RFK Jr. says Trump administration follows ‘gold standard’ science. Here’s what you should know

The message is put out again and again, in news conferences, hearings and executive orders: President Donald Trump and Health Secretary Robert F. Kennedy Jr. say they want the government to follow “gold standard” science.

The problem, scientists say, is that they often do just the opposite by relying on preliminary studies, fringe science or mere intuition to make claims, cast doubt on proven treatments, or even set policy.

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The nation’s top public health agency this week changed its website to contradict the scientific conclusion that vaccines do not cause autism. The move shocked health experts across the country.

Dr. Daniel Jernigan, who resigned from the Centers for Disease Control and Prevention in August, told reporters Wednesday that Kennedy appears to be “moving from evidence-based decision making to decision-based evidence making.”

It was the latest example of the Trump administration challenging established science.

In September, the Republican president offered medical advice based on little or no evidence. He spoke directly to pregnant women and parents, asking them not to take acetaminophen, the active ingredient in Tylenol. He has repeatedly made the long-established fraudulent link between autism and vaccines, saying his assessment is based on a hunch.

“I’ve always had very strong feelings about autism and how it happened and where it came from,” he said.

At a two-day meeting this fall, Kennedy’s hand-picked vaccine advisers at the Centers for Disease Control and Prevention raised questions about vaccinating children against hepatitis B, a vaccination that has long been shown to significantly reduce illness and death.

“The discussion about safety is based on evidence other than case reports and anecdotes,” said Dr. Flor Munoz, a pediatric infectious disease expert at Baylor College of Medicine and Texas Children’s Hospital.

During the nation’s worst year for measles in more than three decades, Kennedy questioned the measles vaccine while defending unproven treatments and claiming that unvaccinated children who died were “really sick.”

Until now, the process of getting drugs and vaccines recommended in the United States to market has typically relied on gold-standard science, scientists say. This process is so strict and transparent that much of the rest of the world follows the lead of US regulatory bodies, granting approval for treatment only after US approval.

Gold standard science

The gold standard can vary because science and medicine are complex and not everything can be tested the same way. This term simply refers to the best possible evidence that can be collected.

“It totally depends on the question you’re trying to answer,” said Dr. Jake Scott, an infectious disease physician and researcher at Stanford University.

What produces the best possible evidence?

There are many different types of studies. The most rigorous is a randomized clinical trial.

It randomly creates two groups of subjects who are identical on everything except the drug, treatment, or other question being tested. Many of them are “blind studies,” meaning that neither the subjects nor the researchers know who belongs to which group. This helps eliminate bias.

It is not always possible or ethical to perform these tests. This is sometimes the case with vaccine trials, said Jessica Steyer, a public health scientist and founder of the Unbiased Science podcast: “Because we have so much data showing how safe and effective it is, it would be unethical to withhold vaccines from a certain group.”

Studying the long-term impact of behavior may be impossible. For example, scientists cannot study the long-term benefits of exercise by having one group not exercise for years.

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Instead, researchers should conduct observational studies, where they follow participants and track their health and behavior without manipulating any variables. Such studies helped scientists discover that fluoride reduces cavities, and subsequent laboratory studies showed how fluoride strengthens tooth enamel.

But studies have limitations because they often can only prove association, not causation. For example, some observational studies have raised the possibility of a link between autism risk and acetaminophen use during pregnancy, but further studies have found no link. The big problem is that this type of study cannot determine whether the pain reliever actually made any difference or whether it was a fever or other health problem that prompted the need for the pill.

Real-world evidence can be particularly powerful

Scientists can learn more when they see how something affects a large number of people in their daily lives.

This real-world evidence can be valuable to prove how well something works, and when there are rare side effects that would never be detected in trials.

Such vaccine evidence has proven useful in both directions. Scientists now know that there can be rare side effects of some vaccines and can alert doctors to be cautious. Data has proven that vaccines provide extraordinary protection from disease. For example, measles has been eradicated in the United States, but it still appears among unvaccinated groups.

The same data proves that vaccines are safe.

“If vaccines caused a wave of chronic disease, our safety systems — which can detect a one-in-a-million event — would have noticed,” Scott told a US Senate subcommittee in September. “But they didn’t.”

The best science is open and transparent

Simply publishing a research paper online is not enough to describe it as open and transparent. Specific things to look for include:

• Researchers set their hypothesis before starting the study and do not change it.
• The authors disclose no conflicts of interest and funding sources.
• The research has been peer-reviewed by subject matter experts who have no connection to this particular study.
• The authors present their work, publish and explain the data underlying their analyses.
• They cite reliable sources.

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This transparency allows science to examine itself. Dr. Stephen Woloshin, a professor at Dartmouth College, has spent much of his career challenging the scientific conclusions that underlie health policy.

“I’m only able to do that because they’re transparent about what they did, and what the underlying resources were, so you can come to your own conclusion,” he said. “That’s how science works.”

Learn about the limitations of individual anecdotes and studies

Stories can be powerful. It’s not data.

Case studies may be published in top journals to help doctors or other professionals learn from a particular situation. But they are not used to make decisions about how to treat large numbers of patients because each case is unique.

Even individual studies should be considered in the context of previous research. Any new, one-time successful study that seems to answer every question definitively or reaches a conclusion that is inconsistent with other well-conducted studies needs a very careful look.

Uncertainty is baked into science.

“Science is not about arriving at certainty,” Woloshin said. “It’s about trying to reduce uncertainty to the point where you can say, ‘I have good confidence that if we do X, we’ll see outcome Y.’ But there’s no guarantee.”

Conduct your own research? Questions to ask

If you come across a research paper online, in a news story, or are quoted by officials to change your mind about something, here are some questions to ask:

• Who did the research? What is their experience? Do they disclose conflicts of interest?
• Who paid for this research? Who might benefit from it?
• Is it published in a reputable journal? Has it passed peer review?
• What question are researchers asking? Who or what do they study? Do they even make comparisons between groups?
• Is there a “Limitations” section where authors point out what their research cannot prove, other factors that could affect their results, or other potential blind spots? What does he say?
• Do you make bold and definitive claims? Does it fit with scientific consensus or challenge it? Is it too good or too bad to be true?

AP Medical Writers Laurent Neergaard in Washington and Mike Staub in New York contributed to this report. The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. AP is solely responsible for all content.