive. There’s no sign of the outbreak slowing, and the nation’s overall case count is on track to be the highest since the mid-1990s, before measles was declared eliminated in 2000. Modeling indicates the country will lose its elimination status and that measles will once again become endemic in the US.

Given the situation, one might expect a vigorous federal response—one dominated by strong and clear promotion of the highly effective, safe measles vaccine. But of course, that’s not the case.

“When those first two little girls died of measles in West Texas, he said immediately—RFK Jr.—that they were malnourished. It was the doctors that stood up and said ‘No, they had no risk factors. They were perfectly well-nourished,'” Offit points out.

Kennedy has also heavily pushed the use of vitamin A, a fat-soluble vitamin that accumulates in the body and can become toxic with large or prolonged doses. It does not prevent measles and is mainly used as supportive care for measles in low-income countries where vitamin A deficiency is common. Nevertheless, vaccine-hesitant communities in Texas have embraced it, leading to reports from doctors that they have had to treat children for vitamin A toxicity.

Poisons

Despite the raging outbreak, Kennedy spent part of last week drumming up fanfare for a rickety plan to rid American foods of artificial food dyes, which are accused of making sugary processed foods more appealing to kids, in addition to posing their own health risks. It’s part of his larger effort to improve Americans’ nutrition, a tenet of terrain theory. Though Kennedy has organized zero news briefings on the measles outbreak, he appeared at a jubilant press conference on removing the dyes.

The conference was complete with remarks from people who seem to share similar beliefs as Kennedy, including famed pseudoscience-peddler Vani Hari, aka “Food Babe,” and alternative-medicine guru and fad diet promoter Mark Hyman. Wellness mogul and special government employee Cally Meads also took to the podium to give a fury-filled speech in which he claimed that 90 percent of FDA’s spending is because we are “poisoning our children,” echoing a claim Kennedy has also made.

Kennedy, for his part, declared that “sugar is poison,” though he acknowledged that the FDA can’t ban it. While the conference was intended to celebrate the removal of artificial food dyes, he also acknowledged that there is no ban, nor forthcoming regulations, or even an agreement with food companies to remove the dyes. Kennedy instead said he simply had “an understanding” with food companies. FDA Commissioner Marty Makary explained the plan by saying: “I believe in love, and let’s start in a friendly way and see if we can do this without any statutory or regulatory changes.” Bloomberg reported the next day that food industry lobbyists said there is no agreement to remove the dyes.

However feeble the move, a focus on banning colorful cereal during a grave infectious disease outbreak makes a lot of sense if you know that Kennedy is a germ theory denialist.

But then again, there’s also the brain worm.