As RFK Jr. fights to be confirmed in Congress, the rest of Trump’s health team is already taking shape.
1DaySooner is an ACX grantee organization that advocates for innovative health policies. They’ve helped me write a list of who some of these people are, and some of the policies they could consider.
For practical reasons, we focus on upside only, so consider these the Venn-diagram-union of the ideas we’re most excited about, and the ones we think they might be most excited about - the new health policy we might get get in our ~90th percentile best outcome.
Jim O’Neill: Deputy Secretary, Health And Human Services
My personal favorite as the only Trump administration official to have commented on this blog (JD Vance only lurks – sad!) O’Neill, previously a Peter Thiel lieutenant, has worked in causes from seasteading to anti-aging; now he’s taking the #2 spot at HHS under RFK. He famously proposed that the FDA consider only safety (and not efficacy) when approving drugs. Given that he hasn’t been chosen for FDA, that’s probably not on the cards, but here are some things we hope O’Neill considers:
Compensating Organ Donors / End Kidney Deaths Act: Both of us co-writing this piece (Scott Alexander of ACX, Josh Morrison of 1DaySooner) have donated kidneys. We’re proud of our decision, but it’s not enough - waiting for people like us has resulted in an kidney shortage that kills a thousand Americans per month. Everyone knows the solution - compensating organ donors - but there hasn’t been enough political will to overcome the “ick” factor and make it happen. O’Neill could change that. He’s been speaking out in favor of compensation since 2009. And the time is right: Representative Nicole Malliotakis has introduced a bipartisan bill to provide $50,000 in refundable tax credits for people who donate kidneys to strangers. This paper found that a similar policy could eventually net 11,500 extra donors per year - which, aside from saving 11,500 people from end-stage kidney disease, could save the government $1 billion. O’Neill could boost this bill by getting it into the Executive Budget released with the State of the Union.
Develop Better Longevity Biomarkers: O’Neill spent 2019 - 2021 as CEO of SENS, the world’s leading anti-aging nonprofit, and will probably bring his interest in longevity to DC. Although there are major cultural barriers to the acceptance of longevity medicine, one of the biggest problems is technical - studying the effects of anti-aging drugs literally takes a lifetime. So one of the field’s holy grails is biomarkers - some sort of blood test for the aging process that could detect success early. This would require a joint effort between policymakers and researchers: the policymakers would encourage companies and labs to share relevant data, the researchers would use the data to develop and validate the markers, and then the policymakers would create a regulatory pathway based on the markers. There are many ways this could go wrong - previous biomarkers have often ended up being correlative rather than causal - but it could mean the difference between this field being doomed vs. possible at all.
Warp Speed for Air Quality: RFK Jr’s “Make America Healthy Again” philosophy is a horseshoe-theory-style union between typical conservative concerns about purity and typical liberal concerns about the environment. There are many ways it could go wrong, but one place it might go very right is in air quality. Recent research has highlighted the role of air quality in both chronic disease (eg particulate matter in the air causing lung problems) and infectious disease (despite the WHO’s attempts at weird language games, respiratory viruses including colds and COVID are airborne). There are some really innovative solutions (advanced air filters, UV-C technology) on the horizon, but we don’t expect this administration to want to throw a lot of money into blue-sky research. Instead, we suggest taking a page from the first Trump administration playbook and offering Operation Warp Speed style advance purchase agreements, which guarantee a market if and only if the technology works. An air quality Warp Speed could go a step further and target a result that is cost-saving to the federal government. For example, you could set the goal of reducing airborne disease in military housing by 50% by the start of 2028. Because the government pays for military healthcare, this would save costs and also create the evidence needed for private industry (workplaces, nursing homes, cruise ships, etc.) to implement air quality interventions for themselves.
Marty Makary: FDA Commissioner
Makary is a Johns Hopkins surgical oncologist, former MedPage Today editor-in-chief, and frequent FOX News guest. He wrote a book Blind Spots about past failures of the medical establishment, like denying babies peanuts to reduce peanut allergies (in fact, this increased the allergies). He’s also been a constant champion of medical transparency. Our wish list builds on this work.
Improve FDA Transparency: The FDA sits on the world’s biggest repository of clinical data, yet its transparency policies remain conservative compared to other global regulators. This opacity slows research, because a lot of data is only shared via costly and inefficient Freedom of Information Act (FOIA) requests. For example, the European Medical Association makes public Complete Response Letters (CRLs), which detail critical safety and efficacy findings, but the FDA only shares them with the drug developer. An impactful focus are for Makary could be addressing the practical and legal challenges that hinder real transparency reform at the FDA. Here’s a very 2025 solution - train an LLM on the agency’s vast repository of clinical data and deploy it as a tool for reviewers and potential automated researcher itself. By automating institutional knowledge, an AI system could significantly reduce regulatory burden by helping FDA staff review submissions, spot issues, predict outcomes, and write responses.
Better Post-Marketing Surveillance: Improvements in transparency for existing data could be paired with modernized surveillance of the real world effects of drugs after they’ve been offered to the public. Unlike countries like England and Israel, America’s healthcare systems are highly fragmented and make it hard to aggregate evidence. A focused attempt to modernize data collection could build on the FDA’s Sentinel Initiative and give the public real-time transparency into who’s taking what drugs and what effects are being observed.
Regulatory Reciprocity: I will keep this one in here until somebody does something about it. It’s the idea that Americans should be allowed to buy medical products if they’ve been approved by some trusted ally, like the European Union, possibly in exchange for the EU giving FDA-approved products the same deal in Europe. This has been amply championed by Alex Tabarrok and the Mercatus crowd for years, and is starting to make inroads in other countries. If full reciprocity is a step too far, 1DaySooner proposes Makary build off innovative pilot programs like Project Orbis, which enables concurrent submissions and reviews of oncology drugs by multiple regulatory agencies, and the CoGenT pilot, which does the same for cell and gene therapies.
Regulatory Capacity For Emergencies/Pandemics: In 2020, Makary criticized the FDA’s slow response to COVID. This time, we could try to be ahead of the game by building the FDA’s capacity and expertise in advance. During peacetime, this team could work on a universal flu vaccine and a pandemic equivalent of the START pilot pioneered by FDA biologics director Peter Marks.
Jay Bhattacharya: NIH Director
Bhattacharya is a rare doctor and medical professor who also has a PhD in economics. His contrarian COVID positions provoked censorship and harassment from Big Tech and the academic establishment; the experience seems to have low-key traumatized him, and his preliminary policy proposals, listed here, focus on using the NIH's grant-giving power to shake up the orthodoxy that wanted him silenced. Here are some other policies we hope he’ll look into:
Increase funding for novel research: Bhattacharya co-authored a paper finding that projects which explore new ideas get less government funding than those confirming existing paradigms. The NIH has already been trying to change this with their High-Risk, High-Reward Research program, including the Transformative Research Award, Pioneer Award, New Innovator Award, and Early Independence Award. These remove many of the barriers to typical R01 grant review – preliminary data, budget approvals, and demonstrations of feasibility – and should be expanded.
Remove Barriers To Human Challenge Trials: In a challenge study, healthy participants volunteer to be exposed to an infectious disease to test a vaccine or treatment (don’t worry about this burden falling on poor people - it’s mostly grad students and effective altruists). During time-sensitive events like a novel pandemic, this lets studies move faster than having to wait for people to get infected naturally. There was a movement to have some of these during COVID - which would have sped up vaccines, shortened lockdowns, and saved tens of thousands of lives - but the health establishment chose paternalism and the moral high of trying to save volunteers from themselves. Matthew Memoli, who as Acting Director of NIH is holding the seat until Bhattacharya’s confirmation, is a leading flu challenge researcher at the NIH who wanted to develop challenge models in March of 2020 but got rejected by Anthony Fauci; Bhattacharya could work with Memoli to speed up these studies.
Release ARPA-H from the NIH: Bhattacharya likes unorthodox things, and the most unorthodox thing you can do in DC is to deliberately decrease the size of your empire. ARPA-H is an innovative government science funder modeled after DARPA. Although it was intended as an independent agency, it got placed within NIH due to bureaucratic machinations. Now it’s in danger of getting shoved into a new National Institute on Innovation and Advanced Research with a lower budget. Separating ARPA-H from the NIH will protect it it from this fate, help it deliver on its intended goals, and help NIH reducing the number of institutes and centers it oversees (granting more research dollars per center).
