Friday, April 27, 2018

Don't Know Much About Health Care and Public Health, and Don't Care Much About Their Missions - but in Leadership Positions in US Government Health Agencies

Here we go again.  As we  We have frequently discussed how health care leadership is often ill-informed ( look here).  More and more people leading non-profit, for-profit and government health care organizations have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.  Obviously health care and health policy decisions made by ill-informed people could have detrimental effects on patients' and the public's health.

Through 2016, our examples of ill-informed leadership in health care tended to be executives of hospital systems (e..g.,in 2014, here, on the mishandling of a patient with Ebola in a hospital system led by generic managers; and in 2013, here, on a luxurious hospital led by a former hotel executive).  Others were top executives of pharmaceutical corporations (e.g., in 2011, here, on previous Pfizer CEOs).

Now, however, the most ill-informed people in health care leadership seem to be running US government health related agencies.  Worse, the latest examples we have found also appear to be mission-hostile leaders.

Ximena Barreto, Deputy Director Of Communications, Office Of The Assistant Secretary For Public Affairs,, Department of Health and Human Services (DHHS)

Ms Barreto's new position was first discussed in an article in Media Matters on April 9, 2018.  The article described her background:

Barreto (who also goes by the surname Barreto-Rice) was a right-wing pundit who used the screen name 'RepublicanChick' on her personal website and social media. She regularly posted commentary on Periscope and briefly co-hosted a YouTube show called The Right View by Deplorable Latinas. She also said she helped Trump’s California efforts during the 2016 election.

I can find nothing to indicate she has any background or expertise in biomedical science, health care, or public health.

Note that the mission of DHHS currently 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.

Yet according to Media Matters, Ms Barreto did not appear to be committed to the health and well-being of all Americans.

As a fringe right-wing political commentator, Ximena Barreto claimed that 'African-Americans are way more racist than white people,' labeled Islam 'a f*** cult' that has 'no place' in the United States,... and attacked the 'retarded' 2017 Women’s March.

In particular,

In her November 30, 2016, Periscope video (starts roughly 8:00 into the video), during a discussion about 'f*** reverse racism,' Barreto said: 'African-Americans are way more racist than white people.'

She continued shortly after: 'I’ve been attacked by more African-Americans on Twitter than white people, in all honesty. … They’re the most racist people I ever met.' She then said that she’s been insulted and called slurs by African-Americans.


During her November 30, 2016, Periscope, Barreto said (starts roughly 7:26 into the video) that Islam advocates for 'killing other people and abusing women; that’s not a religion, that’s a f*** cult. Like, I’m serious. Like, that’s not religion.' She also said during a June 12 video that Islam is 'just a cult. All the practices are cult-like, all that they do.'

In a May 25 post on the now-defunct website Borderland Alternative Media, she suggested that practicing Islam should not be allowed in the United States.

She also expressed sentiments that suggested she was not comfortable with the reality-based approach of the "sciences underlying medicine, public health, and social services."

Barreto has repeatedly pushed the false Pizzagate conspiracy theory that claimed prominent political figures were trafficking children through a Washington, D.C., pizza restaurant. She tweeted in November 2016 that efforts by supporters of former Democratic presidential candidate Hillary Clinton to trigger a recount were 'a hoax so we get distracted from #PizzaGate.'

She appeared in a November 30, 2016, Periscope video in which she also said (starts roughly 1:45 into the video) the presidential recount effort is an attempt to distract people 'from Pizzagate.' She later claimed that former Republican presidential candidate Mitt Romney is also tied to Pizzagate. 'A lot of people are connected to it,' she remarked.

Near the end of the video, Barreto told viewers: 'Don’t listen to the recount and relax. We’ve got to use all of our efforts into Pizzagate and not let that one die because that’s what the mainstream media is trying to get distracted from. So check all the Pizzagate stuff.'

Furthermore, additional investigations by CNN revealed

In May of 2017, Barreto retweeted an image saying the 'our forefathers would have hung' Clinton and Obama for treason. In August of 2017 Barreto retweeted an image of a statue of Obama labeling him 'a Muslim terrorist.' In January of 2017, Barreto wrote in a tweet that Obama was a 'pansy and a traitor.'

The Hill reported on  April 9, 2018, that Ms Barreto was placed on leave.  Her online comments have apparently been erased.

So while Ms Barreto was hired in a top communications role for DHHS, which is supposed to improve the health of all Americans, she previously displayed virulent prejudice against African-Americans and Muslims.  Also, DHHS is supposed to uphold evidence- and science-based health care, public health and social services, but Ms Barreto has promoted grossly false conspiracy theories.

She seems to be uniquely unqualified for her leadership position in DHHS.  In fact, she seems like one of the last people one should consider for such a position.  Worse, since she also appears to have no background or experience in communications, public relations, or journalism, it appears that there was no obvious reason to hire her other than her reputation for taking extreme positions on social media. 

Roger Severino, Director, Office for Civil Rights (OCR), DHHS

Shannon Royce,  Director of the Center for Faith-based and Neighborhood Partnerships at the U.S. Department of Health and Human Services

Mr Severino and Ms Royce work together (see below) and so will be discussed together

According to his official DHHS biography,

Mr. Severino served as Director of the DeVos Center for Religion and Civil Society in the Institute for Family, Community, and Opportunity at The Heritage Foundation.

Before joining Heritage in 2015, Mr. Severino was a trial attorney for seven years in the Department of Justice’s Civil Rights Division....

Mr. Severino was previously chief operations officer and legal counsel for the Becket Fund for Religious Liberty.

Mr. Severino holds a J.D. from Harvard Law School, received a master’s degree in public policy, with highest distinction, from Carnegie Mellon University, and has a bachelor’s degree in business from the University of Southern California.

According to her official biography, Ms Royce

worked for over seven years on Capitol Hill, including serving as Counsel to Senator Chuck Grassley (now Chairman of Senate Judiciary Committee).

In the private sector, Shannon worked in several faith-based non-profits. Early on, she led the D.C. office of the Ethics & Religious Liberty Commission (ERLC), a group focused on issues such as sex trafficking, global hunger, and protecting religious liberty. Most recently, Shannon served as Chief of Staff and C.O.O. at the Family Research Council (FRC)....

Again, neither Mr Severino or Ms Royce have any background or expertise in biomedical science, health care, or public health.

According to a Politico article from January, 2018, they are

politically prominent religious activists inside the Department of Health and Human Services have spent months quietly planning how to weaken federal protections for abortion and transgender care....

Mr Severino in his capacity with the OCR

laid out new protections allowing health care workers with religious or moral objections to abortion and other procedures to opt out. Shannon Royce, the agency's key liaison with religious and grass-roots organizations, has also emerged as a pivotal player.

As we discussed in January, 2018, the OCR is part of an effort officially aimed at protecting doctors, nurses and other health-care workers who decline to participate in care that goes against their moral or religious convictions.  At that time we raised the probably naive hope that this would particularly help health professionals who felt pushed to participate in unethical and illegal activities like conflicts of interest, outright crime, such as fraud, bribery or kickbacks, or other criminal or corrupt practices to which they had moral objections.  That was not to be.

Instead, as Politico suggested in January, the aim was to support people who believe abortion, favorable treatment of LGBT people, even contraception are morally wrong.  In particular, Mr Severino and Ms Royce have
- "selectively post[ed] public comments that were overwhelmingly anti-abortion"
- started a "vast outreach to religious groups," apparently limited to those who agree with the moral positions above
- kept secret "decisions about controversial issues like abortion, contraception and transgender care"

At one point, speaking to a sympathetic religious audience, Ms Royce acknowledged the purpose of their actions,

Royce said last Thursday, appearing at the anti-abortion conference. 'We have such an amazing team at HHS that is absolutely a pro-life team across the spectrum.'


'You will see exciting things in the coming days, and that's all I can say right now. But good stuff is coming,' Royce promised attendees at last Thursday's anti-abortion conference.

Politico noted that people and groups who have religous beliefs compatible with those of Severino and Royce voiced their approval of these policies.

'To have leaders like Roger, like Shannon, it’s so important," said Deanna Wallace of Americans United for Life, an anti-abortion group that was frequently at odds with the Obama administration. 'It’s extremely encouraging to have HHS on our side this time.'


'You're over at HHS, a true bright spot in this administration when it comes to protection of life and protection of conscience,' a moderator at the Evangelicals for Life conference said when introducing Royce last Thursday. 'It's no exaggeration to say that you guys have just had a monster year over at HHS.'

Again, note that the purpose of the OCR on paper was to allow health care professionals to avoid being forced to take actions which they found morally objectionable for whatever reasons, not just to cater to people who are against abortion for religious reasons. 

However, Politico quoted a variety of experts who underlined that the work by Severino and Royce amounted to favoring particular religious beliefs and the people who hold them.

'It’s supposed to be the faith-based partnership center, not the Christian-based partnership center,' said a longtime HHS staffer, referencing the HHS Center for Faith-Based and Neighborhood Partnerships led by Royce.


'This administration is focused on recognizing one set of religious beliefs,' said Gretchen Borchelt of the National Women’s Law Center. 'It’s going to do whatever it can to reshape or violate the law to do that.'

A follow-up article by Kaiser Health News in March emphasized how fundamentally hostile the activities of Severino and Royce are to the DHHS mission, quoting

Mary Alice Carter, executive director of a new watchdog group called Equity Forward. 'But the core issue here is we have individuals coming in who fundamentally don’t believe in the very mission they’re serving.'

'They are coming in with the agenda of burning it down,' she said.

Nonetheless, these efforts are gathering momentum and spreading throughout the Trump regime.  An article in Buzzfeed on April 17, reported that an the annual UN Commission on the Status of Women meeting,

Bethany Kozma — a senior adviser for gender equality and women’s empowerment at the US Agency for International Development (USAID) and anti-transgender activist — emphasized that the US was a 'pro-life nation,'


We have noted, most recently here, how the current Trump administration has been appointing many people without any qualifications in biomedical science, health care, or public health to leadership positions in health and public health agencies.  Obviously health care and health policy decisions made by ill-informed people coule have detrimental effects on patients' and the public's health.

Worse, it now seems that some ill-informed appointments have more nefarious purposes, including the subversion of the mission of these health related agencies.  The group of leaders discussed above seem to be hostile to the notion that health care and public health should serve all people, regardless of their religious beliefs, race, ethnicity, or sex.

Furthermore, they seem to be undermining fundamental principles of US government enshrined in the Constitution, including prohibiting the government from establishing a religion or preventing the free expression of any religion, and equal application of the laws and provision of due process to all people, again regardless of their religious beliefs, race, ethnicity or sex.

We have been writing about health care dysfunction since 2003, and publishing this blog since 2004.  A major concern all along has been how threats to health care professionals' core values generate  health care dysfunction.  Up through 2016, these threats came principally from large private health care organizations.  While the US government was not always as good at defending these values as it could have been, at least it rarely presented its own set of active threats.  Under Trump, that situation has been changing for the worse.  This is obviously hugely dangerous, (and made more so by the regime's threats to other core values of US society, to US law, and the US Constitution.)

To prevent the decline and fall of US health care, and maybe the entire US experiment in representative democracy, health care professionals, academics, patients and citizens concerned about health care will have to join up with the larger populace to defend our core values while they still have any force.   

Wednesday, April 18, 2018

Through the Revolving Door, with a Few Stumbles - Health Care Corporate Executives and Consultants Continue to Become Leaders of Trump's Department of Health and Human Services

We continue to see a remarkable stream of people transiting the revolving door from high-level positions in health care corporations to high-level positions in health care policy or regulation for the Trump administration.  Lately, though, these transitions have not been without missteps. 

The most recent cases we have found, in the order of their public appearance, appear below.

John Bardis, Who Went from MedAssets to Assistant Secretary of Health and Human Services for Administration, Resigned Under Fire

We first discussed the appointment of Mr Bardis in May, 2017, here.  We noted then that most recently Mr Bardis was the CEO of a health care financial firm and thus was responsible for that company's financial fortunes.  While he has previous experience running other health care related companies, he seemed to have no direct experience in health care or public health, per his official biography.

On March 22, 2018, Politico reported

John Bardis, a top HHS official who signed off on ex-Secretary Tom Price's charter jet flights, is resigning effective April 6, the agency confirmed Thursday.

The health care entrepreneur and longtime friend of Price's from Georgia served as HHS assistant secretary of administration since March 2017 and was responsible for departmental operations. He also helped oversee the ReImagine HHS project, an initiative to overhaul the agency and cut costs.

Bardis' office has been the focus of a probe about whether Price's use of charter-jet flights for routine domestic travel — which cost more than $400,000 — complied with federal regulations. The HHS inspector general's office, which is conducting the probe, told POLITICO that the final report is expected later this spring.

Note that the resignation under fire of  Dr Tom Price, Trump's first Secretary of the Department of Health and Human Services (DHHS) after accusations of conflicts of interest and abuse of his office was a signal example of major issues affecting the leadership of health care and public health agencies in the Trump administration. We had written about some of Dr Price's less well publicized conflicts of interests and questionable conduct before we was appointed Secretary of DHHS, here, and here.

Now a good buddy of Price's, who also had a severe conflict of interest, has come a cropper.

Daniel Best from Corporate Vice President of Industry Relations at CVS Health, and from Pfizer Before Then, to Senior Adviser to the Secretary of DHHS for Drug Pricing Reform

This transition was described in some detail in FierceHealthCare on March 29, 2018:

Daniel M. Best, the former corporate vice president of industry relations for CVS Health’s Medicare Part D business, will serve as senior adviser to the secretary for drug pricing reform.


The Trump administration has outlined a number of policy changes it believes can drive down drug prices, and the president predicted during his State of the Union address that drug costs 'will come down substantially.' But skeptics argue that some of those changes—like making generic drugs free for Medicare patients, or moving expensive drug coverage out of Part D plans—would merely shift the cost and raise premiums.

Best, who will help oversee some of those efforts, worked at Pfizer for 12 years prior to his time at CVS. HHS highlighted his expertise in the pharmaceutical industry generally, and his familiarity with Medicare Part D specifically, as critical to the task of trying to reduce prescription drug costs.

However, this appointment rapidly generated some public political push-back because of its revolving door nature.  As reported by Vox on April 9, 2018,

Rep. Keith Ellison (D-MN), one of the top progressives in the House and deputy chair of the Democratic National Committee, sent a letter Monday to HHS Secretary Alex Azar inquiring about the appointment of Daniel Best to oversee drug pricing reform. Best most recently worked at CVS CareMark before starting at HHS last week. He also worked at Pfizer for four years in the early 2000s.

'Given Mr. Best’s career working for the pharmaceutical and pharmacy industry, the decision to hire him poses significant potential for conflicts of interest, placing him in a position to make decisions that may pit the income of his former employers against the interests of patients in reducing prescription drug prices,' Ellison said in the letter, shared exclusively with Vox.

Ellison flagged past drug price hikes at Pfizer and a lawsuit filed against CVS CareMark by HIV patients over access to drugs. In general, pharmacy benefits managers are under the microscope of both parties these days for their role as mysterious administrators with great power over drug transactions.

The Congress member includes a string of questions about who was involved in hiring Best, whether outside groups (particularly pharmaceutical lobbying groups) were consulted, and how Best will prevent any potential conflicts of interest from getting in the way of his job description.
So this case of the revolving door has not gone without (negative) notice, although whether that will be sufficient to change anything remains to be seen.

Note that public biographical information on Mr Best seems to be scanty, but there is nothing to indicate that he has  training, experience, or expertise in biomedical science, health care, or public health.

Adam Boehler from CEO of Landmark Health, Previously Founder of Avalon Healthcare Solutions and Trellis Rx, and Operating Partner of Private Equity Company Francisco Partners, to Director of Center for Medicare and Medicaid Services (CMS) Innovation Center (CMMI)

As reported, again by FierceHealthCare, this time on April 6, 2018,

Health and Human Services Secretary Alex Azar has named a successful healthcare entrepreneur to lead the Centers for Medicare & Medicaid Services Innovation Center.

Adam Boehler, the founder and former CEO of Landmark Health, will join the department next week as the deputy administrator and director of the center. Landmark is a medical group that uses a technology platform to deliver medical services to complex and chronically ill patients at home.

The article also documented that:

He is also the founder of Avalon Healthcare Solutions, a company which provides lab benefit management services, and Trellis Rx, a company that partners with health systems to fund, build and operate specialty pharmacies. Boehler was formerly an operating partner at Francisco Partners, a global private equity firm focused on healthcare technology and services investing.

According to Bloomberg, Mr Boehler has extensive background in the financial sector:

Mr. Adam Boehler serves as Executive Chairman at Avalon Health Management LLC and Avalon Health Services, LLC. Mr. Boehler served as Principal at Accretive, LLC. He served as Vice President of Business Development at MedeAnalytics, Inc. since July 2005. Mr. Boehler joined MedeAnalytics, Inc. in February 2005 and was responsible for all hospital sales, product marketing, and business development. He also drove several major product solutions from concept to customer sale and established MedeFinance’s international business in London. Prior to joining MedeAnalytics, Inc. (formerly MedeFinance), Mr. Boehler was an Associate at Battery Ventures. While at Battery, he focused on investments in software and emerging technologies. Previously, Mr. Boehler was an investment banker at Wasserstein Perella in their media, telecommunications, and technology group, where he worked on merger and acquisition transactions with leading companies such as News Corp., Imax, and SpectraSite Holdings. In addition, he spent time as a public finance consultant for the Financial and Fiscal Commission in South Africa, where Mr. Boehler focused on provincial revenue issues

His educational background was:

Mr. Boehler graduated magna cum laude from the Wharton School at the University of Pennsylvania.

So he also seems to have no training, experience, or expertise in biomedical science, health care, or public health.

Dr Kenneth William Staley from Consultant for McKinsey to Coordinator of US Government Activities to Combat Malaria

The information made public about this appointment was extremely sparse, e.g., see this brief item from the Kaiser Family Foundation on April 10, 2018, in its entirety:

President Donald J. Trump Announces Intent to Appoint Personnel to Key Administration Posts On Monday, President Trump announced his intent to appoint several individuals to key positions in the administration, including Kenneth William Staley, a consultant at McKinsey, to the position of Coordinator of U.S. Government Activities to Combat Malaria Globally (4/9).

At least he actually is Dr Staley, according to the US Department of State website.  

Acting Deputy Assistant Secretary for Counterproliferation in the Department of State’s Bureau of International Security and Nonproliferation. His portfolio includes preventing the smuggling of weapons of mass destruction (WMD), international threat reduction, nuclear nonproliferation policies, tracking, controlling, and securing dangerous chemical and biological material, multilateral arms control, nonproliferation, WMD terrorism, disarmament issues, and responsible use of chemical and biological sciences.

Previously, Dr. Staley served as Director for Biodefense Policy at the White House Homeland Security Council, where he coordinated implementation of the National Strategy for Pandemic Influenza and the development of policies related to biodefense and the medical consequences of weapons of mass destruction.

So he does have a substantial clinical and public health background relevant to his appointment.


We have long chronicled cases in which people leave government leadership positions having to do with medical science, health, health care and public health and soon wind up working for corporations regulated or affected by the policies of these government agencies.  These were examples of the outgoing revolving door.  Such transitions raise worries that people in government might behave in ways that increase their attractiveness for such jobs when they leave.

However, in the Trump regime, we have seen a new a even more pernicious species of the revolving door, transitions from leadership positions in or lobbying/ advocacy positions for health care corporations directly into positions in government agencies that regulate or whose policies influence those selfsame corporations.

So, as I have said before, e.g., one month ago,

The revolving door is a species of conflict of interest. Worse, some experts have suggested that the revolving door is in fact corruption.  As we noted here, the experts from the distinguished European anti-corruption group U4 wrote,

The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy, especially when this power is concentrated within a few firms.
The ongoing parade of people transiting the revolving door from industry to the Trump administration once again suggests how the revolving door may enable certain of those with private vested interests to have excess influence, way beyond that of ordinary citizens, on how the government works, and that the country is still increasingly being run by a cozy group of insiders with ties to both government and industry. This has been termed crony capitalism. The latest cohort of revolving door transits suggests that regulatory capture is likely to become much worse in the near future.

Remember to ask: cui bono? Who benefits? The net results are that big health care corporations increasingly control the governmental regulatory and policy apparatus.  This will doubtless first benefit the top leadership and owners/ stockholders (when applicable) of these organizations, who are sometimes the same people, due to detriment of patients' and the public's health, the pocketbooks of tax-payers, and the values and ideals of health care professionals.  

 The continuing egregiousness of the revolving door in health care shows how health care leadership can play mutually beneficial games, regardless of the their effects on patients' and the public's health.  Once again, true health care reform would cut the ties between government and corporate leaders and their cronies that have lead to government of, for and by corporate executives rather than the people at large.

Thursday, April 05, 2018

Don't Know Much About Health Care and Public Health... but Appointed to Leadership Positions in US Government Health Care Agencies

We have often cited bad leadership and governance of health care organizations as a major causes of health care dysfunction.  In particular, we have discussed how leadership is often ill-informed.  More and more people leading non-profit, for-profit and government health care organizations have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.  Obviously health care and health policy decisions made by ill-informed people are likely to have detrimental effects on patients' and the public's health.

One reason for ill-informed leadership is the doctrine of managerialism promoted in business schools.  This proclaims that people trained in business management should lead every type of human organization and endeavor.  According to this doctrine, there is no need for leadership by people from the disciplines most relevant to the mission and nature of particular organizations.  So, for example, generic business managers, not doctors, nurses or other health professionals should lead hospitals. Likewise, business managers should make health policy, rather than health care professionals, public health, or health policy experts.

Through 2016, our examples of ill-informed leadership in health care tended to be executives of hospital systems (e..g.,in 2014, here, on the mishandling of a patient with Ebola in a hospital system led by generic managers; and in 2013, here, on a luxurious hospital led by a former hotel executive).  Others were top executives of pharmaceutical corporations (e.g., in 2011, here, on previous Pfizer CEOs).

Now, however, the most ill-informed people in health care leadership seem to be running US government health related agencies.  Here are our latest examples, presented in order of initial reports found in the news media...

Charmaine Yoest, Assistant Secretary of Public Affairs, Department of Health and Human Services

Per NBC News, April 29, 2017

The White House says President Donald Trump is appointing the former president of a leading anti-abortion organization to a senior position at the Department of Health and Human Services.

Charmaine Yoest, who actively supported Trump in his campaign, will serve as assistant secretary of public affairs at HHS. From 2008 until February 2016, she was president of Americans United for Life, which campaigned at the federal and state level for tough restrictions on abortion.


Yoest began her career serving under Ronald Reagan in the Office of Presidential Personnel and was an adviser to former Arkansas Gov. Mike Huckabee's 2008 presidential campaign. Most recently she has served as a senior fellow at American Values, a conservative group in Washington.

I can find nothing to indicate she has any background or expertise in biomedical science, health care, or public health.

Note that according to StatNews, in February, 2018 she left her DHHS position, but only to go onto another health related position, at the Office of National Drug Control Policy.

Kellyanne Conway, White House Opioids "Czar"

As first reported by Newsweek, November 29, 2017,

White House counselor Kellyanne Conway will be the point person for the Trump administration's opioid crisis efforts, U.S. Attorney Jeff Sessions announced Wednesday.

President Donald Trump tapped Conway to help 'change the perception' about opioids and reduce addictions and deaths, Sessions said at a press briefing about the Justice Department’s efforts to combat the crisis. Sessions said Trump had made the epidemic 'a top priority for his administration, including every senior official and Cabinet member.'

Conway worked as a pollster before becoming Trump's campaign manager, and she now serves as a White House spokeswoman and Trump surrogate.


She has no formal experience in drug policy or law enforcement. Conway has a law degree and started her own polling company, The Polling Company, in 1995, often consulting on consumer trends. She worked as an adviser for several Republicans, including Mike Pence and Newt Gingrich.

An article in the Atlantic noted,

In the past, these czars have been selected for one of two principal reasons: outstanding knowledge of the underlying policy issues or shrewd understanding of the bureaucratic processes of government.


Kellyanne Conway is neither of those things, obviously enough. A pollster before she joined the Trump campaign, she has emerged there as its most brazen and shameless cable-TV talker.

In addition, the Newsweek article stated,

She has become notorious for defending some of Trump's most blatant mistruths, and she pioneered the term 'alternative facts' to excuse the president's troubles with the truth.

One might hope that someone involved in policy regarding drug abuse would have at least some understanding of evidence-based health policy assessment.  However, Ms Conway's promotion of "alternative facts" suggest outright hostility to the such assessment, and even to the idea of the existence of an objective reality, at least to the extent such a rejection serves political purposes.

In addition, a Politico article from February, 2018, suggested that in her capacity as opioids "czar," Ms Conway has operationalized her hostility to facts and logic in policy making in favor of political advantage and ideology,

White House counselor Kellyanne Conway has taken control of the opioids agenda, quietly freezing out drug policy professionals and relying instead on political staff to address a lethal crisis claiming about 175 lives a day.

By the way, while opioids "czar," Ms Conway has combined her hostility to evidence-based policy-making with contempt for ethical standards.  As reported by US News and World Report in March, 2018,

The U.S. Office of Special Counsel (not to be confused with the office of Special Counsel Robert Mueller) issued a report Tuesday calling for 'disciplinary action' against Conway for 'impermissibly mix[ing] official government business with political views about candidates in the Alabama special [Senate] election' which took place in December. Under the Hatch Act, federal employees are prohibited from engaging in political activities from their official positions, but Conway did just that, according to Special Counsel Henry Kerner, going out of her way to attack Democratic senatorial candidate (and ultimate victor) Doug Jones twice in television interviews in the run-up to the election.

Robert Weaver, Nominated to Direct the Indian Health Service

Mr Weaver's background and qualifications actually is in considerable doubt.  As reported first by CNBC on January 5, 2018,

President Donald Trump's pick to head the nation's Indian Health Service was hit by a bombshell report Friday that suggested he misrepresented his prior work experience to a Senate committee.

And a senator on that committee said later Friday that the story about Trump nominee Robert Weaver has raised 'very serious concerns' that he now wants answers to.

The Wall Street Journal quoted multiple former workers at what was once known as St. John's Regional Medical Center in Joplin, Missouri, who called into question Weaver's claims to the Senate Indian Affairs Committee that he had worked in supervisory and management positions at that hospital.

Weaver, 39, worked at St. John's from 1997 to 2006, according to his resume. His nomination to run the federal agency that provides health services to American Indians and Alaska Natives is pending before the Senate.

'I don't recall that name whatsoever,' Augusto Noronha, the hospital's chief financial officer from 1999 through 2005, told the Journal when asked about Weaver.

A former controller of the hospital told the newspaper, 'I've never heard that name before.'
Another executive said he remembered 'a subordinate named Rob Weaver who registered E.R. patients, gathered insurance information and collected copays, and who eventually supervised a few other patient-registration workers,' according to the Journal.

Weaver eventually declined the nomination, and then wrote a defense of his record in the Washington Examiner in March, 2018. There he stated,

I’ve spent the last decade of my life starting and operating successful businesses and creating jobs in Indian country that improve native peoples’ access to healthcare.

He acknowledged that he never completed college, and described his hospital work experience as purely administrative,

as an entry-level weekend admissions clerk. I then became patient access coordinator in 1999.

Thus he also had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.

Teresa Manning, Deputy Assistant Secretary for Population Affairs, DHHS

I first learned about Ms Manning on the occasion of her resignation, as reported by the Washington Post on January 13, 2018, she

spent much of her career fighting abortion and has publicly questioned the efficacy of several popular contraception methods.


formerly lobbied for the National Right to Life Committee and worked as a legislative analyst for the Family Research Council.

She was notable for her skepticism that contraception even works,

she also has expressed deep skepticism of birth control overall, suggesting in a 2003 interview with NPR that 'contraception doesn’t work.'

I also can find no evidence that he has training or experience in actually caring for patients, or in biomedical, clinical or public health research.

Taylor Weyeneth, Deputy Chief of Staff, Office of National Drug Control Policy

as reported on January 14, 2018 by the Washington Post,

In May 2016, Taylor Weyeneth was an undergraduate at St. John’s University in New York, a legal studies student and fraternity member who organized a golf tournament and other events to raise money for veterans and their families.

Less than a year later, at 23, Weyeneth, was a political appointee and rising star at the Office of National Drug Control Policy, the White House office responsible for coordinating the federal government’s multibillion dollar anti-drug initiatives and supporting President Trump’s efforts to curb the opioid epidemic. Weyeneth would soon become deputy chief of staff.


Weyeneth’s only professional experience after college and before becoming an appointee was working on Trump’s presidential campaign.

He did have some sketchy job experience while he was in ... high school

Weyeneth was 'Director of Production' for Nature’s Chemistry, a family firm in Skaneateles, N.Y., that specialized in processing chia seeds and other health products. One résumé said he served in that job from 2008 to 2013, and two others indicate he stopped working there in September 2011.

In the summer and fall of 2011, the firm was secretly processing illegal steroids from China as part of a conspiracy involving people from Virginia, California and elsewhere in the United States and one person in China, federal court records show. Weyeneth’s stepfather, Matthew Greacen, pleaded guilty to a felony conspiracy charge last year and received two years probation and a fine.

Weyeneth was not charged in the investigation, known as Operation Grasshopper.

Then a subsequent Washington Post story raised further questions about his rudimentary employment history,

A former Trump campaign worker appointed at age 23 to a top position in the White House’s drug policy office had been let go from a job at a law firm because he repeatedly missed work, a partner at the firm said.

While in college, late in 2014 or early in 2015, Taylor Weyeneth began working as a legal assistant at the New York firm O’Dwyer & Bernstien. He was 'discharged' in August 2015, partner Brian O’Dwyer said in an interview.

'We were very disappointed in what happened,' O’Dwyer said. He said that he hired Weyeneth in part because both men were involved in the same fraternity, and that the firm invested time training him for what was expected to be a longer relationship. Instead, he said, Weyeneth 'just didn’t show.'

By then he had the distinction of being called "an emblem of the White House's recklessness,"  in an op-ed by Kathleen Parker.  He was gone from this job in a few days, only to end up as "a mid-level official in the Office of Community Planning and Development in the Department of Housing and Urban Development (see Politico), but at least will seemingly have nothing to do with health care or public health.   

Jim Carroll, Deputy Chief of Staff, Office of National Drug Control Policy

After the resignation of Mr Weyeneth, the administration came up with a nominee to run the Office of National Drug Control Policy, a position that was vacant while Mr Weyeneth was there, as reported by the Associated Press on February 9, 2018,

President Donald Trump has tapped deputy White House chief of staff Jim Carroll to serve as the administration's next drug czar.

Carroll's position as head of the Office of National Drug Control Policy will make him the most public face of the administration's efforts to fight the opioid epidemic — an effort critics say hasn't gone nearly far enough.


Carroll does not appear to have any public health experience. He worked for the Ford Motor Company before joining the administration and also worked for the Justice and Treasury departments.

But the White House said that after law school, Carroll spent five years as the assistant commonwealth attorney for Fairfax, Virginia, where the majority of the cases were drug-related and he worked directly with those affected by drug abuse.

He also worked with attorneys facing substance abuse issues at the Virginia State Bar.

He may have worked with substance abuse issues from a legal standpoint, as a lawyer, but again he has no  training or experience in actually caring for patients, or in biomedical, clinical or public health research.


 Again, it stands to reason that people entrusted with running US government health care, public health and health policy should have some level of knowledge of biomedical science, health care, public health and/or health policy.  I dimly remember that before the Trump administration, many such leaders did have such background.  Not any more.

This is only the latest examples of amazingly ill-informed people taking important responsibilities in government agencies having to do with health care, public health, and/or health policy.  Remember the brew-master with power over major policies in the Veterans Administration having to do with the huge VA health system (look here); or the White House economic adviser who did not seem to understand what health insurance does (look here); the Director of the Office of Management and the Budget who said people who make bad dietary choices do not deserve health insurance (look here)? and then there were all the appointments to health care related leadership positions of people whose main qualification seemed to be they would come through the revolving door after being lobbyists for health care corporations, e.g., look here

How are we to survive these times?  We need health policy leadership that is well-informed, understands the health care mission, avoids self-interest and conflicts of interest, and is accountable, ethical and honest.   (Of course, we have often said we need leadership of health care organizations with these characteristics.)  Right now, we are not coming close.  Preventing even worse health care dysfunction would seem to require wholesale replacement of the current US executive branch leadership that has influence on health care.