Category: the business of health care

Public Health Under Fire: HHS and CDC Tensions Explained

In this post I review HHS Secretary Robert Kennedy Jr. at the Senate Finance Committee regarding his dismissal of CDC Director Dr. Susan Monarez and concerns over his anti-vaccine stance. This culminated in resignations from senior CDC officials alarmed by political interference affecting scientific integrity and public health safety.

updated September 20. 2025

This information is current as of the date of original publication or update but may have changed by the time you read this. Do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with a qualified healthcare professional.

Kennedy visits the Senate

On September 4, 2025, HHS Secretary Robert Kennedy Jr. appeared before the Senate Finance Committee and was heatedly questioned about several issues. Most of his testimony centered around his firing of the newly confirmed CDC Director Dr. Susan Monarez.

He was also grilled on his seeming lack of support for vaccination as an important public health measure. They questioned why he appointed several antivaccine scientists to the Advisory Committee on Vaccines. Even the Republican Senators who had voted for his appointment expressed frustration with his leadership.

In this post I explain some of what lead to this confrontation.

Trump appoints a CDC Director

After being without a CDC Director since he took office in January 2025, President Trump and the Senate confirmed Dr. Susan Monarez. This is the first time in history that a CDC Director needed Senate approval.

President Trump posted this on social media about his choice for CDC director.

“Dr. Monarez brings decades of experience championing Innovation, Transparency, and strong Public Health Systems. She has a Ph.D. from the University of Wisconsin, and PostDoctoral training in Microbiology and Immunology at Stanford University School of Medicine.

“As an incredible mother and dedicated public servant, Dr. Monarez understands the importance of protecting our children, our communities, and our future. Americans have lost confidence in the CDC due to political bias and disastrous mismanagement.

Dr. Monarez will work closely with our GREAT Secretary of Health and Human Services, Robert Kennedy Jr. Together, they will prioritize Accountability, High Standards, and Disease Prevention to finally address the Chronic Disease Epidemic and, MAKE AMERICA HEALTHY AGAIN!”

President Trump and Secretary Kennedy at the MAHA commission meeting

That was in July 2025. Something changed by late August.

I share this article published by KFF Health News. It was written by Dr. Celine Gounder, a physician and medical journalist who specializes in infectious diseases and global health. She was a member of the COVID-19 Advisory Board of President Joe Biden.

(I have edited the article slightly for length.)

Senior CDC Officials Resign After Dr. Monarez’s Ouster, Citing Concerns Over Scientific Independence

Written by Dr. Céline Gounder August 29, 2025

Four senior officials with the CDC, Centers for Disease Control and Prevention, announced their resignations in recent days, citing what they described as growing political interference in the agency’s scientific work, particularly regarding vaccines.

Two of them — Dr. Debra Houry, the CDC’s chief science and medical officer, and Dr. Demetre Daskalakis, who led the National Center for Immunization and Respiratory Diseases — stepped down on Aug. 27, hours after the White House announced the firing of CDC Director Susan Monarez.

Dr. Monarez, confirmed by the Senate in late July, was removed less than a month into her tenure.

White House spokesperson Kush Desai said Monarez “was not aligned with the President’s agenda of Making America Healthy Again.” Monarez’s attorneys argue that the dismissal is unlawful, as only the apresident can remove a Senate-confirmed director.

On Aug. 28, Jim O’Neill, the deputy secretary of the Department of Health and Human Services, was chosen to serve as acting CDC director. In an internal email sent to CDC staffers Secretary Robert F. Kennedy Jr. confirmed O’Neill as the acting CDC director without addressing Monarez’s departure. 

“I am committed to working with you to restore trust, transparency, and credibility to the CDC,” Kennedy told CDC employees, later writing that

“President Trump and I are aligned on the commonsense vision for the CDC: Strengthen the public health infrastructure by returning to its core mission of protecting Americans from communicable diseases by investing in innovation to prevent, detect, and respond to future threats.”

HHS Secretary Robert Kennedy, Jr.

Concern for Vaccine Policy

Houry and Daskalakis said they had become increasingly uneasy about how vaccine policy was being handled. Both pointed to preparations for the Advisory Committee on Immunization Practices, ACIP, meeting, which recommends vaccine schedules.

Houry said they feared “some decisions had been made before there was even the data or the science to support those. We are scientists, and that was concerning to us.”

Daskalakis added that he was “very concerned that there’s going to be an attempt to relitigate vaccines that have already had clear recommendations with science that has been vetted,” which he warned could undermine public trust. “If you can’t attack access, then why not attack trust? And that’s what I think the playbook is,” he said.

“there’s going to be an attempt to relitigate vaccines that have already had clear recommendations with science that has been vetted,

If you can’t attack access, then why not attack trust? And that’s what I think the playbook is,”

Dr. Demetre Daskalakis

Lack of communication and transparency

Both officials cited instances in which evidence reviews were altered or withdrawn. A CDC analysis of thimerosal, a vaccine preservative, was briefly posted before being taken down at the HHS’ direction.

“If there’s something that doesn’t line up with the recommendations, then that information will be taken down, and it’s not there for the public to see for openness and transparency,” Houry said.

The two also criticized the lack of direct communication between CDC scientists and HHS leadership. Daskalakis said his team was never invited to brief Kennedy on measles and COVID-19.

When asked about Kennedy’s calls for “radical transparency,” Houry and Daskalakis learned about changes to the COVID-19 vaccine schedule for children through social media, not through internal channels.

“The radical transparency manifested itself by a Twitter post, which is how Dr. Houry and I learned that the secretary had mandated the change in the children’s vaccine schedule for COVID,” Daskalakis recalled.

“What is the background that led to that decision? And we were denied access to that information. So, I don’t think that that’s radically transparent,” Daskalakis said.

CBS News and KFF Health News reached out to HHS for comment on some of the allegations made by Houry and Daskalakis but did not immediately hear back.

Scientists Raise An Alarm for Public Health

Both officials said they had no jobs lined up when they resigned. Houry described the decision as an effort to raise the alarm about the direction of the agency.

“For us, this was really sending out a bat signal,” Houry said. “We were the very senior scientists and career leaders at CDC. We thought this was the time to stand together and try to do what we could to raise the alarm around public health in our country.”

Daskalakis said remaining at the CDC under current conditions would have made them complicit in what he called the “weaponization” of public health.

“The safety has already been compromised. … We are flying blind in the U.S. already. If we continued … we would be complicit and would be facilitating the ability to go from flying blind to actively harming people,” he said.

Houry emphasized the severity of the moment by noting that she left without a backup plan.

“My leaving without a job was really just showing how dire the circumstances had become,” Houry said.

Daskalakis said his decision was also shaped by his medical oath.

“As a physician, I take the Hippocratic oath: First, do no harm. I am seeing ideology permeating science in a way that is going to harm children and adults. … I think we are seeing things that are happening that are making our country less prepared to be able to respond to the everyday pathogens … but also … to the next big thing.”

Both also expressed concerns about their personal safety in the current climate.

“The environment we live in … stoked by misinformation, especially from people considered by some to be health authorities, makes me worried for all of us in public health,” Daskalakis said. “I am concerned, but that’s part of our job … to be brave and continue to speak the truth even when we are outside of the CDC.”

Photo by Photo By: Kaboompics.com on Pexels.com

Gun Violence-Another Public Health Issue

The resignations came weeks after a shooting outside the CDC’s Atlanta headquarters, which law enforcement linked to COVID misinformation.

Houry said the White House response to the shooting was muted. Kennedy toured the site but later gave an interview expressing distrust of experts.

“That was after the attack. It was based on COVID misinformation. So this is when we were trying to build trust,” she said.

Daskalakis added that while Kennedy later described mass shootings as a public health crisis, he believed the secretary should address misinformation as a root cause.

“The misinformation about the COVID-19 vaccine — that has been documented by the Georgia Bureau of Investigation” as the reason for the CDC shooting. “I would really recommend that the secretary actually do take his own advice and actually address the core problem that led to that shooting as well,” he said.

He also noted that the CDC’s gun violence prevention programs had been sharply reduced. “We talk about violence as a public health problem.

It is, and there’s things we can do to prevent it. Unfortunately, the majority of that program, the staff are terminated,” he said.

“We talk about violence as a public health problem.
It is, and there’s things we can do to prevent it. Unfortunately, the majority of that program, the staff are terminated,”

Dr. Daskalakis

The firings and resignations have sparked calls for oversight. Independent Sen. Bernie Sanders of Vermont called for a bipartisan investigation, Democratic Sen. Patty Murray of Washington urged Kennedy’s removal, and Republican Sen. Bill Cassidy of Louisiana — who voted to confirm Kennedy’s appointment as HHS secretary — said the developments would “require oversight.”

The events come as the FDA narrowed eligibility for updated COVID-19 vaccines to older adults and people with risk factors for severe COVID.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Dr. Monarez Speaks to the Senate

On September 17, 2025, “She testified that she was ousted last month because she refused to cede to Health Secretary Robert F. Kennedy Jr.’s demands to pre-approve vaccine recommendations for the public and fire career scientists.

“He just wanted blanket approval,” Monarez told members of the Senate Committee on Health, Education, Labor and Pensions on Wednesday. “Even under pressure, I could not replace evidence with ideology.”

Monarez described a string of events that she said eventually led to her dismissal, culminating with a “tense” meeting in late August when she clashed with Kennedy over his plans for an influential CDC committee that issues recommendations on vaccines.”

Read the full report from NPR at this link

Ousted CDC director testifies she was fired for resisting pressure from RFK Jr.

Learn about the CDC

I hope you will take the time to learn more about the Centers for Disease Control and Prevention. According to the website, the

  • CDC is the nation’s leading science-based, data-driven, service organization that protects the public’s health.
  • CDC puts science into action to help children stay healthy so they can grow and learn; to help families, businesses, and communities fight disease and stay strong; and to protect the public’s health.

The professionals at the CDC cannot do their job alone. They need the support of elected and appointed government officials and the people they serve.

Health and safety threats are often new and unpredictable, like a viral pandemic or natural disaster, and multiple agencies need to work together to successfully manage threats. Cooperation and support are needed. Blaming and accusations are unproductive and unprofessional and contribute to lack of trust by the people they serve.

Post Graphics

The two graphics about vaccines are currently on the CDC website. The cover photo of CDC headquarters is also on the site.

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I share information and inspiration to help you transform challenges into opportunities for learning and growth.

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Medical stethoscope and heart on a textured background

Dr Aletha

Understanding Kratom: Effects, Risks, and Regulations

In this post I discuss Kratom, a psychoactive herbal substance, gaining attention for its potential use in managing opioid withdrawal, pain, and anxiety. Despite its popularity, it is not FDA-approved, with growing scrutiny due to concerns over safety and increased regulation at state levels.

This information is current as of the date of original publication or update but may have changed by the time you read this. Do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with a qualified healthcare professional.

What is Kratom?

Before I read the following article, I knew little about kratom, other than it is a psychoactive drug that is popular with young people. I was thinking along the lines of the substances used in vaping.

But this article made me pause and realize I needed to learn more.

According to NIDA, the National Institute on Drug Abuse, an agency of the NIH, National Institutes of Health,

“Kratom” commonly refers to an herbal substance that can produce opioid- and stimulant-like effects. Kratom and kratom-based products are currently legal and accessible in many areas of the world.

While there are no uses for kratom approved by the U.S. Food and Drug Administration, people report using kratom to manage drug withdrawal symptoms and cravings (especially related to opioid use), pain, fatigue, and mental health problems.

 NIDA supports and conducts research to evaluate potential medicinal uses for kratom and related chemical compounds.

NIDA also supports research towards better understanding the health and safety effects of kratom use. Rare but serious effects have been reported in people who use kratom, including psychiatric, cardiovascular, gastrointestinal and respiratory problems.

 Compared to deaths from other drugs, few deaths have been linked to kratom products and nearly all cases involved other drugs or contaminants.

More info from NIDA at this link

Kratom (Mitragyna speciosa) Mitragynine. Drugs and Narcotics

Kratom (Mitragyna speciosa) is a tree in the coffee family, found in Thailand and neighboring countries. Traditionally, in Southeast Asia, people have chewed its leaves or made them into a tea that is used to fight fatigue and improve work productivity

Kratom faces increasing scrutiny from states and the feds

by Amanda Hernández, Oklahoma Voice
August 11, 2025

For years, state lawmakers have taken the lead on regulating kratom — the controversial herbal supplement used for pain relief, anxiety and opioid withdrawal symptoms. Some states have banned it entirely. Others have passed laws requiring age limits, labeling, and lab testing.

At least half of the states and the District of Columbia have enacted some form of regulation on kratom or its components — building a patchwork of policies around a product largely unaddressed by the federal government.

But that may soon change. The U.S. Food and Drug Administration is pushing to ban 7-hydroxymitragynine, or 7-OH — a powerful compound found in small amounts in kratom and sometimes concentrated or synthesized in products sold online, at smoke shops, or behind gas station counters.

Federal health officials announced last month that the compound poses serious public health risks and should be classified as a Schedule I controlled substance, alongside heroin and LSD.

The move marks a significant shift in how federal regulators are approaching kratom, which they attempted to ban in 2016. It has sparked debate about how the change could impact the growing 7-OH industry and its consumers.

This year, at least seven states have considered bills to tighten kratom regulations, including proposals for bans, age restrictions, and labeling requirements.

Kratom and 7-OH differences

Kratom, which originates from the leaves of a tree native to Southeast Asia, can have a wide range of mental and bodily effects, according to federal officials, addiction medicine specialists, and kratom researchers. Reports of fatal kratom overdoses have surfaced in recent years, though kratom is often taken in combination with other substances.

Kratom and 7-OH are distinct products with separate markets, but they are closely connected. 7-OH is a semi-synthetic compound derived from kratom and only emerged on the market in late 2023, while kratom itself has been available for decades.

Leading kratom researchers say more research is needed to fully understand the long-term effects of using both substances.

“There’s much we don’t know, unfortunately, on all sides,” said Christopher R. McCurdy, a professor of medicinal chemistry at the University of Florida. McCurdy is a pharmacist and has studied kratom for more than 20 years.

Research suggests kratom may help with opioid withdrawal and doesn’t seem to cause severe withdrawal on its own. Smaller amounts seem to act as a stimulant, while larger doses may have sedative, opioidlike effects.

Very little is known about the risks of long-term use in humans, according to McCurdy.

As for 7-OH, it shows potential for treating pain, but hasn’t been studied in humans, and may carry a high risk of addiction. Researchers don’t yet understand how much is safe to take or how often it should be used, McCurdy told Stateline.

While some leading kratom experts agree that kratom and 7-OH should be regulated, they caution that placing 7-OH under a strict Schedule I classification would make it much harder to study — and argue it should instead be classified as Schedule II as are other opioids.

A federal survey from 2023 estimated that about 1.6 million Americans age 12 and older used kratom in the year before the study. The American Kratom Association, an industry lobbying group, estimated in 2021 that between 11 million and 16 million Americans safely consume kratom products each year.

Since gaining popularity in recent years, 7-OH is in a larger number of products. Some researchers and addiction medicine specialists say many consumers, especially those new to kratom, sometimes don’t understand the difference between products.

“It’s a pure opioid that’s available without a prescription, so it’s akin to having morphine or oxycodone for sale at a smoke shop or a gas station,” McCurdy said. “This is a public health crisis waiting to happen.”

Photo by Laryssa Suaid on Pexels.com

FDA targets 7-OH, not kratom

In late July, the U.S. Department of Health and Human Services recommended that the federal Drug Enforcement Administration place 7-OH in Schedule I, citing a high potential for abuse. The classification would not apply to kratom leaves or powders with naturally occurring 7-OH.

“We’re not targeting the kratom leaf or ground-up kratom,” FDA Commissioner Marty Makary said at a news conference. “We are targeting a concentrated synthetic byproduct that is an opioid.”

Makary acknowledged that there isn’t enough research or data to fully understand how widespread 7-OH’s use or impact may be. Still, he said the Trump administration wants to be “aggressive and proactive” in addressing the issue before it grows into a larger public health problem.

The Trump administration wants to be aggressive and proactive before the issue grows into a larger public health problem.

FDA head Marty Makary

While only small amounts of 7-OH occur naturally in the kratom plant, federal officials have raised concerns about U.S. products containing synthetic or concentrated forms of the compound because it’s more potent than morphine and primarily responsible for kratom’s opioidlike effects

the chemical formula for kratom products; credit NIDA

What will the DEA do with 7-OH?

The FDA’s recommendation to schedule 7-OH will now go to the DEA, which oversees the final steps of the process — including issuing a formal proposal and opening a public comment period.

If finalized, the rule could affect both companies selling enhanced kratom products and consumers in states where those products are currently legal.

The DEA backed off scheduling kratom compounds in 2016 after widespread public opposition.

Kirsten Smith, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University who is studying kratom’s effects in humans, said she was surprised by the FDA’s push to schedule 7-OH.

“We don’t really have a public health signal of a lot of adverse events for either kratom or for 7-OH at this time,” she told Stateline. “I was, frankly, always surprised that kratom was pushed toward scheduling at an earlier time point. … I don’t know that we have data to support scheduling even now.”

Pushback from advocacy groups

Still, some advocacy groups, including the Holistic Alternative Recovery Trust, argue the push to schedule 7-OH is driven more by corporate interests than public health, suggesting the kratom industry is trying to sideline competition from 7-OH products.

“We think that this is just happening because of the legacy kratom manufacturers losing market share and wanting to gin up a crisis with this,” said Jeff Smith, the national policy director for the group, who said he has used 7-OH for sleep and pain management.

While his organization supports regulation and safe consumption, members worry the federal government’s move could drive people to riskier substances or push the market underground.

“It’s made a profound difference in my life,” Smith said. “We think it would be tragic to cut it off based on such a paucity of data when there’s so much potential for this product to help people.”

Public health concerns 

Federal health officials say a key concern is the growing use of kratom and 7-OH products among teens and young adults.

Some officials and addiction medicine specialists have pointed out that these products often come in flavors and packaging designed to appeal to younger buyers, with few controls over where or how they’re sold. In some states without clear regulations, kratom and 7-OH products are available at gas stations or online, sometimes without any age verification.

“Whenever you go into a gas station and even though it’s behind the glass, it’s of eye level, and it has all of these bright colors — it has all of these things that really attract the visual of a kiddo,” said

Socorro Green, a prevention specialist with Youth180, a nonprofit focused on youth substance use prevention in Dallas.

Green added that kratom and 7-OH products may be even more accessible to young people in rural communities, where gas stations and convenience stores are often among the few available retailers.

Some researchers and experts say that certain products may not clearly or accurately disclose their 7-OH content and are sometimes marketed or mistaken for traditional kratom.

Some cities, counties and states have responded by banning kratom or raising the minimum purchase age to 18 or 21. But in many areas, enforcement remains inconsistent, and some addiction specialists say clearer federal and state guidance is needed — especially as more people are using kratom and 7-OH to manage pain, anxiety or withdrawal symptoms on their own.

“There needs to be some kind of oversight, including some way of maybe helping to ensure that people know what they’re getting,” said Terrence Walton, the executive director and chief executive officer of NAADAC, the Association for Addiction Professionals.

State regulations

At least seven states have considered or enacted legislation this year related to kratom — ranging from age restrictions and labeling requirements to outright bans.

In New York, lawmakers passed two bills: one requiring warning labels and prohibiting kratom products from being labeled as “all natural,” and another raising the minimum purchase age to 21. Neither has been sent to the governor.

In Colorado, a new measure, which was signed into law in May, prohibits kratom from being sold in forms that resemble candy or appeal to children, increases labeling requirements, limits concentrations of 7-OH, and bans the manufacture and distribution of synthetic or semi-synthetic kratom.

In Mississippi, a new law that took effect in July raised the minimum purchase age for kratom to 21. It also bans synthetic kratom extracts and products with high concentrations of 7-OH.

Lawmakers in Montana and Texas introduced similar legislation this year, but neither proposal advanced.

Louisiana is the latest state to enact a kratom ban.

Rhode Island became the first state to reverse its ban. The new law establishes a regulatory framework for the manufacturing, sale, and distribution of kratom products, set to take effect in April 2026.

As of this year, Washington, D.C., Alabama, Arkansas, Indiana, Louisiana, Vermont, and Wisconsin have banned kratom. At least half of U.S. states now regulate kratom or its components in some way.

Oklahoma Voice is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Oklahoma Voice maintains editorial independence. Contact Editor Janelle Stecklein for questions: info@oklahomavoice.com.

 

This story is republished under Creative Commons license CC BY-NC-ND 4.0.

Learn more about kratom products marketed as herbal supplements from the National Institutes of Health (NIH) National Center for Complementary and Integrative Health (NCCIH).

How will you respond to this information?

  1. Who do you need to share this information with?
  2. What more do you need to know about kratom?
  3. How do you feel generally about psychoactive drugs?
  4. What should our local governments do about kratom, if anything?

Images in this Post

The images of kratom are from the NIH website and in the public domain. The cover image was generated by AI on WordPress.

Exploring the HEART of Health

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Dr. Aletha

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Aletha Cress Oglesby, M.D.'s avatar by Aletha Cress Oglesby, M.D.