Anti-intellectualism runs deep in American society. The cabinet picks of the current administration reflect this sentiment, with a whole roster of appointees who have little to no expertise in the departments they are overseeing. This is nowhere more evident than with the impending confirmation of Robert F. Kennedy, Jr, as the head of the Department of Health and Human Services (HHS). His appointment will result in serious health consequences for the country, with the potential to reverberate even more broadly.
As described by various observers, the current administration’s turn toward kakistocracy is becoming a reality. Until recently, a rather obscure term, kakistocracy, means “a government run by the worst, least qualified, or most unscrupulous citizens.” As we’ve repeatedly heard, elections have consequences. And who we elect has profound consequences in that elected officials then have the power to appoint people to positions of authority. These appointments impact not only individual voters, but communities, nations, and even the entire world with repercussions that can reverberate for generations. Witness, for instance, the gutting of USAID. This move not only jeopardizes the health of countless people throughout the world, including in the US, but also costs thousands of Americans’ jobs.
The conventional wisdom has been that HHS (which includes NIH, the FDA, the CDC, and CMS) should be run by individuals who have deep experience and expertise. But the principles of kakistocracy suggest otherwise. In fact, installing unqualified or incompetent individuals to run these massive administrative agencies will only accelerate the view that these are bloated and dysfunctional organizations that are doomed to fail. According to legal scholar, Alan Rozenshtein, Trump is moving us backwards rather than forwards:
While the 20th and early 21st centuries saw a trend toward professionalizing the executive branch, Trump’s nominations mark a reversion to governance as a means of rewarding loyalty and advancing personal or ideological agendas. This shift risks immediate harm from unqualified officials in critical roles and normalizes such appointments, setting a dangerous precedent for future administrations to prioritize partisan loyalty over public service.
Unfortunately, professionals who work for government bureaucracies are often viewed in a negative light. As Bruce Jennings and Virginia A. Brown stated in a 2024 Hastings Bioethics Forum blog:
Who likes bureaucrats and bureaucracy? Very few of us. But all democracies rely on an impartial, professional civil service to function. Civil service requires the discipline of competitive performance for employment or promotion. And it requires legal protection from arbitrary dismissal. The civil service bureaucracy provides an important check on the ideological power of the presidency. We believe that abolishing the procedural infrastructure of competent and effective governance is irresponsibly radical.
Although bureaucracies are often lambasted, a healthy democracy needs professionals from a variety of backgrounds who have specialized expertise. This is perhaps nowhere more important than HHS that oversees a nearly $2 trillion budget (over twice as large as the US defense budget). The mission of HHS as stated on its website is: “to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.” Without access to data locally, nationally and internationally, and without qualified leaders and transparency, achieving this ideal is not only unrealistic, but also impossible. Appointing an anti-vax propagandist who lacks any relevant expertise to be responsible for our nation’s health, freezing federal grants for ongoing research on everything from cancer to AIDS to pharmacogenomics, silencing CDC, and even halting scientific meetings are just a few of the ways that this administration is leading us into a health catastrophe through its embracing and empowering of a kakistocracy.
Just one aspect of the looming health catastrophe is the widespread potential for emerging and reemerging infectious diseases. Infectious disease knows no boundaries and requires continuous surveillance and vigilance to prevent and/or treat. Its spread cannot be prevented by building walls and silencing communication among and between global health agencies such as CDC and WHO. Measures to protect the public’s health require experts whose sole focus is working on these issues. Scientific advancements have greatly improved health, quality of life and life expectancy. Paradoxically, the success of public health is often due to its invisibility. For instance, we know when public health efforts are working precisely because we do not see what they have been designed to prevent. Cynically, those leading the kakistocracy and their families have benefited from clean air, clean water, vaccination, chemotherapy, antibiotics, etc. None of this would have been possible without expertise, data sharing, and research.
This is not a call for uncritical obeisance to experts. In fact, the field of bioethics developed in part as a reaction to the authority of medicine and to serve as something of a check and balance on unfettered expertise (in fact, Robert Baker’s latest history of bioethics has “bureaucrats” in the title). Checking the power of authority is vital in a democracy. But we live in a complicated world. Experts are essential in helping us navigate this world. And perhaps even more important is trust. As precious social capital, trust of the public is essential and most often is gained through transparency and accountability. But a kakistocratic regime can easily undermine that trust in science and expertise and often this is done by cutting off access to sound information (or propagating disinformation). The leadership of HHS should reflect a certain level of competence and trust. This new leadership reflects neither. And if this kakistocracy devolves even further into an outright autocracy, these words of the Declaration of Independence ring true:
Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes…But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.
Kayhan Parsi, JD, PhD, HEC-C and Nanette Elster, JD, MPH are both Professors of Bioethics & Health Policy at the Neiswanger Institute for Bioethics, Loyola University Chicago.